Reliability and Quality of Korean YouTube Videos for Education Regarding Gout

BackgroundYouTube has become an increasingly popular educational tool and an important source of healthcare information. We investigated the reliability and quality of the information in Korean-language YouTube videos about gout.MethodsWe performed a comprehensive electronic search on April 2, 2021, using the following keywords—“gout,” “acute gout,” “gouty arthritis,” “gout treatment,” and “gout attack”—and identified 140 videos in the Korean language. Two rheumatologists then categorized the videos into three groups: “useful,” “misleading,” and “personal experience.” Reliability was determined using a five-item questionnaire modified from the DISCERN validation tool, and overall quality scores were based on the Global Quality Scale (GQS).ResultsAmong the 140 videos identified, 105 (75.0%), 29 (20.7%), and 6 (4.3%) were categorized as “useful,” “misleading,” and “personal experience,” respectively. Most videos in the “useful” group were created by rheumatologists (70.5%). The mean DISCERN and GQS scores in the “useful” group (3.3 ± 1.0 and 3.8 ± 0.7) were higher than those in the “misleading” (0.9 ± 1.0 and 1.9 ± 0.6) and “personal experience” groups (0.8 ± 1.2 and 2.0 ± 0.8) (P < 0.001 for both the DISCERN and GQS tools).ConclusionApproximately 75% of YouTube videos that contain educational material regarding gout were useful; however, we observed some inaccuracies in the medical information provided. Healthcare professionals should closely monitor media content and actively participate in the development of videos that provide accurate medical information.     

Water Quality Evaluation of PET Bottled Water by Mineral Balance in the Northeast Asian Region: A Case Study of South Korea

Background

The past few years have seen a demand for drinking water in contemporary society with a focus on safety and taste. Mineral water is now marketed as a popular commercial product and, partly due to health concerns, the production.

Methods

For the study, a comparison was carried out of water samples from 9 types of polyethylene terephthalate (PET) bottled water sold in South Korea as well as from tap water in the cities of Seoul and Chuncheon. These were compared with samples of Japanese PET bottled water in order to determine shared commonalities and identify individual characteristics. To evaluate water quality objectively, we quantified the elements contained in the water samples. Samples were assessed not with the usual sensory evaluation but with the evaluation approach advocated by Hashimoto et al. which employs the Water Index of Taste and the Water Index of Health. The levels of water quality obtained were compared with the “Prerequisites for Tasty Water” and the “Standards for Tasty Water” devised for city water.

Results

The PET Bottled water varieties analyzed in this study—Seoksu, Icis, Bong Pyong, Soon Soo 100, Dong Won Saem Mul, GI JANG SOO and DIAMOND—showed the Water Index of Taste ≥ 2.0 and the Water Index of Health ≥ 5.2, which we classified as tasty/healthy water. SamDaSoo and NamiNeral can be classified as tasty water due to their values of the Water Index of Taste ≥ 2.0 and the Water Index of Health < 5.2.

Conclusion

The South Korean PET bottled water studied here fulfills the “Water Index of Taste,” “Water Index of Health,” “Standard for Tasty Water” and “Prerequisites for Tasty Water” that Japanese people value for city water. We can conclude that bottled water which meets water quality requirements will be considered good-tasting by a majority of people.     

Aneuploid proliferation defects in yeast are not driven by copy number changes of a few dosage-sensitive genes

Aneuploidy—the gain or loss of one or more whole chromosome—typically has an adverse impact on organismal fitness, manifest in conditions such as Down syndrome. A central question is whether aneuploid phenotypes are the consequence of copy number changes of a few especially harmful genes that may be present on the extra chromosome or are caused by copy number alterations of many genes that confer no observable phenotype when varied individually. We used the proliferation defect exhibited by budding yeast strains carrying single additional chromosomes (disomes) to distinguish between the “few critical genes” hypothesis and the “mass action of genes” hypothesis. Our results indicate that subtle changes in gene dosage across a chromosome can have significant phenotypic consequences. We conclude that phenotypic thresholds can be crossed by mass action of copy number changes that, on their own, are benign.     

