BACKGROUND: Although safe and effective, a wide array of complications of esophageal stent placement continues to pose a significant challenge to clinicians in providing optimal care for their patients. METHODS: To identify factors associated with migration of self-expandable metal stent (SEMS) used in treating malignant and benign disease of esophagus, a retrospective study analyzing 105 cases (85 patients) of esophageal SEMS placement between January 2013 and June 2015 was conducted. All cases were performed in a single tertiary referral center. The key outcomes of interest were SEMS migration rates based on indication, stent type, design, and endoscopic findings prior to SEMS placement. Technical success rate, other major adverse outcomes and subgroup analysis of interest were also performed. RESULTS: Overall esophageal SEMS migration rate was 26.7%. Significantly higher rates of stent migration were associated with fully covered stent use (38.1% vs 9.5%, P = 0.001) and stent use in benign conditions (43.9% vs 15.6%, P = 0.002). Our multivariable analysis also showed statistically significant increased risk of migration for SEMS placement in distal esophagus (P = 0.006). CONCLUSIONS: This study validated some of previously reported predictors of stent migration. In addition, stent use in benign esophageal disease was found to be a significant risk factor of SEMS migration. Large, prospective studies are necessary to further clarify modifiable risk factors to reduce the rate of SEMS migration.
Constriction, Pathologic ; Deglutition Disorders ; Esophageal Diseases ; Esophagus ; Humans ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Stents* ; Tertiary Care Centers

Introduction: Influenza-associated severe acute respiratory infections (SARI) are a major contributor to global morbidity and mortality. In response to a cluster of SARI cases and deaths in pregnant women, with two deceased cases testing positive for influenza A(H1N1)pdm09, an investigation was initiated to determine whether there was an increase of paediatric SARI cases admitted to divisional hospital intensive care units in Fiji in may 2016 compared to May 2013–2015. Methods: Retrospective case finding was conducted at the paediatric intensive care units (PICUs) in Fiji’s three divisional hospitals. Data were collected from 1 January 2013 to 26 May 2016. Cases were identified using a list of clinical diagnoses compatible with SARI. Results: A total of 632 cases of paediatric SARI with complete details were identified. The median age of cases was 6 months (Interquartile range: 2–14 months). Children aged less than 5 years had a higher rate of paediatric SARI requiring admission to a divisional hospital PICU in May 2016 compared to May 2013–2015 (Incidence rate ratio: 1.7 [95% CI: 1.1–2.6]). This increase was not observed in children aged 5–14 years. The case-fatality ratio was not significantly different in 2016 compared to previous years. Conclusion The investigation enabled targeted public health response measures, including enhanced SARI surveillance at divisional hospitals and an emergency influenza vaccination campaign in the Northern Division.

Objective: To investigate the effect of pre-existing Schistosoma haematobium (S. haematobium) infection on malaria disease severity. Methods: The study involved the use of twenty-five imprinting control region mice, fifteen of which were initially infected with S. haematobium. Five of the remaining ten schisto-uninfected mice together with five schisto-infected mice were infected with Plasmodium berghei (P. berghei) after four weeks (acute stage) of schistosoma infection. The remaining five schisto-uninfected mice together with five schisto-infected mice were also infected with P. berghei after seven weeks (chronic stage) of schistosoma infection. The last five schisto-infected mice were used as control group. They were then monitored for changes in P. berghei parasitaemia on Days 3, 5, 7, 9 and 11 post-infection. Records on their survivability were also taken. Results: The co-infected mice had significantly higher malaria parasitaemia, compared with the mono-infected mice during acute S. haematobium infection. In contrast, the coinfected mice had significantly lower malaria parasitaemia during chronic S. haematobium infection and a higher survival rate. Conclusions: Co-infection of mice with P. berghei during acute S. haematobium infection resulted in rapid P. berghei development and increased malaria parasitaemia. However, the co-infection resulted in slower P. berghei development and decreased malaria parasitaemia with enhanced survivability of the mice during chronic S. haematobium infection. Therefore, pre-existing chronic S. haematobium infection may provide some protection to the host by reducing parasitaemia.

Introduction: The COVID-19 pandemic caused a shift to delivering health services through telemedicine. This study recognized the perceptions, experiences, and challenges of physicians who practice synchronous teleconsultation in the Philippines. Methods: A qualitative descriptive research design using purposive sampling, eight physicians from NCR were interviewed. Data collected were subjected to thematic analysis for common themes and integrated into an analytic narrative. Results: Eight physicians were included as participants. Different measures taken to remedy the gap included upskilling of physicians, adjustment of clerical work, ensuring data privacy, and creating a conducive workplace. Remote consultations posed limitations on physical examination and emphasized the reliance on diagnostics. Digital platforms used depended on the physician’s preference, type of practice, and patient’s accessibility. This led to an increased dependency on good internet and network service connections to ensure smooth teleconsultations. A lack of respect for the physician’s personal boundaries and work-life balance was cited as a major challenge. Conclusion Telemedicine proved to be an option to provide healthcare despite its limitations, but the shift to its practice exposed many challenges as it is not a replacement for physical consultations.
COVID-19 ; Telemedicine