An 8 year-old female consulted at our institution due to left ear discharge. 6 months prior to consulting, the patient developed infraorbital swelling and erthema after she hit a metal post. The site of trauma eventually developed into a 2 x 2 cm abscess, which spontaneously ruptured. She was given cloxacillin for 7 days with no improvement of symptoms. 4 months prior to consulting, she developed foul-smelling left ear discharge, not associated with pain. She was given unrecalled otic drops and oral medications with no improvement. She eventually developed left facial paresis. Due to the persistence of ear discharge, she was brought to a local clinic where she was diagnosed to have chronic suppurative otitis media (CSOM) and referred to our institution. The patient also had an 8-month history of a recurrent cough and weight loss of 10% over 3 months. She had no history of fever, seizure, or change in sensorium. She has an older sibling who is an ongoing 2nd month of anti-tuberculosiis treatment. She was given BCG vaccination at birth. Her nutritional status is poor, with meals consisting usually of instant noodles, rice, bread, and cookies.
Body Fluids ; Pneumonia ; Patient Discharge ; Ulcer ; Child

In this study, the potential of isolate Pseudomonas lundensis UTAR FPE2 as a hydrocarbon degrader was established. Their biodegradation activity was first detected with the formation of clearing zones on Bushnell-Hass agar plates, with the largest diameter observed on plates supplemented with paraffin, followed by mineral oil and petrol. Utilization of hydrocarbon sources were again detected in broth cultures supplemented with similar hydrocarbon substrates, where the mean viable cell count recovered from hydrocarbon-supplemented broth cultures were higher than the initial inoculum except for napthalene. In both tests, the isolate showed higher degradability towards aliphatic hydrocarbon sources, and the least activity towards the aromatic hydrocarbon naphthalene. The isolate P. lundensis UTAR FPE2 (8 log10 cfu/mL) also degraded crude diesel sample, with 69% degradation during the first three days. To conclude, this study suggests the potential use of this isolate for bioremediation of hydrocarbon-contaminated environments.

Insulin hypersensitivity reactions are rare, but cause significant complexity in the care of patients with diabetes mellitus. A 54-year-old Filipino male with type 2 diabetes mellitus and multiple co-morbidities developed delayed-type hypersensitivity reactions to biphasic isophane human insulin and glargine. Despite good glycemic control on oral hypoglycemic agents, his endocrinologist foresaw the need for future insulin therapy, particularly one basal and one short-acting insulin. Targeted skin tests demonstrated protamine allergy and negative reactions to regular insulin and detemir. Close coordination of care among endocrinologists, allergists, patients and patients' family is needed to optimize glucose control, prevent complications, and minimize the risk of future hypersensitivity reactions.

Key Words: drug hypersensitivity, insulin, diabetes mellitus

The Universal Health Care (UHC) Act of the Philippines, signed into law in 2019, aims to provide a full range of health services to all Filipinos.1 However, its planned implementation was derailed with the COVID-19 pandemic. We observed a large variation in the pandemic response across regions and countries, highlighting the complex interplay of political, structural, economic, and cultural factors on health. 2 The Philippine national government implemented varying levels of community quarantine, risk communication, travel restrictions, testing and monitoring of at-risk individuals, and vaccination policies to control the pandemic, while the local government units (LGUs) were tasked to adopt and coordinate these policies in their communities.

INTRODUCTION: The antinuclear antibody (ANA) test is a screening test for systemic autoimmune rheumatic disease (SARD). We hypothesised that the presence of anti-DFS70 in ANA-positive samples was associated with a false-positive ANA test and negatively associated with SARD. METHODS: A retrospective analysis of patient samples received for ANA testing from 1 January 2016 to 30 June 2016 was performed. Patient samples underwent ANA testing via indirect immunofluorescence method and anti-DFS70 testing using enzyme-linked immunosorbent assay. RESULTS: Among a total of 645 ANA-positive samples, the majority (41.7%) were positive at a titre of 1:80. The commonest nuclear staining pattern (65.5%) was speckled. Only 9.5% of ANA-positive patients were diagnosed with SARD. Anti-DFS70 was found to be present in 10.0% of ANA-positive patients. The majority (51/59, 86.4%) of patients did not have SARD. Seven patients had positive ANA titre > 1:640, the presence of anti-double stranded DNA and/or anti-Ro60. The presence of anti-DFS70 in ANA-positive patients was not associated with the absence of SARD (Fisher's exact test, p = 0.245). CONCLUSION The presence of anti-DFS70 was associated with a false-positive ANA test in 8.6% of our patients. Anti-DFS70 was not associated with the absence of SARD.
Adaptor Proteins, Signal Transducing ; Antibodies, Antinuclear ; Autoimmune Diseases/diagnosis* ; Humans ; Retrospective Studies ; Rheumatic Diseases/diagnosis* ; Transcription Factors

INTRODUCTIONWe evaluated if there was significant stress in caregivers of elderly patients with osteoporotic hip fractures and determine any contributory factors.

