Interdisciplinary Approach to Identify and Characterize COVID-19 Misinformation on Twitter: Mixed Methods Study.

BACKGROUND: Studying COVID-19 misinformation on Twitter presents methodological challenges. A computational approach can analyze large data sets, but it is limited when interpreting context. A qualitative approach allows for a deeper analysis of content, but it is labor-intensive and feasible only for smaller data sets. OBJECTIVE: We aimed to identify and characterize tweets containing COVID-19 misinformation. METHODS: Tweets geolocated to the Philippines (January 1 to March 21, 2020) containing the words coronavirus, covid, and ncov were mined using the GetOldTweets3 Python library. This primary corpus (N=12,631) was subjected to biterm topic modeling. Key informant interviews were conducted to elicit examples of COVID-19 misinformation and determine keywords. Using NVivo (QSR International) and a combination of word frequency and text search using key informant interview keywords, subcorpus A (n=5881) was constituted and manually coded to identify misinformation. Constant comparative, iterative, and consensual analyses were used to further characterize these tweets. Tweets containing key informant interview keywords were extracted from the primary corpus and processed to constitute subcorpus B (n=4634), of which 506 tweets were manually labeled as misinformation. This training set was subjected to natural language processing to identify tweets with misinformation in the primary corpus. These tweets were further manually coded to confirm labeling. RESULTS: Biterm topic modeling of the primary corpus revealed the following topics: uncertainty, lawmaker's response, safety measures, testing, loved ones, health standards, panic buying, tragedies other than COVID-19, economy, COVID-19 statistics, precautions, health measures, international issues, adherence to guidelines, and frontliners. These were categorized into 4 major topics: nature of COVID-19, contexts and consequences, people and agents of COVID-19, and COVID-19 prevention and management. Manual coding of subcorpus A identified 398 tweets with misinformation in the following formats: misleading content (n=179), satire and/or parody (n=77), false connection (n=53), conspiracy (n=47), and false context (n=42). The discursive strategies identified were humor (n=109), fear mongering (n=67), anger and disgust (n=59), political commentary (n=59), performing credibility (n=45), overpositivity (n=32), and marketing (n=27). Natural language processing identified 165 tweets with misinformation. However, a manual review showed that 69.7% (115/165) of tweets did not contain misinformation. CONCLUSIONS: An interdisciplinary approach was used to identify tweets with COVID-19 misinformation. Natural language processing mislabeled tweets, likely due to tweets written in Filipino or a combination of the Filipino and English languages. Identifying the formats and discursive strategies of tweets with misinformation required iterative, manual, and emergent coding by human coders with experiential and cultural knowledge of Twitter. An interdisciplinary team composed of experts in health, health informatics, social science, and computer science combined computational and qualitative methods to gain a better understanding of COVID-19 misinformation on Twitter.

Application and impact assessment of an interactive journal club format among endocrinology fellows-in-training in a tertiary hospital academic center: a case study.

Background: The interactive journal club is designed to utilize a new approach in appraising research in order to maximize the benefits of the traditional journal club. In this new approach, the participants are actively involved in a structured process of critical data appraisal rather than just being passive listeners. In this case study, we applied the interactive journal club format and assessed its impact among our endocrinology fellows-in-training. Methods: We conducted four interactive journal club sessions within a four-week span, one per each week via a virtual platform. The 12 participants were the same throughout all sessions. Each session was recorded following informed consent. At the end of all sessions, feedback was obtained, tabulated and compared. Results: Sessions lasted from 59 to 83 minutes (mean, 67.75 minutes). Participants became more active and spontaneous as the sessions progressed. All participants found the format more fun and proactive. This approach allowed more critical thinking and processing of information. Salient features include increased self-esteem and confidence, additional learning from other participants, better retention of information, and utilization in future practice. Conclusions: Traditional approaches are transformed from passive presentations of recent developments in medicine into an interactive discussion while allowing the retention of the spirit and essence of a traditional journal club, as well as exploring new and improved approaches in clinical training and education.

Use of Facebook to Serve Information Needs of Persons with Diabetes in the Philippines amid the COVID-19 Pandemic.

