The Sex or sexuality is very complex subject. From a biological standpoint, the appearance of the external genitalia is only one parameter. Complete androgen insensitivity syndrome (CAIS), the most common form of male pseudohermaphroditism, embodies the multifaceted nature of this concept. Patients usually present with 46, XY karyotype with bilateral testes, female external genitalia, a shortened vagina, absent or rudimentary mullerian derivatives, normal breast development, and absent or scant pubic and axillary hair, as was the case in the patient presented herein. Prevalence ranges from 1 :20,400 to 1 :62,400 births. Its management often requires a multidisciplinary approach. Aside from addressing health risks, the psychosexual, social and ethical aspects of this condition should also be dealt with.
ANDROGEN INSENSITIVITY SYNDROME

We describe a case of a 57 year old female who presented with multiple papules on bilateral extremities with no other systemic findings. Skin lesions consisted of multiple hyperpigmented scaly papules in a rippled pattern some coalescing into plaques. Histologic examination showed deposits of amorphous eosinophilic materials in the papillary dermis. The diagnosis of lichen amyloidosis was made. Treatment with high potency topical steroid in combination with salicylic acid ointment, emollients, and systemic antihistamine which afforded improvement after 2 weeks. There was 90 percent clearance of lesion within 5 months of therapy. The origin and clinical features of papular primary localized cutaneous amyloidosis (PLCA) are reviewed.

Human ; Female ; Middle Aged ; Amyloidosis, Familial ; Dermis ; Emollients ; Histamine Antagonists ; Histamine H1 Antagonists ; Lichens ; Salicylic Acid ; Skin Diseases, Genetic

Mycetoma is a chronic, debilitating, granulomatous disease affecting the subcutaneous tissue, fascia, muscle, bone and adjacent organs characterized by triad of tumefaction, draining sinus, and grains. The ten-year incidence in our institution from 2000 to 2010 is 3 out of 81,015 cases. We present a 33-year-old man with a nine-year history of painless nodules and draining sinuses on the left foot which were unresponsive to oral antibiotics and topical antifungals. Biopsy of a nodule was consistent with mycetoma. Fungal culture revealed Madurella mycetomatis growth confirming eumycetoma. X-ray of the left foot showed poorly marginated lucencies on the calcaneus and navicular bones. Ultrasound revealed mixed hyperreflective echoes and multiple small cavities. We diagnosed the patient with Stage III eumycetoma based on the radiographic classification of bone involvement and prescribed oral ketoconazole 400 mg daily for nine months achieving 50-60% decrease in lesion size. Surgical debulking was done and ketoconazole was continued at the same dose for another nine months. There was good granulation tissue formation and no appearance of new lesions after surgery.

Human ; Adult ; Anti-bacterial Agents ; Calcaneus ; Cytoreduction Surgical Procedures ; Fascia ; Foot ; Granulation Tissue ; Ketoconazole ; Madurella ; Mycetoma ; Subcutaneous Tissue ; Ultrasonography

CYLD cutaneous syndrome (CCS) encompasses numerous inherited skin adnexal tumor syndromes, such Brooke–Spiegler Syndrome (BSS), familial cylindromatosis (FC), and multiple familial trichoepitheliomas (MFT). These syndromes arise from germline pathogenic variants in the tumor suppressor gene CYLD that show variable expressivity. With merely 115 cases documented worldwide and a singular reported incidence among Filipinos, they are exceptionally rare. We present two cases of trichoepitheliomas in Filipino patients, encompassing their clinical, histopathological, and genetic findings.

Our first case is of a 22-year-old male presenting with an 8-year history of asymptomatic skin-colored papules on the nasolabial folds. He was initially diagnosed with milia and underwent electrocauterization; however, recurrence was observed shortly thereafter. No family history exhibited similar lesions.

The second case involves a 43-year-old female with a 31-year history of asymptomatic skin-colored papules on the nose that progressively disseminated to her forehead and ears that started to obstruct the patient’s airway, prompting her to seek consultation.

Genetic testing conducted on affected patients and their relatives identified mutations in the CYLD gene. The first case underwent CO2 laser treatment, while the second patient underwent excision with reconstructive surgery.

Given the rarity of these disorders and their diverse clinical manifestations, genetic testing serves as an invaluable instrument for the purpose of accurate diagnosis, proactive disease progression surveillance, and family planning efforts. This can also contribute to a more comprehensive understanding of the syndrome and the development of new therapeutic strategies.

