We report a case of 29-year-old female who presented with right heel pain that worsened over a period of two years. The onset of pain was followed by swelling at the medial aspect of right ankle. She was initially treated for plantar fasciitis with multiple steroid injections over the heel. Subsequent MRI revealed a well-defined heterogeneous lesion in continuity with the medial plantar nerve. Excision biopsy was performed and histopathological evaluation revealed monophasic synovial sarcoma. The patient subsequently underwent wide resection and free tissue transfer followed by radiotherapy and chemotherapy. This case highlights an unusual site and presentation of synovial sarcoma which led to delayed diagnosis and treatment.

Purpose: To compare echocontrast cystosonography (ECS) using in-vivo agitated saline with fluoroscopic micturating cystourethrography (MCU) in the detection and grading of vesicoureteric reflux (VUR). Materials and methods: This was a prospective study of 25 children, who had MCU between 2007 and 2009. ECS was performed and findings documented prior to MCU. Baseline renal and bladder sonograms were obtained. The bladder was filled with normal saline followed by introduction of 10–20 mls of air to generate microbubbles. Detection of VUR was based on two sonographic criteria: (1) presence of microbubbles in the pelvicaliceal system (PCS), and (2) increase in dilatation of the PCS. VUR was graded as (1) Grade I: microbubbles seen in ureter only; (2) Grade II: microbubbles seen in non-dilated PCS; and (3) Grade III-V: microbubbles seen in dilated PCS. The ECS findings were compared using MCU as the gold standard. Results: Of the 50 kidney-ureter (K-U) units studied, ECS detected 9 of 10 K-U units with VUR on MCU. ECS did not detect a Grade II VUR. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for criterion 1 was 90%, 87.5%, 88%, 64.3% and 97%, respectively, compared to criterion 2 which was 70%, 90%, 86%, 64% and 92%, respectively. The grading of VUR was similar on both ECS and MCU except for one case. Conclusion: ECS using agitated saline was a sensitive technique for the detection of VUR. ECS grading was comparable with MCU grading of VUR.

Various previous studies have reported the implication of CYP11B2 gene polymorphism in the pathophysiology of cardiovascular diseases. In particular, the -344T/C polymorphism, which is located at a putative binding site for the steroidogenic transcription factor (SF-1) has been associated with essential hypertension, left ventricular dilation and coronary heart disease. In the present study, we aim to determine the allele and genotype frequencies of the CYP11B2 gene in patients with clinical manifestation of coronary heart disease and confirmed by angiography and blood donors and to calculate the association of the gene polymorphism with CHD. A total of 79 DNA from patients with coronary heart disease admitted to the National Heart Institute and 84 healthy blood donors have been genotyped using polymerase chain reaction technique followed by restriction enzyme digestion (RFLP). Results of the study demonstrated that out of 79 for the patients, 40 were homozygous T, 10 were homozygous C and 29 were heterozygous TC. The frequencies of genotype TT, CC and TC for patients were 0.5, 0.13 and 0.36 respectively. The frequencies of allele T and C in patients were 0.68 and 0.31 respectively. While for the blood donors, 40 subjects were of homozygous T, 7 were homozygous C and 37 were heterozygous TC. The genotype frequencies for the TT, CC and TC were 0.47, 0.08 and 0.44 respectively. The frequency of the allele T was 0.69 and allele C was 0.3. Chi-Square analysis showed that there was no significant difference in the genotype and C allele frequencies between the CHD patients and the blood donors. Our study suggests that there is lack of association between -344T/C polymorphism of CYP11B2 gene and coronary heart disease.

