Biomedical Research ; organization & administration ; trends ; Singapore

Aged, 80 and over ; Evidence-Based Medicine ; Geriatrics ; Humans ; Male

INTRODUCTION: XELOX is non-inferior to FOLFOX-4 as a first-line treatment for metastatic colorectal cancer. This study compares the costs associated with XEL0X+/-bevacizumab versus FOLFOX4+/-bevacizumab in a non-reimbursed, out of pocket Philippine health care system.
METHODS: This is a cost-minimization analysis using Philippine General Hospital as base case and a typical Filipino patient of 60 kg with BSA 1.66. The outcome data were derived from the N016966 trial. These included the drugs capecitabine, 5-fluorouracil, oxaliplatin, and bevacizumab (BEV); chemotherapy cycles and corresponding hospital admission for each regimen; resources associated with treatment of adverse events such hospital days, ambulatory consultations, concomitant
medication, and central venous line insertion/removal, with costs and charges based on the local setting.
RESULTS: Highest cost (direct and/or indirect) was for FOLFOX4+BEV, followed by XEL0X+BEV, FOLFOX4, and then XELOX. The use of XELOX resulted in a cost saving of PhP 158,642 per patient compared with FOLFOX4. The use of XEL0X+BEV resulted in a cost saving of PhP 186,144 per patient compared with FOLFOX4+BEV.
CONCLUSION: XEL0X+/-BEV is less costly than FOLFOX4-F/-BEV in an out-of-pocket Philippine tertiary hospital setting from the patient's perspective.

Xelox ; Folfox ; Colorectal Neoplasms ; Capecitabine ; Fluorouracil ; Oxaliplatin ; Bevacizumab

Aged ; Eccrine Porocarcinoma ; pathology ; Female ; Humans ; Sweat Gland Neoplasms ; pathology

Primary endocrine therapy (PET) is often included as a treatment option in elderly women with operable breast cancer. Elderly women tend to have pre-existing comorbidities and are often reluctant to undergo surgery. The benefit of surgery needs to be weighed against a relatively higher potential for operative morbidity and mortality, and a limited life expectancy. But while PET can provide relatively good locoregional control, it is not curative in nature and the possibility of local complications and metastasis remains. We retrospectively reviewed the outcome of PET in a series of 19 elderly women, older than 70 years of age, who had presented with operable non-metastatic breast cancer. Only about a third of these women were deemed medically unfit for surgery; the rest had declined surgery. Compliance was an issue, with almost half of these patients defaulting treatment and follow-up. Local control was achieved in most patients, but disease progression did occur in 5 patients. Three of these patients received additional treatment; which included surgery in 1 patient. PET should therefore not be considered an equivalent alternative to surgery in elderly women who were fi t to undergo surgery. However, having observed that only 1 of the 6 deaths in our study was related to breast cancer, PET does have a role in women whose life expectancy is more likely to be limited by coexisting morbidities than the breast cancer itself.
Aged ; Aged, 80 and over ; Antineoplastic Agents, Hormonal ; therapeutic use ; Breast Neoplasms ; drug therapy ; Drug Therapy ; utilization ; Female ; Humans ; Retrospective Studies ; Tamoxifen ; therapeutic use

Aged ; Dermis ; pathology ; Disease Progression ; Extremities ; Face ; Fatal Outcome ; Humans ; Male ; Sarcoma, Myeloid ; pathology ; Skin ; pathology ; Thorax

INTRODUCTIONThis study aims to analyse the clinico-epidemiological characteristics of Asian patients diagnosed with livedo vasculopathy (LV).

MATERIALS AND METHODSWe performed a retrospective analysis of all patients diagnosed with LV from 1997 to 2007 at our centre.

