SUMMARY Patients with a clinical diagnosis of tuberculous lymphadenitis (TBLN) undergoing fine needle aspiration (FNA) biopsy at Port Moresby General Hospital (PMGH) were recruited in a pilot study to compare Xpert® MTB/RIF (Xpert) with microscopy and cytology. From a total of 1080 patients attending the FNA clinic during the study period 107 were recruited, of whom 105 were analysed. Xpert detected Mycobacterium tuberculosis in 65/105 subjects (62%), acid-fast bacilli (AFB) were found in 35/105 (33%) and cytology was positive in 59/105 (56%). 3 of 7 samples unsuitable for microscopy and 9 of the 28 cases (32%) initially classified as non-TBLN were Xpert positive. Xpert was comparable to cytology but more sensitive than microscopy. Xpert also detected multidrug-resistant tuberculosis (MDR-TB) TBLN cases. The results demonstrated that FNA samples are suitable for Xpert analysis at PMGH to diagnose TBLN, which has the added advantage of detecting MDR-TB.

Asymptomatic malaria is prevalent in highly endemic areas of Papua New Guinea and is a challenge for malaria prevention and control strategies. We used nested polymerase chain reaction (PCR) to determine the prevalence of asymptomatic malaria and parasite species distribution in a small community on the north coast of Madang, Papua New Guinea. A population household study was conducted in October, 2015. A pretested questionnaire was used to collect demographic data. Giemsa-stained thin and thick blood films were examined for detection, identification and quantification of malaria parasites. Due to wide discrepancies in malaria microscopy results, only molecular analysis data are presented here. The prevalence of asymptomatic malaria was 62.5% (40/64) with mixed multispecies infections accounting for 20% (13/64). The prevalence of malaria parasite carriers observed here in the small community is higher than previously reported for the same region. Asymptomatic malaria remains a challenge for malaria elimination and PCR testing should be considered in areas where malaria transmission is low.

Data on the accuracy of Xpert® MTB/RIF (Xpert) assay in detecting TB in lymph node aspirates in Papua New Guinea (PNG) is scanty. This study evaluated Xpert performance in diagnosing tuberculous lymphadenitis (TBLN) using lymph node needle aspirates at the Port Moresby General Hospital (PMGH). The objective of the study was to compare Xpert accuracy to acid fast bacilli (AFB) microscopy, cytomorphology, a composite reference test (CRS) and culture. A total of 107 eligible subjects were recruited out of 1080 clinic attendees. Results showed Xpert detected significantly more cases of TBLN than AFB microscopy (66 vs 35; p=0.001). Compared to AFB microscopy Xpert had a sensitivity of 45.4% (95% CI 33.1-58.1), specificity of 87.8% (95% CI 73.8-95.9), positive predictive value (PPV) of 85.7% (95% CI 71.6-93.4) and negative predictive value (NPV) of 50.0%% (95% CI 43.8-56.1). There was no difference between Xpert and cytomorphology (66 vs 60; p=0.5). Compared to cytomorphology Xpert had a sensitivity of 71.6% (95% CI 58.5-82.5), specificity of 51.1% (95% CI 35.7-66.3), PPV of 66.1% (95% CI 58.2-73.2) and NPV of 57.5% (95% CI 45.2-68.9). There was no difference between Xpert and CRS (66 vs 71; p=0.6). Compared to CRS Xpert had a sensitivity of 76.0% (95% CI 64.4- 85.3), specificity of 66.6% (95% CI 49.0-81.4), PPV of 81.8% (95% CI 73.5-87.9) and NPV of 58.4% (95% CI 46.7-69.4). Culture was completed on 24 subjects with positive isolates in 14 giving a culture yield of 58.3%. Of the 24 subjects, Xpert was positive in 21 subjects. There was no difference between Xpert and culture (21 vs 14; p=0.8). Compared to culture Xpert had a sensitivity of 100.0% (95% CI 76.8-100.0), specificity of 30.0% (95% CI 6.6-65.2), PPV of 66.6% (95% CI 57.1-75) and NPV of 100.0%. The results suggest Xpert is more sensitive than AFB microscopy but comparable to cytomorphology and CRS for TBLN diagnosis in the PNG context. Xpert can be used for diagnosing TBLN at PMGH

