Mefenamic acid is a potent analgesic possessing both anti-inflammatory and antipyretic properties. It is completely absorbed one to two hours after intake. Majority of patients however, expect relief of pain within 15 minutes. A new oral mefenamic acid containing sodium lauryl sulfate with a dissolution rate of 98 per cent in 15 minutes has been introduced. This phase 4 clinical trial was conducted to evaluate the onset of pain relief upon administration of mefenamic acid 500 mg combined with sodium lauryl sulfate. The study was an open, noncomparative clinical trial. Physicians all over the Philippines were asked to fill up a standard 3-page case report form. A total of 2,617 patients with a mean age of 36 years were enrolled. Forty two per cent were males and fifty eight per cent were females. Seventy per cent of patients took the drug every 6-8 hours. Majority (78.38%) reported complete resolution of pain (54.3%) of which occurred within 15 minutes, increasing to 84.93% within 30 minutes). Only 1.12 per cent showed no response. Forty one patients (1.57%) reported minor adverse reactions, majority of whose conditions improved with withdrawal of the drug. The overall assessment of clinical response was very good to excellent in 77.66 percent of patients.(Author)

Human ; Male ; Female ; Adult ; Mefenamic Acid ; Antipyretics ; Dodecyl Sulfate ; Sodium Dodecyl Sulfate ; Analgesics ; Pain ; Anti-inflammatory Agents ; Pain Management

Objective: On 24 September 2022, the Regional Public Health Unit in Ilocos received a report of a cluster of suspected hand, foot and mouth disease (HFMD) in one school in Balungao, Pangasinan Province, the Philippines. On 4 October 2022, the public health unit sent a team from the Field Epidemiology Training Program – Intermediate Course to conduct an outbreak investigation. Methods: Active case-finding was conducted at the school. A suspected case was defined as any student or staff member with mouth ulcers and papulovesicular or maculopapular rash on the palms, fingers, soles of the feet or buttocks occurring from 1 September to 5 October 2022. We interviewed school officials about possible sources of infection and students’ activities. We collected oropharyngeal swab samples for testing. Findings were used for descriptive analysis. Results: Nine suspected cases of HFMD were detected, with the highest number of cases (6, 67%) occurring in children in grade 1. The majority of cases (7, 78%) were 6 years old, and five cases (56%) were male. Seven (78%) of the cases had been exposed to a confirmed case of HFMD, as reported by their parents or guardians and teachers. Six cases (67%) were positive for coxsackievirus A16 and two (22%) for enterovirus. Discussion: The causative agents of this outbreak were coxsackievirus A16 and other enteroviruses. Direct contact with a confirmed case was the source of transmission, with a lack of physical distancing in classrooms likely contributing to transmission. We recommended that the local government implement measures to control the outbreak.

Pelvic kidneys are anatomical abnormalities that occur when the kidney does not rise from the pelvis during embryogenesis. The majority of cases are asymptomatic, though they are associated with higher risks for traumatic injury, infections, renal calculi, and other urological issues. Because of its advantages of flexion and deflection, retrograde intrarenal surgery (RIRS) employing flexible ureterorenoscopy (fURS) is an alternative treatment method for small- to medium-sized calculi in anatomically aberrant kidneys. Presented here is a case of a 43-year-old male with a renal stone in a pelvic left kidney with the ureter crossing the midlineand is located at the prevertebral region at the level of L4 to S1.

The HLA B*58:01 allele has been worldwide reported as a pharmacogenetic susceptibility to allopurinol-induced severe cutaneous adverse reactions (SCARs). To prevent these life-threatening conditions, the American College of Rheumatology hingly recommended that the HLA-B*58:01 be screened prior to the initiation of allopurinol therapy. Therefore, we developed a rapid, robust, inexpensive screening method using SYBR® Green real time PCR to detect the HLA-B*58:01 allele. A total of 119 samples were tested. The assay has a sensitivity of 100% (95% CI: 69.15%-100%), a specificity of 100% (95% CI: 96.67%-100%), a positive predictive value of 100% (95% CI: 69.15%-100%) and a negative predictive value of 100% (95% CI: 96.67%-100%). HLA-B*58:01 genotyping results showed 100% agreement with those obtained from Luminex SSO/SBT/SSP. The lowest limit of detection of this method is 0.8 ng/µL of DNA. The unit cost of the test is only $3.8 USD. This novel screening test using SYBR® real time PCR would be appropriate to identify individuals with the HLA-B*58:01 allele for the prevention of allopurinol-induced SCARs.
Alleles* ; Allopurinol ; Cicatrix ; DNA ; HLA-B Antigens ; Limit of Detection ; Mass Screening* ; Methods* ; Real-Time Polymerase Chain Reaction ; Rheumatology ; Sensitivity and Specificity ; Stevens-Johnson Syndrome

The eco-epidemiology of American cutaneous leishmaniasis (ACL) is driven by animal reservoir species that are a source of infection for sand flies that serve as vectors infecting humans with Leishmania spp parasites. The emergence and re-emergence of this disease across Latin America calls for further studies to identify reservoir species associated with enzootic transmission. Here, we present results from a survey of 52 individuals from 13 wild mammal species at endemic sites in Costa Rica and Panama where ACL mammal hosts have not been previously studied. For Leishmania spp. diagnostics we employed a novel PCR technique using blood samples collected on filter paper. We only found Leishmania spp parasites in one host, the two-toed sloth, Choloepus hoffmanni. Our findings add further support to the role of two-toed sloths as an important ACL reservoir in Central America.

