Alopecia resulting from radiation exposure occurs 2-8 weeks after exposure. It can be temporary or permanent depending on the dose of exposure. Alopecia following fluoroscopy-guided procedures are increasing in frequency. We report the case of a 22-year-old female who underwent fluoroscopically-guided embolization of an arteriovenous malformation. Twelve days after embolization, significant hair shedding was noted, resulting in a large rectangular hairless patch with no erythema or pain on the irradiated site. Hair pull test was positive and the hair mount showed dystrophic anagen hairs. Hair tug test was negative. Trichoscopy showed yellow dots, black dots, vellus hairs, and flame hairs. Histopathologic examination showed an increase in catagen and telogen hairs. On review of the procedure, she received a total peak skin dose of 4.67 Gray from the procedure. The diagnosis of radiation-induced alopecia was made and topical minoxidil was started, resulting in complete hair growth after six months. Patients undergoing fluoroscopy-guided procedures should have adequate follow-up weeks to months post-procedure to monitor for skin and hair reactions. Physicians should also consider delayed radiation reactions in patients with a history of radiation exposure. Safety protocols must be in place, and measures should be done to minimize the dose delivered.

Hansen’s disease (HD), or leprosy, is a chronic infectious disease caused by Mycobacterium leprae. It remains a public health concern in tropical regions like the Philippines. HD can present with a wide range of clinical manifestations and is often misdiagnosed, particularly as autoimmune disorders. This case report discusses a 20-year-old Filipino female initially misdiagnosed with Raynaud’s phenomenon, suspected to be due to an autoimmune condition.

Five years prior to her current presentation, the patient developed progressive swelling of her hands and feet, temperature-induced color changes, and facial erythema. Initial laboratory tests showed anemia, positive antinuclear antibody (ANA), and elevated complement (C3), suggesting a possible autoimmune disorder. A subsequent skin biopsy confirmed lepromatous leprosy with a bacillary index of 6+. Positive anticardiolipin and anti-beta2 glycoprotein 1 antibodies indicated a probable diagnosis of antiphospholipid syndrome (APS). These APS-like findings were thought to result from leprosy reactions and associated immune dysregulation. Due to rifampicin- and dapsone-induced hemolysis, the patient was treated with clofazimine, ofloxacin, clarithromycin, and oral steroids, resulting in clinical improvement after 12 months. Further hematologic evaluation was ongoing, as she was referred for blood dyscrasia.

Leprosy can mimic autoimmune diseases, as demonstrated by this case. Raynaud’s phenomenon and APS-like features may arise from immune dysregulation caused by chronic infection and leprosy reactions. The case highlights the complexity of diagnosing leprosy with autoimmune-like manifestations and emphasizes the importance of early diagnosis and tailored treatment to prevent complications from multisystem involvement.

Lamellar Ichthyosis (LI) is a rare autosomal recessive disorder caused by mutations in genes, primarily TGM1, that affect skin barrier formation. It results in large, hyperpigmented, plate-like scales covering the entire body and persists throughout life. This case illustrates the chronic and debilitating nature of LI, highlights therapeutic approaches that improve quality of life, and emphasizes the importance of genetic testing in managing the condition.

Patient A, a 25-year-old female, and Patient B, a 22-year-old male, are Filipino siblings from non-consanguineous parents with no notable family history. Both were born encased in a collodion membrane that later revealed generalized erythema with large scales and deep fissures. As they aged, symptoms worsened, including reduced sweating, heat intolerance, ectropion, eclabium, cicatricial alopecia, palmoplantar hyperkeratosis, limited finger movement, and blurred vision from corneal scarring. Whole exome sequencing identified a homozygous pathogenic variant in the TGM1 gene (Arg396Cys). Their parents are carriers, giving future offspring a 25% risk of inheriting the condition. Acitretin therapy at 0.2 mg/kg/day, combined with topical keratolytics, led to significant improvement in symptoms and quality of life within four weeks.

Accurate diagnosis of ichthyosiform disorders requires thorough clinical documentation, family history, physical examination, and genetic findings. Effective management of lamellar ichthyosis needs a multidisciplinary approach, focusing on improving quality of life by addressing physical discomfort and social challenges. Genetic testing, especially Whole Exome Sequencing (WES), is crucial for precise diagnosis, genetic counseling, and informed family planning.

Medical students need the basic skills and techniques in family counseling to holistically manage a family. E-learning as a mode of teaching family counseling was experienced by medical students due to the COVID-19 pandemic. This was a case series of ten medical students in a tertiary training hospital who described their thoughts and feelings about the e-learning platform used. A focused group discussion composed of seven students was conducted independently. The students’ perceptions on the use of e-learning were generally negative in nature. The volume of online learning materials to be studied and the poor-quality videos reflected the sudden shift to e-learning due to the pandemic. Limitations on the e-learning format resulted in the inability to recognize non-verbal gestures which was crucial in counseling. The poor internet connectivity within the students’ learning environment was a hindering factor as it prolonged the counseling. Positive perception was mainly due to the effectiveness of the instructor in teaching online family counseling. The adeptness in navigating online platforms and guidance to students during the demo-returndemo resulted in the achievement of the expected outcomes of the workshop. The high preference to face-to-face mode may be attributed to the number of negative perceptions by the students.