New Automated Immunoassay Measuring Immunoglobulin A Antigliadin Antibodies for Prediction of Celiac Disease in Childhood

The prevalence of celiac disease (CD) in Sweden is about 4 cases per 1,000 people. Screening for CD with serological tests indicates similar high prevalences in many other countries. Between 1 November 1992 and 30 April 1995, 133 children (9 months to 16.7 years of age) with suspected CD were studied. The predictive value (PV) of immunoglobulin A antigliadin antibodies (IgA-AGA) in the serum as assayed with two new commercial automated immunoassays—the Pharmacia CAP System Gliadin IgA FEIA (CAP) and the UNICAP-100 (UNICAP)—and with three “in-house” methods was evaluated using assessment of the small intestinal mucosa morphology as the “gold standard.” All serum samples were analyzed for total serum IgA. At presentation the diagnostic sensitivities and specificities of the different tests varied from 0.72 to 0.88 and 0.67 to 0.87, respectively. All methods showed a higher sensitivity for CD in younger children. The area under each assay's receiver operating characteristic curve was calculated and varied between 0.82 and 0.89. The positive and negative PVs for the CAP and UNICAP, which were assays with a high sensitivity and a high specificity, respectively, were estimated. In the clinically selected population (prevalence of CD, 1 in 3) the positive PV was about 55%, and in the general population (prevalence, 1 in 250) it was about 1%. The negative PVs for both CAP and UNICAP were close to 100%; thus, when the AGA test was negative, the risk for CD was small. Interestingly, five children had serum IgA levels below the detection limit (<0.07 g/liter) when on a gluten-free diet, whereas they had normal levels at the time of the first biopsy. In conclusion, the automated immunoassays—based on ImmunoCAP technology—for analysis of IgA-AGA had a reliability comparable to that of the in-house methods.     

Therapeutic Options for the Treatment of Carbapenem-resistant Enterobacteriaceae Infections: Hope in the Times of Hype and Despair

How to cite this article: Ansari AS. Therapeutic Options for the Treatment of Carbapenem-resistant Enterobacteriaceae Infections: Hope in the Times of Hype and Despair. Indian J Crit Care Med 2021;25(7):752–753.

“May your choices reflect your hopes, not your fears”—Nelson Mandela     

Tumour heterogeneity: a problem in biopsy assessment of the proliferation index of oesophageal adenocarcinomas

Tumour heterogeneity may pose a problem when biopsy specimens are taken to measure proliferation (for example, in assessing response to therapy). Two “biopsy specimens” were taken from the centre and two from the edge of the luminal surface of 20 resected oesophageal adenocarcinomas. The proliferation index for each “biopsy specimen” was measured by counting Ki67 labelled nuclei in histological sections. The proliferation index was not associated with tumour differentiation or stage. There was site specific heterogeneity with a significant difference in proliferation index between the central (mean (SD) 36·4 (9·7)) and edge “biopsy specimens” (39·3 (9·9)). There was, however, a wide range of differences between pairs of “biopsy specimens” from both sites. In conclusion, if a tumour is to be sampled for measurement of the proliferation index before and after treatment, then the sequential biopsy specimens (preferably duplicated on each occasion) should be taken consistently from a leading edge of the lesion.     

ΔNp73β puts the brakes on DNA repair

Mammalian cells are barraged with endogenous metabolic byproducts and environmental insults that can lead to nearly a million genomic lesions per cell per day. Networks of proteins that repair these lesions are essential for genome maintenance, and a compromise in these pathways propagates mutations that can cause aging and cancer. The p53 tumor suppressor plays a central role in repairing the effects of DNA damage, and has therefore earned the title of “guardian of the genome.” In this issue of Genes & Development, Wilhelm and colleagues (pp. 549–560) demonstrate that p73—an older sibling of p53—inhibits pathways that resolve DNA double-strand breaks.     

