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Attracting and sustaining investment in Veterinary Services and animal health programmes from national government budgets, development aid and grants, and philanthropic donors requires economic rationale using relevant, reliable and validated analytical approaches. The complex interwoven relationships between animal health, livestock husbandry systems, national food security, global health security and environmental sustainability emphasise the importance of improving data governance and stewardship and applying economic analysis to understand animal disease burdens. These efforts should enable prioritised investment of limited resources and effective monitoring of the impact of programmes over time. Data governance and stewardship capacities are fundamental to development, implementation and performance monitoring of evidence-based policies in animal health. There are challenges in data availability for national and subnational livestock populations in different sectors, for disease incidence and prevalence, and for animal health expenditure in support of optimised allocation of scarce resources, be they finance, land, labour, or management attention and policy focus. Animal health data systems governance and stewardship and economic analysis are core skills for Veterinary Services in developing and applying evidence-based policy, but capability probably varies among World Organisation for Animal Health (WOAH) Members. The WOAH Performance of Veterinary Services programme has several critical competencies that are relevant to economics of animal health and to data governance and stewardship, but these have not yet been targeted for coordinated capacity development. Implementation of publicâ€"private partnership approaches for animal health programmes creates increasing expectations of robust data and methods for prioritisation, options analysis, and assessing impacts and costs. Experience and examples from national systems in New Zealand, Australia, Ethiopia and Indonesia illustrate current challenges associated with prioritisation of animal health programmes using economic analysis. The Global Burden of Animal Diseases programme intends to support WOAH Members and partners to develop capacities for and standardise approaches to economic analysis and prioritisation in animal health programmes.

Les investissements dans les Services vétérinaires et dans les programmes de santé animale à partir des budgets publics nationaux, des aides et subventions au développement et des fonds alloués par des donateurs philanthropiques peuvent être encouragés et pérennisés au moyen d'une argumentation économique solide fondée sur des méthodes analytiques pertinentes, fiables et validées. La complexité et l'imbrication des relations entre la santé animale, les systèmes d'élevage, la sécurité de l'approvisionnement alimentaire à l'échelle nationale, la sécurité sanitaire mondiale et la durabilité environnementale imposent d'améliorer la gouvernance et la gestion des données et de recourir à des analyses économiques pour mieux comprendre l'impact des maladies animales. Ces efforts devraient permettre de définir les investissements prioritaires dans un contexte de ressources limitées et d'assurer un suivi efficace de l'impact des programmes dans le temps. L'existence de capacités de gouvernance et de gestion des données est donc une condition essentielle pour concevoir et mettre en oeuvre des politiques de santé animale fondées sur des données factuelles et pour suivre leurs performances. Les données disponibles sur les populations d'animaux d'élevage des différentes filières aux niveaux national ou infranational, sur l'incidence et la prévalence des maladies ou sur les dépenses de santé animale sont parfois insuffisantes pour étayer une utilisation optimale de ressources limitées, qu'il s'agisse de moyens financiers, des terres, de la main-d'oeuvre, voire des efforts de gestion ou de la volonté politique. La gouvernance et la gestion des systèmes de données de santé animale et la conduite d'analyses économiques sont des compétences cruciales des Services vétérinaires, que ceux-ci mobilisent pour concevoir et mettre en oeuvre des politiques fondées sur des données factuelles ; il est néanmoins peu probable que ces capacités soient d'un niveau homogène parmi tous les Membres de l'Organisation mondiale de la santé animale (OMSA). Le Processus d'évaluation de la Performance des Services vétérinaires mis en place par l'OMSA définit un certain nombre de compétences critiques dans le domaine de l'économie de la santé animale et de la gouvernance et gestion des données, mais ces compétences n'ont pas encore été intégrées dans un effort coordonné de renforcement des capacités. Les stratégies consistant à confier la mise en oeuvre de programmes de santé animale à des partenariats public-privé suscitent des besoins accrus en données et en méthodes robustes pour l'établissement des priorités, l'analyse des options et l'évaluation des impacts et des coûts. Les auteurs mentionnent les expériences et exemples de systèmes nationaux en Nouvelle-Zélande, en Australie, en Ethiopie et en Indonésie pour illustrer les enjeux actuels liés à l'utilisation des analyses économiques pour définir les priorités des programmes de santé animale. Le programme " Impact mondial des maladies animales " vise à aider les Membres et les partenaires de l'OMSA à renforcer leurs capacités dans le domaine de l'analyse économique et de la définition des priorités des programmes de santé animale et à normaliser leurs approches en la matière.

