BACKGROUND: Antibodies to neuronal extracellular membrane antigens, including the NR1 subunit of the N-methyl-D-aspartate receptor, have been associated with neuropsychiatric symptoms. In 2003, the first case of anti-NMDA receptor encephalitis was identified in a young woman with subacute onset of ehavioural changes and seizures.
OBJECTIVES: The aim of this case report is to describe the clinical features, disease course and management of a documented case of anti-NMDA receptor encephalitis in the Philippines. It also aims to highlight a unique feature of the disease as seen in the patient.
CASE DESCRIPTION: The patient is a 36-year-old female with no known co-morbidities presenting with subacute onset of ehavioural change and generalized seizures. She was initially worked-up for viral encephalitis but the diagnostic tests were negative. With a suspicion of anti-NMDA receptor encephalitis, a search was made for the presence of a teratoma. This was confirmed by imaging studies and subsequent surgical resection of an immature mesenteric teratoma was done. Immunohistochemical assay of both blood and CSF were positive for NMDAR antibodies.
CONCLUSION: This is the first confirmed case of anti-NMDA receptor encephalitis reported in the Philippines. It has the unique feature of being associated with an immature mesenteric teratoma, a finding that has not been reported in literature. The possibility of anti-NMDAR encephalitis need to be considered among patients with subacute onset of ehavioural changes and seizures when usual diagnostic tests for the more common etiologies prove negative.

Human ; Female ; Adult ; Anti-n-methyl-d-aspartate Receptor Encephalitis ; Antibodies ; Encephalitis, Viral ; Mesentery ; Receptors, N-methyl-d-aspartate ; Teratoma

Objective:: To describe a unique case of extrapulmonary tuberculosis (TB) of the temporomandibular area focusing on its insidious and destructive course over a 2-year period with insights into the diagnostic and therapeutic pitfalls encountered throughout its clinical development. Methods:: Study Design: Case Report. Setting: Tertiary Government Hospital. Patient: One. Results: A 33-year old man initially presented with right pre-auricular swelling and trismus that were unresponsive to antibiotic therapy. On subsequent follow-ups, initial symptoms were accompanied by a non-healing right pre-auricular wound, right ear discharge, trismus, and right facial paralysis (House-Brackmann III). Cranial and temporal bone computed tomography scans revealed osteolytic destruction of the right temporomandibular region extending to the auditory canal and of the right mastoid bone extending to the right mandibular condyle and parotid. Infected malignancy of the parotid, mandible and temporal bone were considered, but definitive diagnosis from an incision biopsy revealed caseating granulomatous inflammation consistent with tuberculosis. He was started on anti-tuberculosis medications with significant resolution of pre-auricular swelling, non-healing pre-auricular wound, facial paralysis and ear discharge but minimal improvement in mouth opening. Conclusion Tuberculosis of temporomandibular region is rare and is associated with nonspecific manifestations. Delay in diagnosing and initiating appropriate treatment can lead to morbidity and serious complications involving destruction of the temporal bone, middle ear, mandible and parotid gland over its progression. A high index of suspicion by the physician and awareness of the patient’s health seeking behaviors could have aided in the early diagnosis and treatment of this extrapulmonary TB.
Human ; Male ; Tuberculosis ; Trismus ; Facial Paralysis ; Temporomandibular Joint Disorders

BACKGROUND: The monofilament test is a simple and inexpensive tool used for the detection of diabetic peripheral neuropathy in the community setting but it is unclear whether its use can be extended to patients with neuropathy that is not due to diabetes.

OBJECTIVE: We aimed to determine the sensitivity and specificity of the monofilament test in detecting peripheral neuropathy, diabetic or non-diabetic, using Nerve Conduction Studies (NCS) as the gold standard.

METHODS: In a health assessment activity in Marinduque, patients were assessed by a neurologist as to whether or not they have neuropathy. Monofilament testing was done using the NHANES protocol with a 10-g Semmes Weinstein monofilament. Nerve Conduction Study was used as the gold standard.

RESULTS: Fourteen patients were included in the study. A positive monofilament test was found to be significantly associated with a positive NCS result (p<0.015). The sensitivity of the monofilament test was 57.1%; the specificity was 100%. Positive predictive value was 1, negative predictive value was 0.7, pre-test probability was 83% and post-test probability was 96%.

