To assess the salt tolerance of the malaria vector Anopheles farauti sensu stricto, larvae were collected from a freshwater environment on the outskirts of Honiara, Solomon Islands and placed in trays containing water with salinity varying from freshwater to seawater. Dead larvae and pupae and emerged adults were recorded and preserved. Most adults and nearly half of the larvae and pupae were then subjected to DNA analysis for species identification. No adult An. farauti emerged after prolonged immersion of larvae in undiluted seawater (3.5% salinity), although temporary immersion before pupation was compatible with survival. Salinities of up to 2.2% to 2.5% were compatible with good survival and adult emergence, at least from fourth instars. The results suggest that higher salinities may slow larval development and show that mortality at a given salinity is not uniform.
Animals ; Anopheles - drug effects ; Anopheles - growth & ; development ; Colony Count, Microbial ; Sensitivity and Specificity

Disasters ; Medicine ; Physical And Rehabilitation Medicine ; Rehabilitation

This case report presents two patients who underwent fibular strut grafting for complex revisions of previous lumbar spine arthrodeses. A case review of the Electronic Medical Record at the index institution was performed to evaluate the timeline of events of the two patients who underwent fibular strut grafting for complex revisions of previous lumbar spine arthrodesis, including imaging studies, progress notes, and laboratory results. One patient had developed chronic L3 vertebral body osteomyelitis from a prior fibular allograft and instrumentation placed for a traumatic burst fracture. The second patient had a severe scoliosis recalcitrant to prior arthrodeses in the context of Marfan syndrome and a persistent L4-5 pseudarthrosis. Both patients underwent free vascularized fibular autograft revision arthrodeses. At most recent long-term follow-up, both patients had improved clinically and neither had required further revision. The use of free vascularized fibular grafting is an excellent option for a variety of spinal indications, and these two reports indicate that the technology may have an indication for use after multiple failed surgeries for osteomyelitis or correction of a multi-level large spinal deformity secondary to Marfan syndrome.
Allografts ; Arthrodesis ; Autografts* ; Congenital Abnormalities ; Electronic Health Records ; Fibula ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; Marfan Syndrome ; Osteomyelitis ; Pseudarthrosis ; Scoliosis ; Spine* ; Transplants

INTRODUCTION: We investigated sex and ethnic differences in the incidence, clinical characteristics and 1-year mortality of patients with newly diagnosed AF in a multi-ethnic population. METHOD: This retrospective cohort study of patients diagnosed with AF from 2008 to 2015 was based on medical claims, casemix and subvention data submitted to the Ministry of Health. Patients with AF were matched with controls without AF for age (3-year bands), sex and ethnicity, and categorised as middle-aged (45-64 years) or elderly (≥65 years) among major ethnic groups in Singapore (Chinese, Malay and Indian). RESULTS: Among 40,602 adults with AF (elderly 74%), Malays had the highest age-standardised incidence rate of AF, followed by Chinese and Indians; and the rate was higher in men. Despite having the worst cardiovascular risk profile, Indians had the lowest prevalence and incidence of AF. The 1-year mortality rate after newly diagnosed AF was 22-26 deaths per 100 people. Newly diagnosed AF was independently associated with increased 1-year all-cause mortality among middle-aged (adjusted odds ratio [AOR] 9.08, 95% confidence interval [CI] 7.36-11.20) and elderly adults (AOR 3.60, 95% CI 3.40-3.80) compared with those without AF. Sex differences in mortality among patients with AF were limited to elderly adults (men: AOR 1.17, 95% CI 1.11-1.24), while Indians were associated with a 30% increased odds of mortality compared with Chinese regardless of age (middle-aged: AOR 1.27, 95% CI 1.09-1.548 elderly: AOR 1.33, 95% CI 1.22-1.45). CONCLUSION Variations in incidence, clinical profile and 1-year mortality of patients with AF in a nationwide cohort were influenced by sex and ethnicity. Newly diagnosed AF portends a worse prognosis and is a marker of high mortality within the first year.
Adult ; Aged ; Atrial Fibrillation/complications* ; Ethnicity ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore/epidemiology*

