Neuropathology and neurologic impairment were characterized in a clinically relevant canine model of hypothermic (18°C) circulatory arrest (HCA) and cardiopulmonary bypass (CPB). Adult dogs underwent 2 hours of HCA (n = 39), 1 hour of HCA (n = 20), or standard CPB (n = 22) and survived 2, 8, 24, or 72 hours. Neurologic impairment and neuropathology were much more severe after 2-hour HCA than after 1-hour HCA or CPB; histopathology and neurologic deficit scores were significantly correlated. Apoptosis developed as early as 2 hours after injury and was most severe in the granule cells of the hippocampal dentate gyrus. Necrosis evolved more slowly and was most severe in amygdala and pyramidal neurons in the cornu ammonis hippocampus. Neuronal injury was minimal up to 24 hours after 1-hour HCA, but 1 dog that survived to 72 hours showed substantial necrosis in the hippocampus, suggesting that, with longer survival time, the injury was worse. Although neuronal injury was minimal after CPB, we observed rare apoptotic and necrotic neurons in hippocampi and caudate nuclei. These results have important implications for CPB in humans and may help explain the subtle cognitive changes experienced by patients after CPB.
Micafungin was reported to be non-inferior to liposomal amphotericin B (LAmB) in treating patients with candidaemia and invasive candidiasis (IC). The current study aimed to evaluate the economic impact of using micafungin versus LAmB for treatment of candidaemia and IC in Turkey. A decision analytic model, which depicted economic consequences upon administration of micafungin or LAmB for treating patients with candidaemia and IC in the Turkish hospitals, was constructed. Patients were switched to an alternative antifungal agent if initial treatment failed due to mycological persistence. All patients were followed up until treatment success or death. Outcome probabilities were obtained from published literature and cost inputs were derived from the latest Turkish resources. Expert panels were used to estimate data that were not available in the literature. Cost per patient treated for each intervention was then calculated. Sensitivity analyses including Monte Carlo simulation were performed. For treatment of candidaemia and IC, micafungin (€4809) was associated with higher total cost than LAmB (€4467), with an additional cost of €341 per treated patient. Cost of initial antifungal treatment was the major cost driver for both comparators. The model outcome was robust over a wide variation in input variables except for drug acquisition cost and duration of initial antifungal treatment with micafungin or LAmB. LAmB is cost-saving relative to micafungin for the treatment of candidaemia and IC from the Turkish hospital perspective, with variation in drug acquisition cost of the critical factor affecting the model outcome.
Micafungin was shown to be as efficacious as caspofungin in treating patients with candidaemia and invasive candidiasis (IC). However, it remains unknown if micafungin or caspofungin is a cost-effective definitive therapy for candidaemia and IC in Turkey. The present study aimed to determine the economic impact of using micafungin versus caspofungin for treatment of candidaemia and IC in the Turkish setting. A decision analytic model was constructed and was populated with data (i.e. transition probabilities, duration of initial antifungal treatment, reasons for treatment failure, percentage of patients who stepped down to oral fluconazole, and duration on oral fluconazole) obtained from a published randomised clinical trial. Cost inputs were derived from the latest Turkish resources while data that were not readily available in the literature were estimated by expert panels. One-way sensitivity analyses, threshold analyses, scenario analyses and probabilistic sensitivity analyses were conducted. Caspofungin (€2693) incurred a lower total cost than micafungin (€4422), with a net cost saving of €1729 per treated patient. Drug acquisition cost was the main cost driver for both study arms. The model outcome was robust over wide variations (of ±100.0% from the base case value) for all input parameters except for micafungin drug cost and the duration of initial treatment with micafungin. Caspofungin appears to be a cost-saving option in treating candidaemia and IC from the Turkish hospital perspective.
