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

Transplantation is one of the most progressive areas of medicine. Following its rapid development, organ transplantation has become part of the globalisation process, and is now available in all corners of the world in different social and cultural environments. Almost a decade into a new century, transplantation faces new challenges, with record numbers of patients on the waiting list, a scarcity of donor organs, inequity in access to transplantation, organ commercialisation, increasing living donation and the use of marginal donors. Probably more than in any other field of medicine, the cultural influences are very prominent in transplantation due to the complexity of the process and the ethical issues surrounding every step from donation, access to transplantation to outcome. These influences have led to different practical approaches around the world, which aim to be in agreement with the respective societal principles and moral values. Herein, we provide an overview of some of these challenges and their possible resolution in culturally diverse areas of the world.
Cultural Diversity ; Health Services Accessibility ; Humans ; Living Donors ; Organ Transplantation ; ethnology ; legislation & jurisprudence ; Religion ; Tissue and Organ Procurement ; Waiting Lists

OBJECTIVE: This work presents an updated and broad documentation of current practices of blenderized whole food tube feed (BTF) handlers (n=40) in some tertiary (n=8) and specialty (n=2) hospitals in the National Capital Region, Philippines.

STUDY DESIGN: Descriptive study

METHODS: Survey questionnaire and checklists which reflect processes and practices on BTF production were developed and pre-tested. These tools were then administered to 40 respondents from 8 tertiary and 2 specialty hospitals in the National Capital Region, Philippines. Observations were also recorded concerning BTF handling and administration as well as the sanitation of the preparation facility. The study further conducted additional interviews, and on-the-job observations with the same group of respondents in each of the test hospitals to validate survey responses and actual demonstration made in the documentation phase.

RESULTS: Not all of the participating BTF handlers were observed to follow even simple personal and workplace hygienic practices. Moreover, not all BTF handlers had previous exposures to food safety systems training, and all test hospitals have yet to establish hazard analysis critical control point (HACCP) plans for BTF. The absence of accredited raw ingredient suppliers for the majority of the BTF facilities, failure to always wash raw materials prior to preparation, and the use of soft-boiled whole eggs were identified as sources of potential microbiological hazards. Total plate count was established to be as high as log10 7.19 CFU.ml-1. Ninety-three percent of the BTFs had plate counts exceeding the acceptable standard limit.

CONCLUSION: The microbiological quality of the BTFs analyzed was attributed to the observed poor hygienic practices, as well as the inherent microflora of BTF ingredients. Familiarity with good manufacturing practices (GMPs), good hygienic practices (GHPs), and HACCP is recommended to improve the microbiological quality of BTFs. The results of this work may be used as basis for advancing efforts to further improve BTF safety, especially that the country had just recently ratified the Philippine Food Safety Act of 2013.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Enteral Nutrition ; Feeding Methods ; Food Handling ; Hospitals ;

BACKGROUND: Lepra reactions occur in 10-30% of patients with leprosy. The standard of treatment is prednisone. However , prolonged steroid use may cause side effects such as osteoporosis, hypertension, hyperlipidemia, atherosclerosis and infections. Fusidic acid targets cytokine systems responsible for the production of Type 1 lepra reaction (T1R) and erythema nodosum leprosum (ENL). It may be given as a steroid-sparing agent in treating lepra reactions.

OBJECTIVE: To determine the safety and efficacy of fusidic acid as a steroid-sparing agent in the treatment of  Type 1 and Type 2  lepra reactions.

METHODS: A randomized controlled trial was conducted on 67 subjects with lepra reactions, aged 18-60, each assigned to receive either prednisone or prednisone + fusidic acid for 12 weeks. Severity of lepra reactions were graded quantitatively using a modified scale by Walker et al and van Brakel et al, and qualitatively using modified National Leprosy Control Program (NLCP) Guidelines at baseline, weeks 2,4,6,8,10 and 12. Doses of prednisone needed to control lepra reactions were also noted at each follow up and statistical analyses were done . Adverse reactions were noted.

RESULT: Sixty subjects (89.55%) completed the study. The prednisone + fusidic acid group had lower quantitative and qualitative scores compared to the prednisone group. There were significant differences between the two groups for the quantitative severity scores (p=1.44x10-11) and qualitative severity grading (p=9.36x10-14) at week 12. The mean dose of prednisone was 21.5 mg in the prednisone group and 2 mg in the prednisone + fusidic acid group at week 12 (p=1.01x10-12). No adverse reactions were reported.

CONCLUSION: Fusidic acid tablet 250mg/tab two tablets three times a day is an effective and safe steroid-sparing agent for the treatment of lepra reactions.

Human ; Male ; Female ; Leprosy ; Prednisone

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

BACKGROUND:The purpose of this study was to use point-of-care ultrasound (POCUS) to investigate the relationship between tobacco smoke exposure and the characteristics of the common carotid artery (CCA). The effect of both primary and secondary smoking on CCA properties was evaluated. METHODS:We performed a prospective cross-sectional study across 20 primary care clinics in Bandung, West Java, Indonesia in July 2016. Point of care ultrasound was performed on a convenience sample of Indonesian patients presenting to clinic. The CCA wall stiffness and carotid intima-media thickness (CIMT) were measured during diastole and systole. These measurements were correlated with smoke exposure and cardiovascular disease. RESULTS: We enrolled 663 patients in the study, with 426 patients enrolled in the smoking category and 237 patients enrolled in the second-hand smoke category. There was an overall positive correlation with the measured lifestyle factors and the ultrasound-measured variables in the group of individuals who smoked. For all variables, age seemed to contribute the most out of all of the lifestyle factors for the positive changes in CIMT and CCA wall stiffness. CONCLUSION:Our data yielded correlations between CCA properties and cardiovascular risk, as well as between CIMT and arterial stiffness. We were also able to demonstrate an increase in thickness of the CIMT in patients who have been exposed by tobacco through the use of ultrasound. Further large scale studies comparing patients with multiple cardiac risk factors need to be performed to confirm the utility of ultrasound findings of cardiovascular disease and stroke.

