The introduction of peptide receptor radionuclide therapy (PRRT) to the Philippines has allowed for novel approaches in the management of neuroendocrine tumors (NETs). This case report details the management of a 66-year-old Filipino man diagnosed with metastatic pancreatic NET after biopsy and staging with Ga-68 DOTATATE PET-CT. After poor response to somatostatin analogue therapy, the patient was advised to undergo PRRT. Upon completing four cycles of PRRT with Lu-177 DOTATATE, the metastatic hepatic lesions showed resolution and the pancreatic tail tumor exhibited regression, allowing the patient to undergo surgical resection of the primary tumor. On follow-up, he was declared to be in remission with good quality of life and no imaging evidence of recurrence. The case underscores the diagnostic and therapeutic utility of radiolabeled somatostatin analogues along with the importance of a multidisciplinary approach in the management of an initially unresectable metastatic pancreatic NET
Receptors, Peptide ; Pancreatic Neoplasms ; Neuroendocrine Tumors

BACKGROUND: Glutathione is a major antioxidant in the body that serves as a substrate for conjugation reactions and regulates cell proliferation. Low levels of glutathione have been linked to cancer, liver problems and other chronic diseases. Studies have shown that oral supplementation is not effective in increasing the glutathione level in the body.

OBJECTIVES: The purpose of the study was to prepare a niosomal formulation of glutathione and to characterize the niosomal formulation. Furthermore, the study compared the effect of the charge inducer in the formulation.

METHODOLOGY: The method was divided to the preparation, characterization and stability study of the niosomal formulation. The niosomal formulation was produced by thin film hydration with varying Span 60 (Sorbitan monostearate) and cholesterol ratios. Niosomal formulation with highest entrapment efficiency was further characterized for mean particle size, surface morphology, and in vitro drug release.

RESULTS AND DISCUSSION: Formulation A entrapped 98.21% of the glutathione. Addition of charge inducer increased its entrapment efficiency to 98.91%. Furthermore, both niosomal formulations released glutathione at pH 7.4 in 1.0M phosphate buffer saline (PBS). The mean vesicular size obtained was 1,242.97 + 40.52nm. Differential Scanning Calorimetry revealed compatibility between glutathione and its excipients. Both formulations do not cause cytotoxicity in human dermal fibroblast. The stability study also revealed that it was stable at 5°C and 40°C for 3 months.

CONCLUSION: Results of this study suggested the potential use of niosomes in the targeted delivery of glutathione. This is the first report on the use of niosomal preparations through thin film hydration technique in the delivery of reduced L-glutathione.

Introduction: Literature shows that infant distress and care-giving can be sources of stress of primary care givers, especially for first-time mothers. This study aimed to determine the efficacy of Dunstan baby Language in decreasing parenting stress among first time mothers compared with those receiving standard newborn care alone. Methods: This research utilized a quasi-experimental approach, where 18 first-time mothers with babies 0-2 months old were allocated to receive standard care plus Dunstan baby language training or standard care alone. Maternal stress was measured at baseline and after the intervention period with the Parental Stress Scale. The scores were compared within and between the two study arms. A repeated measures mixed model was used for the Parental Stress Scale (PSS) results. Results: A total of 27 participants were enrolled in the study. The Dunstan baby language group had 18 participants, while the control group had 9 participants. An apparent decrease was noted in the week 1 to week 2 and the week 2 to week 3 Parental Stress Scale scores in the Dunstan baby language group compared with the control group which had minimal changes in their mean scores. The mean difference between the two groups was not significant. Conclusion The use of Dunstan baby language in addition to standard care may decrease stress among first time mothers with 0-2 month old babies.
Parenting

Background and Introduction. The RxBox is a telemedicine device that measures and transmits vital signs to remote experts. It has been deployed to primary care health centers (PCHC) in the Philippines serving disadvantaged populations, to decrease morbidity and mortality due to common diseases and poor access to care. Factors affecting its adoption by healthcare workers is unknown.

Materials and Methods. The study determined social and behavioral factors that affect adoption of a telemedicine device into the clinical workflow using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. This is a mixed methods research using review of records, survey and focused group discussions.

Results and Discussion. RxBox telemedicine devices were installed in 79 primary care health centers (PCHC) and were used a total of 15,705 times within the study period. An ordinary least squares regression analysis using the combined site and individual-level data showed that among the UTAUT parameters, only compatibility, facilitating conditions, and social factors have significant relationships with intent-to-use of the RxBox. The innovation assisted primary care health workers in their clinical responsibilities, improved the stature of their PCHC in the community, and helped in the care for patients. Training and technology support after deployment as well as encouragement by peer and champions (the PCHC physician, local government leaders) reinforced continuous use after training. Users described the experienced improvements in quality of services provided by the PCHC and the consequent benefits to their patients.

Conclusions. These factors should be accounted for in designing strategies to reinforce health workers' attitudes and enhance support towards acceptance and use of novel telemedicine devices into clinical routine in local health centers. Lessons are immediately useful for local leaders in low- and lower middle-income countries that suffer disproportionately from unnecessary maternal deaths and mortality due to non-communicable diseases. This contributes to the body of knowledge and should bolster national-level advocacy to institute an enabling policy on telehealth Information Communication Technology (ICT) and use of Filipino innovations towards health systems strengthening. Results can be used by implementers, evaluators, and regulators of health ICT, especially in resource-poor settings. Likewise, the study can encourage more research in the field to spur more dynamic local health ICT and biomedical device industries.