BACKGROUND: Aerococcus urinae is a rare pathogen of endocarditis with high rates of embolic events, valvular damage and mortality.
CASE 1:A 24 y/o male, with mitral valve prolapse, presented with recurrent fever and body malaise for four months. ?-hemolytic streptococci was isolated in his blood 3 months prior, antibiotics for 10 days temporarily relieved his symptoms. He denied illicit drug use, recent dental, genitourinary manipulations. On admission, he was febrile with a 4/6 holosystolic murmur at the apex. He had leukocytosis and elevated acute phase reactants. Blood cultures: Aerococcus urinae. A TEE revealed: ruptured chordae and vegetation at the posterior mitral valve leaflet. Gentamicin for 14 days and Ceftriaxone for 28 days was completed. Mitral valve replacement was done and LV dimension returned to normal.
CASE 2:A 51 y/o male presented with 9 days of fever, chills, and malaise. He was treated with norfloxacin with no relief of symptoms. On admission, he was febrile, with a grade 2/6 holosystolic murmur at the apex and left parasternal area. He had leukocytosis and blood culture grew Aerococcus urinae. Echocardiogram showed mitral stenosis, aortic stenosis and vegetations at the mitral valve and non coronary cusp. Pen-G plus Gentamicin for 14 days and upon discharge, amoxicillin for 2 weeks was completed.
DISCUSSION: Risk factors associated with A. urinae endocarditis are >65 year s of age, male, urologic abnormalities, malignancy and diabetes. Diagnosis isusually made by culture as our cases and both were found to have vegetations by echocardiography. B-lactam and amino glycoside treatment is effective and although mortality is high, both patients improved and were discharged.
CONCLUSION: A. urinae endocarditis does occur in a young population and to those without urologic abnormality.

Human ; Male ; Middle Aged ; Young Adult ; Aerococcus ; Amoxicillin ; Anti-bacterial Agents ; Aortic Valve Stenosis ; Diabetes Mellitus ; Endocarditis ; Mitral Valve ; Risk Factors ;

The Covid pandemic nearly brought our lives into a different dimension beyond our imagination. Measures to ensure the safety of everyone have never been stricter. The education system had to deal with similar restrictions. Everyone shifted to online virtual classes, which has never been easy to both the teachers and students. Not only are we concerned of our responsibilities as educators but responsive to the needs of students and patients as well during these times of uncertainties. This article briefly describes my personal insight on teaching medicine and how patients continue to take part in the learning process of students despite restrictions.

Covid-19

Objectives: This study is designed to estimate appropriate intervention thresholds for the Philippines Fracture Risk Assessment Tool (FRAX) model to identify postmenopausal women with high fracture risk. Methods: Age dependent intervention thresholds were calculated for a woman of body mass index 25 kg/m2 aged 50e80 years with a previous fragility fracture without other clinical risk factors. Fixed thresholds were developed using a database of 1546 postmenopausal women who underwent dualenergy X-ray absorptiometry for clinical reasons. Major and hip fracture risks were estimated using clinical risk factors with and without bone mineral density (BMD) input. Women were categorized to high risk and low risk groups according to the age dependent thresholds. The best cut-points were determined considering the optimum sensitivity and specificity using receiver operating characteristic analysis. Results: The age dependent intervention thresholds of major fracture risk ranged from 2.8 to 6.9% while hip fracture risk ranged from 0.4 to 3.0% between 50 and 80 years of age. Major fracture threshold of 3.75% and hip fracture threshold of 1.25% were the best fixed thresholds observed and non-inclusion BMD in the fracture risk estimations did not change the values. As a hybrid method, 3% major fracture and 1% hip fracture risks for those < 70 years old and age-dependent thresholds for those aged 70 years and above can be recommended. Conclusions The intervention thresholds estimated in the current study can be applied to identify Filipino postmenopausal women with a high fracture risk. Clinicians should decide on the type of thresholds most appropriate.

Objectives: This study is designed to estimate appropriate intervention thresholds for the Philippines Fracture Risk Assessment Tool (FRAX) model to identify postmenopausal women with high fracture risk. Methods: Age dependent intervention thresholds were calculated for a woman of body mass index 25 kg/m2 aged 50e80 years with a previous fragility fracture without other clinical risk factors. Fixed thresholds were developed using a database of 1546 postmenopausal women who underwent dualenergy X-ray absorptiometry for clinical reasons. Major and hip fracture risks were estimated using clinical risk factors with and without bone mineral density (BMD) input. Women were categorized to high risk and low risk groups according to the age dependent thresholds. The best cut-points were determined considering the optimum sensitivity and specificity using receiver operating characteristic analysis. Results: The age dependent intervention thresholds of major fracture risk ranged from 2.8 to 6.9% while hip fracture risk ranged from 0.4 to 3.0% between 50 and 80 years of age. Major fracture threshold of 3.75% and hip fracture threshold of 1.25% were the best fixed thresholds observed and non-inclusion BMD in the fracture risk estimations did not change the values. As a hybrid method, 3% major fracture and 1% hip fracture risks for those < 70 years old and age-dependent thresholds for those aged 70 years and above can be recommended. Conclusions The intervention thresholds estimated in the current study can be applied to identify Filipino postmenopausal women with a high fracture risk. Clinicians should decide on the type of thresholds most appropriate.

