A 25-year old primigravida at 11-weeks period of amenorrhoea presented with bilateral optic neuritis following Varicella Zoster viral (VZV) infection. She was serologically positive for systemic lupus erythematosus but negative for virus. The exact pathogenesis of the patient's severe optic neuritis, adduction and neurological deficit was unknown. The initiation of high dose steroids for optic neuritis was a big clinical dilemma in a pregnant patient with viral infection. The patient was treated with high dose steroids after three days of commencement of antiviral treatment. At 6 months after presentation, her visual acuity in the right eye was 6/36 with perception to light in the left.
*Herpes Zoster ; Lupus Erythematosus, Systemic/complications ; Optic Neuritis/*virology ; Pregnancy Complications, Infectious/*virology

Objective: To determine the efficacy Eucalyptus teritocornis ethanoloic leaf extract in the treatment of Staphylococcus aureus infected skin wound in Albino Spraque Dawley rats (Rattus norvegicus). Design: Experimental design: four (4) treatment groups with 5 rats each. Population: Twenty (20) Albino Spraque Dawley rats of the same age, sex and weight (+/-20 grams) were randomly distributed into 4 treatment groups. Intervention: Each group was assigned, to either E. tereticornis ethanol extract, 2 percent Mupirocin cream. Plain normal saline solution and no treatment. Outcome measures: Cure rate, rate of epithelialization, Rate of granulation, Scar formation and Bacterial growth in culture Results: The study revealed a 100 percent cure rate for the E. tereticornis extract treated group 7 days post treatment which is clinically higher than the 40 percent cure rate of the no treatment group, 60 percent cure rate of the Plain NSS group and 80 percent cure rate of the 2 percent. Mupirocin cream treated group. On the histologic findings, the rate of epitheliazation and rate of granulation of tissue was found to be comparable in the E. tereticornis group and 2 percent Mupirocin cream group and was significantly higher than the NSS group and no treatment group. Growth of bacterial culture and scar formation were found not be statistically significant. Conclusion: Based on the data, there is no sufficient evidence to suggest that E. Tereticornis ethanolic leaf extract is efficacious in the treatment of S. aureus infected wound lesions, however, the rate of epithelialization and granulation of tissue was found to be statistically higher in the E. tereticornis group which is comparable to the rate of epitheliazation and granulation of tissue of the 2 percent Mupirocin group.
Child ; STAPHYLOCOCCUS AUREUS ; PLANTS, MEDICINAL ; RATS ; SPRAGUE-DAWLEY

OBJECTIVE: To determine the completeness and acceptability of the cause of (COD) statements in death certificates before and after the conduct of an educational intervention aimed at improving COD certification in Province X.

METHODS: A random sample of 7939 death certificates from the year 1986-2006 was obtained. Part 1 of the COD section of the certificates was evaluated for completeness and for acceptability of the COD. Interrupted time series study was employed with semi-annual as the time point used in the analysis. The study covered 42 time points from 1986-2006. The proportions of complete and acceptable COD for each time point were calculated and segmented linear regression was applied to compare the time trend before and after the educational intervention.

RESULTS: Of the 7939 death certificates, only 35.3% were completely filled up, of which 16.5% had acceptable overall COD. The average proportions of all the death certificates with acceptable item entries in the immediate, antecedent, and underlying causes are 30.1%, 57.0% and 25.0%, respectively. The time series data on the acceptability of the COD statement revealed a significantly higher trend after the educational intervention.

CONCLUSION: A large proportion of the COD section of death certificates have incomplete and unacceptable entries. However, the acceptability of the COD statement improved after the educational intervention.

Human ; Death Certificates ; Interrupted Time Series Analysis ; Certification ; Employment

We report the case of a rare association of a congenital Gerbode defect with severe mitral regurgitation due to abnormal linear structure of mitral valve, diagnosed in an adult patient. The case highlights the importance of a thorough examination interpreting the echocardiographic findings on a pathophysiological basis. It also underlines the complementary role of different imaging techniques with transesophageal echocardiography, allowing the precise assessment of both structural and functional abnormalities in such a complex case. The patient underwent mitral valve replacement with a bileaflet mechanical prosthesis and repair of the Gerbode defect. The imaging findings were confirmed during the surgical procedure, leading to a good outcome.
Adult* ; Echocardiography ; Echocardiography, Transesophageal ; Heart Septal Defects ; Humans ; Mitral Valve Insufficiency ; Mitral Valve* ; Prostheses and Implants

BACKGROUND: In 2012, the Philippine Department of Health (DOH) established the Health Systems Research Management (HSRM). One of the HSRM components is increasing the research capacity of the Centers for Health Development (CHD) which is the regional office of the DOH.

OBJECTIVE: To determine the research capacity of CHDs and to describe research input, research process, and research output.

METHODS: A descriptive cross-sectional study design was employed. The data were collected using self-administered questionnaire with the Regional Director as the CHD respondent. The research capacity level was determined using rating scale measurement. Based on the ratings, each CHD was assigned a score with the corresponding capacity level: excellent (85-100%); good (70-84%); fair (51-69%); poor (<50%).

RESULTS: Fourteen (82%) of the 17 CHDs participated in the study. The institutional capacity level of the CHDs was poor in the areas of research management (43.0%) and in structure/ organization/ monitoring/ evaluation (30.0%), while it was fair in the area of resource mobilization (54.5%). Research input, research process, and research output were found to be lacking.

