RATIONALE AND OBJECTIVES

Individuals with myeloproliferative neoplasia (MPN) have blood cell parameters representing abnormal proliferation of the cell line/lines affected. Considering the implication of symptom burden scores to treatment response and disease progression, with the same implication among changes in blood cell parameters, a question of correlation between the two variables becomes inevitable. This study aims to determine the correlation of controlled blood counts, severity of symptoms and quality of life of individuals with MPN.

This is a cross-sectional analytical study and a sub-study from the Filipino myeloproliferative neoplasia quality of life (MPN-QOL) multicenter study. Secondary data obtained from the parent study will be used as primary data of this sub-study. Comparative analyses were conducted using Chi-Square Test of Homogeneity or Fisher’s Exact Test. Association analysis used Cramer’s V coefficient.

Data in this study has shown 52.65 years old as the average age of participants. Most participants had mild symptom burden at 60.53% with the most common symptom being fatigue. Comparative analysis showed the absence of identified statistical difference in the overall symptom burden severity among the three types of MPN.

In this study, there was no statistically significant correlation between the severity of symptom burden or quality of life, and the degree of blood count control among the three types of MPN. In practice, controlling hematologic parameters has been a goal to achieve among patients with MPN. This study suggests symptom control and quality of life is not necessarily affected by blood count control.

BACKGROUND AND OBJECTIVE

Contraceptives are widely acknowledged for preventing unwanted pregnancies. However, there is a prevalent lack of awareness regarding contraceptives, leading to unaddressed misconceptions. This study aimed to identify common contraceptive misconceptions among men and women of reproductive age and explore how primary health workers address them.

A qualitative study was conducted in two phases within District 5, Manila City. Phase 1 comprised focused group discussions with men and women of reproductive age (n=60), while Phase 2 involved conducting in-depth interviews with primary healthcare providers (n=16). MAXQDA, a qualitative software, to organize and code the data, was utilized.

Women of reproductive age reported several misconceptions about contraceptives, including concerns about adverse health effects, emotional and behavioral changes, perceived ineffectiveness, and cosmetic or bodily changes. For instance, they believed that contraceptives could lead to serious health complications, such as cancer, genital injury, and even death. Primary healthcare providers addressed these misconceptions through open dialogue during service delivery, particularly during prenatal and postpartum check-ups and infant immunizations. They utilized patient education strategies, including the teach-back method, and conducted community outreach and workshops on contraceptives and family planning, especially during Women’s Month.

Several misconceptions were identified among women of reproductive age regarding the proper use and safety of contraceptive methods, as well as misguided beliefs. In contrast, men did not exhibit any misconceptions about contraceptives, which warrants further investigation. Primary healthcare providers have taken a proactive approach to address this issue by offering comprehensive explanations and ensuring clear understanding between healthcare providers and women. Promoting contraceptive health literacy could help bridge the knowledge gap between men and women of reproductive age.

Background: Asthma is a chronic inflammatory disease characterized by bronchoconstriction and breathing difficulties, which can be triggered by both allergic and non-allergic mechanisms. In allergic asthma, a hyperreactivity reaction occurs, leading to an increase in fractional exhaled nitric oxide (FeNO) levels. Therefore, FeNO is used to differentiate allergic and non-allergic types of asthma. In recent years, studies have been conducted to assess FeNO as an indicator of treatment effectiveness and symptom control. Our goal is to introduce FeNO measurement in Mongolia for the first time and utilize it for asthma diagnosis and treatment outcome evaluation. Aim: Study of FeNO levels in Asthma Diagnosis in Relation to Laboratory Findings and Lung Function Materials and Methods: This study included a total of 70 adult patients (18 years and older) with asthma who visited the Outpatient Clinic of Mongolia-Japan Hospital and Shargaljuut Spa Clinic from May to December 2024. Based on their allergic history, total IgE levels, and peripheral blood eosinophil count, participants were classified into allergic (>5%) and non-allergic (<5%) asthma. The study aimed to determine the diagnostic specificity and sensitivity of FeNO levels. Asthma control levels were assessed using the Asthma Control Test (ACT), lung function was evaluated using spirometry, and exercise capacity was measured with the 6-minute walk test. Results: In a single measurement, there were no differences between the allergic and non-allergic groups in parameters other than total IgE, peripheral blood eosinophil count, and FeNO levels. For diagnosing the allergic form of asthma, at a FeNO level of 25 ppb, sensitivity (Se) was 0.68, specificity (Sp) was 0.30 (p=0.008); at 40 ppb, Se was 0.77, Sp was 0.31 (p=0.001); and at 50 ppb, Se was 0.74, Sp was 0.33 (p=0.001). Lung function and exercise capacity were similar in both asthma groups. Conclusion The sensitivity of FeNO in distinguishing between allergic and non-allergic forms of asthma is 67-81%, and its sensitivity tends to increase as the FeNO level rises. By distinguishing the allergic type in which inhaled corticosteroids are more effective, the outcome of asthma treatment can be predicted in advance based on the FeNO level.

