Potential impact of ocular intense pulsed light on eyelash microbiome in severe meibomian gland dysfunction: report of 2 cases

Meibomian gland dysfunction (MGD) is a prevalent worldwide eye disorder that causes eye irritation, inflammation, chronic dryness, and blurred vision. Traditional therapies offer temporary improvement, but their efficacy varies in severe MGD cases. Ocular intense pulsed light (IPL) has emerged as a novel therapy, providing long-term symptom relief and shorter treatment durations compared to traditional approaches. However, the impact of IPL on the bacterial community within the eyes remains limited. To address this, we conducted a preliminary study using metagenomics and next-generation sequencing. We compared the bacterial eyelash communities of Thai females with severe MGD before and after 2-4 IPL treatments, and against a group of healthy females. Our findings revealed higher bacterial diversity in healthy individuals compared to severe MGD cases. IPL treatments increased diversity in the MGD group, making their core bacterial community more similar to that of healthy subjects. Notably, the presence of Koribacteraceae in severe MGD and Bifidobacterium in healthy individuals and post-IPL-treated MGD exemplified this shift. Clustering analysis showed a closer relationship between post-IPL-treated MGH and healthy subjects, while the pre-IPL treatment group formed a separate branch. These results suggest that IPL treatment can reshape the eyelash microbiome in MGD cases, but further research is needed to understand the implications and the microbiome’s role in MGD pathogenesis and treatment response

Policy characteristics facilitating primary health care in Thailand: A pilot study in transitional country

<p>Abstract</p> <p>Background</p> <p>In contrast to the considerable evidence of inequitable distribution of <it>health</it>, little is known about how health <it>services (particularly primary care services) </it>are distributed in less developed countries. Using a version of primary health care system questionnaire, this pilot study in Thailand assessed policies related to the provision of primary care, particularly with regard to attempts to distribute resources equitably, adequacy of resources, comprehensiveness of services, and co-payment requirement. Information on other main attributes of primary health care policy was also ascertained.</p> <p>Methods</p> <p>Questionnaire survey of 5 policymakers, 5 academicians, and 77 primary care practitioners who were attending a workshop on primary care. Descriptive statistics with Fischer's exact test were used for data analysis.</p> <p>Results</p> <p>All policymakers and academicians completed the mailed questionnaire; the response rate among the practitioners was 53.25% (41 out of 77). However, the responses from all three groups were consistent in reporting that (1) financial resources were allocated based on different health needs and special efforts were made to assure primary care services to the needy or underserved population, (2) the supply of essential drugs was adequate, (3) clinical services were distributed equitably, (4) out-of-pocket payment was low, and that some primary health care attributes, particularly longitudinality (patients are seen by same doctor or team each time they make a visit), coordination, and family- and community-orientation were satisfactory. Geographical variations were present, suggesting inequitable distribution of primary care across regions. The questionnaire was robust across key stakeholders and feasible for use in a transitional country.</p> <p>Conclusion</p> <p>A primary care systems questionnaire administered to different types of health professionals was able to show that resource distribution was equitable at a national level but some aspects of primary care practice across regions is still of concern, in at least in this transitional country.</p

Cost-effectiveness of therapeutic infant formulas for cow's milk protein allergy management

Cow's milk protein allergy (CMPA) is children's most common food allergy. Therapeutic infant formulas for CMPA lead to symptom-free and potentially benefit early tolerance induction and reducing the allergic march in non-breastfed babies. This study assessed the cost-effectiveness of CMPA management with different therapeutic infant formulas in Thailand, which may reflect situations in developing countries throughout Asia. An analytic decision model was developed to simulate the occurrence of eczema, urticaria, asthma, rhinoconjunctivitis, or being symptom-free in infants with CMPA over 36 months. Extensively hydrolyzed casein formula with added probiotic Lacticaseibacillus rhamnosus (previously Lactobacillus rhamnosus) strain GG (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), soy protein-based formula (SPF), and amino acid formula (AAF) were compared from the healthcare payer perspective. The results from a prospective cohort study were used for comparative effectiveness measures, while local experts were interviewed to estimate the healthcare resource used in the management of CMPA. The costs of healthcare resources were obtained from standard, publicly available sources. The direct medical cost of CMPA management was lowest for EHCF+LGG (USD 1,720), followed by SPF (USD 2,090), EHWF (USD 2,791), and AAF (USD 7,881). Compared with other formulas, EHCF+LGG was expected to save USD 370 (SPF), USD 1,071 (EHWF), and USD 6,161 (AAF) in the total cost of CMPA management over 36 months. In conclusion, EHCF+LGG was the most cost-effective strategy for managing non-breastfed infants with CMPA. This strategy was associated with more children developing immune tolerance to cow's milk and being symptom-free, contributing to overall cost-saving potential

Ocular Microbiota of Severe Meibomian Gland Dysfunction (Chronic Dry Eyes) after Intense Pulsed Light (IPL)

