Dermatomyositis is a rare disease characterized by classic skin lesions and muscle weakness. In rare cases, life-threatening hypercalcemia may develop caused by regression of dystrophic calcifications. Here we report a 36-year-old man who presented with progressive proximal weakness, difficulty in ambulation, and weight loss. He had the V-sign, Gottron’s papules, and hard, chalky nodules on both antecubital, thigh, and hip areas. Laboratory examinations revealed hypercalcemia (3.47 mmol/L) and shortened QT interval. Workup for malignancy and tuberculosis yielded negative results. Biopsy of the antecubital areas revealed calcinosis cutis. Serum calcium levels gradually normalized with hydration and steroids. Our case illustrated that a high index of suspicion for dermatomyositis is warranted for early diagnosis and ascertaining the etiology of hypercalcemia is vital in the management of this life-threatening complication. While hypercalcemia from dermatomyositis may respond to steroids, to date, individualization of treatment remains the standard of care.

A 26-year-old female came in with progressive blurring of vision. She had developed memory loss and complained of headache, significant weight loss, and exertional left calf pain after prolonged walking. Pertinent physical findings included light perception on visual acuity examination, and the brachial and radial pulses of both arms were not appreciable. Thoracic and abdominal aortic imaging by computed tomography with contrast revealed narrowing along the thoracic aorta and its branches. Carotid Doppler showed bilaterally thickened walls in the common carotid arteries, with near total occlusion of the left carotid artery. These findings were consistent with bilateral ocular ischemic syndrome in Takayasu arteritis. She was given methylprednisolone 500 mg intravenously daily for 3 days with noted improvement in vision. She was discharged and showed improvement on prednisone 35 mg/day and aspirin 80 mg/day. On follow-up two weeks post-discharge, she reported being able to see silhouettes of persons and objects.

BACKGROUND: Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality of patients. One of the mechanisms that have been investigated in the development of CIN is the presence of hyperuricemia. Thus, it has been postulated that using urate-lowering agents may be beneficial in preventing CIN. This report aims to determine the efficacy of giving allopurinol along with standard IV hydration in reducing the incidence of contrast-induced nephropathy after coronary catheterization. METHODS: We conducted as electronic search using PUBMED, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Kidney and Transplant register of Studies, Google Scholar, and Research Gate. Studies fulfilling the inclusion and exclusion criteria were quality assessed based on the criteria provided in the Cochrane Handbook for Systematic Reviews of Interventions. Only published full manuscripts written in English from 1966 to April 2018 were included. The incidences of CIN were analyzed using a random-effects model in Review Manager (Rev Man) Version 5.3 with a 95% confidence interval. RESULTS: Five studies of 2,033 were included with a total of 753 patients. Results showed that there is a 63% decrease in CIN [RR = 0.37 (0.25 to 0.54, 95% CI, Z = 5.10, p < 0.00001) in the allopurinol group compared to those who received hydration alone. When adjusted for heterogeneity by using the random effects model, there remains a 35% decrease in the incidence of CIN [RR = 0.65 (0.43 to 0.99, 95% CI, Z = 2.02, p = 0.04) in the allopurinol group. CONCLUSION: Allopurinol administration may be protective in the development of CIN in patients undergoing coronary interventions. However larger, multi-centered randomized-controlled trials are needed to validate this claim.

Objectives: Effective communication has been correlated with improved outcomes in diabetes mellitus. Patient comprehension bears an effect on understanding, improving healthcare access and utilization, interaction with healthcare providers, caring for one’s own health, and shared decision making. Currently, there is a gamut of information on diabetes-related terms from various sources. However, no material has yet been available for clinical use in the third world setting. Hence, we explored the most common themes discussed during an outpatient diabetes consult in our hospital. Methodology: Consultation audio recordings (N = 96) and focus group discussions (N = 32) were conducted among adults with diabetes. Transcribed results underwent qualitative content and thematic analyses to develop the conceptual framework. Results: The study generated the following themes: diabetes mellitus diagnosis, lifestyle modification, treatment targets, hypoglycemia precautions, diabetes complications, and medication safety. There was a good understanding of these themes among patients with a higher educational attainment, however, among those with lower educational attainment, the attitude of patients toward diabetes care is paternalistic. Conclusion The themes discussed in outpatient diabetes consult reflects the dimensions of diabetes care mainly influenced by socio-cultural factors, patient-doctor relationships and adaptability to limitations of resources. The results will be used to develop and validate a culturally appropriate diabetes health literacy tool.
Diabetes Mellitus ; Health Literacy

Behçet's disease (BD) is a systemic vasculitis characterized by recurrent acute vascular inflammation. There is currently limited epidemiological data in Southeast Asia. We discuss a 26-year-old woman who came to our institution for recurrent vulvar abscesses for a year. Physical examination showed labial, tongue, and vulvar ulcers. Pathergy test was negative and biopsy done were unremarkable . We diagnosed her clinically as a case of Behçet’s disease. We started her on colchicine 0.6 mg once daily and educated her on skin, oral, and perineal hygiene. On follow-up after one month, she noted resolution of her lesions. However, symptoms recurred in the last three months after discontinuing treatment. We used telemedicine to communicate due to the COVID-19 pandemic and lockdown, advising her to continue her medication. Timely diagnosis is essential in order to provide symptomatic relief and enhance patient education.
Behcet Syndrome ; Ulcer ; Vasculitis

