INTRODUCTION

Most cancer-related deaths globally are caused by lung cancer. The diagnosis is typically made following the evaluation of respiratory symptoms such as chronic cough or incidental finding of pulmonary lesions such as nodules and mass. Cardiac metastasis occurs in 2-18% of lung cancers, but cardiac tamponade complicating malignant pericardial effusion is an extremely rare and life-threatening initial presentation of non-small cell lung carcinoma.

A 59-year-old-male with a smoking history of 72 pack-year presented at the emergency room with severe dyspnea and was assessed to be in cardiac tamponade. The patient arrested for 16 minutes but returned to spontaneous circulation after 650mL of serosanguinous fluid was removed by pericardiocentesis. The work-up for infectious and immunologic causes was negative. Chest CT scan with contrast did not reveal any pulmonary mass. However, the pericardial fluid cytology immunohistochemical stains pointed to a primary lung adenocarcinoma. PET scan was requested which confirmed hypermetabolic focus in the left lung base. included patients admitted at East Avenue Medical Center for DFU. The primary endpoint was major amputation of the lower extremities. Data were analyzed using Receiver Operating Characteristic (ROC) analysis and logistic regression.

This case showed an extremely rare situation where life-threatening cardiac tamponade was the initial presentation of non-small cell lung adenocarcinoma, which highlights the need for vigilance in atypical presentation. Comprehensive diagnostic approach, including PET scans and cytologic analysis, must be done when standard imaging is inconclusive.

Background: This study aimed to analyze the trend of occupational noise-induced hearing loss (ONIHL) in Brazilian workers at a metallurgical plant with a hearing conservation program (HCP), which has been addressed in a previous study. Methods: All 152 workers in this time series (20032018) participated in the HCP and used personal protective equipment. All annual audiometry records in the company's software were collected from the electronic database. The trend of ONIHL was analyzed with the joinpoint regression model. The hearing thresholds of ONIHL cases at the end of the series were compared with those found in a national reference study. Results: The binaural mean hearing thresholds at 3, 4, and 6 kHz at the end of the series were higher for ages ≥50 years, exposures ≥85 dB (A), time since admission >20 years, and maintenance workers. Significance was found only in the group divided by age. There was an increasing time trend of ONIHL, though with a low percentage variation for the period (AAPC = 3.5%; p = 0.01). Hearing thresholds in this study differed from the reference one. Conclusion Despite the unmet expectation of a stationary trend in the study period, the time pace of ONIHL evolution did not follow what was expected for a population exposed to noise. These findings signal to the scientific community and public authorities that good ONIHL control is possible when HCP is well implemented.

Objective. The study compared functional outcomes among post-operative geriatric fragility hip fracture patients who received complete and incomplete rehabilitation.

Methods. This is an ambispective cohort study of 50 acute fragility hip fractures over a 40-month period (October 2017 to November 2020) treated with either arthroplasty or internal fixation under the UP-PGH Orthogeriatric Fracture Liaison Service (FLS). Patients were contacted and interviewed through Telemedicine. They were asked to answer two questionnaires - the Modified Harris Hip Score (MHHS) and the EuroQol-5D-5L (EQ-5D-5L). The scores were tallied and used to describe and compare the post-operative functional outcomes between the two rehabilitation pathways.

Results. Among the 50 patients included in this study, twenty-three (46%) patients underwent complete rehabilitation, while 27 (54%) underwent incomplete rehabilitation. The average corrected MHHS was at 82.5 suggesting good outcomes among all patients, with a higher-than-average outcome of 83.6 among patients who underwent complete rehabilitation, and an outcome of 75.9 among patients who underwent incomplete rehabilitation. Results to the EQ-5D--5L survey showed that a majority of patients who underwent complete rehabilitation reported having 'no problems' in terms of self-care, and anxiety or depression. However, the same group had more patients reporting 'any problems' in terms of mobility. On the other hand, a bigger proportion of patients from the incomplete rehabilitation group presented with 'any problems' in terms of usual activities. Proportions were similar for both groups in terms of pain or discomfort, with neither group having patients who reported extreme pain or discomfort.

