The full cost of tonsillectomy at Children’s hospital 1 in 2019

Objective: Determine full cost of tonsillectomy at Children’s Hospital 1 in 2019. Methods: Coss–sectional descriptive study 304 tonsillectomy children at Children’s Hospital 1 in 2019. Results: The study results showed that the cost of tonsillectomy (excluding consultation fees and pre-operation tests) depend on surgery devices. The average cost of cautery tonsillectomy was 1,740, 869 VND (68% direct cost, 32% indirect cost), of the coblator tonsillectomy was 3,610,031 VND 84.58% direct cost, 15.46% indirect cost), and of the plasma peak tonsillectomy one was 3,600,124 VND (84.54% direct cost, 15.46% indirect cost). In 3 surgery methods, the percentage’s cost of drugs, medical disposible items, and operation team were the largest share in direct costs; in indirect costs, the percentage of human management was the highest proportion, followed by the percentage of facility maintenance cost, and the percentage of other regular expenses cost was very low. Conclusion: The average cost of cautery tonsillectomy was 1,740, 869 VND, of the coblator tonsillectomy was 3,610,031 VND, and of the plasma peak tonsillectomy one was 3,600,124 VND.This cost is higher than the current hospital fee the patient or the health insurance paid. This implies a mismatch between input costs and hospital rates. Key words: Tonsillectomy cost, Children’s Hospital 1, cautery, Coblator, Plasma Peak Blade.

Prediction of clinical efficacy by plasma concentration of apatinib in patients with solid tumor.

e15000 Background: To explore the correlation between plasma concentration of apatinib and clinical efficacy. Methods: 42 patients were enrolled. Plasma specimens of all patients were collected. At 7:40 am, fasting blood was drawn as plasma trough concentration (Ctrough). At 8 am, apatinib mesylate (APA-M, 250mg qd) was orally administrated. At 11 am, venous blood was drawn as plasma peak concentration (Cpeak). Each patient has Ctrough and Cpeak samples. A total of 84 plasma samples were obtained. The concentration of APA-M in plasma was determined by UPLC-MS/MS. Results: 1) 42 patients were evaluable. Treatment response was assessed by RECIST1.1. 2 patients achieved complete response (CR), 16 partial response (PR), 12 stable disease (SD) (tumor shrinks), 5 SD (tumor enlargement), 7 progressive disease (PD). Objective response rate (ORR) was 42.9% (18/42) and disease control rate (DCR) was 83.3% (35/42). 2) On day 1 and 456 after oral APA-M from different patients, median trough concentration (Ctrough median) was 264.38 ng/ml (1.18 ng/ml-918 ng/ml), and median peak concentration (Cpeak median) was 543.61 ng/ml (71.11 ng/ml-1609.4 ng/ml), respectively. 3) The Ctrough median in patients with CR, PR and SD (tumor shrinks) was significantly higher than that SD (tumor enlargement) and PD ( P＜0.05). There was significantly difference between CR and PR with SD (tumor shrinks) ( P＜0.05). But there was no significantly difference between CR and PR ( P＞0.05). (Table) 4) The Cpeak median in patients with CR, PR, SD (tumor enlargement) and PD was significantly higher than that SD (tumor shrinks) ( P＜0.05). But there was no significantly difference between CR and PR with SD (tumor enlargement) ( P＞0.05). (Table). Conclusions: The plasma Ctrough of Apatinib can predict the clinical efficacy of patients with solid tumor. Perspective clinical studies with adequate sample size are required to validate our results. [Table: see text]

Effects of co-administration of Unani pharmacopoeia formulations Qurs Tabasheer Sartani and Arq Hara Bhara with CAT-I antitubercular drugs in rats

Objectives Tuberculosis continues to be a major public health problem globally, despite incredible advancements in healthcare system. In Unani system of medicine, Qurs Tabasheer Sarthani (QTS) and Arq Hara Bhara (AHB) have been traditionally used for tuberculosis like conditions. The study was aimed to investigate the effects of co-administration of QTS and AHB with category I first line antitubercular drugs (CAT-I) on the indices of liver and kidney function in rats. Methods QTS and AHB were prepared individually and mixed to achieve final compound Unani pharmacopoeia formulation (UPF). The human equivalent doses for rats were calculated and administered with and without CAT-I. The effects of the formulations on serum indices of kidney and liver function, hematological markers and plasma CAT-I drug levels were estimated at 14th, 60th & 180th days of treatment. Results The administration of UPF, CAT-I and UPF + CAT-I altered the levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma glutamyltransferase (GGT) and haematological markers. These alterations were within permissible range and randomly distributed among groups during various time points. Administration of CAT-I alone resulted in moderate histopathological changes which were completely abrogated in CAT-I + UPF co-administered animals. The co-administration of UPF with CAT-I improved the plasma peak rifampicin (RIF) levels, without altering the liver and kidney functions. Conclusions The co-administration of UPF with ATT improved liver and kidney functions and increased the plasma levels of RIF. These beneficial findings provide a scope to evaluate the pharmacokinetic studies in humans.

