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

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

Introduction: Nosocomial contaminants such as Pseudomonas aeruginosa and Serratia marcescens are increasingly developing resistance to many antibiotics. One of the promising alternatives that may complement, if not substitute, the use of antibiotics is quorum quenching, the process of interfering with chemical signals that mediate communication between microorganisms. Eleusine indica, a ubiquitous grass used traditionally to treat infections, has been shown to contain metabolites, such as fatty acid derivatives and p-coumaric acid, capable of quorum quenching. To date, there has been no study on the quorum quenching activity of E. indica.

Objectives: This study aimed to determine the in vitro activity of crude ethanolic extract of E. indica leaves against selected quorum-sensing regulated virulence factors of P. aeruginosa and S. marcescens.

Methodology: E. indica leaves were collected, washed, air-dried, and homogenized. Following ethanolic extraction and rotary evaporation, the extract was screened for antimicrobial activity through disk diffusion test and broth microdilution assay. The quorum quenching activity of the extract against P. aeruginosa was measured through swarming motility assay, while the activity against S. marcescens was measured through swarming motility and pigment inhibition assays. The quorum quenching assays were conducted in triplicates, and analysis of variance (ANOVA) was performed to identify differences among the treatment groups.

Results: Disk diffusion test revealed that no zones of inhibition formed against both P. aeruginosa and S. marcescens for varying concentrations of up to 200 mg/mL of the crude extract. Likewise, the MIC of the extract against both P. aeruginosa and S. marcescens was determined to be >200 mg/mL. However, it was shown that the extract, at 50 mg/mL, has statistically significant activity (p<0.05) against the swarming motility of P. aeruginosa, and it is 71.6% as effective in reducing the swarming area of the bacteria compared to cinnamaldehyde. This was not observed when the extract was tested against the swarming motility of and pigment production by S. marcescens.

Conclusion: In this study, the quorum quenching activity of the crude ethanolic extract of E. indica leaves was found to be effective against P. aeruginosa but not against S. marcescens. The compounds that will be identified by further studies may conceivably be used as an adjunct therapy in P. aeruginosa infections and as coating agents in medical devices.

Eleusine ; Pseudomonas aeruginosa ; Quorum Sensing ; Serratia marcescens ; Prodigiosin