Glutathione (GSH) is a naturally produced tripeptide composed of glutamine,glycine,and cysteine. GSH has several important metabolic and regulatory functions in our body but it is most popular for its antioxidant role. Oxidative stress states such as chronic diseases or low protein levels can deplete intracellular glutathione. Glutathione levels may be increased by correcting any protein deficiency, administering glutathione supplements or other precursors, usually by oral or intravenous routes. Glutathione supplements are generally considered safe to administer either intravenously or orally. Dermatologists need basic knowledge about glutathione supplements need to be scientifically studied by dermatologists before these supplements become part of our therapeutic options.

Human ; Antioxidants ; Biological Products ; Chronic Disease ; Cysteine ; Dermatologists ; Dietary Supplements ; Glutamine ; Glutathione ; Glycine ; Oxidative Stress ; Protein Deficiency

BACKGROUND: Glutathione is an important intracellular anti-oxidant involved in different cellular and body functions. In recent years, glutathione-containing products have become extremely popular as evidenced by the proliferation of these products especially for 'skin whitening'. The investigators conducted this exploratory study in preparation for further investigations to validate the efficacy and safety of glutathione-containing products.
OBJECTIVES: 1) To describe the different glutathione products, their claims on efficacy and safety, as advertised on the Internet; 2) To report the best current evidence on the claims of efficacy and safety of glutathione supplements and glutathione-containing products for the skin.
METHOD: An online search for glutathione distributors was conducted from February to March 2008 to find out their claims on the efficacy and safety of glutathione-containing supplements or IV glutathione. For the search of the best current evidence on glutathione products, various electronic databases were searched up to September 2008 for any human clinical trials or reports of adverse events. Key informants were also interviewed.
RESULTS: From the Internet search, there were 20 brands oftopical glutathione products, 21 oral preparations, and 2 injectable glutathione products. There were also a variety of glutathione formulations available, mainly capsules containg glutathione plus other antioxidants. All products claimed a skin 'whitening' effect. There were no published human clinical trials, whether quasi-experimental or controlled trials (ex. RCTs) supporting the claims of skin whitening or skin rejuvenating effects of glutathione. There was one unpublished randomized controlled trial and one local clinical trial ongoing in the Philippines. No adverse events associated with glutathione products were reported in published literature. Anecdotal reports of adverse effects were gathered during key informant interviews.
CONCLUSIONS: The evidence on whitening and skin rejuvenation effects and safety is insufficient because these are based on testimonials and anecdotal reports, all of which are at high risk of bias. The magnitude of glutathione's skin whitening effect nor its side-effects have not yet been established.
RECOMMENDATIONS: Good quality, randomized, controlled trials are needed to validate claims of skin 'whitening' from the use of glutathione supplementation or glutathione skin products. Health professionals and consumers should document and report adverse events related to glutathione-containing products for the sake of public safety.

Human ; Androsterone ; Antioxidants ; Capsules ; Dietary Supplements ; Glutathione ; Oxidants ; Philippines ; Rejuvenation ; Research Personnel ; Safety

OBJECTIVES:To determine the prevalence of breastfeeding-related skin problems as well as the knowledge, attitude and practices on breastfeeding among mothers in Barangay Batasan Hills, Quezon City.   
METHODOLOGY: This is a cross-sectional study conducted at the Superhealth Center in Barangay Batasan Hills, Quezon City, Metro Manila, Philippines. Included in the study were women of reproductive age who had breastfed at least on child in the past or who were breastfeeding at the time of the survey. An exploratory phase was conducted to determine the extent of the problem. Data gathered from this phase helped in the formulation of a questionnaire. A cross sectional survey was then conducted to determine the common reasons for breastfeeding, the average number of children being breastfed by the participants, the frequency and duration of breastfeeding per child, the hygienic practices of breastfeeding women, the prevalence of breastfeeding-related skin conditions, health seeking behavior of those who experienced the skin conditions, and the common reasons for discontinuation of breastfeeding.   
RESULTS: Ninety-four women participated in the survey. The most common reason for breastfeeding given was, "breast milk is good for the health of the baby" (59.6%). Most of the women learned about breastfeeding from their mothers (41.5%). Most of the participants were able to breastfeed one child (43.6%). The average time spent for breastfeeding one child was three hours per day. Most of the mothers used damp cloth/cotton balls (38.3%) or tepid water (34.0%) to prepare their nipple prior to breastfeeding. Majority of them (72.3%) did not experience any breastfeeding-related skin problems. Among the 27.7%, who experienced skin problems, nipple cracks or fissures (15.0%), breast engorgement (10.6%), and nipple pain (4.2%) were the top three reported skin problems. None of the respondents discontinued breastfeeding due to breastfeeding-related skin problems. A minority of interviewed women (7.0%) discontinued breastfeeding because they were unable to express milk.   
CONCLUSION: The proportion of women with breastfeeding-related skin problems in Barangay Batasan Hills, Quezon City was 27.7%. More than half of those who experienced such problems still continued to breastfeed without any intervention. There was a low rate of discontinuation of breastfeeding (7.4%) among the participants of this study. This finding may be due to the prevalent support of the respondents' mothers and relatives as well as the active promotion of breastfeeding by the local health units and centers in the barangay.

