Thoracolumbar junction pathologies can be treated through various anterior and posterior approaches. In recent decades, minimally invasive endoscopic procedures, including percutaneous endoscopic transforaminal discectomy (PETD), have emerged to reduce tissue disruption and iatrogenic instability. This surgical video describes the steps required to perform PETD and highlights the importance of optimal preoperative planning. A 47-year-old male patient with a T12–L1 disc herniation in the left paracentral and foraminal region, compressing the spinal cord, was treated with PETD. Under fluoroscopic guidance, precise skin markings were made, followed by sequential placement of the needle, guidewire, dilator, and working cannula using an inside-outside technique. The advantages and limitations of this approach were described. Successful removal of the herniated fragment and associated osteophyte was achieved using PETD. The patient’s pain decreased abruptly after surgery and fully resolved in the medium term. The patient ambulated independently 1 month after the procedure. PETD is a safe and efficient alternative for treating thoracolumbar junction pathologies in patients with disc herniation and/or myelopathy caused by neural compression. This fully endoscopic technique can achieve ventral decompression even under sedation.

Immunoglobulin G4 (IgG4)-related sclerosing cholangitis (IgG4-SC) is a rare condition with symptoms often mimicking malignancy, infection, or other autoimmune diseases. This case report describes the unique case of a 62-year-old male initially diagnosed with IgG4-SC, followed by subsequent diagnosis of cholangiocarcinoma. Biliary tract cancer in the setting of IgG4 related disease has been previously described; however, this patient course is novel as it encompasses the spectrum of challenges in IgG4-SC management, including diagnostic uncertainty, risk of infection with immunosuppressive agents, and development of malignancy diagnosed shortly following IgG4-SC diagnosis. We review the literature of management, outcomes, and malignancy risk and furthermore, highlight a promising recent therapy in treatment of IgG4 related disease, inebilizumab.

Background: Valganciclovir (ValG) is the most widely used drug for cytomegalovirus (CMV) prophylaxis in kidney transplant recipients (KTRs). However, it is associated with dose-limiting side effects and considerable costs. Some centers have identified valacyclovir (ValA) as an economically attractive alternative with a lower risk of bone marrow suppression. The comparative effectiveness of these two drugs is not well-established.This study aims to compare the efficacy and safety of ValA and ValG for CMV prophylaxis in KTRs. Methods: Searches were conducted of the Medline, Cochrane, Web of Science, Embase, and Ovid databases. Endpoints encompassed the incidence of CMV disease, CMV viremia, acute rejection, leukopeniaeutropenia, and other infections, including BK polyomavirus and non-CMV herpesviruses (HVs). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results: Six studies, comprising 888 patients (438 receiving ValA), were included. The groups were comparable in CMV viremia incidence (RR, 0.70; 95% CI, 0.31–1.57; P=0.4) and the development of CMV disease (RR, 0.74; 95% CI, 0.09–5.97; P=0.8). No significant differences in acute rejection rates were observed (RR, 0.97; 95% CI, 0.50–1.91;P=0.8). However, the rate of leukopeniaeutropenia was significantly lower in the ValA group (RR, 0.57; 95% CI, 0.42–0.77; P<0.01). No significant differences were noted for BK viremia (RR, 0.67; 95% CI, 0.24–1.87; P=0.4) or other HV infections (RR, 1.43; 95% CI, 0.61–3.38; P=0.4). Conclusions The drugs demonstrate comparable efficacy in preventing CMV infection following kidney transplantation. However, ValA may have a lower impact on bone marrow suppression.

Health Policy ; Health ; Policy

OBJECTIVES

This study aimed to assess the effectiveness of fear-based strategies on the decisions of Filipino drug users to surrender to authorities under the Philippine government's anti-drug policy. It also examined the influence of these scare tactics on the discontinuance of drug use among drug surrenderers. The fear appeals included community shaming and threats of imprisonment, torture or death under Oplan Tokhang launched by the Philippine government in 2016.

A combination of survey questionnaires and in-depth interviews was conducted with 56 surrenderers from selected communities in Marikina City, Metropolitan Manila. These individuals participated in a series of communitybased activities, including dance therapy (referred to as ‘Zumba’), Bible study and other religious activities, seminars on the dangers of drugs, and livelihood training programs. Readiness to change and levels of self-efficacy were measured after several months of participating. The effectiveness of fear appeals was further evaluated through actual drug testing.