Para atraer y mantener las inversiones en los Servicios Veterinarios y los programas de sanidad animal procedentes de los presupuestos de los gobiernos nacionales, la ayuda para el desarrollo y las subvenciones, así como de donantes filántropos, se requiere un razonamiento económico en el que se utilicen enfoques analíticos pertinentes, fiables y validados. Las complejas relaciones entre la sanidad animal, los sistemas de ganadería, la seguridad alimentaria nacional, la seguridad sanitaria mundial y la sostenibilidad ambiental ponen de relieve la importancia de mejorar la gobernanza y la gestión de datos y de aplicar el análisis económico para comprender el impacto de las enfermedades animales. Estos esfuerzos deberían permitir establecer prioridades para la inversión de los limitados recursos y realizar un seguimiento eficaz de las repercusiones de los programas a lo largo del tiempo. Las capacidades de gobernanza y gestión de datos son fundamentales para el desarrollo y la implementación de políticas de sanidad animal con una base empírica y para el seguimiento de sus resultados. Existen dificultades en cuanto a la disponibilidad de datos sobre las cabañas ganaderas nacionales y subnacionales de los distintos sectores, la incidencia y prevalencia de las enfermedades y el gasto en sanidad animal que plantean problemas a la hora de optimizar la asignación de unos recursos que son escasos, ya sean los recursos financieros, las tierras, la mano de obra o la atención a la gestión y la orientación de las políticas. La gobernanza y la gestión de los sistemas de datos zoosanitarios y el análisis económico son competencias esenciales para que los Servicios Veterinarios elaboren y apliquen políticas con base empírica, pero es probable que la capacidad varíe entre los Miembros de la Organización Mundial de Sanidad Animal (OMSA). El Proceso de Prestaciones de los Servicios Veterinarios de la OMSA abarca varias competencias esenciales que son relevantes para la economía de la sanidad animal y para la gobernanza y la gestión de datos, pero que aún no han sido objeto de actividades coordinadas de desarrollo de capacidades. La aplicación de enfoques de asociación público-privada para los programas de sanidad animal aumenta aún más las expectativas de datos y métodos sólidos para el establecimiento de prioridades, el análisis de opciones y la evaluación de las repercusiones y los costos. La experiencia y los ejemplos de los sistemas nacionales de Nueva Zelanda, Australia, Etiopía e Indonesia ilustran los retos actuales asociados al establecimiento de prioridades en los programas de sanidad animal mediante el análisis económico. El programa sobre el impacto global de las enfermedades animales pretende ayudar a los Miembros y socios de la OMSA a desarrollar capacidades y armonizar enfoques para el análisis económico y el establecimiento de prioridades en los programas de sanidad animal.

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INTRODUCTION: Phaeochromocytoma may present with uncontrolled hypertension leading to haemorrhagic stroke (HS), ischaemic stroke (IS) and transient ischaemic attack (TIA). False elevation in the levels of CATS/ METS has been reported in acute cerebrovascular disease. Our aim was to analyse the frequency and pattern of elevations of CATS/METS in patients with acute cerebrovascular disease and to determine associated factors. MATERIALS AND METHODS: This is a retrospective study of 112 samples of CATS/ METS received by the laboratory over a two-year period, from patients with acute cerebrovascular disease. CATS/METS were measured using LC/MS/MS method. Clinical details and CATS/METS level were obtained from the database. Mann-Whitney U test and Kruskal Wallis test were used for statistical analysis. These statistical analyses were performed using SPSS v.20.0 (IBM Corp., Armonk, NY, USA). RESULTS: Of the 112 patients, 39% had HS, 54% had IS and 7% had TIA. A total of 29% of patients had elevated CATS/ METS. Elevated levels of CATS/METS were noted in 41% and 25% of HS and IS patients, respectively (p=0.53). Median norepinephrine, epinephrine and metanephrine levels in HS were significantly higher than IS (p< 0.05). Systolic blood pressure was higher in those who had elevated CATS/ METS (p=0.04). Only for two patients with elevated CATS/METS repeat testing was performed. Age, diastolic blood pressure and the time of sample collection in relation to the presentation, for CATS/METS were not significantly different between groups that had elevated levels of CATS/ METS versus those who did not. CONCLUSION: We noted that CATS/METS were elevated in one-third of patients, especially in patients with high systolic blood pressure. Increase in CATS/METS should be appropriately followed up with repeat testing. Since false elevation in CATS/METS has been reported in cerebrovascular disease, screening for phaeochromocytoma is best deferred for a month.