The pattern of antibiotics prescribed to patients with peripheral lymphadenopathy was assessed and compared with existing standard treatment guidelines (STGs) in Papua New Guinea (PNG). Information was obtained from patients referred to the Port Moresby General Hospital for fine needle aspiration biopsy by interviewing patients and reviewing patients’ clinic attendance record books and referral letters. Of the 107 patients recruited for the study, 51 (48%) were prescribed antibiotics and, of these, prescription data were obtained from 40 (78%). Amoxycillin, which is recommended as a first-line antibiotic for peripheral lymphadenopathy in PNG STGs, was prescribed in only 18/40 patients (45%). There was also high variability in other antibiotic selection, antibiotic combinations and treatment duration. The results highlight a need for ongoing training on rational antibiotic prescribing.

Antegrade transmalleolar drilling method is one of the options for the treatment of osteochondral lesion of talus (OLT). We present five patients who underwent tibial drilling for treatment of OLT and later developed distal tibial cystic formation induced by cartilage opening or heat necrosis during drilling. Antegrade transmalleolar drilling can be a possible option for the treatment of OLT if the lesion is not easily reachable; however, other viable treatment should be considered due to its possibility of distal tibial pathologic change.
Adult ; Ankle Joint/surgery ; Cartilage, Articular/*surgery ; Female ; Humans ; *Iatrogenic Disease ; Male ; *Musculoskeletal Diseases/etiology/surgery ; *Orthopedic Procedures/adverse effects/methods ; Talus/*surgery ; *Tibia/injuries/surgery ; Young Adult

Acute Coronary Syndrome ; diagnosis ; Aged ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Humans ; Male ; Pneumothorax ; complications ; diagnosis ; Takotsubo Cardiomyopathy ; diagnosis ; etiology

INTRODUCTION: Salba-chia (Salvia hispanica L.) is a popular functional food containing high levels of protein, total dietary fiber, and is an excellent source of α-linolenic acid. Chia seeds significantly decreases weight, suppresses appetite, and has a potential benefit in the management of Type 2 diabetes mellitus (T2DM). This study aimed to determine the effectiveness of chia seeds as an adjuvant treatment for T2DM. METHODS: Randomized controlled trials from 1990 onwards involving Type 2 diabetic patients given chia seed were included. PubMed, Cochrane, ClinicalKey, Google Scholar, and Hinari were searched systematically using MeSH terms “chia”, “Salvia hispanica”, “dietary supplement”, and “diabetes”. The quality of trials was assessed using the Cochrane Collaboration tool. Data on the study design, blinding status, characteristics of participants, medications taken by participants, chia seed intervention, comparator, duration of intake, and interval of assessment were extracted. The percent change of outcome from baseline was compared between the chia and control groups. RESULTS: Four randomized trials with a total of 213 diabetic patients were enrolled in the treatment group using ground salba-chia or the control group using bran. The supplementation of chia resulted in a statistically significant decrease in fasting glucose (-2.90 mmol/L; 95% CI, -3.08, -2.72; p < 0.001), waist circumference (-2.49 cm; 95% CI -2.81, -2.17; p < 0.001), total cholesterol (-2.72 mmol/L; 95% CI -3.68, -1.74; p < 0.001), HDL (-3.69 mmol/L; 95% CI -3.95, -3.42; p < 0.001), LDL (-3.22 mmol/L; 95% CI -4.08, -2.36; p < 0.001); and an increase adiponectin levels (6.50 mg/L; 95% CI 6.25, 6.25; p < 0.001). CONCLUSION Intake of chia seeds resulted in a statistically significant decrease in fasting blood glucose, waist circumference, total cholesterol levels, HDL and LDL cholesterol levels, and increased adiponectin. Chia seeds are generally safer and have lesser side effects compared to the placebo. Chia is effective as adjunctive treatment for Type 2 diabetic patients.