CONCLUSION: Monofilament testing was found to be useful in detecting peripheral neuropathy in the community setting. If monofilament testing is positive, then peripheral neuropathy is ruled in. If the test is negative but the clinical suspicion is high, then NCS may be warranted. This cuts back the need for NCS to detect neuropathy in the community setting by more than half.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Nutrition Surveys ; Neurologists ; Diabetic Neuropathies ; Sensitivity And Specificity ; Probability ; Neural Conduction

OBJECTIVE: Testicular size is an important determinant of sexual maturity in males. The authors determined the average testicular volume of patients in different age groups who underwent scrotal ultrasonography at the Jose R. Reyes Memorial Medical Center (JRRMMC). METHODS: A database search was performed using the SoliPacs system from January 2016 to October 2020. Ultrasound reports including a scrotal examination were included. Testicular measurements, i.e., length, width, and height were recorded. Ultrasound reports with abnormal testes findings were excluded from the study. RESULTS: A total of 769 patients fulfilled the search criteria. A total of 1354 testes were included in the study after excluding 184 testes with ultrasonographic testicular abnormalities. Testicular size began increasing in size after the age of 10, starting at an average size of 1.9 ml, reaching adult size (15.1 ml) at 17 years of age. The average testicular size, around 17 ml remains the same throughout adulthood (17 to 60 years of age) and begins to decline during senescence (>60 years of age). CONCLUSION Scrotal ultrasonography is a useful and convenient tool in determining testicular volume. The results of this study demonstrate the average adult testicular volume (17 ml) among Filipinos sampled in JRRMMC, as well as the trends in volume growth and decline according to age.
ultrasonography

Mucoepidermoid Carcinoma (MEC) is an epithelial malignant tumor that was first described as a salivary gland malignancy. Though common in salivary gland, it is extremely rare in the vulva with only 2 cases reported in the English language literature and none yet in the Philippines. Due to its low incidence, prognosis and definitive management is still unclear. This is a case of a 68-year-old woman with a history of vulvar pruritus and vulvar mass at the left labia majora. Punch biopsy and review of slides revealed Invasive Squamous Cell Carcinoma, Non-Keratinizing type. She underwent Radical Vulvectomy and Bilateral Lymph Groin Dissection; Wide Excision of Perineal Area; Protective Transverse Loop Colostomy; Gracilis Myocutaneous Flap with Identification of Right and Left Median Circumflex Artery with a final histopathology report of Primary Cutaneous MEC of the vulva with lymph node metastasis.
Vulva ; Vulvar Diseases ; Biopsy

INTRODUCTION: National annual prostatic digital rectal exam (DRE) campaign advocated by the Philippine Urological Association (PUA) started 2 decades ago in over 60 urological centers in the country. It is being used as a tool to educate Filipinos regarding benign and malignant prostate diseases. However, after each campaign, most patients were lost to follow-up leading to delay in diagnosis and low adherence to medications.
OBJECTIVE: To evaluate the effect of short message service (SMS) in the adherence to follow-up of participants after a campaign.
METHODS: The investigators enrolled 126 participants aged 40 years old and above with significant LUTS and/or a prostate cancer suspect, in a two arm, parallel, randomized controlled pilot study at the Jose R. Reyes Memorial Medical Center (center with the most number of participants annually in the Philippines). Participants received daily SMS text messages for 3 days (n = 63) or usual care (n = 63). The primary outcome was follow-up at the outpatient clinic within 1 month after campaign. The investigators used Epi Info version 7 to analyze the data.
RESULTS: Among participants receiving SMS, 21/63 (33.3%) returned, compared to 5/63 (7.94%) in the control group. The relative risk [RR] = 4.2, odds ratio = 5.8 and uncorrected chi-square (X2) = 12.4, at 95% confidence inetrval; p = 0.000429).
CONCLUSION: This pilot study illustrated the feasibility of using SMS reminder among Filipino national prostatic DRE participants to improve adherence to follow-up. However, further research needs to be done to investigate the impact on adherence to medications and delay in diagnosis.

Human ; Male ; Middle Aged ; Text Messaging ; Odds Ratio ; Risk ; Control Groups ; Pilot Projects ; Arm ; Prostatic Diseases ; Prostatic Neoplasms ; Ambulatory Care Facilities

This case report discusses penile strangulation caused by a ball bearing of a fidget spinner in a 9 year - old child. Initial examination revealed a 2 cm x 2 cm metallic ball bearing encircling the base of the penis with gross edema of the distal penile shaft and erythematous penile skin. To release the bearing, a modified string method was used. After removal, skin erosion was treated with debridement and applied with hydrocolloid dressing. Analysis and cross referencing of the case with literature suggest that successful extraction of a constricting object and treatment of penile strangulation, due to the varied nature, causes and effects of penile strangulation, greatly depends on immediate diagnosis and treatment. This spares one from immediate and long term complications, or necrosis with subsequent auto-amputation.