The family practitioner plays an important role in the detection and treatment of mental disorders. It is said that over half of all persons affected with mental illness are initially seen and treated by the non-psychiatrist in the outpatient setting rather than in the specialty mental health clinic. Objective: This paper aims to evaluate perceived level of confidence and competence of the primary care practitioner in the recognition, diagnosis, and management of mental disorders. Methods: A survey of family physicians and general practitioners using a thirteen (13)-point questionnaire during an annual convention of the Philippine Academy of Family Physicians (PAFP) was conducted. The questionnaire included items that attempted to quantify: exposure to psychiatry during residency and current medical practice; proportion of mental illness cases among total patient load; signs and symptoms that would be associated with mental illness; familiarity with standardized criteria for diagnosing mental illness i.e. schizophrenia and depression; familiarity with therapeutic medications; and perceived level of confidence in treating psychiatric cases. Results and Conclusion: The study implies that the family physician, although aware of the general signs and symptoms indicative of mental illness, is still hesitant in formulating a definitive diagnosis. Possible reasons for this attitude may be inadequate training in psychiatry as well as unfamiliarity and perceived difficulty with the DSM-IV.
Human ; Male ; Female ; MENTAL DISORDERS ; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS ; PHYSICIANS, FAMILY

This study aimed to compare dexmedetomidine and propofol, in terms of haemodynamic parameters, respiratory rates and offset times, when used for sedation in patients undergoing elective orthopaedic and surgical procedures under regional anaesthesia. This was a prospective, randomised, single-blind study where 88 patients were recruited. Patients were randomised into two groups to receive either dexmedetomidine or propofol infusion. Central neuraxial blockade (spinal, epidural or combined spinal epidural) was performed. After ensuring an adequate block and stable haemodynamic parameters, dexmedetomidine was infused 15 minutes later at 0.4 μg/kg/hr, and propofol, at a target concentration of 2.5 μg/ml. Both drugs were titrated to achieve a bispectral index score of 70 before surgery commenced. Sedation level was monitored using the bispectral index score and assessed by the Observer Assessment of Alertness Scale score. Drug infusion was adjusted to maintain bispectral index scores ranging between 70-80 during surgery. Both groups showed reductions in mean arterial pressure and heart rate from baseline readings throughout the infusion time. However there was no significant reduction in the first 15 minutes from baseline (p > 0.05). Haemodynamic parameters and respiratory rate between both groups were not significantly different (p > 0.05). No patient demonstrated significant respiratory depression or SpO2 ≤ 95%. Offset times were also not significantly different between both groups (p = 0.594). There were no significant differences in haemodynamic parameters, respiratory rates and offset times between dexmedetomidine and propofol used for sedation in patients undergoing elective orthopaedic and surgical procedures under regional anaesthesia.

Hypertrophic cardiomyopathy (HCM) is caused by dominant mutations in sarcomere genes. The diagnosis of HCM is usually established by identifying unexplained left ventricular hypertrophy (LVH) on cardiac imaging studies; however, LVH is not an invariable feature of disease. The expression of LVH is highly age-dependent, and LV wall thickness is frequently normal during childhood. Overt development of hypertrophy, and the ability to make a clinical diagnosis, does not typically occur until adolescence or later. Genetic testing allows identification of family members who have inherited the pathogenic sarcomere mutation (G +) before the emergence of clinical manifestations (LVH -). As such, a new and important subset of individuals with preclinical HCM (G+ / LVH-) can be identified early in life, before a clinical diagnosis can be made. Our evaluation of preclinical HCM has indicated that although there are no distinguishing morphologic features of early disease, there is evidence of myocardial dysfunction prior to the development of LVH. Subtle impairment of diastolic function is detectable in otherwise healthy sarcomere mutation carriers and can differentiate these family members from those who did not inherit the mutation. In contrast, systolic function appears relatively preserved in preclinical HCM, but impaired in overt disease. This preliminary finding suggests that both the sarcomere mutation and the characteristic changes in myocardial architecture (LVH, fibrosis and disarray) are required to perturb force generation. By studying this intriguing preclinical cohort, we can better understand the early stages of disease pathogenesis and potentially develop therapy to alter the clinical expression of sarcomere mutations.
Cardiomyopathy, Hypertrophic ; diagnosis ; genetics ; Genotype ; Humans ; Mutation ; Pedigree ; Phenotype ; Sarcomeres ; genetics

