Direct electrical stimulation of the human cortex can produce subjective visual sensations, yet these sensations are unstable. The underlying mechanisms may stem from differences in electrophysiological activity within the distributed network outside the stimulated site. To address this problem, we recruited 69 patients who experienced visual sensations during invasive electrical stimulation while intracranial electroencephalography (iEEG) data were recorded. We found significantly flattened power spectral slopes in distributed regions involving different brain networks and decreased integrated information during elicited visual sensations compared with the non-sensation condition. Further analysis based on minimum information partitions revealed that the reconfigured network interactions primarily involved the inferior frontal cortex, posterior superior temporal sulcus, and temporoparietal junction. The flattened power spectral slope in the inferior frontal gyrus was also correlated with integrated information. Taken together, this study indicates that the altered electrophysiological signatures provide insights into the neural mechanisms underlying subjective visual sensations.
Humans ; Male ; Female ; Adult ; Visual Perception/physiology* ; Electric Stimulation ; Middle Aged ; Young Adult ; Electrocorticography ; Electroencephalography ; Brain Mapping

JMJD1C (Jumonji Domain Containing 1C), a member of the lysine demethylase 3 (KDM3) family, is universally required for the survival of several types of acute myeloid leukemia (AML) cells with different genetic mutations, representing a therapeutic opportunity with broad application. Yet how JMJD1C regulates the leukemic programs of various AML cells is largely unexplored. Here we show that JMJD1C interacts with the master hematopoietic transcription factor RUNX1, which thereby recruits JMJD1C to the genome to facilitate a RUNX1-driven transcriptional program that supports leukemic cell survival. The underlying mechanism hinges on the long N-terminal disordered region of JMJD1C, which harbors two inseparable abilities: condensate formation and direct interaction with RUNX1. This dual capability of JMJD1C may influence enhancer-promoter contacts crucial for the expression of key leukemic genes regulated by RUNX1. Our findings demonstrate a previously unappreciated role for the non-catalytic function of JMJD1C in transcriptional regulation, underlying a mechanism shared by different types of leukemias.
Core Binding Factor Alpha 2 Subunit/genetics* ; Humans ; Leukemia, Myeloid, Acute/pathology* ; Jumonji Domain-Containing Histone Demethylases/chemistry* ; Gene Expression Regulation, Leukemic ; Oxidoreductases, N-Demethylating/genetics* ; Cell Line, Tumor

Hepatitis B core antibody （anti-HBc） is an important marker of prior HBV exposure and potential viral persistence. During acute HBV infection， anti-HBc IgM is the earliest antibody to appear shortly after HBsAg， usually lasting for 6 — 12 months， followed by anti-HBc IgG. In patients with chronic infection experiencing acute hepatitis flares， anti-HBc IgM may reappear， though typically at lower titers than in acute infection. “Isolated anti-HBc positivity” may indicate resolved/functional cure of prior HBV infection or occult HBV infection， and there is still a risk of HBV reactivation or transmission during chemotherapy， immunotherapy， blood transfusion， or organ transplantation. Therefore， accurate recognition of the clinical significance of anti-HBc is essential for comprehensive evaluation and individualized management of HBV infection.

INTRODUCTION

Kawasaki Disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) are two related conditions that primarily affect pediatric patients. The overlap in clinical symptoms, physical findings, and laboratory results between MIS-C and KD complicates diagnosis and treatment, as children with MIS-C may fulfill the criteria for KD. Early recognition of distinguishing clinical, laboratory, and echocardiographic findings is crucial for timely diagnosis and appropriate treatment, which can mitigate the risk of severe cardiovascular, gastrointestinal, and neurological complications.

This study aims to compare the clinical profile, laboratory profile, 2-D echocardiographic findings, treatment, and outcome ofchildren with KD vs MIS-C at a tertiary hospital in the Philippines.

A retrospective, analytic cohort study was done to differentiate the clinical profiles, laboratory profile, treatments, and outcomesof pediatric patients aged less than 19 years old, admitted with a diagnosis of KD, from January 2016 to December 2019 (pre-COVID-19 pandemic), and MIS-C cases admitted from January 2020 to December 2023, in a private, urban, tertiary hospital. Descriptive statistics (frequency and proportion, mean and standard deviation, median and inter-quartile range) were used to summarize the general and clinical characteristics of the participants. Independent T-test, Mann-Whitney U test and Fisher’s Exact/Chi-square test were used to determine the difference of mean, median and frequency of laboratory parameters among groups.