The success rate for smoking cessation in the country remain low despite the intensified efforts of the government to curb smoking. There is a need to support tobacco control policies with clinical interventions for smoking cessation. However, cessation experts in the country are few and healthcare workers with training on tobacco interventions are limited.  The project aimed to address the clinical aspect of tobacco control by establishing tobacco cessation services in the community. This was done by providing brief tobacco intervention training among health workers and community leaders, thus allowing this intervention to be integrated in the existing programs of the community health center. This also led to the creation of possible referral mechanisms to cessation support providers. This was complemented with health education activities that promote smoke-free behavior. Keywords: tobacco; cigarette smoking; tobacco dependence; smoking cessation; brief advice; brief tobacco intervention​​​​​
Tobacco ; Pilot Projects

Background: Autoimmune diseases represent a significant health burden for 3% to 9% of the general population, and rheumatology, perhaps more than any other medical subspecialty, encompasses a broad array of such diseases that affect a wide range of organ systems including the eye. It serves as a sensitive barometer of autoimmune phenomena in many of the rheumatic diseases.

Objective: The study determined the various ocular manifestations of all autoimmune inflammatory disorders at the University of Santo Tomas Hospital, Section of Rheumatology and the Department of Ophthalmology from 2003 to 2018.

Methodology: A retrospective cohort study was done involving chart review of patients from both private division and clinical division. Sex, age, duration of disease, medications given, and ocular manifestations were determined. Statistical analysis included frequencies, percentages, and logistic regression analysis.

Results: Sixty-seven patients were included in the study. Of these, 58.2% (39/67) had ocular manifestations secondary to an established autoimmune disease. It was found out that 58.97% (23/39) had Vogt-Koyanagi-Harada syndrome. Other autoimmune diseases with ophthalmologic manifestations were systemic lupus erythematosus at 12.8% (5/39), ankylosing spondylitis at 10.25% (4/39), rheumatoid arthritis and Behcet's syndrome at 5.12% (2/39), and granulomatosis with polyangiitis, scleroderma and psoriatic arthritis at 2.56% (1/39).

Conclusion: In this population, the frequency of ocular manifestations of autoimmune diseases remained low with anterior uveitis as the most common. Close coordination between specialties is very important in the course of treatment and management to lessen its complications and related morbidity.

Autoimmune Diseases

Objective: The project aims to develop a community kitchen manual for public health emergencies.

Participants: The officers and members of the Samahan ng Nagkakaisang Kababaihan ng BASECO served as community respondents for this project. These eight women were in charge of the community kitchen operations, particularly the feeding program during the COVID-19 pandemic.

Implementation: The whole project comes in three phases. The design stage was executed in phase one of this project. The phase one also focused on the development of manual content based on available literatures and considered the interviews conducted with respondents.

Discussion: The manual contains guidelines on food safety and meal preparations. Based on the interview, the proponents identified specific contents that must be included in the guidelines, as compared with the need to improve current operations of the group's community kitchen. Looking at the activities of the community, the proponents indicated the food flow guidelines to ensure a safe, nourishing and accessible community kitchen (S.N.A.C.K).

Conclusion: The designed community kitchen manual may be of use to lay groups putting up community kitchens, since there is no existing manual in the Philippines. However, phases two and three must be conducted to validate its usefulness and accuracy in the field.

Food Security ; Food Safety

Objective: Double contour sign (DCS) is considered part of the new gout classification. This study aims to determine the agreement of blinded musculoskeletal sonologists in identifying the double contour sign among asymptomatic hyperuricemic patients. Methods: Participants with asymptomatic hyperuricemia (n=65) underwent a gray-scale ultrasound assessment of both of their 1st metatarsophalangeal joints (MTPJs) done on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 independent blinded sonologists for presence of double contour sign. Results: Among the 130 1st MTPJs, the sonologists were able to positively identify DCS on 48R and 52L, negative in 10R and 10L, with discordant readings in 7R, 3L. The overall kappa agreement was statistically significant at 0.674 (substantial agreement) and 0.842 (almost perfect agreement) on the right and left respectively, (both p<0.001). Conclusion and Recommendation There is a high proportion of positive double contour sign seen among persistently asymptomatic hyperuricemic patients. It might be prudent to perform musculoskeletal ultrasound early on to detect monosodium urate crystal deposits in similar patients. A close follow up to monitor clinical gouty arthritis maybe necessary or consider utility of urate lowering drugs in crystal dissolution in prospective studies.
Hyperuricemia ; Gout