Dapiprazole produces miosis by blocking the alpha 1 receptors in the dilator muscle of the iris.Intraocular dapiprazole for reversing mydriasis has been compared with intraocular carbachol.Ten adult rabbits of same breed, weight, and age group were used.Both pupils were dilated with one drop each of 2.5% phenylephrine and 0.5% tropicamide.After 10 minutes, when full mydriasis was present, 0.2 ml of aqueous humor was removed from the anterior chamber of each eye through a limbal puncture and replaced with equal amount of 0.5% dapiprazole solution on one eye, and with 0.01% carbachol on the other eye.Pupillary diameter recordings were performed immediately before and a few minutes after drug injection, as well as 24 hours after limbal puncture.Intraocular pressure, corneal thickness, corneal endothelial cell count, and protein in the aqueous humor were evaluated prior to surgery and one day postoperatively.The results showed no difference in the miotic efficacy of dapiprazole and carbachol.The level of aqueous humor protein was significantly higher in the carbachol-treated eyes than in the dapiprazole-treated eyes.No significant difference in intraocular pressure, corneal thickness, and corneal endothelial cell density was noted.Intraocular 0.5% daapiprazole is comparable to 0.1% carbachol in efficacy and safety with less effect on the blood-aqueous barrier.
Animal ; CARBACHOL ; CATARACT ; DAPIPRAZOLE

Fungal corneal ulcer could lead to a devastating outcome. The relative scarcity of readily available, inexpensive but effective topical antifungal drug has left many ophthalmologists desperate and frustated in treating the condition. The use of oral itraconazole has long been proven to be of clinical value in a number of forms of mycoses. Its safety profile is extremely good with minimal reported adverse effects. We investigated an aqueous form of itraconazole which we prepared into a 0.1 mg/ml concnetration and compared its efficacy as a topical antifungal against the standard drug. Natamycin 5 percent in the treatment of fungal keratitis in rabbits. A randomized animal trial was done using 24 rabbit eyes divided into 2 treatment groups. All rabbit corneas were inoculated with Aspergillus flavus and treated after 48 hours with either Topical itraconazole or Natamycin 5 percent for a period of 2 weeks. Results showed inhibition of the disease with both treatment groups. We also found no significant difference between the severity, progression and remission of the keratitis between both treatment groups clinically and statistically. Topical itraconazole 0.1 mg/ml was shown to be comparable to our standard topical antifungal Natamycin 5 percent in treating fungal keratitis. (Author)
Animal ; ASPERGILLUS KERATITIS ; OPHTHALMOLOGY ; ASPERGILLUS FLAVUS ; NATAMYCIN ; ITRACONAZOLE ; FUNGAL CORNEAL ULCER ; FUNGAL KERATITIS

Background and Objectives: Immature platelet fraction (IPF) is a new hematologic parameter that reflects the rate of thrombopoiesis. It has been suggested to be a predictor of platelet recovery in patients with thrombocytopenia. This study aimed to determine the relationship between IPF and platelet count among pediatric patients with thrombocytopenia due to dengue fever. Methods: This was a prospective cross-sectional study of 77 thrombocytopenic pediatric dengue fever patients. IPF was included in the daily complete blood count extraction. Baseline and daily IPF, platelet count, hematocrit, white blood cell count and presence of fever were recorded according to day of illness. The pattern of IPF in relation to the pattern of platelet count was analyzed. The proportion of patients showing platelet recovery at different time points was also determined. A receiver operating characteristic analysis was done to determine an IPF cut-off value predictive of platelet recovery within 24 hours. Results: The IPF increased as the platelet count decreased. The highest increase in IPF coincided with the trough of platelet count. Eighty -seven percent of the patients showed platelet recovery after the increasing trend of IPF, 87% after the peak value and 95% after the decreasing trend. An IPF value of more than 6.6% was found to be predictive of platelet recovery within 24 hours, with a sensitivity of 45% and specificity of 70%. Conclusion There was an observed inverse relationship between IPF and platelet count but with a statistically weak correlation. The decreasing trend of IPF can be a possible good predictor of an increasing trend in platelet count. These findings suggest a possible role of IPF as an additional parameter to predict platelet recovery in pediatric dengue fever patients.
Thrombocytopenia ; Dengue

