A 17‑year‑old nulligravid presented with labile mood, insomnia, and hyper‑productive speech for 2 days, which progressed to seizures. Cerebrospinal fluid was positive for anti‑N‑methyl‑d‑aspartate (NMDA) receptor antibodies. Despite immunotherapy and seizure prophylaxis, she had status epilepticus and rapid decrease in sensorium. She was placed on ventilatory support and was admitted in the intensive care unit. On the 44th hospital day, an incidental finding of an ovarian teratoma was seen on abdominal computed tomography scan. She underwent right salpingo‑oophorectomy, which revealed an immature teratoma. The absence of an intensive care admission and prompt surgery and immunotherapy are known predictors of good outcome in anti‑NMDA receptor (NMDAR) encephalitis, with improvement seen in 80% of patients. Because most ovarian teratomas are only diagnosed as an incidental finding, anti‑NMDAR encephalitis with a concurrent ovarian teratoma should be suspected in young females presenting with sudden‑onset neuropsychiatric symptoms, to provide the timely intervention necessary for a good prognosis.
Encephalitis ; Immunotherapy ; Seizures ; Teratoma

BACKGROUND: The modified Ferriman-Gallwey (mFG) score is the gold standard for the clinical evaluation of hirsutism. However, racial variations in terminal hair growth limit this tool. This study aimed to determine the mFG cut-off score among Filipino women and its association with biochemical hyperandrogenism.METHODS: A total of 128 Filipino women were included in this prospective cross-sectional study and were divided into two groups: a polycystic ovary syndrome (PCOS) group (n=28) and a non-PCOS group (n=100). The participants underwent mFG score determination, ovarian ultrasound conducted by a single sonographer, and hormone testing. The mFG cut-off score was determined based on the 95th percentile of the non-PCOS group. Logistic regression was used to analyze the relationship between mFG score and biochemical hyperandrogenism.RESULTS: Although the mFG score was generally low in both the PCOS and non-PCOS groups, the former exhibited a higher mean score than the latter (4.3±3.0 vs. 2.0±2.2, P<0.001). Normal values for the total mFG score ranged from 0 to 7. Using a cut-off score of 7, a higher proportion of hirsute women (mFG score ≥7) was observed in the PCOS group versus the non-PCOS group (17.9% vs. 5.0%, P=0.025). Elevated calculated free testosterone (FT) was also found to be significantly associated with hirsutism (odds ratio, 6.2; 95% confidence interval, 1.2 to 32.4 pmol/L; P=0.030).CONCLUSION: A score of 7 and above constitutes hirsutism in this population of Filipino women. Hirsute women are more likely than non-hirsute women to have elevated calculated FT.
Cross-Sectional Studies ; Female ; Gonadal Disorders ; Hair ; Hirsutism ; Humans ; Hyperandrogenism ; Logistic Models ; Polycystic Ovary Syndrome ; Prospective Studies ; Reference Values ; Testosterone ; Ultrasonography

Human ; Female ; Influenza, Human

OBJECTIVE: To determine and analyze the demographic data, clinical, presentation and course, as well as maternal and neotal outcome of pregnant Filipino patients with influenza-like illness (ILI) versus confirmed cases of Influenza AH1N1 during the 2009-2010 pandemic who presented at the Influenza-like-illness (ILI) Clinic at a tertiary hospital in the Philippines from May 2009 until February 2010.
DESIGN: Cohort study
SETTING: The Medical City
PATIENTS: Pregnant patients who presented with influenzalike illness (ILI) and were seen at the Influenza-like-illness (ILI) Clinic from May 2009 until February 2010.
METHODOLOGY: This is a cohort study that reviewed the charts of pregnant patients who presented with influenza-like illness, diagnosed as Case under Observation (CUO) at the Influenza-like Illness (ILI) Clinic at The Medical City, from May 2009 until February 2010. The pregnant patients were classified into two groups: those who tested positive and those who tested negative to the H1N1-rRT-PCR (realtime reverse transcriptase polymerase chain reaction) throat swab test. Demographic characteristics, course and management of illness as well as prenatal and peripartum course were compared between the two groups. Followup was also done by phone calls. Any history of preterm labor, hospital admissions, respiratory illness, and complications were gathered. Maternal and neonatal outcome were documented including mode of delivery, birthweight, maturity and any neonatal complications.
MAIN OUTCOME: Pregnant women presenting with influenzalike illness (ILI) and confirmed Influenza A H1N1 infection have a higher rate of hospital admission (59.1% and 61.5%) compared to non-pregnant women of reproductive age (19.1% and 29.4%) with similar conditions (P = 0.05). Pregnant women who presented with influenza-like illness and with a positive throat swab result were significantly younger than those with negative results, with a 2.25 times higher risk for pregnant women aged 30 years old to have a positive throat swab test result (RR - 2.25; 95% CI = 1.08-4.67; P = 0.005). Difficulty of breathing was significantly more common among those with negative throat swab test result (44.4%) (P = 0.02). Association between the types of specimen collected with throat swab test results among pregnant patients with ILI showed a significantly higher proportion of subjects to have a positive result with nasooropharyngeal samples (P = 0.03).
CONCLUSION: Pregnant women with influenza-like illness (ILI) and confirmed cases of Influenza A H1N1 have a higher rate of hospitalization compared to non-pregnant women of reproductive age with similar conditions. Pregnant women who presented with influenza-like illness and with a positive throat swab result were significantly younger than those with negative results. Difficulty of breathing was significantly more common among those with negative throat swab test result. A significantly higher proportion of subjects have a positive result with naso-oropharyngeal samples. The issue of protecting the Filipino pregnant women from this vaccine-preventable disease remains a challenge to every healthcare worker in this country.

Human ; Female ; Adult ; Influenza, Human ; Influenza A Virus, H1n1 Subtype ; Peripartum Period ; Pharynx ; Delivery, Obstetric ; Health Personnel ; Vaccines