BACKGROUND

Drug use and abuse is a public health issue that has come into focus in the Philippines in the past years. Excluding the years of the COVID-19 pandemic, there has been a yearly increase in the number of admissions to treatment and rehabilitation centers. The census in the University of the Philippines-Philippine General Hospital (UP-PGH) National Poison Management and Control Center (NPMCC) shows a parallel increase in drug-positive patients consulting in the emergency room (ER).

OBJECTIVE

The objective of this study was to describe the demographic, clinical, and drug use profiles of substance users admitted to the UP-PGH and referred to the NPMCC for drug testing.

METHODS

This is a cross-sectional study where participants included patients aged 10 years and above who were referred to the NPMCC for drug testing within three days of the ER consult. Once consent or assent from children was obtained, patients were interviewed and examined. Urine samples were collected for drug screening using drugs of abuse screening test kits. A split sample was sent to the UP Drugs of Abuse Research Laboratory (UP DARL) for analysis using the liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF/MS). The data was encoded in the REDcap platform. The results were analyzed and summarized using descriptive statistics.

RESULTS

Three hundred eighty-four (384) individuals participated in the study and submitted urine samples for testing from 1 January 2019 to 28 February 2020. One hundred thirty-four (134) samples were positive for substances of abuse detected by drug screening test kits for methamphetamine (MAP), delta-9-tetrahydrocannabinol (THC), cocaine, 3,4-methylenedioxymethamphetamine (MDMA), benzodiazepines, and opioids, and by LC-QTOF/ MS analysis. Majority of the patients were males with an average age of 34.54 ± 1.16 years old. Many complained of neurobehavioral changes necessitating consultation at the hospital emergency room. The neurologic and cardiovascular systems were frequently affected. By using the drugs of abuse test kit, methamphetamine was the most common substance of abuse detected and was seen in 40.3% of the samples. Amphetamine type stimulants were the most common group of drugs identified by LC-QTOF/ MS analysis and was seen in 103 instances. New psychoactive substances detected more frequently than others include paramethoxymethamphetamine (PMMA), 3,4- methylenedioxy methamphetamine (MDMA) and 3,4- methylenedioxyamphetamine (MDA). A few cathinones like butylone and cathinone were also detected.

CONCLUSION

Methamphetamine was the most common substance of abuse detected in urine samples of the participants. New psychoactive substances were also detected in urine samples when LC-QTOF/MS analysis was utilized. Most persons who use drugs are unemployed young- to mid-adult males. The participants often had neurobehavioral and cardiovascular signs and symptoms.

Human ; Methamphetamine

A 24-year-old Filipino male was diagnosed with hemolytic anemia when he presented with abrupt onset of anemia, hemoglobinuria, and increased bilirubins, after intentionally ingesting mothballs containing paradichlorobenzene. He was transfused with six units of packed red blood cells (PRBC) and was discharged improved. Paradichlorobenzene, a known oxidant, causes denaturation and precipitation of hemoglobin. These precipitates form Heins bodies within the erythrocytes that are removed by the reticuloendothelial system, fragmenting cells to produce hemoytic anemia from paradicholorobenzene ingestion as confirmed by the UP-National Poison Management and Control Center.

Human ; Male ; Adult ; Hemoglobinuria ; 4-dichlorobenzene ; Anemia, Hemolytic ; Chlorobenzenes ; Erythrocytes ; Hemoglobins ; Poisons ; Oxidants ; Mononuclear Phagocyte System ; Bilirubin

BACKGROUND: The monofilament test is a simple and inexpensive tool used for the detection of diabetic peripheral neuropathy in the community setting but it is unclear whether its use can be extended to patients with neuropathy that is not due to diabetes.

OBJECTIVE: We aimed to determine the sensitivity and specificity of the monofilament test in detecting peripheral neuropathy, diabetic or non-diabetic, using Nerve Conduction Studies (NCS) as the gold standard.

METHODS: In a health assessment activity in Marinduque, patients were assessed by a neurologist as to whether or not they have neuropathy. Monofilament testing was done using the NHANES protocol with a 10-g Semmes Weinstein monofilament. Nerve Conduction Study was used as the gold standard.

RESULTS: Fourteen patients were included in the study. A positive monofilament test was found to be significantly associated with a positive NCS result (p<0.015). The sensitivity of the monofilament test was 57.1%; the specificity was 100%. Positive predictive value was 1, negative predictive value was 0.7, pre-test probability was 83% and post-test probability was 96%.

CONCLUSION: Monofilament testing was found to be useful in detecting peripheral neuropathy in the community setting. If monofilament testing is positive, then peripheral neuropathy is ruled in. If the test is negative but the clinical suspicion is high, then NCS may be warranted. This cuts back the need for NCS to detect neuropathy in the community setting by more than half.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Nutrition Surveys ; Neurologists ; Diabetic Neuropathies ; Sensitivity And Specificity ; Probability ; Neural Conduction

OBJECTIVES: Systemic lupus erythematosus (SLE) is an autoimmune disease of multisystemic involvement. The cardiac and cerebrovascular systems are one of the more commonly involved systems, owing to advanced atherosclerosis in SLE. Risk factors for the development of vascular events in SLE were analyzed in this study. 

METHODS: This is a retrospective case-control analysis of SLE patients admitted in a tertiary hospital in the year 2008. Data were subjected to logistic regression analysis using SPSS v.16.

RESULTS:  Seventy-six charts were retrieved and reviewed. The composite vascular event rate in this cohort was 7.6%. Disease duration and thrombocytopenia were associated with increased risk of vascular events. None of the other traditional risk factors were found to correlate with vascular events in this cohort analysis. Statins showed a trend towards protection against vascular events, however, this was not statistically significant.