Background: There is limited information available regarding the management of IVIG-refractory Kawasaki Disease (KD). Objective: This study aimed to evaluate the safety and efficacy of a second intravenous immunoglobulin (IVIG) infusion versus intravenous methylprednisolone (IVMP) in patients with IVIG-refractory KD. Methodology: Cochrane Library, PubMed, Medline, Elsevier (Science Direct), Springer Link and BMJ databases were searched from May 1, 2020 to December 31, 2020. We included randomized controlled trials (RCTs) and high-quality prospective and retrospective studies, with population restricted to children 0 months to 18 years, with KD refractory to initial IVIG at 2g/kg, who remained febrile for 24-48 hours after completion of initial IVIG, and who received second-line monotherapy with either a second dose IVIG or IVMP. We conducted a meta-analysis using Review Manager [RevMan] 5.4.1 software. Results: A total of six studies (n=188 patients) were analyzed. The incidence of coronary artery lesions was comparable between a second dose of IVIG and IVMP (RR 0.82, 0.34-1.96, P=0.66) in patients with IVIG-refractory KD. The rate of fever resolution to a second IVIG, compared to IVMP, was not significantly different between groups (RR 0.97, 0.84-1.13, P=0.72). There was a significantly higher incidence of adverse events in the IVMP group (RR 0.42, 0.26-0.57, P=0.0002), but these were all transient and resolved without further treatment. Conclusion There is no significant difference in the incidence of coronary artery lesions and rate of fever resolution post-retreatment with a second dose of IVIG versus IVMP in IVIG-refractory KD. More adverse events were reported in the IVMP group.
Mucocutaneous Lymph Node Syndrome ; Immunosuppressive Agents ; Immunoglobulins, Intravenous ; Methylprednisolone

Background: Since the start of SARS-CoV-2 pandemic, a post-infection hyperinflammatory process in children with features similar to Kawasaki disease, termed multisystem inflammatory syndrome in children (MIS-C),1 was identified. Thousands of MIS-C cases have already been reported worldwide.2 As possible cases of MIS-C in neonates were increasingly identified, multisystem inflammatory syndrome in neonates (MIS-N) as a distinct entity was proposed as neonates may not manifest all the typical features described in older children. Case Presentation: We describe the case of a previously well term neonate with sudden signs of bowel obstruction who later had multisystem involvement (cardiac, gastrointestinal, and hematologic). The baby was born to a 23-yearold multigravida with an unremarkable prenatal history except for COVID-19 infection during her 34th week age of gestation. The mother presented with mild respiratory symptoms and resolved with supportive management. Our patient was born stable, then had sudden manifestations of feeding intolerance on the 16th day of life and upon work-up had moderate anemia, elevated inflammatory and cardiac markers, ileus, and dilatation of proximal left coronary artery. RT-PCR for SARS-CoV2 was negative. The baby was managed with intravenous immunoglobulin (IVIG) and steroids, with rapid clinical and laboratory parameters improvement thereafter. Conclusion MIS-N is still evolving as a disease entity with no clear, directed guidance yet on diagnosis and management. Management is extrapolated from treatment of MIS-C. Additional case reports and series are warranted to increase awareness and enable better understanding of the disease pathology among clinicians for timely investigation, diagnosis, and management.
SARS-CoV-2

Background: With the surge of COVID-19 infections, there were concerns about shortage of mechanical ventilator in several countries including the Philippines. Objective: To transform a locally made, low-cost, neonatal ventilator into a volume- and pressure-controlled, adult ventilator and to determine its safe use among ventilated, adult patients at the Philippine General Hospital. Methods: The modification of the neonatal ventilator (OstreaVent1) to the adult OstreaVent2 was based on the critical need for adult ventilators, in volume or pressure mode, in the Philippines due to the COVID-19 pandemic. The adult ventilator settings were calibrated and tested for two days to check for consistency and tolerance and then submitted to a third party for certification. Once certified, a safety trial of 10 stable adult patients on mechanical ventilator was conducted. The patients were placed on the OstreaVent2 for four hours while ventilator parameters, patient’s vital signs, and arterial blood gases were monitored at baseline, during, and after placement on the OstreaVent2. A poststudy chest radiograph was also done to rule out pulmonary complications, particularly atelectasis and pneumothorax. Results: The prototype OstreaVent2 received an FDA Certification for Medical Listing after passing its thirdparty certification. Ten patients (60% male) recruited in the study had a mean age of 39.1 ± 11.6 years. Half of the patients had a diagnosis of non-COVID-19 pneumonia. During the 4-hour study period, the patients while on the OstreaVent2, had stable ventilator settings and most of the variabilities were within the acceptable tolerances. Vital signs were stable and arterial blood gases were within normal limits. One patient developed alar flaring which was relieved by endotracheal tube suctioning. No patient was withdrawn from the study. One patient who was already transferred out of the ICU subsequently deteriorated and died three days after transfer to the stepdown unit from a non-ventilator related cause. Conclusion The new OstreaVent2 is safe to use among adults who need ventilator support. Variabilities in the ventilator’s performance were within acceptable tolerances. Clinical and blood gas measurements of the patients were stable while on the ventilator.
Respiration, Artificial