MATERIALS AND METHODSA prospective cohort study was performed from June 2005 to June 2006 in a single tertiary hospital. Patients admitted during this period and their primary caregivers were interviewed on admission and at 6 months. Information on patient's demographics, comorbidities, functional and mental status, placement post-discharge and financial strain were noted. Caregiver stress was measured using the caregiver strain index (CSI). Relationships between key variables were analysed to derive possible correlations.

RESULTSThe study comprised caregivers of 76 patients with a mean age of 77 years (range, 50 to 95; SD, 11). Within 1 week of admission, 45 of the 76 caregivers (59.2%) were significantly stressed based on the CSI while at 6 months, 30 of the caregivers (50%) were significantly stressed. The mean CSI within 1 week of admission and at 6 months post-admission was 7.18 and 6.25 respectively (P = 0.042). The most significant contributory factor to stress was financial strain (P = 0.01) attributable to medical bills, rehabilitation costs and transport expenses.

CONCLUSIONThere is a significant amount of stress that is experienced by caregivers of elderly patients with hip fractures which commences from admission of the patient and it remains high at 6-months post-fracture. Financial strain has been found to be the only significant cause on both univariate and multivariate analysis. Adequate resources should be available to caregivers of patients with osteoporotic hip fractures.

Aged ; Aged, 80 and over ; Caregivers ; economics ; psychology ; Cost of Illness ; Female ; Hip Fractures ; etiology ; rehabilitation ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Prospective Studies ; Stress, Psychological

INTRODUCTIONPeutz-Jeghers Syndrome (PJS) is an uncommon autosomal dominant hamartomatous polyposis syndrome. Morbidity arises from polyp-related complications and increased risks of malignancy. We report on PJS patients registered in the Singapore Polyposis Registry, identified principal causes of morbidity and appraised current management strategies. A followup protocol based on recent literature has been proposed.

MATERIALS AND METHODSA search of a prospectively collected database in the Singapore Polyposis Registry was made. Only patients who fulfilled the diagnostic criteria of PJS were included. The clinical records were retrieved for review. Information on affected family members was obtained from the Registry's pedigree records.

RESULTSSeven unrelated patients fulfilled the criteria of having PJS. Principal causes of morbidity include recurrent bouts of abdominal colic, episodes of intestinal obstruction, gastrointestinal bleeding and the need for repeated laparotomies. Six out of 7 patients had initial presentation with acute intestinal obstruction requiring emergency laparotomy. Management was mostly problem-oriented and marked inter-surgeon variation with regard to cancer screening and genetic counselling was observed.

CONCLUSIONPatients with PJS suffer gastrointestinal complications from polyposis and are at increased risks for developing cancers. A move towards surveillance and planned comprehensive care may reduce the morbidity of the condition. A protocol driven approach conducted in the setting of a Polyposis Registry is ideally suited to facilitate such care.

Adolescent ; Adult ; Child ; Cohort Studies ; Critical Pathways ; Disease Management ; Female ; Gastrointestinal Diseases ; complications ; epidemiology ; Humans ; Male ; Peutz-Jeghers Syndrome ; complications ; therapy ; Population Surveillance ; Prevalence ; Registries ; Singapore ; epidemiology ; Young Adult

Not all cancer cells are born equal. While the great majority of the cells that make up tumours are destined to differentiate, albeit aberrantly, and eventually stop dividing, a handful of cancer cells appear to possess limitless replicative potential. This review presents compelling evidence to suggest that the bulk of malignant cells of most cancers are generated by a rare fraction of stem cell-like cancer cells. These cells, dubbed cancer stem cells, are phenotypically similar to the normal stem cells of the corresponding tissue of origin, but they exhibit dysfunctional patterns of self-renewal and differentiation. Cancer stem cells that are capable of recapitulating brain tumours as xenografts in mice are characterised by defined stem cell markers. These brain tumour stem cells demonstrate enhanced chemoresistance and radioresistance mechanisms compared to non-stem cells in the heterogeneous tumour, which suggest that they may be the likely candidates for tumour progression and recurrence. Indeed, recent work has shown that such aberrant signalling pathways may be targeted in novel anti-cancer therapeutic strategies. The stem cell concept of tumour progression prompts immediate attention to a new paradigm in cancer research with a focus on this minority subset of cells, and the design of novel therapeutic strategies to target these cells that are insignificant within the population of tumour cells, but that are in fact the relevant cells to be destroyed.
Cell Transformation, Neoplastic ; Glioma ; pathology ; radiotherapy ; Humans ; Models, Biological ; Neoplastic Stem Cells ; drug effects ; pathology ; Singapore

