Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE.

This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion.

Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

Human ; Male ; Child Preschool: 2-5 Yrs Old ; Endoscopy ; Propofol ; Dexmedetomidine ; Sleep Apnea, Obstructive ; Anesthetics ; Apnea ; Consensus ; Paper ; Patients ; Pharmaceutical Preparations ; Research Report ; Sleep ; Sleep Apnea Syndromes ; World Health Organization

INTRODUCTION

Acute coronary syndrome (ACS) and end-stage renal disease (ESRD) are both prevalent globally. The diagnosis and management of ACS in ESRD is difficult because the interplay of cardiovascular and renal disease is complicated. The guidelines for ACS may not be applicable to the ESRD population because the trials from which these are drawn mostly excluded ESRD patients.

OBJECTIVE

To determine the clinical profile and outcomes of CKD patients on dialysis admitted for ACS in the Philippine General Hospital (PGH).

METHODS

We did a retrospective cohort study and employed a retrospective review of electronic medical records among ESRD patients presenting with ACS in PGH from May 2021 to November 2023. The collected data was analyzed using univariate and bivariate statistics using PRISM software.

RESULTS

A total of 48 patients with ESRD were admitted for ACS in this study – 8 with STEMI and 40 with NSTEMI. The mean age was 61 years old and 33 (68.8%) were male. Among those with STEMI, six (75%) presented with Kilip II or more. While among those with NSTEMI, 17 (42.5%) had a GRACE score >140 and 27 (67.5%) had an NSTEMI TIMI risk score >2. On average, the patients were on hemodialysis for 31 months prior to admission. The most common comorbidities were hypertension (91.7%) and heart failure (83.3%). On admission, 18 (37.5%) presented with SBP >160, 7 (14.6%) patients presented with shock, and 4 (8.3%) patients presented with cardiac arrest. 38 (79.2%) patients had anemia on admission. 21 (43.8%) patients had left ventricular hypertrophy on electrocardiogram while 34 (70.8%) patients had cardiomegaly on chest radiography. The average left ventricular ejection fraction on echocardiogram was 46% and 27 (90%) patients had segmental wall motion abnormalities. The most common angiographic finding was 3-vessel coronary artery disease seen in 50% of patients. Almost all patients received dualantiplatelet therapy, high dose statin, and beta-blocker. The mortality rate was high at 43.8% with cardiovascular causes being the most common cause of death.

CONCLUSION

This study demonstrates the high mortality rate among patients with ESRD presenting with ACS. Our study portrays that patients with ESRD present with higher risk features including abnormalities in vital signs, laboratories, imaging, high prognostications score, and high in-hospital morbidity.

Human ; Kidney Failure, Chronic ; End-stage Renal Disease ; Acute Coronary Syndrome ; Myocardial Infarction

The detection of insecticide resistance is pivotal for characterising the phenotypic resistance of field-collected Aedes aegypti populations, enabling the early identification of resistance trends and safeguarding the efficacy of chemical interventions in vector control programmes. Although the World Health Organization (WHO) adult tube test remains the standard screening method, its reliance on binary classifications of susceptibility and resistance limits the ability to compare the magnitude of resistance among different insecticides. To address this limitation, probit analysis was performed on adult mortality data obtained from a field-collected strain exposed to WHO-recommended discriminating and intensity concentrations. LC50 values were subsequently normalised using a concentration ratio (CR) framework, allowing resistance levels to be quantified and compared across insecticides. The relationship between the CR and slope parameters derived from probit analysis enabled the inference of resistance magnitude within field populations. The results demonstrated that pirimiphos-methyl retained high efficacy against the tested populations, whereas substantial intra-population variation in resistance intensity was observed among pyrethroids and malathion. Lambda-cyhalothrin exhibited the highest level of resistance, followed by permethrin and alpha-cypermethrin. These findings highlight the value of data-driven approaches for enhancing the interpretation of insecticide resistance profiles and providing a more comprehensive assessment of resistance status. By utilising mortality data generated from WHO-recommended discriminating and intensity bioassays, resistance can be evaluated beyond the binary outcomes of standard susceptibility tests, thereby supporting more informed decisions on insecticide rotation and resistance management in vector control programmes.

