Anthelmintic Resistance of Gastrointestinal Strongyles Infecting Sheep in Nziih, West Cameroon

Aims: This study aimed to investigate the levels of efficacy of anthelmintics that were most commonly used in sheep farms in Nziih locality. Study Design: Longitudinal prospective study. Place and Duration of Study: The study was carried out in Nziih locality in August 2019 and September 2020. Methodology: Resistance against Albendazole (12.5 mg/kg) and Ivermectin (0.2 mg/kg) was evaluated using faecal egg count reduction test in naturally occurring gastrointestinal strongyles of sheep in Nziih. A total of 300 young animals were randomly selected from 5 farms in 2019 and in 2020. Faecal samples were collected from each animal on the first day of treatment (D0) and collected again 14 days later (D14). Faecal Egg Counts were performed using the Willis and Mac Master techniques and resistance was declared when faecal egg count reduction (FECR) was less than 95 % and the lower limit of confidence interval (LCI) less than 90%. Pooled faecal samples for each treatment group were set for D0 and D14 to identify resistant strongyles genera by calculating persistent larval rate (PLR). Results: Resistance against Ivermectin was detected while there was none against Albendazole. Moreover, it was declared only in 2 farms out of the 5 selected. From 2019 to 2020, the status of resistance has shifted from suspicion to resistance for ivermectin and from absence of resistance to suspicion to Albendazole. Resistance was recorded in 2 sites: Pastorale1 (FECR= 85 %, LCI= 42.61 %) and Pastorale 3 (FECR=90.5 %, LCI= 72.26 %) in large flock herds and in farms where sheep were dewormed at least 4 times per year. Trichostrongylus were more persistent than Haemonchus and Oesophagostomum/Chabertia with PLR of 21.22 %, 13.71 %, and 7.40 % respectively. Conclusion: Anthelmintics must be used correctly in conjunction with farmer education in Nziih.

Comparison of maternal and neonatal outcomes between COVID-19 positive and negative parturients who delivered in a tertiary hospital: A retrospective cohort study / Philippine Journal of Obstetrics and Gynecology

Introduction@#The coronavirus disease 2019 (COVID-19) is a respiratory disease caused by novel coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2. Its growing number of cases with a very limited number of studies in the country is quite alarming, especially to the vulnerable populations, such as pregnant women.@*Objective@#To determine and compare the maternal and neonatal outcomes of COVID-19 positive versus negative parturient@*Materials and Methodology@#This is a retrospective cohort study of 131 parturient in a tertiary hospital. @*Results@#We analyzed a total of 131 patients, of whom 65 (49.6%) were COVID positive. At the time of testing, more than half were at their early term of pregnancy (64.89%) and at term (14.5%). Based on disease severity, 45 women (69.2%) exhibited mild disease, 39 were asymptomatic and 6 symptomatic, 19 (29.2%) moderate disease, and 1 (1.5%) severe disease. Among those symptomatic, the most common signs and symptoms were cough (33.85%), myalgia (10.77%), and a radiographic finding of localized or multilobar infiltrates (30.76%). Those who had laboratory examinations, the c-reactive protein (CRP) and D-dimer were found to be elevated. Based on maternal outcomes, there was a higher incidence of preterm birth (21.54%, P = 0.048) and longer length of hospital stay (P = 0.005) in the COVID-19-positive group. While the neonatal outcomes were similar in both groups, except for longer hospital stay, and delayed institution of breastfeeding among the COVID-19-positive group. @*Conclusion@#In this study, there was no evidence that the presence of COVID-19 infection during pregnancy causes increased morbidity and mortality in mothers and their neonates. Close surveillance should be done on this population, especially if detected before term, as these patients are predisposed to having preterm labor. Further research is needed to understand the true extent of the risks to improve the management of these special population.

