BACKGROUND

Lithium has been known as a second-line treatment for hyperthyroidism. However, it has a narrow therapeutic range especially in patients with impaired renal function. Toxicity can cause neurological, gastrointestinal, cardiovascular, and renal symptoms, including rare cases of renal failure needing renal replacement therapy. This case report highlights a rare instance of acute lithium toxicity in a patient with multinodular goiter and chronic kidney disease, following methimazole-induced agranulocytosis.

A 55-year-old Filipino woman with chronic kidney disease and multinodular toxic goiter who developed methimazole-induced agranulocytosis presented with altered mental status after pre-treatment with lithium. Laboratory tests confirmed elevated lithium levels, consistent with acute lithium toxicity. She developed acute kidney injury, necessitating urgent hemodialysis with hemoperfusion. After two sessions, her neurological status and renal function improved. The patient resumed pre-treatment with carbimazole and subsequently underwent successful RAI then maintained on levothyroxine for long-term thyroid management

Lithium toxicity is rare but can cause life-threatening complications, particularly in patients with pre-existing kidney disease. Hemodialysis remains the treatment of choice for severe toxicity, significantly improving patient outcomes. Lithium toxicity can occur even within therapeutic levels, emphasizing the need for careful monitoring. This case highlights the importance of clinical vigilance when using lithium.

The use of cadavers remains essential for medical students studying anatomy, as it provides irreplaceable handson experience. Given that the available cadavers must be reused over time, an effective preservation method is necessary to maintain tissue integrity. Formaldehyde-based solutions are commonly used in cadaver preservation due to their costeffectiveness, practicality, and long-term tissue stability. However, given formaldehyde is carcinogenic and an irritant, it poses risks to both users and preserved cadavers. As a result, numerous studies have investigated cadaver embalming techniques as an effort to safeguard users and preserve cadavers. This review examines research on low-formaldehyde embalming solutions. Literature was retrieved from databases including PubMed, Cochrane Library, Wiley Online Library, Google Scholar, and ScienceDirect, with a focus on preservation efficacy, safety, and practical application. The reviewed literature identifies several low-formaldehyde formulations that effectively preserve cadavers while minimizing health risks. These solutions offer a variety of chemical compositions and application methods for institutes seeking safer cadaver preservation.The findings emphasize the need for anatomy instruction to switch to low-formaldehyde embalming. These approaches can preserve cadavers and reduce health hazards, but cost and resource availability remain important consideration. Further study is needed to enhance low-formaldehyde embalming solutions for anatomical institutes' different needs. This review concludes that low-formaldehyde embalming solutions are essential for cadaver preservation safety. This study helps anatomy professionals modify embalming practices in their institutions to improve cadaver preservation and user safety by revealing the benefits and downsides of several options.

Cadavers are essential for anatomical education, but limited availability necessitates long-term preservation.While formalin is widely used, it is carcinogenic and alters muscle morphology and joint mobility, reducing anatomical accuracy. The modified Larssen solution (MLS) has shown promise in improving joint flexibility, yet its efficacy remains underexplored. This study aimed to evaluate muscle condition and joint range of motion in rat specimens preserved with 4% formalin followed by MLS immersion, compared to continuous 4% formalin preservation. Eighteen rat cadavers were allocated into three groups: intracardiac perfusion followed by 0.9% NaCl immersion, intracardiac perfusion and threemonth immersion in 4% formalin, and intracardiac perfusion with 4% formalin followed by three-month immersion in MLS. Statistical analysis included the t-test or Mann–Whitney test, depending on data distribution. Pearson correlation was used to assess the relationship between muscle fiber fragmentation and joint range of motion. Data from the NaCl group were excluded due to sample decomposition. The MLS group showed significantly redder muscle color (P<0.05), softer muscle consistency (P<0.05), and a non-significant increase in joint range of motion (P>0.05), without observable muscle fiber fragmentation. Correlation analysis could not be conducted due to the absence of fragmentation. MLS may serve as an effective alternative preservative by maintaining muscle color, texture, and structural integrity. Although the increase in joint mobility was not statistically significant, it was more pronounced than in the 4% formalin group. Future studies should explore longer observation periods and potential correlations with histological findings.

