1.Tinea Imbricata: Case series on three patients in Sarangani, Philippines.
Non Lemuel Benedict R. ; Dofitas Belen L.
Acta Medica Philippina 2010;44(3):67-71
The imbricata or Tokelau ringworm is an unusual superficial dermatophytosis caused by the anthropophilic Trichophyton concentricum. Three cases of the Tinea imbricata observed at the Municipal Health Office of Kiamba, Sarangani Province, Philippines are reported in this study. All three patients were from an indigenous ethnic group of Sarangani Province and lived in isolated upland communities. Patient 1 was a 30 year old male, Patient 2 was a 40 year old female, and Patient 3 was a 19 year old female. Lesions lasted - 27 years, - 25 years, and 2 years, respectively. All patients presented with characteristic expensive polycyclic to serpiginous scaling lesions, with areas of sparing. Microscopic examination of skin scrapings prepared with potassium hydroxide revealed the characteristic broad, branched, septate, irregular hyphae. Trichopyton concentricum, the causative agent, was isolated in one of the patients using Mycobiotoc agar. Histopathologic examination on 2 of the patients revealed acute and chronic inflammation, and Periodic Acid Schiff- positive fungal hyphae. All patients were started on Griseofulvin 500mg tab once daily. The case series presented here is the first account of Tinea imbricata in the Philippines since the 1990s.
Human ; Male ; Female ; Adult ; Agar ; Ethnic Groups ; Griseofulvin ; Hydroxides ; Hyphae ; Inflammation ; Periodic Acid ; Philippines ; Polynesia ; Potassium Compounds ; Skin ; Tinea ; Trichophyton ; Tinea Capitis
2.Efficacy and safety of petroleum jelly versus permethrin 1% shampoo in the treatment of Prediculosis capitis: An assessor-blinded, randomized controlled trial.
Lipana Ma. Karen ; Tan-Gabon Kathleen Nicole ; Frez Ma.Lorna F. ; Dofitas Belen L.
Journal of the Philippine Dermatological Society 2015;24(2):11-19
BACKGROUND: The high rates of infestation, treatment failures and treatment costs have created the search for new therapies againts head lice.
OBJECTIVE: We compared the efficacy and safety of scalp occlusion with petroleum jelly (PJ) versus permethrin 1% shampoo against Pediculus humanus capitis among school-aged children
METHOD: Seventy-seven children were diagnosed with Pediculosis capitis. Thirty-eight subjects did eight-hour scalp occlusion with PJ, and 39 used permethrin shampoo, both followed by nit combing. Treatments were applied once weekly for three consecutive weeks. Patients were assessed at weeks 1,2,3 and 11. The primary outcome was the proportion of cured subjects and change in quality of life (QOL) scores om week 3 of follow-up. Cure was defined as the absence of variable lice on the hair/scalp or nits on the hair shaft attached within one centimeter from the scalp on visual examination.Secondary outcomes were relapse rate at week 11 ,cosmetic acceptability and adverse events. Effects on QOL were measured using the Dermatology Life Quality Index at baseline and at the end of the third week of treatment.
RESULTS: At Week 3, cure achieved in 47% (18/38) in PJ group 52% (17/33) in permethrin group (RRR 6.7%, 95% Cl: -40.4% to 38%). Relapse rate in the 12th week were 44% (8/18) and 58% (10/17), respectively (p=0.486, Fisher's test ). The differences in treatment effects were not statistically significant.
CONCLUSION: Petroleum jelly scalp occlusion was comparable in cure rates to permethrin. PJ can be a safe, affordable alternative to permethrin as a pediculicide.
Human ; Petrolatum
3.Rapid review on the use of oral fatty acid supplements in the prevention or as adjunct treatment of COVID-19
Rowena Natividad S. Flores-Genuino ; Marquis Von Angelo Syquio G. Joson ; Belen L. Dofitas
Acta Medica Philippina 2020;54(Rapid Reviews on COVID19):901-945
Key Findings
There is lack of clinical evidence supporting the role of oral fatty acid supplements as prevention and adjunctive
therapy for COVID-19.
Long-chain polyunsaturated fatty acids (PUFAs) mediate inflammation and adaptive immune responses. Omega-3
fatty acids promote anti‐inflammatory effects and reduce influenza virus replication.
No clinical evidence supporting the use of oral fatty acid supplements as prevention and adjunctive therapy of
COVID-19 was found.
We found indirect evidence from one systematic review on acute respiratory distress syndrome (ARDS) and two
longitudinal cohort studies on community-acquired pneumonia that showed non-significant and inconsistent
results.
