OBJECTIVE: To conduct an external quality assessment (EQA) of dengue and chikungunya diagnostics among national-level public health laboratories in the Asia Pacific region following the first round of EQA for dengue diagnostics in 2013. METHODS: Twenty-four national-level public health laboratories performed routine diagnostic assays on a proficiency testing panel consisting of two modules. Module A contained serum samples spiked with cultured dengue virus (DENV) or chikungunya virus (CHIKV) for the detection of nucleic acid and DENV non-structural protein 1 (NS1) antigen. Module B contained human serum samples for the detection of anti-DENV antibodies. RESULTS: Among 20 laboratories testing Module A, 17 (85%) correctly detected DENV RNA by reverse transcription polymerase chain reaction (RT-PCR), 18 (90%) correctly determined serotype and 19 (95%) correctly identified CHIKV by RT-PCR. Ten of 15 (66.7%) laboratories performing NS1 antigen assays obtained the correct results. In Module B, 18/23 (78.3%) and 20/20 (100%) of laboratories correctly detected anti-DENV IgM and IgG, respectively. Detection of acute/recent DENV infection by both molecular (RT-PCR) and serological methods (IgM) was available in 19/24 (79.2%) participating laboratories. DISCUSSION: Accurate laboratory testing is a critical component of dengue and chikungunya surveillance and control. This second round of EQA reveals good proficiency in molecular and serological diagnostics of these diseases in the Asia Pacific region. Further comprehensive diagnostic testing, including testing for Zika virus, should comprise future iterations of the EQA.

Introduction: Sepsis has been redefined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. The quick sepsis-related organ failure assessment (qSOFA) is a simple tool developed to prompt clinicians to consider patients at high risk for poor outcome. Studies have compared its utility with National Early Warning Score (NEWS) and the systemic inflammatory response syndrome (SIRS) criteria. These scoring systems may be utilized to prognosticate illness severity among patients with suspected infection and may be relevant in low- and middle-income settings where laboratory data are not readily available. Objective: To determine and compare the accuracy of qSOFA, NEWS, and SIRS criteria in predicting in-hospital mortality in patients suspected to have infection presenting at the emergency department (ED) Methods: This is a prospective cohort study. Patients ≥18 years old with suspected infection admitted to the ED between June 2018 to July 2018 were included in the study. SIRS, NEWS, and qSOFA scores were collected at presentation and patients were followed up until expired or discharged. Results: A final population of 213 were included in the study with a mean age of 47 years (SD 21.2) and 124 (58.2%) females. The most common site of infection was respiratory (33.8%). Twelve patients (5.6%) died in-hospital. Among patients with qSOFA≥2, mortality rate was at 38% vs 3.5% for qSOFA<2. Specificity for mortality was highest for qSOFA (96%). Sensitivity was highest for SIRS (75%). SIRS, qSOFA, and NEWS had no significant difference in predicting in-hospital mortality with an area under the receiver operating curve of 0.659, 0.711, 0.711 respectively. Conclusion SIRS, qSOFA, and NEWS have similar prognostic accuracy to predict mortality but have limited use when applied individually which brings into question the sole utility of qSOFA despite its high specificity. It is reasonable to further validate or develop new scoring systems with higher predictive accuracy appropriate across different populations.
Sepsis ; News

BACKGROUND

Seborrheic keratosis is a common benign skin tumor treated with invasive methods like electrodessication, cryotherapy, or surgery. Topical therapy with trichloroacetic acid (TCA) may be a cheaper, non-invasive alternative with less complications. While TCA has been studied for other skin conditions, more research is needed on its use for seborrheic keratosis.

To compare the safety and efficacy of one time application of 80% TCA peel to 65% TCA peel in the clearance of raised seborrheic keratosis in Filipino patients.

One hundred one patients were randomized to either 80% or 65% TCA groups. Each participant underwent one session of treatment and was followed up after a month. Pre- and post-test size and thickness of lesions were compared between groups.

Based on Physician’s Lesion Assessment (PLA), both concentrations of TCA achieved high treatment success (TCA80: 66.7%, TCA65: 68%, p-value 0.89). A similar trend was observed based on Subject’s Self-Assessment (TCA80: 74%, TCA65: 74.5%, p-value 0.95). Similar reductions in lesion size and thickness were observed in both concentrations. In terms of safety, pain, pruritus, and erythema were mostly observed during and immediately after treatment, with little to no adverse events observed after 1 month in both groups.

One time application of either 80% or 65% TCA is effective in decreasing the size and thickness of seborrheic keratosis with little to no complications 1 month post- treatment. Both concentrations were safe, causing minimal and non-persistent pain, pruritus, and erythema immediately after application.

Anemia, Aplastic ; therapy ; Bone Marrow Transplantation ; statistics & numerical data ; China ; Cooperative Behavior ; Family ; Hematopoietic Stem Cell Transplantation ; statistics & numerical data ; Hemoglobinopathies ; therapy ; Hong Kong ; Humans ; Immunologic Deficiency Syndromes ; therapy ; Leukemia ; therapy ; Lymphoma ; therapy ; Malaysia ; Myelodysplastic Syndromes ; therapy ; Peripheral Blood Stem Cell Transplantation ; statistics & numerical data ; Philippines ; Singapore ; Thailand ; Tissue Donors ; statistics & numerical data ; Transplantation, Autologous ; statistics & numerical data ; Transplantation, Homologous ; statistics & numerical data