Health-economic evaluation of meniscus tear treatments: a systematic review.

PURPOSE: To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment. METHODS: Our systematic review focuses on health-economic evaluation studies of meniscus tear treatment interventions found in PubMed and Embase databases. A qualitative, descriptive approach was used to analyze the studies' results and systematically report them following PRISMA guidelines. The health-economic evaluation method for each included study was categorized following one of the four approaches: partial economic evaluation (PEE), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), or cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. Comparisons of input variables and outcomes were made, if applicable. RESULTS: Sixteen studies were included; of these, six studies performed PEE, seven studies CUA, two studies CEA, and one study combined CBA, CUA, and CEA. The following economic comparisons were analyzed and showed the respective comparative outcomes: (1) meniscus repair was more cost-effective than arthroscopic partial meniscectomy (meniscectomy) for reparable meniscus tear; (2) non-operative treatment or physical therapy was less costly than meniscectomy for degenerative meniscus tear; (3) physical therapy with delayed meniscectomy was more cost-effective than early meniscectomy for meniscus tear with knee osteoarthritis; (4) meniscectomy without physical therapy was less costly than meniscectomy with physical therapy; (5) meniscectomy was more cost-effective than either meniscus allograft transplantation or meniscus scaffold procedure; (6) the conventional arthroscopic instrument cost was lower than laser-assisted arthroscopy in meniscectomy procedures. CONCLUSION: Results from this review suggest that meniscus repair is the most cost-effective intervention for reparable meniscus tears. Physical therapy followed by delayed meniscectomy is the most cost-effective intervention for degenerative meniscus tears. Meniscus scaffold should be avoided, especially when implemented on a large scale. LEVEL OF EVIDENCE: Systematic review of level IV studies.

"Cost-effectiveness of ACL treatment is dependent on age and activity level: a systematic review".

PURPOSE: To systematically review the literature on health-economic evaluations of anterior cruciate ligament (ACL) injury between reconstruction surgery (ACLR) and non-operative treatment (NO) and suggest the most cost-effective strategy between the two. METHODS: All economic studies related to ACLR versus NO post-ACL injury, either trial based or model based, published until April 2022, were identified using PubMed and Embase. The methodology of the health-economic analysis for each included study was categorized according to the four approaches: cost-minimization analysis (CMA), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), and cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. RESULTS: Of the seven included studies, two compared the strategies of early ACLR and NO alone, and five compared early ACLR and NO with optional delayed ACLR. All studies performed a CUA, and one study performed a CBA additionally. The CHEC scores of the included studies can be considered good, ranging from 15 to 18 from a maximum of 19. Applying the common standard threshold of $50,000 per QALY, six studies in young people with high-activity levels or athletes showed that early ACLR would be preferred over either NO alone or delayed ACLR. Of six studies, two even showed early ACLR to be the dominant strategy over either NO alone or delayed ACLR, with per-patient cost savings of $5,164 and $1,803 and incremental per-patient QALY gains of 0.18 and 0.28, respectively. The one study in the middle-aged people with a moderate activity level showed that early ACLR was not more cost-effective than delayed ACLR, with ICER $101,939/QALY using the societal perspective and ICER $63,188/QALY using the healthcare system perspective. CONCLUSION: Early ACLR is likely the more cost-effective strategy for ACL injury cases in athletes and young populations with high-activity levels. On the other hand, non-operative treatment with optional delayed ACLR may be the more cost-effective strategy in the middle age population with moderate activity levels. LEVEL OF EVIDENCE: Systematic review of level III studies.

