Gout is the most common inflammatory arthritis among Filipinos, characterized by hyperuricemia leading to mono- sodium urate crystal deposition and an ensuing inflammatory response. Though typically a disorder of middle- aged and older adults, tophaceous gout presenting before the age of 30 is rare and suggests aggressive disease progression. Allopurinol, a first-line urate-lowering therapy, is generally effective but may cause rare, potentially life-threatening adverse reactions such as allopurinol hypersensitivity syndrome (AHS). Febuxostat, a non-purine xanthine oxidase inhibitor, is an alternative for patients intolerant to allopurinol. Although hypersensitivity reactions to febuxostat are extremely rare, isolated case reports document their occurrence in both patients with prior AHS and in allopurinol-naïve individuals. Hypersensitivity to both agents is exceedingly uncommon and presents a major therapeutic challenge. In such cases, febuxostat desensitization, conducted in collaboration with allergy specialists, may permit a viable solution to safely reintroduce urate-lowering therapy and prevent further disease progression. This case report describes a patient with young-onset, tophaceous gout who developed severe hypersensitivity reactions to both allopurinol and febuxostat — an unusual and challenging therapeutic dilemma. The case highlights the need for individualized management strategies, including the consideration of drug desensitization, in patients with limited urate-lowering options.

Human ; Male ; Adult: 25-44 Yrs Old ; World Health Organization ; Therapeutics ; Specialization ; Solutions ; Research Report ; Pharmaceutical Preparations

BACKGROUND

Early-stage endometrial cancer often presents with favorable survival rates, but high-risk factors, including TP53 mutations and high-grade serous pathology, can lead to recurrence and poor prognosis. The standard primary treatment for endometrial cancer is surgical staging, and lymph node metastases significantly impact adjuvant therapy decisions. The subgroup of p53-abnormal (p53abn) indicates the worst prognosis and potential benefits from adjuvant chemotherapy. Molecular classification, while recommended, faces practical challenges due to resource constraints.

OBJECTIVES

The study aimed to assess the incidence of p53 abnormal expression in clinical stage 1 endometrial cancer cases that underwent surgery at a government tertiary hospital, and assess its relationship with clinicopathologic factors and pelvic and paraaortic lymph node metastasis (LNM).

METHODS

A cross-sectional retrospective analysis was conducted on clinical early-stage endometrial cancer cases that underwent surgical primary treatment between January 2018 and December 2022. Patient records were reviewed to gather demographics, surgical information, and pathological evaluations. Preoperative clinical staging was determined through imaging, and surgical staging involved comprehensive lymphadenectomy. Immunohistochemistry studies for p53 were carried out on formalin-fixed paraffin-embedded tissue samples.

RESULTS

A total of 233 endometrial cancer cases were included. The mean age at diagnosis was 53.7 years. Common comorbidities included hypertension (47.2%) and dyslipidemia (20.6%). Most cases were endometrioid histology (82.8%) and low-grade tumors (85.8%). Tumor grade (p=0.010), myometrial invasion (pCONCLUSION

Tumor grade, myometrial invasion, and LVSI were all significantly associated with lymph node involvement. While p53 immunohistochemical stains show promise in predicting metastasis and has been associated with tumor aggressiveness, this should still be correlated with clinicopathological parameters to carry out a more accurate risk stratification of early-stage patients.

Therapeutics ; Survival Rate ; Risk Factors ; Recurrence ; Prognosis ; Pathology ; Endometrial Neoplasms ; Immunohistochemistry ; Tumor Suppressor Protein P53 ; Lymph Node Excision ; Risk Assessment

BACKGROUND

The survival advantage of HER2-positive breast cancer from targeted treatment is commonly undermined by catastrophic health expenditure (CHE), particularly in resource-limited areas. Recognizing that financial catastrophe leads to non-adherence to treatment and dissaving practices, we examined the out-of-pocket (OOP) expenses of patients with HER2-positive breast cancer.

OBJECTIVE

The study aimed to estimate the median total per-cycle out-of-pocket expenditure of HER2-positive breast cancer treatment from the patient perspective, in public and private clinics, evaluate the association of catastrophic health expenditure with non-adherence to treatment, and describe dissaving practices.

