Dengue remains a public health threat that consumes a significant number of resources for its prevention and control. This systematic review aimed to solidify recent costing evidence in dengue management among South East Asian (SEA) countries. All studies conducted between 2010 and 2020 were retrieved using four international databases i.e. PubMed, Scopus, Web of Science, and Emerald Insight. The review was reported according to PRISMA guidelines. Quality assessments were done independently by two reviewers using a checklist adapted for the cost of illness studies. We identified 13 original articles representing several SEA countries. Among the common reported costing measure include total cost/ health expenditure; direct medical cost; direct non-medical cost; and indirect cost. The estimated total cost for dengue management varied between countries largely due to the difference in the total incidence of dengue cases. The estimated cost spent on dengue per capita GDP ranges from less than 0.001% to 0.1%, depending on the recorded number of dengue cases of the year. The majority of the articles focused on the economic burden from the perspective of treatment such as hospitalization and ambulatory care. In a nutshell, the economic burden of managing dengue infection is costly and the evidence suggests a steady increase in health expenditure with the growing number of dengue cases

Hypotension secondary to autonomic dysfunction is a common complication of acute spinal cord injury (SCI) that may worsen neurologic outcomes. Midodrine, an enteral α-1 agonist, is often used to facilitate weaning intravenous (IV) vasopressors, but its use can be limited by reflex bradycardia. Alternative enteral agents to facilitate this wean in the acute post-SCI setting have not been described. We aim to describe novel application of droxidopa, an enteral precursor of norepinephrine that is approved to treat neurogenic orthostatic hypotension, in the acute post-SCI setting. Droxidopa may be an alternative enteral therapy for those intolerant of midodrine due to reflex bradycardia. We describe two patients suffering traumatic cervical SCI who were successfully weaned off IV vasopressors with droxidopa after failing with midodrine. The first patient was a 64-year-old male who underwent C3–6 laminectomies and fusion after a ten-foot fall resulting in quadriparesis. Post-operatively, the addition of midodrine in an attempt to wean off IV vasopressors resulted in significant reflexive bradycardia. Treatment with droxidopa facilitated rapidly weaning IV vasopressors and transfer to a lower level of care within 72 hours of treatment initiation. The second patient was a 73-year-old male who underwent C3–5 laminectomies and fusion for a traumatic hyperflexion injury causing paraplegia. The addition of midodrine resulted in severe bradycardia, prompting consideration of pacemaker placement. However, with the addition of droxidopa, this was avoided, and the patient was weaned off IV vasopressors on dual oral therapy with midodrine and droxidopa. Droxidopa may be a viable enteral therapy to treat hypotension in patients after acute SCI who are otherwise not tolerating midodrine in order to wean off IV vasopressors. This strategy may avoid pacemaker placement and facilitate shorter stays in the intensive care unit, particularly for patients who are stable but require continued intensive care unit admission for IV vasopressors, which can be cost ineffective and human resource depleting.

Objective: Several graft options can be used to construct a neovagina. This study aimed to evaluate the efficacy of creating a neovagina using a fresh human amnion in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Methods: Ten patients were analyzed retrospectively. Anatomical success was defined by a postoperative vaginal length ≥5 cm, and a width sufficient to comfortably accommodate the insertion of two fingers. Functional success was achieved when a score of >26.5 was attained on the Arabic validated version of the functional sexual function index (FSFI). Results: Overall, the mean vaginal length before surgery was 2.15±0.85 cm (range, 1.5-4.5). The mean vaginal length after surgery was 5.5±0.53 cm (range, 5-6), and all patients (n=10) achieved anatomical success. The FSFI score after surgery was 29.2±2.4, and eight patients achieved functional success. The mean operative time and estimated blood loss were 83.5±50.31 minutes (range, 42-210) and 122.0±75.69 mL (range, 20-250), respectively. None of the patients required intraoperative blood transfusion or experienced injury to vital organs. Four patients developed postoperative leukocytosis within 48 hours, and one patient experienced chronic pelvic pain that lasted more than 6 months postoperatively. No major postoperative complications, such as pelvic abscesses, open wounds, chronic vaginal discharge, or reoperation, were reported. Conclusion In conclusion, surgical dissection of the vesicorectal space and utilization of fresh human amnion to create a neovagina over a vaginal mold are technically feasible and safe, and are linked to favorable anatomical and functional outcomes in MRKH patients with vaginal agenesis.