INTRODUCTIONThe Singapore Polyposis Registry (SPR) was established in 1989 in Singapore General Hospital (SGH). The aims were to provide a central registry service to facilitate identification, surveillance and management of families and individuals at high risk of colorectal cancer.

MATERIALS AND METHODSThis is a review of published literature in the department.

RESULTSThe registry currently has 253 families with several genetic conditions-93 familial adenomatous polyposis (FAP) families, 138 Amsterdam-criteria positive presumed Lynch syndrome (LS) families, 12 families with Peutz Jeghers syndrome, 2 families with Cowden's syndrome, and 8 families with hereditary mixed polyposis syndrome (HMPS). There are also 169 families with a strong family history of colorectal cancer but no abnormal genes yet identified. In FAP, a diagnostic tool developed has allowed a 94% local APC germline detection rate in FAP families. Knowledge obtained studying the phenotype of FAP patients has allowed better choice of surgery between ileal pouch anal anastomosis (IPAA) against an ileal-rectal anastomosis (IRA). In LS, our review has noted a highly heterogenous mutational spectrum and novel variants made up 46.7% (28/60) of all variants identified in this cohort. This may suggest that our Southeast Asian ethnic groups have distinct mutational variants from Western populations. Pathogenic mutations were only confined to MLH1 and MSH2, and identified in 28.8% of families.

CONCLUSIONThe impact of predictive gene testing for hereditary cancer risk in clinical practice has allowed evolution of care. Risk-reducing surgery and aggressive surveillance allows reduction in morbidity and mortality of patients. The SPR will continue to grow and improve outcomes in hereditary colorectal cancer patients and families.

Adaptor Proteins, Signal Transducing ; genetics ; Colorectal Neoplasms ; diagnosis ; ethnology ; genetics ; surgery ; Disease Management ; Female ; Genetic Testing ; methods ; Humans ; Male ; MutL Protein Homolog 1 ; MutS Homolog 2 Protein ; genetics ; Mutation ; Neoplastic Syndromes, Hereditary ; classification ; diagnosis ; ethnology ; genetics ; surgery ; Nuclear Proteins ; genetics ; Registries ; statistics & numerical data ; Singapore ; epidemiology

Key Findings There is currently no evidence to support the use of virgin coconut oil in the adjunctive treatment of COVID-19. • Virgin coconut oil is naturally extracted from fresh coconut kernel and is rich in medium chain triglycerides, with lauric acid as the predominant fatty acid. • Virgin coconut oil is currently explored as an adjunctive treatment for patients with COVID-19 due to its antiviral and immunomodulatory properties. • In vitro studies show that lauric acid or its derivative exert inhibitory activities against viruses with similar structure to coronavirus (enveloped ssRNA virus) such as Junin virus, vesicular stomatitis virus, human immunodeficiency virus type 1 (HIV-1), and Semliki Forest virus. • Animal studies demonstrate antiviral activity of monolaurin, the pharmacologically active metabolite of lauric acid, on avian influenza virus and Simean immunodeficiency virus, which are both enveloped ssRNA viruses. • Clinical trials among patients with HIV report that virgin coconut oil can increase CD4+ T lymphocyte counts and reduce viral load. • In vitro and animal studies demonstrate anti-inflammatory properties of virgin coconut oil. • At present, there are no studies that investigate the effectiveness of virgin coconut oil in the adjunctive treatment of COVID-19 infection. • There is currently one ongoing clinical trial in the Philippines evaluating the use of virgin coconut oil in the adjunctive treatment of COVID-19. • Nausea, vomiting, mild diarrhea, and abdominal pain have been reported, but no serious adverse events have been identified with the use of virgin coconut oil. • To date, there are no guidelines that mention virgin coconut oil as an option for the adjunctive treatment of COVID-19.
Coronavirus ; Covid-19