Incidence and trends of ophthalmic cancer in Singapore: Data from Singapore Cancer Registry

INTRODUCTION@#Limited data are available on the incidence of primary ophthalmic cancers worldwide. We describe the incidence and trends of primary ophthalmic cancers in Singapore.@*METHODS@#Data on ophthalmic cancers diagnosed in Singapore from 1996 to 2016 were retrieved from the Singapore Cancer Registry for analysis. All were histologically proven primary ophthalmic cancers. Calculations of incidence and age-specific frequency of ophthalmic malignancy were made.@*RESULTS@#A total of 297 cases were included, with males constituting 59.9%. The race distribution was 78.5% Chinese, 16.5% Malay, 3.7% Indians and 1.3% others. There was an overall increase in ophthalmic malignancies. The mean age of onset was 47.4 years. The most common cancers were retinoblastoma (93.3%) in patients younger than 15 years, and lymphoma (71.3%) in patients aged 15 years and older. There has been an increase in lymphomas from 16.7% in 1968-1995 to 71.3% in 1996-2016 in those aged 15 years and older. The most common types of ophthalmic cancer according to location are lymphoma of the orbit, conjunctiva, cornea and lacrimal gland; retinoblastoma of the retina; and malignant melanoma of the choroid and ciliary body.@*CONCLUSION@#Our study reported the incidence and trends of ophthalmic cancer in the Singapore population and showed an overall increase in ophthalmic malignancies in Singapore from 1996-2016. A substantial increase in lymphomas over the last 2 decades was noted. The data could aid clinicians, epidemiologists and policymakers in implementing strategies to address trends in ophthalmic cancers and spur aetiological research to improve quality of life in patients with such cancers.

Financial assistance for the treatment of schizophrenia in select institutions in the Philippines

@#<p style="text-align: justify;"><strong>Objective:</strong> This paper aims to characterize existing financial assistance available to patients with schizophrenia. Specifically, we described (1) the funding mechanisms for the treatment of patients with schizophrenia; (2) the process for accessing financial assistance; and (3) the experiences of consumers of services of these support mechanisms.</p><p style="text-align: justify;"><strong>Methods:</strong> We employed qualitative techniques using key informant interviews (KII) and focus group discussion (FGD). Key informants were officials from institutions providing or offering financial assistance for patients with any health-related concerns, including schizophrenia. Focus group participants were support group members or caregivers of patients with schizophrenia. Purposive sampling was used to select participants for both providers and consumers of financial assistance or scheme. Topic guides for KII and FGD were used for data collection. Thematic analysis was performed on the qualitative data gathered from the informants and focus group participants.</p><p style="text-align: justify;"><strong>Results:</strong> Securing financial assistance for schizophrenia followed a generally similar process, whether the source is from government offices or civil society organizations, and can be grouped into three main stages: (a) pre-application, (b) application, and (c) post-application. While the process of seeking financial assistance appears to be straightforward, issues were encountered in all of the stages by both providers and recipients alike, namely: (a) Financial assistance as an augmentation to patient resources; (b) Mismatch between demand and service capability; (c) Measures of organizational effectiveness; (d) Health professionals and support groups as "bridges" / "facilitators" to financial assistance providers; (e) Financial and non-financial costs incurred by caregivers in applying for financial assistance; and (f) Recipient-provider relationship as a barrier to the feedback process.</p><p style="text-align: justify;"><strong>Conclusion:</strong> This study provides a glimpse of available financial and other relevant assistance to clients, including clients suffering from schizophrenia. More extensive research covering more organizations, support groups, and caregivers from different parts of the country is recommended.</p>

Transition experience to professional nurse: A phenomenological approach

Purpose@#Transition programs have been adopted by many healthcare institutions to assist the new graduate nurse as they adjust to the work environment. The use of structured residency programs and prolonged orientations are considered best practices to ease the new graduate nurse into their role. This study aims to describe the lived experience of new graduate registered nurses as they enter the workforce.@*Design@#Using a qualitative research design, Van Manen's phenomenological inquiry, study participants were selected using non-probability purposive sampling. Data were collected between December 2018- September 2019 with in-depth interviews using semi-structured questionnaires. The sample (N=7) consisted of participants born between the years 1986-1996, graduated within three years of the study, and practice in the northeastern region of the United States.@*Method@#Amodified Colaizzi approach allowed the researchers to return to the study participants to validate themes.@*Findings@#The experience and perceptions of new graduate registered nurses are unified in two major themes discussed within this article: emotional ambivalence and the need to escape.@*Conclusion@#New graduate nurses continue to feel overwhelmed and need structured guidance during their professional transition training programs. In the absence of strong support by the institution, new graduates leave the bedside.

