This report describes an approach to recover SARS-CoV-2 RNA from rapid antigen test kit (RTK-antigen) cassettes for whole-genome sequencing (WGS). RNA samples were recovered from 33 RTK-antigen cassettes for WGS, with 18 samples achieving more than 80% genome coverage. This work provides a proof-of-concept that positive RTK-antigen cassettes can be safely transported, stored and subjected to WGS, enabling swift identification of circulating variants.

Purpose: To describe the clinical presentation, ocular complications, treatment, and visual outcomes in a series of 17 patients from New Zealand with neuroretinitis secondary to Bartonella henselae. Methods: Retrospective cross-sectional single-center study from 2001 to 2024. Data was extracted from a clinical database of all patients treated for B. henselae over the past 23 years. Statistical analysis was performed using IBM SPSS Statistics ver. 26.0. Results: Seventeen patients (19 eyes) were included with 11 (65%) being female. The mean age at presentation was 28.3 ± 12.3 years (range, 13–60 years). The mean presenting visual acuity (Early Treatment Diabetic Retinopathy Study testing) was 50 ± 23 (range, 4–90). The mean final visual acuity was 78 ± 12 (range, 45–90). Eleven patients (65%) had cats or kittens at home, with only one (6%) recounting a history of being scratched. Eight patients (47%) demonstrated the characteristic macular star at presentation, with all eventually developing macular star within a mean of 6 days. Four patients (24%) had macular oedema, three (18%) had vasculitis, two (12%) had uveitis, two (12%) had disc granuloma, and one (6%) had multifocal chorioretinitis. Six patients (35%) were treated with rifampicin and doxycycline, one (6%) with rifampicin and azithromycin, two (12%) with doxycycline only, two (12%) with co-trimoxazole monotherapy, and one patient (6%), who was breast-feeding, was treated with erythromycin. Four patients (24%) did not have receive any treatment. Conclusions The characteristic macular star is not always manifest at initial presentation for patients with neuroretinitis secondary to B. henselae, nor is there always a preceding history of cat exposure. Not all patients require treatment to have a good visual outcome, and the immune status of the patient is important.

Purpose: The study aimed to measure the radiation-absorbed dose, effective dose, and associated risks of radiation-induced cancers during chest computed tomography (CT) imaging procedures at Square Hospital, Dhaka, Bangladesh. Methods: A total of 23 patients were examined using a 64-slice CT scanner and thermolumi nescence dosimeters. The dose-length product was recorded and converted into an equivalent effective dose using age-dependent conversion coefficients for multi-slice CT as provided by the European Guidelines. Organ doses were further converted into lifetime attributable risks (LARs) for cancer incidence and mortality based on data from the Biological Effects of Ionizing Radiation VII (BEIR VII) report. Results: The effective dose ranged from 3.1 millisieverts (mSv) to approximately 35.3 mSv. The mean LAR for cancer incidence was 20.6 cases per 100,000 males and 69.3 cases per 100,000 females. The LAR for cancer mortality was 21.5 cases per 100,000 males and 62.0 cases per 100,000 females. Female patients were found to face significantly higher risks than male patients. Conclusions The results highlight a noticeable increase in LAR for both cancer incidence and mortality due to chest CT examinations, particularly for female patients. These findings underscore the importance of carefully evaluating the risks associated with CT imaging procedures.

Microangiopathic hemolytic anemia (MAHA) is a rare subtype of hemolytic anemia characterized by elevated hemolytic markers and red blood cell destruction. Though uncommon, MAHA can occur as a complication of acute pancreatitis because of the associated inflammatory response. Patients with MAHA secondary to pancreatitis show favorable outcomes when treated with plasma exchange.This paper presents the case of a patient diagnosed with acute pancreatitis-induced hemolytic anemia and thrombocytopenia, who was managed successfully with plasma exchange, steroids, and rituximab. Clinicians should maintain a high index of suspicion in patients with acute pancreatitis who present with anemia, thrombocytopenia, and schistocytes on peripheral smears, even in the absence of end-organ injuries and with normal ADAMTS13 activity. The early initiation of plasmapheresis can be lifesaving. The timely introduction of rituximab in cases where plasma exchange and steroids are insufficient, despite the ADAMTS13 activity status, may lead to better outcomes.

