PURPOSE: To evaluate the efficacy of switching to aflibercept in diabetic macular edema (DME) with suboptimal response to previous anti-vascular endothelial growth factor (anti-VEGF) injections. METHODS: A prospective interventional case series study recruited patients from a single center diagnosed with DME with suboptimal response to anti-VEGF injections. Three consecutive monthly injections of aflibercept were performed. The primary outcome measure was mean change in visual acuity after switching to aflibercept. RESULTS: Forty-two patients (42 eyes) were included. Baseline logarithm of the minimum angle of resolution (logMAR) visual acuity was 0.87 ± 0.23 and improved significantly to 0.62 ± 0.29, 0.56 ± 0.34, and 0.46 ± 0.35 at 1, 2, and 3 months, respectively, after the first injection. Mean baseline retinal thickness was 451.57 ± 107.09 µm and decreased significantly at 1, 2, and 3 months after switching to aflibercept (346.52 ± 79.03, 328.24 ± 81.98, and 313.71 ± 85.79 µm, respectively). Both visual improvement and mean change in retinal thickness were significant in patients with pre-aflibercept best-corrected visual acuity less than 1.0 logMAR but were not significant in patients with best-corrected visual acuity more than 1.0 logMAR. CONCLUSIONS: Switching to aflibercept in DME patients with an unsatisfactory response to previous anti-VEGF injections provided acceptable short-term visual and retinal architectural improvement.
Diabetic Retinopathy ; Endothelial Growth Factors ; Humans ; Macular Edema ; Outcome Assessment (Health Care) ; Prospective Studies ; Retinaldehyde ; Visual Acuity

Objective: The aim of this study was to introduce a gelatin/bovine serum albumin (BSA) tissue standard, which provides dissolution properties identical to those of biological tissues. Further, the study evaluated whether the utilization of endodontic activating devices led to enhanced phantom dissolution rates. Materials and Methods: Bovine pulp tissue was obtained to determine a benchmark of tissue dissolution. The surface area and mass of samples were held constant while the ratio of gelatin and BSA were varied, ranging from 7.5% to 10% gelatin and 5% BSA. Each sample was placed in an individual test tube that was filled with an appropriate sodium hypochlorite solution for 1, 3, and 5 minutes, and then removed from the solution, blotted dry, and weighed again. The remaining tissue was calculated as the percent of initial tissue to determine the tissue dissolution rate. A radiopaque agent (sodium diatrizoate) and a fluorescent dye (methylene blue) were added to the phantom to allow easy quantification of phantom dissolution in a canal block model when activated using ultrasonic (EndoUltra) or sonic (EndoActivator) energy. Results: The 9% gelatin + 5% BSA phantom showed statistically equivalent dissolution to bovine pulp tissue at all time intervals. Furthermore, the EndoUltra yielded significantly more phantom dissolution in the canal block than the EndoActivator or syringe irrigation. Conclusions Our phantom is comparable to biological tissue in terms of tissue dissolution and could be utilized for in vitro tests due to its injectability and detectability.

Objective: The aim of this study was to introduce a gelatin/bovine serum albumin (BSA) tissue standard, which provides dissolution properties identical to those of biological tissues. Further, the study evaluated whether the utilization of endodontic activating devices led to enhanced phantom dissolution rates. Materials and Methods: Bovine pulp tissue was obtained to determine a benchmark of tissue dissolution. The surface area and mass of samples were held constant while the ratio of gelatin and BSA were varied, ranging from 7.5% to 10% gelatin and 5% BSA. Each sample was placed in an individual test tube that was filled with an appropriate sodium hypochlorite solution for 1, 3, and 5 minutes, and then removed from the solution, blotted dry, and weighed again. The remaining tissue was calculated as the percent of initial tissue to determine the tissue dissolution rate. A radiopaque agent (sodium diatrizoate) and a fluorescent dye (methylene blue) were added to the phantom to allow easy quantification of phantom dissolution in a canal block model when activated using ultrasonic (EndoUltra) or sonic (EndoActivator) energy. Results: The 9% gelatin + 5% BSA phantom showed statistically equivalent dissolution to bovine pulp tissue at all time intervals. Furthermore, the EndoUltra yielded significantly more phantom dissolution in the canal block than the EndoActivator or syringe irrigation. Conclusions Our phantom is comparable to biological tissue in terms of tissue dissolution and could be utilized for in vitro tests due to its injectability and detectability.

