BACKGROUND AND OBJECTIVE

The COVID-19 pandemic has adversely affected various healthcare services worldwide, including tuberculosis (TB) control programs. This paper examines the impact of the COVID-19 pandemic on TB case notification rate (CNR) and treatment success rate (TSR), and the challenges and interventions in TB-DOTS (directly observed treatment short-course) services in the Province of South Cotabato, SOCCSKSARGEN Region, Philippines. 

An explanatory sequential mixed methods design was used to describe the experiences of South Cotabato in implementing TB-DOTS services during COVID-19 pandemic. Monthly data on CNR and TSR under TB-DOTS from March 2019 to February 2022 were retrieved from the Department of Health’s Integrated Tuberculosis Information System (ITIS) through records review. One-way analysis of variance (ANOVA) and Tukey’s test were used to analyze quantitative data. Focus group discussions (FGD) were conducted among four groups of program implementers (NTP coordinators, nurses, medical technologists, and barangay health workers) encompassing the challenges encountered in the implementation of TB-DOTS services as well as interventions done before and during the COVID-19 pandemic.

During the pre-COVID-19 period (March 2019-February 2020), a CNR of 334 per 100,000 population was reported in the province. There is a 35.19% decrease in TB CNR during COVID-19 Year 1 (March 2020-February 2021) at 216 per 100,000 population, followed by a 37.63% increase in Year 2 at 298 per 100,000 population. The mean TSR covering the pre-COVID period was 96% (SD = 0.01) while the mean TSR in COVID-19 Year 1 was 93% (SD = 0.02), significantly lower than that of the pre-pandemic period, followed by monthly TSR ranging from 91% to 98% (SD = 0.02), an increase in Year 2. From the FGDs, six pre-existing barriers were identified such as patients’ f inancial constraints, hard-to-reach areas, poor health seeking behavior, persistence of TB stigma, medicine and supply shortages, and inadequate health workforce were experienced before and during the COVID-19 pandemic. On the other hand, six emerging challenges brought by the COVID-19 pandemic were reallocation of services, movement restriction, additional protocols, reporting delays, and fears among patients and health workers. The decrease in CNR and TSR during COVID-19 Year 1 aligned with the emergence of new challenges in TB-DOTS services brought by the pandemic. These aggravated pre-existing barriers which further caused delays in the diagnosis and treatment of TB patients. Nine interventions done to address these challenges were also described, the most critical being health education, strengthening community-based services, use of telecommunications, resource pooling for essential medicines, adjusting medication dispensing, and coordination with local government units and policy enhancements.

TB-DOTS services in South Cotabato experienced various difficulties during the COVID-19 pandemic which led to initial declines in CNR and TSR. Addressing barriers and challenges were vital in ensuring the continuity of TB services and mitigating the impact of COVID-19 crisis on CNR and TSR. This study demonstrates the adaptability and resilience of South Cotabato's TB-DOTS services in response to COVID-19 challenges and highlights the need for strategies ensuring continuity of TB services and healthcare system resilience in light of Universal Health Care. Recommendations are outlined to improve current policies and practices as well as lay future directions for research on health service delivery and program implementation in relation to pandemics and other types of disasters.

Background/Aims: Chronic constipation is prevalent yet under-diagnosed across Asia, compromising quality of life and burdening healthcare systems. Cultural stigma, varied diets, and limited access to standardized diagnostic tools delay timely care. Methods: The Bali Chronic Constipation Roundtable in November 2024, brought together experts from 11 Asian countries. The group reviewed epidemiological data, analyzed multinational questionnaire on clinical practice pattern, and conducted structured discussions to identify key barriers and propose region-specific recommendations. Results: Chronic constipation prevalence varies across Asia, ranging from 1.8% in India to 16.6% in Japan, with women and the elderly disproportionately affected. Under-reporting persists owing to cultural taboos and widespread self treatment with laxatives and traditional medications. Although the Rome IV criteria remains the global standard, they may not fully reflect Asian symptom profiles, and diagnosis is limited by scarce motility laboratories. First line therapies such as dietary-fiber optimization and osmotic laxatives are widely available, but newer pharmacotherapies (prucalopride, linaclotide, lubiprostone, and elobixibat) remain costly and unevenly accessible. Biofeedback for dyssynergic defecation is underutilized due to limited availability. Experts recommend expanded regional research on to refine diagnostic criteria, coupled with enhanced physician education and public awareness. They advocate accessibility to second-line and novel therapies that incorporate culturally attuned regional guidelines, and improved access to gastrointestinal motility testing. Conclusions The Bali Chronic Constipation Roundtable highlighted Asia’s need for region specific diagnostics and management. Addressing diagnostic and treatment gaps will improve outcomes, while ongoing researcher clinician policy collaboration must standardize guidelines, advance research, and ensure equitable care across Asia.