Congenital divided nevus of the eyelids is a rare form of melanocytic nevus which involves contiguous portions of the upper and lower eyelid margins unilaterally, hence the term ‘kissing nevus’. While usually present at birth, these nevi may also appear later in life. When the mass enlarges, it may cause cosmetic issues to the patient, as well as functional problems such as mechanical ptosis, ectropion, and epiphora.

We report three cases of congenital divided nevus of the eyelids, all presenting with unilateral upper and lower hyperpigmented lid masses since birth. The first case had an upper lid mass measuring 11 mm x 19 mm, and a lower lid mass measuring 55 mm x 47 mm, with both masses extending into the palpebral conjunctiva, and causing severe ptosis and corneal neovascularization due to chronic irritation. The second case presented with hyperpigmented masses at the lateral third of the right upper eyelid measuring 8 mm x 17 mm and of the lower eyelid measuring 9 mm x 15 mm on the lower lid with lashes growing through the masses. There was extension of the mass into the palpebral conjunctiva. The third case presented with a 23 x 18 mm hyperpigmented, well-circumscribed, verrucated mass at the medial half of the upper eyelid crossing the eyelid margin, and a 15 x 13 mm lesion at the medial third of the lower lid with the same characteristics, with small crusty lesions and clotted blood. All three patients underwent excision biopsy with lid reconstruction using full thickness skin grafts from the supraclavicular area. Six months postoperatively, the first case underwent a repeat full thickness skin graft due to graft contraction, and also received two sessions of fractional carbon dioxide (CO2 ) laser, two sessions of intralesional triamcinolone injections, and silicone gel application with further improvement of graft healing and scarring. The second case also underwent two sessions of intralesional steroid injection for scar management. During follow-up, which spanned 13 months for the first case, 10 months for the second case, and two months for the third case, improved functional and cosmetic outcomes were observed.

This case series highlights the outcomes of the most common surgical technique done for congenital divided nevi of the eyelids. Congenital divided nevi are usually diagnosed clinically and malignant degeneration is rare, hence lid reconstruction may be done without frozen section. The cases in the series were treated due to cosmetic and functional purposes, hence the importance of continuous post-operative follow-up to monitor for graft dehiscence, scar development, recurrence of the mass, malignant degeneration, and development of lid malposition. Additional procedures for scar management, such as CO2 laser and intralesional steroid injections, may be necessary to further enhance outcomes in complex cases. All three cases in this series exhibited improved functional and cosmetic outcomes post-operatively, with significant reduction in ptosis and scarring. Longterm follow-up revealed satisfactory recovery with minimal complications, with no recurrence nor malignant degeneration.

BACKGROUND/IMPORTANCE OF THE STUDY

At present, there is not much data on the prevalence of cancer in the young adult population in the local setting, in addition to prevalence and determinants of distress in this population. The findings of this study may help to understand the current situation of this young population, and it may also provide a reference for further improving outcomes among these patients who have a distinct set of needs compared to the older counterparts, in addition to a long life expectancy ahead of them.

This study employed an observational cross-sectional design that included young adult cancer patients, aged 19 to 39 years old, seen at the hospital outpatient clinics and Cancer Center from October 2023 to December 2023. Demographic and clinical data were collected. The participants were also asked to fill out the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) Screening Tool and Problem List after signing the written informed consent. Data were collated and analyzed per clinical variable.

The mean age of the participants was 34.55 years (SD=3.97), with most of them being 36 to 39 years old (51.67%). Comparative analyses of different demographic and clinical characteristics indicated that none of the characteristics were significantly different between those without and with significant distress levels (p >0.05). The mean distress score was 4.11 (SD=2.60) and categorizing these scores using the established cut-off score showed that 58.33% (95% CI = 44.88% to 70.93%) had distress. Time from cancer diagnosis significantly predicted distress development, specifically between 6 and 12 months from cancer diagnosis (aOR = 0.03, p = 0.042). Factors significantly contributing to distress are concerns on changes in eating, loss or change of physical abilities, worry or anxiety, sadness or depression, loss of interest or enjoyment, loneliness, changes in appearance, feelings of worthlessness or being a burden, relationship with friends, ability to have children, taking care of oneself, finances, access to medicine, issues on sense of meaning or purpose, and on death, dying and afterlife (pCONCLUSION

Significant distress is present in more than 50% of young adult cancer patients seen in a private tertiary institution in the Philippines. The time from cancer diagnosis significantly predicted distress development. Emotional and practical concerns significantly contributed to distress in this population.