Background: Asthma management should be individualized, evidence-based, aimed at controlling clinical symptoms, preventing severe exacerbations, and improving quality of life. Studies have shown that inhalation therapy with iodine- bromide saltwater improves lung function in chronic obstructive pulmonary disease (COPD), while radon-containing mineral water inhalation reduces inflammation and oxidative stress in asthma. Several studies have analyzed the composition of the Shargaljuut hot spring, with Oyuntsesteg et al. identifying high levels of Na+-HCO3 - and Na+-SO4. Other studies on mineral water therapies have reported benefits such as thinning bronchial secretions, improving sputum clearance, reducing inflammation and acidity, mitigating oxidative stress, and enhancing quality of life. Aim: To study the effectiveness of combined asthma treatment with inhaled corticosteroids and hot spring inhalation. Materials and Methods: The study included 67 participants diagnosed with asthma who consented to participate and underwent 10 days of combined inhaled corticosteroid therapy and mineral water inhalation at Shargaljuut sanatorium. A total of 57 participants completed the pre- and post-treatment assessments. Treatment result was assessed using Asthma control questionnaire 7, asthma symptom control with Asthma Control Test (ACT), and exercise tolerance by a 6-minute walk test. Chest X-rays were taken for all participants to rule out pneumonia, cancer, or pulmonary fibrosis. Treatment outcomes were evaluated using ACT scores, peripheral blood eosinophil count, total IgE levels in serum, spirometry indices (FEV1, FVC, FEV1/FVC), and the 6-minute walk distance. Results: The average age of participants was 52±12 years, with a predominance of females. The mean asthma control score was 14.2±4.80, indicating poor asthma control. After 10 days of inhaling corticosteroids combined with hot spring inhalation post-treatment quality of life increased by 0.5 points, FEV1 improved by 7.5%, FVC by 4.2%, peripheral blood eosinophil count decreased by 0.3%, and total Ig E levels dropped from 73.3 (22.5; 216) to 73.2 (21.3; 223) u/ml (p=0.000). Conclusion In cases of uncontrolled asthma remission, combining of inhaled corticosteroid therapy with hot spring inhalation at Shargaljuut improved asthma symptoms, quality of life, enhanced lung function, and reduced inflammatory markers (p<0.001).

Background: According to WHO research, there are approximately 24 million people living with schizophrenia worldwide and schizophrenia is characterized by a combination of psychotic and non-psychotic symptoms. Since the cause of the disease is not fully understood, antipsychotic medications are used as symptomatic treatment. According to the 2022 statistics of the NCMH, 718 people with schizophrenia are being treated under active surveillance in Mongolia. The reason for conducting this study is that the manifestation of drug side effects resulting movement disorders in patients with schizophrenia, which has not been studied in Mongolia. Aim: To investigate the relationship between adherence of medication regimen and abnormal involuntary movements in patients with schizophrenia. Materials and Method: The study was conducted using a descriptive method, cross-sectional design, purposive sampling with the questionnaire and standardized tests. Ethical approval for this study was approved by the NCMH (№3/77 30th of January, 2023) and Research Ethics Review Committee of MNUMS (№2023/3-02). Each participant was asked to complete 5 groups of 36 questionnaires, and standard tests were used to assess patients’ adherence to medication regimens (Morisky scale) and abnormal involuntary movement scale (AIMS). The study was conducted between March and August 2023, and the results were summarized and analyzed using STATA 14 software. Results: The study included 209 patients with schizophrenia, aged 18-79 years, of whom 47.4% (n=99) were male and 52.6% (n=110) were female (p=0.21). Of the participants, 28.2% (n=59) had less than secondary education, 76.5% (n=160) were unmarried, and 85.2% (n=178) had a disability due to mental health. 32.5% (n=68) of the patients with schizophrenia in the study used a combination of typical and atypical medications, and the most commonly used antipsychotic drugs were haloperidol (30.6%), chlorpromazine (26.8%), levomepromazine (25.8%), risperidone (24.4%), and quetiapine (21.1%). 1.4% (n=3) of the patients had good, 52.6% (n=110) had moderate, and 45.9% (n=96) had poor adherence to the medication regimen (Cronbach’s α=0.781). However, according to the results of the test for assessing abnormal involuntary that are performed without self-control, 49.76% (n=104) responded that they felt more sensitive to facial and oral movements, and 44.5% (n=93) to limb movements. The patients’ adherence to the medication regimen was statistically significant with facial and oral movements (n=104; p=0.036) and general body movement disorders (n=94; p=0.05). Conclusion 32.5% of patients with schizophrenia were taking typical and atypical antipsychotics, and 45.9% had poor adherence to medication regimens and were more likely to exhibit clinical forms of abnormal involuntary movements, including facial (p=0.036) and general movement disorders (p=0.05).