Does elective orthopaedic surgery in pandemic era increase risk of developing COVID-19? A combined analysis of retrospective and prospective study at Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

BACKGROUND: To date, no recommendations have been published on when and how to start again carrying out elective, non-urgent surgery on COVID-19-negative patients after the epidemic peak has been reached in a given country or region and the pressure on healthcare facilities, healthcare workers and resources has been released by so far that elective surgery procedures can be safely and ethically programmed again. This study aims to investigate whether elective orthopaedic surgery will increase the risk of developing COVID-19. MATERIALS AND METHODS: This was a combined retrospective and prospective studies performed at a national tertiary hospital in Jakarta, Indonesia. Subjects were patients who underwent elective orthopaedic surgeries at our institution from April to May 2020. Those who were previously infected with COVID-19 from polymerase chain reaction (PCR) reverse transcriptase (RT) examination obtained via nasopharynx and oropharynx swab, as well as those who were reluctant to participate were excluded from the study. RESULTS: A total of 35 subjects (mean age 32.89 ± 17.42) were recruited. Fifteen (42.9%) subjects were male, and 20 subjects (57.1%) were female. Mean duration of surgery was 240 min with the longest and shortest duration of 690 and 40 min, respectively. General anaesthesia was performed in the majority of cases in 18 surgeries (51.4%) with local anaesthesia as the least in 2 surgeries (5.7%). Length of stay of our study was 6 days of average. None of the patients developed symptoms suggestive of COVID-19 infection. CONCLUSION: We found that elective orthopaedic surgery may not be associated with increased cases of COVID-19 cases. However, our study was limited by short duration of follow-up. Further studies are required in order to investigate the affect of undergoing elective surgery and the number of COVID-19 cases.

Extracorporeal methods in the treatment of poisoning.

Among the various ways of managing poisoning, haemodialysis may help in enhancing excretion of the toxic substance. We report a case, a Russian male, 35 years old, who was rushed to the Gleneagles Hospital Medan from the airport after being evacuated from Banda Aceh together with another older Russian who died as they arrived at the admission and Emergency Department. From the result of intensive allo anamnesis and the high anion gap metabolic acidosis, in the absence of disturbed renal and liver function, we presumed this patient was suffering from methanol intoxication. The time of exposure was approximately 70 hours before. The exact length of dialysis time to excrete the noxious substance from the blood without plasma methanol determination was difficult. Moreover the time elapsed from exposure to treatment had been approximately 70 hours, which means the optic nerve had been so long exposed to formic acid, the toxic metabolite of methanol, that the damage should have been very severe. Ethanol is also known to be an antidote of methanol, which can be given orally by nasogastric tube, or i.v. It should be given early, and plasma ethanol level should be closely monitored to make it effective and safe. This was also unavailable. Another antidote is fomepizole which is also as yet unavailable in Medan. Folic acid, thiamin, and i.v. folinic acid are also recommended by the literature, as well as oral steroid.

Cholera in Indonesia in 1993-1999.

Cholera-specific surveillance in Indonesia was initiated to identify the introduction of the newly recognized Vibrio cholerae non-O1, O139 serotype. Findings from seven years (1993-1999) of surveillance efforts also yielded regional profiles of the importance of cholera in both epidemic and sporadic diarrheal disease occurrence throughout the archipelago. A two-fold surveillance strategy was pursued involving 1) outbreak investigations, and 2) hospital-based case recognition. Rectal swabs were transported to Jakarta for culture and isolates were characterized by serotypic identification. Outbreak findings showed that V. cholerae O1, Ogawa serotype, was the predominant etiology in all 17 instances of investigated epidemic transmission. Monitoring of eight hospitals representing seven provinces provided 6,882 specimens, of which 9% were culture positive for V. cholerae: 589 (9%) for O1 and 20 (< 1%) for non-O1 strains. Proportional representation of V. cholerae O1 among cases of sporadic diarrheal illness was variable, ranging from 13% in Jakarta to < 1% in Batam. Overall, 98% of V. cholerae O1 cases were the Ogawa serotype. There was no instance of non-O1, O139 serotype introduction in either epidemic or sporadic disease form. Anti-microbial drug susceptibility was consistently demonstrated, both temporally and spatially, except against colistin. Evidence is provided that epidemic and sporadic cholera occurrence in western Indonesia is associated with periods of low rainfall. Conversely, in the more eastern portion of the country, heavy rainfall may have contributed to epidemic cholera transmission.