A study on the knowledge, attitude and behavior regarding mental health of residents in a selected barangay / The Health Sciences Journal

INTRODUCTION@#Stigmatizing attitudes are barriers to treatment of mental health disorders. The burden of stigma has not been established locally. This study aimed to assess the stigma in the community by determining the knowledge, attitudes and behaviors of barangay residents towards mental health and persons with mental health illness.@*METHODS@#A total of 422 participants were included using convenience sampling. Participants were given self-administered questionnaires that consisted of the Mental Health Knowledge Schedule (MAKS), Community Attitudes Towards the Mentally Ill (CAMI), and Reported and Intended Behavior Scale (RIBS) tools. The mean scores and percentages were computed and compared across the sociodemographic data of the respondents.@*RESULTS@#Knowledge levels were relatively high with a mean score of 26.63. Depression, stress, bipolar disorder and drug addiction were recognized as mental illnesses by the majority of the participants. Scores in the stigmatizing ideologies authoritarianism (3.07) and social restrictiveness (2.58) were low, while the positive ideologies benevolence (3.76) and community health ideology (3.85) had higher scores. Participants were reluctant to work with mentally-ill people (3.18) but were willing to be friends with them (3.87).@*CONCLUSION@#This study concludes that the respondents were generally knowledgeable about mental health illness. There was a general acceptance and less stigmatizing attitude, and a willingness to interact with people with mental illness.

Physician Empathy in Public and Private Internal Medicine Residency Training Programs in Pasig City

@#RESEARCH QUESTION: What are the levels of patient-perceived and self-assessed physician empathy among internal medicine (IM) residents in two tertiary hospitals in Pasig City? Is there a significant difference in patient-perceived and selfassessed physician empathy levels between public and private tertiary hospitals? Background: Empathy is important because it has been speculated to have a positive effect on patient outcomes; it is a skill that can be learned and developed. OBJECTIVES: This study obtained quantitative measurements of patient-perceived and self-assessed physician empathy. Empathy levels between public and private tertiary hospitals were compared. GENERAL STUDY DESIGN : This study utilized a quantitative cross-sectional design, with surveys as the strategy for data collection. PARTICIPANTS: 162 out-patient department patients aged 19-75, and 69 IM residents were sampled from one private and one public tertiary hospital. OUTCOME MEASURES: The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and the Jefferson Scale of Physician Empathy (JSE) were used to measure the empathy levels. ANALYSIS: Sample size calculation was done using OpenEpi. An alpha level of 0.05 was used for computing the independent samples t-test. RESULTS: Internal Medicine patients from the private hospital rated the physicians with higher empathy scores (mean=31.23) compared to their public hospital counterparts (mean=29.01), which is statistically significant (p=.0134). Residents from the private hospital also scored a higher self-assessed empathy score (mean=110.46) compared to physicians from the public hospital (mean=102.13), which is also statistically significant (p=.0147). CONCLUSION: This study provided preliminary information on the empathy levels of physicians in the Philippine setting between private and public hospitals, showing that physician empathy levels are consistently higher in the private hospital facility. The results can help hospitals incorporate or improve training in empathy in internal medicine residency programs, as empathy is known to affect patient health outcomes.