METHODS

This was a cross-sectional micro-costing analysis of the treatment of HER2-positive breast cancer from the patient perspective from a tertiary cancer center and select private clinics in the Philippines. Random sampling of patients with HER2-positive breast cancer was done. Using a validated questionnaire, a guided interview was administered. Catastrophic health expenditure was estimated as having OOP of >20% of the household income. OOP costs were assessed retrospectively from the time of confirmed HER2 diagnosis up to the date of survey, while household income referred to the corresponding period. The proportion of patients experiencing catastrophic health expenditure was computed. Fisher's exact was used to assess for any association between CHE and non-adherence to treatment. Descriptive statistics were used to report dissaving practices. All statistical analyses were performed using Stata analytical software version 12.

RESULTS

A total of 101 patients participated in the study. The mean age of participants from the tertiary cancer center and private clinics were 52 and 58 years old respectively. Patients from the private clinics had a median total OOP expenditure of PhP 54,737.06 (IQR = PhP 102,670.00), compared with patients from tertiary cancer center who had a median total OOP expenditure of PhP 13,920.66 (IQR = PhP 20,830.00). The overall prevalence of CHE (90.9%, 95% CI 0.81, 0.95) and nonadherence to treatment with trastuzumab (79%, 95% CI 0.70, 0.87) were high, and similar in both groups. A number of dissaving practices such as resignation from work, borrowing money from friends, selling assets were observed.

CONCLUSION

The high rate of CHE and treatment delay among patients with HER2-positive breast cancer were not addressed by the existing cancer programs. Most OOP expenditure was for trastuzumab. Current cancer support programs have potential to address the financial impact of their treatment.

Human ; Therapeutics ; Survival ; Patients ; Neoplasms ; Philippines ; Health Expenditures ; Breast Neoplasms

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

Pulmonary aspergilloma is the most common pulmonary involvement due to Aspergillus. It usually develops in a pre-existing cavity in the lung, most often due to tuberculosis. Hemoptysis occurs secondary to local invasion of the blood vessels lining the cavity. Recurrence of which, is an indication to do surgery, lobectomy in particular. Antifungals like amphotecin B given intravenously and itraconazole given orally, have been the traditional management. But with the emergence of newer antifungals, Echinocandins in particular, which functions to inhibit the β-(1,3) p-glucan synthase, an enzyme necessary for the synthesis of an essential component of the cell wall of fungi, one may need not undergo surgery. The most common antifungal medication for Aspergillus is voriconazole, a second-generation triazole. This case demonstrates the efficient utilization of Voriconazole along with Anidulafungin, which is necessary for the fungal cell wall integrity. For immunocompromised patients with pulmonary aspergilloma, this dual therapy presents a viable substitute for surgical intervention and an efficient treatment approach.

CASE

We present a case of a 54-year-old married patient, who presented with massive hemoptysis four days before consulting a private physician. She had ten episodes of hemoptysis four hours before admission and was rushed to the hospital. The patient had multiple comorbidities, including diabetes, hypertension, and asthma, contributing to an immunocompromised state. She had a history of anti-tuberculosis treatment in 2000, which was discontinued due to an allergic reaction. During her hospital stay, she experienced febrile episodes, and capillary glucose monitoring was beyond acceptable levels, prompting antibiotic initiation. A chest CT scan revealed pulmonary tuberculosis with cicatricial atelectasis of the lingular segment and infected cavitary formation. A bronchoscopy and biopsy of the cavitary lesion were scheduled. Surgical intervention, particularly lobectomy, was not pursued due to multiple factors, including the patient's immunocompromised status, her underlying comorbidities, and the response to antifungal therapy. After eight to 14 fourteen (8-14) hospital days, no episodes of hemoptysis were noted, and the biopsy result revealed fungal colonization consistent with Aspergillus species. The patient was discharged with oral Voriconazole and other maintenance medications. A repeat chest CT scan after five months of antifungal therapy showed regression of the fungus ball.

