Bullous hemorrhagic dermatosis (BHD) is a rare cutaneous manifestation characterized by tense hemorrhagic bullae that appear at sites distant from low molecular weight heparin (LMWH) injections, typically within seven days of exposure. As of March 2022, only 94 cases have been reported. It most commonly affects elderly males with predisposing factors for thromboembolism, such as carcinoma, and usually involves the extremities.

This case highlights the importance of maintaining a high index of suspicion for bullous hemorrhagic dermatosis (BHD) in patients receiving low molecular weight heparin, even beyond the typical 7-day window and in demographics not commonly affected. Early recognition and prompt discontinuation of the offending agent, as demonstrated in this atypical presentation involving a Filipino elderly woman with multiple comorbidities and no malignancy, can lead to favorable outcomes. Clinicians should be aware of this rare but reversible complication to avoid misdiagnosis and ensure appropriate management.

Human ; Female ; Aged: 65-79 Yrs Old ; Affect ; Aged ; Blister ; Carcinoma ; Causality ; Demography ; Diagnostic Errors ; Enoxaparin ; Extremities ; Heparin ; Heparin, Low-molecular-weight ; Index ; Injections ; Lead ; Male ; Molecular Weight ; Neoplasms ; Patients ; Research Report ; Skin Diseases ; Thromboembolism ; Women

Knee pain is a common clinical complaint with a broad differential diagnosis. In critically ill patients, acute monoarticular pain and swelling typically raise concern for septic arthritis. However, alternative etiologies such as crystal-induced arthritis, trauma, and hemarthrosis must also be considered.

This report presents a rare case of spontaneous hemarthrosis in a patient receiving prophylactic enoxaparin. Although uncommon, spontaneous hemarthrosis is a significant complication of anticoagulation therapy, particularly with low molecular weight heparins (LMWH) like enoxaparin.

Human ; Male ; Aged: 65-79 Yrs Old ; Hemarthrosis ; Covid-19 ; Enoxaparin

OBJECTIVES

A growing body of evidence points to a positive association between periodontitis and
various systemic diseases, including cardiovascular diseases (CVD), hypertension, and rheumatoid arthritis. However,
there is limited data on the prevalence and odds of having systemic conditions among Filipino periodontal patients.
Thus, this study aimed to determine the association of periodontal disease with systemic conditions among Filipino
patients at a university dental clinic.

METHODS

The periodontal and medical charts of all patients who underwent periodontal consult at a university
dental clinic within two academic years were reviewed. Periodontal diagnoses which had originally been assigned
using the 1999 classification of periodontal diseases were reclassified based on the 2018 European Federation
of Periodontology-American Academy of Periodontology classification. Listed medical conditions in the patients’
charts were self-reported. The prevalence of various systemic conditions in 715 periodontitis cases was compared
to that of 834 control patients without periodontitis. Fisher’s exact test was performed to evaluate the difference
in the prevalence of comorbidities between groups, while adjusted odds ratios (AOR) were computed using logistic
regression analysis, accounting for age, sex, educational attainment, and smoking status.

RESULTS

The prevalence of having at least one systemic condition was significantly higher among periodontitis patients
(44.5%) compared to non-periodontitis patients (36.3%). Compared to controls, a significantly higher number of
periodontitis cases had two systemic comorbidities (P=0.001). The prevalence of hypertension (18.6% versus 5.04%),
CVD including hypertension (20.42% versus 6.95%), arthritis (9.37% versus 3.0%), and diabetes mellitus (5.73% versus
0.84%) were all significantly higher in patients with periodontitis compared to non-periodontitis controls.
The odds of having CVD (AOR=1.81), hypertension (AOR=2.14) and diabetes (AOR=3.05) were higher in periodontitis cases. Meanwhile, the prevalence of asthma (9.23% versus 5.31%), respiratory diseases including asthma (12.95% versus 8.25%), and allergies (18.82% versus 13.71%) were significantly higher in non- periodontitis patients compared to periodontitis cases.

