Anticoagulation therapy remains the cornerstone of treatment for cerebral venous sinus thrombosis (CVST). Endovascular therapy may be considered in selected patients with clinical deterioration despite optimal medical treatment. However, conventional mechanical thrombectomy using aspiration and/or stent-retrievers might be inadequate in extensive CVST because of large and organized thrombi and non-availability of venous thrombectomy devices. We present a technical modification using an angioplasty non-compliant (NC) balloon as an adjunct to suction thrombectomy for venous sinus mechanical thrombectomy in a case of extensive CVST. Conventional methods of thrombectomy failed to recanalize the sinuses; hence, an angioplasty NC balloon was used to decimate the clot with simultaneous suction thrombectomy to achieve near-complete recanalization of the affected sinuses with good clinical outcome. We name this the “pipeline-pigging” technique. The pipeline-pigging method of using a normal angioplasty NC balloon for venous sinus mechanical thrombectomy may serve as an effective and economical technical adjunct for extensive CVST refractory to conventional methods. This approach facilitates thrombus fragmentation, aspiration and improved delivery of thrombolytics and may expand the endovascular armamentarium for extensive CVST.

Cystinosis is a rare autosomal recessive lysosomal storage disorder with an incidence of approximately 1 in 100,000 to 200,000 live births. It is the most common cause of inherited pediatric Fanconi syndrome (FS). Here, we describe the cases of two infants from unrelated families who presented with polyuria and features of proximal renal tubular dysfunction. Although no corneal cystine deposition was observed at presentation, clinical suspicion and genetic analysis confirmed the diagnosis of nephropathic cystinosis. Both patients carried the same pathogenic variant in the CTNS gene, suggesting that it is a hotspot in this region. These patients were managed with oral cysteamine therapy, cysteamine eye drops, and supportive therapy for FS and are currently doing well. Genetic diagnosis plays a crucial role in the early detection of cystinosis, facilitating timely initiation of cysteamine therapy, and should be considered in infants with FS.

OBJECTIVE

To perform a cost comparison of the 5-year total direct medical costs of iStent inject® W vs. trabeculectomy vs. glaucoma medications for the treatment of primary open-angle glaucoma, with and without phacoemulsification, from the perspective of Filipino patients.

This cost-comparative analysis compared total private sector costs of surgery, post-operative care, and medication usage over 5 years on combined phacoemulsification (combined) or standalone (SA) procedures using iStent inject W, trabeculectomy, and glaucoma medications for the general population and senior citizens/individuals with disabilities. Data, including unit costs and frequencies, were obtained from published literature and local primary research. Scenario analysis consisted of three payment models: 100% out-of-pocket (OOP), coverage from PhilHealth public health insurance, and combined subsidies from both private and PhilHealth insurance.

iStent inject W was less costly than glaucoma medications in all scenarios and patient populations. When compared with trabeculectomy, iStent inject W, was less costly in all patient populations in the OOP scenario, providing savings of 5% for SA procedures and 5% to 6% for combined procedures. It was also less costly as a combined procedure in all populations in the combined private health and PhilHealth insurance scenario, offering 6% savings in the general population and 9% in elderly and disabled patients. However, it was costlier by 1% in the PhilHealth scenario. As an SA procedure, it was costlier vs. trabeculectomy in both populations in the PhilHealth and PhilHealth plus private health insurance scenarios by 18% to 22% and 101% to 109%, respectively. The highest incremental cost for iStent inject W was US$1,662 vs. trabeculectomy as an SA procedure in the general population under the combined private health and PhilHealth insurance scenario.

For Filipino glaucoma patients who are treated in the private sector, iStent inject W, whether combined or as an SA procedure, may be cost-saving compared with glaucoma medications over a 5-year period; however, it may be costlier compared with trabeculectomy depending on health insurance coverage scenarios.

Introduction: Clonidine is frequently utilized as a stimulus of growth hormone secretion to diagnose growth hormone deficiency in children. This clinical audit evaluates the efficacy and safety profile of clonidine as a sensitive, first-line screening agent to exclude GHD in children. Methodology: A clinical audit was conducted on seven patients (4 females, 3 males) aged 7.1 to 12.3 years (median age 11.1) evaluated with clonidine stimulation test. The cohort included one prepubertal and six post-pubertal (highest tanner 2) children. Bone age was delayed at BA/CA ratio at 0.63–0.9 (median 0.8). Baseline IGF-1 levels ranged from 56 to 264 ng/mL. None of the children received sex steroid priming. A peak GH threshold of >10 ng/mL was utilized to exclude GHD. Safety profiles, specifically hemodynamic stability and level of consciousness, were actively monitored. Results: Clonidine effectively stimulated GH secretion and excluded GHD in six out of seven patients, yielding peak GH levels between 10.3 and 20.6 ng/mL. One patient with peak GH of 7.6 ng/mL with clonidine, and subsequent test with insulin tolerance test (ITT), confirmed GHD with a peak GH of 7.4 ng/mL. All participants (n = 7) experienced drowsiness. Hemodynamic adverse events were notable. Three patients experienced mild hypotension, and three patients developed clinically significant hypotension requiring normal saline fluid bolus. Conclusion Clonidine is a highly effective, sensitive first-line screening agent to exclude GHD, as it reliably stimulates GH peaks above diagnostic thresholds. However, close supervision is required due to drowsiness and the potential for severe hypotension requiring fluid resuscitation. Clinical judgment remains essential as secondary testing with another GH secretagogue is warranted when clinical suspicion persists.
Child ; Clonidine ; Clinical Audit ; Growth Hormone