OBJECTIVES: This paper aims to evaluate the competence and confidence of the primary care practitioner in the recognition, diagnosis and treatment of mental disorders.
METHODOLOGY: A validated 13 point questionnaire which incorporated items from the DSM IV was given to the participants of the annual convention of the Philippine Academy of Family Physician held in Davao City Sept 8-10, 2000.
RESULTS: Four hundred eighty five family physicians returned the self administered questionnaire. Fifty one percent (248/ 485) claimed they would immediately refer patients to the psychiatrist while 28% (137/ 485) would initiate treatment on their own. Fourteen percent (68/ 485) and 10.9% (53/ 485) of the respondents indicated that they were familiar with the DSM IV criteria for schizophrenia and depression respectively; however only 11.3 % (55/485)were confident in using the criteria for diagnosis. Fortytwo percent (204/485) described schizophrenic patients as being irritable and aggressive, 30% (146/485) believed that hallucinations were the hallmark symptom, while 18% (88/485) considered bizarre behavior as the most significant indicator of schizophrenia. For depression the subjective feeling of sadness and worthlessness was most indicative of depression for the respondents (63% or 305), while 21% or 102 considered low self esteem or unstable self image as one of the criteria for depression and 16% or 78 thought of diminished interest or pleasure in all activities as the more important symptom to look for when diagnosing depression. Tricyclic antidepressants were still the preferred drug by most family physicians in treating depression (72% or 340) while 62% (301/ 485) prescribed benzodiazepines and 51% (248/ 485) also used the newer selective serotonin reuptake inhibitors. Patients with schizophrenia would be given typical psychotropic drugs like chlorpromazine or haloperidol more commonly (88% or 427), while 46% (224/ 485) had begun to prescribe atypical antipsychotic medications.
CONCLUSION:The family physician seems to be hesitant or unsure with their diagnosing or treating psychiatric patients though willing to administer psychotropic medications.

Human ; Male ; Female ; Psychiatry ; Physicians ; Schizophrenia ; Depression

Objective: To understand the current status of national free antiretroviral therapy in interprovincial migrating people living with HIV/AIDS (PLWHA) and influencing factors in China. Methods: Descriptive and trend test analyses were performed to evaluate the historical characteristics and trends of main descriptive indicators on national free antiretroviral therapy for the interprovincial migrating PLWHA by using the data collected from National Comprehensive HIV/AIDS Information System from 2011 to 2015. Logistic regression model was used to explore the main factors that influencing the coverage of national free antiretroviral therapy among the interprovincial migrating PLWHA in China. Results: The proportion of interprovincial migrating PLWHA gradually increased in last 5 years from 7.1% (17 784/250 645) in 2011 to 10.3% (54 596/528 226) in 2015 (Z=51.38, P<0.000 1) in China. The coverage rate of free antiretroviral therapy in interprovincial migrating PLWHA increased from 37.3% (6 641/17 784) in 2011 to 71.0% (38 783/54 596) in 2015, showing a significant rising tendency (Z=96.23, P<0.000 1), but it was slightly lower than that in non-interprovincial migrating PLWHA in 2015 (71.5%, 338 654/473 630). Multivariate logistic regression analysis showed that the PLWHA who were females, aged ≥50 years, of Han ethnic group, married or had spouse, had the educational level of high school or above, infected through homosexual intercourse, with CD(4)(+)T cells counts ≤500 cells/μl at the first visit, identified to be infected with HIV in medical setting, living in urban areas et al, were more likely to receive free antiretroviral therapy. Conclusions: The coverage rate of free antiretroviral therapy varied among the interprovincial migrating PLWHA with different characteristics. It is still necessary to take effective measures to further increase the coverage of free antiretroviral therapy in interprovincial migrating PLWHA and to include the free antiretroviral therapy in interprovincial migrating PLWHA into standardized management system as soon as possible.
Anti-Retroviral Agents/therapeutic use* ; China/epidemiology* ; Female ; HIV ; HIV Infections/epidemiology* ; Healthcare Disparities ; Humans ; Logistic Models ; Middle Aged ; Transients and Migrants/statistics & numerical data*

