Giant Cell Tumour (GCT) of bone is a benign, locally aggressive neoplasm. GCT of the foot is rare, comprising of about 5% of cases of all GCTs. GCT of Calcaneus is exceedingly rare, comprising of 1.2% of all calcaneal tumours. Due to its uncommon occurrence at this site, diagnosis can be delayed. In this report, we present the case of a Campanacci Grade 3 GCT of calcaneus in a 43-year-old female patient with 8 months history of worsening pain and disability. We treated her successfully by resection of Oscalcis and reconstruction with a femoral head allograft and K-wire fixation, a relatively cheaper and technically lesser challenging method of reconstruction. Three years’ postsurgery, she remains disease free, and her graft has healed. She continues to walk independently and remains disease free clinically and radiologically. We discuss a comparison with other reported cases where surgeons have opted for detailed intra-lesional curettage (DILC) and cementoplasty to fill the defect for a Grade 2 disease, some have even used a sural for soft tissue coverage with a maximum follow-up of two years. While in our patient we went for Calcanues resection and reconstruction with allograft because of a Grade 3 disease that poses greater risk of local recurrence with just DILC. Our patient has a three-year follow-up where she remains disease free

INTRODUCTION: Glaucoma is a leading cause of permanent blindness, often going undetected in its early, asymptomatic stages, especially in older age groups. In Malaysia, glaucoma is a growing public health issue due to an increase in the ageing population. While screening is essential for early glaucoma detection, the most suitable strategy for Malaysia's healthcare system remains unclear. This study explored the perspectives of eye healthcare professionals on the most suitable glaucoma screening strategies for Malaysia. MATERIAL AND METHODS: This qualitative study used semi-structured interviews with 19 eye health professionals (ophthalmologists, optometrists, nurses, ophthalmic technicians, and assistant medical officers) practicing in the Klang Valley. The interviews were conducted face-to-face in their workplace or via a video conferencing platform. All interviews were recorded, transcribed, and analysed using thematic analysis. RESULTS: Six major themes were identified: types of glaucoma screening programmes, accessible screening locations, target screening population, instruments and use of digital technology, trained personnel, and referral criteria. Opportunistic case finding and population-based programmes were identified as the glaucoma screening programmes in which trained personnel conducted screening at accessible locations. Glaucoma screening for high-risk individuals was recommended, focusing on visual acuity testing, tonometry, anterior chamber angle assessment, funduscopy, perimetry, and retinal nerve fibre assessment. A lack of clear referral criteria due to low awareness and poor implementation of existing guidelines was observed. CONCLUSION: Further investigations are required to identify the best combination of components for glaucoma screening. This will enable policymakers to develop an effective glaucoma screening programme in Malaysia.

BACKGROUND AND OBJECTIVE

Myeloproliferative disorders are characterized by symptoms that can potentially impair the quality of life of our Filipino patients. The Myeloproliferative Neoplasm Symptom Assessment Form-Total Symptom Score (MPN-SAF TSS) is used to determine symptoms at baseline and during treatment. A validated Filipino version of this questionnaire would be a helpful tool in assessing the burden of symptoms of Filipino patients with MPN. Understanding the symptom burden and symptom experience of patients with MPN is needed in developing a comprehensive wholistic management plan that addresses the physical and emotional aspects of a chronic disease such as MPN. This study aimed to translate the MPN-SAF TSS to the Filipino language.

METHODS

Translation, validation, and reliability testing of the MPN-SAF TSS was done following the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines for linguistic translation and validation.

RESULTS

No major discrepancies were found on forward and backward translation of the MPN-SAF TSS tool. The 0-10 scoring scale (where 0 = absent/as good as it can be and 10 = worst imaginable/daily/as bad as it can be) was deemed appropriate and was retained. Content and face validity as evaluated by Filipino hematologists showed that majority of the translated questions were relevant. Some words were further improved according to their valid recommendations. Ten MPN patients voluntarily answered the updated Filipino version of the questionnaire for face validity and cognitive debriefing was done to further refine the translation according to the patient’s perspective. The back translation was identical to the original versions of MPN-SAF TSS.

Validity and reliability testing of the revised and translated MPN-SAF TSS among 30 patients with MPN demonstrated that the MPN-SAF TSS Filipino version was conceptually equivalent with the English version, with good internal consistency (Cronbach’s alpha=0.89); excellent reliability with an intraclass correlation coefficient of 0.98 and convergent validity of r=0.77. 