The most common known side effects of omega-3-fatty acids are gastrointestinal in nature. They may also cause
allergy and affect blood clotting if taken with other medications that affect clotting.
There are 2 ongoing clinical trials on eicosapentaenoic fatty acids as an adjunctive therapy to standard oral
nutrition supplements or standard of care in COVID-19 patients.
WHO Interim guidelines, CDC interim guidelines, Infectious Diseases Society of America COVID-19 treatment
guidelines, and the American Thoracic Society did not give any recommendation on the use of nutritional
supplements in patients with COVID-19.
Covid-19
4.Perspectives of a “Good Death” among patients who have recovered from severe COVID-19, immediate family members of patients who have died from COVID-19, and health care providers who took care of patients who have died from COVID-19 in a tertiary hospital.
Ma. Lourdes Josefina K. Cabaluna ; Carla Ysabella B. Dofitas ; Belen L. Dofitas
Acta Medica Philippina 2022;56(18):17-27
Background. The premise of a "good death" is vital in delivering proper care of terminally-ill patients but the COVID-19 pandemic has brought about new challenges and necessary protocols. There is a need to explore this gap in knowledge and understand perspectives of various stakeholders in COVID-19-related deaths.
Objectives. To describe the perception, barriers, and facilitators of a "good death" from COVID-19 survivors, relatives, and healthcare providers in the setting of a COVID-19 tertiary hospital.
Methods. The study was done in a COVID-19 tertiary hospital in Metro Manila from September to December 2021. Three groups of target respondents were invited to participate in the study: 8 survivors of severe/critical COVID-19, 9 close relatives of COVID-19 patients who had died, and 9 healthcare providers who directly cared for COVID-19 patients who had died. Semi-structured in-depth interviews were conducted by video calls which explored themes on good death. Thematic analysis was also done.
Results. A total of 26 respondents were included in the study: 8 COVID-19 survivors, 9 relatives, and 9 healthcare providers. The definition of "Good Death" among the participants focused on "being at peace" and having "everything in order". The experience with COVID-19 were influenced by the fear of the infection and isolation restrictions during hospitalization. Recurring themes across all groups were the fear of COVID-19 and death, importance of family in the healthcare process, difficulty in communication, and cremation viewed as necessary but not preferred.
Conclusion. A "good death" is perceived as a peaceful, prepared experience. The main barriers of a "good death' were the strict restrictions on physically comforting and communicating with patients. Video/voice calls and compassionate health care providers facilitated a better hospitalization experience. Careful study and focus on these factors can improve interventions for terminally ill patients to achieve a "good death" in the Filipino socio-cultural context.
Death ; COVID-19 ; Perception
5.Systematic review and meta-analysis on Synthetic Antifungal versus Keratolytic Agents for Topical Treatment of Pityriasis Versicolor
Rowena Natividad F. Genuino ; Belen L. Dofitas ; 2Maria Christina Filomena R. Batac ; Maria Bettina Teresa G. Pascual ; Aedrian A. Abrilla
Acta Medica Philippina 2020;54(Online):1-15
Background:
Pityriasis versicolor is a common fungal infection of the superficial skin layer caused by Malassezia
furfur, a normal commensal in the skin. Keratolytic agents are popular, cheap, and readily available over-the-counter treatments for pityriasis versicolor. Conventional antifungal agents are more expensive, requiring prescription, and may induce resistant strains. However, evidence of their comparative safety and efficacy is still lacking.
Objectives:
To assess the efficacy and safety of synthetic antifungals compared to keratolytic agents in the topical treatment of pityriasis versicolor through a systematic review.
Methods:
We searched the following databases: MEDLINE (from 1966) through PubMed, CENTRAL (Issue 9 of
12, September 2021), EMBASE (from 1974), LILACS (from 1987); Herdin (from 1970), www.clinicaltrials.gov, www.
isrctn.com, www.trialregister.nl. We contacted researchers in the field, hand searched relevant conference abstracts, and the Journal of the Philippine Dermatological Society 1992-2019. We included all randomized controlled trials involving patients with diagnosed active pityriasis versicolor where topical antifungal was compared with a topical keratolytic for treatment. Two review authors independently applied eligibility criteria, assessed risk of bias using the Cochrane collaboration tool, and extracted data from included studies. We used RevMan 5.3 to pool dichotomous outcomes using risk ratios (RR) and continuous outcomes using the mean difference (MD), using random-effects meta-analysis. We tested for statistical heterogeneity using both the Chi² test and the I² test. We presented results using forest plots with 95% confidence intervals. We planned to create a funnel plot to determine publication bias but were unable to due to few studies. A Summary of Findings table was created using GRADE profile software for the primary outcomes.