Current Asthma Prevalence Using Methacholine Challenge Test in Korean Children from 2010 to 2014

BackgroundMost epidemiological studies depend on the subjects'' response to asthma symptom questionnaires. Questionnaire-based study for childhood asthma prevalence may overestimate the true prevalence. The aim of this study was to investigate the prevalence of “Current asthma” using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and methacholine challenge test in Korean children.MethodsOur survey on allergic disease included 4,791 children (age 7–12 years) from 2010 to 2014 in Korean elementary schools. Bronchial hyperresponsiveness (BHR) was defined as provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (FEV1) (PC20) ≤ 16 mg/mL. “Current asthma symptoms” was defined as positive response to “Wheezing, current,” “Treatment, current,” or “Exercise, current.” “Current asthma” was defined when the subjects with “Current asthma symptoms” showed BHR on the methacholine challenge test or had less than 70% of predicted FEV1 value.ResultsThe prevalence of “Wheezing, ever,” “Wheezing, current,” “Diagnosis, ever,” “Treatment, current,” “Exercise, current,” and “Current asthma symptoms” was 19.6%, 6.9%, 10.0%, 3.3%, 3.5%, and 9.6%, respectively, in our cross-sectional study of Korean elementary school students. The prevalence of BHR in elementary school students was 14.5%. The prevalence of BHR in children with “Wheezing, ever,” “Wheezing, current,” “Diagnosis, ever,” “Treatment, current,” and “Exercise, current” was 22.3%, 30.5%, 22.4%, 28.8%, and 29.9%, respectively. BHR was 26.1% in those with “Current asthma symptoms.” The prevalence of “Current asthma” was 2.7%.ConclusionsOur large-scale study provides 2.7% prevalence of current asthma in Korean elementary school children. Since approximately one third of the children who have “Current asthma symptoms” present BHR, both subjective and objective methods are required to accurately predict asthma in subjects with asthma symptoms.     

Text Mining and Natural Language Processing Approaches for Automatic Categorization of Lay Requests to Web-Based Expert Forums

Background

Both healthy and sick people increasingly use electronic media to obtain medical information and advice. For example, Internet users may send requests to Web-based expert forums, or so-called “ask the doctor” services.

Objective

To automatically classify lay requests to an Internet medical expert forum using a combination of different text-mining strategies.

Methods

We first manually classified a sample of 988 requests directed to a involuntary childlessness forum on the German website “Rund ums Baby” (“Everything about Babies”) into one or more of 38 categories belonging to two dimensions (“subject matter” and “expectations”). After creating start and synonym lists, we calculated the average Cramer’s V statistic for the association of each word with each category. We also used principle component analysis and singular value decomposition as further text-mining strategies. With these measures we trained regression models and determined, on the basis of best regression models, for any request the probability of belonging to each of the 38 different categories, with a cutoff of 50%. Recall and precision of a test sample were calculated as a measure of quality for the automatic classification.

Results

According to the manual classification of 988 documents, 102 (10%) documents fell into the category “in vitro fertilization (IVF),” 81 (8%) into the category “ovulation,” 79 (8%) into “cycle,” and 57 (6%) into “semen analysis.” These were the four most frequent categories in the subject matter dimension (consisting of 32 categories). The expectation dimension comprised six categories; we classified 533 documents (54%) as “general information” and 351 (36%) as a wish for “treatment recommendations.” The generation of indicator variables based on the chi-square analysis and Cramer’s V proved to be the best approach for automatic classification in about half of the categories. In combination with the two other approaches, 100% precision and 100% recall were realized in 18 (47%) out of the 38 categories in the test sample. For 35 (92%) categories, precision and recall were better than 80%. For some categories, the input variables (ie, “words”) also included variables from other categories, most often with a negative sign. For example, absence of words predictive for “menstruation” was a strong indicator for the category “pregnancy test.”

Conclusions

Our approach suggests a way of automatically classifying and analyzing unstructured information in Internet expert forums. The technique can perform a preliminary categorization of new requests and help Internet medical experts to better handle the mass of information and to give professional feedback.     