Background: Nitric oxide (NO) is a biological messenger molecule that plays a significant role in the pathogenesis of inflammation. It has anti-inflammatory effects under physiological conditions but can act as a pro-inflammatory mediator when produced excessively under abnormal conditions. NO is involved in the pathogenesis of inflammatory diseases affecting the joints, intestines, and lungs. Therefore, compounds that inhibit NO production are considered important for the treatment of inflammatory diseases and are used clinically. The RAW 264.7 mouse macrophage-like cell line is a widely used model for inflammation studies. Lipopolysaccharide (LPS), a component of the outer membrane of Gram-negative bacteria, is used to activate RAW 264.7 cells and create an inflammation model. Glycyrrhiza uralensis, also known as licorice, is a perennial herbaceous plant in the Fabaceae family. It has been widely used in traditional medicine due to its anti-inflammatory, antiviral, and hepatoprotective properties. Recent studies have shown that licorice contains bioactive compounds such as glycyrrhizin, liquiritigenin, and isoliquiritigenin, which play an important role in inhibiting the synthesis of pro-inflammatory cytokines in macrophages induced by LPS. Inula helenium L., also known as elecampane, is a perennial herbaceous plant used as an expectorant, anti-infective, anti-inflammatory, and anti-helminthic agent in various respiratory diseases. Licorice and Inula helenium are included in Mongolian traditional medicine prescriptions, but their anti-inflammatory effects have not been fully determined, which forms the basis for this research. Aim: To study the effect of Glycyrrhiza uralensis and Inula helenium extracts on the production of NO, the end product of inflammation, in RAW 264.7 macrophage cell lines stimulated with lipopolysaccharide. Materials and Methods: The non-toxic dose of the plant extracts was determined in RAW 264.7 mouse macrophage-like cell line cultures using the MTT assay. Nitric oxide production in RAW 264.7 cell line cultures stimulated with lipopolysaccharide was assessed using the Griess method. Statistical analysis of the results was performed using SPSS 25.0 software, with the p-value calculated by one-way ANOVA, and the differences between groups were evaluated. Results: In RAW 264.7 cell cultures, Glycyrrhiza uralensis and Inula helenium extracts were non-toxic and promoted cell growth at doses ranging from 1 to 25 μg/ml, while a dose of 50 μg/ml was toxic and inhibited cell growth (p<0.01). When the combined plant extracts were applied to cells at doses ranging from 1 to 100 μg/ml, they were also non-toxic and enhanced cell growth, while a dose of 500 μg/ml was toxic and inhibited growth (p<0.001). In terms of nitric oxide production, Glycyrrhiza uralensis extract increased NO production in a dose- and time-dependent manner compared to the control or PBS-treated group. However, Inula helenium extract did not show a dose- or time-dependent effect on NO production. In the lipopolysaccharide-induced inflammation model, licorice extract inhibited NO production at a dose of 30 μg/ml after 12 hours, and further reduced NO production in a dose- and time-dependent manner after 48 hours. Conversely, no significant changes were observed in the Inula helenium extract group at a dose of 25 μg/ml after 48 hours, but a reduction in LPS-induced NO production was observed at a dose of 25 μg/ml after 48 hours. Conclusion Glycyrrhiza uralensis extract alone increased NO production in a dose- and time-dependent manner. It also reduced LPS-induced NO production in a dose- and time-dependent manner. In contrast, Inula helenium extract inhibited LPS-induced NO production at a dose of 25 μg/ml after 48 hours.

: The increasing prevalence of noncommunicable diseases (NCDs), driven by factors such as population growth, urbanization, and economic development, presents significant individuals, families, challenges and to healthcare systems. These diseases are often linked to lifestyle choices, poor diet, and physical inactivity. As a result, there is growing interest in finding alternatives to synthetic drugs, particularly those derived from medicinal plants. Medicinal plants are known to contain bioactive compounds that offer therapeutic properties with fewer side effects compared to conventional pharmaceuticals. This study explores the cytoprotective effects of Glycyrrhiza uralensis (licorice) and Inula helenium (elecampane) extracts against oxidative stress induced by hydrogen peroxide (H₂O₂) in RAW 264.7 macrophage-like cells.
The study found that both plant extracts were non-toxic at doses ranging from 1 to 25 µg/mL and promoted cell growth (p<0.01). The results suggest that these extracts support cell survival and exhibit biological activity.
To assess the antioxidant effects, various concentrations of H₂O₂ (10–400 µM) were tested, and 200 µM was found to significantly reduce cell viability. Licorice and elecampane extracts (10 µg/mL and 25 µg/ mL, respectively) enhanced cell viability and reduced oxidative damage. Both extracts significantly reduced cell death compared to the H₂O₂-only group (p<0.01), highlighting their potent antioxidant properties. Conclusion Glycyrrhiza uralensis and Inula helenium extracts demonstrated strong cytoprotective and antioxidant effects, supporting their potential as natural therapeutics for oxidative stress-related conditions.