CONCLUSION: SLE patients with longer disease duration and have thrombocytopenia are at risk of developing vascular events. Lupus patients may be considered a high-risk group for atherosclerosis and may benefit from statin therapy. traditional risk factors, however, cannot fully account for advanced atherosclerosis seen in SLE patients. Various inflammatory and immunologic factors play a role and warrant further investigation.

Human ; Humans ; Retrospective Studies ; Risk Factors ; Hydroxymethylglutaryl-coa Reductase Inhibitors ; Tertiary Care Centers ; Logistic Models ; Case-control Studies ; Lupus Erythematosus, Systemic ; Lupus Erythematosus, Discoid ; Atherosclerosis ; Immunologic Factors ; Thrombocytopenia

BACKGROUND AND PURPOSE: The purpose of this report is to increase awareness on the possible long-term effects cyanide poisoning by intentional silver jewelry cleaning agent.

CASE: We report a case of a 24 year old male who developed parkinsonism after surviving acute cyanide intoxication by intentional ingestion of a now-illegal cyanide-based silver jewelry cleaner. MRI showed multiple high signal intensities in the basal ganglia, substantia nigra, and cerebral cortex consistent with the clinical and radiological findings reported rarely in literature.

DISCUSSIONS: As cyanide causes neurotoxicity by impairing oxygen utilization, this adds evidence for the affinity of cyanide for structures with high oxygen requirement. Current theories on the pathomechanism of cyanide-induced neurotoxicity are reviewed.

 

Human ; Male ; Adult (a Person 19-44 Years Of Age) ; Male ; Silver ; Oxygen ; Jewelry ; Basal Ganglia ; Substantia Nigra ; Parkinsonian Disorders ; Cerebral Cortex ; Magnetic Resonance Imaging ; Cyanides ; Poisoning

OBJECTIVES

Bickerstaff brainstem encephalitis (BBE) is an uncommon disease characterized by the occurrence of ataxia, ophthalmoplegia, sensorial disturbance, and pyramidal tract signs such as hyperreflexia and toe extensor response. In Asia, preponderance of cases has been reported in Japan. It has not been previously reported in the Philippines. This will describe the clinical symptoms, laboratory features and diagnostic criteria and treatment of this rare disease.

CASE REPORT

A 31- year old Vietnamese-American from Makati City presented with a 3-week history of diarrhea and flu-like symptoms followed by dizziness, gait instability, diplopia, generalized weakness and rapidly progressive sensorial deterioration. Neurologic findings included ataxia, bilateral external ophthalmoplegia, ocular bobbing, hyperreflexia, bilateral toe extensor response and altered sensorium. Cranial MRI, Complete CSF Analysis, EMG-NCV and RNS were unremarkable. Brainstem auditory evoked potential indicated failed conduction between the lower and upper pons. Blink reflex study indicated failed conduction along the medullary interneuronal pathway. Plasmapheresis and intravenous corticosteroid therapy were instituted. Patient's condition improved from a comatose state and was discharged ambulatory with minimal residual neurologic deficits after 38 days of hospitalization. Serum Anti-ganglioside antibody assay were positive for GM1b lgG and GQ 1DG.

CONCLUSION

The clinical characteristics, laboratory features and course of this patient were consistent with Bickerstaff's Brainstem Encephalitis.

Human ; Male ; Adult: 25-44 Yrs Old ; Encephalitis ; ; Antibodies ; ; Amino Acids, Peptides, And Proteins ; ; Blood Proteins ; ; Immunoproteins ; ; Immunoglobulins ; ; Diarrhea ; ; Adrenal Cortex Hormones ; ; Pyramidal Tracts ; ; Ophthalmoplegia ; ; Ataxia ; ; Plasmapheresis

OBJECTIVES

Bickerstaff brainstem encephalitis (BBE) is an uncommon disease characterized by the occurrence of ataxia, ophthalmoplegia, sensorial disturbance, and pyramidal tract signs such as hyperreflexia and toe extensor response. In Asia, preponderance of cases has been reported in Japan. It has not been previously reported in the Philippines. This will describe the clinical symptoms, laboratory features and diagnostic criteria and treatment of this rare disease.

CASE REPORT

A 31- year old Vietnamese-American from Makati City presented with a 3-week history of diarrhea and flu-like symptoms followed by dizziness, gait instability, diplopia, generalized weakness and rapidly progressive sensorial deterioration. Neurologic findings included ataxia, bilateral external ophthalmoplegia, ocular bobbing, hyperreflexia, bilateral toe extensor response and altered sensorium. Cranial MRI, Complete CSF Analysis, EMG-NCV and RNS were unremarkable. Brainstem auditory evoked potential indicated failed conduction between the lower and upper pons. Blink reflex study indicated failed conduction along the medullary interneuronal pathway. Plasmapheresis and intravenous corticosteroid therapy were instituted. Patient's condition improved from a comatose state and was discharged ambulatory with minimal residual neurologic deficits after 38 days of hospitalization. Serum Anti-ganglioside antibody assay were positive for GM1b lgG and GQ 1DG.

CONCLUSION

The clinical characteristics, laboratory features and course of this patient were consistent with Bickerstaff's Brainstem Encephalitis.

Human ; Male ; Adult: 25-44 Yrs Old ; Encephalitis ; ; Antibodies ; ; Amino Acids, Peptides, And Proteins ; ; Blood Proteins ; ; Immunoproteins ; ; Immunoglobulins ; ; Diarrhea ; ; Adrenal Cortex Hormones ; ; Pyramidal Tracts ; ; Ophthalmoplegia ; ; Ataxia ; ; Plasmapheresis