Background: In the absence of significant pleural effusion, conventional medical thoracoscopy (MT) is often not feasible due to the risk of lung injury. Dry MT mitigates these risks by inducing artificial pneumothorax through needle insufflation or blunt dissection. Although the Veress needle is commonly used by surgeons to create pneumoperitoneum before laparoscopic surgeries, its application in dry MT has not been widely reported in recent times. Methods: We report on a series of 31 patients who underwent dry MT with artificial pneumothorax induction using Veress needle under thoracic ultrasonography (TUS) guidance. A procedure was considered technically successful if it met all the following criteria: successful pneumothorax induction, allowing smooth insertion of the semi-rigid thoracoscope; absence of immediate significant procedural-related complications; and no delayed complications such as persistent air leaks, defined as leakage lasting more than 5 days necessitating extended chest tube placement. Results: Complete pneumothorax induction was achieved in 25 cases, resulting in an 80.6% technical success rate; however, biopsies were successfully performed in all cases. The most frequent histopathological diagnoses were malignancy (n=9, 29.0%), followed by inflammatory pleuritis (n=8, 25.8%) and tuberculosis (n=8, 25.8%). No procedural complications were reported. Conclusion These results indicate that TUS-guided dry MT utilizing a Veress needle is technically feasible and secure when performed by experienced MT practitioners in TUS.

Objectives: This study aimed to achieve expert consensus on menopause management in the Asia-Pacific region, taking into account patient diversity, the latest evidence, and current treatment options. Methods: A focused literature search was performed to identify clinical practice statements on menopause management. Menopause experts were nominated by members of the Asia-Pacific Menopause Federation (APMF) society. A modified Delphi methodology, involving iterative rounds of anonymous surveys, was employed until consensus was reached for each statement. Consensus was defined as ≥ 70% of experts voting ‘agree’ or ‘strongly agree’ for a given clinical practice statement. Results: A total of 39 participants from 14 different APMF member societies were involved. Eighty-five clinical practice statements reached a consensus. Based on the clinical practice statements, an algorithm was created as a tool to guide clinicians on menopause management. APMF experts agreed that, in addition to vasomotor symptoms, Asian women experiencing somatic or psychological symptoms may also benefit from treatment with menopausal hormone therapy (MHT). MHT should also be considered for the prevention of osteoporosis in asymptomatic peri- and postmenopausal women. Conclusions This APMF consensus statement supersedes the previous one published in 2008. It provides guidance to gynecologists, endocrinologists, family physicians, and other healthcare professionals in delivering optimal care to menopausal women in the ethnically and culturally diverse Asia-Pacific region.

Objectives: The purpose of this study was to develop a valid and reliable instrument for assessing patients’ behavior toward the risk of hypoglycemia through self-assessment. Insufficient education and supervision of type 2 diabetes mellitus (DM) outpatients by healthcare providers is a significant concern, affecting their behavior during the treatment process. Additionally, inappropriate behavior typically increases the risk of hypoglycemia. To mitigate this risk, several studies have recommended evaluating patients’ behavior, necessitating the development of a new instrument. Methods: The study procedures were conducted in 3 stages: instrument development (face and content validity, stage I), construct validity and reliability test (stage II), and criterion validity (stage III). Stage I involved 5 healthcare practitioners, including internal medicine doctors, nurses, dietitians, and pharmacists in hospitals and community health centers. Stage II included 20 respondents using a 1-shot test method. Stage III involved 237 type 2 DM outpatients at Central General Hospital (RSUP) in Jakarta, employing a cross-sectional design and consecutive sampling. Results: The results indicated that the developed instrument was valid and reliable, comprising 9 domains (29 questions). These domains included behavior toward blood glucose monitoring, diet, physical activity, medication, assistance from healthcare providers, hypoglycemia management, self-care, family support, and insulin use. Furthermore, poor behavior was found to increase the risk of hypoglycemia by 2.36 times. Conclusions Based on these results, the developed instrument could be effectively used to evaluate behavior toward hypoglycemia among type 2 DM outpatients, confirming its validity and reliability.