CONCLUSION

The Filipino version of the MPN-SAF TSS was demonstrated to be a valid and reliable tool in evaluating the symptom burden of Filipino patients with MPN.

Human ; Translations

OBJECTIVE

The study aimed to investigate the potential anti-angiogenic effects of acetone extracts from Annona squamosa leaves in vivo.

METHODS

Crude acetone extract of A. squamosa leaves was prepared via simple maceration. Physicochemical and phytochemical screening of the extract were also performed. The anti-angiogenic effect of A. squamosa was assessed using in vivo chorioallantoic membrane (CAM) assay, with quantitative analysis performed using ImageJ software (U. S. National Institutes of Health, Bethesda, Maryland, USA). The eggs were treated with 1000 ppm, 500 ppm, and 250 ppm doses of the extract. Quercetin was utilized as the positive control while distilled water was used as the negative control.

RESULTS

The results of the study showed the presence of alkaloids, flavonoids, tannins, and phenolic compounds in the leaves of A. squamosa. CAM assay revealed a significant (PCONCLUSION

The acetone extract of A. squamosa leaves possesses anti-angiogenic properties in vivo, suggesting its potential for developing anti-angiogenic agents. Further research to identify and isolate the specific bioactive compounds responsible for this activity is recommended.

Plants ; Alkaloids ; Flavonoids ; Phytochemicals

OBJECTIVES

 

METHODS

We included all SLE cases reported between January 2021 and December 2022 based on our Rheumatology Section census in this retrospective chart review. We evaluated the changes in the prednisone dosage and the lupus disease activity before, during and after completion of tuberculosis (TB) treatment. The characteristics of the patients were also described.

RESULTS

All the subjects in the study were females with a mean age of 35.85 years. The pulmonary site (50 %) is the most common area of involvement in tuberculosis infection. Prior to anti-TB treatment, the mean MEX-SLEDAI score was 5.45 (SD ± 4.20) within 1 year prior to the TB diagnosis with prednisone dosage mean of 14 mg (SD ± 17.0). Three months after anti-tuberculosis medication initiation, the prednisone dosages and the MEX-SLEDAI increased however, the changes were not statistically significant. Within 1 month of completion of anti-TB treatment, there was decrease in the MEX-SLEDAI with mean of 3 (SD ± 3.68) and dosages of prednisone with mean of 4.38 mg (SD 3.13). The changes were statistically significant with p-values of

CONCLUSION

There were no significant changes in the MEX-SLEDAI and prednisone dosage within 3 months of starting antiTB medications. However, completion of treatment results to better SLE disease scores and lower prednisone requirements.

Human ; Female ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Tuberculosis ; Therapeutics ; Rheumatology ; Diagnosis ; Censuses ; Prednisone

BACKGROUND AND OBJECTIVES

The in vitro bioequivalence assessment using a dissolution apparatus, as specified by the United States Pharmacopeia (USP), is a critical parameter in the formulation and development of generic pharmaceutical products. This study is crucial for evaluating the interchangeability of generic drugs with their reference innovator counterparts. Post-market surveillance of generic drugs ensures consistent quality after distribution in the market. Metformin hydrochloride, a widely prescribed oral hypoglycemic agent for managing type 2 diabetes, is among the most utilized medications globally.

In the Philippines, there is a growing need to assess the bioequivalence of various generic formulations of metformin HCl f ilm coated tablets to ensure compliance with regulatory requirements. The Philippine Food and Drug Administration (FDA) mandates in vivo or in vitro bioequivalence including, dissolution profile comparison, as a prerequisite for the registration of generic drugs. This study aims to evaluate the quality and in vitro bioequivalence of metformin HCl f ilm-coated tablets available in the Philippine market by comparing their dissolution profiles against the innovator, Glucophage. This research seeks to provide insights into the interchangeability, therapeutic equivalence, and overall quality of these generic formulations, thus contributing to public health and regulatory standards.

METHODS

Generic metformin HCl film-coated tablets were subjected to quality control tests, including weight variation, thickness and diameter, hardness, friability, and disintegration tests, in accordance with USP guidelines. To assess in vitro bioequivalence, dissolution testing was performed, and the concentration of the dissolved drug was determined using a microplate assay reader to measure absorbance. Dissolution profiles of the generic metformin HCl film-coated tablets were compared to that of the innovator drug, Glucophage to evaluate bioequivalence.

