Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases.
Blood Patch, Epidural* ; Cerebrospinal Fluid* ; Drainage* ; Intracranial Aneurysm* ; Intracranial Hypotension* ; Retrospective Studies*

Background: Health information systems (HIS) such as Electronic Medical Record (EMR) systems are essential in the integration of fragmented local health systems. Investing in HIS is crosscutting; it can address multiple interrelated health system gaps. However, public health authorities, especially those in resource-constrained communities, are often faced with the dual challenge of upgrading and digitalizing local HIS and addressing other more apparent health system gaps. Objectives: The study aimed to identify and document strategies that not only motivate policy change towards adoption of electronic HIS but also address other health system gaps. Methodology: The author, in his capacity as a local health official in a resource-constrained community, developed, implemented, and documented a social marketing strategy wherein community stakeholders were influenced to invest in an electronic medical record (EMR) system because it was shown to also have the capacity to address other priority health system gaps identified. Results: The strategy, based on situational, stakeholder, and risk analyses, prompted local governance to first invest in improving the delivery of services accredited by the national health insurance program (PhilHealth), for which reimbursements would require electronically submitted claim forms. Community stakeholders then supported the proposal to invest in an EMR system because they were persuaded that it can facilitate increased financing from PhilHealth claims reimbursements, which could be used to enable not only improvement in existing health services but to also initiate other health programs. Conclusion Social marketing using the perspective of health as an investment influenced stakeholders to invest in an EMR system.
Public Health ; Health Information Systems ; Health Communication ; Social Marketing

The X-linked dystonia-parkinsonism (XDP) is a severe progressive, adult-onset X-linked endemic disorder in Filipinos, which is characterized by dystonic movements that start in the third of fourth decade, and replaced by parkinsonism beyond the 10th year of illness. Understanding the pathophysiology of XDP and development of rational therapies will depend on observations from imaging pathological and genetic studies. In this paper we summarize the results of these studies on patients with XDP. The cranial magnetic resonance imaging shows hy-perintense putaminal rim in both dystonic and parkinsonian stages, and atrophy of the caudate head or putamen in the parkinsonian stage. Neuropathological findings show atrophy of the caudate nucleus and putamen, with mild to severe neuronal loss and gliosis. In the neostriatum, the dystonic phase of XDP shows the involvement of striosomes and matrix sparing, while the later, i.e., p[arkinsonian phase, shows matrix involvement as well. In the dystonic phase, the loss of striosomal inhibitory projections lead to disinhibition of nigral dopaminergic neurons, perhaps resulting in a hyperkinetic state; while in the parkinsonian phase, severe and critical reduction of matrix-based projection may result in extranigral parkinsonism. Genetic sequencing of the XDP critical region in Xq13.1 has revealed an SVA retronsposon insertion in an intron of TAF1. This may reduce neuron-specific expression of the TAF1 isoform in the caudade nucleus, and subsequently interfere with the transcription of many neuronal genes, including DRD2. Findings from imaging, pahtology, and genetics studies are gradually shedding light on the pathophysiology of XDP, which hopefully will lead to mare rational and directed therapies.

Human ; Adult ; Atrophy ; Caudate Nucleus ; Dopaminergic Neurons ; Dystonic Disorders ; Genetic Diseases, X-linked ; Gliosis ; Introns ; Parkinsonian Disorders ; Protein Isoforms ; Putamen

Background: For anatomic total arthroscopic repair, cementless humeral fixation has recently gained popularity. However, few studies have compared clinical, radiographic, and patient-reported outcomes between cemented and press-fit humeral fixation, and none have performed follow-up for longer than 5 years. In this study, we compared long-term postoperative outcomes in patients receiving a cemented versus press-fit humeral stem anatomic arthroscopic repair. Methods: This study retrospectively analyzed 169 shoulders that required primary anatomic total shoulder arthroplasty (aTSA). Shoulders were stratified by humeral stem fixation technique: cementation or press-fit. Data were collected pre- and postoperatively. Primary outcome measures included range of motion, patient reported outcomes, and radiographic measures. Results: One hundred thirty-eight cemented humeral stems and 31 press-fit stems were included. Significant improvements in range of motion were seen in all aTSA patients with no significant differences between final cemented and press-fit stems (forward elevation: P=0.12, external rotation: P=0.60, and internal rotation: P=0.77). Patient reported outcome metrics also exhibited sustained improvement through final follow-up. However, at final follow-up, the press-fit stem cohort had significantly better overall scores when compared to the cemented cohort (visual analog score: P=0.04, American Shoulder and Elbow Surgeon Score: P<0.01, Simple Shoulder Test score: P=0.03). Humeral radiolucency was noted in two cemented implants and one press-fit implant. No significant differences in implant survival were observed between the two cohorts (P=0.75). Conclusions In this series, we found that irrespective of humeral fixation technique, aTSA significantly improves shoulder function. However, within this cohort, press-fit stems provided significantly better outcomes than cemented stems in terms of patient reported outcome scores.Level of evidence: III.

