OBJECTIVE: To establish the effectiveness and safety of topical aspirin on patients with persistent lichen simplex chronicus (LSC) despite corticosteroid therapy
METHODS: Fifty-four male and female patients with LSC who underwent topical corticosteroid therapy in the past were randomized to receive 3 percent aspirin ointment for two weeks followed by placebo ointment for two weeks or placebo first followed by aspirin with a crossover design after a 2-week washout period on a preselected involved area. Outcomes looked for were pruritus by visual analogue scale (VAS), activities of daily living score (ADLS), size of lesion, number of skin markings and photographic assessment score (PAS). All comparisons were done both on per protocol and intention-to-treat bases.
RESULTS: Data were complete for 42 (77.8 percent) subjects. On per protocol analysis, there were significantly greater reductions in lesion size and number of skin markings on aspirin use than on placebo use (p=0.005 and p0.001, respectively). Proportions of subjects with improved signs and symptoms were all significantly greater in the aspirin group than in the placebo group (69 percent versus 9.5 percent by VAS, 85.7 percent versus 19 percent by ADLS and 100 percent versus 4.8 percent by PAS; all 0.001). Intention-to-treat analysis of the results had similar findings. One adverse event of transient burning sensation after topical aspirin use was reported.
CONCLUSION: Topical aspirin can be safely used for two weeks and is significantly more effective than topical placebo in decreasing pruritus and impairment of activities of daily living, as well as in improving the size and morphology of LSC lesions.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Adrenal Cortex Hormones ; Aspirin ; Intention To Treat Analysis ; Neurodermatitis ; Ointments ; Pruritus ; Sensation ; Skin Diseases

Extramammary Paget Disease (EMPD) is a rare intraepithelial cancer often mistaken for inflammatory and infectious skin conditions, leading to diagnostic delays and increased morbidity. It constitutes 6.5% of cutaneous Paget Disease, predominantly affecting older individuals aged 50 to 80, with a higher prevalence in women. Notably, 10% to 30% of EMPD cases are linked to concurrent visceral malignancies, highlighting the importance of cancer screening.

This is a case of a 77-year-old Filipino male with a four-year history of a solitary, well-defined, irregularly-shaped, erythematous plaque with erosions on the perianal area. Despite two years of self-administered hydrocortisone cream, the lesion progressively expanded into an 8x4x2 cm plaque, accompanied by intermittent pruritus and stinging pain. On consultation, dermoscopy showed milky-red areas, telangiectasias, and hyperpigmentation. Histopathology revealed polygonal neoplastic cells with pleomorphic vesicular nuclei, conspicuous nucleoli, and pale eosinophilic cytoplasm above the basal epidermis. Immunohistochemistry was positive for CK7, GCDFP15, CEA, and EMA, and negative for CK20. Further imaging showed no evidence of concurrent malignancies, reinforcing the diagnosis of primary EMPD. While awaiting further evaluation by other specialties, he was managed with an eight-week course of topical Imiquimod 5% cream, resulting in a reduction in both erythema and lesion thickness.

Overall, this case highlights the importance of recognizing cutaneous cancers that mimic benign skin conditions. The application of diagnostic tools in dermatology, such as dermoscopy, histopathology, and immunohistochemical staining, is crucial for identifying key disease features and establishing an accurate diagnosis, enabling timely and appropriate intervention.

Human ; Male ; Aged: 65-79 Yrs Old ; Paget Disease, Extramammary ; Imiquimod ; Neoplasms ; Tumors

BACKGROUND

Scabies, caused by Sarcoptes scabiei var. hominis, is a prevalent and burdensome skin disease in the Philippines, ranking second in disability. Recognized as a neglected tropical disease (NTD) by the WHO, scabies management is targeted for inclusion in universal healthcare programs worldwide by 2030. Current treatment involves topical neurotoxic drugs like permethrin, but issues such as expense and inconvenience hinder compliance. Oral ivermectin, recommended by the WHO only recently, is more cost-effective and easier to administer but is considered a second-line option in clinical practice guidelines. This research aimed to determine the comparative efficacy, safety, cost-effectiveness, and acceptability of oral ivermectin, alone or in combination with topical permethrin, versus topical permethrin alone, in the treatment of classic scabies among Filipino patients.

METHODS

This 4-part study was conducted from July 2021 to September 2023 and aimed to compare the efficacy, safety, cost-effectiveness, and acceptability of oral ivermectin alone or in combination with topical permethrin versus topical permethrin alone for treating classic scabies among Filipino patients. Quantitative methods included a systematic review and network meta-analysis of 38 randomized controlled trials (RCTs) and a pharmacoeconomic evaluation using decision tree modeling. Qualitative methods involved a multiple case study of patient experiences and perceptions and in-depth interviews with physicians.