The results indicated that 82.1% of the 56 drug users voluntarily surrendered to authorities while the rest claimed to have been pressured by family, friends, police, religious persons, or local officials. The primary motivations for surrender included fears of being killed or jailed, and a desire for rehabilitation. Readiness to change was generally high, but levels of self-efficacy were mixed. Out of the 56 drug surrenderers, only 37 underwent drug testing, where 40.5% tested positive even after months of participating in the community rehabilitation program.

The findings showed that scare tactics were effective in encouraging or forcing drug users to surrender to local authorities. However, their effectiveness in preventing continued drug use was inconclusive. Structural weaknesses in community rehabilitation policies and programs were identified. Over time, the initial fear-inducing impact of the scare tactics diminished as surrenderers became desensitized. Recommendations for enhancing the efficacy of the government’s anti-drug campaign were provided.

BACKGROUND AND OBJECTIVES

The drug problem in the Philippines is influenced by various factors, but research on the specific risk factors and onset of drug use—an early predictor of severe drug abuse—is limited. This crosssectional study aims to identify factors associated with the onset of illicit drug use, focusing on variables such as sex, perceived socioeconomic status, adverse life events (including physical, verbal, and sexual abuse, and bullying), adverse home environments (like family substance abuse and parental separation), and premorbidities (such as anxiety and depression). Understanding these factors is crucial since early drug use often predicts more severe abuse later.

This cross-sectional study involved 354 participants aged 7 to 34 years, all undergoing rehabilitation for at least three months. Data were collected through self-administered questionnaires at their rehabilitation centers. Regression analysis was used to examine the relationship between the onset of drug use and the identified risk factors.

Regression analysis revealed that, apart from premorbidities, all the examined factors were significantly correlated with the onset of drug use. Specifically, being male, having higher affluence, experiencing more adverse life events, and living in a more adverse home environment were associated with an earlier onset of drug use. Among these factors, adverse life events and home environment were the strongest predictors of the onset of illicit drug use, while premorbidities did not show a significant relationship with drug use onset.

The study highlights that sex, socioeconomic status, adverse life events, and home environment are significant in the early onset of drug use, while premorbidities are not. Early intervention should focus on these key risk factors. A risk-focused approach, guided by biopsychosocial perspectives, is recommended. Targeted interventions should address adverse life events and home environments to prevent early drug use and subsequent abuse effectively.

Background: Valganciclovir (ValG) is the most widely used drug for cytomegalovirus (CMV) prophylaxis in kidney transplant recipients (KTRs). However, it is associated with dose-limiting side effects and considerable costs. Some centers have identified valacyclovir (ValA) as an economically attractive alternative with a lower risk of bone marrow suppression. The comparative effectiveness of these two drugs is not well-established.This study aims to compare the efficacy and safety of ValA and ValG for CMV prophylaxis in KTRs. Methods: Searches were conducted of the Medline, Cochrane, Web of Science, Embase, and Ovid databases. Endpoints encompassed the incidence of CMV disease, CMV viremia, acute rejection, leukopeniaeutropenia, and other infections, including BK polyomavirus and non-CMV herpesviruses (HVs). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results: Six studies, comprising 888 patients (438 receiving ValA), were included. The groups were comparable in CMV viremia incidence (RR, 0.70; 95% CI, 0.31–1.57; P=0.4) and the development of CMV disease (RR, 0.74; 95% CI, 0.09–5.97; P=0.8). No significant differences in acute rejection rates were observed (RR, 0.97; 95% CI, 0.50–1.91;P=0.8). However, the rate of leukopeniaeutropenia was significantly lower in the ValA group (RR, 0.57; 95% CI, 0.42–0.77; P<0.01). No significant differences were noted for BK viremia (RR, 0.67; 95% CI, 0.24–1.87; P=0.4) or other HV infections (RR, 1.43; 95% CI, 0.61–3.38; P=0.4). Conclusions The drugs demonstrate comparable efficacy in preventing CMV infection following kidney transplantation. However, ValA may have a lower impact on bone marrow suppression.