Context: Exposure to environmental pollutants (EP) and Endocrine-disrupting chemicals (EDCs) is associated with several general negative health effects which compromise women's reproductive health, maternal, and neonatal outcomes. Unfortunately, many nonpregnant and pregnant women are unaware of their active exposure to these potentially slow-acting toxic substances, EPs, and EDCs. At any stage of life, and in the long-term minute exposures, there is no established safe level of exposure to these substances. Due to the potentially harmful effects on women in general, and to the pregnant and her unborn child in particular, it is important to establish the prevalence of their exposure. Aims: The aim of this study was to determine the magnitude (prevalence) of exposure among nonpregnant and pregnant women aged 18–49 years to common EPs/EDCs such as bisphenol A, pesticides, phthalates, and perfluorinated compounds among others. Settings and Design : This study was conducted at the Philippine General Hospital, University of the Philippines Manila. Subjects and Methods : The study participants were nonpregnant and pregnant women, with low-risk singleton pregnancy, and had a prenatal checkup and eventual delivery at the Philippine General Hospital. After consent, women were asked to answer a survey focused on their sociodemographics and frequency of exposure to EP- and EDC-containing items. Satatistical Analysis Used: Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Null hypotheses were rejected at 0.05 α-level of significance. The computer software STATA 13.1 was used for data analysis. Results: One hundred and fifty-nine survey responses by women were analyzed. Possible EDC-containing household items (carpets, linoleum, upholstered, and stain-resistant furniture) are more prevalent in the homes of pregnant women compared to nonpregnant women. Pregnant women are also exposed to wallpapers compared to nonpregnant individuals. Nonpregnant women were 1.5 times more exposed to lotions. Unexposure to hand sanitizers is 1.3 times higher among pregnant individuals. Conclusions There are differences in the prevalence of exposure to household EDC-containing items between pregnant and nonpregnant women, with pregnant women having a higher prevalence of exposure.
Endocrine-disrupting chemicals ; environmental pollutants ; pregnancy

BACKGROUND: Polycystic ovarian syndrome (PCOS) is a prevalent condition affecting women of reproductive age, characterized by metabolic, endocrine, and reproductive disturbances including insulin resistance, abnormal uterine bleeding, infertility, and hyperandrogenism, and is associated with diabetes and cardiovascular disease. The etiology of PCOS is unclear and exposure to endocrine-disrupting chemicals (EDCs) present in everyday products may play a role by disrupting hormonal pathways. OBJECTIVES: To determine the association between exposure to EDC-containing products, sociodemographic factors, and PCOS diagnosis among nonpregnant reproductive-aged women. MATERIALS AND METHODS: A survey assessed the frequency of EDC exposure in homes and workplaces. The Rotterdam Criteria were used for the diagnosis of PCO features with clinical history and ultrasound. The association between PCOS and EDC exposure was determined using Chi-square and logistic regression analysis. RESULTS: The study identified significant sociodemographic factors associated with PCOS (P < 0.001) including age, civil status, and household income. Increased likelihood of PCOS was linked to frequent use of scented candles (odds ratio [OR] = 2.07), cleaning sprays (OR = 2.28), and floor polish (OR = 2.07), exposure to new upholstered furniture (OR = 4.00), thermal receipts (OR = 2.16), and consumption of microwaved and processed foods (OR = 2.60), as well as water sourced from wells (OR = 7.69). Additional associations were found with access to public markets (OR = 0.26) and the use of paper food wrappers (OR = 1.72). CONCLUSION These findings suggest that frequent exposure to EDC-containing products and certain sociodemographic factors may contribute to the development of PCOS among women of reproductive age. Results underscore the importance of reducing exposure to EDCs to prevent or mitigate the development of PCOS and other reproductive consequences.
Female

Background and Objectives: The Philippines faces challenges in the screening of tuberculosis (TB), one of them being the shortage in the health workforce who are skilled and allowed to screen TB. Deep learning neural networks (DLNNs) have shown potential in the TB screening process utilizing chest radiographs (CXRs). However, local studies on AIbased TB screening are limited. This study evaluated qXR3.0 technology's diagnostic performance for TB screening in Filipino adults aged 15 and older. Specifically, we evaluated the specificity and sensitivity of qXR3.0 compared to radiologists' impressions and determined whether it meets the World Health Organization (WHO) standards. Methods: A prospective cohort design was used to perform a study on comparing screening and diagnostic accuracies of qXR3.0 and two radiologist gradings in accordance with the Standards for Reporting Diagnostic Accuracy (STARD). Subjects from two clinics in Metro Manila which had qXR 3.0 seeking consultation at the time of study were invited to participate to have CXRs and sputum collected. Radiologists' and qXR3.0 readings and impressions were compared with respect to the reference standard Xpert MTB/RiF assay. Diagnostic accuracy measures were calculated. Results: With 82 participants, qXR3.0 demonstrated 100% sensitivity and 72.7% specificity with respect to the reference standard. There was a strong agreement between qXR3.0 and radiologists' readings as exhibited by the 0.7895 (between qXR 3.0 and CXRs read by at least one radiologist), 0.9362 (qXR 3.0 and CXRs read by both radiologists), and 0.9403 (qXR 3.0 and CXRs read as not suggestive of TB by at least one radiologist) concordance indices. Conclusions qXR3.0 demonstrated high sensitivity to identify presence of TB among patients, and meets the WHO standard of at least 70% specificity for detecting true TB infection. This shows an immense potential for the tool to supplement the shortage of radiologists for TB screening in the country. Future research directions may consider larger sample sizes to confirm these findings and explore the economic value of mainstream adoption of qXR 3.0 for TB screening.
Tuberculosis ; Diagnostic Imaging ; Deep Learning