CONCLUSION

Periodontitis patients were more likely to present with CVD, hypertension, and diabetes mellitus. On the other hand, no association was found between periodontitis and respiratory diseases, as well as between periodontitis and asthma.

Human ; Male ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Regression (psychology) ; Respiratory Tract Diseases ; Regression Analysis ; Periodontal Diseases ; Cardiovascular Diseases

This study aims to determine the prevalence of erectile dysfunction (ED) and identify its associated risk factors among young and middle-aged Filipino male patients diagnosed with diabetes mellitus. This study utilized a cross-sectional design to investigate the prevalence and associated factors of ED among male patients with diabetes. A total of 423 participants were recruited from clinical settings using purposive sampling. Data were collected using structured interviews and medical records, including demographics, comorbidities and laboratory results. Among 423 male diabetic patients, 78% were found to have ED. Patients with ED were significantly older (median: 49.5 versus 42 years, p<0.001), had higher body mass index (BMI), longer diabetes duration and more comorbidities. Univariable logistic regression showed that age (OR: 1.06, p<0.001), diabetes duration (OR: 1.11, p<0.001), hypertension (OR: 1.62, p = 0.042), dyslipidemia (OR: 1.75, p = 0.022), elevated HbA1c (>9.0%; OR: 3.43, p = 0.034) and serum creatinine (OR: 1.01, p = 0.008) were significantly associated with ED. However, none remained significant in the multivariable model. Male Filipino patients with diabetes have a significant burden of ED. Results of the univariable models show that age, duration of diabetes, hypertension, dyslipidemia, HbA1c and serum creatinine are significant individual predictors of ED.

Human ; Male ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Tertiary Care Centers ; Risk Factors ; Risk ; Medical Records ; Erectile Dysfunction ; Diabetes Mellitus ; Philippines

INTRODUCTION

Hypertension is a serious public health issue that puts individuals at risk for various morbidity and mortality indicators. One of the most crucial factors in managing blood pressure and preventing complications is medication adherence which is linked to several determinants. This study explored the correlation between medication adherence among middle-aged hypertensive adults and the different domains of quality of life (QOL), which includes physical, psychological, social relationship and environment.

METHODS

This cross-sectional study involved 96 Filipino residents of Brgy. San Jose, Navotas City aged 35 to 65 years old diagnosed with hypertension and prescribed anti-hypertensive medications. Pearson’s correlation coefficient was used to calculate the correlation between different domains of QOL as well as the overall QOL score.

RESULTS

Results revealed a statistically significant but weak positive correlation between overall QOL and medication adherence (r = 0.336, p<0.001). Among the QOL domains, environmental domain had the strongest correlation with adherence (r = 0.446, p = 0.00), followed by physical health (r = 0.443, p = 0.01) and psychological well-being (r = 0.382, p = 0.01). The social relationship domain showed negligible correlation (r = 0.163, p = 0.4).

CONCLUSION

The study demonstrates that while medication adherence is modestly associated with better perceived QOL, especially in physical, psychological and environmental aspects, other factors likely influence both outcomes. These findings highlight the need for holistic, community-based interventions that address not only medication adherence but also environmental and psychosocial barriers to care in managing hypertension.

Human ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Quality Of Life ; Public Health ; Medication Adherence ; Antihypertensive Agents ; Blood Pressure ; Interpersonal Relations

Valacyclovir-associated neurotoxicity (VAN) is a recognized adverse effect in elderly patients with renal impairment but remains underdiagnosed due to its nonspecific presentation and overlap with acute neurologic emergencies. We report a 78-year-old Filipino female with end-stage renal disease on maintenance hemodialysis who developed acute disorientation, agitation, vivid visual hallucinations and generalized weakness shortly after initiation of valacyclovir for herpes zoster. Given the abrupt onset of neuropsychiatric symptoms, viral encephalitis was initially considered. Magnetic resonance imaging of the brain showed no evidence of acute infarction or encephalitis, while electroencephalography demonstrated diffuse generalized slowing consistent with an encephalopathic process. Review of the medication history revealed valacyclovir dosing that exceeded recommendations for patients with end-stage renal disease. Valacyclovir was discontinued and emergent hemodialysis was initiated resulting in marked improvement in sensorium after the second session and complete resolution of symptoms after the third. This case shows VAN as an important diagnostic mimic of acute encephalopathy in elderly patients with renal failure and emphasizes the critical role of early medication review in preventing unnecessary investigations and enabling prompt, reversible management.

