Orbital cellulitis is a potential blinding condition resulting from infection of the orbital contents, including the optic nerve. It may be fatal in cases with extension into the optic canal and subsequently the brain. Common aetiologies include extension of infection from paranasal sinusitis or preseptal cellulitis. This case report depicts the unusual occurrence of orbital cellulitis following a trivial superficial conjunctiva laceration wound from a motor-vehicle accident. Aggressive treatment with systemic antibiotics resulted in good visual outcome. All wound on or around the globe must be diligently treated to prevent such detrimental complication.
Orbital Cellulitis

Introduction: Septic arthritis is an infection of the joint. Considered a medical emergency, it requires prompt diagnosis and treatment. Local data on the clinical profile of septic arthritis patients in the Philippines are still limited. Therefore, this study aims to determine the clinical characteristics and outcomes of patients with septic arthritis in the local setting. Objective: To determine the clinical profile and outcome of adult Filipino patients with septic arthritis admitted at a tertiary hospital. Methodology: This is a retrospective descriptive study of the medical records of patients with septic arthritis admitted at Chong Hua Hospital, Cebu City, from January 2012 to December 2019. Results: Fifty- seven patients were included in this study. Sixty-four percent were males. Forty-three percent were between the ages of 45 to 64 years old. Diabetes mellitus (49.12%) was identified as the most common comorbidity. 94% of patients presented with monoarthritis, with the knee being the most commonly involved joint (73%). 85% of patients presented with joint pain and swelling. Gram-negative bacilli were the most common pathogen isolated at 31.5%. In addition, 87% of patients had synovial fluid white blood cell counts of more than 50,000/uL. Ceftriaxone was the most commonly used empiric antibiotic (31.5%). Based on sensitivity results, empiric antibiotic treatment was adequate in 66.67% of the cases. 64% of patients underwent surgical intervention in addition to antibiotic therapy. Conclusion This study highlights the unique characteristics of septic arthritis in this population, such as its prevalence in middle-aged patients and the isolation of gram-negative bacilli as the most common isolate. This study showed that the majority of patients were male, with monoarthritis as the most common presentation. Half of the studied population had diabetes mellitus. High clinical suspicion and awareness of risk factors should be emphasized so that timely and adequate treatment may be provided.
Septic arthritis

Child restraint system (CRS) can protect children in the event of crash and reduce the severity of injuries. As such, it is crucial to understand the prevalence of CRS usage and knowledge attributes on CRS usage among drivers. This study aims to assessdrivers’ knowledge on CRS usage.A semi-structured questionnaire was developed and pilot tested to verify its validity and reliability. The questionnaireaddressesdrivers’ knowledge about CRS currently available in the Malaysian market, the types of restraints used and views on fitting restraints to passenger vehicles. Seventy four percentfrom 500 respondents cited that they are usingor theyhave used CRS,64% knowabout CRS and its function, and 43% areawareof ISOFIX. In short, majority of the respondents are aware of CRS use and functions. Awareness and education program should berigorously introduced to public towards the implementation of the CRS law.
Child restraint system ; children passenger safety ; road traffic accident ; child injury

Since ancient times, various herbal medicines have been used in folk medicine to treat a variety of diseases. While the majority of drugs belong to the Kingdom of Plantae, some drugs from the Kingdom of Animalia are listed in various Materia medica of alternative medicines. Animal-derived drugs are mentioned in the Unani system of Medicine (USM) and have been used successfully to treat a variety of diseases. Marjan (Corallium rubrum) is a vital marine drug of animal origin that has been used in USM since ancient times and continues to be used today. It possesses a variety of beneficial pharmacological properties, including tonic effects on the heart, brain, stomach, and eyes, pregnancy protection, expectorant, and hemostyptic properties. It is used to treat hemoptysis, palpitation, bleeding piles, hemiplegia, heart failure, and general weakness. It is also an ingredient in a variety of Unani formulations with pharmacological significance. Unani physicians expanded the uses of Marjan and successfully used it to treat a variety of new diseases. There is a dearth of scientific research on its pharmacological and medicinal properties. The urgent need is to validate the Unani claims about its beneficial cardiac and nervine actions, as well as other significant actions mentioned in the Unani literature.

Since ancient times, various herbal medicines have been used in folk medicine to treat a variety of diseases. While the majority of drugs belong to the Kingdom of Plantae, some drugs from the Kingdom of Animalia are listed in various Materia medica of alternative medicines. Animal-derived drugs are mentioned in the Unani system of Medicine (USM) and have been used successfully to treat a variety of diseases. Marjan (Corallium rubrum) is a vital marine drug of animal origin that has been used in USM since ancient times and continues to be used today. It possesses a variety of beneficial pharmacological properties, including tonic effects on the heart, brain, stomach, and eyes, pregnancy protection, expectorant, and hemostyptic properties. It is used to treat hemoptysis, palpitation, bleeding piles, hemiplegia, heart failure, and general weakness. It is also an ingredient in a variety of Unani formulations with pharmacological significance. Unani physicians expanded the uses of Marjan and successfully used it to treat a variety of new diseases. There is a dearth of scientific research on its pharmacological and medicinal properties. The urgent need is to validate the Unani claims about its beneficial cardiac and nervine actions, as well as other significant actions mentioned in the Unani literature.