BUCCAL FILM: A NOVEL APPROACH FOR ORAL MUCOSAL DRUG DELIVERY SYSTEM

Buccal drug delivery especially refers to the delivery of drugs through the buccal mucosal membrane lining of the oral cavity. For geriatric and pediatric patients who undergo difficulties in swallowing conventional oral solid dosage forms, the buccal film is a better alternative. The buccal film is appropriate for the drugs which experience high first-pass metabolism and is used for enhancing bioavailability with reducing dosing frequency to mouth plasma peak levels, which thus limit side-effects and make it cost-effective. It enhances the efficacy of API in the oral cavity after the contact with less saliva as contrasted to tablets, without chewing and no need for water for administration. This review briefly describes the advantages and limitations of buccal film, an anatomical structure of oral mucosa, highlighting the mechanisms of drug permeation, formulation technologies, methodology in evaluating buccal film, and recent advances of the buccal film as a tool for drug delivery for various treatments.

A Pilot Screening of Agro-Food Waste Products as Sources of Nutraceutical Formulations to Improve Simulated Postprandial Glycaemia and Insulinaemia in Healthy Subjects

The control of glucose homeostasis is the main goal for both the prevention and management of diabetes and pre-diabetes. Numerous drugs are available, despite their side effects. This is constantly leading people to be inclined to natural alternative treatments. Evidence indicates antioxidant-based nutraceuticals as an optimal tool for the glycaemic control. Currently, a great interest has been focused on the valorisation of agro-food by-products as sources of bioactive compounds including polyphenols. In this sense, we tested the efficacy of novel nutraceutical products based on polyphenolic extract from nectarines (NecP), tomato peels (TP), and olive leaves (EOL) on glycaemic and insulinemic responses. The three formulations contained, respectively, 0.007 mg abscisic acid (ABA)/g, 0.5 mg carotenoids/g, and 150 mg oleuropein/g. Twenty healthy subjects consumed a regular glucose solution (RG) or a treatment beverage (TB) obtained by mixing RG with the individual formulations (TB NecP, TB EOL, and TB TP), separately, and on different days. All three formulations significantly lowered the 30 min glucose plasma peak (p < 0.05 for all); similarly, NecP and TP also significantly lowered the 30 min insulin plasma peak (p < 0.05 for all). These results may lead to the hypothesis of a formulation of a multi-component nutraceutical with a synergistic efficacy for the glycaemic control.

Stratification observed by the in situ plasma density measurements from the Swarm satellites

The stratification phenomenon is investigated using the simultaneous in situ plasma density measurements obtained by the Swarm satellites orbiting at different altitudes above the F2 peak. For the first time, the continuous distribution morphology and the exact locations are obtained for the nighttime stratification, which show that the stratification events are centered at the EIA (equatorial ionization anomaly) trough and extend towards the two EIA crests, with the most significant part being located at the EIA trough. Another new discovery is the stratification in southern mid-latitudes; stratification events in this region are located on a local plasma peak sandwiched by two lower density strips covering all the longitudes. The formation mechanism of the stratification for the two latitudinal regions is discussed, but the stratification mechanism in southern mid-latitudes remains an unsolved problem. Highlights. This paper addresses the following: first application of in situ plasma densities for the direct analysis of the stratification in F2 layer, refined features of the exact location and continuous morphology for the stratification phenomenon, a new discovery of stratification covering all longitudes in southern mid-latitudes.