Purpose: The objective of this study was to evaluate the natural history of early and late rectourethral fistulas (RUFs) and to determine the long-term outcomes of a multidisciplinary management approach. Methods: A multicenter retrospective study was performed on patients with RUF who were treated by a combined colorectal and urological team. Early RUF (ERUF) was defined as occurring within 31 days after surgery, while late RUF (LRUF) was defined as occurring thereafter. Surgical procedures and the surgeons involved were recorded, in addition to clinical assessments, radiological findings, and oncological assessments. Results: A total of 72 patients diagnosed with RUF were treated between January 1, 2010, and June 2023. Patients were divided into ERUF (n=37) and LRUF (n=35) groups. After conservative management, comparisons of success rates for graciloplasty, York-Mason, and delayed coloanal anastomosis as second and third treatments showed higher rates for graciloplasty in ERUF than in LRUF (83% vs. 40%, P=0.034; 71% vs. 33%, P=0.500; and 60% vs. 40%, P>0.999, respectively). The ERUF group demonstrated significantly higher cure rates after the second treatment (83.8% vs. 40.0%, P<0.001). At final follow-up, complete healing was significantly more frequent in ERUF than in LRUF (83.8% vs. 42.9%, P<0.005). Definitive digestive and urinary diversion rates were lower in ERUF (13.5% vs. 48.5%, P=0.001; and 13.5% vs. 25.7%, P=0.240, respectively). Conclusion These findings suggest that 30% of patients required a definitive colostomy, with a significantly higher proportion observed in the LRUF group. Moreover, repeated surgical procedures in the LRUF group were frequently unsuccessful.

Background: and Purpose In patients with ischemic stroke and isolated cervical internal carotid artery occlusion (c-ICA-O), endovascular therapy (EVT) can improve cerebral perfusion. To maintain vessel patency, EVT is frequently combined with carotid artery stenting (CAS). We assessed the efficacy and safety of emergent CAS during EVT for isolated c-ICA-O. Methods: This retrospective multinational cohort study (42 centers) included consecutive patients who underwent EVT for isolated c-ICA-O within 24 hours from the time last seen well. Patients who underwent emergent CAS were compared with those who did not. Co-primary outcomes were c-ICA vessel patency and symptomatic intracerebral hemorrhage (sICH) 24 hours post-EVT. Secondary outcomes included any intracerebral hemorrhage (ICH) at 24 hours and disability at 3 months (modified Rankin Scale [mRS] shift). Outcomes were adjusted using inverse probability of treatment weighting. Results: Of 317 patients (mean age, 68.6 years [standard deviation, 12.9]; median National Institutes of Health Stroke Scale 11 [interquartile range, 6–17]; 26.8% female), 219 (69.1%) underwent CAS, whereas 98 (30.9%) did not. At 24 hours, vessel patency was more common after CAS (83.5% vs. 40.7%; adjusted odds ratio [aOR], 9.45; 95% confidence interval [CI], 4.91–18.17); sICH rates did not differ (2.3% vs. 3.1%; aOR, 0.92; 95% CI, 0.18–4.73). Any ICH was more common after CAS (19.3% vs. 9.3%; aOR, 2.50; 95% CI, 1.12–5.60). CAS was not associated with mRS at 3 months (adjusted common odds ratio, 0.98; 95% CI, 0.62–1.56). Conclusions In patients undergoing EVT for isolated c-ICA-O, emergent CAS was technically effective and reasonably safe. More frequent vessel patency in patients who underwent CAS did not translate into improved functional outcome at 3 months.

Background: Type 2 diabetes mellitus (T2DM) is a complex, multifactorial disease with a significant global burden. Although genome-wide association studies (GWAS) have identified many T2DM-associated variants, most lie in non-coding regions, making it difficult to interpret their functional roles. Methods: We aimed to identify genetically regulated Cytosine–phosphate–Guanine (CpG) sites associated with T2DM by conducting a methylome-wide association study (MWAS), followed by Mendelian randomization (MR) and functional validation using human pancreatic cells and mouse models. MWAS was performed using summary statistics from large-scale GWAS and a DNA methylation (DNAm) prediction model to test associations between genetically predicted DNAm and T2DM. Results: We identified 111 CpG sites significantly associated with T2DM in Europeans, including 8 novel sites near genes not previously linked to T2DM. These findings were replicated in independent datasets. Many CpGs also showed associations with cardiometabolic traits, highlighting shared epigenetic mechanisms. Trans-ethnic MR analysis confirmed consistent effects for six CpGs in East Asians. Functional analysis revealed that several CpGs regulate gene expression in human pancreatic α- and β-cells. Among them, 2´-5´-oligoadenylate synthetase like (OASL) expression, regulated by a significant CpG, was differentially expressed in α-cells of T2DM cases compared to controls. Supporting evidence from mouse models suggests a role for OASL in glucose regulation. Conclusion Our study identifies novel genetically regulated CpG sites associated with T2DM risk and highlights OASL as a potential epigenetic regulator of glucose metabolism in α-cells. These findings provide mechanistic insights into the epigenetic architecture of T2DM and suggest potential targets for cross-ethnic biomarker development and therapeutic intervention.

