Analgesia, Epidural ; Female ; Humans ; Labor, Obstetric ; Pregnancy

Background: The Psoriasis Registry (PsorReg) was created by the Psoriasis Foundation of the Philippines with the goal of assessing the true magnitude of psoriasis in Davao City. Objectives: To determine the demographic and clinical profiles of Filipino patients enrolled in PsorReg. Methods: Cross-sectional study among adult patients enrolled in PsorReg. Results: A total of 131 patients were included in the study. Mean age was 43.89 ± 15.8 years old. Chronic plaque psoriasis (96.2%) was the most common clinical pattern. 63.4% had nail involvement, while 35.1% had psoriatic arthritis. BMI was normal in 51.1% of patients. Common co-morbidities were hypertension (19.1%), diabetes (10.7%), and dyslipidemia (9.2%). Most common treatment were topical medications, while biologics were the least common. 42.7%, 49.6% and 37.4% had moderate psoriasis using BSA, PASI, and PGA, respectively. Majority (47.3%) reported a large effect of psoriasis on their quality of life. Conclusion This study determined the demographic and clinical profiles of adult Filipino patients registered in PsorReg in Davao City.
Psoriasis ; Registries ; Philippines ;

BACKGROUND: Systemic sclerosis (SSc) is a rare, connective tissue  disease  with  multisystem involvement.This is due to immunological processes,vascular endothelial cell injury  and extensive activation of fibrolast that commonly affects the skin and other internal organs such as the esophagus, lungs, heart, and kidneys. SSc has one of the highest mortality among  the  autoimmune  rheumatic  diseases,  hence  the  emphasis  on  the  early  recognition  and  management  to  prevent significant progression of the disease.
CASE: A 22-year-old  female  presented  with  a  one-year history of multiple hard and hypopigmented patches on the face, neck, trunk and upper extremities. Further examination revealed mask-like facies, microstomia, frenulum sclerosis, Raynaud's phenomenon, pitted scars on the digital pulp of hands  and  sclerodactyly.Baseline  blood  chemistry,chest radiograph and electrocardiography  were  all  negative  for systemic involvement. Autoantibodies were positive for dsDNA, SS-A/Ro and Scl-70. Skin biopsy revealed sclerosing dermatitis, which was consistent with SSc.
OUTCOME: The  patient  was  initially  started  with  oral prednisone 0.5 mg/kg/day and was increased to 0.75 mg/kg/day for eight weeks. Prednisone was slowly tapered to 5.0 mg/day and methotrexate 15.0 mg/week was included in  the  management for eight weeks which resulted in decreased joint pains, halted the progression of skin induration, decreased in pruritus and palmar edema.
CONCLUSION: The characteristic dermatological findings of SSc are not only important signs to dermatologists, but these serves as diagnostic clues for clinicians from other disciplines as well. In our case, the presence of the autoantibody Scl-70 indicated the potential risk of pulmonary fibrosis and pulmonary arterial hypertension that accounts with high mortality.Hence,physicians should be aware of the possible risk of organ damage,even when asymptomatic because there is a high risk of disease progression. The importance of early recognition and a multidisciplinary approach lead to the good outcome in this case.

Human ; Female ; Adult ; Autoantibodies ; Prednisone ; Methotrexate ; Cicatrix ; Microstomia ; Sclerosis ; Raynaud Disease ; Pulmonary Fibrosis ; Hypertension, Pulmonary ; Edema ; Rheumatic Diseases ; Scleroderma, Systemic ; Scleroderma, Diffuse

INTRODUCTIONManagement of complicated monochorionic twins and certain intrauterine structural anomalies is a pressing challenge in communities that still lack advanced fetal therapy. We describe our efforts to rapidly initiate selective feticide using radiofrequency ablation (RFA) and selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS), and present the latter as a potential model for aspiring fetal therapy units.

METHODSFive pregnancies with fetal complications were identified for RFA. Three pregnancies with Stage II TTTS were selected for SFLP. While RFA techniques utilising ultrasonography skills were quickly mastered, SFLP required stepwise technical learning with an overseas-based proctor, who provided real-time hands-off supervision.

RESULTSAll co-twins were live-born following selective feticide; one singleton pregnancy was lost. Fetoscopy techniques were learned in a stepwise manner and procedures were performed by a novice team of surgeons under proctorship. Dichorionisation was completed in only one patient. Five of six twins were live-born near term. One pregnancy developed twin anaemia-polycythaemia sequence, while another was complicated by co-twin demise.

DISCUSSIONProctor-supervised directed learning facilitated the rapid provision of basic fetal therapy services by our unit. While traditional apprenticeship is important for building individual expertise, this system is complementary and may benefit other small units committed to providing these services.