Objective: To determine if vitamin supplementation can prevent the development of color vision abnormalities in patients taking ethambutol as part of DOTS for tuberculosis (TB). Methods: A randomized, placebo-controlled, single-blind clinical trial was conducted among newly diagnosed category-1 TB patients enrolled in DOTS health centers in the third district of Manila from June 2011 to August 2012. Before starting therapy, the participants underwent a complete eye evaluation including baseline color vision tests using the Ishihara Color Vision Plates (Ishihara), Farnsworth Panel D-15 (FD 15), and Lanthony Desaturated D-15. Only subjects who passed the three color vision tests were included in the study. They were divided into 2 groups: Group A received vitamin supplementation and Group B received a placebo. Follow-up color vision testing was done monthly for 3 months. Results: There were 105 patients included in the study, 77 males and 28 females, age ranging from 16 to 68 years with a mean of 37 years. Forty three (43) patients received vitamin supplementation (group A) and 62 received placebo (group B). After one month of DOTS, 5 of 43 patients (11. 6%) in group A and 10 of 62 patients (16.1%) in group B developed color vision abnormalities, detected only with the Lanthony Desaturated test. The absolute risk reduction (ARR) of color vision abnormalities by vitamin supplementation was 4.5%, with the number needed to treat (NNT) of 23. After the second month of therapy, ARR was 7.4% and NNT was 14. ARR was highest in the third month at 8.3%, with a corresponding decreased NNT of 12. Among patients who developed color vision abnormalities, reversal of the abnormalities was observed in 80% of 5 subjects in group A, and 40% of 10 patients in group B. By the third month of treatment, all in group A already had normal color vision, while 40% in group B still showed abnormal color vision. Conclusion This study showed that vitamin supplementation was effective in reducing the risk of, and in reversing cases of, color vision abnormalities among patients undergoing DOTS therapy for tuberculosis.
Tuberculosis ; Ethambutol ; Color Vision ; Optic Neuritis

p style=text-align: justify;strongOBJECTIVE:/strong To evaluate the necessity of placing a drain in post-thyroidectomy patients, we aimed to determine whether insertion of a passive drain as compared to no drain in post-thyroidectomy patients would significantly affect hematoma formation, wound infection, wound dehiscence and length of hospital stay.METHODS:br /Design:/strong Prospective randomized controlled trialbr /strongSetting:/strong Tertiary government training hospitalbr / strongSubjects:/strong Patients who underwent thyroidectomy for various pathologies were divided into two postoperative treatment arms: one group with insertion of a passive drain, and another group without a drain. Hematoma, wound infection, wound dehiscence and length of hospital stay were the outcomes measured per treatment arm.RESULTS:/strong A total of 66 patients were evaluated. There were 54 females (81.81%) and 12 males (18.18%). The mean age for the drain group was 44.88 years and 43.67 years for the no drain group. Four patients developed complications in the drain group and two developed complications in the no drain group. The rate of complications between both groups was not statistically significant. The mean hospital stay of the drain group was 3.15 days which in the no drain group was 2.51 days. The difference in length of hospital stay was statistically significant.CONCLUSIONS:/strong There was no difference in the development of complications among the drain and no drain group. Thyroidectomy without surgical drains was associated with a significant reduction in hospital stay compared to thyroidectomy with routine placement of drains./p
Human ; Male ; Female ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Thyroid Diseases ; Thyroidectomy-surgery ; Drainage ; Postoperative Care ; Thyroid Gland ; Postoperative Complications ; Hematoma

This is an unusual case of a 55 year old male with appendicitis caused by the incarceration of the appendix in an area of tissue reaction from a prosthetic mesh used for open inguinal hernia repair which migrated transanatomically from the right inguinal area into the right lower peritoneal cavity. Isolated appendicitis caused by such phenomenon has never been reported in current literature.

Human ; Male ; Middle Aged ; Appendix ; Appendicitis ; Hernia, Inguinal ; Peritoneal Cavity