: The parathyroid glands play a crucial role in calcium regulation through parathyroid hormone (PTH) production. Indicators for those with hyperparathyroidism would be elevated serum calcium and PTH levels with further evaluation followed by imaging with neck ultrasonography and parathyroid scintigraphy. Limitations in the initial imaging modalities include operator-dependent sensitivity in neck ultrasonography, and poor spatial resolution, and poor sensitivity for smaller-sized adenomas in parathyroid scintigraphy. : This case report describes a 24-year-old female with elevated parathyroid hormone, and borderline elevated calcium levels with an initial diagnosis of primary hyperparathyroidism secondary to a suspected parathyroid adenoma. The dual tracer dual-phase scintigraphy accompanied by SPECT/CT and subtraction method was negative for a parathyroid adenoma, however, ultrasonography of the neck showed a suspicious nodular structure. Due to the high clinical suspicion, a subsequent 18F-Choline PET/CT was done and identified an 18F-Choline-avid lesion, highly suggestive of a parathyroid adenoma. This prompted parathyroidectomy in which histopathology as well as intraoperative reduction in parathyroid hormone levels, confirmed the presence of a parathyroid adenoma. This is the first recorded 18F-Choline PET/CT usage for a parathyroid adenoma in the country and highlights the potential of its usage as a sensitive and specific imaging modality in cases where conventional imaging is inconclusive.
Human ; Female ; Young Adult: 19-24 yrs old ; parathyroid adenoma ; parathyroid neoplasms ; hyperparathyroidism

Sodium nitrite (SN, NaNO2) is a water-soluble, white-yellow crystalline powder with broad applications in food preservation, automotive maintenance, and animal control. It is a strong oxidizing agent that can oxidize hemoglobin iron (Fe) to its oxidized state, leading to methemoglobin formation. An increasing trend of suicide cases by SN ingestion has been reported globally following its popularization in online suicide forums providing detailed instructions of its use solely or as part of a “suicide kit.” We report a case of a 21-year-old male who was found continuously vomiting, with blood per orem and cyanosis of the mouth and digits. Within minutes of the onset of symptoms, the patient lost consciousness and was pronounced dead on arrival at the nearest emergency room. Autopsy findings showed lip erosions, hemorrhage, and perioral and peripheral cyanosis. Internal examination showed characteristic bright red muscle discoloration, dark brown arterial blood, red-brown congested visceral organs, and hyperemic esophageal and gastric mucosa. Methemoglobin studies from sampled arterial blood showed elevated levels (17.5%). Further investigation of the decedent’s belongings, social media posts, and recent online purchases reinforced the intentional sodium nitrite ingestion. While there are plenty of reported SN poisoning in suicide cases internationally, limited reports have been published locally. Death by SN poisoning is preventable with Methylene blue. The role of forensic pathologists through autopsy may be the last chance to detect such cases. The lack of systemic death investigation, experts, and local laboratories to reliably detect the signs of SN poisoning may have affected the low detection rate of cases locally. Further reporting of cases can raise the awareness of medical professionals that is fundamental to the ultimate saving of lives.

Dyshidrotic eczema (DE) and palmoplantar psoriasis (ppPSO) are both conditions presenting with vesicopustules on the palms and soles. While they have differences, distinguishing them can be a challenge in cases complicated with allergic contact dermatitis (ACD).

A 24-year-old male clerk, presented with a one-year history of vesicopustules on the palms and soles, associated with onycholysis and subungual hyperkeratosis. He admits to frequent hand washing and using rubbing alcohol as well as wearing a new pair of rubber shoes. Patch testing (International Standard series) showed +++ Potassium dichromate 0.5%, Carba Mix 3.0%, Thuiram mix 1.0%, Textile dye 6.6% and ++ Formaldehyde 2%. Gram stain was negative and KOH from plantar area showed spores and long-septate hyphae. Dermoscopy showed a bright pink background with erosions, patchy dotted vessels atop with yellow crust, and scales. Histopathology revealed psoriasiform-spongiotic dermatitis with macrovesiculation and eosinophilic spongiosis which was consistent with subacute eczema. He was managed as a case of recalcitrant DE with secondary dermatophytosis and ACD to textile dye and rubber, but still keeping in mind the possibility of eczematized ppPSO. The patient was managed accordingly, with particular emphasis on avoiding allergens. The condition improved, and nail changes resolved with topical medications and a short course of oral corticosteroid and oral anti-fungal thus favoring our initial impression of recalcitrant DE complicated by dermatophytosis and ACD.

This highlights the diagnostic challenge in distinguishing between severe DE and ppPSO in the setting of concomitant ACD, underscoring the importance of a comprehensive evaluation.

Mycosis fungoides is the most common type of cutanoues T-cell Lymphoma. It is a mature T-cell non-Hodgkin lymphoma with presentation in the skin but with potential involvement of the nodes, blood, and viscera. This case reports a 24-year-old female who presented with a two-year history of progressively increasing hypopigmented macules and patches. Skin punch biopsy and immunohistochemical stains done were suggestive of a malignant T-cell process. The patient was managed with a short course topical corticosteroids and maintained on a topical moisturizer. The patient underwent multiple sessions of narrowband UV-B Phototherapy at 2-3 times per week and showed significant improvement of the skin lesions hence, was advised to be maintained on phototherapy.