The study included 87 patients, with 60 categorized in the KD group (13 diagnosed with complete KD and 47 with incomplete KD) and 27 in the MIS-C group. MIS-C patients were more likely to be older (p = 0.023), present with GI symptoms such as vomiting (48.2% in MIS-C vs. 12.8% in KD) and abdominal pain (40.7% vs. 6.4%), respiratory symptoms such as shortness of breath (29.6% vs 0%) and wheezing (14.8% vs 0%), have lower WBC (6.30 in MIS-C vs. 13.07 in complete KD and 10.18 in incomplete KD, p < 0.001), ANC (5,940 in MIS-C vs. 13,660 in complete KD and 10,432 in incomplete KD, p = 0.002), and platelet count (280 in MIS-C vs. 368 incomplete KD and 364 in incomplete KD, p = 0.13), and experience more complications such as myocarditis (14.81% vs. 0%), hypotension (18.52% vs. 0%), shock (14.81% vs. 0%), and pneumonia (40.74% vs. 17.02% for incomplete KD and 7.69% for complete KD). In contrast, key features of KD, including conjunctival injection (100% in KD vs. 25.9% in MIS-C), rash (100% vs 59.3%), oral changes (92.3% vs. 22.2%), and cervical lymphadenopathy (92.3% vs. 29.6%), elevated laboratory results of CRP (12.89 in MIS-C vs. 46.53 incomplete KD and 111.15 in incomplete KD, p < 0.001), ESR (41.91 in MIS-C vs. 61.73 in complete KD and 82.49 in incomplete KD, p= 0.003), and AST/ALT ratios (0.42 in MIS-C vs. 1.88 in complete KD and 0.62 in incomplete KD, p = 0.034) were more frequently observed in KD patients. Combination therapy involving intravenous immunoglobulin (IVIG), methylprednisolone, and acetylsalicylic acid (ASA) was more common in MIS-C patients than in KD patients (48.15% in MIS-C vs. 7.69% for complete KD and 2.13% forincomplete KD), who mainly received IVIG and ASA alone (84.62% in complete KD and 93.62% in incomplete KD vs 3.7% in MIS-C).

This study highlights key clinical and laboratory differences between MIS-C and KD in a private tertiary hospital setting. MIS-C patients were generally older, exhibited more GI and respiratory symptoms, and had a higher risk of serious complications. In contrast, KD cases more often presented with classic mucocutaneous signs and elevated inflammatory markers. These findings underscore the importance of early differentiation, as MIS-C often requires more intensive management. The study also identifies practical diagnostic indicators including CBC parameters such as WBC, ANC, and platelet count that may aid clinicians, particularly in resource-limited settings. Further multicenter research involving both public and private hospitals is needed to validate and enhance the diagnostic criteria.

INTRODUCTION

Multisystem Inflammatory Syndrome in Children (MIS-C) is a delayed hyperinflammatory condition affecting multiple organ systems. Prominent symptoms include fever, skin rashes, and gastrointestinal symptoms, manifesting prior to critical signs such as cardiac involvement, hypotension, and shock.

To determine if certain demographic, clinical, and laboratory markers are predictive of poor outcomes in patients diagnosed with MIS-C.

This is a retrospective, cross-sectional study (2020-2023) of children who met the 2020 CDC MIS-C criteria. Data on demographics, comorbidities, clinical course, outcomes, laboratory results and 2D Echocardiogram findings were obtained and analyzed.

There were 28 patients with MIS-C, with a median age of 4.5 years. The majority of patients were male (64%). The percentage of neutrophils showed a significant association with hypotension/shock (OR 1.16). White blood cell count (WBC) and ferritin were significantly associated with ICU admission (OR 3.5 and 2.9, respectively). Pericardial effusion was observed in 71.4% while myocarditis was present in 67.9% of patients. The most notable risk factor was HIV infection, which was significantly associated with a more than 50-fold increase in the odds of developing ARDS and 165-fold increase in the odds of mortality; there was only one mortality, and only one patient with documented HIV infection.