OBJECTIVES: The use of Facebook (FB) to share and gather information on diabetes is commonplace but no data is available on its use among Filipinos during the COVID-19 pandemic. We sought to determine the engagement from instructional slide decks on diabetes and its management shown on two Philippine-based FB pages under the Enhanced Community Quarantine (ECQ). METHODOLOGY: We used Insights data from the slide decks and slide shows shown on the Philippine Society of Endocrinology, Diabetes and Metabolism's (PSEDM) public FB page and the Endocrine Witch's FB page. The slide set contained a mix of mostly images and text on COVID-19 and Diabetes, dietary advice, medications and self-care in the setting of the ECQ where access to insulin, ambulatory clinics and healthy food is limited. Data was summarized in terms of post clicks, reactions, shares and comments. Total engagement rate was computed. RESULTS: We noted a high engagement rate (4-15%) in both public FB pages with higher engagement rates in slides shown in the Filipino language for most topics. The slides that gathered more shares and reactions were primarily those containing general information on COVID-19 and diabetes, nutrition including the safety of canned goods, as well as sick day rules. CONCLUSION: In the setting of the ECQ, the use of image and text-based slide-decks on the PSEDM and Endocrine Witch FB pages to communicate health information yielded high engagement.

A Randomized Controlled Trial on the Effectiveness of Short Message Service (SMS) Reminders in Improving Postpartum Follow-up among Gestational Diabetes Mellitus Patients.

OBJECTIVE: This study assessed whether short message service (SMS) reminders would improve follow-up rate among gestational diabetes mellitus (GDM) patients by 12 weeks postpartum. METHODOLOGY: In this single-center, single-blind randomized controlled trial, we assigned 308 patients with GDM to either of 2 arms, usual care alone versus usual care with SMS reminders. In the usual care group, 154 patients received a 10-minute short lecture on GDM and a 75 g oral glucose tolerance test (OGTT) request prior to discharge. In the SMS group, 154 patients received twice a week SMS reminders at 4 weeks, 8 weeks, and 10 weeks after delivery in addition to usual care. The primary outcome was clinic visit within 6 to 12 weeks postpartum with a 75 g OGTT result. RESULTS: In our population, the overall follow-up rate was 19.8% (61/308). Follow up rates were 20.1% (31/154) for the usual care group and 19.5% (30/154) for the SMS. The addition of SMS reminders was not associated with an increase in follow-up rate at 12 weeks postpartum (adjusted RR 0.98, 95% CI 0.63-1.52; p=0.932). The use of insulin or metformin for GDM control was associated with increased follow-up (adjusted RR 1.92, 95% CI 1.20-3.07; p=0.006). CONCLUSION: SMS reminders did not improve postpartum follow-up rate among GDM patients at 12 weeks postpartum.

Challenges and unmet needs in basal insulin therapy: lessons from the Asian experience.

Basal insulin therapy can improve glycemic control in people with type 2 diabetes. However, timely initiation, optimal titration, and proper adherence to prescribed basal insulin regimens are necessary to achieve optimal glycemic control. Even so, glycemic control may remain suboptimal in a significant proportion of patients. Unique circumstances in Asia (eg, limited resources, management of diabetes primarily in nonspecialist settings, and patient populations that are predominantly less educated) coupled with the limitations of current basal insulin options (eg, risk of hypoglycemia and dosing time inflexibility) amplify the challenge of optimal basal insulin therapy in Asia. Significant progress has been made with long-acting insulin analogs (insulin glargine 100 units/mL and insulin detemir), which provide longer coverage and less risk of hypoglycemia over intermediate-acting insulin (Neutral Protamine Hagedorn insulin). Furthermore, recent clinical evidence suggests that newer long-acting insulin analogs, new insulin glargine 300 units/mL and insulin degludec, may address some of the unmet needs of current basal insulin options in terms of risk of hypoglycemia and dosing time inflexibility. Nevertheless, more can be done to overcome barriers to basal insulin therapy in Asia, through educating both patients and physicians, developing better patient support models, and improving accessibility to long-acting insulin analogs. In this study, we highlight the unique challenges associated with basal insulin therapy in Asia and, where possible, propose strategies to address the unmet needs by drawing on clinical experiences and perspectives in Asia.

Acute mania after levothyroxine replacement for hypothyroid-induced heart block.