A study was done to describe awareness, knowledge and attitude level on Urinary Tract Infection among university students of Burapha University, Thailand. Cross-sectional study was conducted with the use of self-modified questionnaire consisting of socio-demographic questions and AKA domains. Total of 91 respondents (male students n=13 and female n=76) aged 19 years old participated. The total AKA level was found to be in high category (75.86 ± 13.81) and between the domains, Attitude (70.00 ± 13.28) is categorized as positive, followed by both Knowledge (57.24 ± 15.94) and Awareness (39.37 ± 13.01) which is categorized as moderate. Correlation between Awareness-Attitude was found significant at p=0.003. After the adjustment of covariates, female gender was found to have the strongest relationship compared to other covariates and all independent factors combined accounted 14.8% of variability in Total AKA. The sociodemographic factors’ of the students influenced the level of AKA and female gender have found to have be best predictor for Total AKA on UTI. Thus, this research has provided ample findings to further formulate an educational tool for the public.

There is evidence that a substantial part of genetic predisposition to prostate cancer (PCa) may be due to lower penetrance genes which are found by genome-wide association studies. We have recently conducted such a study and seven new regions of the genome linked to PCa risk have been identified. Three of these loci contain candidate susceptibility genes: MSMB, LMTK2 and KLK2/3. The MSMB and KLK2/3 genes may be useful for PCa screening, and the LMTK2 gene might provide a potential therapeutic target. Together with results from other groups, there are now 23 germline genetic variants which have been reported. These results have the potential to be developed into a genetic test. However, we consider that marketing of tests to the public is premature, as PCa risk can not be evaluated fully at this stage and the appropriate screening protocols need to be developed. Follow-up validation studies, as well as studies to explore the psychological implications of genetic profile testing, will be vital prior to roll out into healthcare.
Genetic Predisposition to Disease ; genetics ; Genetic Testing ; Humans ; Kallikreins ; genetics ; Male ; Membrane Proteins ; genetics ; Prostatic Neoplasms ; diagnosis ; genetics ; Prostatic Secretory Proteins ; genetics ; Protein-Serine-Threonine Kinases ; genetics ; Risk Factors

Introduction: A cross-sectional study was conducted to provide preliminary insight of Awareness, Knowledge and Attitude (AKA) assessment on urinary tract infection (UTI) among adolescents which includes the general level of AKA and correlation between the domains as well as the relationship between Total AKA and the sociodemographic factors. Methods: A modified and adapted questionnaire was developed, consisting of socio-demographic questions and AKA domains employing descriptive statistics, linear regression and multiple regression analysis via SPSS Version 23.0. Results: In general, AKA level was reported as moderate (0.5 ± 0.11). Among the three domains, Knowledge (0.70 ± 0.12) risen with the most astounding mean, took after Awareness (0.36 ± 0.22) and Attitude (0.65 ± 0.11). A positive but weak correlation was found between the domains; Awareness and Knowledge is significant at p = 0.034, r = 0.157; R2 = 0.02 and similarly, a weak correlation was also found between Knowledge and Attitude which is significant at p = 0.000, r = 0.411; R2 = 0.17. After covariates adjustment, female gender was found to have the strongest relationship with Total AKA. Conclusion: The general level of Total AKA on UTI is moderate. The AKA domains in this study was found to be positively correlated and female was found to be the best predictor for a better Total AKA on UTI. Thus, these findings provide important information to formulate an effective education intervention to improve the AKA on UTI among adolescents.