Mechanism of apoptotic regulation of follicular regression: toward understanding the molecular basis for tissue remodeling and regeneration

“There are one hundred and ninety-three living species of monkeys and apes. One hundred and ninety-two of them are covered with hair. The exception is a naked ape self-named Homo sapiens.” —Desmond Morris, The Naked Ape (1967)     

Identifying and characterizing longitudinal patterns of insomnia across the deployment cycle in active duty Army soldiers

Study ObjectivesThe present study characterized a sample of 4,667 Army soldiers based on their patterns of insomnia before, during, and after deployment, and explored pre-deployment factors predictive of these patterns.MethodsData were analyzed from the Army Study to Assess Risk and Resilience in Service members (STARRS)—Pre/Post Deployment Study (PPDS), using surveys that captured data approximately 1–2 months pre-deployment, and 3- and 9-month post-deployment from soldiers deployed to Afghanistan. Patterns of insomnia across time were examined. Theoretically derived variables linked to sleep disturbance were examined as predictors of the insomnia patterns.ResultsFive longitudinal patterns of insomnia characterized the majority of the sample: “No Insomnia” (no insomnia symptoms at any timepoint; 31%), “Deployment-related Insomnia” (no pre-deployment insomnia, developed insomnia symptoms during deployment and recovered; 40%), “Incident Insomnia” (development insomnia during or shortly after deployment that did not remit; 14%), “Chronic Insomnia” (insomnia both pre- and post-deployment; 11%), and “Other Insomnia” (reported insomnia at ≥1 timepoint, but no clear pattern across the deployment cycle; 4%). Several pre-deployment factors were predictive of insomnia trajectories, including lifetime major depressive episodes, traumatic brain injury history, posttraumatic stress disorder, and past year personal life stressors.ConclusionsDistinct longitudinal patterns of insomnia were identified, with more than half of the sample reporting insomnia at some point in the deployment cycle. Identifying mental health conditions that are associated with different insomnia patterns prior to deployment can inform targeted interventions to reduce long-term sleep difficulty.     

Heterogeneously Vancomycin-Resistant Staphylococcus epidermidis Strain Causing Recurrent Peritonitis in a Dialysis Patient during Vancomycin Therapy

Methicillin-resistant Staphylococcus epidermidis (MRSE) was recovered over a 2-month period from the dialysis fluid of a peritoneal dialysis (PD) patient who experienced recurrent episodes of peritonitis during therapeutic and prophylactic use of vancomycin. Characterization of five consecutive MRSE isolates by molecular and microbiological methods showed that they were representatives of a single strain, had reduced susceptibility to vancomycin, did not react with DNA probes specific for the enterococcal vanA or vanB gene, and showed characteristics reminiscent of the properties of a recently described vancomycin-resistant laboratory mutant of Staphylococcus aureus. Cultures of these MRSE isolates were heterogeneous: they contained—with a frequency of 10⁻⁴ to 10⁻⁵—bacteria for which vancomycin MICs were high (25 to 50 μg/ml) which could easily be selected to “take over” the cultures by using vancomycin selection in the laboratory. In contrast, the five consecutive MRSE isolates recovered from the PD patient during virtually continuous vancomycin therapy showed no indication for a similar enrichment of more resistant subpopulations, suggesting the existence of an “occult” infection site in the patient (presumably at the catheter exit site) which was not accessible to the antibiotic.     

Allylamine Cardiotoxicity: II. Histopathology and Histochemistry

The progression of cardiac lesions induced in the rat by allylamine administration (0.1% in drinking water) was studied histopathologically and histochemically. Early changes (4-8 days) consisted of piecemeal acute apical and subendocardial myocardial necrosis with morphologic features of coagulation necrosis and myocytolysis. These early lesions progressed and coalesced; resolution of the subendocardial necrosis was associated with remarkably proliferative fibroblastic tissus. Late lesions (21 days to 3 months) consisted of extensive dense fibrous tissue with adjacent continuing focal necrosis and organization. Although vascular alterations were not present during the early course of injury, after 21 days an exuberant proliferation of cells, predominantly within the intima of intramyocardial smaller arteries and not associated with total occlusion or thrombosis, became evident. Other late lesions included rare intraventricular mural thrombi and cartilagenous metaplasia of trabeculae carnae. Early histochemical alterations (3 days) included focal myocardial cell “calcification,” demonstrated by the alizarin red S stain, and increased monoamine oxidase (MAO) staining in apical subendocardium and periarterial myocytes. As necrosis continued and fibrosis developed (7-21 days) MAO dramatically increased in pericicatricial and periarterial cells. Biochemical measurement of myocardial MAO showed an initial drop in activity, followed by a steady rise to high activity (21 days), especially toward a Type “B” MAO substrate. Although there are many similarities between allylamine-induced myocardial necrosis and ischemic or catecholamine-induced myocardial damage, other unusual findings—especially the early histochemical and chemical MAO alterations and the proliferative late vascular and cicatricial lesions—suggest that the primary pathophysiologic effect of allylamine, mediated through the MAO system, is on the medial smooth muscle of intramyocardial arteries.     