RESULTSSeventy patients were diagnosed with LV with a mean age of 39 years, female: male ratio of 3:1 and no racial predilection. Most cases remained purely cutaneous, presenting with painful leg ulcers and atrophie blanche. Peripheral neuropathy was the only extra-cutaneous complication (9%). In patients who were screened, associations included hepatitis B (7%) and hepatitis C (4%), positive anti-nuclear antibody (14%), positive anti-myeloperoxidase antibody (5%), positive anti-cardiolipin antibodies (7%) and positive lupus anticoagulant (2%). In 49 patients who achieved remission, 55% required combination therapy, most commonly with colchicine, pentoxifylline and prednisolone. In those treated successfully with monotherapy, colchicine was effective in 59% followed by prednisolone (17.5%), pentoxifylline (17.5%) and aspirin (6%). Mean follow-up period was 50 months.

CONCLUSIONLV in Asian patients is a high morbidity, chronic relapsing ulcerative skin condition. Most patients require induction combination therapy for remission. As further evidence emerges to support a procoagulant pathogenesis, a standardised protocol is needed to investigate for prothrombotic disorders during diagnosis.

Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Cellulitis ; complications ; epidemiology ; pathology ; Female ; Humans ; Livedo Reticularis ; complications ; epidemiology ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Skin ; pathology ; Time Factors ; Young Adult

INTRODUCTIONTigecycline is an antibiotic belonging to the glycylcycline class with in vitro activity against most Gram-negative bacteria, other than Pseudomonas aeruginosa. This study investigated the in vitro activity of tigecycline against multi-resistant isolates of Enterobacteriaceae and Acinetobacter spp. isolated from clinical specimens in Singapore.

MATERIALS AND METHODSMinimum inhibitory concentrations (MICs) to tigecycline were determined for 173 isolates of multi-resistant Escherichia coli, Klebsiella spp., Enterobacter spp. and Acinetobacter spp. using agar dilution.

RESULTSThe MIC required to inhibit the growth of 90% of organisms varied from 0.5 to 4 mg/L for the study isolates. Based on a resistance breakpoint of >or=8 mg/L, resistance rates varied from 0% to 9%.

CONCLUSIONSTigecycline demonstrates good in vitro activity against multi-resistant strains of Enterobacteriaceae, with more variable activity against multi-resistant strains of Acinetobacter spp.

Acinetobacter ; drug effects ; Anti-Bacterial Agents ; pharmacology ; Drug Resistance, Multiple, Bacterial ; Enterobacteriaceae ; drug effects ; Escherichia coli ; drug effects ; Klebsiella ; drug effects ; Minocycline ; analogs & derivatives ; pharmacology ; Singapore

Severe acute respiratory syndrome (SARS) was an unknown disease barely 3 years ago. After the World Health Organization declared the world SARS-free on 5 July 2003, there were episodic recurrences of SARS between September 2003 and May 2004, including 4 cases of laboratory-acquired SARS. SARS posed a mammoth challenge because of the impact of nosocomial transmission on healthcare manpower and facilities, and the resources needed for controlling and preventing further spread. Through worldwide scientific collaboration, the medical community has made much progress in unraveling its enigma, though much more needs to be discovered. This paper highlights how we can apply our knowledge of its epidemiology, mode of transmission, clinical course, ICU admission, complications, predictors of poor outcome, treatment and infection control to help us avert a catastrophic outbreak, and to manage our resources and patients. SARS preparedness and response planning must be flexible and dynamic so that appropriate measures can be implemented as an outbreak progresses. Even if SARS does not reemerge, the experience gained from such planning is valuable in preparing for threats of bioterrorism or a global avian influenza A (H5N1) virus pandemic.
Cross Infection ; prevention & control ; Disease Outbreaks ; prevention & control ; Disease Transmission, Infectious ; prevention & control ; Global Health ; Humans ; Severe Acute Respiratory Syndrome ; epidemiology

Aged ; Carcinoma, Renal Cell ; pathology ; Female ; Goiter, Nodular ; etiology ; pathology ; surgery ; Humans ; Kidney Neoplasms ; pathology ; Thyroid Neoplasms ; pathology ; secondary ; surgery ; Thyroidectomy