BACKGROUND

Mpox, a zoonotic disease identified in central Africa in 1958, is mainly endemic to the Congo basin and West Africa. Collecting demographic and clinical data is crucial for early recognition and differentiation of skin lesions as the Philippines addresses this public health challenge.

We describe the demographics, clinical profile, and outcomes of suspected and confirmed mpox cases in the Philippines from July to November 2022.

This case series reviewed suspected and confirmed mpox cases at the Research Institute for Tropical Medicine from July to November 2022. Clinical data, demographics, and outcomes were collected through retrospective chart reviews and summarized using descriptive statistics.

Fifteen cases were reviewed, including 2 confirmed mpox cases, with an average age of 37.8 years and 80% male. The other symptoms associated with rash at presentation included fever (20%) followed by lymphadenopathy, malaise and chills reported in 1 case each. All patients had pustules and erythematous papules, with 67% showing vesicles. Lesions mainly appeared on the extremities (93%), trunk (60%), and head/neck (47%), evolving into crusts within 1–2 days. Non-confirmed cases were often misdiagnosed as varicella (60%), arthropod bites (20%), or folliculitis (7%).

Young to middle-aged males with travel histories were common in suspected and confirmed mpox cases. Lesions typically included papules and pustules on the extremities, evolving into crusts and erosions within 1–2 days. Confirmed cases had umbilicated papules and fever, while PCR-negative cases were diagnosed with local skin conditions. Testing is vital for timely detection and management, especially since mpox resembles other conditions.

This study was carried out to investigate fifteen cases of acute lethal infection of calves (< or = 4 months of age) by the protozoan parasite Theileria (T.) annulata in the south of Portugal. Calves developed multifocal to coalescent nodular skin lesions, similar to multicentric malignant lymphoma. Infestation with ticks (genus Hyalomma) was intense. Theileria was seen in blood and lymph node smears, and T. annulata infection was confirmed by isolation of schizont-transformed cells and sequencing of hypervariable region 4 of the 18S rRNA gene. At necropsy, hemorrhagic nodules or nodules with a hemorrhagic halo were seen, particularly in the skin, subcutaneous tissue, skeletal and cardiac muscles, pharynx, trachea and intestinal serosa. Histologically, nodules were formed by large, round, lymphoblastoid neoplastic-like cells. Immunohistochemistry (IHC) identified these cells as mostly CD3 positive T lymphocytes and MAC387 positive macrophages. A marker for B lymphocytes (CD79alphacy) labeled very few cells. T. annulata infected cells in these nodules were also identified by IHC through the use of two monoclonal antibodies (1C7 and 1C12) which are diagnostic for the parasite. It was concluded that the pathological changes observed in the different organs and tissues were caused by proliferation of schizont-infected macrophages, which subsequently stimulate a severe uncontrolled proliferation of uninfected T lymphocytes.
Animals ; Base Sequence ; Cattle ; Cattle Diseases/epidemiology/*parasitology/pathology ; Cell Growth Processes/physiology ; DNA, Protozoan/chemistry/genetics ; Disease Outbreaks/*veterinary ; Female ; Immunohistochemistry/veterinary ; Lymphocytes/parasitology/*pathology ; Male ; Molecular Sequence Data ; Polymerase Chain Reaction/veterinary ; Portugal/epidemiology ; RNA, Ribosomal, 18S/chemistry/genetics ; Sequence Analysis, DNA ; Skin Diseases/epidemiology/parasitology/pathology/*veterinary ; Theileria annulata/*isolation & purification ; Theileriasis/epidemiology/parasitology/*pathology

We describe a minimally invasive endovascular approach to treat an arteriovenous fistula of the scalp. We performed a direct puncture of the lesion through the patient’s scalp for liquid embolic agent injection along with external compression of the superficial temporal artery to perform a “manual pressure-cooker technique.” The combination of these minimally invasive techniques resulted in an excellent clinical and radiographic outcome.

