Background: Melioidosis is a potentially fatal disease caused by Burkholderia pseudomallei. Over a century after its discovery, there seems to be a paucity of reported cases in the Philippines relative to other countries where it is found to be endemic. This suggests that the true burden of melioidosis in the country is not well-defined. The rarity of the disease, its protean clinical manifestations, and the lack of pathognomonic features pose a great diagnostic challenge. Furthermore, the proper recognition of the organism is an extreme necessity as it is intrinsically resistant to numerous antibiotics and requires specific long-term treatment. Case: This is a case of a 49-year-old Filipino diagnosed with a metastatic spinal disease from a primary thyroid carcinoma and underwent posterior spinal decompression and stabilization. Revision of instrumentation was done following identification of an implant loosening. During the interim, wound dehiscence and infection developed. The patient was readmitted and underwent debridement of the lumbosacral spine. Wound cultures all yielded growth of Burkholderia pseudomallei. The patient received meropenem and then trimethoprim-sulfamethoxazole with ciprofloxacin during the intensive and eradication phase, respectively. Erythrocyte sedimentation rate and C-reactive protein were monitored and a significant reduction in both values reflected a good therapeutic response. Conclusion This is a rare case of a deep surgical site infection caused by Burkholderia pseudomallei. It is known that melioidosis is a potentially fatal infection but is under-reported in the Philippines. At present, further epidemiological studies along with an increased level of awareness of melioidosis are greatly needed to help define the true burden of illness and optimize patient management following prompt recognition.
Melioidosis ; Philippines ; Burkholderia pseudomallei

OBJECTIVETo examine the Eastern-Western difference in the interpretation of Integrative Medicine Attitude Questionnaire (IMAQ) by assessing the psychometric properties of a revised Chinese medicine (CM)-specific version of IMAQ (CM-IMAQ).

METHODSFactor and Rasch analysis were performed with data collected from a mail survey of 165 Hong Kong Western medical doctors (WMD) randomly sampled from the official registry. The structural validity, unidimensionality, item fit, and differential item functioning (DIF) of the Hong Kong CM-IMAQ were evaluated.

RESULTSConfirmatory factor analysis (CFA) demonstrated that the original IMAQ factor structure was not concordant with our data on Chinese WMD, and subsequent explanatory factor analysis (EFA) validated a new three-factor model for CM-IMAQ: (1) attitude towards "tonification", (2) attitude towards the effectiveness of CM, and (3) attitude towards CM knowledge. The original IMAQ factor on holism and doctor-patient relationship disappeared. Rasch analysis confirmed the unidimensionality of "tonification" and the effectiveness domains, but further refinement of the knowledge domain is needed.

CONCLUSIONSCultural adaptation of the IMAQ has demonstrated differences between Eastern and Western doctors trained in allopathic medicine in their interpretations of holism in healthcare. For Chinese WMD, the emphasis of holistic care is placed on "tonifying" the body rather than on nurturing the mind and spirit. Confucian and Taoist conceptualizations of mental health as well as the persistent stigma towards mental illness within modern Chinese culture may explain why Chinese WMD do not regard mental health promotion as part of routine healthcare.

Aged ; Attitude of Health Personnel ; Emotions ; Factor Analysis, Statistical ; Female ; Holistic Health ; statistics & numerical data ; Hong Kong ; epidemiology ; Humans ; Integrative Medicine ; statistics & numerical data ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Surveys and Questionnaires