The prevalence of spiritual struggle among patients with chronic illness

Background@#During the last 10 years, there is an increase in the number of studies showing positive associations between spirituality and health. Studies cited that many patients would like spiritual issues embedded into their medical care but not many physicians deal with this elusive domain of well-being. Spiritual screening is a first step towards addressing the spiritual needs of patients.@*Objectives@#To determine the prevalence of spiritual struggle in chronically ill patients. @*Data Collection@#This is a descriptive cross-sectional type of study. Using the STATCALC of Epi Info Software for a simple random sampling, we enrolled 80 chronically ill patients from the service wards of the Quirino Memorial Medical Center, aged 19 years old and above, non-pregnant, and claimed to be Christians. Patients’ religious disposition was screened using the Religious Struggle Screening Protocol (RUSH Protocol) resulting to 3 actions: 1) referral to chaplain/spiritual counselor for a visit, 2) referral to chaplain/spiritual counselor for spiritual assessment, or 3) No Action. A patient perception feedback was likewise conducted. @*Results@#Among 80 patients recruited, 100% of the subjects recognized the importance of spirituality in coping with their condition; of which 90% expressed desire to be visited or referred for spiritual support. As to the degree of comfort received from one’s religion or spirituality in their journey with illness, 82% receive complete level of comfort, and almost all of them (96%) wished to be visited by a chaplain. The remaining 18% claimed to receive less comfort than needed, and therefore, have the potential for religious/spiritual struggle -- 80% of which, desired to be referred for spiritual assessment. All patients found it helpful to be asked about their spiritual needs during history-taking, with 95% feeling comfortable with the way the spiritual needs were elicited by the researcher using the RUSH Protocol algorithm. @*Conclusion@#Spiritual issues should be considered as part of the patients’ medical care. The RUSH Protocol may be formally integrated in the history taking as an initial step for spiritual assessment to support vulnerable patients with chronic illness.

Clinical experience of Filipino clinicians on the use of Bedaquiline for treating multidrug-resistant Tuberculosis

@#<p><strong>BACKGROUND:</strong> The Philippines is among countries globally with high multidrug-resistant tuberculosis (MDR-TB) burden. An operations research on Bedaquiline (BDQ), a new drug for MDR-TB, was launched by the Department of Health (DOH) in 2016.</p><p><strong>OBJECTIVES:</strong> This paper aimed to gather the opinions and first-hand experiences of clinicians in the Philippines regarding BDQ.</p><p><strong>METHODS:</strong> A facilitated roundtable discussion among nine clinicians included in the operations research on BDQ in the Philippines was conducted in June 2018. Topics covered included: (a) considerations in the use of BDQ, (b) outcomes of patients given BDQ, and (c) perceptions on effectiveness and safety of BDQ. Recordings and field notes from the discussion were subjected to framework analysis.</p><p><strong>RESULTS AND CONCLUSION:</strong> Participants gave BDQ an overall positive feedback due to the effectiveness, less toxicity, and ease of administration compared to other anti-TB drugs. Issues on BDQ included the novelty of the drug that caused doubts at first use and the limited application of the drug as dictated by the inclusion criteria within the context of the operations research, among others. The significant number of patients lost to follow up and ways to address this challenge were also discussed.</p>

Mapping the global geographic potential of Zika virus spread

The Americas are presently experiencing the most serious known outbreak of Zika virus (ZIKV). Here, we present a novel set of analyses using environmental characteristics, vector mosquito distributions, and socioeconomic risk factors to develop the first map to detail global ZIKV transmission risk in multiple dimensions based on ecological niche models. Our model predictions were tested against independent evaluation data sets, and all models had predictive ability significantly better than random expectations. The study addresses urgent knowledge gaps regarding (1) the potential geographic scope of the current ZIKV epidemic, (2) the global potential for spread of ZIKV, and (3) drivers of ZIKV transmission. Our analysis of potential drivers of ZIKV distributions globally identified areas vulnerable in terms of some drivers, but not for others. The results of these analyses can guide regional education and preparedness efforts, such that medical personnel will be better prepared for diagnosis of potential ZIKV cases as they appear.

Regulatory convergence and harmonization: barriers to effective use and adoption of common standards / La convergencia y la armonización regulatorias: barreras en el uso y la adopción eficaces de normas comunes

ABSTRACT Objective To evaluate 1) the level of use and adoption of eight Technical Documents (TDs) published by the Pan American Network for Drug Regulatory Harmonization (PANDRH) member states and 2) identify the hurdles that can prevent countries from successfully adopting a common standard. Methods An in-depth analysis of the incorporation of PANDRH Technical Document No. 1 (“TDNo1”) recommendations in member states’ national requirements was carried out. Results The results illustrate the role of PANDRH in promoting convergence/harmonization among its members. Conclusions The study results show that the rate of use of TDs varied greatly by product/area and country. Timing, TD content, and product/area, and, more importantly, national capacities, are critical determinants of the level of TD guideline adoption. While PANDRH TDs have proven instrumental for the harmonization/convergence of member states’ national requirements, as shown by the level of convergence across a majority of the national requirements issued for vaccine licensing, several countries had yet to incorporate common standards due, in large part, to weak national regulatory capacities. Therefore, harmonization/convergence initiatives should include the strengthening of national regulatory capacities as part of their core strategy, which will, in turn, allow for the incorporation and deployment of common standards in all participating countries.

