Intravitreal bevacizumab: safety of multiple doses from a single vial for consecutive patients.

OBJECTIVES: To report the incidence of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor and the safety profile of multiple doses of bevacizumab from the same vial reused for multiple patients. DESIGN: Case series. SETTING: A private hospital in Hong Kong. PATIENTS: A systematic retrospective review of consecutive intravitreal anti-vascular endothelial growth factor injections between 5 June 2006 and 17 December 2010 at a single institute was conducted. Patients were identified from prospectively designed audit forms, and each patient's medical record was reviewed for any documented complications. Bevacizumab 1.25 mg/0.05 mL to 2.50 mg/0.1 mL was aspirated from the designated vial, with a maximum of 10 consecutive injections being aspirated from the same vial. The opened vial was then discarded without overnight storage. Ranibizumab was aspirated from the commercially available 1 mg/0.1 mL single-use vial. RESULTS: A total of 1655 intravitreal anti-vascular endothelial growth factor injections into 392 eyes of 383 patients were evaluated during the study period. There were 1184 bevacizumab injections and 471 ranibizumab injections. There was one case of suspected endophthalmitis after ranibizumab injection, though culture of the vitreous tap was negative. The point prevalence of endophthalmitis was 0.06% (1/1655) for the total number of injections: 0.21% (1/471) after ranibizumab, and 0% after bevacizumab. CONCLUSION: Although many centres aliquot multiple syringes from a single vial to be kept in a refrigerator for use, the current study shows that so long as proper sterile techniques are implemented, there were no cases of endophthalmitis from using the same vial, which was reused for a maximum of 10 consecutive injections. For intravitreal injection, bevacizumab costs approximately US$50 to US$100 per dose, as opposed to US$2000 per dose for ranibizumab. Sharing multiple doses of bevacizumab from a single vial can substantially reduce the cost of treatment.

Knowledge, attitudes and risk perceptions about tuberculosis: US National Health Interview Survey.

BACKGROUND: Tuberculosis (TB) disproportionately affects the human immunodeficiency virus (HIV) infected, foreign-born, Black, Hispanic, American Indian/Alaska Native, Asian, homeless, incarcerated, alcoholic, diabetic or cancer patients, male, those aged >44 years, smokers and poor persons. METHODS: We present TB knowledge, attitudes and risk perceptions overall and for those experiencing TB disparities from the 2000-2005 US National Health Interview Survey (NHIS). RESULTS: A total of 32% of respondents said TB is curable; 44% correctly recognized that TB is transmitted by air. Persons with less knowledge about TB transmission were aged 18-24 years, alcohol abusers, educated <12 years, Hispanics or males. Persons less likely to say TB is curable were aged 18-44 years, smokers, HIV-tested, uninsured, alcohol abusers or homeless/incarcerated. Only 28% of foreign-born persons from Mexico/Central America/the Caribbean said TB was curable. CONCLUSIONS: Knowledge about TB transmission and curability was low among a representative US population. Renewed TB educational efforts are needed for all populations, but should be targeted to populations disproportionately affected, especially those who are HIV-infected, homeless/incarcerated, Black, alcohol abusers, uninsured or born in Mexico/Central America/the Caribbean.

Cost comparison of anterior cruciate ligament reconstruction: autograft versus allograft.

PURPOSE: To compare the economic costs associated with anterior cruciate ligament (ACL) reconstruction using either autograft or allograft. The surgical costs are reported, including charge categories, for each procedure. All operations were performed in the Southern United States of America. TYPE OF STUDY: Evaluation of cost data collected from a group of patients participating in a prospective, nonrandomized trial. METHODS: A total of 122 patients with ACL-deficient knees undergoing surgical reconstruction using either bone-patellar tendon-bone autograft (n = 86) or freeze-dried Achilles tendon allograft (n = 37) were analyzed (1 patient underwent 2 allograft reconstructions). Patient selection for groups was based on the physician performing the surgery (2 surgeons performed autografts and 1 performed allografts). Groups were compared with respect to age, sex, race, and occupation. Hospital charge data were retrieved from the billing department and divided into various categories for comparison of the 2 groups. RESULTS: The mean hospital charge for ACL reconstruction was 4,622 dollars for allograft and 5,694 dollars for autograft (P < .0001). Differences included increased operating room time and a greater likelihood of overnight hospitalization for autograft procedures. This was slightly offset by higher charges for operating room supplies for allograft reconstructions owing to the cost of the graft itself. CONCLUSIONS: Allograft reconstruction of the ACL was significantly less expensive than autograft bone-patellar tendon-bone reconstruction. Allograft ACL reconstruction is a less costly alternative to autograft reconstruction. LEVEL OF EVIDENCE: Level IV, economic analysis with no sensitivity analysis.

Effect of safety packaging on aspirin ingestion by children.

The effectiveness of child-resistant closures, required under the Poison Prevention Packaging Act of 1970, in reducing the incidence of accidental ingestion of aspirin and aspirin-containing products among children less than 5 years of age has been investigated. Data from Poison Control Centers and the National Center for Health Statistics were analyzed to determine the ingestion level before and two to three years after safety closures were required. Baby aspirin and nonbaby aspirin products were analyzed separately. For baby aspirin. It is estimated that safety packaging has reduced the incidence of ingestions 45% to 55%. For nonbaby aspirin products, the reduction has been 40% to 45%.