The Migrant Cells in Allotransplants of Heart,Kidney and Skin. 1. A Comparative Electron Microscopic Analysis of the Migrant Cells

The cells migrating into allotransplants of heart, kidney and skin have been assessed by electron microscopy and related to the physiological activity of these organs recorded at the time of their removal. The migrant cells consisted of macrophages—arriving in the transplants either as early macrophages or monocytes, neutrophils, blast-like cells and erythrocytes. The proportions of these types to the total number of cells varied from one tissue to another and also from one area to another within any given transplant. The overall dominant cell was the macrophage. Owing to their enormous size gained in the course of maturation, the macrophages come to occupy most of the interstitial tissue space and appear to be carrying on their legitimate function of phagocytosis of damaged cells. The only cells which were phagocytosed were “self” erythrocytes and platelets which had become extravasated, and later damaged, in the interstitium along with other circulating blood cells as a result of increased vascular permeability. Macrophages undergoing pinocytosis were more common in heart than in kidney allotransplants but this indicates, in general, that the macrophages were phagocytosing soluble “self” particles contained in the protein-rich extravasated plasma. However, ruffled “angry” macrophages were as much a feature of skin autotransplants as any allotransplant which renders the regulation of pinocytosis even more complex and not just a response to “not-self”. There was no evidence which would support claims that lymphocytes caused direct parenchymal damage and so initiate acute rejection or that they are the most numerous cells to be found in allotransplants. The migrant cells are a consequence of an initial inflammatory reaction in allotransplants and not the cause of it. A physiological assessment of function points to a failure of afferent peripheral perfusion due to increased venular pressure as the cause of acute rejection in all allotransplants.     

Clustering Patterns of Comorbidities Associated with In-Hospital Death in Hospitalizations of US Adults with Venous Thromboembolism

Background: Venous thromboembolism (VTE) is a significant source of mortality, morbidity, disability, and impaired health-related quality of life in the world.Objective: We aimed to evaluate the clustering patterns and associations of 29 comorbidities with in-hospital death among adult hospitalizations with a diagnosis of VTE in the United States by analyzing data from the 2009 Nationwide Inpatient Sample.Methods: This cross-sectional study included 153,124 adult hospitalizations with a diagnosis of VTE. Adjusted rate ratios and 95% confidence intervals (CI) for in-hospital death were generated by using multivariable log-linear regression models to measure independent associations between comorbidities and in-hospital death.Results: We estimated that 44,200 in-hospital deaths occurred in 2009 among 773,273 US adult hospitalizations with a diagnosis of VTE. Subgroups of hospitalizations with comorbidities of “congestive heart failure,” “chronic pulmonary disease,” “coagulopathy,” “liver disease,” “lymphoma,” “fluid and electrolyte disorders,” “metastatic cancer,” “peripheral vascular disorders,” “pulmonary circulation disorders,” “renal failure,” “solid tumor without metastasis,” or “weight loss” were positively and independently associated with 1.07 (95% CI: 1.02-1.12 ) to 2.06 (95% CI: 1.97-2.16) times increased likelihoods of in-hospital death, when compared to those without the corresponding comorbidities. The clustering patterns of these comorbidities by 4 disease categories (i.e., “cancer,” “cardiovascular/respiratory/blood,” “gastrointestinal/urologic,” and “nutritional/bodyweight”) were associated with 2.74 to 10.28 times increased likelihoods of in-hospital death, as compared to hospitalizations without any of these comorbidities. The overall increase in the cumulative number of comorbidities corresponded to significantly elevated risks (P-trend<0.01) for in-hospital death among hospitalizations with a diagnosis of VTE.Conclusion: The presence of multiple comorbidities is ubiquitous among hospitalizations of adults with VTE and among in-hospital deaths with VTE in the United States. The findings of our study further suggest that, among hospitalizations of adults with VTE, the presence of certain comorbidities or clustering of these comorbidities significantly elevates the risk of in-hospital death.     