Leptospirosis remains a major public health concern in tropical regions, including Malaysia, where it is endemic. To date, evidence from remote and understudied areas remains limited. This study aims to assess the epidemiological evidence of leptospirosis among market traders in Sabah, addressing the limited available data for this potentially high-risk occupational group in this region. A cross-sectional study was conducted among 295 market traders in Kudat Town, Sabah. Sociodemographic, occupational, environmental and behavioural data were collected using a modified validated questionnaire. Venous blood samples were collected to test for Leptospira antibodies using the Microscopic Agglutination Test; a titre of 1:50 or higher was considered seropositive. Seroprevalence was estimated descriptively, while factors associated with leptospiral seropositivity were examined using univariable and multivariable logistic regression analyses. The seroprevalence of leptospirosis among market traders was 5.4% (95% CI: 3.1–8.7). Antibodies were detected against 11 Leptospira serovars/strains, mainly Lep175. In univariable analysis, predictors for seropositivity included trading frequency, rodent presence, and proximity to garbage piles. With only 16 cases, the initial multivariable model had a low EPV of 4, suggesting possible overfitting. After reducing the model (EPV = 8), proximity to garbage piles remained strongly associated (AOR = 52.61; 95% CI: 13.50–205.13; p < 0.001), while rodents at home also became significant (AOR = 5.70; 95% CI: 1.12–29.08; p = 0.037). This study provides the first empirical evidence of leptospirosis exposure among market traders in Sabah. Although the overall seroprevalence was low, the findings indicate a measurable risk and underscore the need for further large-scale studies and integrated One Health interventions to reduce exposure in this vulnerable population.

BACKGROUND

Undernutrition remains a public health concern in the Philippines despite multitude of government efforts using different nutrition specific and sensitive interventions. Hence, the role civil society organizations play is important in augmenting the health and nutrition programs in the country. Community feedback is important as they are the receiving end of these programs.

OBJECTIVE

The study aimed to know the perceived impact and community insights on the implemented health and nutrition programs in the four selected sites in the Philippines.

METHODS

Qualitative program evaluation was used, and 50 discussants were recruited through purposive sampling. Semi-structured interview guide for focus group discussion was utilized to determine the perceived impact of the programs among the discussants, and thematic analysis was used to generate codes and themes.

RESULTS

The implemented health and nutrition programs were found to be a source of hope for the family and community and beyond basic necessities. However, there remain barriers in successful acquisition of new information such as a lack of resources and environmental influences. There are also learned opportunities such as continued support from the Civil Society Organization (CSO), and impact capacity building that are not sponsor-driven.

CONCLUSION

Overall, the participants see the health and nutrition programs as helpful for their children as these programs foster proper child rearing. The programs also empower the parents and the community through capacity building. However, there is a need to revisit implementing rules and guidelines to further maximize the benefits and resources of the programs.

Program Evaluation ; Public Health ; Play And Playthings ; Residence Characteristics ; Evaluation Studies As Topic ; Malnutrition ; Nutritional Status

BACKGROUND AND OBJECTIVE

Self-assessment and metacognition can be practiced with an exam wrapper (EW). EW is a structured, metacognitive, and self-regulated learning strategy that involves guided self-reflection on an exam already taken to improve study habits. This research describes how internal medicine (IM) residents at two tertiary private hospitals performed in written examinations using an EW. The relationship between the residents' metacognition, the exam wrapper, and exam performance was also determined.

METHODS

This study employed a pre-experimental pre- and post-test design. The EW was constructed and tested for validity and reliability. It included (1) a description of study habits, (2) accuracy in self-efficacy perception and exam score prediction, (3) perceived reasons for exam mistakes, and (4) future study plans of residents. A complete enumeration of 24 IM residents was conducted. Respondents completed the Metacognitive Awareness Inventory (MAI) at the beginning of the study. The intervention consisted of (1) residents taking Exam 1: Gastroenterology, followed by EW; (2) Exam 2: Endocrinology and EW; then (3) Exam 3: Oncology, EW, and MAI. Scores were compared using a paired t-test or analysis of variance (ANOVA). The relationships between metacognition scores, the EW, and exam performance were determined using the Pearson correlation coefficient. The level of significance was set at p < 0.05.