Human ; Female ; Aged: 65-79 Yrs Old ; Magnetic Resonance Imaging ; Kidney Failure, Chronic ; Magnetic Resonance Spectroscopy ; Electroencephalography ; Medication Review ; World Health Organization

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

Myiasis is a parasitic infestation of humans caused by dipteran flies' larvae, which feed on the host's tissue. It affects various body parts, including the skin, eyes, ears, nose, mouth, and gastrointestinal tract. Cutaneous myiasis is the most common clinical form, while wound myiasis is the main manifestation. Myiasis can be caused by various fly families, including blowflies, flesh flies, and botflies, with different types depending on the site and infestation type. A rare occurrence rarely reported in medical literature, Sarcophaga species infestation within a tracheostomy tube in a patient with laryngeal carcinoma, is presented in this case. Given that the airway is protected and has built-in barriers against external contamination, the presence of flesh flies (Sarcophaga spp.) at a tracheostomy site is extremely uncommon. By showing how weakened respiratory structures, along with particular environmental and patient factors, may make people more susceptible to this uncommon parasitic complication, this report adds to our understanding of the condition. Recognizing such atypical infestations is crucial for clinicians in early diagnosis, prevention, and effective management of similar cases.

CASE PRESENTATION

The study details a rare instance of Sarcophaga species myiasis in a tracheostomy tube in a patient who Had laryngeal carcinoma after radiation therapy. The 71-year-old farmer patient first complained of pruritus, localized warmth, and tightness in his neck. Prior tracheostomy excision and cobalt therapy were part of his medical history. After being treated for pneumonia, the patient experienced severe bleeding at the tracheostomy site, which led to additional testing. Many larvae were seen emerging from necrotic tissues during clinical examination, which raised the possibility of myiasis. Sarcophaga spp., a rare discovery in respiratory structures, were confirmed to be present by species identification. More than 100 larvae were removed during the emergency surgical procedure, which also involved replacing the compromised tracheostomy tube and cutting and draining necrotic areas. Following surgery, there were no more bleeding or reinfestation episodes, and the patient showed signs of stable recovery.

CONCLUSION

The parasitic infestation known as myiasis, which is brought on by dipteran fly larvae, is usually linked to exposed wounds and weakened tissue. Flesh flies, or Sarcophaga species, are drawn to recently opened, exudative wounds, which makes them more likely to infest susceptible people. Although myiasis commonly occurs in cutaneous wounds, ocular, and nasopharyngeal sites, it is extremely uncommon to occur in tracheostomy incisions, especially in tropical areas like the Philippines. The need for increased clinical awareness of this uncommon complication is highlighted by this case, which shows an unusual manifestation of Sarcophaga species myiasis within a tracheostomy tube of a patient who had laryngeal carcinoma following radiation therapy. Prioritizing preventive measures, such as thorough wound hygiene, efficient fly control techniques, and ongoing postoperative monitoring, is necessary due to the grave consequences of tracheostomy-associated myiasis. Parasitic infestations are more likely to occur in patients recuperating from head and neck surgery, especially those who have had extended wound exposure. Patient outcomes can be improved and morbidity can be considerably decreased by teaching family members and caregivers about wound surveillance, early detection, and prompt intervention. To reduce the chance of infestation, preventive measures like appropriate wound dressing, environmental sanitation, and fly management must be strengthened. In order to develop more focused preventive measures, more research is necessary to identify the endemic distribution of rare myiasis-causing species and to characterize them. Clinicians can establish more efficient management procedures by identifying particular environmental factors and patient vulnerabilities that contribute to atypical myiasis cases. The knowledge gathered from this report adds to the body of knowledge on tracheostomy-associated myiasis and is a useful
guide for early detection and treatment of similar cases.