Intussusception at the pediatric ward of Dr. Pirngadi Hospital, Medan.

A retrospective study had been conducted on hospitalized infants and children in the Pediatric ward of Dr. Pirngadi Hospital, Medan from January 1, 1987 through December 31, 1988. The purpose is to assess the incidence and clinical manifestations of intussusception. During the same period, there were 6484 infants and children hospitalized, 39 (0.6%) with intussusception, consisting of 23 (58.9%) males and (41.1%) females. Most of the cases (53.85%) were in age group of 4-6 months. Thirty four patients (87.12%) were wellnourished, and 5 patients (12.82%) undernourished. The major symptoms of intussusception were bloody diarrhoea (87.17%), vomiting (82.05%) and abdominal distention (66.41%). Successful reposition with barium enema occurred in 1 (20%) out of 5 patients. The major symptoms of intussusception were bloody diarrhoea (87.17%), vomiting. Surgical intervention was performed in 22 patients (56.41%). The result was as follows: discharged in good condition in 15 (68.18%) and deaths occurred in the remaining cases (7 cases = 31.82%). Of those 7 cases who died after operation, 2 cases were hospitalized in less than 2 days, 3 cases in less than 3 days and the remaining 2 cases in more than 3 days, after the symptoms developed.

Influence of rete testis fluid deprivation on the kinetic parameters of goat epididymal 5 alpha-reductase.

A surgical technique to cannulate the rete testis of the goat was utilized to examine the effects of rete testis fluid (RTF) deprivation on the enzymatic activity of epididymal 5 alpha-reductase. Kinetic techniques were used to determine whether the regional enzymatic effect of RTF deprivation is to decrease the apparent number of 5 alpha-reductase active sites or the catalytic activity of each active site within the epididymal epithelium. Paired comparisons of (Vmax)app and (Km)app values between control and RTF-deprived epididymides indicated that RTF deprivation affected the value of (Vmax)app with no apparent change in the values of (Km)app in caput, corpus, and cauda epididymal regions. We conclude that RTF deprivation in the goat epididymis for 7 days results in a decreased number of apparent 5 alpha-reductase active sites within the epididymal epithelium.

[Methyl-cytosine specific restriction in Escherichia coli K-12]. / Izuchenie metil-tsitozin spetsificheskoi restriktsii u Escherichia coli K-12.

Experiments on transformation of Escherichia coli K-12 cells by plasmids carrying RM systems with different recognition sites containing 5-methylcytosine have shown that the gene mcrB determines the function of restriction. The data obtained made it possible to believe that E. coli possesses no restriction system recognizing specifically cytosine methylated in position 4.

Oxyuriasis at the Department of Pediatrics, Dr. Pirngadi Hospital, Medan.

During the period of 3 months (February-April 1987), a prospective study on oxyuariasis among children had been conducted at Child Health Department of Dr. Pirngadi Hospital Medan. All children over 8 months of age were included in this study. The diagnosis was based on the modified Scoth's technique. Oxyuriasis ova were found in 21 out 119 children (17.65%). The peak incidence was found in the school age.

[Cloning of the restriction-modification genes of Bacillus centrosporus in Escherichia coli]. / Klonirovanie genov restriktsii-modifikatsii Bacillus centrosporus v Escherichia coli.

A genomic library of Bacillus centrosporus was obtained using pBR327 as a vector. The total plasmid DNA of the library was cleaved by the BcnI restriction endonuclease and then transformed in Escherichia coli RR1. Two clones possessing restriction and DNA modification profiles of BcnI were identified among the transformants. Their respective plasmids were 13.3 and 9.05 kbp in size. Restriction mapping of both plasmids showed each of them to contain two sites for HindIII and one for both Eco31I and Eco47III, located at the same distance. This was assumed to be the location region of the BcnI restriction-modification genes. Confirmation of the assumption was obtained by deletion mapping of the recombinant plasmids. Special features concerning cloning of the restriction-modification genes are discussed on the basis of the results obtained.