We present a case of a 50-year-old man with chronic kidney disease (CKD) presenting with acute diarrhea and fever. He was admitted a month prior for COVID-19, where he received antibiotics for radiographic findings of pneumonia and elevated procalcitonin. In the emergency department, his stool sample tested positive for Clostridioides difficile antigen and toxin. He was given oral vancomycin and intravenous metronidazole for fulminant C. difficile infection and was discharged with resolution of symptoms. This case documents a potential risk associated with routine antibiotic use during the pandemic and the pitfalls in interpreting procalcitonin, especially in patients with COVID-19 and CKD.
COVID-19 ; Clostridioides difficile ; antibiotic-associated colitis

Background: Diabetes self-management is a fundamental aspect of diabetes care and has a significant impact on diabetes- related mortality and morbidity. Assessment of self-care management is thus essential for clinicians and educators seeking better outcomes. However, there are no Filipino-validated tools to objectively measure this. Methodology: A cross-sectional analytic study was done among adult Type 2 diabetic mellitus (T2DM) patients at the Ilocos Training and Regional Medical Center (ITRMC) Department of Internal Medicine outpatient clinic and three private diabetes clinics to determine the reliability and validity of the Filipino-translated Diabetes Self-Management Questionnaire (DSMQ) and its association with glycemic control as measured using glycosylated hemoglobin (HbA1c) values and categorized into good (< 7%), moderate (7-8.9%) and poor (> 9%) control. The English version of the DSMQ was translated to Filipino using forward-backward translation. The pre-tested Filipino translated questionnaire was then distributed to the participants and the responses were analyzed using Cronbach’s alpha, Pearson’s coefficient, and one–way analyses of variance. Results: There were a total of 78 respondents. The test-retest reliability showed a statistically significant correlation (p < 0.05). All the items showed a high difficulty index. Known group validity was computed based on categorized HbA1c values. DSMQ sum scores and subscales showed no significant differences among the three categories of glycemic control. Conclusion The Filipino-translated DSMQ is a reliable tool for measuring the self-care of Filipinos with type 2 diabetes mellitus. Future research using it with a larger sample size and analysis for other factors affecting diabetes control may be better able to demonstrate its association with glycemic control.
self-management

Extramedullary plasmacytoma is a rare complication from multiple myeloma. We report a 56-year-old lady with underlying multiple myeloma who developed swelling over the left eye. It caused a non-axial proptosis, exposure keratopathy and visual acuity of counting fingers. A tissue biopsy revealed infiltration of tissue fragments with neoplastic plasma cells positive for CD138 and Kappa light chain restrictions consistent with plasmacytoma. Following radio-chemotherapy, the mass shrunk tremendously but her visual outcome remained poor.

Giant cell tumour of tendon sheath is a benign soft tissue lesion most commonly found in the flexor aspect of hand and wrist. However, it is uncommon in foot and ankle and rare in bilateral achilles tendon. We report a case of 17-year-old female who presented with progressive enlargement of bilateral achilles tendon for six months. MRI findings showed that most of the tumour had intermediate to low signal intensity. Histopathology confirmed the diagnosis of giant cell tumour of tendon sheath. To help the patient regain the strength of the achilles tendon and walking abilities, a large area of tendon tumour was excised, followed by reconstruction with transfer of the peroneus brevis (PB) and posterior tibial (PT) tendon autograft. At two years followup, functional result was satisfactory.

Background: Infection can be severely complicated by a dysregulated, whole-body inflammatory response known as sepsis. While previous research showed that genetic predisposition is linked to outcome differences, current patient characterization fails to determine which septic patients have greater tendencies to develop into severe sepsis or go into septic shock. As such, the identification of prognostic biomarkers may assist in identifying these high-risk patients and help improve the clinical management of the disease. Objective: In this study, we aimed to identify molecular patterns involved in sepsis. We also aimed to identify essential genes associated with the disease’s survival which could serve as potential prognosticators for the disease. Methods: We used weighted gene co-expression analysis (WGCNA) to analyze GSE63042, an RNA expression dataset from 129 patients with systemic inflammatory response syndrome or sepsis, including 78 sepsis survivors and 28 sepsis nonsurvivors. This analysis included identifying gene modules that differentiate sepsis survivors from nonsurvivors and qualitatively assessing differentially expressed genes. We then used STRING’s protein-protein interaction and gene ontology analysis to determine the functional and pathway relationships of the genes in the top modules. Lastly, we assessed the prognosticator abilities of the hub genes using ROC analysis. Results: We found four diverse co-expression gene modules significantly associated with sepsis survival. Our differential gene expression analysis, combined with protein-protein interaction and gene ontology analysis, revealed that the hub genes of these modules – TAF10, SNAPIN, PSME2, PSMB9, JUNB, and CEBPD – may serve as candidate markers for sepsis prognosis. These markers were significantly downregulated in sepsis nonsurvivors compared with sepsis survivors. Conclusion Weighted gene co-expression analysis, gene ontology enrichment analysis, and proteinprotein network interaction analysis of transcriptomic data from sepsis survivors and nonsurvivors revealed TAF10, SNAPIN, PSME2, PSMB9, JUNB, and CEBPD as potential biomarkers for sepsis prognosis. These genes are associated with functions related to proper immune response, and their downregulation in sepsis nonsurvivors suggests eventual immune exhaustion in late sepsis. Further analyses, however, are necessary to validate their roles in sepsis progression and patient survival.
prognosis