Human ; Animals ; Male ; Female ; Aged: 65-79 Yrs Old ; Research Report ; Patients ; Carcinoma ; Sarcophagidae ; Tracheostomy

OBJECTIVES

This study aimed to evaluate the psychometric properties of the Tagalog version of the PsAQoL to assess its reliability and consistency.

METHODS

This is a prospective validation study involving 47 patients with PsA from June to August 2023. The
psychometric properties tested were internal consistency (Cronbach’s alpha coefficients), test-retest reliability, convergent validity (Spearman’s rank correlation), and known group validity (Mann-Whitney U Test or Kruskal- Wallis One-Way Analysis of Variance).

RESULTS

The PsAQoL on both week 0 and week 2 had Cronbach’s alpha coefficients of 0.926 indicating high
internal consistency. Test-retest reliability was 0.929, which demonstrates excellent reliability and low level of random measurement error. The PsAQoL scores highly correlated with the Health Assessment Questionnaire-Disability Index (r=0.754, pCONCLUSION

The Tagalog version of the PsAQoL demonstrates excellent psychometric properties and is recommended for monitoring of Tagalog-speaking patients with psoriatic arthritis in healthcare settings.

Human ; Male ; Female ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Analysis Of Variance ; Aptitude ; Health ; Index ; Patients ; Psychometrics ; Reproducibility Of Results ; Statistics, Nonparametric ; Validation Study

BACKGROUND

The global impact of the COVID-19 pandemic has instigated a profound public health crisis, particularly affecting professionals like dentists who, due to their close interaction with saliva—a potential viral reservoir—and the aerosols generated during specific procedures, face elevated risks of infection. To mitigate this, the Centers for Disease Control and Prevention (CDC) and the Philippine Dental Association (PDA) have established guidelines for averting cross-infection in dental settings.

OBJECTIVE

This study, conducted in an urbanized Metro Manila City, delves into the infection control practices of dentists amid the pandemic.

METHODS

Dentists from a Metro Manila city dental chapter were invited to participate in an online survey (Google Forms) consisting of participants' demographics, patient triage, engineering, administrative controls, disinfection personal hygiene, personal protective equipment (PPE), and waste management practices. Descriptive statistics, employing frequency distributions and percentages, summarized the dentists' adherence to infection control protocols.

RESULTS

Out of forty-nine respondents (49), the majority (92%) provided their teams' orientation on COVID-19 infection control protocols before reopening. Notably, 57% deferred elective procedures and 43% postponed aerosolgenerating procedures (AGPs). Only 39% utilized rubber dam isolation during AGPs. Most respondents reported full implementation of recommended administrative controls during the pandemic, with 92% isolating their treatment areas from other parts of the clinic. Most respondents adopted high-efficiency particulate air (HEPA) filtration units (82%) as one of their clinic’s engineering controls, and an extraoral vacuum machine, accounting for 71% of the respondents. The most common disinfection product used by the participants was alcohol, which was at 94%. Additionally, over 90% adhered to all recommended hand hygiene practices for both dental staff and patients. For the waste management protocols, only 55% of the respondents have their infectious waste collected by third-party Treatment Storage and Disposal (TSD) facilities.

CONCLUSION

The data shows that with the guidelines posted by both the PDA and CDC, the city’s dental practitioners could still provide services to the community in the safest manner at the time by being updated and following the infection control practices suggested by both organizations. Although some areas could have been improved, such as third-party waste management and the utilization of RT-PCR testing, some of these problems could have been attributed to the lack of availability in their areas.

Human ; Male ; Female ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; World Health Organization ; Residence Characteristics ; Quarantine ; Public Health ; Centers For Disease Control And Prevention (u.s.) ; Covid-19 ; Centers For Disease Control And Prevention, U.s.