CONCLUSION

In this case, pulmonary aspergilloma in an immunocompromised patient was successfully treated with a combination antifungal therapy utilizing anidulafungin and voriconazole. The favorable clinical response to dual antifungal therapy provides a feasible non-surgical alternative to surgical intervention, which has historically been the preferred option for treating recurrent hemoptysis, particularly in high-risk patients. The fungus ball's regression and the fungal infection's resolution support the growing role of more recent antifungal medications in the treatment of complicated pulmonary infections. This case suggests that echinocandins combined with triazole therapy are a viable less invasive treatment option for pulmonary aspergilloma than surgery.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Anidulafungin ; Immunocompromised Host ; Patients ; Therapeutics ; Voriconazole

OBJECTIVES

The increasing prevalence of Kawasaki disease in Southeast Asia (SEA) and its potential relation with Coronavirus Disease 2019 (COVID-19) infection resulted in heightened interest in KD in the region, thus, this paper aimed to determine the trend and the socioeconomic facilitators of scientific productivity of KD research within the region. Specifically, this article determined the number of publication and citations related to KD per country, institution, and journal. We also explored the networks of countries within the region to the rest of the world and the keywords mostly associated with KD research in the region. Lastly, correlation of these bibliometric indices with socioeconomic factors in the region was analyzed.

METHODS

A literature search of KD papers in SEA was performed using Scopus database. We obtained bibliographic data from the available literature and visualized network of existing collaborations and keywords using VOSviewer software.

RESULTS

A total of 196 papers were included in the study. Bibliometric analysis showed a rising trend in publication within the region, most of which were from institutions in Singapore and Thailand. The most common topics on KD studies included clinical features, complications, treatment, and comorbidities. 

Country characteristics such as gross domestic product (GDP) per capita, research and development (R&D) expenditure (% GDP), and number of physician and R&D researchers were positively correlated with bibliometric indices of KD research in SEA. Moreover, number of international linkages was significantly associated with KD research productivity in the region. 

CONCLUSION

In summary, we showed an increasing trend of KD research in SEA. Funding allocation and capacity building are necessary to strengthen research productivity within the region.

Asia ; Asia, Southeastern ; Bibliometrics ; Capacity Building ; Coronavirus ; Covid-19 ; Database ; Disease ; Efficiency ; Gross Domestic Product ; Guanosine Diphosphate ; Infection ; Infections ; Literature ; Mucocutaneous Lymph Node Syndrome ; Paper ; Physicians ; Prevalence ; Publications ; Research ; Research Personnel ; Rest ; Singapore ; Socioeconomic Factors ; Software ; Thailand ; Therapeutics

OBJECTIVES

In Asia, younger individuals (below age 45) are diagnosed to have type 2 diabetes with increased rates of obesity defined by lower BMI yet with greater visceral adiposity (waist circumference and waisthip ratios). The prevalence data on type 1 diabetes is not well established, considered to be low, but is seen to be increasing as well. This changing phenotype therefore, presents a clinical dilemma in terms of correctly classifying diabetes and deciding on the consequent appropriate treatment. Distinguishing type 1 from type 2 diabetes has become more difficult with type 2 diabetes dramatically increasing in young adults and children. This study aims to define the characteristics of diabetes among young adults in the Philippines to provide a basis for appropriate management amidst changes in diabetes phenotypes seen globally.

METHODS

In this cross-sectional analytic study, we characterized the demographic, metabolic, and autoimmune features of diabetes among young adult Filipinos aged 18 to 45 years old consulting at a tertiary referral center in Manila, Philippines. Baseline serum A1c, FBS, 75-g oral glucose tolerance test, insulin, serum C-peptide, insulin autoantibodies, leptin, adiponectin, lipid profile, and thyroid function tests were obtained from the participants and analyzed. The homeostasis model assessment (HOMA) was used to estimate the insulin sensitivity.

RESULTS

A total of 348 patients with diabetes were included, with females comprising two-thirds of the participants. The mean age at diagnosis of diabetes was 35.9±7.22 years. The mean BMI was 28.12 kg/m2, with median waist to hip ratio (WHR) of 0·93. Metabolic syndrome was found in 60% of participants and 67.82% were obese by body mass index. The mean A1c was 9.07±2.52%. Good glucose control (A1c less than 7.0%) was seen in 23% of participants  while nearly half (48%) had HbA1c which was >9.0%. The median levels of fasting insulin and C-peptide were 12.62 (range 1.33–90.42) mIU/L and 0.78 ng/mL (range 0–16.2), respectively. 