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INTRODUCTION: Hyponatraemia is one of the most frequent laboratory findings in hospitalised patients. We present an unusual case of hyponatraemia in a 23-year-old female secondary to acute intermittent porphyria (AIP), a rare inborn error of metabolism. CASE REPORT: The patient presented with upper respiratory tract infection, fever, seizures and abdominal pain. An initial diagnosis of encephalitis was made. In view of the unexplained abdominal pain with other clinical findings such as posterior reversible encephalopathy syndrome by CT brain, temporary blindness as well as hyponatraemia, acute intermittent porphyria was suspected. Urine delta aminolaevulinic acid (δ-ALA) and porphobilinogen were elevated confirming the diagnosis of AIP. Genetic studies were done for this patient. The patient had a complete resolution of her symptoms with carbohydrate loading and high caloric diet. CONCLUSION: Although rare, AIP should be considered as a cause of hyponatraemia in a patient who presents with signs and/or symptoms that are characteristic of this disease.

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Leech is an uncommon nasal foreign body, which can cause epistaxis. It is an aquatic segmental worm living in fresh water most commonly in tropical areas. Once it is attached in the nose, it will secrete an anticoagulant enzyme named hirudin, and that will result in continuous bleeding more than from a normal wound even after it is removed. We present a case of a live leech in the nose that caused unilateral epistaxis in a patient with a recent history of jungle trekking.

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The onset of carcinoma of the larynx, especially of the glottis, is heralded mainly by a change of voice. It has a male preponderance and is almost exclusively common to smokers and patients with heavy alcohol consumption. We report a case of glottic carcinoma in a non-smoker female patient. The only possible risk factor for her is a history of laryngopharyngeal reflux.

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Discharging ear is a common symptom in the primary care and private general clinics. Most of the cases are treated with the antibiotic ear drops for otitis externa or otitis media. However, despite an adequate standard therapy, a malignant tumour can also be present with non-specific symptom such as ear discharge, especially in the case of persistent ear discharge. In this paper we have reported a case of an adult woman presented with non-resolving ear discharge who was treated repeatedly with antibiotic ear drop, which was later diagnosed as squamous cell carcinoma.

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We describe a rare tumor site in a 46 year old man who presented with a two week history of headache. Physical examination revealed bilateral papilloedema with no other localizing signs. Computed Tomographic Scan as well as Magnetic Resonance Imaging of the brain revealed a lesion with a dura tail located adjacent to the falx cerebri of the right frontal lobe. This lesion was not invading the inner table of the skull base. A tumor blush was seen on angiogram. There were no abnormalities on CT scan of the abdomen and fundoscopy was normal. Intraoperatively a vascular tumor not attached to the dura was noted and removed totally. Histopathological examination was typical of a hemangioblastoma. Analysis revealed no mutations of the VHL gene in 5 regions, exon 5-8 of the p53 gene, exon 1-2 of the p16 gene and exon 5,6 and 8 of the PTEN gene. This is the first case report of a supratentorial hemangioblastoma in a non-Von Hippel Lindau patient with genetic evidence.

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Frequent loss of heterozygosity (LOH) and mutations of the tumor suppressor gene PTEN (phosphatase and tensin homologue deleted from chromosome 10) have been found in sporadic gliomas. The most documented regions of allelic losses include 9p21, 10q23-25 and 17p1 3 whereas PTEN aberrations are preferentially found in glioblastoma multiformes. This research aimed to detect the incidence of allelic losses on chromosomes 10q, 9p, 17p and 13q and mutations on exons 5, 6 and 8 of PTEN in malignant gliomas. Malignant glioma specimens obtained were classified histopathologically according to the WHO criteria. Each tumor was then subjected to polymerase chain reaction (PCR)-LOH analysis using microsatellite markers and single-stranded conformational polymorphism (SSCP) analysis. Twelve of 23 (52%) malignant glioma cases showed allelic losses whereas 7 of 23 (30%) samples showed aberrant band patterns and mutations of PTEN. Four of these cases showed LOH in 10q23 and mutations of PTEN. The data on LOH indicated the involvement of different genes in the genesis of glioma whereas mutations of PTEN indicated the role of PTEN tumor suppressor gene in the progression of glioma in Malay population.

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Loss of heterozygosity (LOH) on several loci and mutations on PTEN tumor suppressor gene (10q23.3) occur frequently in sporadic gliomas. We have performed polymerase chain reaction (PCR)-LOH analysis using microsatellite markers and single-stranded conformational polymorphism (SSCP) analysis to determine the incidence of allelic losses on chromosome 10q, 9p, 17p and 13q and mutations of exons 5, 6 and 8 of the PTEN gene in malignant gliomas. Twelve of 23 (52.2%) malignant glioma cases showed allelic losses whereas 7 of 23, (30.4%) samples showed aberrant band patterns and mutations of the PTEN gene. Four of these cases showed LOH on 10q23 and mutations of the PTEN gene. The data on LOH indicated the involvement of different genes in gliomagenesis whereas mutations of the PTEN gene indicated the role of PTEN tumor suppressor gene in the progression of glioma in Malay population.

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