RESUMEN Objetivo Evaluar (1) la medida en que se usan y se han adoptado ocho documentos técnicos (DT) publicados por los estados miembros de la Red Panamericana para la Armonización de la Reglamentación Farmacéutica (Red PARF) y (2) definir los obstáculos que pueden impedir que los países adopten una norma común. Métodos Se realizó un análisis minucioso de la incorporación de las recomendaciones contenidas en el Documento Técnico No. 1 (“DTNo1”) de la Red Panamericana para la Armonización de la Reglamentación Farmacéutica en los requisitos nacionales de los estados miembros. Resultados Los resultados ilustran el papel que desempeña la Red Panamericana para la Armonización de la Reglamentación Farmacéutica en la promoción de la convergencia y armonización entre sus miembros. Conclusiones Los resultados del estudio indican que el uso de los DT varía enormemente según el producto o el área y el país. El momento, el contenido del DT, el producto o área y, lo que es más importante, la capacidad nacional son factores determinantes del grado de adopción de las directrices contenidas en los DT. Si bien los DT de la Red Panamericana para la Armonización de la Reglamentación Farmacéutica han sido decisivos en la armonización y convergencia de los requisitos nacionales de los estados miembros, como demuestra el grado de convergencia de la mayor parte de los requisitos nacionales emitidos para la concesión de licencias para vacunas, varios países no habían incorporado normas comunes todavía debido, en gran parte, a una capacidad de reglamentación nacional deficiente. Por lo tanto, las iniciativas en pro de la armonización y convergencia deben comprender el fortalecimiento de la capacidad de reglamentación nacional como parte de su estrategia central, lo cual permitirá, a su vez, que se incorporen y desplieguen normas comunes en todos los países participantes.

Creation and validation of the Singapore birth nomograms for birth weight, length and head circumference based on a 12-year birth cohort

<p><b>INTRODUCTION</b>Both gestation and birth weight have significant impact on mortality and morbidity in newborn infants. Nomograms at birth allow classification of infants into small for gestational age (SGA) and large for gestational age (LGA) categories, for risk stratification and more intensive monitoring. To date, the growth charts for preterm newborn infants in Singapore are based on the Fenton growth charts, which are constructed based on combining data from various Western growth cohorts. Hence, we aim to create Singapore nomograms for birth weight, length and head circumference at birth, which would reflect the norms and challenges faced by local infants.</p><p><b>MATERIALS AND METHODS</b>Growth parameters of all babies born or admitted to our unit from 2001 to 2012 were retrieved. Following exclusion of outliers, nomograms for 3 percentiles of 10th, 50th, and 90th were generated for the gestational age (GA) ranges of 25 to 42 weeks using quantile regression (QR) combined with the use of restricted cubic splines. Various polynomial models (second to third degrees) were investigated for suitability of fit. The optimum QR model was found to be a third degree polynomial with a single knotted cubic spline in the mid-point of the GA range, at 33.5 weeks. Check for goodness of fit was done by visual inspection first. Next, check was performed to ensure the correct proportion: 10% of all cases fall above the upper 90th percentile and 10% fall below the lower 10th percentile. Furthermore, an alternative formula-based method of nomogram construction, using mean, standard deviation (SD) and assumption of normality at each gestational age, was used for counterchecking.</p><p><b>RESULTS</b>A total of 13,403 newborns were included in the analysis. The new infant-foetal growth charts with respect to birth weight, heel-crown length and occipitofrontal circumference from 25 to 42 weeks gestations with the 10th, 50th and 90th were presented.</p><p><b>CONCLUSION</b>Nomograms for birth weight, length and head circumference at birth had significant impact on neonatal practice and validation of the Singapore birth nomograms against Fenton growth charts showed better sensitivity and comparable specificity, positive and negative predictive values.</p>

Magnitude, Distribution, and Estimated Level of Underreporting of Acute Gastroenteritis in Jamaica.