Bovine-derived dural substitutes are commonly used in cranial and spinal duraplasty. Although they are generally well tolerated, allergic reactions have been reported—almost all presented with eosinophilic meningitis. A 7-year-old girl with Li-Fraumeni syndrome and diffuse pediatric glioma underwent a third salvage resection in which a bovine collagen dural onlay was placed. Ten days post operatively, she developed fever, lethargy, and a subcutaneous scalp fluid collection. Cultures and imaging were negative for infection; cerebrospinal fluid (CSF) revealed pleocytosis (elevated white blood cells and protein) without eosinophilia. High-dose dexamethasone produced transient clinical and radiographic improvement, but fever and fluid re accumulated whenever steroids were tapered. Given the steroid dependence and persistently negative infectious work-up, the graft was explanted. Pathology demonstrated a foreign-body giant cell reaction without eosinophils, and the patient’s symptoms resolved permanently after removal. This report documents the first pediatric case of bovinederived dural graft hypersensitivity without eosinophilic meningitis. Clinicians should consider graft-related allergy in children who develop recurrent fluid collections and fevers after duraplasty—even when CSF eosinophils are absent and cultures remain negative and should recognize that definitive treatment may require graft removal rather than prolonged steroid therapy.

OBJECTIVE

This study aimed to identify the different risk factors for developing sepsis in patients undergoing percutaneous nephrolithotomy

This is a case-control study of all patients who underwent percutaneous nephrolithotomy in the National Kidney and Transplant Institute from 2017 to 2021. Demographic, stone characteristics, perioperative data and post-operative parameters were recorded. The association of clinical variables and sepsis was determined using logistic regression analysis.

A total of 536 patients who underwent percutaneous nephrolithotomy were included in the study with 58 of them suffering from sepsis with a prevalence rate of 9.9%. The majority [392 (67.82%)] of the patients were 31-59 years old. Majority of patients suffering from sepsis also belonged to the same age group were predominantly male [33 (56.9%)], mostly diabetic [15 (26.32%)] and hypertensive [14 (24.56%)] and underwent previous PCNL [49 (8.45%)]. Imaging of patients who had sepsis showed staghorn calculi [30 (51.72%)] with mild [20 (34.48%)] and moderate [23 (39.66%)] seen on imaging. Patients who were requiring transfusion post operatively (Grade II Clavien-Dindo Classification) were seen to have sepsis.

The following factors are contributory to the development of sepsis: a high Guy's stone score, high degree of obstruction or hydronephrosis, previous stone surgery and a higher volume of blood loss.

Introduction: Leptospirosis is a zoonotic disease transmitted through exposure to water or soil contaminated with the urine of infected animals, particularly rats. Despite ongoing prevention efforts, leptospirosis remains a public health concern in the Philippines, especially in flood-prone urban communities. This study assessed the knowledge, attitudes, and practices (KAP) regarding leptospirosis among residents of Barangay Doña Imelda, Quezon City, and examined the association of selected sociodemographic factors with KAP. Methods: A cross-sectional design was used with 345 residents of Barangay Doña Imelda. Data were collected using an adapted KAP questionnaire. Open-ended questions were used to probe the responses further. Statistical analyses included descriptive statistics and Spearman’s Rho correlation, Independent T-test, One-way and Welch ANOVA, and appropriate post hoc tests. Relationships among KAP domains were evaluated using Spearman’s rank correlation coefficient. Statistical significance was set at p < 0.05. Results: Respondents demonstrated high levels of knowledge (86.80%) and positive attitudes (90.91%) toward leptospirosis, but comparatively lower practice scores (69.25%). Knowledge scores differed significantly according to household size and civil status, while attitude and practice scores varied significantly across sex, educational attainment, and household income. Weak but significant positive correlations were observed between knowledge and attitude (rs = 0.126, p = 0.020), knowledge and practice (rs = 0.169, p = 0.002), and attitude and practice (rs = 0.170, p = 0.001). Conclusion Residents of Barangay Doña Imelda demonstrated adequate knowledge and positive attitudes toward leptospirosis; however, preventive practices remained suboptimal. Significant associations between KAP and selected sociodemographic factors were identified. Targeted health education, improved symptom recognition, and increased access to preventive resources may help strengthen leptospirosis prevention in high-risk urban communities.
Leptospirosis ; Knowledge ; Attitude ; Parks, Recreational ; Philippines