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INTRODUCTION: Neurological disorders, structural or functional, are prevalent all over the world and are accompanied by physical and social morbidity. In this study, we aimed to calculate the cost of investigating neurological disorders and compare the costs incurred in a government hospital with that in a private hospital. MATERIALS AND METHODS: This study was conducted at the Dr. Ruth KM Pfau Civil Hospital, Karachi, Pakistan. One hundred patients were enrolled in the study; 10 each investigated for epilepsy, cerebrovascular accidents (CVAs), headache, neuropathy, myopathy, cranial nerve palsies, movement disorders, demyelinating diseases, central nervous system (CNS) infections, and dementia. Receipts and records in the patients' medical history were used for the calculation of the cost of procedures, which was then compared with the costs of these investigations in a private hospital. A bottom-up costing approach was taken with individual costs being estimated and then being grouped to calculate the overall economic burden of the disorders. Data were analyzed using IBM SPSS version 23.0. One-way analysis of variance (ANOVA) was done to compare the mean cost (taken by the patient, covered by the government, total cost in the government hospital, and total cost in the private hospital) across diseases in government and private hospitals separately. Pearson correlation and scatter plot were also done to study the cost in private and public hospitals. p-values less than 0.05 were considered statistically significant. The margin of error in the study was 5%. RESULTS: The mean age was 38.2 ± 20.5 years. Some 51% data were received from female samples. The mean income of samples was 13863.6 ± 9715.9 Pakistani Rupees (PKR) or 78.38 ± 58.29 United States Dollars (USD). The mean cost covered by government hospitals was 8866.0 ± 5071.0 PKR (53.19 ± 30.42 USD) per patient, whereas in government hospitals patients were charged on average 2662.9 ± 3774.7 PKR (16 ± 22.65 USD), while in private hospitals patients paid on average 29041.3 ± 12992.6 PKR (174.21 ± 78 USD). CONCLUSION: The costs of investigations in private hospitals were approximately three times the costs in government hospitals. The maximum cost was generated by patients being investigated for demyelinating disorders. Investigations conducted in government-run hospitals are more cost effective and these institutions should receive increased funding to cater to the maximum number of patients.
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The high prevalence of extended-spectrum ß-lactamases (76.3 %) and metallo-ß-lactamases (7.3 %) amongst the bacteria Pseudomonas aeruginosa is a critical problem that has set forth an enormous therapeutic challenge. The suggested role of nanoparticles as next generation antibiotics, and inadequate information on antibacterial activity of aluminium oxide nanoparticles has led us to investigate the green synthesis of aluminium oxide nanoparticles (Al2O3 NPs) using leaf extracts of lemongrass and its antibacterial activity against extended-spectrum ß-lactamases and metallo-ß-lactamases clinical isolates of P. aeruginosa. The synthesized Al2O3-NPs were characterized by scanning electron microcopy, high resolution-transmission electron microscopy, atomic force microscopy, X-ray diffraction, Zeta potential, and differential light scattering techniques. The X-ray diffraction data revealed the average size of the spherical Al2O3-NPs as 34.5 nm. The hydrodynamic size in Milli Q water and Zeta potential were determined to be 254 nm and +52.2 mV, respectively. The minimal inhibitory concentration of Al2O3-NPs was found to be in the range of 1,600-3,200 µg/ml. Treatment at concentrations >2,000 µg/ml, resulted in complete growth inhibition of extended-spectrum ß-lactamases and metallo-ß-lactamases isolates. Scanning electron microcopy analysis revealed the clusters of nanoparticles attached to the bacterial cell surface, causing structural deformities in treated cells. High resolution-transmission electron microscopy analysis confirmed that nanoparticles crossed the cell membrane to become intracellular. The interaction of nanoparticles with the cell membrane eventually triggered the loss of membrane integrity, most likely due to intracellular oxidative stress. The data explicitly suggested that the synthesized Al2O3-NPs can be exploited as an effective bactericidal agent against extended-spectrum ß-lactamases, non-extended-spectrum ß-lactamases and metallo-ß-lactamases strains of P. aeruginosa, regardless of their drug resistance patterns and mechanisms. The results elucidated the clinical significance of Al2O3-NPs in developing an effective antibacterial therapeutic regimen against the multi-drug resistant bacterial infections. The use of leaf extract of lemongrass for the synthesis of Al2O3-NPs appears to be cost effective, nontoxic, eco-friendly and its strong antibacterial activity against multi-drug resistant strains of P. aeruginosa offers compatibility for pharmaceutical and other biomedical applications.