Jamaica is the third largest island in the Caribbean. The epidemiology of acute gastroenteritis (AGE) is important to Jamaica, particularly in the areas of health, tourism, and because of the potential impact on the local workforce and the economy. Data collected by the National Surveillance Unit on the prevalence of AGE transmitted by food are not accurate. To determine the true magnitude, risk factors, and the extent of underreporting of AGE in Jamaica, we conducted a cross-sectional, population-based retrospective survey during the periods of 21 February–7 March and 14-27 June 2009, corresponding to high- and low-AGE season respectively. Of the total 1,920 persons selected randomly by a multistage cluster-sampling process, 1,264 responded (response rate 65.8%). Trained interviewers administered a standardized, validated questionnaire during face-to-face interviews. The overall prevalence of self-reported AGE was 4.0% (95% CI 2.9-5.1) at a rate of 0.5 episodes/per person-year. The highest monthly prevalence of AGE (14.6%) was found among the 1-4 year(s) age-group and the lowest (2.1%) among the 25-44 years age-group. Of the 18 cases (36%) who sought medical care, 11% were hospitalized, 33% were treated with antibiotics, and 66.7% received oral rehydration fluids. Only 2 cases who sought medical care reportedly submitted stool specimens. The mean duration of diarrhoea was 3.1 days, which resulted in a mean loss of 4 productive days, with over half of the cases requiring someone to care for them. The burden of syndromic AGE for 2009 was extrapolated to be 122,711 cases, showing an underreporting factor of 58.9. For every laboratory-confirmed AGE case, it was estimated that 383 more cases were occurring in the population. This research confirms that the prevalence of AGE is underreported in Jamaica and not being adequately detected by the current surveillance system. The components of the integrated surveillance system for AGE in Jamaica, particularly the laboratory aspect, need to be strengthened.

Evaluation of a Task-Shifting Strategy Involving Peer Educators in HIV Care and Treatment Clinics in Lusaka; Zambia

Rapid expansion of antiretroviral therapy (ART) and a shortage of health care workers (HCWs) required the implementation of a peer educator (PE) model as part of a task-shifting strategy in Lusaka District clinics. The purpose of this study was to evaluate patient and staff perceptions regarding whether the PE program: a) relieved the workload on professional HCWs; and b) delivered services of acceptable quality. Qualitative and quantitative data were gathered from five primary care clinics delivering ART in Lusaka; Zambia. Closed surveys were conducted with 148 patients receiving ART; 29 PEs; and 53 HCWs. Data was imported into Microsoft Excel to calculate descriptive statistics. Six focus group discussions and eight key informant (KI) interviews were conducted; recorded; transcribed; and coded to extract relevant data. Survey results demonstrated that 50 of 53 (96.1) HCWs agreed PEs reduced the amount of counseling duties required of HCWs. HCWs felt that PEs performed as well as HCWs in counseling patients (48 of 53; 90.6) and that having PEs conduct counseling enabled clinical staff to see more patients (44 of 53; 83). A majority of patients (141 of 148; 95.2) agreed or strongly agreed that PEs were knowledgeable about ART; and 89 of 144 (61.8) expressed a high level of confidence with PEs performing counseling and related tasks. Focus group and KI interviews supported these findings. PEs helped ease the work burden of HCWs and provided effective counseling; education talks; and adherence support to patients in HIV care. Consideration should be given to formalizing their role in the public health sector

Prevalence of Gastrointestinal Pathogens in Sub-Saharan Africa: Systematic Review and Meta-Analysis

