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

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

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

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

Objectives: Leprosy is a chronic granulomatous infection caused by the obligate intracellular organism Mycobacterium leprae. Current diagnostic tests for confirmation and treatment monitoring such as slit skin smear and biopsy are invasive and require time for processing, reading, and interpretation. Dermoscopy is a technique that allows the visualization of structures not readily seen by the naked eye. It can be performed at the point of care, providing a non-invasive link between clinical and histopathologic examination. This study aimed to determine the dermoscopic findings and associated clinicopathologic findings of the different forms of leprosy. Methods: A cross-sectional study was conducted. All new and follow-up patients aged 19 years old and above clinically diagnosed with leprosy were invited to participate in the study during the three-month investigation period. Clinical and dermoscopic photographs of representative skin lesions were taken, and a review of slit skin smear and histopathology results was done. Data analysis was performed using Stata SE version 13. The association between dermoscopic findings and the following parameters: anatomic location, Ridley-Jopling classification, WHO classification, treatment duration, and average bacteriologic index were analyzed using Fisher’s exact test. The level of significance was set at 5%. Results: A total of 57 lesions were included. Linear vessels (p=0.031), structureless areas (p=0.008), and globules (p=0.002) were found to be significantly associated with the anatomic location. Decreased hair was found to be significantly associated with treatment duration (p=0.038). No significant associations were found between dermoscopic findings and Ridley-Jopling classification, WHO classification, and ABI. Eight biopsies taken at the time of dermoscopy were reviewed, with all sites showing structureless or globular areas corresponding to the presence of granulomas on histopathology (100%). No other notable associations were observed. Conclusion Dermoscopy is a potentially useful tool to aid in the diagnosis and treatment monitoring of leprosy. Limitations of this study include the small sample size, the preponderance of subjects in the lepromatous pole, and assessments by a single trained dermoscopist. A longer study duration including a larger number of newly diagnosed leprosy patients is recommended.
Leprosy ; Dermoscopy

Objectives: Currently, there are no local studies examining wound dressing usage among pressure ulcers in Filipino patients. The study aims to provide preliminary Philippine data among in-patients with pressure ulcers: their demographic characteristics, wound characteristics, wound dressing usage, and associated outcomes per wound dressing. Methods: A retrospective chart review of patients admitted at the Philippine General Hospital from 2011 to 2017 with a diagnosis of pressure ulcer was conducted. Results: Eighty-five records were retrieved; 56% were female and 44% male, with a mean age of 47.67 ± 23.03 years. The mean number of ulcers per patient was 1.65 ± 1.37, mostly in Stages 2 and 3, and 90.6% were in the sacral area. Seventy-three (85.9%) had utilized at least one form of the wound dressing, mostly plain gauze (83.5%), usually with silver sulfadiazine or Dakin’s solution. Only a smaller subset used silver-impregnated dressings (10.55%) and hydrocolloid dressings (5.9%). Comparing advanced versus basic dressings for improved wound outcomes, the crude odds ratio was 3.81 (1.62 - 8.99; p-value 0.003), which on stratification accounting for bed turning, became 8.92 (1.66 - 47.97; p-value 0.009) for those bed turned and 3.05 (1.01-9.20; p-value 0.075) for those not bed turned. Conclusion Filipino in-patients with pressure ulcers were similar to those in the literature in terms of the mean number of ulcers and site of involvement. Basic gauze dressings, combined with topical agents, constitute the majority of wound dressing practice. Use of an advanced wound dressing showed a trend favoring improved outcomes, enhanced by pressure redistribution through bed repositioning.
Pressure Ulcer ; Retrospective Studies