Acute overdose of metformin can show potentially fatal lactic acidosis. Management should be directed towards close monitoring of renal function and hemodynamics. Patients may require dialysis or extracorporeal membrane oxygenation in cases of hemodynamic instability. This case presents an adolescent with massive metformin ingestion estimated at 100 g leading to metformin-associated lactic acidosis and subsequent respiratory failure, cardiovascular collapse, and acute kidney injury. The complications were successfully managed with venoarterial extracorporeal membrane oxygenation, continuous renal replacement therapy, and mechanical ventilation.

Objective. The present study aims to correlate the LGU list of PhilHealth Sponsored Members in a municipality of Batangas with the list of poor residents as identified by the Participatory Action Research (PAR) methodology. Method. Interview of key informants documented the processes utilized by the LGU in determining PhilHealth beneficiaries for the Sponsored Program and the Participatory Action Research (PAR) survey in the classification of households into poor, middle and rich in four barangays of the municipality. The list of LGU Sponsored members was then cross matched with the PAR household classification. Results. The comparison of the LGU list of Sponsored members and the household classification by the PAR survey showed a wide discrepancy: (1) 464 "Not Found" Sponsored households or 70% of the LGU's Sponsored list; (2) inclusion of the non-poor: 140 middle class families as classified by the PAR survey or 21.1% of the LGU's Sponsored list; and (3) exclusion of 413 or 87.5% of true poor families identified by the PAR Survey. Only 59 families or 8.9% of the LGU Sponsored list were classified as poor families by PAR. Conclusion. PAR offers communities, LGUs and the National Health Insurance Program a tool to validate the coverage of the Sponsored program. LGUs and the PhilHealth should consider such tool or similar tools to validate their identification, selection and enrollment of the poor, which is extremely vital in achieving universal coverage. Given the right tool, communities are in the best position to identify the poor for the Sponsored program. By way of collaboration with the underprivileged themselves, the academe has a role in assisting communities in acquiring collective awareness of their own situation and developing capacity for improving their lives. The academe also has a role in assisting LGUs in improving their health systems and national health programs in validating and improving their implementation. Further studies should be done to investigate the following: the identity of the "not found" SP members; the utilization of PhilHealth benefits by the poor; and the prospect of utilizing the PAR method by other non-academic institutions in monitoring the progress of community programs.
Human ; Male ; Female ; PUBLIC-PRIVATE SECTOR PARTNERSHIPS ; HEALTH SERVICES ; INSURANCE, HEALTH ; HEALTH CARE ECONOMICS AND ORGANIZATIONS ; ECONOMICS ; FINANCING, ORGANIZED ; INSURANCE

Objective: The therapeutic benefits of poly(ADP-ribose) polymerase inhibitors highlight the need to evaluate BRCA1/2 defects in tubal/ovarian cancer (OC). We sought to determine the pattern and disease characteristics associated with tumor BRCA1/2 mutations and BRCA1 methylation in women with OC. Methods: We obtained 111 OC specimens from 2 university hospitals and assessed BRCA1/2 mutations and BRCA1 methylation in tumor DNA. The frequency and pattern of BRCA1/2 defects were examined. Associations between patient/disease characteristics and BRCA1/2 defects were ascertained (Fisher’s exact test). Platinum-free interval (PFI), progression-free survival (PFS), and overall survival (OS) based on the underlying BRCA1/2 defect were determined (Kaplan-Meier analysis [log-rank test]). Results: We observed a BRCA1/2 dysfunction rate of 40% (28/70) in high-grade serous tubal/ovarian cancer (HGSC), including 14.3% BRCA1 methylation (n=10), 7.1% BRCA1 mutation (n=5), and 18.6% BRCA2 mutation (n=13). Defects in BRCA1/2 genes were associated with stage III/IV HGSC (BRCA1 methylation: P=0.005 [stage III/IV] and P=0.004 [HGSC]; BRCA1/2 mutation: P=0.03 [stage III/IV] and P<0.001 [HGSC]). Patients with BRCA1/2-mutated cancers showed improved OS (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.43–0.99; P=0.045) and a trend toward improved PFI (HR, 0.48; 95% CI, 0.22–1.06; P=0.07) and PFS (HR, 0.72; 95% CI, 0.51–1.03; P=0.07). No survival differences were observed between BRCA1-methylated and BRCA1/2 wild-type non-BRCA1-methylated cancers. Conclusion We observed a high tumor BRCA1/2 dysfunction rate in HGSC with a unique predominance of BRCA2 over BRCA1 mutations. While BRCA1/2 mutations conferred survival benefits in OC, no such association was observed with BRCA1 methylation.