Human ; Female ; Adult: 25-44 Yrs Old

This article describes the partnership between the College of Public Health, University of the Philippines Manila and the province of Laguna in the context of implementation of the field practice course. This partnership paved the way for the development and implementation of projects in seven field practice sites. Projects concentrated mainly on improving quality of data and health information system, development of educational materials, and addressing health problems such as tuberculosis, hypertension and rabies. After the implementation of the various activities, there is a need for both parties (the College of Public Health and the Provincial Health Office of Laguna) to monitor and evaluate if projects have been sustained. Moreover, successful projects must also be fully documented which can serve as models for other areas in the province of Laguna.

Human ; Rabies ; Health Information Systems ; Public Health ; Tuberculosis ; Quality Improvement ; Universities ; Teaching Materials ; Hypertension

Background: Herbal supplementation has been used by diabetic patients, unfortunately it has regulatory, safety, and efficacy concerns. Objective: This review was conducted to determine the best evidence in terms of the identified active substance, mechanism of action, pre-clinical and clinical studies of commonly used local herbal preparations. Methods: This is a qualitative review of both local and international published medical literature to identify and summarize information on the use of herbal supplementation in diabetes. Results: After the initial review, the authors identified thirteen herbal preparations that have been investigated for its anti-diabetic properties. Six have extensive studies including randomized controlled trials but cinnamon and fenugreek seed are not readily available locally. Their detailed review eventually focused on four locally available herbal preparations i.e. bitter melon, turmeric, aloe vera and banaba. They decrease glucose absorption and gluconeogenesis, improve glucose utilization and insulin production. Unlike conventional anti-diabetics, herbal preparations also have favorable effect on lipid metabolism and anti-oxidant effect. Bitter melon seems to be the best herbal preparation. But human studies of bitter melon showed it is inferior to conventional anti-diabetic drugs in terms of its anti-diabetic effect but better in terms of its effect on lipid metabolism and anti-oxidant properties. Turmeric, aloe vera and banaba have also been shown to have anti-diabetic effects. Conclusion In summary, herbal preparation may have multiple beneficial effect for patients with diabetes. Use of combined preparations can produce complementation of the effects and may be a promising approach to the use of herbal supplementation as treatment standard among patients with diabetes.
Dietary Supplements ; Plant Preparations

Background: In the past musculoskeletal complaints were treated with topical preparations from medicinal plants until the advent of NSAIDs. However, because of the side effects of NSAIDs, interest has increased on going back to the use of topical traditional herbal medicines in patients with musculoskeletal pain. Objective: This review was conducted to identify the active substance, its mechanism of action, pre-clinical and clinical studies and propose a topical herbal formulation balancing its analgesic and anti-inflammatory effect with skin care effect among patients with various somatic pain conditions. Methods: This is a qualitative review of both local and international published medical literature to identify and summarize information on the use of topical herbal preparation for the treatment of musculo-skeletal pain. Results: After the initial review, the authors identified six herbal preparations that have been investigated for its analgesic and anti-inflammatory properties in clinical trials. They eventually arrived at a consensus to consider the final combination of ginger, capsaicin, peppermint and virgin coconut oil. Gingerol, a naturally occurring plant phenol, is one of the major components of ginger known to have diverse pharmacologic effects including anti-oxidant, anti-apoptotic, and anti-inflammatory activities in vitro and in vivo. Capsaicin is a highly selective agonist for the transient receptor potential vanilloid 1 receptor expressed in nociceptive sensory nerves. The mechanisms underlying capsaicin-induced analgesia likely involve reversible ablation of nociceptor terminals. Local application of peppermint oil generates a long-lasting cooling effect on the skin and result to muscle relaxation. Ginger, capsicum and peppermint have been shown in clinical trials to relieve musculoskeletal pain and inflammation. Virgin coconut oil on the other hand has no analgesic effect but has been shown in some studies to be favorable for skin conditions and facilitate skin penetration of some substances. Conclusion Using combined preparation may have the advantage of complementation of its effect i.e. analgesic and anti-inflammatory effect of ginger, warm sensation of capsicum and the cold sensation of peppermint.
Musculoskeletal Pain ; Anti-Inflammatory Agents, Non-Steroidal ; Plant Preparations