Background: Leprosy, a chronic granulomatous disease affecting mainly the skin and peripheral nerves, has widely recognized ocular complications. It is a significant cause of visual impairment in countries where it is still prevalent, including the Philippines. Methods: This was a cross-sectional study that determined the clinical profile and distribution of ocular pathology among Filipino patients with leprosy seen at a tertiary institution in the Philippines. Results: A total of 67 patients consented to be included in the study and were evaluated by an ophthalmologist. Thirty-seven out of the 67 patients diagnosed with leprosy had reported ocular findings. The average age was 41.2 ± 13.1 years and the majority of patients were men (78%). Thirty-six patients were multibacillary cases, 10 (27%) had a lepra reaction, and 24 (65%) were undergoing multi-drug therapy. Three patients had varying degrees of visual acuity impairment (one was visually impaired with visual acuity [VA] 6/24-6/60, one with VA 3/60-5/60, and one with VA <3/60). Steroid-induced cataracts occurred in four patients (6%) with concurrent or previous systemic corticosteroid treatment for lepra reactions. Univariate logistic regression and Fisher’s exact test of patient-, disease-, and treatment-related variables on ocular morbidity revealed non-significant values for all variables except for age with an odds ratio of 1.1 (95% CI, 1.04, 1.16) (p = 0.001). Conclusions No ocular morbidities directly caused by leprosy were seen, and treatment-related ocular findings (steroid-induced cataracts) were the only morbidities documented. There is an age-related risk for developing ocular morbidity in patients with leprosy.
Cataract ; Cross-Sectional Studies ; Eye Diseases ; Leprosy

Background: Xerosis is one of the most common dermatologic complaints in the elderly. People in the tropics, including the Philippines, have effectively used coconut oil as a traditional moisturizer for centuries. Its film-forming qualities allow it to act as a skin moisturizer and as a protectant against moisture loss. To date, only one randomized clinical trial has proven the efficacy and safety of coconut oil as a skin moisturizer for xerosis. With the increasing number of VCO products in the market, this study aimed to validate the use of an indigenous agricultural product, virgin coconut oil, for senile xerosis. With its moisturizing, antioxidant, and antiseptic effects, VCO may be superior and more cost-effective compared to the frequently used synthetic mineral oil. Objective: This study aimed to determine the efficacy and safety of virgin coconut oil compared to mineral oil for the treatment of senile xerosis. Methods: This was a community-based assessor-blinded, randomized controlled trial, which included elderly patients with mild to moderate senile xerosis of the legs. Participants were instructed to apply the test oil twice daily to the legs for 2 weeks. The following primary outcomes were measured at baseline and 2-weeks post treatment: skin dryness (over-all dry skin score, ODSS), skin hydration (corneometer readings), skin lipid content (sebumeter readings), and quality of life (Dermatology Life Quality Index). Secondary outcomes like patient-assessed clinical efficacy and adverse effects were also measured. Results: A total of 148 participants (59 males, 89 females) with mean age of 68 years (SD 6.02) were included in the study. Eighty-one (81) were assigned under the VCO group and 67 under the mineral oil group. There was a total of 25 dropouts, 7 in the virgin coconut oil group, and 18 in the mineral oil group. The distribution of the patients’ ODSS after treatment with VCO and mineral oil showed a trend towards improvement: 43% in the VCO group had no visible signs of leg xerosis versus 22.4% in the mineral oil group. The proportion of participants with>1 point decrease in ODSS, was statistically greater in the VCO group at 74% (60/81) compared to the mineral oil group, 34% (23/67) (p<0.0001). VCO showed significantly greater skin hydration at 74% (60/81) as compared to 46% (31/67) in the mineral oil group (p<0.0010). Improvement in the skin lipid content using the sebumeter showed 82.7% (67/81) in the VCO group compared to 61.2% (41/67) in the mineral oil group (p=0.6591). Moreover, the patients’ perceived efficacy of the oil applied on their skin was 29.6% (24/81) in the VCO group compared to 5.9% (4/67) in the mineral oil group (p=0.0030). Baseline DLQI scores showed no significant difference in the assessed quality of life of the patients between the two treatments (p=0.0161).Over all, the VCO group showed 32.1% (26/81) treatment success compared to 8.9% (6/67) in the mineral oil group (p=0.004614). Adverse events in the 2 groups were all mild and transient with 8% (6/74) patients in the VCO group and 26.5% (13/49) in the mineral oil group (p=0.089). Conclusion Among elderly patients with mild to moderate xerosis, 2-week topical application of VCO was superior to mineral oil in the immediate improvement of leg xerosis based on primary outcome measures of the Over-all Dry Skin Score (ODSS), corneometer, sebumeter readings, and the Dermatology Life Quality Index.
Coconut Oil ; Mineral Oil