CONCLUSION: The capacity level of the CHDs in the various aspects of institutional research ranged from poor to fair. Specific areas under research input, research process, and research output that need improvement were identified which can be used as benchmark for capacity-building activities and as information-base against which the effectiveness of these activities in the CHDs can be evaluated.

Research

Mitral regurgitation (MR) represents the second most frequent valvular heart disease. The appropriate management of organic MR remains unclear in many aspects, especially in several specific clinical scenarios. This review aims to discuss the current guideline recommendations regarding the management of organic MR, while highlighting the controversial aspects encountered in daily clinical practice. The role of imaging is essential in establishing the most appropriate type of surgical treatment (repair or replace), which is based on morphological mitral valve (MV) characteristics (reparability of the valve) and local surgical expertise in valve repair. The potential advantages of 3-dimensional echocardiography in assessing the MV are discussed. Other modern imaging techniques (tissue Doppler and speckle tracking) may provide additional useful information in borderline cases. Exercise echocardiography (evaluating MR severity, pulmonary pressure, or right ventricular function) may have an important role in the management of difficult cases. Finally, the moment when surgery is no longer an option and alternative solutions should be sought is also discussed. Although in everyday clinical practice the timing of surgery is not always straightforward, some newer clinical and echocardiographic indicators can guide this decision and help improve the outcome of these patients.
Echocardiography ; Heart Valve Diseases ; Humans ; Mitral Valve ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency*

INTRODUCTIONThe objective of this case report was to illustrate the diagnostic and intervention approach of anomalous right coronary artery (RCA).

CLINICAL PICTUREA 60-year-old man presented with acute inferior myocardial infarction. Cardiac catheterisation revealed an anomalous RCA arising from the posterior coronary sinus as the infarct-related artery.

TREATMENTAd hoc percutaneous coronary intervention with stent implantation was performed using a few technical modifications.

OUTCOMEGood angiographic result was achieved within 90 minutes, with 260 mL of contrast used.

CONCLUSIONA high index of suspicion and logical diagnostic and intervention approach are required for the proper management of anomalous RCA.

Angioplasty, Balloon, Coronary ; Cardiac Catheterization ; methods ; Coronary Angiography ; Coronary Vessel Anomalies ; complications ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; surgery

Background: Early-onset sepsis (EOS) is a leading cause of morbidity and mortality among neonates. Diagnosis of EOS can be difficult as clinical signs are subtle. The use of the Neonatal EOS Calculator (NEOSC) may help screen high-risk neonates for EOS and may result in a significant reduction in unnecessary antibiotic use. Objective: To determine the diagnostic accuracy of the NEOSC in screening for EOS in neonates more than 35 weeks age of gestation. Methodology: This was a retrospective, case-control study where 245 septic (cases) and 245 non-septic (controls) neonatal and maternal medical records were reviewed. The EOS risk classification from the NEOSC was compared with the actual clinical outcome. An online statistical software (medcalc.org) was used to compute for the sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and accuracy of the NEOSC. Results: Based on the NEOSC, only 64 of 245 clinically septic neonates were truly positive for sepsis while 181 were falsely negative for sepsis. Of the 245 non-septic neonates, 3 were falsely positive for sepsis, while 242 were truly negative for sepsis. With a 95% confidence interval, the computed variables showed a Sn 26.12%, Sp 98.78%, PPV 76.12%, NPV 89.95%, PLR 21.33, and NLR 0.75. The accuracy of the NEOSC is 89.33%. Conclusion The NEOSC had poor sensitivity and is not recommended in screening for EOS in neonates more than 35 weeks age of gestation. It may be used as an adjunct in EOS diagnosis due to its high specificity and accuracy.
Neonatal Sepsis

Obesity, which continues to increase worldwide, was shown to irreversibly impair the differentiation potential and angiogenic properties of adipose tissue mesenchymal stromal cells (ADSCs). Because these cells are intended for regenerative medicine, especially for the treatment of inflammatory conditions, and the effects of obesity on the immunomodulatory properties of ADSCs are not yet clear, here we investigated how ADSCs isolated from former obese subjects (Ex-Ob) would influence macrophage differentiation and polarization, since these cells are the main instructors of inflammatory responses. Analysis of the subcutaneous adipose tissue (SAT) of overweight (OW) and Ex-Ob subjects showed the maintenance of approximately twice as many macrophages in Ex-Ob SAT, contained within the CD68＋ /FXIII-A− inflammatory pool. Despite it, in vitro, coculture experiments revealed that Ex-Ob ADSCs instructed monocyte differentiation into a M2-like profile, and under inflammatory conditions induced by LPS treatment, inhibited HLA-DR upregulation by resting M0 macrophages, originated a similar percentage of TNF-α＋ cells, and inhibited IL-10 secretion, similar to OW-ADSCs and BMSCs, which were used for comparison, as these are the main alternative cell types available for therapeutic purposes. Our results showed that Ex-Ob ADSCs mirrored OW-ADSCs in macrophage education, favoring the M2 immunophenotype and a mixed (M1/M2) secretory response. These results have translational potential, since they provide evidence that ADSCs from both Ex-Ob and OW subjects can be used in regenerative medicine in eligible therapies. Further in vivo studies will be fundamental to validate these observations.