Presently there is a gross lack of information on cost and cost weights in many developing countries that implementcasemix system. Furthermore, studies that employed Activity Based Costing method (ABC) to estimate the costs of radiologyprocedures were rarely done in developing countries, including Malaysia. The main objective of this study is to determinethe costs of radiology procedures for each group in casemix system, in order to develop cost weights to be used in theimplementation of the casemix system. An economic evaluation study was conducted in all units in the Department ofRadiology in the first teaching hospital using the casemix system in Malaysia. From the 25,754 cases, 16,173 (62.8%)of them were from medical discipline. Low One Third and High One Third (L3H3) method was employed to trim theoutlier cases. Output from the trimming, 15,387 cases were included in the study. The results revealed that the totalinpatients’ charges of all the radiology procedures was RM1,820,533.00 while the cost imputed using ABC method wasRM2,970,505.54. The biggest cost component were human resources in Radiology Unit (Mobile) (57.5%), consumables(78.5%) of Endovascular Interventional Radiology (EIR) Unit, equipment (81.4%) of Magnetic Resonance Imaging (MRI)Unit, reagents (68.1%) of Medical Nuclear Unit. The one highest radiology cost weight, was for Malaysia DiagnosisRelated Group (MY-DRG®)B-4-11-II (Hepatobiliary and Pancreas Neoplasms with severity level II, 2.8301). The methodof calculation of the cost of procedures need to be revised by the hospital as findings from this study showed that the costimposed to patient is lower than the actual cost.

Objective To evaluate in-vitro antioxidant, anti-inflammatory and antitumor abilities against human breast adenocarcinoma (MCF7) and human prostate cancer (PC3) as well as the suppressor effect of bacterial exopolysaccharide (BAEPS) on Ehrlich ascites carcinoma (EAC). Methods In-vitro antioxidants characters of BAEPS were determined using various methods, while anti-inflammatory activity was estimated against cyclooxygenase (COX-1 and COX-2). In-vitro study, anticancer against MCF7 and PC3 were assessed by the mitochondrial dependent reduction of yellow MTT. In in-vivo study against EAC progression, mice were inoculated with EAC cells and then were orally administered BAEPS at 200 mg/kg after 24 h (equals to 0.10 of determined LD

Introduction: To compare the anxiety levels demonstrated by children during cast removal procedure between oscillating saw vs cast shear methods. Material and methods: A randomised prospective study of 102 children (mean age 8.3 ± 3.5 years) with fractures involving upper or lower limbs. Children undergoing removal of cast were divided into 2 groups; either by an oscillating saw or a cast cutting shear. The level of anxiety was assessed by recording the heart rate with a portable fingertip pulse oximeter before, during and after removal of the cast. Objective assessment was performed by documenting the fear level on Children’s Fear Scale (CFS). Results: There was a significant increase in the heart rate of children during cast removal while using the oscillating saw compared to cast shear (p<0.05). The noise level produced by the saw exceeded 80 dB (mean 103.3 dB). The fear level was significantly lower in the cast shear group (p<0.05). Conclusion: The noise produced by the oscillating saw was associated with an increased anxiety level in children undergoing cast removal. Cast shear is a simple and inexpensive instrument that can be used for cast removal in overly anxious children.

Objective: To evaluate the antioxidant and antidiabetic mechanism(s) of ethyl acetate extract fraction of Moringa oleifera (M. oleifera) leaves on streptozotocin-induced diabetes in male Sprague-Dawley rats. Methods: A total of 24 adult male rats were segregated randomly into four groups (6 rats each group). Streptozotocin-induced diabetes rats were given (oral gavage) ethyl acetate extract fraction of M. oleifera (200 mg/kg b.w.) for 30 d. The rats of control and experimental groups were sacrificed after 24 hours of final dose of treatment, to extract blood and pancreatic tissue for biochemical and histopathological analysis. Results: The ethyl acetate extract fraction of M. oleifera significantly reversed (P<0.05) the manifestation of streptozotocin on the levels of serum glucose & insulin, lipid profile, hepatic damage markers (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and lactate dehydrogenase), malondialdehyde formation, antioxidants (glutathione, Vitamin C & Vitamin E), antioxidant enzymes (superoxide dismutase, glutathione S-transferase, glutathione peroxidase and catalase) and pro-inflammatory cytokines (IL-1 β , TNF- α & IL-6). Histopathological analysis of pancreatic tissues was in concurrence with the biochemical results. Conclusions: These findings support that M. oleifera leaves have potent therapeutic effect on diabetes mellitus via increasing antioxidant levels and inhibition of pro-inflammatory mediators.