Objective: To investigate the effects of hepatitis B virus (HBV) genotype and mutations on the development of hepatocellular carcinoma (HCC) and to establish a new qualified HCC risk scores. Methods: A cohort study enrolling patients with chronic HBV infection was conducted. HBV genotypes were identified by nested multiplex PCR. HBV mutations in the basic core promoter region and PreS region were sequenced after PCR amplification. Scores on risk factors were set based on nomogram. Results: Totally, 1 525 patients were followed-up in this research. A total of 1 110 patients infected with genotype C were followed-up for 8.52 (Q(R): 5.36-11.68) years on average, of whom the incidence of HCC was 11.93/1 000 person-years. In genotype C HBV infected patients, male gender, aged 40 years and over, and four DNA mutations (T1674CG, A1762T/G1764A, A3120T, and A2962G) can increase the risk of HCC (P<0.05); interferon therapy can reduce the risk of HCC (P<0.05). A new HCC predicting model was established according to the results. After validation, the predicted disease-free survival rate was consistent with the real one. Conclusions: Hepatitis B virus genotypes and mutations were closely associated with HCC. The new risk scoring system can well predict HCC occurrence in genotype C HBV infected patients.
Adult ; Aged ; Carcinoma, Hepatocellular/virology* ; China/epidemiology* ; Cohort Studies ; DNA, Viral/genetics* ; Female ; Genotype ; Hepatitis B virus/genetics* ; Hepatitis B, Chronic/complications* ; Humans ; Liver Neoplasms/virology* ; Male ; Middle Aged ; Mutation ; Predictive Value of Tests ; Risk Factors ; Sensitivity and Specificity

Objective: To understand the current situation on management of diabetes mellitus patients aged 35 and above in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases, in China. Methods: Local residents, aged 18 years and above were randomly selected by a complex, multistage, probability sampling method. Face-to-face questionnaire survey was carried out between November and December 2016. Rates regarding prevalence, treatment and management of diabetes were calculated, and influencing factors of diabetes were analyzed by using the non-conditional logistic regression model. Results: A total of 3 213 residents aged ≥35 years were included in this study, of which 11.48% (369/3 213) reported that they had ever been informed by a doctor or other health worker that their blood sugar level was high or being diabetic. The rate of self-reported treatment among the diabetic patients was 83.20% (307/369). Rates on overall management and standardized management were 69.92% (258/369) and 53.66% (198/369), respectively. Higher rates were seen in residents aged 55 to 64 years, 76.32% for overall management and 59.65% for standardized management. Through multiple logistic regression analysis, we found that standardized management for diabetes was much higher in the Demonstration Areas located in the eastern areas (OR=2.942, 95%CI: 1.547-5.594), or patients with characteristics including high implementation score (OR=3.499, 95%CI: 1.865-6.563), already signed family doctors (OR=5.661, 95%CI: 3.237-9.899), or without hypertension (OR=1.717, 95%CI: 1.010- 2.920). Residents who were living in the first and second batch areas of implementation or responding to the NCDs with positive attitude were more likely to accept standardized management. Conclusion: Prevention and management programs on diabetes had met the requirements set for the Demonstration Areas which had promoted the specific implementation and further development of standardized management on diabetes.
Adult ; Aged ; Asian People/statistics & numerical data* ; China/epidemiology* ; Diabetes Mellitus/therapy* ; Humans ; Hypertension/epidemiology* ; Logistic Models ; Middle Aged ; Noncommunicable Diseases/prevention & control* ; Population Surveillance ; Prevalence ; Risk Factors ; Self Care ; Surveys and Questionnaires

Objective: This study determined the incidence of and risk factors for color-vision abnormalities among Filipino patients undergoing directly observed treatment short-course (DOTS) for tuberculosis. Methods: A prospective single-cohort study involving newly diagnosed patients with category-1 tuberculosis, recruited from DOTS health centers in Manila, was conducted. All patients were given a fixed-dose combination of rifampicin, isoniazid, ethambutol, and pyrazinamide for 60 days, after which treatment was continued with rifampicin and isoniazid for 4 more months. The participants underwent complete eye evaluation including color-vision testing and were followed up every month up to the conclusion of treatment. Results: Out of 93 patients initially enrolled, 64 completed the prescribed follow-up and constituted the study group. Baseline color vision was normal. After 1 month of therapy, color vision tested with the Ishihara plates remained normal in all patients, but one failed the Farnsworth Panel D 15 and was classified as tritan while 30 (47.88%) failed the Lanthony Desaturated test. The type of abnormality was unclassified in 20 (66.67 %)patients and tritan in 10 (33.3%). Visual acuity remained unchanged from baseline. Repeat testing after ethambutol and pyrazinamide were stopped showed that color vision was normal using the Ishihara plates and the Farnsworth test, while 5 failed the Lanthony test. Of these, 3 were unclassified and 2 were tritan. In the 3rd to 6th months follow-up, no color-vision abnormalities were noted in the 3 tests. The only risk factor identified was age (p = 0.01) with older patients having a higher risk. Conclusion The incidence of color-vision abnormalities among patients undergoing DOTS was 47.88% using the Lanthony Desaturated test after an average of 39.66 days on quadruple anti-TB therapy. Age was the only significant risk factor observed. The color-vision abnormalities returned to normal within an average of 37.85 days after discontinuing ethambutol and pyrazinamide.
Ethambutol ; Tuberculosis ; Color Vision