Anidulafungin has been shown to be non-inferior to, and possibly more efficacious, than fluconazole in treating patients with invasive candidiasis (IC). This study aimed to determine the cost-effectiveness of anidulafungin vs fluconazole for treatment of IC in the Turkish setting. A decision analytic model was constructed to depict downstream economic consequences of using anidulafungin or fluconazole for treatment of IC in the Turkish hospitals. Transition probabilities (ie treatment success, observed or indeterminate treatment failures) were obtained from a published randomised clinical trial. Cost inputs were from the latest Turkish resources. Data not available in the literature were estimated by expert panels. Sensitivity analyses were performed to assess the robustness of the model outcome. While anidulafungin [TL 17 171 (USD 4589)] incurred a higher total cost than fluconazole [TL 8233 (USD 2200) per treated patient, treatment with anidulafungin was estimated to save an additional 0.58 life-years, with an incremental cost-effectiveness ratio of TL 15 410 (USD 4118) per life-years saved. Drug acquisition cost and hospitalisation were the main cost drivers for anidulafungin and fluconazole arms respectively. The model findings were robust over a wide range of input variables except for anidulafungin drug cost. Anidulafungin appears to be a cost-effective therapy in treating IC from the Turkish hospital perspective.
Conference abstracts: Malaysia in affiliation
(1). PO-211. AGE-SPECIFIC STRESS-MODULATED
CHANGES OF SPLENIC IMMUNOARCHITECTURE
IN THE GROWING BODY. Marina Yurievna Kapitonova, Syed Baharom Syed Ahmad Fuad, Flossie Jayakaran; Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia
syedbaharom@salam.uitm.edu.my
(2). PO-213. A DETAILED OSTEOLOGICAL STUDY OF THE ANOMALOUS GROOVES NEAR THE
MASTOID NOTCH OF THE SKULL. ISrijit Das, 2Normadiah Kassim, lAzian Latiff, IFarihah Suhaimi, INorzana Ghafar, lKhin Pa Pa Hlaing, lIsraa Maatoq, IFaizah Othman; I Department of Anatomy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 2 Department of Anatomy, Universiti Malaya, Kuala Lumpur, Malaysia. das_sri jit23@rediffmail.com
(3). PO-21S. FIRST LUMBRICAL MUSCLE OF THE
PALM: A DETAILED ANATOMICAL STUDY WITH
CLINICAL IMPLICATIONS. Srijit Das, Azian Latiff, Parihah Suhaimi, Norzana Ghafar, Khin Pa Pa Hlaing, Israa Maatoq, Paizah Othman; Department of Anatomy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. das_srijit23@rediffmail.com
(4). PO-336. IMPROVEMENT IN EXPERIMENTALLY
INDUCED INFRACTED CARDIAC FUNCTION
FOLLOWING TRANSPLANTATION OF HUMAN
UMBILICAL CORD MATRIX-DERIVED
MESENCHYMAL CELLS. lSeyed Noureddin Nematollahi-Mahani, lMastafa Latifpour, 2Masood Deilami, 3Behzad Soroure-Azimzadeh, lSeyed
Hasan Eftekharvaghefi, 4Fatemeh Nabipour, 5Hamid
Najafipour, 6Nouzar Nakhaee, 7Mohammad Yaghoobi, 8Rana Eftekharvaghefi, 9Parvin Salehinejad, IOHasan Azizi; 1 Department of Anatomy, Kerman University of Medical Sciences, Kerman, Iran; 2 Department of Cardiosurgery, Hazrat-e Zahra Hospital, Kerman, Iran; 3 Department of Cardiology, Kerman University of Medical Sciences, Kerman, Iran; 4 Department of Pathology, Kerman University of Medical Sciences, Kerman, Iran; 5 Department of Physiology, Kerman University of Medical Sciences, Kerman, Iran; 6 Department of Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran; 7 Department
of Biotechnology, Research Institute of Environmental Science, International Center for Science, High Technology & Environmental Science, Kerman, Iran; 8 Students Research Center, Kerman University of Medical Sciences, Kerman, Iran; 9 Institute of Bioscience, University Putra Malaysia,
Kuala Lumpur, Malaysia; 10 Department of Stem Cell, Cell Science Research Center, Royan Institute, ACECR, Tehran, Iran. nnematollahi@kmu.ac.ir
(5).