BACKGROUND

Myeloproliferative neoplasms (MPN) are a heterogeneous group of disorders characterized by the cellular proliferation of one or more hematologic cell lines. Patients with MPN who are Philadelphia-negative such as those with Polycythemia Vera (PV), Essential Thrombocytosis (ET), or Myelofibrosis (MF) experience a cluster of symptoms related to the disease activity which can affect their quality of life.

This study aimed to explore the symptoms and symptom experience as well as lived experience of Filipino patients with MPN using a qualitative phenomenological approach to get a deeper understanding of the disease symptomatology.

Twenty-three patients with myeloproliferative neoplasms were purposively selected according to: 1) type of MPN (PV, ET, MF) 2) status of MPN disease (newly diagnosed vs. chronic) 3) age (≤50 years old; >50 years) and 4) sex (male vs. female). The investigators conducted key informant interviews using a semi-structured interview guide. Interview scripts and narratives were transcribed and analyzed using categorical aggregation and thematic analysis.

Twenty patients proceeded with the interview (8 PV, 6 ET, 6 MF). The meta-themes identified were 1) symptom experience and 2) disease perception. Three sub-themes under symptom experience were a) heterogenous and complex symptomatology; b) dynamic nature of symptoms; c) living and coping with symptoms. Three sub-themes under disease perception were a) struggle with the concept of the disease; b) anxiety and uncertainty; c) acceptance and hope. The most common symptoms experienced by the patients were fatigue, bone pain, and abdominal discomfort. Vascular symptoms specifically headache, numbness, and problems in concentration were commonly reported by patients with PV. Fever and weight loss were the least common. Sources of anxiety/uncertainty include the unpredictability of symptom occurrence and blood counts, the burden of taking maintenance medications, the financial burden of living with MPN, and the unpredictability of disease and complications.

Patients with MPN had heterogenous, co-occurring, and dynamic symptoms which affected their overall productivity both at home and at work. Patients with MF had the most symptom burden while patients with ET had the least. This study provided valuable insights on disease perceptions, sources of anxiety, and coping mechanisms of patients with MPN. A deeper understanding of the symptom experience and disease perceptions of the patients will enhance the physician-patient interaction especially when discussing management options.

INTRODUCTION

Pure red cell aplasia (PRCA) is defined as anemia in the presence of severe reticulocytopenia and absent or markedly decreased erythroid precursors in the marrow. When associated with another disease entity, it is classified as secondary acquired PRCA. A rare entity, thymolipoma, which constitutes 2% to 9% of thymic tumors has been associated with PRCA in some studies. The prevalence of thymolipoma among patients with myasthenia gravis reaches 43.8%. This paper presents the rare presentation of myasthenia gravis associated with thymolipoma and PRCA.

We present the case of a 64-year-old female who was diagnosed with myasthenia gravis and has been on maintenance pyridostigmine (Mestinon) for 12 years. She presented with symptoms of anemia and became transfusion requiring. Routine chest CT showed a thymic mass which was confirmed to be a thymolipoma during biopsy. Bone marrow studies confirmed the absence of erythroids, hence the diagnosis of secondary acquired PRCA.

There have been case reports associating PRCA with thymolipomas. Thymolipomas, which constitute 2% to 9% of thymic tumors are found among patients with myasthenia gravis, but the majority remains asymptomatic despite increasing tumor size. PRCA with associated thymic mass shows improvement of symptoms with tumor removal and immunosuppression. Oral corticosteroids result in a response rate of 39% while cyclosporine results in 77% response. This can be tapered off once response has been achieved.

This case report emphasizes the importance of early bone marrow studies among patients with myasthenia gravis presenting with sudden onset anemia.