Objective: We carried out a bibliometric study on the scientific papers related to second generation anti-psychotic drugs (SGAs) in Malaysia. Methods: With the SCOPUS database, we selected those documents made in Malaysia whose title included descriptors related to SGAs. We applied bibliometric indicators of production and dispersion, as Price’s law and Bradford’s law, respectively. We also calculated the participation index of the different countries. The bibliometric data were also been correlated with some social and health data from Malaysia (total per capita expenditure on health and gross domestic expenditure on R&D). Results: We found 105 original documents published between 2004 and 2016. Our results fulfilled Price’s law, with scientific production on SGAs showing exponential growth (r = 0.401, vs. r = 0.260 after linear adjustment). The drugs most studied are olanzapine (9 documents), clozapine (7), and risperidone (7). Division into Bradford zones yields a nucleus occupied by the Medical Journal of Malaysia, Singapore Medical Journal, Australian and New Zealand Journal of Psychiatry, and Pharmacogenomics. Totally, 63 different journals were used, but only one in the top four journals had an impact factor being greater than 3. Conclusion: The publications on SGAs in Malaysia have undergone exponential growth, without evidence a saturation point.

Introduction: Non-classical congenital adrenal hyperplasia (CAH) represents a group of inherited, autosomal recessive disor- ders that typically presents with androgenetic alopecia, but may present with alopecia universalis on rare occasions. Case report: We report a case of a 14-year-old Filipino female with non-classical congenital adrenal hyperplasia presenting with alopecia universalis, treated with a combination of Tretinoin and Minoxidil solution, low dose prednisone and an oral supplement containing zinc gluconate, nicotinamide, superoxide dismutase, vitamin E and selenium, with noted gradual hair regrowth and improvement in Dermatology Life Quality Index (DLQI). Conclusion Alopecia universalis in a patient diagnosed with non-classical congenital adrenal hyperplasia is a rare and atypical manifestation, with no case reports available to describe its occurrence. Due to its rarity, there is no standard treatment for pa- tients with this condition. However, the combination of tretinoin and minoxidil solution, low dose prednisone and an oral supple- ment containing zinc gluconate, nicotinamide, superoxide dismutase, vitamin E and selenium shows promising results.
Minoxidil ; Tretinoin

Background: Among other structures, nuclear grooves are vastly found in papillary thyroid carcinoma (PTC). Considering that the application of artificial intelligence in thyroid cytology has potential for diagnostic routine, our goal was to develop a new supervised convolutional neural network capable of identifying nuclear grooves in Diff-Quik stained whole-slide images (WSI) obtained from thyroid fineneedle aspiration. Methods: We selected 22 Diff-Quik stained cytological slides with cytological diagnosis of PTC and concordant histological diagnosis. Each of the slides was scanned, forming a WSI. Images that contained the region of interest were obtained, followed by pre-formatting, annotation of the nuclear grooves and data augmentation techniques. The final dataset was divided into training and validation groups in a 7:3 ratio. Results: This is the first artificial intelligence model based on object detection applied to nuclear structures in thyroid cytopathology. A total of 7,255 images were obtained from 22 WSI, totaling 7,242 annotated nuclear grooves. The best model was obtained after it was submitted 15 times with the train dataset (14th epoch), with 67% true positives, 49.8% for sensitivity and 43.1% for predictive positive value. Conclusions The model was able to develop a structure predictor rule, indicating that the application of an artificial intelligence model based on object detection in the identification of nuclear grooves is feasible. Associated with a reduction in interobserver variability and in time per slide, this demonstrates that nuclear evaluation constitutes one of the possibilities for refining the diagnosis through computational models.

Background: Ophthalmologic evaluation is often neglected in routine screening of Hansen’s disease patients. In line with the global aim of reducing grade 2 disability, eye examination should be an essential part of routine examination of Hansen’s disease patients. Objective: To describe the ophthalmologic profile of patients with Hansen’s disease seen in a tertiary hospital. Methods: A point-prevalence survey was conducted. Sixty-six Hansen’s disease patients, aged 18 and above, underwent complete ophthalmologic examination including visual acuity, refraction, external eye examination, intraocular pressure determination, dilated pupil examination, palpebral aperture measurement, corneal sensation testing, and tear breakup time determination. Statistical analysis was done. Results: All patients had ocular findings with lepromatous leprosy (62%) being the highest. Fifty-three percent had Type 2 lepra reaction. Most were males, disease duration in majority was < 5 years and bacillary morphologic index was 4.0 – 4.99. Patients with Grade 1 and Grade 2 disability of the eyes were 62% and 17% respectively. The most common ocular complications were: abnormal tear breakup time (79%), cataracts (53%),blepharitis (47%), madarosis (39%) and corneal opacities (24%). Conclusion There is a significant number of ocular findings among leprosy patients in this study. The highest number of ocular complications is among patients in the lepromatous pole. There is a preference of M. leprae for cooler areas; hence, the anterior chamber was greatly affected.
Leprosy