Evaluation of rapid antigen detection test for group A Streptococci pharyngitis among children in an out-patient clinic in Malaysia

One of the most common conditions encountered in the out-patient setting is acute pharyngitis. Group A Streptococcus (GAS) accounts for 15%-30% of cases of sore throat particularly in children under 15 years old. Rapid antigen testing (RADT) is an alternative diagnostic method to detect GAS pharyngitis. This study was done to evaluate the agreement between RADT whereby BIONEXIA® Strep A Plus (BioMérieux, France) kit was used and throat culture in the diagnosis of GAS pharyngitis in children presented with a sore throat. One hundred and ten children from a primary health care clinic with sore throat were included in this study. All children were evaluated based on McIsaac scoring and throat swab samples were taken for both throat culture and RADT testing. The prevalence of GAS pharyngitis by RADT in this study was 7.3% over one year. A higher incidence of GAS pharyngitis was noted in the school-aged children than the preschool-age children. There was no correlation between cough, lymph node enlargement, and tonsillar enlargement in predicting GAS pharyngitis. The sensitivity and specificity of RADT were 100% and 98%, respectively, when taking throat culture as a gold standard. A good agreement between RADT and throat culture was achieved (k=0.848). McIsaac scoring was noted to have good predictability for GAS pharyngitis with AUC=0.82. In conclusion, the rapid streptococcal antigen detection test showed excellent sensitivity and specificity and detecting GAS from the throat swab samples. Thus, it can be used to aid in the diagnosis of group A Streptococcal pharyngitis and could reduce the overuse of antibiotics. McIsaac score has also proven to be useful as a screening tool for bacterial pharyngitis

Demonstration of enhanced warhead performance with more powerful explosives

Enhanced warhead performance has been demonstrated for several warhead configurations loaded with more powerful explosives. This paper presents experimental results from several warheads loaded with one of the new more powerful explosives, LX-19. The LX-19 formulation is a volume analog to LX-14 (HMX/Estane) that consists of 95.8 wt.% epsilon CL-20 formulated with 4.2 wt.% Estane binder. The LX-19 formulation, characterization, and evaluation efforts presseted in this paper are the result of several studies that have been ongoing since 1991. The warhead configurations that have been tested include a trumpet lined shaped charge, a hemispherical lined shaped cahrge, an EFP charge, and a fragmentation warhead, Performation improvements have been demonstrated with all configurations that were tested

Meal skipping among patients with type 2 diabetes mellitus (T2DM) and its associations with glycaemic control, eating out of home and binge eating

Meal skipping is a common way to restrict diet, but its practice by patients with type 2 diabetes mellitus (T2DM) remains undetermined due to the scarcity of the research. The main aim of this study was to assess how common patients with T2DM skipped meals. Its associations with sociodemographic and clinical characteristics, HbA1c, eating out of home and binge eating were examined too. This cross-sectional study was conducted in 2015 among 203 patients at a public healthcare clinic in Kuala Lumpur. A self-administered questionnaire including the Malay-version Binge Eating Scale was used. The proportions of participants who frequently skipped meals and ate out of home were 41.4% and 61.6%, respectively. Only 2% of them had binge eating disorder. Multiple logistic regression showed only Chinese was significantly associated with frequent meal skipping compared to Malay (adjusted odds ratio: 0.36; 95% confidence interval: 0.16-0.77; p value= 0.009) after controlling for age, employment status, educational status, HbA1c, presence of complication, type of treatment, eating out of home and binge eating. In conclusion, meal skipping was a frequently practised eating behaviour. Eating out of home was common too, but binge eating was rare. Meal skipping was not influenced by both eating practices and it had insignificant associations with glycaemic control. Cultural and religious factors may play an important role in defining their eating practice. Further studies are needed to assess the safety and acceptability of this practice, but clinically, its effects must be individually examined to prevent unwanted consequences on their health

The effectiveness of “prompt sheet” in initiating a discussion of sexual dysfunction among male patients with diabetes in a primary care setting: an open-label control trial