Included participants were diagnosed with diabetes within a year and as such, majority did not have any micro- or macrovascular complications. The most common diabetes complication was sensory neuropathy detected by monofilament testing, which was found in 28% of participants, followed by non-proliferative diabetic retinopathy in 13%. A history of previous diabetic ketoacidosis was found in 10 patients (2.87%). Glutamic acid decarboxylase (GAD) and insulin auto-antibodies were found in 3.2% and 19.3% of participants, respectively. Approximately half (51.73%) of the participants were insulin resistant by HOMA-IR.

CONCLUSION

In contrast with Caucasians and other Asians, diabetes among young Filipino adults is associated with lower BMI but with a similarly high visceral adiposity as shown by an elevated WHR. Metabolic syndrome with insulin resistance as defined by a variety of indices is predominant. Type 1 diabetes with autoantibodies occur in only a small fraction of this population. Data derived from this work can provide a framework for cluster analysis towards personalized management specific to this population.

Human ; Acids ; Adiponectin ; Adiposity ; Adult ; Aged ; Antibodies ; Asia ; Asian ; Asian Continental Ancestry Group ; Autoantibodies ; Body Mass Index ; C-peptide ; Carboxy-lyases ; Child ; Cluster Analysis ; Demography ; Diabetes Complications ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Diabetic Retinopathy ; Diagnosis ; Fasting ; Female ; Glucose ; Glucose Tolerance Test ; Glutamate Decarboxylase ; Glutamic Acid ; Insulin ; Insulin Resistance ; Ketosis ; Leptin ; Lipids ; Metabolic Syndrome ; Obesity ; Patients ; Peptides ; Phenotype ; Philippines ; Population ; Prevalence ; Serum ; Therapeutics ; Thyroid Gland ; Thyroid Function Tests ; Young Adult

BACKGROUND

In the context of acute psychiatric care characterized by severe hallucinatory symptoms, providing timely and effective interventions poses challenges. Therapy administered by Mental Health Nurses (TKN) emerges as a promising solution to comprehensively address these acute symptoms. This therapeutic approach is designed to alleviate hallucination symptoms during the acute phase.

OBJECTIVES

This study aimed to investigate the effectiveness of Therapy administered by Mental Health Nurses (TKN) as an intervention tailored for individuals facing acute hallucinatory challenges. The overarching goals include exploring the therapeutic dimensions of the intervention, assessing the potential for tailored interventions based on demographic factors, and translating findings into practical implications for mental health professionals.

METHODS

This study used a quasi-experimental design with a one-group pre-post-test structure. A total of 117 participants diagnosed with schizophrenia from outpatient psychiatric wards were selected in community setting, excluding individuals with concurrent mental retardation to maintain sample homogeneity. Data collection, conducted over two months from July to August 2023, included a pre-test assessment before any intervention to establish baseline hallucinatory symptoms. Therapy by Mental Health Nurses (TKN) was administered over two weeks, consisting of four 30- to 45-minute sessions for each participant. After each session, participants underwent reassessment for hallucinatory symptoms, totaling five assessments. Psychotic Syndrome Rating Scale (PSYRAT) was used to measure hallucination scores. The data analysis employed paired t-tests for baseline and post-intervention scores within a two-week period. A Repeated Measures Analysis of Variance (ANOVA) assessed the effect of interventions on hallucination scores, with age, gender, and adherence status as factors. Post hoc analyses, including pairwise comparisons, identified specific subgroup differences and assessed the time effect within the same group.

RESULTS

The study cohort primarily consisted of adults (90.6%), maintaining a balanced gender distribution with 51.3% males and 48.7% females. A substantial portion had low educational backgrounds (59%), and the majority were unemployed (87.2%), with family members serving as the predominant primary caregivers (87.2%). Regarding medication adherence, over half adhered to the prescribed regimen (52.1%). Results demonstrated an improvement in hallucination symptoms for adolescents and the elderly compared to adults. While gender and adherence status did not individually influence symptoms significantly, age category emerged as a significant contributing factor (F = 3.991, p = 0.021). Interaction effects emphasized the substantial influence of time on symptom shifts over the intervention (F = 24.164, p < 0.001). Particularly, the mean difference of 4.636 (p < 0.001) from Time 1 to Time 5 signified a substantial decrease in hallucination scores, highlighting the cumulative impact of the therapy. These findings underscore the effectiveness of Therapy administered by Mental Health Nurses (TKN) across diverse demographic factors, providing valuable insights for tailored interventions in psychiatric emergencies.