Objective: This study aimed to determine the prevalence, analyze, and compare the risk factors of anxiety, depression, and quality of life of cancer patients in the out-patient cancer clinic of the Cancer Institute one year into the pandemic. These were compared to the prevalence of anxiety and depression before the pandemic. Methods: A cross-sectional analytic study described the prevalence of anxiety, depression, and quality of life and analysis of its related factors among patients with cancer seen in the outpatient cancer clinic of the Cancer Institute of the Philippine General Hospital from November 1 to 20, 2021, using the Hospital Anxiety and Depression Scale – Pilipino and EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 (Quality of Life questionnaire) tools. Results: A total of 408 cancer patients were enrolled in the study. The prevalence of anxiety and depression was 58.33% and 24.51%, respectively. Before the pandemic, the prevalence of anxiety and depression was 9.45% and 4.72%, respectively. Two hundred seventy participants (66.18%) had a positive quality of life. The comparison between the prevalence of anxiety and depression between this study (one year into the pandemic) and the pre-pandemic study revealed a statistically significant difference in the majority of both, with more anxious and depressed cancer patients in this study. The participants agreed that the pandemic had affected their daily activities. Conclusion The study showed that the COVID-19 pandemic significantly increased anxiety and depression among cancer patients. The quality of life (QOL) of cancer patients in this study has not been distinctly affected by the pandemic, but for those who have, they still require the attention and support of not just the physicians but the community as a whole. Our findings highlight the need to integrate better psychosocial support and the important role of carers in the evolving pandemic response measures.
pandemic ; anxiety ; depression ; quality of life ; cancer ; COVID-19

Background and Objective: Dyslipidemia in hypothyroidism results from the effects of thyroid hormones on lipid metabolism. These, in combination with hypothyroidism-induced hemodynamic changes, are risk factors for cardiometabolic diseases. We determined the prevalence of metabolic syndrome (MS) among adult Filipinos with hypothyroidism and compared clinical and laboratory characteristics of those with versus without MS. Methods: This is a retrospective study of 105 patients with biochemically confirmed hypothyroidism. A review of records obtained anthropometric measurements, blood pressure, fasting blood glucose, lipid profile, and thyroid hormones. Clinical and laboratory characteristics were then compared between MS and those without. Significant differences were determined by two-way ANOVA, while heterogeneity of categorical variables was determined by chi-square or Fisher exact test. All data analyses were performed using Stata version 17.0 with a significance level of p<0.05. Results: The prevalence of MS is 36.19% (95%CI: 27.04%,46.15%). Body mass index (BMI) peaks at obese class I among those with MS. There is a significantly higher proportion of patients diagnosed to have diabetes (28.95% vs. 7.46%; p=0.003) and hypertension (52.63% vs. 14.93%; p<0.001) in the MS group. No significant differences were noted between groups regarding age, sex, etiology of hypothyroidism, blood pressure, fasting glucose, lipid profile, and thyroid hormone levels. Conclusion Our study showed that the prevalence of MS in adult Filipinos with hypothyroidism is increased at 36.19%. Only BMI, presence of diabetes, and hypertension were shown to be significantly higher. Emphasis must be placed on early screening among hypothyroid patients at high risk of developing MS. A prospective study using waist circumference and clinical and metabolic parameters is needed to validate these findings.
dyslipidemia ; hypothyroidism ; metabolic syndrome ; prevalence

BACKGROUND: The worldwide incidence of osteomyelitis is approximately 21.8 cases per 100,000 person-years. The cornerstone of treatment is prolonged (4-6 weeks) intravenous antibiotic administration. This entails additional cost, inconvenience, and added manpower from the healthcare system. Thus, studies have explored the possible use of oral antibiotics as alternatives to improve patient compliance and reduce costs. Our meta-analysis aimed to compare the efficacy of oral versus intravenous antibiotics in treating adult patients with osteomyelitis. MATERIALS AND METHODS: Electronic databases (PubMed, Medline, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar, and Research Gate) from 1966 to April 2020 were searched using the terms “oral antibiotics”, “osteomyelitis”, “randomized controlled trial”. Only studies that directly compared oral versus intravenous antibiotics and confirmed osteomyelitis through biopsy and/or imaging were included. Primary outcome is remission (resolution of symptoms with no relapse and bacteriologic eradication); secondary outcomes, (a) relapse (persistence of the pathogen after treatment) and (b) adverse events. The validity of included studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. We performed a random-effects model in Review Manager Version 5.3 with 95% confidence interval. The I 2 test was used to assess heterogeneity. RESULTS: Seven of 89 trials comprised of 1,282 patients were included in the final analysis. All studies included patients with osteomyelitis of the lower extremities. Oral antibiotics used were Ciprofloxacin, Ofloxacin, and Co-trimoxazole; intravenous antibiotics used were deemed appropriate by the infectious disease specialist. Patients were only given either oral or intravenous antibiotics. Results showed an 8% increase in remission rates [RR 1.08 (0.81 to 1.44, 95% CI, Z = 0.52, p=0.60)] with no heterogeneity (I2 = 0%) in the intravenous antibiotics group. However, this was not statistically significant. Furthermore, there was a 62% decrease in relapse rates in the intravenous antibiotics group [RR 1.62 (0.85 to 3.07, 95% CI, Z = 1.47, p = 0.14)] with no heterogeneity (I2 = 0%) but was not statistically significant. CONCLUSION: Oral are comparable to intravenous antibiotics in treating osteomyelitis in terms of remission and relapse rates. However, larger and double-blinded trials should be done to generate more robust data to validate these claims.
Osteomyelitis ; Administration, Intravenous ' ; Parenteral Nutrition