INTRODUCTION: Psychiatric comorbidity is common in patients with functional dyspepsia (FD) but a good screening tool for psychiatric disorders in gastrointestinal clinical practice is lacking. Aims: 1) Evaluate the performance and optimal cut-off of 12-item General Health Questionnaire (GHQ-12) as a screening tool for psychiatric disorders in FD patients; 2) Compare health-related quality of life (HRQoL) in FD patients with and without psychiatric comorbidities. METHODS: Consecutive patients fulfilling Rome III criteria for FD without medical co-morbidities and gastroesophageal reflux disease were recruited in a gastroenterology clinic. The followings were conducted at 4 weeks after index oesophagogastroduodenoscopy: self-administrated questionnaires on socio-demographics, dyspeptic symptom severity (4-point Likert scale), GHQ-12, and 36-item short-form health survey (SF-36). Psychiatric disorders were diagnosed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) by a trained psychiatrist, which served as reference standard. RESULTS: 55 patients underwent psychiatrist-conducted interview and questionnaire assessment. 27 (49.1%) had current psychiatric disorders as determined by SCID (anxiety disorders: 38.2%, depressive disorders: 16.4%). Receiver operating characteristic curve analysis of GHQ-12 revealed an area under curve of 0.825 (95%CI: 0.698-0.914). Cut-off of GHQ-12 at > or =3 gave a sensitivity of 63.0% (95%CI = 42.4-80.6%) and specificity of 92.9% (95%CI = 76.5%-98.9%). Subjects with co-existing psychiatric disorders scored significantly lower in multiple domains of SF-36 (mental component summary, general health, vitality and mental health). By multivariate linear regression analysis, current psychiatric morbidities (Beta = -0.396, p = 0.002) and family history of psychiatric illness (Beta = -0.299, p = 0.015) were independent risk factors for poorer mental component summary in SF-36, while dyspepsia severity was the only independent risk factor for poorer physical component summary (Beta = -0.332, p = 0.027). CONCLUSIONS: Concomitant psychiatric disorders adversely affect HRQoL in FD patients. The use of GHQ-12 as a reliable screening tool for psychiatric disorders allows early intervention and may improve clinical outcomes of these patients.
Area Under Curve ; Axis, Cervical Vertebra ; Comorbidity ; Diagnostic and Statistical Manual of Mental Disorders ; Dyspepsia ; Early Intervention (Education) ; Gastroenterology ; Gastroesophageal Reflux ; Health Surveys ; Humans ; Linear Models ; Mass Screening ; Mental Disorders ; Psychiatry ; Quality of Life ; Surveys and Questionnaires ; Risk Factors ; ROC Curve ; Rome ; Sensitivity and Specificity

The COVID-19 pandemic created the urgent need to use online and virtual platforms to facilitate development of skills and competencies as part of remote learning of students. MyDispense®, a learning management system developed by Monash University in Australia, is a practice-based online tool utilized by the University of the Philippines College of Pharmacy to teach dispensing skills in Dispensing and Incompatibilities courses (Phar 154 and Pharm 133). This commentary describes how MyDispense® was used as an online retail pharmacy simulation through the SEIPS (Systems Engineering Initiative for Patient Safety) model, with discussion on how the person, tasks, organization, tools and technology, and virtual environment work within the teaching and learning process in dispensing. The application of MyDispense® as a learning platform both in remote and traditional teaching can be further explored to maximize its features and utility.
COVID-19

The COVID-19 pandemic created the urgent need to use online and virtual platforms to facilitate development of skills and competencies as part of remote learning of students. MyDispense®, a learning management system developed by Monash University in Australia, is a practice-based online tool utilized by the University of the Philippines College of Pharmacy to teach dispensing skills in Dispensing and Incompatibilities courses (Phar 154 and Pharm 133). This commentary describes how MyDispense® was used as an online retail pharmacy simulation through the SEIPS (Systems Engineering Initiative for Patient Safety) model, with discussion on how the person, tasks, organization, tools and technology, and virtual environment work within the teaching and learning process in dispensing. The application of MyDispense® as a learning platform both in remote and traditional teaching can be further explored to maximize its features and utility.
Remote learning