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.

Ganoderma lucidum, a medicinal mushroom renowned for its production of a diverse array of compounds, accounts for the pharmacological effects including anti-inflammatory, antioxidant, immunomodulatory, and anticancer characteristics. Thus, it is recognized as a valuable species of interest in the pharmaceutical and nutraceutical industries due to its important medicinal properties. Recent advances in omics technologies such as genomes, transcriptomics, proteomics, and metabolomics have considerably increased our understanding of the bioactives in G. lucidum. This review explores the application of molecular breeding techniques to enhance both the yield and quality of G. lucidum across the food, pharmaceutical, and industrial sectors. The article discusses the current state of research on the use of contemporary omics technologies which studies and highlights future research directions that may increase the production of bioactive compounds for their therapeutic potential. Additionally, predictive methods with computational studies have recently emerged as effective tools for investigating bioactive constituents in G. lucidum, providing an organized and cost-effective strategy for understanding their bioactivity, interactions, and possible therapeutic uses. Omics and machine learning techniques can be applied to identify the candidates for pharmaceutical applications and to enhance the production of bioactive compounds in G. lucidum. The quantification and production of the bioactive compounds can be streamlined by the integrating computational study of bioactive compounds with non-destructive predictive machine learning models of the same. Synergistically, these techniques have the potential to be a promising approach for the future prediction of the bioactive constituents, without compromising the integrity of the fungal organism.

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.

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.

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.

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.

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.