Background: Erectile dysfunction (ED) affects millions of men worldwide yet many are undiagnosed and untreated. Both doctors and men may have a miscommunication that ED is taboo to be brought up in the consultation. This study determined the effectiveness of prompt sheet in initiating a discussion of sexual dysfunction in a primary care setting. Methods: This was an open label control trial done at two government primary care clinics, one as a control and the other, an intervention group. All doctors in the participating clinics were given education on diagnosis and management of ED. Participants who came for their diabetes mellitus follow-up were approached. Those who consented to the study had their sociodemographic data recorded and erectile function evaluated using International Index of Erectile Function (IIEF-5). The patients in the intervention group (n = 69) received a prompt sheet allowing participants to indicate their decision, prior to consultation, of whether to discuss about erectile dysfunction. The prompt sheet was presented to their treating doctors during consultation. The control group (n = 65) received usual care. All participants would provide a written feedback whether there was any discussion about erectile dysfunction after the consultation. Results: A total of 134 participants completed the study. Ethnic distributions in intervention group differed significantly from the control group with 46.4% Chinese, 44.9% Malay, 7.2% Indian and 53.8% Chinese, 15.4% Malay, 29.2% Indian respectively. Other baseline characteristic of both groups (age, body weight, education level, employment, smoking, marital status, duration of diabetes and prevalence of ED) were similar. The prevalence of ED in both groups was about 80%. In the intervention group, only 59% of participants opted to discuss their sexual problems and among them, 80.5% of them had it discussed during the consultation. Thus, in the intervention group, 47.8% of total participants discussed about erectile dysfunction, compared to 4.6% in the control group (Odds Ratio (OR) 18.4, 95% Confidence Interval (CI): 5.4–66.2, p < 0.001). Sub-analysis did not reveal any relationship between either ethnicity or severity of ED and participant’s option to discuss ED. Conclusions: Prompt sheet is a simple and inexpensive tool to cue a discussion of erectile dysfunction during consultation. More importantly, prompt sheet provides patients an opportunity to indicate their interest of discussing ED to bridge the gap of miscommunication between men and doctors

Stroke Riskometer Application (SRA™) influence on lifestyle changes of home bound familial Malaysian stroke caregivers: a randomised controlled trial in a primary care based longer term stroke care facility

Abstract Background In countries where access to Specialist stroke care services are limited, primary care physicians often manage stroke patients and the caregiving family members. This study aimed to evaluate the impact of Stroke Riskometer Application (SRA™) on promoting healthier lifestyles among familial stroke caregivers for primary prevention. Methods A parallel, open-label, 2-arm prospective, pilot randomised controlled trial was conducted at a long-term stroke service at a university based primary care clinic. All stroke caregivers aged ≥ 18 years, proficient in English or Malay and smartphone operation were invited. From 147 eligible caregivers, 76 participants were randomised to either SRA™ intervention or conventional care group (CCG) after receiving standard health counselling. The intervention group had additional SRA™ installed on their smartphones, which enabled self-monitoring of modifiable and non-modifiable stroke risk factors. The Stroke Riskometer app (SRATM) and Life's Simple 7 (LS7) questionnaires assessed stroke risk and lifestyle practices. Changes in clinical profile, lifestyle practices and calculated stroke risk were analysed at baseline and 3 months. The trial was registered in the Australia-New Zealand Clinical Trial Registry, ACTRN12618002050235. Results The demographic and clinical characteristics of the intervention and control group study participants were comparable. Better improvement in LS7 scores were noted in the SRA™ arm compared to CCG at 3 months: Median difference (95% CI) = 0.88 (1.68–0.08), p = 0.03. However, both groups did not show significant changes in median stroke risk and relative risk scores at 5-, 10-years (Stroke risk 5-years: Median difference (95% CI) = 0.53 (0.15–1.21), p = 0.13, 10-years: Median difference (95% CI) = 0.81 (0.53–2.15), p = 0.23; Relative risk 5-years: Median difference (95% CI) = 0.84 (0.29–1.97), p = 0.14, Relative risk 10-years: Median difference (95% CI) = 0.58 (0.36–1.52), p = 0.23). Conclusion SRA™ is a useful tool for familial stroke caregivers to make lifestyle changes, although it did not reduce personal or relative stroke risk after 3 months usage. Trial registration No: ACTRN12618002050235 (Registration Date: 21st December 2018)