SUN-555 Vitamin E Sequestration by Liver Fat in Vitro and in Women with Hepato-Steatosis

BACKGROUND: The global obesity epidemic has sobering consequences to human health. Especially concerning is obesity-associated hepato-steatosis (HS), a common cause of chronic liver disease in the Americas and Western Europe that precedes non-alcoholic steatohepatitis (NASH). Maintenance of normal body weight is the only current means to prevent HS and NASH. We hypothesized that excess liver fat in obesity-associated HS could act as a pathophysiologic chemical depot for fat-soluble vitamins and alter normal physiology. Because clinical trials with Vitamin E (α-T) have shown that NASH partially responds to this supplement, we selected α-T as a model vitamin to test the sequestration hypothesis. INTERVENTIONS: Under an IND and IRB-approved protocol, two deuterium-labeled α-tocopherols (d3-α-T and d6-α-T) were administered orally and intravenously, respectively, to 10 healthy women and 6 women with HS. Serial blood samples obtained over 72 h were analyzed by LC-MS/MS. In parallel, we performed studies in hepatocytes in cell culture and mouse model. RESULTS: In healthy women who received oral d3- and intravenous d6-α-T, 85% of the initial plasma peak d6-α-T disappeared within 20 minute and reappeared in the plasma peaking between 6-8 h. Compared to healthy subjects, subjects with HS had similar d6-α-T entry rates into liver, but reduced release rates into plasma (p&lt;0.001). Similarly, pharmacokinetics parameters (AUC and Maximum Concentration [Cmax]), were reduced (AUC0-8,p&lt;0.01;Cmax p&lt;0.02) in HS subjects, indicating reduced hepatic d6-α-T output. Consistently, livers of mice fed with a high fat diet (42% fat) had more vitamin E compared to controls diet (5% fat), with both diets having the same α-T content CONCLUSION: These findings suggest the unique role of the liver in vitamin E physiology which is dysregulated by excess liver fat (measured by magnetic resonance spectroscopy). Considered together, the findings imply that obesity-associated HS may produce unrecognized hepatic α-T sequestration, which might subsequently drive liver disease. The data here raise the intriguing possibility that timely α-T supplementation might attenuate progression of HS to NASH, perhaps by correcting an unrecognized fat-induced, localized, hepatic vitamin E deficiency prior to onset of inflammation, hepatitis, and fibrosis. Additionally, our findings raise the possibility that HS may similarly alter hepatic physiology of other fat-soluble vitamins.

Stratification observed by the in situ measurements from the Swarm satellites

Stratification phenomenon is investigated using the simultaneous in situ plasma density measurements obtained by the Swarm satellites orbiting at different altitudes above F2 peak. For the first time, the continuous distribution morphology and the exact locations are obtained for the nighttime stratification, which show that the stratification events are centered at the EIA (equatorial ionization anomaly) trough and extend towards the two EIA crests with the most significant part being located at the EIA trough. Another new discovery is the stratification in southern mid-latitudes; stratification events in this region are located on a local plasma peak sandwiched by two lower density strips covering all the longitudes. The formation mechanism of the stratification for the two latitudinal regions is discussed, but the stratification mechanism in southern mid-latitudes remains an unsolved problem.

Cytotoxicity and Differentiating Effect of the Poly(ADP-Ribose) Polymerase Inhibitor Olaparib in Myelodysplastic Syndromes

Myelodysplastic syndromes (MDS) are highly heterogeneous myeloid diseases, characterized by frequent genetic/chromosomal aberrations. Olaparib is a potent, orally bioavailable poly(ADP-ribose) polymerase 1 (PARP1) inhibitor with acceptable toxicity profile, designed as targeted therapy for DNA repair defective tumors. Here, we investigated olaparib activity in primary cultures of bone marrow mononuclear cells collected from patients with MDS (n = 28). A single treatment with olaparib induced cytotoxic effects in most samples, with median IC50 of 5.4 µM (2.0–24.8 µM), lower than plasma peak concentration reached in vivo. In addition, olaparib induced DNA damage as shown by a high proportion of γH2AX positive cells in samples with low IC50s. Olaparib preferentially killed myeloid cells causing a significant reduction of blasts and promyelocytes, paralleled by an increase in metamyelocytes and mature granulocytes while sparing lymphocytes that are not part of the MDS clone. Consistently, flow cytometry analysis revealed a decrease of CD117+/CD123+ immature progenitors (p < 0.001) and induction of CD11b+/CD16+ (p < 0.001) and CD10+/CD15+ (p < 0.01) neutrophils. Morphological and immunophenotypic changes were associated with a dose-dependent increase of PU.1 and CEBPA transcription factors, which are drivers of granulocytic and monocytic differentiation. Moreover, the combination of olaparib with decitabine resulted in augmented cytotoxic and differentiating effects. Our data suggest that olaparib may have therapeutic potential in MDS patients.