Objective: The therapeutic benefits of poly(ADP-ribose) polymerase inhibitors highlight the need to evaluate BRCA1/2 defects in tubal/ovarian cancer (OC). We sought to determine the pattern and disease characteristics associated with tumor BRCA1/2 mutations and BRCA1 methylation in women with OC. Methods: We obtained 111 OC specimens from 2 university hospitals and assessed BRCA1/2 mutations and BRCA1 methylation in tumor DNA. The frequency and pattern of BRCA1/2 defects were examined. Associations between patient/disease characteristics and BRCA1/2 defects were ascertained (Fisher’s exact test). Platinum-free interval (PFI), progression-free survival (PFS), and overall survival (OS) based on the underlying BRCA1/2 defect were determined (Kaplan-Meier analysis [log-rank test]). Results: We observed a BRCA1/2 dysfunction rate of 40% (28/70) in high-grade serous tubal/ovarian cancer (HGSC), including 14.3% BRCA1 methylation (n=10), 7.1% BRCA1 mutation (n=5), and 18.6% BRCA2 mutation (n=13). Defects in BRCA1/2 genes were associated with stage III/IV HGSC (BRCA1 methylation: P=0.005 [stage III/IV] and P=0.004 [HGSC]; BRCA1/2 mutation: P=0.03 [stage III/IV] and P<0.001 [HGSC]). Patients with BRCA1/2-mutated cancers showed improved OS (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.43–0.99; P=0.045) and a trend toward improved PFI (HR, 0.48; 95% CI, 0.22–1.06; P=0.07) and PFS (HR, 0.72; 95% CI, 0.51–1.03; P=0.07). No survival differences were observed between BRCA1-methylated and BRCA1/2 wild-type non-BRCA1-methylated cancers. Conclusion We observed a high tumor BRCA1/2 dysfunction rate in HGSC with a unique predominance of BRCA2 over BRCA1 mutations. While BRCA1/2 mutations conferred survival benefits in OC, no such association was observed with BRCA1 methylation.

Pediatric intracerebral hemorrhage is a rare condition among children. We discuss the case of a 7-year-old Filipino male with generalized tonic seizures and diagnosed to have both SARS-CoV-2 infection and hypertension secondary to renal arterial stenosis. The occurrence of intracerebral hemorrhage in children, though commonly caused by arteriovenous malformations, may be secondary to an acute hypertensive episode. In this case, the presence of COVID-19 in the patient may have been contributory to the development of spontaneous intracerebral hemorrhage due to its direct endothelial effects, as well as its dysregulatory action on the renin-angiotensin-aldosterone system.
COVID-19 ; Hypertensive Crisis ; Renal Artery Obstruction

Bullous pemphigoid (BP) is the most common autoimmune blistering disease primarily characterized by tense blisters and occasionally with urticarial plaques, affecting the skin and mucous membranes. These are caused by autoantibodies against BP180 and BP230 which target antigens on the basement membrane zone. The diagnosis relies on the integration of clinical, histopathological, immunopathological, and serological findings. The management depends on the clinical extent and severity. We present in this article a literature review and the clinical consensus guidelines of the Immunodermatology Subspecialty Core Group of the Philippine Dermatological Society in the management of BP.
Pemphigoid, Bullous