Tweet Content Related to Sexually Transmitted Diseases: No Joking Matter

Background

Online social media, such as the microblogging site Twitter, have become a space for speedy exchange of information regarding sexually transmitted diseases (STDs), presenting a potential risk environment for how STDs are portrayed. Examining the types of “tweeters” (users who post messages on Twitter) and the nature of “tweet” messages is important for identifying how information related to STDs is posted in online social media.

Objective

The intent of the study was to describe the types of message emitters on Twitter in relation to two different STDs—chlamydia and human immunodeficiency virus (HIV)—as well as the nature of content tweeted, including how seriously the topic was treated.

Methods

We used the Twitter search engine to look for tweets posted worldwide from August 1-7, 2013, and from September 1-7, 2013, containing the words “chlamydia” or “HIV”, and the hashtags “#chlamydia” or “#HIV”. Tweeters were classified by two independent reviewers according to the type of avatar of the user (human, logo, or fantasy), the identification of the emitter (identifiable, semi-identifiable, or non-identifiable), and the source (private company, general media, scientific media, non-governmental, individual account, academic institution, government department, or undefined). Tweet messages were also independently classified according to their nature (serious or jokes/funny), and whether their main message was factual or of a personal nature/experience.

Results

A total of 694 tweets were posted by 426 different users during the first 7 days of August and September, containing the hashtags and/or simple words “chlamydia” and/or “HIV”. Jokes or funny tweets were more frequently posted by individual users (89%, 66/74), with a human avatar (81%, 60/74), from a non-identifiable user (72%, 53/74), and they were most frequently related to chlamydia (76%, 56/74). Serious tweets were most frequently posted by the general media (20.6%, 128/620), using a logo avatar (66.9%, 415/620), and with identifiable accounts (85.2%, 528/620). No government departments, non-governmental organizations, scientific media, or academic institutions posted a joke on STDs. A total of 104 of these analyzed tweets were re-tweeted messages, belonging to 68 unique tweets. The content was serious (99%, 67/68), factual (90%, 52/58), and about HIV (85%, 58/68).

Conclusions

Social media such as Twitter may be an important source of information regarding STDs provided that the topic is presented appropriately. Reassuringly, the study showed that almost 9/10 of tweets on STDs (chlamydia and HIV) were of serious content, and many of the tweets that were re-tweeted were facts. The jokes that were tweeted were mainly about chlamydia, and posted by non-identifiable emitters. We believe social media should be used to an even larger extent to disseminate correct information about STDs.     

Relationship of the changes of cervical MRI,TCD and BAEP in patients with “isolated” vertigo

Objective: To study the relationship and changes of cervical MRI, TCD and BAEP in patients with “isolated” vertigo. Methods: The relationship and changes of cervical MRI, TCD and BAEP were investigated respectively in 125 patients with “isolated” vertigo and 100 healthy controls. Results: There were statistically significant differences between two groups for overall abnormalities of TCD (X² = 61.96, P<0.01), BAEP (X² = 97.99, P<0.01), and cervical MRI severity scale (Z = -8.71, P<0.01). In vertigo group, results showed significant correlations between TCD and cervical MRI, TCD and BAEP as well. And analysis on TCD PI and some items of BAEP demonstrated positive linear correlations. There were no statistical differences or correlations in control group. Conclusions: TCD is a sensitive method of “isolated” vertigo screening. A combined test protocol of cervical MRI, TCD and BAEP has superiorities to assess “isolated” vertigo.     