Human ; Female ; Adult ; Infant ; Breast Feeding ; Lactation Disorders ; Milk, Human ; Mothers ; Nipples ; Pain ; Prevalence ; Water

BACKGROUND

The Philippines has the highest number of new leprosy cases in the Western Pacific Region, with 1,000 to 2,000+ cases detected annually over the past decade. Out of 46 filariasis-endemic provinces in the country, 43 have eliminated lymphatic filariasis. However, many grade 2 disabilities acquired from these neglected tropical diseases (NTDs) remain undetected due to inadequate monitoring during and after treatment. This was further exacerbated by the detrimental impact of COVID-19 on healthcare access. The pandemic prompted initial adoption of teletraining, making a feasibility study necessary.

OBJECTIVE

This study aimed to determine the feasibility of using telehealth and distance learning to train healthcare workers and patients in the integrated rehabilitation and prevention of impairments and disabilities from leprosy, lymphatic filariasis, mycetoma, diabetes, pressure ulcers, and other chronic wounds.

METHODS

Selected rural health units, patients with disabilities, and their caregivers in a leprosy- and lymphatic filariasis-endemic region were recruited. Municipal health officers and leprosy coordinators helped in the conceptualization, planning, implementation, and evaluation of the teletraining program to ensure its acceptability and utilization. Asynchronous and synchronous methods were used. The main reference was the "Ten Steps" guide. Training materials were shared via Google Drive and flash drives sent to each study site. One-day didactics and skills trainings were conducted through live-interactive sessions using online platforms (Zoom or Google Meet). Topics focused on nerve function assessment (for leprosy and diabetes), problems of mobility, lymphedema, wound care, and self-care. Participants practiced and demonstrated their skills on local patients, with mentoring through Messenger chats. Knowledge and performance assessments were conducted.

RESULTS

The study was conducted from 2021 to 2022 and the actual training implemented within four months of 2022. Two municipalities of Sultan Kudarat province, Mindanao Island group with one rural health unit (RHU) each had participated. All participants (N=16; eight RHU personnel and eight village health workers) attended the synchronous skills training, 12 (75%) submitted return demo videos, and 13 (81.25%) had practicum patients. All participants rated the training as successfully attaining objectives and activities. All were generally satisfied with the teletraining because of improved knowledge and skills gained and were willing to continue it. Efficiency, speed, quality of training, and trainers had high ratings. Teletraining was considered effective in improving the wound care of their patients. Patients were also satisfied with the home care. However, the unreliable internet service in the study sites created difficulties during synchronous sessions and negatively affected appropriateness of teletraining. Finding patients for practicum was challenging. Some supplies were not available in local drugstores and had to be shipped from Manila, raising costs. Overall, the rating of the teletraining was good.

CONCLUSION

Teletraining of health workers from distant health units on integrated disability prevention and care is feasible in terms of implementation, acceptability, and practicality if stable internet connectivity is available. Larger studies are recommended.

Human ; Telehealth ; Telemedicine ; Leprosy ; Lymphatic Filariasis ; Elephantiasis, Filarial ; Pressure Ulcer