Objective: Osteoarthritis (OA), particularly knee OA, affects 24% of adults and is a significant cause of disability. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used but have many adverse effects. Antioxidant and anti-iflammatory properties of Curcuma longa might decrease pain thus improving joint function. Methods: This systematic review and meta-analysis evaluated randomized controlled trials (RCTs) on Curcuma longa efficacy for knee OA. We reported mean differences (MD) with 95% confidence interval (CI) for continuous outcomes and evaluated Visual Analog Scale (VAS) for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) total score over 4 to 6 weeks for treatment effects. Results: Ten RCTs with 786 patients were included. Curcuma longa significantly improved VAS for pain than placebo (MD:18.25, 95% CI: 7.79 to 28.72, p=0.0006). It was not inferior to NSAIDs in WOMAC total score improvement (MD: –11.99, 95% CI: –39.21 to 15.23, p=0.39). Both dosages (<1,000 and ≥1,000 mg/day) of Curcuma longa demonstrated similar improvement in VAS for pain compared to placebo (MD: 27.02, 95% CI: 1.45 to 52.60, p=0.04; MD: 21.48, 95% CI: 1.78 to 41.18, p=0.03). Conclusion Curcuma longa benefits knee OA pain and function, being more effective than placebo and comparable to NSAIDs.Despite positive results, limitation and heterogeneity of the studies necessitates further research to explore optimal dosages and administration methods of Curcuma longa as therapeutic option for knee OA.

Statins represent the first-line therapy for cholesterol management. However, for patients prone to statin side effects, unable to tolerate higher doses, or requiring additional low-density lipoprotein cholesterol (LDL-C) reduction, ezetimibe alone or in combination with statins is recommended. This meta-analysis aimed to evaluate the safety and efficacy of combining lowor moderate-intensity statins with ezetimibe compared to high-intensity statin monotherapy, yielding reliable evidence to guide clinical decision-making and personalize treatment strategies. PubMed, Embase, and Scopus were systematically searched from inception until May 2023. All randomized controlled trials (RCTs) comparing a high-intensity statin with a low/ moderate-intensity statin with ezetimibe were included. The outcomes of interest comprised changes in concentrations of lipids—LDL-C, high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TGs)—and apolipoprotein (Apo) A1, Apo B, and high-sensitivity C-reactive protein (hs-CRP), along with major adverse cardiovascular events (MACE). All data were analyzed using Review Manager version 5.4. p-values less than 0.05 were considered to indicate statistical significance. Overall, 20 RCTs, with 5,412 participants, were included. A low/moderate-intensity statin combined with ezetimibe yielded a significantly greater reduction in LDL-C levels than high-intensity statin monotherapy (mean difference [MD], −6.59; 95% confidence interval [CI], −10.95, −2.24; p=0.003; I 2 =84%). No significant differences were observed between combination and high-intensity statin monotherapy regarding TC, TG, or HDL-C levels. However, hs-CRP levels were significantly higher with combination therapy (MD, 0.32; 95% CI, 0.01, 0.64; p=0.04; I 2 =0%). Combination therapy involving a low/moderate-intensity statin with ezetimibe was significantly associated with lower LDL-C levels than high-intensity statin monotherapy. No significant differences were observed for TC, TGs, HDL-C, alanine transaminase, or MACE. However, creatine phosphokinase levels significantly increased with monotherapy.