Purpose: There has been limited work assessing the use of re-irradiation (re-RT) for local failure following stereotactic spinal radiosurgery (SSRS). We reviewed our institutional experience of conventionally-fractionated external beam radiation (cEBRT) for salvage therapy following SSRS local failure. Materials and Methods: We performed a retrospective review of 54 patients that underwent salvage conventional re-RT at previously SSRS-treated sites. Local control following re-RT was defined as the absence of progression at the treated site as determined by magnetic resonance imaging. Results: Competing risk analysis for local failure was performed using a Fine-Gray model. The median follow-up time was 25 months and median overall survival (OS) was 16 months (95% confidence interval [CI], 10.8–24.9 months) following cEBRT re-RT. Multivariable Cox proportional-hazards analysis revealed Karnofsky performance score prior to re-RT (hazard ratio [HR] = 0.95; 95% CI, 0.93–0.98; p = 0.003) and time to local failure (HR = 0.97; 95% CI, 0.94–1.00; p = 0.04) were associated with longer OS, while male sex (HR = 3.92; 95% CI, 1.64–9.33; p = 0.002) was associated with shorter OS. Local control at 12 months was 81% (95% CI, 69.3–94.0). Competing risk multivariable regression revealed radioresistant tumors (subhazard ratio [subHR] = 0.36; 95% CI, 0.15–0.90; p = 0.028) and epidural disease (subHR = 0.31; 95% CI, 0.12–0.78; p =0.013) were associated with increased risk of local failure. At 12 months, 91% of patients maintained ambulatory function. Conclusion Our data suggest that cEBRT following SSRS local failure can be used safely and effectively. Further investigation is needed into optimal patient selection for cEBRT in the retreatment setting.

BACKGROUND: Ports and naval bases play a significant role in understanding marine macrofouling and the associated transport of species across boundaries. Structures on ports and piers become habitats of foulers, whether indigenous or non-indigenous. There is a paucity of literature on species composition of foulers in ports in the Philippines. Naval Base Heracleo Alano in Cavite City, formerly known as Sangley Point, is a potential habitat for non-indigenous species.

METHODS: The study assessed benthic biofoulers at four areas in close proximity at Naval Base Heracleo Alano, Cavite City, using artificial collectors. Fouler collector design was adapted from the North Pacific Marine Sciences
Organization (PICES). Fouler collectors were deployed in 4 sampling points from November 2015 and retrieved in February 2016. Collected fouling organisms were identified using taxonomic keys. Species diversity (H) through Shannon Wiener Index, Species Evenness (H'/H'max), and Simpson's Index were determined.

RESULTS AND DISCUSSION: A total of 6203 organisms belonging to 20 families was collected. Common macrofoulers were bivalves, polychaetes, decapods, amphipods, and barnacles. Shannon-Wiener index values as well as species evenness were relatively consistent. Values of the Simpson's index indicated the presence of dominant species, Balanus sp. The macrofouling community contained 7 non-indigenous species, namely, Mytella charruana, Brachidontes, Mytilopsis sallei, Hydroides, Stylochus, Sabella, and Membranipora membranacea. The macrofouling organisms present in the area may pose problems in submerged equipment and cause some financial loss to the facility; the non-indigenous could be potential threats to the local ecosystem. All seven non-indigenous species are potentially invasive, although their abundance suggests otherwise.

CONCLUSION: A baseline listing of species was generated and showed various species of foulers in the naval base, with Balanus being the dominant species, which is the same as other studies in the Asian region. Seven nonindigenous
species were detected. There is a need to monitor the non-indigenous species, as Mytilopsis sallei (origin: Carribean) has been reported to in huge numbers in the Indo West Pacific region, particularly in Singapore, Hongkong, Thailand, India, Taiwan, China, Malaysia, Japan, and Australia; Brachidontes (Origin: Indo- Pacific) has spread to the Mediterranean and Red Sea.