RESULTS

There seems to be comparable efficacy between oral ivermectin and permethrin, with limited evidence favoring the combination ivermectin/permethrin regimen. Adverse events were minor, and cost-effectiveness analyses favored ivermectin-based regimens over permethrin. Patient and physician perspectives supported the effectiveness of all treatments, with oral ivermectin recognized as safe but underutilized.

CONCLUSION

Evidence synthesis suggests that oral ivermectin, especially in combination with permethrin, could be a viable and cost-effective alternative for scabies treatment in the Philippines. The optimal dosing regimen, safety in specific populations, and factors influencing treatment choice need further exploration. Recommendations include advocating for oral ivermectin inclusion in regulatory guidelines and national formulary, considering it as a first- or second- line treatment, and conducting further research, including mixed-methods designs, to confirm efficacy, safety, and cost-effectiveness in different settings. Shared decision-making, considering ethical, logistical, socioeconomic, and psychological aspects, is crucial in implementing effective scabies control programs.

Ivermectin ; Permethrin ; Scabies

OBJECTIVE: This randomized, single-blind, two-arm controlled study compared the efficacy, safety, and tolerability of an intravaginal suppository preparation containing metronidazole 750mg + miconazole 200mg (Neopenotran Forte) with another vaginal preparation containing metronidazole 500 mg + nystatin 10000 IU (Flagystatin) in the treatment of bacterial vaginosis (BV), candidal and trichomonial vulvovaginitis (CVV, TV), mixed vaginitis and in the prevention of secondary candidal vulvovaginitis.

MATERIALS AND METHODS: Women ages 18-45 years with chief complaints of abnormal vaginal discharge or vaginal/vulvar itching were examined and microbiologic confirmation of BV, VVC, TV or mixed infection was made. They were then randomly assigned to receive either treatment once daily (nightly) for 7 days. A total of 261 subjects had evaluable clinical and microbiological findings at the end of the study. Test of cure by Amsel criteria and Nugent score were performed twice after treatment.

RESULTS: The overall test revealed that microbiological cure rate is significantly different between the two treatment groups.

CONCLUSION: The odds of being cured microbiologically is 2.35 times more in the metronidazole 750mg + miconazole nitrate 200mg group compared to the metronidazole 500 mg + nystatin 10000 IU group. However, no significant difference in the clinical cure between the two groups was found. Both drugs are safe and convenient to use.

Human ; Female ; Adult ; Young Adult ; Vaginosis, Bacterial ; Candidiasis, Vulvovaginal ; Suppositories ; Vaginitis

Bangladesh has one of the highest rates of malnutrition in the world although the country is endowed with agricultural produce that could be properly utilised to prepare adequate food for children. Considering this, three weaning foods were formulated using locally available cereals and nutritious fruits such as wheat, soya flour, jackfruit and mango. Methods: Standard procedures of Association of Official Analytical Chemists (AOAC) and American Public Health Association (APHA) were used to determine the chemical composition and microbiological analysis. Organoleptic qualities were analysed by twenty adult panelists of the Institute of Food Science and Technology, Bangladesh, using a 9-hedonic scale against a cereal based commercial brand as standard for proximate and sensory properties. Results: The moisture content of the developed weaning foods ranged from 2.78-3.59%, crude protein content 14.74-16.55%, fat 11.04-12.70%, ash 1.38-1.68%, crude fibre 1.04-1.52%, carbohydrate 65.83-71.09% and energy content from 445.80-465.48 kcal/100g of the foods. The formulated weaning foods A, B and C were significantly different (p<0.05) in moisture, protein, fat, carbohydrate and energy contents from the commercial brand, D. According to rat bioassay method, the prepared weaning foods C and B had the highest Protein Efficiency Ratio and Feed Efficiency Ratio than the commercial brand, D. Total bacterial counts were nil for all weaning foods. Sensory analysis revealed acceptability of all the weaning foods and preference for weaning food C that compared favorably with the standard in all the quality attributes. Conclusion: The formulated weaning foods are inexpensive and nutritious, and its ingredients are locally available. These foods have the potential for improving malnutrition problems facing children in Bangladesh.
Malnutrition ; Artocarpus ; Mangifera ; Soybeans ; Child ; Bangladesh

Variations of the anterior cerebral artery-anterior communicating artery complex are commonly identified in aneurysm surgery. An infraoptic course of the anterior cerebral artery is exceedingly rare. Robison first described this anomaly from an anatomic dissection in 1959. A unilateral anomalous infraoptic anterior cerebral artery is more common than anomalies of bilateral infraoptic anterior cerebral arteries. We present the case of an unruptured aneurysm at the anterior communicating artery in a patient with bilateral infraoptic anterior cerebral arteries, identified by computed tomography angiography and verified during surgery. Implications for aneurysm formation and surgical treatment are discussed.
Aneurysm ; Angiography ; Anterior Cerebral Artery* ; Arteries ; Humans ; Intracranial Aneurysm* ; Vascular Surgical Procedures