Objectives: Daily levothyroxine is the treatment of choice and standard of care in hypothyroidism, sufficient to restore thyroid stimulating hormone (TSH) to normal range. For many patients, daily lifelong therapy is required, making adherence a major issue. In such cases, weekly replacement may be a suitable alternative to improve adherence. In this study, we aimed to determine the efficacy and safety of weekly levothyroxine replacement among adults with hypothyroidism. Methodology: Electronic databases were searched. Two reviewers (HCC and RBL) independently screened the abstracts, reviewed full-text papers, critically appraised the quality of included studies using PRISMA guidelines. Meta-analysis was performed using the random-effects model. The primary outcome is the difference in serum TSH levels between weekly and daily administration, while secondary outcomes included adverse events and symptoms of hypothyroidism. Results: The primary outcome is the difference in serum TSH levels between weekly and daily administration. Secondary outcomes included adverse events and clinical symptoms. The study included two randomized trials (n=109) in the primary analysis. The difference in TSH levels was 1.78 mIU/mL higher [(95% confidence interval (CI): 1.28 to 2.28, p<0.00001] at 6 weeks and 1.22 mIU/mL higher (95% CI: 0.76 to 1.67, p<0.00001) at 12 weeks for the weekly regimen. There was no significant heterogeneity between the two groups. There was no significant difference in hypothyroid symptoms and adverse events before and after levothyroxine treatment within each group. Conclusions Weekly levothyroxine resulted in less suppression and higher mean serum TSH levels, while still remaining within the normal reference range. It may be a suitable alternative for non-adherent patients. However, larger randomized trials with longer duration of follow-up are needed to firmly establish its role.
Hypothyroidism ; Thyroxine ; Thyroid Hormones

Background: Flavonoids from Emblica officinalis effectively reduced serum and tissue lipid levels through their inhibitory effect on the hepatic β-hydroxy-β-methylglutaryl coenzyme A reductase activity. This study aimed to determine the efficacy and safety of E. officinalis extract in adults with dyslipidemia. Methods: We searched the following electronic databases: MEDLINE (PubMed), MEDLINE (Ovid), Google Scholar, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, and ClinicalTrials.gov from inception until January 31, 2022. Two reviewers independently screened the abstracts, reviewed full-text papers, and critically appraised the quality of included studies. Meta-analysis was performed using the random-effects model. Our primary outcomes were total cholesterol, LDL-C, serum triglycerides, and HDL-C levels, while secondary outcomes included adverse events. Results: A total of four randomized trials (N = 227) were included in the final analysis. There were statistically significant decreases in total cholesterol levels (SMD = -21.23 mg/dL, 95% CI: -34.22, -8.25; P = 0.001) and LDL-C levels (SMD = -25.12 mg/dL, 95% CI: -40.24, -10.00; P = 0.001) and significant increase in HDL-C levels (SMD = 4.74 mg/dL, 95% CI: 0.40, 9.07; P = 0.03) after 12 weeks of intervention favoring the use of the Emblica extract over placebo. However, there were no statistically significant difference in the serum triglycerides levels following 12 weeks of treatment (SMD = -22.28 mg/dL, 95% CI: -53.33, 8.76; P = 0.16). There was high heterogeneity noted across all outcomes: total cholesterol (P = 0.01, I2 = 72%), LDL-C (P = 0.0004, I2 = 83%), HDL-C (P < 0.00001, I2 = 91%) and serum triglycerides (P < 0.00001, I2 = 93 %). The intervention was well tolerated and adverse events reported in the three of four studies were all mild: dyspepsia (7 events – treatment), mild diarrhea (3 events – placebo), fever (1 event – placebo), headache (1 event – placebo). Conclusion Compared to placebo, Emblica officinalis fruit extract resulted in lower total cholesterol and LDL-C levels and increased HDL-C levels but with no effect on serum triglyceride levels based on low certainty of evidence. Trials with a larger sample size that directly compare E. officinalis extract to statins, preferably local data, are needed to support its use in patients with dyslipidemia further.
dyslipidemia ; Emblica officinalis ; Phyllanthus emblica ; meta-analysis