Conclusion. In spite of the heterogenous nature of the hip fracture population, functional outcome measures show generally good outcomes of patients under the UP-PGH Orthogeriatric FLS, with no significant difference among patients who receive complete rehabilitation from those who undergo incomplete rehabilitation. Continuing this study may better describe and differentiate the functional outcomes in order to pave the way for evidence-based protocols dedicated to providing the highest quality of care for acute fragility fracture patients.

Introduction: Sepsis has been redefined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. The quick sepsis-related organ failure assessment (qSOFA) is a simple tool developed to prompt clinicians to consider patients at high risk for poor outcome. Studies have compared its utility with National Early Warning Score (NEWS) and the systemic inflammatory response syndrome (SIRS) criteria. These scoring systems may be utilized to prognosticate illness severity among patients with suspected infection and may be relevant in low- and middle-income settings where laboratory data are not readily available. Objective: To determine and compare the accuracy of qSOFA, NEWS, and SIRS criteria in predicting in-hospital mortality in patients suspected to have infection presenting at the emergency department (ED) Methods: This is a prospective cohort study. Patients ≥18 years old with suspected infection admitted to the ED between June 2018 to July 2018 were included in the study. SIRS, NEWS, and qSOFA scores were collected at presentation and patients were followed up until expired or discharged. Results: A final population of 213 were included in the study with a mean age of 47 years (SD 21.2) and 124 (58.2%) females. The most common site of infection was respiratory (33.8%). Twelve patients (5.6%) died in-hospital. Among patients with qSOFA≥2, mortality rate was at 38% vs 3.5% for qSOFA<2. Specificity for mortality was highest for qSOFA (96%). Sensitivity was highest for SIRS (75%). SIRS, qSOFA, and NEWS had no significant difference in predicting in-hospital mortality with an area under the receiver operating curve of 0.659, 0.711, 0.711 respectively. Conclusion SIRS, qSOFA, and NEWS have similar prognostic accuracy to predict mortality but have limited use when applied individually which brings into question the sole utility of qSOFA despite its high specificity. It is reasonable to further validate or develop new scoring systems with higher predictive accuracy appropriate across different populations.
Sepsis ; News

INTRODUCTION: Okra is reported to have anti-diabetic effects, but the literature shows conflicting results. The experiment aimed to determine the efficacy of three doses of okra seed powder suspension as a glucose lowering agent on streptozotocin-induced diabetic rats and its cellular effects on the liver and pancreas. METHODS: Twenty-five Sprague Dawley rats that were given streptozotocin 60 mg/kg intraperitoneally were randomly allocated to one of five treatment groups: okra seed powder at 100 mg/kg, 150 mg/kg and 200 mg/kg, acarbose (positive control) and vehicle only (negative control). The treatments were given as a 1.5 mL oral gavage daily for 21 days. Significant differences in blood glucose were determined between treatment groups in terms of relative change from baseline, using One-Way ANOVA with Dunnett’s method with acarbose as the referent group. Repeated measures ANOVA was used to analyze the blood glucose levels across the time point collections (baseline, T1 and T2). Histopathologic changes on the liver and pancreas were described using counts and proportions. RESULTS: Mean blood glucose values increased from baseline to T2 in all treatment groups. Increasing trend was observed only up to T1 in the 150 mg/kg and the 200 mg/kg okra seed treatment groups. Comparing okra treatment groups to acarbose, the percentage increase of mean blood glucose from baseline to T2 was lowest in the 200 mg/kg okra group (p = 0.040). The okra-treated rats had no fatty change and a dose-dependent decrease in cellular degeneration in the liver and none for the 200 mg/ kg treatment group. CONCLUSION The 200 mg/kg okra suspension has a potential lowering effect on blood glucose and a hepatoprotective effect. A longer period of observation with higher doses of okra suspension is recommended to study these effects further.