Objective: Several graft options can be used to construct a neovagina. This study aimed to evaluate the efficacy of creating a neovagina using a fresh human amnion in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Methods: Ten patients were analyzed retrospectively. Anatomical success was defined by a postoperative vaginal length ≥5 cm, and a width sufficient to comfortably accommodate the insertion of two fingers. Functional success was achieved when a score of >26.5 was attained on the Arabic validated version of the functional sexual function index (FSFI). Results: Overall, the mean vaginal length before surgery was 2.15±0.85 cm (range, 1.5-4.5). The mean vaginal length after surgery was 5.5±0.53 cm (range, 5-6), and all patients (n=10) achieved anatomical success. The FSFI score after surgery was 29.2±2.4, and eight patients achieved functional success. The mean operative time and estimated blood loss were 83.5±50.31 minutes (range, 42-210) and 122.0±75.69 mL (range, 20-250), respectively. None of the patients required intraoperative blood transfusion or experienced injury to vital organs. Four patients developed postoperative leukocytosis within 48 hours, and one patient experienced chronic pelvic pain that lasted more than 6 months postoperatively. No major postoperative complications, such as pelvic abscesses, open wounds, chronic vaginal discharge, or reoperation, were reported. Conclusion In conclusion, surgical dissection of the vesicorectal space and utilization of fresh human amnion to create a neovagina over a vaginal mold are technically feasible and safe, and are linked to favorable anatomical and functional outcomes in MRKH patients with vaginal agenesis.

Objective: Several graft options can be used to construct a neovagina. This study aimed to evaluate the efficacy of creating a neovagina using a fresh human amnion in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Methods: Ten patients were analyzed retrospectively. Anatomical success was defined by a postoperative vaginal length ≥5 cm, and a width sufficient to comfortably accommodate the insertion of two fingers. Functional success was achieved when a score of >26.5 was attained on the Arabic validated version of the functional sexual function index (FSFI). Results: Overall, the mean vaginal length before surgery was 2.15±0.85 cm (range, 1.5-4.5). The mean vaginal length after surgery was 5.5±0.53 cm (range, 5-6), and all patients (n=10) achieved anatomical success. The FSFI score after surgery was 29.2±2.4, and eight patients achieved functional success. The mean operative time and estimated blood loss were 83.5±50.31 minutes (range, 42-210) and 122.0±75.69 mL (range, 20-250), respectively. None of the patients required intraoperative blood transfusion or experienced injury to vital organs. Four patients developed postoperative leukocytosis within 48 hours, and one patient experienced chronic pelvic pain that lasted more than 6 months postoperatively. No major postoperative complications, such as pelvic abscesses, open wounds, chronic vaginal discharge, or reoperation, were reported. Conclusion In conclusion, surgical dissection of the vesicorectal space and utilization of fresh human amnion to create a neovagina over a vaginal mold are technically feasible and safe, and are linked to favorable anatomical and functional outcomes in MRKH patients with vaginal agenesis.

Objective: Several graft options can be used to construct a neovagina. This study aimed to evaluate the efficacy of creating a neovagina using a fresh human amnion in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Methods: Ten patients were analyzed retrospectively. Anatomical success was defined by a postoperative vaginal length ≥5 cm, and a width sufficient to comfortably accommodate the insertion of two fingers. Functional success was achieved when a score of >26.5 was attained on the Arabic validated version of the functional sexual function index (FSFI). Results: Overall, the mean vaginal length before surgery was 2.15±0.85 cm (range, 1.5-4.5). The mean vaginal length after surgery was 5.5±0.53 cm (range, 5-6), and all patients (n=10) achieved anatomical success. The FSFI score after surgery was 29.2±2.4, and eight patients achieved functional success. The mean operative time and estimated blood loss were 83.5±50.31 minutes (range, 42-210) and 122.0±75.69 mL (range, 20-250), respectively. None of the patients required intraoperative blood transfusion or experienced injury to vital organs. Four patients developed postoperative leukocytosis within 48 hours, and one patient experienced chronic pelvic pain that lasted more than 6 months postoperatively. No major postoperative complications, such as pelvic abscesses, open wounds, chronic vaginal discharge, or reoperation, were reported. Conclusion In conclusion, surgical dissection of the vesicorectal space and utilization of fresh human amnion to create a neovagina over a vaginal mold are technically feasible and safe, and are linked to favorable anatomical and functional outcomes in MRKH patients with vaginal agenesis.

Objective: Several graft options can be used to construct a neovagina. This study aimed to evaluate the efficacy of creating a neovagina using a fresh human amnion in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Methods: Ten patients were analyzed retrospectively. Anatomical success was defined by a postoperative vaginal length ≥5 cm, and a width sufficient to comfortably accommodate the insertion of two fingers. Functional success was achieved when a score of >26.5 was attained on the Arabic validated version of the functional sexual function index (FSFI). Results: Overall, the mean vaginal length before surgery was 2.15±0.85 cm (range, 1.5-4.5). The mean vaginal length after surgery was 5.5±0.53 cm (range, 5-6), and all patients (n=10) achieved anatomical success. The FSFI score after surgery was 29.2±2.4, and eight patients achieved functional success. The mean operative time and estimated blood loss were 83.5±50.31 minutes (range, 42-210) and 122.0±75.69 mL (range, 20-250), respectively. None of the patients required intraoperative blood transfusion or experienced injury to vital organs. Four patients developed postoperative leukocytosis within 48 hours, and one patient experienced chronic pelvic pain that lasted more than 6 months postoperatively. No major postoperative complications, such as pelvic abscesses, open wounds, chronic vaginal discharge, or reoperation, were reported. Conclusion In conclusion, surgical dissection of the vesicorectal space and utilization of fresh human amnion to create a neovagina over a vaginal mold are technically feasible and safe, and are linked to favorable anatomical and functional outcomes in MRKH patients with vaginal agenesis.