Psychiatric disturbances can manifest after levothyroxine (LT4) treatment for severe hypothyroidism. We present the case of a young Filipino man with Hashimoto's thyroiditis and high-grade heart block, who was given a full replacement LT4 dose on admission. Twenty-four hours after this dose, he developed manic symptoms, which were addressed with sedatives and neuroleptics with gradual restoration of euthymia the following day. A comprehensive workup did not reveal any findings suggestive of another aetiology for either mania or heart block. We ultimately ascribed the mania as secondary to LT4, and the heart block to hypothyroidism. Although mania is more likely to be precipitated by high starting LT4 doses, reports have shown that symptoms can still arise even at lower doses and with more gradual titration, especially in long-standing hypothyroidism.

Indicators of Accurate Health Information on the Internet on the Use of Momordica Charantia in Diabetes Mellitus.

OBJECTIVES: The increasing use of the Internet as a source of health information makes the accuracy of such information crucial. An example is the use of the widely advertised bitter melon (Momordica charantia) in treating diabetes despite its unproven efficacy. This study aims to assess the accuracy of websites containing information on bitter melon's role in diabetes, to search for the presence of the proposed quality indicators, and to determine their correlation with accuracy. METHODOLOGY: An Internet search was used to generate a list of websites. The accuracy of each website was determined by comparing its content with that of a tool that was developed from authoritative sources. The presence of the proposed quality indicators, taken from published guidelines, was then correlated with accuracy. RESULTS: Of the 158 websites identified, 10 (6.33%) were characterized as "most accurate" and 21 (13.3%) as "somewhat accurate." The identified indicators of accuracy were the HONcode logo (OR 12.1, p=0.011); the author, identified as a healthcare professional (OR=6.11, p=0.008); and a citation from a peer-reviewed medical literature (OR 2.92, p=0.029). CONCLUSION: These findings suggest that most of the Internet-based information on bitter melon's role in diabetes is inaccurate. The public can use several indicators of accurate information on the use of bitter melon in diabetes to improve health care.

Prevalence of medication errors in admitted patients at the Philippine General Hospital

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Medication errors are preventable events that can cause or lead to inappropriate drug use. Knowing the prevalence and types of errors can help us institute corrective measures and avoid adverse drug events.<br /><strong>OBJECTIVE:</strong> This study determined the prevalence of medication errors and its specific types in the four main service wards of a tertiary government training medical center.<br /><strong>METHODS:</strong> This is a retrospective, descriptive chart review study. From the master list of admissions, systematic sampling was done to retrieve the required number of charts. Relevant pages such as order sheets, nurses' notes, therapeutic sheets were photographed. For prolonged admissions, only the first 7 days were reviewed. Each chart was evaluated by two people who then met and agreed on the errors identified.<br /><strong>RESULTS:</strong> The overall prevalence of medication errors is 97.8%. Pediatrics had the most (63.3/chart), followed by Medicine, OB-Gynecology, and Surgery (7.3/chart). The most common type of errors identified were prescribing, followed by compliance, then administration errors.<br /><strong>CONCLUSION:</strong> Medication errors are present in the four main wards in our hospital. We recommend orientation of all incoming first year residents on proper ordering and prescribing of drugs, as well as a prospective observational study to determine true prevalence of all types of medication errors.</p>

Validation of the Filipino-translated version of the Michigan neuropathy screening instrument among Filipino patients with diabetes mellitus seen at the Philippine General Hospital / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To assess the validity of the Filipino-translated version of the Michigan Neuropathy Screening Instrument(MNSI) in screening for diabetic neuropathy among Filipino patients with diabetes mellitus using nerve conduction velocity(NCV) as gold standard and to determine the most accurate cut-off score for the diagnosis of neuropathy using MNSI.<br /><strong>METHODOLOGY:</strong> A cross-sectional analytic study was done among adult diabetic patients. The original MNSI Questionnaire was translated and back-translated to the Filipino language. Each patient answered the Filipino version of MNSI Questionnaire followed by a lower extremity examination done by the investigator. All patients underwent NCV as reference standard. Sensitivity and specificity of MNSI were determined.<br /><strong>RESULTS:</strong> We studied a total of 150 subjects. Eighty-seven (58%) were diagnosed to have diabetic neuropathy based on NCV. The sensitivity and specificity of the MNSI Questionnaire improved to 73.6% and 52.4% respectively when the cut off was reduced to ?4, whereas for the MNSI Examination, the sensitivity and specificity improved to 86.2% and 55.6% respectively when the cut off was reduced to ?1. Combining both MNSI Questionnaire and MNSI Examination further improves the sensitivity to 95.4% whereas specificity is at 39.7%.<br /><strong>CONCLUSION:</strong> The analyses in 150 subjects confirm that the Filipino-version of MNSI is a valid screening tool for diabetic neuropathy when compared with NCV as gold standard.</p>