Background: and Purpose Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration. Methods: As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated. Results: A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52–2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38–3.18). For isolated BZI, RR was 2.59 (95% CI 1.24–5.41). RR was 2.96 (95% CI 1.71–5.12) for studies only including anterior circulation stroke patients. Conclusion This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.

Objective: To describe the cochlear anatomy among Filipinos through high resolution computed tomography (HRCT) imaging. Methods: Design: Retrospective Study Setting: Tertiary Private University Hospital Patients: Cochlear images retrospectively obtained from computed tomography (CT) scans of subjects who underwent cranial, facial, paranasal sinus and temporal bone computed tomography from October 2009 to July 2010 were reconstructed and analyzed. Results: 388 cochlear images were obtained from the scans of 194 subjects (101 males and 93 females, aged 1 to 90 years old, mean = 52 years) and reconstructed for analysis. The mean coiled cochlear height measured 4.36 mm on the right (A.D.) and 4.34 mm on the left (A.S.). Measurement from the oval window to the distal end of the basal turn (equivalent to the horizontal dimension of the cochlea or the mean length of the basal turn) was 7.55 mm A.D. and 7.60 mm A.S. The vertical and horizontal dimensions of right and left cochleas were identical in all subjects (S.D. = 0.35). The right and left cochlear turns were identical in each subject, exhibiting 2 1/2 turns in 92.3% of subjects and 2 3/4 turns in 7.7% of subjects.The cochlear dimensions were similar in all subjects, regardless of age. No cochlear ossification or malformation was noted on any CT image. Conclusion The 7.55 mm mean length of the cochlear basal turn among Filipinos in this study was 1.24 mm shorter than the average length of the basal turn of 8.81 mm reported elsewhere. Further studies of the cochlear dimensions in specific age groups and its correlation to audiometric status are recommended to determine other significant physiologic correlations.
Cochlea ; Magnetic Resonance Imaging

Background: and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT. Methods: This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke. Results: Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04). Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.

Objective: To demonstrate SLEEP-GOAL as a more holistic and comprehensive success criterion for Obstructive Sleep Apnoea (OSA) treatment. Methods: A prospective 7-country clinical trial of 302 OSA patients, who met the selection criteria, and underwent nose, palate and/or tongue surgery. Pre- and post-operative data were recorded and analysed based on both the Sher criteria (apnoea hypopnea index, AHI reduction 50% and <20) and the SLEEP-GOAL. Results: There were 229 males and 73 females, mean age of 42.4±17.3 years, mean BMI 27.9±4.2. The mean VAS score improved from 7.7±1.4 to 2.5±1.7 (p<0.05), mean Epworth score (ESS) improved from 12.2±4.6 to 4.9±2.8 (p<0.05), mean body mass index (BMI) decreased from 27.9±4.2 to 26.1±3.7 (p>0.05), gross weight decreased from 81.9±14.3kg to 76.6±13.3kg. The mean AHI decreased 33.4±18.9 to 14.6±11.0 (p<0.05), mean lowest oxygen saturation (LSAT) improved 79.4±9.2% to 86.9±5.9% (p<0.05), and mean duration of oxygen <90% decreased from 32.6±8.9 minutes to 7.3±2.1 minutes (p<0.05). The overall success rate (302 patients) based on the Sher criteria was 66.2%. Crosstabulation of respective major/minor criteria fulfilment, based on fulfilment of two major and two minor or better, the success rate (based on SLEEP-GOAL) was 69.8%. Based solely on the Sher criteria, 63 patients who had significant blood pressure reduction, 29 patients who had BMI reduction and 66 patients who had clinically significant decrease in duration of oxygen <90% would have been misclassified as “failures”. Conclusion: AHI as a single parameter is unreliable. Assessing true success outcomes of OSA treatment, requires comprehensive and holistic parameters, reflecting true end-organ injury/function; the SLEEP-GOAL meets these requirements