Results:
We included 8 RCTs with a total of 617 participants that compared azole preparations (ketoconazole,
bifonazole and econazole) versus keratolytic agents (selenium sulfide, adapalene, salicylic-benzoic acid). Pooled data showed that azoles did not significantly differ from keratolytic agents for clinical cure (RR 0.99, 0.88, 1.12; 4 RCTs, N=274, I2=55%; very low-quality evidence), and adverse events (0.59 [0.17, 2.06]; very low-quality evidence) based on 6 RCTs (N=536). There were two patients given a keratolytic agent (selenium sulfide shampoo) who had acute dermatitis and discontinued treatment.
Conclusion
It is uncertain whether topical azoles are as effective as keratolytic agents in clinical clearance and
occurrence of adverse events in patients with pityriasis versicolor. A wider search of grey literature and local studies are warranted. Larger RCTs with low risk of bias are recommended.
Azoles
;
Tinea Versicolor
6.Knowledge, attitudes, and practices of barangay health workers in Marawi City regarding Hansen’s disease.
Aznaida T. Pandapatan ; Belen L. Dofitas ; Mia Katrina R. Gervasio ; Jolene Kristine G. Dumlao
Acta Medica Philippina 2024;58(17):8-16
OBJECTIVE
To assess the knowledge, attitudes, and practices of Barangay Health Workers (BHWs) in Marawi City regarding Hansen’s Disease (HD).
METHODSA cross-sectional study was conducted among the Barangay Health Workers of Marawi City. This study was conducted in two phases. Phase 1 was questionnaire development where the knowledge, attitudes, and practices (KAP) questionnaire was formulated and administered to six Barangay Health Workers for pre-testing. Phase 2 of the study included the survey and focus group discussion (FGD). A questionnaire comprising of 27 questions was administered to BHWs to assess knowledge, attitude, and practices regarding HD.
RESULTSA total of 49 BHWs underwent the Phase 2 survey and six BHWs joined the FGD. The mean age of all the survey participants was 34.9 ± 19.3 years. Among the 49 participants, 40 (81.6%) were females. The knowledge of BHWs was found to be adequate only in six (12%) BHWs. Positive attitude was observed in 12 (24.5%) and adequate practices regarding HD were observed in 33 (67.3%) BHWs. First-hand experience of diagnosing HD patients was significantly associated with adequate knowledge (p < 0.001) and positive attitude of BHWs (p < 0.001). There was a significant association between > 5 years of experience as BHWs (p = 0.027) and first-hand experience in diagnosing leprosy (p = 0.005) with adequate practices of BHWs regarding HD. In the FGD, BHWs expressed their lack of training which highlighted the need for refresher courses on HD.
CONCLUSIONKnowledge about HD is low among Marawi BHWs due to their inadequate training. The attitudes and practices of BHWs are also affected because of deficient knowledge regarding etiology and transmission of HD. There is a need for adequate training and refresher courses on HD to increase the knowledge of BHWs regarding HD.
Leprosy ; Knowledge ; Attitude ; Health Personnel ; Healthcare Workers ; Social Stigma
7.Systematic review and meta-analysis on synthetic antifungal versus keratolytic agents for topical treatment of Pityriasis Versicolor
Rowena Natividad F. Genuino ; Belen L. Dofitas ; Maria Christina Filomena R. Batac ; Maria Bettina Teresa G. Pascua ; Aedrian A. Abrilla
Acta Medica Philippina 2024;58(1):64-78
Background:
Pityriasis versicolor is a common fungal infection of the superficial skin layer caused by Malassezia
furfur, a normal commensal in the skin. Keratolytic agents are popular, cheap, and readily available over-the-counter treatments for pityriasis versicolor. Conventional antifungal agents are more expensive, requiring prescription, and may induce resistant strains. However, evidence of their comparative safety and efficacy is still lacking.
Objectives:
To assess the efficacy and safety of synthetic antifungals compared to keratolytic agents in the topical treatment of pityriasis versicolor through a systematic review.
Methods:
We searched the following databases: MEDLINE (from 1966) through PubMed, CENTRAL (Issue 9 of
12, September 2021), EMBASE (from 1974), LILACS (from 1987); Herdin (from 1970), www.clinicaltrials.gov, www.
isrctn.com, www.trialregister.nl. We contacted researchers in the field, hand searched relevant conference abstracts, and the Journal of the Philippine Dermatological Society 1992-2019. We included all randomized controlled trials involving patients with diagnosed active pityriasis versicolor where topical antifungal was compared with a topical keratolytic for treatment. Two review authors independently applied eligibility criteria, assessed risk of bias using the Cochrane collaboration tool, and extracted data from included studies. We used RevMan 5.3 to pool dichotomous outcomes using risk ratios (RR) and continuous outcomes using the mean difference (MD), using random-effects meta-analysis. We tested for statistical heterogeneity using both the Chi² test and the I² test. We presented results using forest plots with 95% confidence intervals. We planned to create a funnel plot to determine publication bias but were unable to due to few studies. A Summary of Findings table was created using GRADE profile software for the primary outcomes.