Content analysis of tweets of pregnant women with diabetes

OBJECTIVES: Describe health beliefs of pregnant women with diabetes using tweets. Describe how information on diabetes in pregnancy is shared on Twitter. METHODS: Tweets by women with diabetes were identified from Symplur Signals. "Status" tweets were mapped to the Health Belief Model. Tweets by women with preexisting diabetes and gestational diabetes (GD) were analyzed separately. Links within tweets were surveyed for the Health on the Net (HON) Foundation seal. RESULTS: Women with GD tweeted about cravings and the connection of high carbohydrate meals with big babies. Perceived barriers included food restriction, hunger, lab tests, clinic consults and blood glucose monitoring. Perceived benefits of blood glucose testing and a healthy diet were linked to healthy babies. Blood glucose monitoring, weight gain, and age of gestation were cues to action. Perceived barriers of women with preexisting diabetes were feelings of helplessness, loss of control, and anger. Nine domains (9.7%) had the HON Code seal. Women with preexisting diabetes shared blog posts. Women with GD shared links from organizations. CONCLUSION: Women with GD and preexisting diabetes had differing perceptions of susceptibility, severity, barriers, benefits, cues to action, and self-efficacy; and shared links to information differently on Twitter.

Thyroid cancer in Plummer's disease.

Thyroid cancer with concomitant hyperthyroidism is rare. Most foci of malignancy are small and seen postoperatively as incidental findings after surgery for hyperthyroidism. Thyroid masses with clinical features of malignancy and concomitant hyperthyroidism are less-commonly reported. We report two cases of multinodular toxic goitre or Plummer's disease with clinical features of malignancy. Both patients had large multinodular goitres with evidence of metastasis to the manubrium for the first patient and to the lymph node and lungs for the second patient. Both were clinically euthyroid but with free hormone excess and suppressed thyroid stimulating hormone (TSH) on laboratory testing. Both patients received methimazole prior to thyroidectomy. Histopathology revealed follicular variant of papillary cancer with metastasis to the manubrium for the first patient and follicular thyroid cancer with lymph node metastasis for the second. While rare, thyrotoxicosis can occur with malignancy, Plummer's disease may harbour cancer and behave aggressively.

A comparison of the accuracy of clinical decisions based on full-text articles and on journal abstracts alone: a study among residents in a tertiary care hospital.

BACKGROUND: Many clinicians depend solely on journal abstracts to guide clinical decisions. OBJECTIVES: This study aims to determine if there are differences in the accuracy of responses to simulated cases between resident physicians provided with an abstract only and those with full-text articles. It also attempts to describe their information-seeking behaviour. METHODS: Seventy-seven resident physicians from four specialty departments of a tertiary care hospital completed a paper-based questionnaire with clinical simulation cases, then randomly assigned to two intervention groups-access to abstracts-only and access to both abstracts and full-text. While having access to medical literature, they completed an online version of the same questionnaire. FINDINGS: The average improvement across departments was not significantly different between the abstracts-only group and the full-text group (p=0.44), but when accounting for an interaction between intervention and department, the effect was significant (p=0.049) with improvement greater with full-text in the surgery department. Overall, the accuracy of responses was greater after the provision of either abstracts-only or full-text (p<0.0001). Although some residents indicated that 'accumulated knowledge' was sufficient to respond to the patient management questions, in most instances (83% of cases) they still sought medical literature. CONCLUSIONS: Our findings support studies that doctors will use evidence when convenient and current evidence improved clinical decisions. The accuracy of decisions improved after the provision of evidence. Clinical decisions guided by full-text articles were more accurate than those guided by abstracts alone, but the results seem to be driven by a significant difference in one department.

Hyponatremia and cerebral edema associated with radioiodine therapy for papillary thyroid carcinoma / Journal of the ASEAN Federation of Endocrine Societies

Among the serious complications associated with radioiodine therapy (RAI) for thyroid cancer, cerebral edema is uncommon and has been reported previously in cases of swelling of brain metastases. This case is of a patient with papillary thyroid carcinoma who complained of nausea and vomiting after RAI and was then found unconscious the next day. Laboratory results showed electrolyte imbalances including hyponatremia and cranial imaging only revealed cerebral edema, and she regained consciousness after sodium correction. The etiology of the cerebral edema here is likely multifactorial - due to hyponatremia from hypothyroidism, aggravated by vomiting, copious water intake and a low sodium diet.

