Port Moresby General Hospital (PMGH) is the largest hospital in Papua New Guinea. It is located in Korobosea, a suburb of Port Moresby in the National Capital District. A major teaching hospital, it is adjacent to the University of Papua New Guinea's School of Medicine and Health Sciences. .
We employed single cell RNA sequencing (scRNA-seq) of fine needle aspirates (FNAs) to describe the cells and communication networks characterizing granulomatous lymph nodes of TB patients. We uniformly identified several cell types known to characterize granulomas. Overall we found the T cell cluster to be the most abundant. Other cell clusters that were uniformly detected, but that varied in abundance amongst the individual patient samples, were the B cell, plasma cell and macrophage/dendritic and NK cell clusters. When we combined all our scRNA-seq data from our current 19 patients, we distinguished T, B, macrophage, dendritic and plasma cell subclusters. The sizes of these subclusters also varied dramatically amongst the individual patients. In comparing FNA composition we noted trends in which T cell populations were negatively correlated with NK cell populations and with macrophage/dendritic cell populations. In addition, we discovered that the scRNA-seq pipeline detects Mtb RNA transcripts and associates them with their host cell’s transcriptome, thus identifying individual infected cells. The number of infected cells also varies in abundance amongst the patient samples. CellChat analysis identified predominating signaling pathways amongst the cells comprising the various granulomatous lymph nodes, identifying several pathways involved in immune cell maturation, migration and adhesion.
Using a sociomaterial perspective based on interviews with health workers, we examine how clinic-based HIV viral load testing and early infant diagnosis technologies reshape health care realities in Papua New Guinea. The use of such technologies redefine professional roles and health care experiences by empowering health workers to translate biomedical data into client-centered clinical management, while also contributing systemic tensions, such as the paradoxical recentralizing of care and heavier workloads. Despite these challenges, health workers view these clinic-based technologies as transformative tools that support ethical decision-making, reduce preventable deaths and expand equitable health care.
The International Paediatric Oncology Society Global Mapping Programme aims to collect data on global paediatric oncology services by continent, with Africa and Latin America completed. This study reports on the methodology and lessons learned for Oceania, a unique continent with resource disparity across countries, multiple small island developing states, small populations and complex climate and cultural factors. Recruitment and data collection processes have built invaluable regional connections and highlighted the challenges impacting regional childhood cancer care. This first comprehensive overview of paediatric oncology capacity in Oceania addresses a critical evidence gap and will inform future cancer control plans and advocacy.
Background: Tuberculosis (TB) treatment loss to follow-up (LTFU) is an important public health problem because treatment interruption may contribute to unsuccessful treatment outcomes and ongoing transmission. This study describes characteristics and issues reported by TB patients who were lost to follow-up during treatment at Port Moresby General Hospital (PMGH), Papua New Guinea. Methods: A cross-sectional descriptive study was conducted among confirmed pulmonary and extrapulmonary TB patients who had received TB treatment for more than one month and subsequently stopped treatment for more than two months. Eighty-eight patients were selected from the medical ward, TB ward and TB clinic at PMGH between May 2015 and May 2016. Data were collected using a standardized questionnaire through face-to-face interviews after informed consent. Descriptive statistics were used. Results: Of 88 participants, 54 (61%) were female and 34 (39%) male. The largest age group was 23–32 years (36, 41%). Primary education was reported by 46 (52%) and no formal education by 14 (16%). HIV infection was reported in 20 (23%), alcohol use in 40 (46%), smoking in 39 (44%), and betel-nut chewing in 60 (68%). Personal factors were reported in 64 (72%), socioeconomic factors in 37 (42%), and health-system factors in 76 (86%). Symptom resolution was reported in 31 participants, belief in sorcery in 18, and TB-drug adverse effects in 15. Treatment interruption occurred during the continuation phase in 51 (58%) and intensive phase in 37 (42%). Conclusion: Health-system factors were the most frequently reported category among TB patients experiencing LTFU, followed by personal and socioeconomic factors. Patient education, adverse-effect management, treatment support, improved follow-up systems and attention to transportation barriers may improve treatment continuity. Because the study included only patients who experienced LTFU, the findings should be interpreted as descriptive rather than as statistically demonstrated risk factors.
BACKGROUND:Maximal safe surgical resection remains a major determinant of outcome in high grade glioma, with increasing resection and lower residual tumour volume associated with improved survival. However, the oncologic benefit of aggressive resection is conditional on preservation of neurological function and timely delivery of adjuvant therapy. Much of the evidence informing operative strategy derives from highly resourced healthcare systems and may not be directly applicable across heterogeneous practice environments. We therefore sought to synthesise contemporary evidence regarding extent of resection and develop a capability-aligned framework for context aware operative decision making. METHODS:A structured narrative synthesis was undertaken examining literature relating to extent of resection, residual tumour burden, surgically acquired neurological deficits, operative adjuncts, tumour biology, and timing of adjuvant therapy in high grade glioma. This evidence was integrated with literature describing variability in neurosurgical and oncological capacity across diverse healthcare settings. Tumour complexity was stratified according to established anatomical and functional determinants of resectability and mapped to a four-level institutional capability classification to develop an evidence-informed conceptual framework. RESULTS:Increasing extent of resection was consistently associated with improved survival; however, this benefit was strongly influenced by preservation of neurological function and access to timely adjuvant therapy. Operative adjuncts increased the likelihood of achieving safe maximal resection, while tumour biology and treatment context modified the relative contribution of surgery to overall outcome. Variability in institutional capability influenced both operative safety and the ability to realize meaningful oncological benefit. Integration of tumour complexity with institutional capacity provided a structured basis for calibrating operative ambition, aligning operative strategy with available infrastructure, and guiding referral across heterogeneous practice environments. CONCLUSION:Extent of resection strategies derived from highly resourced settings cannot be uniformly extrapolated across heterogeneous healthcare systems. An evidence-informed, capability-aligned framework integrating tumour complexity, institutional capacity, and access to downstream neuro-oncology care provides a pragmatic conceptual model for context aware surgical decision making in high grade glioma.