Objective: This study examined the risk factors and survival outcomes of dogs infected with CPV-2. Molecular characterization of CPV-2 genotypes circulating in Egypt was performed to determine the evolution of CPV-2 nationally and globally. Methods: An age-matched case-control study was conducted on 47 control and 47 CPVinfected dogs. Conditional logistic regression analysis examined the association between the potential risk factors and CPE in dogs. Survival analysis was performed to determine the survival pattern of the infected dogs. Thirteen fecal samples from infected dogs were collected to confirm the CPV genotype by CPV-2 VP2 gene sequencing, assembly of nucleotide sequences, and phylogenic analysis. Results: Unvaccinated and roamer dogs had eight and 2.3 times higher risks of CPV infection than vaccinated dogs and non-roamer dogs, respectively. The risk of death from CPE was high among dogs without routine visits to veterinary clinics and among non-roamer dogs.Molecular characterization of CPV-2 confirmed its genotype identity and relationship with the CPV-2 c and b clade types. Conclusions and Relevance: This study highlights the potential factors for CPE control, especially vaccination and preventing dogs from roaming freely outside houses. Isolated CPV genotypes are closely related to southern Asian genotypes, suggesting a substantial opportunity for global transmission.

Objective: To compare the effectiveness of laser-engineered copper-nickel titanium (SmartArch) and superelastic nickel-titanium (SENT) archwires in aligning teeth and inducing root resorption and pain experienced by patients. Methods: Two-arm parallel groups with a 1:1 allocation ratio were used. The participants were patients aged 11.5 years and older with 5–9 mm of mandibular anterior crowding who were indicated for non-extraction treatment. The primary outcome was alignment effectiveness, assessed using Little’s irregularity index (LII) over 16 weeks with a single wire (0.016-inch) in the SmartArch group and 2 wires (0.014- and 0.018-inch) in the SENT group (8 weeks each). Secondary outcomes included root resorption evaluated by pre- and post-intervention periapical radiographs and pain levels recorded by the participants during the first week. Results: A total of 40 participants were randomly allocated into 2 groups; 33 completed the study and were analyzed (16 in the SmartArch group and 17 in the SENT group, aged 16.97 ± 4.05 years). The total LII decrease for the SmartArch and SENT groups was 5.63 mm and 5.29 mm, respectively, which was neither statistically nor clinically significant. Root resorption was not significantly different between the groups. The difference in pain levels was not statistically significant for the first 5 days following wire placement; however, there was a significant difference favoring the SENT group in the final 2 days. Conclusions SmartArch and SENT archwires were similarly effective during the alignment phase of orthodontic treatment. Root resorption should be observed throughout the treatment with either wire. SmartArch wires demonstrated higher pain perception than SENT wires.

OBJECTIVE: To determine whether resveratrol (Res) can correct osteoporosis induced in a rat model of male hypogonadism. METHODS: Thirty-two rats were randomly divided into 4 groups, 8 in each group; 1) a control sham group: underwent a similar surgical procedure for induction of orchiectomy (ORCD) without ligation of any arteries or veins or removal of the testis and epididymis; 2) a control + Res-treated group (Con+Res): underwent sham surgery similar to the control, but was then treated with Res, as described below; 3) an ORCD-induced group: bilateral ORCD surgery as described above, and 4) a ORCD+Res-treated group: bilateral ORCD surgery followed by Res treatment. Res treatment began 4 weeks after ORCD and continued for 12 weeks. After 12 weeks, bone mineral density (BMD) and bone mineral content (BMC) were measured in the tibia and femur of each rat's right hind leg. Blood levels of bone turnover indicators such as deoxypyridinoline (Dpd), N-telopeptide of type I collagen (NTX I), alkaline phosphatase (ALP), and osteocalcin (OC), as well as receptor activator of nuclear factor kappa B (RANK) and osteoprotegerin (OPG) were assessed. RESULTS: ORCD significantly decreased BMD (P<0.01) and significantly increased bone resorption, manifested by increased RANK. In addition, it inhibited serum levels of OPG and OC. Res treatment after ORCD effectively increased serum levels of bone formation markers such as OPG and OC, compared with testisectomized rats (P<0.05). CONCLUSION Res could ameliorate bone loss induced by male hypogonadism, possible via restoration of the normal balance between RANK and OPG.
Rats ; Male ; Animals ; Bone Density ; Resveratrol/pharmacology* ; Osteoporosis ; Osteoprotegerin/pharmacology* ; Bone Remodeling ; Hypogonadism ; RANK Ligand/pharmacology*