Ocular IPL therapy has recently been widely used for MGD, especially for patients not showing improvement with traditional therapies (warm compresses and lid scrubs) to clean debris and reduce bacterial overgrowth. Insights on the ocular microbiome and quantitative microbiome in MGD after a course of IPL could provide useful data on bacterial community monitoring and associated mechanisms linked with IPL. Ocular swabs were obtained from a severe MGD patient and age-sex matched healthy for metagenomics, followed by 16S rRNA gene sequencing and qPCR. Of 10 samples, including left and right eyes (el, er) of severe MGD females before (Db) and after 2-4 IPLs (Da2, Da3, and Da4) and the matched non-MGD females (H), both of ~40 years Using 16S rRNA gene sequencing as microbiota and combined 16S rRNA gene qPCR as quantitative microbiota revealed significant disperse in the microbiome structures of Db compared with Da and H (HOMOVA, p<0.001). Bacterial Propionibacterium acnes and unclassified taxa in the family Propionibacteriaceae and order Actinomycetales represented the core Db microbiota and were reduced after 2-4 IPLs in Da, making the Da microbiome and clinical (mucocutaneous junction, corneal, and conjunctival fluorescein score) closer to H (NMDS with Pearson’s correlation, p<0.05). The recovery of the Da microbiome also allowed Da metabolic potentials to be closer to H. Our findings first demonstrated the ocular microbiome dysbiosis in severe MGD, dispersed from Da and H, in Thai subjects, correlated with bacterial quantity and clinical MGD, including the mucocutaneous junction process. The results additionally provided taxa representing Db vs. Da and H and preliminarily underlie the idea that IPL could improve dysbiosis in the MGD microbiome. Doi: 10.28991/ESJ-2023-07-05-015 Full Text: PD

DRG coding practice: a nationwide hospital survey in Thailand

<p>Abstract</p> <p>Background</p> <p>Diagnosis Related Group (DRG) payment is preferred by healthcare reform in various countries but its implementation in resource-limited countries has not been fully explored.</p> <p>Objectives</p> <p>This study was aimed (1) to compare the characteristics of hospitals in Thailand that were audited with those that were not and (2) to develop a simplified scale to measure hospital coding practice.</p> <p>Methods</p> <p>A questionnaire survey was conducted of 920 hospitals in the Summary and Coding Audit Database (SCAD hospitals, all of which were audited in 2008 because of suspicious reports of possible DRG miscoding); the questionnaire also included 390 non-SCAD hospitals. The questionnaire asked about general demographics of the hospitals, hospital coding structure and process, and also included a set of 63 opinion-oriented items on the current hospital coding practice. Descriptive statistics and exploratory factor analysis (EFA) were used for data analysis.</p> <p>Results</p> <p>SCAD and Non-SCAD hospitals were different in many aspects, especially the number of medical statisticians, experience of medical statisticians and physicians, as well as number of certified coders. Factor analysis revealed a simplified 3-factor, 20-item model to assess hospital coding practice and classify hospital intention.</p> <p>Conclusion</p> <p>Hospital providers should not be assumed capable of producing high quality DRG codes, especially in resource-limited settings.</p

Acceptance and use of complementary and alternative medicine among medical specialists: a 15-year systematic review and data synthesis.

BackgroundComplementary and Alternative Medicine (CAM) has gained popularity among the general population, but its acceptance and use among medical specialists have been inconclusive. This systematic review aimed to identify relevant studies and synthesize survey data on the acceptance and use of CAM among medical specialists.MethodsWe conducted a systematic literature search in PubMed and Scopus databases for the acceptance and use of CAM among medical specialists. Each article was assessed by two screeners. Only survey studies relevant to the acceptance and use of CAM among medical specialists were reviewed. The pooled prevalence estimates were calculated using random-effects meta-analyses. This review followed both PRISMA and SWiM guidelines.ResultsOf 5628 articles published between 2002 and 2017, 25 fulfilled the selection criteria. Ten medical specialties were included: Internal Medicine (11 studies), Pediatrics (6 studies), Obstetrics and Gynecology (6 studies), Anesthesiology (4 studies), Surgery (3 studies), Family Medicine (3 studies), Physical Medicine and Rehabilitation (3 studies), Psychiatry and Neurology (2 studies), Otolaryngology (1 study), and Neurological Surgery (1 study). The overall acceptance of CAM was 52% (95%CI, 42-62%). Family Medicine reported the highest acceptance, followed by Psychiatry and Neurology, Neurological Surgery, Obstetrics and Gynecology, Pediatrics, Anesthesiology, Physical Medicine and Rehabilitation, Internal Medicine, and Surgery. The overall use of CAM was 45% (95% CI, 37-54%). The highest use of CAM was by the Obstetrics and Gynecology, followed by Family Medicine, Psychiatry and Neurology, Pediatrics, Otolaryngology, Anesthesiology, Internal Medicine, Physical Medicine and Rehabilitation, and Surgery. Based on the studies, meta-regression showed no statistically significant difference across geographic regions, economic levels of the country, or sampling methods.ConclusionAcceptance and use of CAM varied across medical specialists. CAM was accepted and used the most by Family Medicine but the least by Surgery. Findings from this systematic review could be useful for strategic harmonization of CAM and conventional medicine practice.Systematic review registrationPROSPERO CRD42019125628