RESULTS

All tested generic metformin HCl film-coated tablets complied with USP specifications for quality control tests, except for the hardness test, where three brands failed to meet the required standards. While for dissolution testing, five out of six generic brands demonstrated acceptable dissolution profiles and were bioequivalent to the innovator drug Glucophage. However, one brand (Brand A) failed to meet the bioequivalence criteria, exhibiting a dissolution profile outside the acceptable limits.

CONCLUSION

This study demonstrates that most generic metformin HCl film-coated tablets available in the Philippine market meet the United States Pharmacopeia (USP) quality control requirements and exhibit in vitro bioequivalence with the innovator drug. However, the failure of three brands to meet the hardness specifications and the lack of bioequivalence in one brand highlight the need for stringent quality assurance and  regulatory oversight. Ensuring compliance with these standards is critical to maintaining the safety, efficacy, and therapeutic interchangeability of generic drugs. These findings emphasize the importance of continuous post-market surveillance to uphold the quality of generic medications in the market, to safeguard public health.

Metformin Hydrochloride ; Metformin

Background/Aims: The real-world efficacy of computer-aided detection (CADe) systems, such as GI Genius (Medtronic), is unclear. We examined the colonoscopy metrics using CADe alone and with a mucosal exposure device (EndoCuff; Olympus) in a real-world setting. Methods: We retrospectively reviewed screening and surveillance colonoscopies before, during, and after CADe use in a large tertiary care center. Outcomes included the adenomas per colonoscopy (APC), sessile serrated lesions per colonoscopy, adenoma detection rate (ADR), sessile serrated lesion detection rate (SSLDR), advanced ADR, total polyp detection rate, and true histology rate. The ADR and SSLDR were further examined according to size, colon location, and EndoCuff use. Results: A total of 798 colonoscopies were performed, including 386 pre-CADe, 178 CADe, and 234 post-CADe. In cases where CADe was used with the EndoCuff, the 1 to 5 mm ADR increased from 36.3% (pre-CADe) to 52.1% (CADe) (p=0.01). The 1 to 5 mm SSLDR increased from 9.6% (pre-CADe) to 17.1% (CADe) (p=0.02). The right-sided ADR increased from 30.8% (pre-CADe) to 42.7% (CADe) (p=0.03). The right-sided SSLDR increased from 12.3% (pre-CADe) to 24.8% (CADe) (p<0.001). No significant changes were observed when only CADe was used. No differences were found in other outcome measures. Post-CADe metrics returned to pre-CADe levels. Conclusions GI Genius is useful for identifying small and right-sided polyps only when used with the EndoCuff.

BACKGROUND AND OBJECTIVE

Long-term treatment of people living with HIV (PLHIV) encounters various challenges, such as medication adherence, stigma, discrimination, and healthcare access. Patient satisfaction with healthcare services is vital for maintaining treatment adherence. Therefore, understanding the factors influencing patient satisfaction is crucial. We conducted a qualitative study to explore these factors in primary HIV care facilities in Metro Manila, Philippines.

METHODS

In this qualitative study, we interviewed PLHIV aged 18-59 receiving antiretroviral therapy (ART) in primary HIV care facilities in Metro Manila. Data saturation was reached after 19 in-depth interviews. We transcribed all audio files verbatim in Filipino and analyzed the data using deductive and inductive thematic analysis, guided by the SERVQUAL model as a theoretical framework. We employed MAXQDA, a qualitative data analysis software for coding and data management. We illustrated themes and sub-themes with quotes derived from the data.

RESULTS

Six key themes emerged regarding factors influencing patient satisfaction: tangibles, reliability, responsiveness, assurance, empathy, and location. The first five themes aligned with the SERVQUAL model, while location emerged as a new theme. PLHIV preferred accessible clinics, a clean and pleasant ambiance, and positive interactions with healthcare providers. Moreover, they suggested facility improvements, including expansion, better ventilation, enhanced service delivery, and increased healthcare staff.

CONCLUSION

Enhanced service delivery and positive healthcare interactions, along with favorable physical attributes of primary HIV care facilities, drive patient satisfaction and long-term retention. These modifiable factors contribute to the continuous care of PLHIV, ultimately improving their quality of life.

Human ; Male ; Hiv ; Patient Satisfaction ; Philippines