The outcome was good in non-immunocompromised patients and the only recorded mortality was a patient not previously known to have HIV. We identified statistically significant factors that were associated with adverse outcome measures, with the limitation of a small sample, such as HIV infection and risk for ARDS and mortality; elevated neutrophil percentage and risk for hypotension/shock; elevated WBC and ferritin and risk for ICU admission; and saw a high prevalence of pericardial effusion and myocarditis in these patients, highlighting the critical role of hyperinflammation and cardiac involvement in disease progression and outcome.

Menopause is an inevitable phase in every woman’s life, significantly impacting their physical, psychological, and social well-being, with wide-ranging effects on their quality of life, including their ability to work. This systematic review employed a meta-synthesis to explore the workplace experiences of menopausal women. This study employed meta-synthesis to integrate findings from several qualitative and mixed-methods studies. Using the Critical Appraisal Skills Programme checklist and structured according to the PRISMA 2020 flow diagram, the review synthesized data from 12 final articles. Four key themes emerged from the thematic analysis: Impact and Symptom Experience, Disclosure and Attitude, Coping Tactics and Self-Management, and Workplace Policies and Practices. A meta-theme, Menopause as a Diversity-Wellbeing Concern in the Workplace, highlighted the need to recognize menopause as a critical diversity issue affecting women across all stages of their careers, from entry-level roles to senior positions. This review underscores the importance of tailored support and creating inclusive workplace environments that value and respect menopausal women, allowing them to thrive professionally while navigating this life stage.

OBJECTIVE

To compare the refractive absolute error when axial length (AL), anterior chamber depth (ACD) and keratometry (K) are sourced from different measuring devices (IOL Master vs a combination of automated keratometer and A-scan) and inputted into the Barrett Universal II or SRK/T formula.

This was a retrospective study. Medical charts of eyes that underwent uncomplicated phacoemulsification with in-the-bag implantation of Envista or multifocal FineVision IOL were reviewed. The results of manifest refraction at 1 month after surgery were collected. The predicted refraction corresponding to the IOL power implanted was collected from 4 IOL sheets: using the SRK/T with AL, ACD, and K from IOL Master (Group A); SRK/T formula with AL and ACD from A-scan and K from the automated keratometer (Group B); Barrett formula with AL, ACD and K from IOL Master (Group C); and Barrett formula using with AL, ACD from A-scan and K from automated keratometer. For each group, the absolute error, prediction error, and variances of prediction error were computed.

A total of 132 eyes were included in the study: 56 in the monofocal group and 76 in the multifocal group. The means of manifest refraction spherical equivalent (MRSE) were 0.06 ± 0.38 D and –0.08 ± 0.31 D in the monofocal and multifocal groups, respectively. When AL and K were obtained from various sources and entered into the Barrett formula, the mean absolute error difference in both the monofocal (p = 0.70) and multifocal (p = 0.10) groups did not reach statistical significance. If the SRK/T formula was used, similar outcomes were observed (monofocal p = 0.97; multifocal p = 0.37). When compared to A-scan groups, the prediction error variances are significantly smaller in the groups that used the IOL Master as their data source. Among the four groups, the Barrett group using IOL Master as the data source showed the lowest overall variation of prediction error (monofocal F = 0.04; multifocal F = 0.03).

Though the refractive outcomes may not be statistically different, using the IOL Master as the source of AL and K makes the refractive outcomes more consistent and predictable. Combining the AL and K from the IOL Master with the Barrett Universal II formula further increases the predictability of refractive outcomes.

BACKGROUND

Sepsis is a life-threatening organ dysfunction in response to an infection, and immediate administration of the first antibiotic dose, along with other resuscitative efforts, improves patient outcomes. This paved the way for the development of evidence-based sepsis pathways in different health institutions.

This study aims to assess the process of initial antibiotic therapy, from the time the loading dose of antibiotic was ordered to the time it was administered, for adult patients with sepsis admitted at the Emergency Department (ED) of the University of the Philippines – Philippine General Hospital (UP-PGH).

In phase 1 of the study, a review of medical records was done to identify all adult patients diagnosed with sepsis in the ED from February 1 to August 31, 2022. A variant of time-motion analysis was used wherein three points in the sepsis pathway were identified: the t ime of diagnosis of sepsis/first chart order of antibiotics (point A), the time the chart order was noted by the nurse-in-charge (point B), and the documented time of f irst dose administration (point C). The mean and median duration (in hours) were then computed between these points. As an additional aim, we briefly presented the outcome of the population used. In phase 2, individual interviews and focused group discussions were done, involving key medical personnel in the sepsis pathway: physicians, nurses, pharmacists, and utility personnel. The data transcribed from these interviews was analyzed through a thematic examination.