The eco-epidemiology of American Cutaneous Leishmaniasis (ACL) is drivenby animal reservoir species that are a source of infection for sand flies thatserve as vectors infecting humans with Leishmania spp parasites. The emergence and re-emergence of this disease across LatinAmerica calls for further studies to identify reservoir species associated withenzootic transmission. Here, we present results from a survey of 52 individualsfrom 13 wild mammal species at endemic sites in Costa Rica and Panama where ACLMammal hosts have not been previously studied. For Leishmania spp. diagnostics we employed a novel PCR technique usingblood samples collected on filter paper. We only found Leishmania spp parasites in one host, the two toed sloth, Choloepus hoffmanni. Our findings addfurther support to the major role of two toed sloths as an ACL reservoir inCentral America.

BACKGROUND: There is a perceived need among policymakers and other actors in the local health system to better address the challenges in financing healthcare, in general, and chronic or debilitating conditions, in particular, in order to develop appropriate policy and program responses.
OBJECTIVE: This paper aimed to present perceived issues and challenges in financing schizophrenia and colorectal cancer in the Philippine context, as identified by stakeholders.
METHODS: Verbatim transcription of the proceedings of a moderated discussion of stakeholders in schizophrenia and colorectal cancer care was analyzed for themes on challenges and recommendations in the financing of the two conditions in the local setting.
RESULTS: A total of 28 stakeholders representing healthcare providers, professional organizations, health maintenance organizations, patient support groups, and government participated in the meeting. Three main issues on financing debilitating conditions were identified by participants: a) government support for the two conditions is currently limited; b) coverage by third-party payors for schizophrenia or colorectal cancer is either absent or restricted; and c) the process of accessing medicines or alternative modes of financing for healthcare was perceived to be disparate and inconvenient for patients and their caregivers. Participants also provided recommendations in improving the mechanism of healthcare financing.
CONCLUSION: The general picture that emerged from this moderated discussion pointed to limitations in the prevailing mechanisms for financing schizophrenia and colorectal cancer in the Philippines. Improvements in the current financing mechanisms, and identification of alternative modes, is necessary to ensure universal health coverage.

Human ; Healthcare Financing ; Health Maintenance Organizations ; Caregivers ; Universal Coverage ; Delivery Of Health Care ; Insurance, Health, Reimbursement ; Government ; Self-help Groups ; Colorectal Neoplasms ; Schizophrenia

Objective: To explore possible associations of a multidisciplinary team approach compared to a non-multidisciplinary team approach on delay and completion of treatment of head and neck cancer patients. Methods: Design: Historical Cohort Study Setting: Tertiary Private Training Hospital Participants: A total of 240 records of head and neck cancer patients from January 2016 and December 2018 were included in the study; 117 underwent a multidisciplinary team approach and 123 underwent a non- multidisciplinary team approach. Results: Only 24.79% of head and neck cancer patients under the multidisciplinary team approach had treatment delays compared to 37.40% under the non-multidisciplinary team approach. The proportion of treatment delays was significantly higher (χ2 = 4.44, p = .035) with the non-multidisciplinary team approach. Comparative treatment completion of 77.78% and 69.11% under the multidisciplinary and non-multidisciplinary team approaches, respectively, were not significantly different (χ2 = 2.31, p = .129). Conclusion The multidisciplinary approach might be associated with decreased delay in treatment among patients with head and neck cancer compared to the non-multidisciplinary team approach. A possible trend toward better treatment completion rate was also observed, but it did not reach statistical significance.
patient care team ; head and neck neoplasms ; time-to-treatment ; appointment and schedules ; neoplasm staging

Side-to-side intestinal anastomosis is a surgical procedure where an incision is performed between two parallel segments of gut and then they are sutured together. The purpose of this paper is to investigate if the standard surgical practice diameter used in anastomosis leads to undesirable closed circulatory flows which may be harmful to the gut tissue. A finite element model for the chyme flow in a side by side anastomosis with realistic user configurable parameters is developed and solved in a wide range of situations. We analyze the flow crossing the anastomosis, the normalized pressure difference in the gut section and the streamlines that show the presence or absence of closed flow regions for a set of surgically feasible anastomosis diameter values. In contrast with the findings of simpler analytical models, closed flows do not appear in any of these cases. The study shows that the current standard surgical practice where the anastomosis diameter is similar to the gut diameter does not lead to undesirable effects predicted by some simple analytical models.
Intestines ; Anastomosis, Surgical

Background: Non-specific focal uptake in the skeleton is a diagnostic pitfall on 18F-PSMA-1007 PET/CT, but adjunctive measures to aid interpretation of these lesions are currently lacking. We present two cases where dual time point imaging provided additional information. Case Presentation: The first patient had a PI-RADS 3 lesion on MRI. No PSMA-avid abnormality was seen on PET, save for focal uptake in the right pubis with no anatomic correlate. Additional imaging showed a decrease in lesion SUV, and this was interpreted as benign. Another patient, diagnosed with prostate cancer, had multiple PSMA-avid pelvic foci. Two suspiciously malignant bone lesions had increasing SUV trend after dual time point imaging despite only faint sclerosis on CT. In contrast, one faint PSMA-avid lesion with no anatomic abnormality was read as benign after a decrease in SUV. A decrease in lesion SUV may point to a benign etiology, while an increase would heighten suspicion for malignancy. One possible molecular explanation is that a true PSMA-overexpressing lesion would bind to the tracer for a longer period than a false positive. Conclusion Dual time point imaging provides additional information that may be useful in the interpretation of non-specificskeletal lesions with increased 18F-PSMA-1007 uptake.
PSMA-1007 ; Positron Emission Tomography Computed Tomography