Evaluation of Alere i Influenza A&B for Rapid Detection of Influenza Viruses A and B

Rapid and accurate diagnosis of influenza is important for infection control, as well as for patient management. Alere i Influenza A&B is an isothermal nucleic acid amplification-based integrated system for detection and differentiation of influenza virus A and influenza virus B. The performance of the Alere i Influenza A&B was screened using frozen nasopharyngeal-swab specimens collected in viral transport medium (VTM) that were originally tested fresh with the FilmArray Respiratory Panel (RP) assay during the 2012–2013 influenza outbreak. In total, 360 VTM specimens were selected for Alere i Influenza A&B testing: 40 influenza virus A H1N1-2009 (influenza virus A-1), 40 influenza virus A H3N2 (influenza virus A-3), 37 influenza virus A “equivocal” or “no subtype detected” (influenza virus A-u), 41 influenza virus B, and 202 influenza virus-negative specimens, as initially determined by the FilmArray RP assay. The Alere assay showed sensitivities of 87.2%, 92.5%, 25.0%, and 97.4% for influenza virus A-1, influenza virus A-3, influenza virus A-u, and influenza virus B, respectively, after discordant resolution by Prodesse ProFLU+ PCR. The specificities were 100% for both influenza virus A and influenza virus B. In general, the Alere i Influenza A&B provided good sensitivity, although the assay did show poorer sensitivity with samples determined to have low influenza virus A titers by Prodesse ProFlu+ PCR (a mean real-time PCR threshold cycle [C_T] value of 31.9 ± 2.0), which included the majority of the samples called influenza virus A “equivocal” or “no subtype detected” by a single BioFire FilmArray RP test. The integrated, rapid, and simple characteristics of the Alere i Influenza A&B assay make it a potential candidate for point-of-care testing, with a test turnaround time of less than 15 min.     

Emerging therapeutics in the management of COVID-19

The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019, COVID-19) pandemic has placed a tremendous burden on healthcare systems globally. Therapeutics for treatment of the virus are extremely inconsistent due to the lack of time evaluating drug efficacy in clinical trials. Currently, there is a deficiency of published literature that comprehensively discusses all therapeutics being considered for the treatment of COVID-19. A review of the literature was performed for articles related to therapeutics and clinical trials in the context of the current COVID-19 pandemic. We used PubMed, Google Scholar, and Clinicaltrials.gov to search for articles relative to the topic of interest. We used the following keywords: “COVID-19”, “therapeutics”, “clinical trials”, “treatment”, “FDA”, “ICU”, “mortality”, and “management”. In addition, searches through the references of retrieved articles was also performed. In this paper, we have elaborated on the therapeutic strategies that have been hypothesized or trialed to-date, the mechanism of action of each therapeutic, the clinical trials finished or in-process that support the use of each therapeutic, and the adverse effects associated with each therapeutic. Currently, there is no treatment that has been proven to provide significant benefit in reducing morbidity and mortality. There are many clinical trials for numerous different therapeutic agents currently underway. By looking back and measuring successful strategies from previous pandemics in addition to carrying out ongoing research, we provide ourselves with the greatest opportunity to find treatments that are beneficial.     

Use of Opioids and Sedatives at End-of-Life

Despite their proven efficacy and safety, opioid and sedative use for palliation in patients afflicted with cancer in Singapore have been shown to be a fraction of that in other countries. This paper explores the various psychosocial and system-related factors that appear to propagate this conservative approach to care in what is largely a western-influenced care practice. A search for publications relating to sedative and opioid usage in Asia was performed on PubMed, Google, Google Scholar, World Health Organization, and Singapore''s government agency websites using search terms such as “opioids,” “sedatives,” “palliation,” “end-of-life-care,” “pain management,” “palliative care,” “cancer pain,” “Asia,” “Singapore,” and “morphine.” Findings were classified into three broad groups – system-related, physician-related, and patient-related factors. A cautious medico-legal climate, shortage of physicians trained in palliative care, and lack of instruments for symptom assessment of patients at the end of life contribute to system-related barriers. Physician-related barriers include delayed access to palliative care due to late referrals, knowledge deficits in non-palliative medicine physicians, and sub-optimal care provided by palliative physicians. Patients'' under-reporting of symptoms and fear of addiction, tolerance, and side effects of opioids and sedatives may lead to conservative opioid use in palliative care as well. System-related, physician-related, and patient-related factors play crucial roles in steering the management of palliative patients. Addressing and increasing the awareness of these factors may help ensure patients receive adequate relief and control of distressing symptoms.