Conventional size-based criteria have limitations in accurately assessing neoadjuvant therapy (NAT) response in soft tissue sarcomas (STS). This systematic review evaluated the association between dynamic contrast-enhanced MRI (DCE-MRI) parameters and histopathology-based response to NAT in STS and summarized which DCE-MRI parameters show the most consistent associations across diverse clinical contexts. Following Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines, a comprehensive search was conducted to identify studies evaluating treatment response to NAT in STS using DCE-MRI. Thirteen studies comprising 234 patients were included. Quantitative DCE-MRI parameters, particularly Ktrans , showed a strong predictive performance for treatment response and demonstrated high discriminatory ability in several cohorts during both early and late post-treatment phases. Related measures such as ΔKtrans , Kep, and Ve also correlated significantly with histopathologic necrosis. Semi-quantitative markers, including the integrated area under the curve in the first 60 seconds after injection (iAUC60), wash-in rate, and time-to-peak, showed consistent associations with tumor perfusion and hypoxia. Qualitative features, including time–intensity curve patterns, effectively differentiated responders from non-responders, with type II curves most strongly associated with favorable outcomes. In conclusion, DCE-MRI, particularly quantitative pharmacokinetic parameters such as Ktrans , shows promise for assessing treatment response in STS and demonstrates generally concordant associations with histopathology-based response. However, protocol and endpoint heterogeneity and small cohort sizes limit the ability to establish definitive cutoffs and reduce generalizability, highlighting the need for standardized prospective validation.

Background: Dry medical thoracoscopy (MT) allows access into the pleural cavity in the absence of effusion; but its role, safety, and techniques remain poorly defined. This scoping review summarises current evidence on indications, procedural approaches, diagnostic yield, and safety of dry MT; and highlights gaps to guide future research. Methods: We conducted a scoping review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed and Google Scholar databases were systematically searched for original studies reporting on dry MT involving pneumothorax induction. Study selection and data extraction followed the Joanna Briggs Institute methodology. Results: Thirteen studies involving 357 patients were included. 146 cases (40.9%) were completely ‘dry’ (complete absence of pleural fluid). Techniques for pneumothorax induction varied, including blunt dissection, Veress needle, Boutin needle, bladeless trocar, Saugman cannula and guidewire-assisted catheter insertion. Procedural success ranged from 80.6% to 100%, though definitions were inconsistently reported. Thoracic ultrasound was frequently used for site selection and needle guidance, but standardised criteria were lacking. Malignancy and chronic pleurisy were common histological findings. Complications occurred in 5.9% of cases, most commonly chest pain. No studies reported long-term follow-up. Conclusion Dry MT appears technically feasible and generally safe. Heterogeneity in techniques, outcome definitions, and limited follow-up constrain further interpretation. Future studies should aim to standardise procedural definitions, evaluate predictors of success, and compare pneumothorax induction methods. Prospective research with long-term outcomes is needed to definite the role of dry MT more clearly.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic had direct effects on population health through infection and morbidity, as well as indirect effects on population mental health. We estimated the network structure of post-traumatic stress symptoms (PTSS) and depressive symptoms throughout the pandemic in Korea and aimed to identify the most central and bridging symptoms. METHODS: Participants aged 30–64 years completed mental health surveys across 3 phases of the COVID-19 pandemic: March 2020 (n=1,925), February–March 2021 (n=1,754), and December 2021–January 2022 (n=1,595). Using PTSS and depressive symptom data, we conducted network analyses, and the primary measures of symptom importance (centrality) were expected influence and bridge expected influence. RESULTS: In the comorbidity network, although the most central symptoms fluctuated over the course of the pandemic, sleep problems were consistently identified as the most influential bridge symptoms throughout. The symptom network structure differed between the subacute and chronic phases of the pandemic. CONCLUSIONS We found evidence of changes in the network structure of PTSS and depressive symptoms, even as sleep problems retained a consistent role as a bridging symptom. Although overall network structures varied across phases of the pandemic, the bridging role of sleep-related symptoms remained consistently strong, suggesting that sleep problems may represent a general and enduring mechanism underlying PTSS–depression comorbidity. During future pandemics, prompt screening for sleep problems may help prevent the development of comorbidity between PTSS and depressive symptoms.

OBJECTIVES

This study aimed to determine the motivating and hindering factors affecting the Infant and Young Child Feeding (IYCF) practices of Muslim mothers in select municipalities of Maguindanao.

A pretested questionnaire was administered through face-to-face interviews conducted among 320 randomly selected Muslim mothers with a child aged 6-23 months.