Purpose: This study employed a convolutional neural network (CNN) algorithm to develop an automated dental age estimation method based on the London Atlas of Tooth Development and Eruption. The primary objectives were to create and validate CNN models trained on panoramic radiographs to achieve accurate dental age predictions using a standardized approach. Materials and Methods: A dataset of 801 panoramic radiographs from outpatients aged 5 to 15 years was used. A CNN model for dental age estimation was developed using a 16-layer CNN architecture implemented in Python with TensorFlow and Scikit-learn, guided by the London Atlas of Tooth Development. The model included 6 convolutional layers for feature extraction, each followed by a pooling layer to reduce the spatial dimensions of the feature maps. A confusion matrix was used to evaluate key performance metrics, including accuracy, precision, recall, and F1 score. Results: The proposed model achieved an overall accuracy, precision, recall, and F1 score of 74% on the validation set. The highest F1 scores were observed in the 10-year and 12-year age groups, indicating superior performancein these categories. In contrast, the 6-year age group demonstrated the highest misclassification rate, highlightingpotential challenges in accurately estimating age in younger individuals. Conclusion: Integrating a CNN algorithm for dental age estimation represents a significant advancement in forensic odontology. The application of AI improves both the precision and efficiency of age estimation processes, providing results that are more reliable and objective than those obtained via traditional methods.

Background/Aims: Amitriptyline is prescribed off-label for irritable bowel syndrome (IBS). We conducted a meta-analysis to assess its efficacy. Methods: A systematic literature review was conducted until November 10, 2023, using MEDLINE, Embase, Cochrane Library, and Web of Science to study the efficacy of amitriptyline in patients with IBS. We included all randomized controlled trials that compared amitriptyline to placebo. Revised Cochrane risk-of-bias tool was used to assess the quality of studies. Meta-analyses were performed using a bivariate random-effects model. Statistical analyses were performed using R Software 4.2.3 and heterogeneity was assessed with I 2 statistics. Results: Seven trials were included with 796 patients (61% female). Amitriptyline was associated with better treatment response (OR, 5.30; 95% CI, 2.47 to 11.39; P < 0.001), reduced Irritable Bowel Syndrome Symptom Severity Scores (MD, –50.72; 95% CI, –94.23 to –7.20; P = 0.020) and improved diarrhea (OR, 10.55; 95% CI, 2.90 to 38.41; P < 0.001). No significant difference between the 2 groups regarding the adverse effects was observed. Three trials showed an overall low risk of bias, 2 trials showed an overall high risk of bias due to randomization and missing data, and 2 trials had some concerns regarding missing data. Conclusions Amitriptyline was found to be well-tolerated and effective in treating IBS compared to placebo. These findings support the use of amitriptyline for the management of IBS, particularly among patients with the IBS diarrhea subtype. Future research should focus on the dose-dependent effects of amitriptyline in IBS to better guide clinicians in personalized titration regimens.

Paragangliomas are rare neuroendocrine tumors that frequently arise in the organ of Zuckerkandl (OZ). Surgical resection remains the cornerstone of treatment. Although vascular resection and reconstruction have been reported in a few cases, no prior reports have documented the simultaneous resection of both the aorta and inferior vena cava (IVC), along with their bifurcation. We present the case of a 50-year-old man with a large paraganglioma of the OZ, successfully managed through combined resection of the aorta, IVC, their bifurcation, and the psoas muscle. Dacron Y-grafts were used to reconstruct both the aorta and IVC. This case underscores the importance of detailed anatomical knowledge of major vessels, meticulous vascular control, and the technical intricacies of vascular reconstruction. We emphasize the significance of comprehensive perioperative management and provide a literature review on en bloc vascular resection for paraganglioma, offering insights into current surgical practices and outcomes.

Paragangliomas are rare neuroendocrine tumors that frequently arise in the organ of Zuckerkandl (OZ). Surgical resection remains the cornerstone of treatment. Although vascular resection and reconstruction have been reported in a few cases, no prior reports have documented the simultaneous resection of both the aorta and inferior vena cava (IVC), along with their bifurcation. We present the case of a 50-year-old man with a large paraganglioma of the OZ, successfully managed through combined resection of the aorta, IVC, their bifurcation, and the psoas muscle. Dacron Y-grafts were used to reconstruct both the aorta and IVC. This case underscores the importance of detailed anatomical knowledge of major vessels, meticulous vascular control, and the technical intricacies of vascular reconstruction. We emphasize the significance of comprehensive perioperative management and provide a literature review on en bloc vascular resection for paraganglioma, offering insights into current surgical practices and outcomes.