A total of 508 adult patients were diagnosed with sepsis on record review, 442 of whom met the inclusion criteria. The median time it took for the nursein-charge to acknowledge the antibiotic order (points A to B) is 0.73 hours (IQR 0.27-1.7). Meanwhile, the median time between acknowledgment of the order to administration of antibiotics is 1.94 hours (IQR 0.83-6.63). More importantly, the median time from diagnosis-to-first dose (points A to C) is 3.53 hours (IQR 1.59–7.96), while the corresponding mean duration is 5.72 hours. In all cases, 44.6% and 12.4% of loading doses were given within three hours and within one hour after diagnosis, respectively. The all-cause mortality of all qualified cases was 64.7%. A total of 28 key medical personnel were recruited for phase 2. Issues regarding governance, information systems, finances, service delivery, and human resources were identified. In particular, the electronic chart system, a more stable supply of antibiotics, and the new pharmacy at the ER helped facilitate antibiotic delivery. Lack of personnel, gaps in information, and repetitive paperwork were cited as areas for improvement in the existing system.

In more than half of the study population, the target time from diagnosis to loading dose of at least 1 hour was not reached. The significant delays in sepsis treatment call for system-wide improvements to hasten the process of antibiotic delivery and reduce the poor outcomes associated with sepsis.

war ; Armed Conflicts ; Nuclear Energy ; Atomic Energy ; Radiation ; Nuclear Weapons

BACKGROUND AND OBJECTIVES

COVID-19 has quickly spread over the world and became an unprecedented burden on health care systems. COVID-19 diagnosis necessitates the use of precise testing methods such as RT-PCR. This method is generally reported as positive or negative, however, studies have shown its semi-quantitative capability through Ct values. This study determined an association that exists between the Ct values, clinical features, and laboratory findings among COVID-19 patients admitted in a tertiary infectious disease hospital in Manila, Philippines. This attempts to further explore the utility of RT-PCR in disease severity classification and diagnosis.

This was an observational retrospective study that utilized a purposive sampling method, wherein patients were selected based on the DOH case definition of confirmed COVID-19, and were stratified according to disease severity. Baseline laboratory data of the patients were gathered from medical records covering the period of June 2021 to January 2022 using a Data Collection Form. Chi-square test was used to measure the degree of association between the groups and categorical variables. Regression Analysis was used to identify predictors for certain variables. SPSS Statistics for Windows, Version 25.0 was utilized for the statistical analysis.

The total WBC, neutrophil, lymphocyte and monocyte counts, serum urea, LDH, CRP and PTT were found to be predictors of COVID-19 severity. There was no significant difference observed between the disease severity and the patient’s clinical outcome. All routine laboratory tests that were taken at baseline (ORF Gene, N-Gene, Hematocrit, White Blood Cells, Neutrophil, Lymphocyte, Monocyte, Platelet Count, Urea, Creatinine, SGPT, SGOT, Na, K, LDH, Ferritin, C Reactive Protein, Procalcitonin, D-Dimer, PT, PTT) were not significant predictors of the clinical outcome. Although WBC, neutrophil, lymphocyte, and monocyte count, urea, LDH, CRP, and PTT were predictors  of disease severity. The study also reported that the odds of having severe to critical disease increases by 20.6% for every one unit increase in neutrophil count, and 17.4% for every one unit increase in lymphocyte count. Among the laboratory parameters, neutrophil count (p=0.010654063) and urea (p= 0.04149874 have direct relationship with the N gene Ct values while Orf gene Ct Values have direct relationship with lymphocyte count (p=0.01269027). Similarly, regression showed that as monocyte count, creatinine levels, and serum ferritin decrease, Ct values increase. Sex was found to not be a significant predictor of disease severity and clinical outcome. There was also no significant difference observed between the disease severity and the patient’s clinical outcome.

The study showed that the Ct values for both ORF and N genes were not significant predictors of both disease severity and clinical outcome. However, ORF gene Ct values have direct relationship with lymphocyte counts while N gene Ct values have direct correlation with neutrophil count and urea levels. Similarly, monocyte, creatinine, and ferritin are negatively correlated with Ct values. It is important to monitor the patient’s laboratory biomarkers in order to determine the proper course of treatment and management for each case.