Results revealed that prelacteal feeding was practiced by 16.6% of the Muslim mothers, giving mostly plain water. Solid/semi-solid foods were introduced at a mean age of 6.1 ± 1.4 months, with home-cooked lugao (porridge) (55.0%) and commercial baby food (31.3%) as the top foods introduced. The majority of Muslim mothers (82.5%) fed processed foods as complementary food to their children, including instant noodles (85.2%) and canned goods (51.5%). These processed foods were mostly obtained from sari-sari stores, with TV as the top source of information. More than 80% of the Muslim mothers cited food availability, economic reasons, and convenience in food preparation as the top three motivating factors in the practice of complementary feeding (CF). In addition, almost all the Muslim mothers (~97%) mentioned seeing their children grow healthy as the top reason for improving their food preparation practices, followed by positive feedback from their families. Meanwhile, household duties, low milk output, and a new pregnancy make it difficult to continue breastfeeding, while high complementary food costs, a limited budget, and a lack of food make it difficult to provide complementary food. The preparation of food for infants and young children is hindered by an increased workload and a lack of understanding.

The results revealed suboptimal practices in prelacteal feeding and the reliance on processed foods among Muslim mothers, with economic factors, availability, and convenience as motivating factors in complementary feeding practices. Challenges such as household duties, low milk output, and financial constraints hinder breastfeeding and nutritious food provision for infants and young children. The study reinforced the necessity for holistic strategies in IYCF promotion among Muslim mothers.

Purpose: The optimal reconstruction method following distal gastrectomy has not been elucidated. Since Billroth-II (B-II) reconstruction is commonly associated with increased bile reflux, Braun jejunojejunostomy has been proposed to reduce this complication. Materials and Methods: We retrospectively analyzed 325 patients with gastric cancer who underwent distal gastrectomy with B-II reconstruction between January 2015 and December 2017, comprising 159 patients without Braun anastomosis and 166 with Braun anastomosis.Outcomes were assessed over three years using annual gastroscopy based on the residual food, gastritis, and bile reflux criteria and the Los Angeles classification for reflux esophagitis. Results: In the first postoperative year, the group with Braun anastomosis showed a significant reduction in bile reflux compared to the group without Braun anastomosis (75.9% vs. 86.2%; P=0.019). Moreover, multivariate analysis identified Braun anastomosis as the sole factor associated with this outcome. Additionally, the group with Braun anastomosis had a lower incidence of heartburn (12.0% vs. 20.1%; P=0.047) and reduced use of prokinetics (P<0.001) and acid reducers (P=0.002) compared to the group without Braun anastomosis.However, these benefits diminished in subsequent years, with no significant differences in residual food, gastritis, or reflux esophagitis between the groups. Both groups showed similar body mass index scores and nutritional outcomes over the 3-year follow-up period. Conclusions Although Braun anastomosis offers short-term benefits in reducing bile reflux after B-II reconstruction, these effects are not sustainable. The routine use of Braun anastomosis should be reconsidered, though either approach remains a viable option depending on the patient’s circumstances.

Purpose: The optimal reconstruction method following distal gastrectomy has not been elucidated. Since Billroth-II (B-II) reconstruction is commonly associated with increased bile reflux, Braun jejunojejunostomy has been proposed to reduce this complication. Materials and Methods: We retrospectively analyzed 325 patients with gastric cancer who underwent distal gastrectomy with B-II reconstruction between January 2015 and December 2017, comprising 159 patients without Braun anastomosis and 166 with Braun anastomosis.Outcomes were assessed over three years using annual gastroscopy based on the residual food, gastritis, and bile reflux criteria and the Los Angeles classification for reflux esophagitis. Results: In the first postoperative year, the group with Braun anastomosis showed a significant reduction in bile reflux compared to the group without Braun anastomosis (75.9% vs. 86.2%; P=0.019). Moreover, multivariate analysis identified Braun anastomosis as the sole factor associated with this outcome. Additionally, the group with Braun anastomosis had a lower incidence of heartburn (12.0% vs. 20.1%; P=0.047) and reduced use of prokinetics (P<0.001) and acid reducers (P=0.002) compared to the group without Braun anastomosis.However, these benefits diminished in subsequent years, with no significant differences in residual food, gastritis, or reflux esophagitis between the groups. Both groups showed similar body mass index scores and nutritional outcomes over the 3-year follow-up period. Conclusions Although Braun anastomosis offers short-term benefits in reducing bile reflux after B-II reconstruction, these effects are not sustainable. The routine use of Braun anastomosis should be reconsidered, though either approach remains a viable option depending on the patient’s circumstances.