CONCLUSION

Therapy administered by Mental Health Nurses (TKN) demonstrates effectiveness in reducing schizophrenia symptoms, especially among adolescents and the elderly. The impact of time on the intervention's effectiveness is notable, with a cumulative effect observed over the intervention period. Sustained and consistent engagement with the therapy leads to more substantial improvements in hallucination symptoms. Therefore, tailored interventions considering age are crucial for optimal effectiveness. This understanding enables practitioners to optimize the therapy schedule, aligning it with the natural progression of symptom alleviation.

Human ; Hallucinations ; Therapeutics ; Therapy ; Mental Health ; Nurses

A singular medical incident can alert health officials to an emerging, if not widespread, but possibly undetected publichealth concern.

Our issue contains a remarkable case of a ruptured hepatic abscess in a 3-year-old, which turned out to be MethicillinresistantStaphylococcus aureus (MRSA) by authors Torrico and Tarnate.The concern is that the infection is communityacquired,and the patient was immunocompetent. This sounds the alarm for the occurrence of antimicrobial resistance (AMR)in the communities and calls for a response from health authorities to investigate, analyze, and propose solutions for sucha sentinel event.

We need to support these efforts and, in this issue, we publish such work from our investigators. Antimicrobial resistanceis an urgent global health concern.The impact is magnified in low to middle-income countries where health risks are high,and health infrastructure is weak. Thus, it is imperative that determinants of AMR are scrutinized to allow crafting offocused strategies to combat the problem.

The article by Dela Cruz and Hernandez on the prevalence and practices of antibiotic misuse among adult residents ofRodriguez, Rizal, contributes to this analysis.The paper reveals a disturbing prevalence of self-medication and identifiesbarriers to accessing proper health education and care. This is a global problem, and the paper from Brazil relates the observationof community pharmacists of antibiotic misuse to the rise of antimicrobial resistance.

Dela Cruz and Hernandez recommend stricter antibiotic regulation, and this falls squarely into the scope of concernof another article in this issue, the “Research Needs in Philippine Pharmaceutical Sciences: A Qualitative Perspective fromRegulatory and Clinical Research Sectors of the Pharmaceutical Industry” by Pena and co-authors.Interestingly, whiledrug registration and clinical trials were the focus of the paper, it may be a desired expansion of the regulatory reach of theindustry to temper the use of antibiotics as it is being dispensed to end users.Antimicrobial stewardship involves ethicalpromotion of use and equitable access to appropriate treatment, and these concerns require the responsible participation of thepharmaceutical industry.

Health challenges are complex. The analysis of these challenges requires surveillance of literature for sentinel events, useof community-based research to investigate phenomena, and system mapping to identify relevant sectors to improve strategyand to involve relevant stakeholders.

We support this type of scholarship, which seeks to expand the focus from isolated clinical interventions towards placinga spotlight on relevant work that will lead to impactful reform of broad health ecosystems.

Human ; Child Preschool: 2-5 Yrs Old ; Therapeutics ; Staphylococcus Aureus ; Pharmaceutical Preparations ; Research Personnel ; Health Services Needs And Demand ; Methicillin-resistant Staphylococcus Aureus ; Antimicrobial Stewardship

Methicillin-resistantStaphylococcus aureus(MRSA) is an uncommon etiologic agent of hepatic abscess in children, particularly those without an underlying immunocompromised condition.

We describe a rare case of community-acquired MRSA (CA-MRSA) hepatic abscess with rupture into the anterior abdominal wall in an otherwise healthy 3-year-old Filipino male, manifesting as a one-week history of an enlarging epigastric mass accompanied by abdominal pain and fever. He was treated noninvasively with ciprofloxacin (intravenous at 10 mg/kg every 12 hours for 14 days followed by oral at 15 mg/kg every 12 hours for 28 days), and clindamycin (intravenous at 10 mg/kg every 6 hours for 14 days followed by oral at 10 mg/kg every 6 hours for 28 days), resulting in the resolution of the hepatic abscess and its associated symptoms.

CA-MRSA hepatic abscess is extremely rare in immunocompetent children, and an appropriate diagnostic approach involving imaging and culture studies is crucial in its diagnosis and management.

Human ; Child Preschool: 2-5 Yrs Old ; Therapeutics ; Staphylococcus Aureus ; Staphylococcus ; Residence Characteristics ; Research Report ; Dihydrotachysterol