Objectives: Leprosy is an infectious disease affecting the skin and nerves caused by Mycobacterium leprae. Closer physical distance was found to increase risk transmission. Thus, targeted provision of prophylactic medications to household contacts of patients with leprosy could possibly aid in decreasing its incidence in a cost-effective manner. This study aimed to determine the attitudes towards disclosure of the diagnosis of leprosy and acceptance of immuno- and chemoprophylaxis for household contacts of patients undergoing treatment in a dermatology outpatient clinic of a tertiary hospital in the Philippines. Methods: We conducted a prospective, single-center, cross-sectional and mixed methods study at a dermatology clinic of a tertiary hospital. All diagnosed leprosy patients, household contacts of leprosy patients, and individuals with no leprosy and no known contact with a leprosy case were invited. Eligible participants who gave consent were included in the cross-sectional survey, followed by in-depth interviews of selected participants. STATA 12 was used to analyze the data. Descriptive statistics were used to summarize information. Chi-square was computed to obtain a measure of association of important variables. The field notes and the verbatim transcriptions of the interviews and narratives were filed using an analytic memo system. Results: Fifty-five participants (22 Hansen’s disease patients, 13 household contacts, and 20 individuals unaffected by and unexposed to leprosy) were enrolled. Mean age of respondents was 38 years, 60% were female, and 85% were living in an urban setting. Majority of the patients with leprosy were borderline lepromatous (45%) to lepromatous type (27%) with mean treatment duration of 13 months. Overall, the respondents were willing to disclose the diagnosis of leprosy to their household members to facilitate provision of prophylaxis. They were also generally willing to receive prophylaxis despite potential side effects, expense, incomplete protection, and the need for yearly assessment for the development of leprosy. All respondents felt hopeful about the availability of medications that can prevent the development of leprosy and its complications, with some feeling anxious and only a few being embarrassed about receiving them. Conclusions Prophylactic medications were found to be generally acceptable despite some concerns. There is also a willingness to disclose the diagnosis of leprosy to facilitate the targeted provision of prophylaxis to household contacts.
Leprosy ; Post-Exposure Prophylaxis ; Attitude

Background: Skin diseases that are longstanding or highly symptomatic can have devastating consequences in the quality of life of children. There is a need to have a validated Filipino translation of a dermatology quality of life tool for young patients with skin diseases. Objectives: To assess the validity and reliability of the Indeks ng Kalidad ng Buhay Pang-dermatolohiya ng mga Bata (IKPaB), a Filipino translation of the Children’s Dermatology Life Quality Index (CDLQI). Methods: This cross-sectional study was conducted among children aged 4 to 16 years at a tertiary hospital outpatient department. The IKPaB was pretested and revised using focus group discussion until it was approved by the original developers for validation. Face validity was determined through cognitive debriefing interviews. Construct validity was determined by comparing IKPaB scores of participants with skin disease and without skin disease using Mann-Whitney U test. Criterion validity was determined by comparing IKPaB with a validated Filipino-translated PedsQL as the criterion, using Spearman rank correlation. Internal consistency reliability was determined using Cronbach’s coefficient. Multiple regression was used to correlate age, sex and disease duration. Results: The IKPaB was assessed to be comprehensible, clear, and culturally appropriate. Among 288 participants, it showed satisfactory construct validity (U = 8849, Z= 0.87; P = 0.89) and internal consistency reliability (α = 0.89), with a negative but weak correlation with the PedsQL® (rho= -0.300, P = 0.000). Conclusion The IKPaB is a valid and reliable Filipino translation of CDLQI. We recommend further validation for use in clinical practice and research.
Quality of Life ; Child