A significant proportion of vulnerable people in sub-Saharan Africa (SSA) remain at risk for contracting diarrhoeal diseases due to the presence of many risk factors facilitating their transmission. A systematic review of published articles from the SSA region was done to determine the prevalence and types of diarrhoeal pathogens in circulation; based on a search of databases; including EBSCO host; PubMed; Scopus; Science Direct; Google scholar and Web of Science was done between September 2009 and December 2010. Data were summarized from 27 studies; with pooled data analysed and reported. Pathogens were isolated from between 26.8-65.6of cases; with an overall isolation rate of 55.7(95CI; 48.2-62.9). Isolation rates were highest amongst adult cases followed by children; and the odds of isolating a pathogen was greater in diarrhoeal cases (Odds Ratio 4.93 (95CI; 1.99 to 12.23); than in asymptomatic controls. Overall isolation ranged from 8to 99; and heterogeneity testing suggests differences between age groups (Q=5.806; df=2; P=0. 055). Mixed E. coli spp.; (29.95); Cryptosporidium (21.52); Cyclospora (18); Entamoeba; (13.8); Shigella spp. (10.49); Salmonella spp. (8.36); and Campylobacter spp. (8.33); were most commonly reported; and rotavirus was the most common virus isolated. This is the first review to look at the range of enteric pathogens circulating in SSA; and has confirmed high rates of isolation of pathogens from diarrhoeal cases. Public health practitioners can use this information to understanding the challenges related to diarrhoeal illness and set priorities for their prevention and control

Cystic neoplasms of the pancreas: current diagnostic modalities and management

Cystic neoplasm of the pancreas is a relatively uncommon condition covering a wide spectrum of pathology. The increasing incidence as a result of routine imaging tests in asymptomatic patients presents a diagnostic and therapeutic problem to the clinician. This paper discusses the role of the various investigative modalities in the management of cystic neoplasia of the pancreas.

Obstructive sleep apnoea in Singapore: polysomnography data from a tertiary sleep disorders unit

<p><b>INTRODUCTION</b>Comprehensive sleep architecture and respiratory event data in local patients with suspected obstructive sleep apnoea (OSA) from overnight polysomnography (PSG), the gold standard for the evaluation of sleep-related breathing disorders, are not widely available. We present 1 year retrospective PSG data with the objective of describing PSG characteristics of patients evaluated for OSA in Singapore.</p><p><b>MATERIALS AND METHODS</b>PSG data of patients evaluated for OSA in 1 year (January through December 2005) in the Sleep Laboratory of a public tertiary hospital were retrospectively reviewed.</p><p><b>RESULTS</b>Five hundred and eighty-four diagnostic PSG studies were performed in patients with symptoms suggestive of sleep-disordered breathing, including snoring, excessive daytime sleepiness, unrefreshing sleep, or recurrent unexplained awakenings. There were 449 male patients (76.9%) and 135 female patients (23.1%), with a mean age of 47.5 years (SD 12.7). Men were on average younger than women, 46.1 years versus 52.0 years (P <0.0005). The mean body mass index (BMI) was 27.9 (SD 6.7), with no significant difference between genders. An association was shown between apnoea-hypopnoea index (AHI) and BMI (Pearson correlation index r = 0.362). Men had overall significantly higher AHI (16.5 vs 9), shorter mean sleep onset latency (11 vs 16.5 minutes), more light sleep (65.5% vs 58.9%), less deep sleep (17.7% vs 23%), and more respiratory event related arousals per hour of sleep (11.6 vs 5.1) (P <0.0005). Severity was classified: AHI <5 ("Normal Overall AHI") (28.3%), AHI 5-15 ("Mild") (22.3%), AHI >15-30 ("Moderate") (18.3%), AHI >30 ("Severe") (31.2%). There was no significant age difference among the 4 groups. More severe OSA patients were significantly heavier, and had more light sleep, less deep sleep, less REM sleep, more respiratory event related arousals and lower levels of oxygen desaturation.</p><p><b>CONCLUSION</b>OSA is predominant in middle-aged, overweight Singapore males and much less common in females who tend to be older. A majority of patients have moderate to severe OSA, which significantly disturbs normal sleep architecture. The relatively lower BMI compared to Caucasian OSA populations may be related to local craniofacial characteristics and/or higher percentage of body fat for BMI which has been described in Singaporeans.</p>