Results:
We included 8 RCTs with a total of 617 participants that compared azole preparations (ketoconazole,
bifonazole and econazole) versus keratolytic agents (selenium sulfide, adapalene, salicylic-benzoic acid). Pooled data showed that azoles did not significantly differ from keratolytic agents for clinical cure (RR 0.99, 0.88, 1.12; 4 RCTs, N=274, I2=55%; very low-quality evidence), and adverse events (0.59 [0.17, 2.06]; very low-quality evidence) based on 6 RCTs (N=536). There were two patients given a keratolytic agent (selenium sulfide shampoo) who had acute dermatitis and discontinued treatment.
Conclusion
It is uncertain whether topical azoles are as effective as keratolytic agents in clinical clearance and
occurrence of adverse events in patients with pityriasis versicolor. A wider search of grey literature and local studies are warranted. Larger RCTs with low risk of bias are recommended.
Azoles
;
Tinea Versicolor
8.Systematic review and meta-analysis on oral azoles for the treatment of pityriasis versicolor.
Rowena Natividad S FLORES-GENUINO ; Belen L. DOFITAS ; Leonila F. DANS ; Ma. Lourdes E. AMARILLO
Acta Medica Philippina 2019;53(1):21-30
Background: Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear. Objectives. To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis Versicolor.
Methods: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status. We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis Versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, time-to-cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess the risk of bias, pool studies, and calculate for treatment effects.
Results: We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality. Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence).There were few adverse effects and were mostly minor and transient.
Conclusions: Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.
Ketoconazole ; Itraconazole ; Fluconazole ; Tinea Versicolor ; Pityriasis ; Systematic Review ; Meta-analysis
9.Recurrent ulcerations and neuropathy in a Filipino child with previously undiagnosed leprosy: A case of Lucio phenomenon in the Philippines.
Mia Katrina R. GERVASIO ; Aznaida T. PANDAPATAN ; Belen L. DOFITAS
Acta Medica Philippina 2019;53(2):191-196
Lucio phenomenon is a distinct necrotizing lepra reaction arising from diffuse lepromatous leprosy that may easily be mistaken for other systemic conditions. We report a 17-year old female admitted for a 4-year history of recurrent, extensive ulcerations with crusting and purulent discharge, involving the arms, legs, face, and back. Clinical presentation, slit skin smear and skin biopsy confirmed the diagnosis of Lucio phenomenon and treatment with multidrug therapy resulted in resolution of the ulcerations.
Human ; Leprosy
10.Serum cytokines in erythema nodosum leprosum versus non-reactional leprosy: A systematic review and meta-analysis.
Mia Katrina R. GERVASIO ; Felix Paolo J. LIZARONDO ; Belen L. DOFITAS
Acta Medica Philippina 2019;53(2):142-151
BACKGROUND: Erythema nodosum leprosum is an immune-mediated complication of leprosy whose underlying mechanism has not yet been fully elucidated, making management difficult.
OBJECTIVES: To determine the serum cytokine profile of ENL compared to non-reactional leprosy states.
METHODS: An open literature search was performed using MEDLINE, Cochrane Library, TRIP and HERDIN electronic databases using the keywords ("cytokines" or "inflammatory mediators") and ("erythema nodosum leprosum" or "ENL") and ("leprosy" or "lepra"). Studies were selected by two independent review authors. Risk of bias was assessed using the Newcastle-Ottawa Scale and statistical analysis was performed using RevMan 5.3 software.
RESULTS: Eight cross-sectional studies with 197 participants were included. Meta-analysis showed that both serum IL-17 and serum IFN-? were significantly decreased (Z 2.39, p = 0.02 and Z 2.74, p = 0.01, respectively) in ENL compared to non-reactional states. However, for IL-1?, IL-6, IL-10, IL-22, TNF-? and TGF-?, no significant differences were found between the two groups.
CONCLUSION: ENL appears to be an exacerbation of the Th2 cytokine response seen in the lepromatous pole of leprosy. However, despite pooling of data, sample sizes remain small resulting in significant heterogeneity. Future studies involving large sample sizes and investigating a wider range of cytokines are encouraged.
Cytokines ; Leprosy