The first part of the critical care guidelines of the Philippine College of Surgeons (PCS) and supported by Glaxo Wellcome Philippines, Inc. dealt with resuscitation fluids, blood transfusion, assessment of volume resuscitation, nutritional support and cardiovascular support. The second part deals with the last 2 aspects identified by the Technical Working Group (TWG) namely: surgical intensive care units and implementation of guidelines. The literature search, limited to english publications. Used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane Library, Issue 4, 2000; 2) National Library of Medicine - Medline (PubMed, no time limit): and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD. Manual searching of the reference lists of review articles and some important meta-analyses and randomized controlled trials (RCTs) was also done. The search terms used were: 1) Cochrane library: surgical intensive care, guidelines implementation, 2) Medline: surgical intensive care, 3) HERDIN: intensive care. Titles of all articles were printed and all members of the TWG went over the list and checked the titles of articles whose abstracts they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. (Author)

National Library Of Medicine (u.s.) ; Philippines ; Medline ; Pubmed ; Libraries ; Critical Care ; Nutritional Support ; Information Services ; Blood Transfusion ; Surgeons

Objective: To determine the prevalence and severity of retinopathy of prematurity (ROP) and its associated factors on initial examination of infants screened at a tertiary hospital. Methods: A descriptive retrospective study was done using clinical charts of infants screened for ROP at a tertiary hospital from January 2007 to August 2009. Results of the initial examination were collated and analyzed. Results: A total of 112 eyes of 56 infants were screened. Upon initial examination, 21(18.75%) eyes of 11 infants were positive for ROP. Of these, 14 (12.5%) eyes of 8 infants had severe ROP warranting laser or surgical intervention. Sixty-nine (61.6%) eyes of 35 infants had immature retina, while 22 (19.64%) eyes of 11 infants had mature retina. Three (2.68%) eyes had stage 5 ROP. The infants with stage 5 ROP had mean gestational age of 28 6/7 weeks by LMP and mean birth weight of 1,282 grams. The positive cases were most commonly associated with oxygen exposure (100%), sepsis (85.71%), and blood transfusion (80.95%). Conclusion The finding of more than half of the positive cases warranting laser or surgical interventions on initial examination merits re-evaluation of screening recommendations and their timing.
Retinopathy of Prematurity ; Gestational Age ; Sepsis ; Birth Weight

Objective: This study determined the prevalence of Graves ophthalmopathy among thyroid-disease patients at a tertiary government hospital. Methods: Patients with thyroid disease seen at a tertiary hospital from February to September 2007 were enrolled. All patients underwent ophthalmologic examination consisting of visual-acuity testing; exophthalmometry; examination for presence of lid retraction, lid lag, and lateral flare; globe position; external-ocular-muscle-movement grading; corneal light reflex; and direct funduscopic examination. All clinical findings were recorded and data were analyzed. Chi square and Fisher’s exact tests determined the association of gender and age to the different ocular signs and symptoms. One-way analysis of variance (ANOVA) compared the average number of ocular symptoms among the different age groups. Results: A total of 121 patients, 20 males and 101 females, with thyroid disease were evaluated. 47.93% had Graves ophthalmopathy, occurring more frequently among patients aged between 30 and 49 years. The most common signs were eyelid retraction, proptosis, and lid lag. Conclusion Graves ophthalmopathy occurs frequently among patients with thyroid disease, especially those more than 30 years of age.
Graves Ophthalmopathy ; Graves Disease ; Exophthalmos ; Thyroid Diseases

Objective    To explore the association between radiotherapy and the risk of subsequent primary lung cancer in female patients with breast cancer. Methods    The EMbase, Web of Science, PubMed, CNKI, VIP and WanFang databases were searched from the establishment date to July 1, 2021. The relative risk (RR) with 95% confidence interval (CI) were combined and all statistical analyses were performed by STATA 12.0 software. Results    A total of 10 publications including 466 510 participates from 14 studies were included. The meta-analysis indicated that radiotherapy was a risk factor for the occurrence of second primary lung cancer among female breast cancer patients [RR=1.45, 95%CI (1.18, 1.78), P<0.001]. Subgroup analysis based on the relative position of breast cancer and lung cancer was conducted and the results demonstrated that radiotherapy only increased the incidence rate of ipsilateral lung cancer [RR=1.27, 95%CI (1.10, 1.45), P=0.001], without significant change of the risk of contralateral lung cancer [RR=1.16, 95%CI (0.77, 1.74), P=0.487]. Conclusion    Radiotherapy is one of the risk factors for subsequent primary pulmonary carcinoma among female breast cancer patients, especially for ipsilateral lung carcinoma. However, more high-quality studies are still needed to verify above findings.