Red cell alloimmunisation is defined as the development of antibodies in response to foreign red cell antigens through transfusion or pregnancy. In pregnant women even without the history of previous blood transfusion, this is possible through previous or current pregnancy with the presence of paternal red cell antigen inherited by the fetus. This study was aimed to determine the prevalence of red cell alloimmunisation among pregnant women without previous history of blood transfusion and the association with number of pregnancy and history of obstetric complications. This was a cross-sectional study in which 150 pregnant women were randomly selected from the antenatal clinic. Ten mls of peripheral blood was obtained for antibody screening using indirect antiglobulin test besides the routine antenatal screening. In this study, the majority (37.3%) of the women were primigravidae. Red cell alloantibodies were detected in two out of 150 (1.3%) patients which were subsequently identified as anti-C and anti-D. However none of the primigravida was alloimmunised. One woman of gravida 2 (2.9%) and gravida 3 (3.6%) each were positive for alloimmunisation. One of them also had a bad obstetric history. This study showed that the prevalence of red cell alloimmunisation among pregnant women was low in this centre. Nevertheless, red cell alloantibody screening test should be made available to reduce possible complications of alloimmunisation in mothers and fetuses.

INTRODUCTION: A multidisciplinary approach is essential to optimize patient care. In the practice of oncology, surgeons, medical oncologists, and pathologists are essential for the histology-based diagnosis of cancer patients. In breast cancer, hormone receptor and HER2 positivity are both predictive and prognostic, and so testing for these has been strongly recommended for every newly diagnosed breast cancer patient. A unique but meaningful information that can be provided by medical oncologists, as customers, is their satisfaction to the services (e.g. HER2 testing) and product (e.g. reports) of the pathology laboratory. Any quality initiative effort to improve HER2 testing can also be extended to hormone receptor (ER/PR) testing. This study measures the general satisfaction of medical oncologists practicing in Metro Manila with local HER2 testing services and reports.
METHODS: This cross-sectional study had survey questionnaires distributed to medical oncologists practicing in Metro Manila chosen on the basis of their considerable experience with requesting HER2tests and with the use of anti-HER2 therapy in their management of breast carcinoma patients. Demographics, practice information, rating of satisfaction per laboratory service category, and a checklist of elements of IHC/FISH reports were collected.
RESULTS: 32 medical oncologists participated in the survey, most of whom were from tertiary hospitals. Breast carcinoma cases make up around 26-50% of cancer cases in their practice. More than half request HER2 testing for their breast cancer patients. Medical oncologists are generally satisfied with the services for IHC and FISH HER2 testing (composite scores >2) provided by the laboratories. Overall, medical oncologists were very satisfied with diagnostic accuracy and completeness of relevant information in the report. Laboratory services were mostly rated good, with the exception of pathologists' responsiveness to problems and notification of equivocal results. For both IHC and FISH, patient/physician identification, date of service, specimen identification/ site/ type, results, and interpretation were reported to be included in the reports. However, time to/duration of/ type of fixation, method and image analysis method, antibody clone/ vendor, and comment that an FDA-approved method was used, were reported missing by the many.
CONCLUSION: For both IHC and FISH, overall satisfaction was found to be moderately directly correlated with diagnostic accuracy. In a country like the Philippines where quality initiatives of laboratories may still be far from ideal, medical oncologists can demand inclusion of their preferences into assessments processes by laboratories and correct assumptions of laboratory managers as to what element of the services and products they value most. Measurement of customer satisfaction can be integrated into the quality assurance programs of laboratories and corresponding hospitals.  

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Patient Care ; Oncologists ; Surgeons ; Breast Neoplasms ; Surveys And Questionnaires ; Pathologists