Introduction: A 7.2 magnitude earthquake arising from the West Valley Fault will result in thousands of lives lost and severe damage to property and infrastructure. This study aimed to determine the disaster preparedness of barangays in Metro Manila along the West Valley Fault. Methods: This was a cross-sectional study of high risk barangays in six cities along the West Valley Fault using the Disaster Preparedness Audit. A total of 40 barangays were assessed on their levels of disaster preparedness in terms of percentage fulfilment of different criteria in the four thematic areas: 1) prevention and mitigation 2) preparedness 3) response and rehabilitation, and; 4) recovery. Results: None of the surveyed barangays could fulfil all the 27 criteria for disaster preparedness. Most were only able to satisfy 50-74% of the criteria. As per thematic area, no barangay met ≥75% of the criteria for prevention and mitigation whereas 87.5%, 67.5% and 80% satisfied ≥75% of the criteria for preparedness, response and recovery, respectively. In terms of overall disaster preparedness, less than half of the surveyed barangays satisfied ≥75% of the total criteria. Conclusion Most of the barangays surveyed are inadequately prepared to cope with disaster arising from a major earthquake generated by the West Valley Fault.

Background: Asians with Graves’ ophthalmopathy (GO) may have earlier compressive features due to narrower orbital apex and increased orbital volume. Objective: To determine the risk factors associated with activity and severity of GO among adults. Methodology: This was a cross-sectional analytical study of 163 adults with Graves’ disease (GD) from the outpatient clinics of the Philippine General Hospital. Demographics, clinical data, thyrotropin receptor antibody (TRAb) and urine iodine (UIE) levels were obtained. All participants were evaluated for activity and severity of GO by a single ophthalmologist. Results: The population was predominantly composed of females (81%) and nonsmokers (69%), with a mean age of 35 + 11 years and median GD duration of 2 years. Median TRAb was 8.9 U/L while UIE was 171 mcg/L. Eight percent exhibited active GO, with 85% having mild disease. Multivariate analysis showed male sex to be associated with severe disease (OR 3.71, p=0.041), while elevated TRAb was associated with both active (OR 1.03, p=0.002) and severe GO (OR 1.02, p=0.007). Conclusion Lower rates of active and severe GO were seen compared to previous reports. In this population of predominantly nonsmokers, elevated TRAb emerged as a risk factor for active and severe GO.
Graves Ophthalmopathy ; Graves Disease ; Long-Acting Thyroid Stimulator

This study investigated the acute effects of green tea extract (GTE) and its polyphenol constituents, (-)-epigallocatechin-3-gallate (EGCG) and (-)-epicatechin (EC), on basal and stimulated testosterone production by rat Leydig cells in vitro. Leydig cells purified in a Percoll gradient were incubated for 3 h with GTE, EGCG or EC and the testosterone precursor androstenedione, in the presence or absence of either protein kinase A (PKA) or protein kinase C (PKC) activators. The reversibility of the effect was studied by pretreating cells for 15 min with GTE or EGCG, allowing them to recover for 1 h and challenging them for 2 h with human chorionic gonadotropin (hCG), luteinizing hormone releasing hormone (LHRH), 22(R)-hydroxycholesterol or androstenedione. GTE and EGCG, but not EC, inhibited both basal and kinase-stimulated testosterone production. Under the pretreatment conditions, the inhibitory effect of the higher concentration of GTE/EGCG on hCG/LHRH-stimulated or 22(R)-hydroxycholesterol-induced testosterone production was maintained, whereas androstenedione-supported testosterone production returned to control levels. At the lower concentration of GTE/EGCG, the inhibitory effect of these polyphenols on 22(R)-hydroxycholesterol-supported testosterone production was reversed. The inhibitory effects of GTE may be explained by the action of its principal component, EGCG, and the presence of a gallate group in its structure seems important for its high efficacy in inhibiting testosterone production. The mechanisms underlying the effects of GTE and EGCG involve the inhibition of the PKA/PKC signalling pathways, as well as the inhibition of P450 side-chain cleavage enzyme and 17beta-hydroxysteroid dehydrogenase function.
Androstenedione ; pharmacology ; Animals ; Camellia sinensis ; Chorionic Gonadotropin ; pharmacology ; Cyclic AMP-Dependent Protein Kinases ; metabolism ; Flavonoids ; pharmacology ; Gonadotropin-Releasing Hormone ; pharmacology ; Humans ; Leydig Cells ; drug effects ; metabolism ; Male ; Phenols ; pharmacology ; Plant Extracts ; pharmacology ; Polyphenols ; Protein Kinase C ; metabolism ; Rats ; Rats, Wistar ; Signal Transduction ; drug effects ; Testosterone ; metabolism