RESULTS

The final EW comprises 16 items, with overall indices of content validity ratio of 0.72 and item-rated content validity of 0.8. The internal consistency coefficient is 0.65 (Kuder-Richardson 20). Nineteen out of 24 residents (79.17%) completed the study. Mean exam percentage scores were 57.97%, 42%, and 51.16% for Exams 1, 2, and 3, respectively. Exam 2 differed significantly from the other two exams (p = 0 and p = 0.04). EWs for the first two exams were not significantly different and revealed: (1) top study habits included studying right before an exam and skimming the textbook; (2) 68.42% vs. 63.16% accuracy of selfefficacy perception; (3) 26.32% vs. 31.58% accuracy of grade estimation; (4) 31.58% vs. 26.32% accuracy of error analysis; (5) most errors were due to not reading about the topic, and (6) most planned to “read more." Mean MAI scores were 36.79 ± 9.10 (pretest) and 36.05 ± 9.44 (post-test) (p = 0.81). All correlations were not statistically significant.

CONCLUSION

Residents performed poorly during exams, crammed their studies, preferred low-impact learning strategies, and lacked self-reflection skills and metacognition monitoring. Time issues related to reading or studying were common. There is no significant relationship between metacognition score and exam wrapper use or exam performance in IM residency trainees.

Human ; Metacognition ; Self-control ; Self-regulation

Introduction: Obstructive sleep apnoea (OSA) is characterised by recurrent pharyngeal collapses that occur five or more times per hour of sleep or more and reduce or completely block airflow for at least 10 seconds. Obesity predis-poses individuals to and potentiates OSA. Materials and methods: As a pre- and post-training activity measure, 30 obese people between the ages of 25 and 45 were asked to complete the STOP-BANG questionnaire and a 6-minute walk test. After that, they engaged in aerobic activity. Results: The scores for the six-minute walk test and the stop-bang questionnaire were 0.0005 and 0.0003, respectively with a “p” value- ≤0.001 (significant). In our investigation, the effects of aerobic exercise on exercise tolerance and obstructive sleep apnoea were significantly different. Con-clusion: Aerobic exercise is a better intervention for increasing exercise tolerance and obstructive sleep apnoea in obese patients. This intervention may be a significant contributor to cardiorespiratory fitness and can be considered a useful tool for enhancing quality of life.

Abstract Introduction: Type 2 diabetes mellitus (T2DM) is a major global health concern characterized by insulin resistance, hyperglycemia, and chronic inflammation. Interest in natural adjunctive therapies has increased, particularly in mangosteen (Garcinia mangostana), which contains xanthone compounds in the peel with potential antidiabetic properties. Methods: This systematic review followed PRISMA 2020 guidelines. Literature searches were conducted using PubMed, Google Scholar, and ClinicalKey up to December 2022 for studies assessing mangosteen peel extract (MPE) or α-mangostin in diabetic human subjects. Eligible studies included randomized controlled and quasi-experimental trials reporting glycemic or metabolic outcomes. Risk of bias was evaluated using the Cochrane RoB tool. The primary result of this study is to evaluate the effects of mangosteen peel extract supplementation on key glycemic outcomes in patients with T2DM, specifically fasting blood glucose (FBG), HOMA-IR, and HbA1c. Results: A total of two studies (n=2) met the inclusion criteria. A randomized controlled pilot trial reported significant improvement in insulin sensitivity (HOMA-IR −53.2% vs −15.2%; p = 0.004) after 26 weeks of standardized mangosteen extract. A small quasi-experimental study reported a significant reduction in FBG following 7 days of mangosteen peel decoction. Discussion: Limited clinical evidence indicates that mangosteen peel extract may improve insulin sensitivity and lower fasting glucose in T2DM. However, the conclusions are limited by the small number of available studies, the short follow-up duration in one trial, and variability in extract preparation. Conclusion: Mangosteen peel extract demonstrates promising glycemic benefits, including improved insulin sensitivity and reduced fasting glucose. However, the available evidence remains limited by small sample sizes, short follow-up periods, and heterogeneity in extract formulations. Larger randomized controlled trials using standardized preparations are required before clinical recommendations can be made.
Garcinia mangostana ; mangosteen peel extract ; &alpha ; -mangostin ; type 2 diabetes mellitus ; insulin resistance ; oxidative stress