Sweet's syndrome associated with Hashimoto's thyroiditis.

Sweet's syndrome or acute febrile neutrophilic dermatosis is characterised by the abrupt onset of painful erythematous plaques or nodules, pyrexia (>38°F) and histopathologic evidence of a dense neutrophilic infiltrate without vasculitis. It has been reported in association with many diseases, however, its association with Hashimoto's thyroiditis is rare. A 47-year-old Filipino woman with a 30-year history of an asymptomatic anterior neck mass developed painful, erythematous annular plaques on her arms with associated fever. Skin biopsy confirmed the diagnosis of Sweet's syndrome. The anterior neck mass was confirmed to be Hashimoto's thyroiditis. This is a rare association with only two reported cases in the literature. There are no published cases in the Philippines on Sweet's syndrome and Hashimoto's thyroiditis to date.

Cushing's syndrome in pregnancy.

A 22-year-old G(1)P(0) was admitted at 26 weeks gestation for preeclampsia, hyperglycaemia and cushingoid features. Elevated 24-h urine free cortisol (UFC) and suppressed plasma adrenocorticotrophic hormone (ACTH) suggested ACTH-independent Cushing's syndrome. Ultrasound showed left adrenal mass. She delivered preterm at 28 weeks due to severe preeclampsia and fetal distress. The infant expired after 4 days. Blood pressure was controlled after delivery and the patient was discharged on ketoconazole. Adrenalectomy was planned postpartum; however, she withdrew consent and was lost to follow-up. A 33-year-old G(1)P(1) presented with gestational diabetes. Pregnancy was complicated by premature delivery at 31 weeks for fetal distress. The baby improved and survived. Three months postpartum, she was evaluated for osteoporosis after sustaining a fracture from a fall. Cushingoid facies, elevated 24-h UFC, suppressed ACTH and a right adrenal mass on MRI confirmed an ACTH-independent Cushing's syndrome. She underwent adrenalectomy and improved.

Screening for diabetes mellitus among asymptomatic overseas Filipino workers

BACKGROUND: Diabetes mellitus is becoming prevalent in developing countries like the Philippines. Mass screening is not recommended and is not cost effective. Targeted screening is a more practical way to detect people with disease.Overseas employment is one of the most common occupations in the country. Primary medical examination is done in pre-employment clinics with routine panel of diagnostics, urinalysis included. Fasting blood sugar(FBS) and oral glucose tolerance test (OGTT) are not part of the panel of pre-employment medical examination for overseas Filipino workers (OFW). They are mostly done when they are referred to endocrinology or diabetes clinics when suspicion arises or glucosuria is noted on urinalysis. However, there are patients who consulted endocrinology clinics but deny any symptoms of diabetes.                                                                                                                                                                 OBJECTIVE: The objective of this study is to determine the prevalence of diabetes among OFW by employing FBS and OGTT among those who had urinalysis and referred to endocrinology clinic.RESULTS: Among the 192 OFWs with glucosuria, doing FBS detected 21 percent, 51 percent and 28 percent with diabetes mellitus (DM), impaired fasting glucose (IFG) and normal fasting glucose respectively. By doing OGTT among the OFW with normal FBS, 46 percent were reclassified as diabetic or have impaired glucose tolerance (IGT). OGTT among those with IFG also detected 71 percent with diabetes or IGT. Overall the patients with glucosuria have a DM prevalence that is more than ten times that of the general population done by the National Nutrition and Health Survey in 2003.Among the 149 OFWs without glucosuria, FBS detected 36 percent, 54 percent, and 10 percent with DM, IFG and normal fasting sugar respectively. OGTT among those with normal FBS detected 67 percent of them to have diabetes or prediabetes. Doing the same among those with IFG reclassified 60 percent to have DM or IGT. Similarly the prevalence of DM is about ten times of the national survey.CONCLUSION: Among OFW with or without glucosuria referred for suspicion of diabetes FBS confirmed many to have diabetes and pre-diabetes. This prevalence is doubled by employing OGTT as part of the screening test.