Survey of patient perceptions towards short-term mobile medical aid for those living in a medically underserved area of Swaziland.

BACKGROUND: An increasing number of short-term medical missions (STMMs) are being dispatched to provide humanitarian healthcare; however, extensive investigations on how recipient patients perceive STMMs are lacking. The current study evaluated the perceptions of patients toward medical services provided by a Taiwanese STMM in a resource-poor area of Swaziland. METHODS: A structured questionnaire survey was completed by patients who had received medical services from the medical mission of Taipei Medical University in Swaziland in July 2014. RESULTS: In total, 349 questionnaires were valid for the analysis. More respondents were female than male (69.6% vs 30.4%). The most common chief complaint was musculoskeletal problems (45.8%), followed by respiratory symptoms (35.0%). Most of the patients stated that their overall experience with the medical services was excellent (91.4%). Universal patients would like to see the service provided in the future (99.7%). Nearly 90% of the patients were aware of how to take care of the medical problem they were diagnosed with. A majority of the patients comprehended what their medical providers said. Only a few patients did not understand what physicians said (5.2%). CONCLUSION: Medical services provided by the STMM were helpful in resolving patients' problems. The data have crucial implications for evaluating overseas mobile medical aid from the viewpoint of patients.

Strategy to better select HIV-infected individuals for latent TB treatment in BCG-vaccinated population.

OBJECTIVE: To evaluate the T-SPOT.TB interferon-γ releasing assay and the tuberculin skin test (TST), for the diagnosis of latent tuberculosis infection(LTBI) and the development of subsequent active tuberculosis, in BCG-vaccinated HIV-infected individuals. METHODS: HIV-infected individuals without clinical suspicion of active TB or a past history of TB were enrolled from 1 January 2008 to 30 November 2010. Both T-SPOT.TB test and TST were offered to the participants whom were followed up prospectively until April 30, 2012 for development of TB. RESULTS: Among the 909 participants, 25% had positive TST reactions with cut-off point of 5 mm and 15% had positive T-SPOT.TB results. After a median follow-up of 2.97 years, there were 5 cases developed culture-confirmed active TB (all had dual positive TST and T-SPOT.TB results), and the incidence was 0.17 per 100 person-years. The relative risks (RRs) for subsequent active TB in HIV-infected individuals with positive TST results, positive T-SPOT.TB results and dual positive results compared with the risk for individuals with negative results were 40.6 (95% CI 2.1-767.9), 73.9 (95% CI 3.9-1397.7) and 226.5 (95% CI 12.0-4284), respectively. The number needed to treat to prevent one subsequent TB case among patients with a positive TST, a positive T-SPOT.TB and dual positive results was 35, 22 and 8 respectively. CONCLUSIONS: Adopting positive results of the TST and T-SPOT.TB to screen LTBI among BCG-vaccinated HIV-infected individuals might be feasible. Number needed to treat for isoniazid preventive therapy could be reduced significantly by using dual positive strategy.

Hyaluronan regulates PPARγ and inflammatory responses in IL-1ß-stimulated human chondrosarcoma cells, a model for osteoarthritis.

The carbohydrate polymer, hyaluronan, is a major component of the extracellular matrix in animal tissues. Exogenous hyaluronan has been used to treat osteoarthritis (OA), a degenerative joint disease involving inflammatory changes. The underlying mechanisms of hyaluronan in OA are not fully understood. Pro-inflammatory interleukin (IL)-1ß downregulates peroxisome proliferator-activated receptor gamma (PPARγ), and increases expression of matrix metalloproteinases (MMPs) which are responsible for the degeneration of articular cartilage. The effects of low- and high-molecular-weight hyaluronan (oligo-HA and HMW-HA) on the inflammatory genes were determined in human SW-1353 chondrosarcoma cells. HMW-HA antagonized the effects of IL-1ß by increasing PPARγ and decreasing cyclooxygenase (COX)-2, MMP-1, and MMP-13 levels. It promoted Akt, but suppressed mitogen-activated protein kinases (MAPKs) and nuclear factor kappa B (NFκB) signaling, indicating anti-inflammatory effects. In contrast, the cells had overall opposite responses to oligo-HA. In conclusion, HMW-HA and oligo-HA exerted differential inflammatory responses via PPARγ in IL-1ß-treated chondrosarcoma cells.

Pathology associated to the Baker's cysts: a musculoskeletal ultrasound study.

The purpose of this study was to know the pathology associated with Baker's cyst (BC) in a rheumatology clinic and to evaluate the incidence, characteristics, and complications of BC. We reviewed the rheumatology ultrasound laboratory charts of patients with BC from Oct 2006 through Dec 2008. Demographic and disease data were also collected. Of the 1,120 patients who underwent ultrasound studies, 145 (12.9%) were found to have 180 BCs. The associated diseases were as follows: 91 (50.6%) osteoarthritis (OA) of the knee, 37 (20.6%) rheumatoid arthritis (RA), 25 (13.9%) gout, 14 (7.8%) seronegative spondyloarthropathy (SpA), and 13 (7.2%) pyrophosphate arthropathy. We found ruptured BCs in 12 patients, whose associated pathologies were in the following: four RA, four OA of the knee, two gout, one SpA, and one pyrophosphate arthropathy. The most frequent associated arthropathy of BCs was OA (50.6%), followed by RA (20.6%). However, in the cases of ruptured BC, the inflammatory pathology (66.7%) is more frequent than the degenerative one (33.3%).

Characteristics of amebic liver abscess in patients with or without human immunodeficiency virus.

BACKGROUND AND PURPOSE: Amebic liver abscess (ALA) is the most common extra-intestinal amebiasis. This study was performed to review the clinical features of patients with amebic liver abscesses and compare them in Taiwanese patients with or without human immunodeficiency virus (HIV). METHODS: The medical charts of 27 inpatients with ALA treated at the Taipei Medical University Hospital, Taipei, Taiwan, were retrospectively analyzed. ALA was defined as positive findings of indirect hemagglutination test (IHA) and imaging study. Patients were divided into 2 groups according to their HIV infection status. RESULTS: The most common clinical symptoms were fever (89.9%) and abdominal pain (81%). The mean white blood cell count in HIV-uninfected patients was significantly higher than in infected patients (17,830 +/- 4,722/microL vs 11,549 +/- 5,325/microL; p < 0.01). The aspartate aminotransferase levels were significantly lower in HIV-infected patients than in uninfected patients (85.7 +/- 59.1 IU/L vs 31.7 +/- 21.2 IU/L; p < 0.01). Three HIV-uninfected patients and 10 infected patients had IHA titer >1:1024 (p < 0.05). The duration of hospital stay was longer for HIV-uninfected patients than for infected patients (24.8 +/- 14.6 days vs 11.6 +/- 5.9 days; p <0.05). CONCLUSIONS: HIV-infected patients with ALA had a more insidious onset of illness, significantly lower white cell count and liver enzymes, and shorter duration of hospital stay than uninfected patients. Physicians should be alert to ALA for early diagnosis and treatment.