Headaches are among the top reasons for consultation in primary care clinics and can be classified either as primary or secondary. Primary headaches are unrelated to any medical condition and usually benign in nature. Secondary headaches are caused by an underlying pathology or condition. The mnemonic “HEADACHES” may be used to remember the red flags and it includes: Headache of sudden onset, Elderly onset, Altered mental status or neurologic deficits, Different or new pattern, Associated systemic symptoms, Cancer or immunocompromised state, Headache with exertion or position change, Eye findings and Secondary risk factors. Patients presenting with red flags are suggested to have underlying causes or secondary headaches and presence of which warrants diagnostic investigation or referral to specialists. Diagnostic imaging is not routinely recommended for patients with headache unless presenting with red flags or with suspected underlying pathology.

Human ; Headache ; Primary Health Care ; Primary Care ; Migraine Headache ; Migraine Disorders

OBJECTIVE

This study compared the demographics, clinical profile, treatment, and outcomes of retinoblastoma patients seen at medical institutions in the Philippines between two time periods: 2010 to 2015 and 2016 to 2020.

METHODS

This was a multicenter, analytical, cohort study using review of medical charts and databases of retinoblastoma patients seen in 11 medical institutions from 2010 to 2020.

RESULTS

There were 636 patients (821 eyes) included in this study: 330 patients were seen in 2010 to 2015 while 306 in 2016 to 2020. More cases per annum were seen in the latter timeline. The number of patients with unilateral disease was not significantly different between the two time periods (p=0.51). Age at onset of symptom, age at initial consultation, and delay in consult were also not significantly different between the two time periods (p > 0.05). Patients had significantly different distributions of intraocular grades (p < 0.0001) and systemic staging (p < 0.0001) between the two time periods. Enucleation was the most common surgical treatment performed in both timelines. There was significant difference in the status of patients based on the need for systemic chemotherapy (p < 0.01). There was significant difference in outcome between the two time periods, including the proportions of living and deceased patients.

CONCLUSION

This study compared the most comprehensive data on retinoblastoma patients in the country. There was no improvement in early health seeking behavior based on similar age at initial consult and delay in consult. Enucleation remained the most common treatment mode as opposed to chemotherapy due to similar percentage of patients with unilateral disease, an indication for enucleation rather than chemotherapy.

Human ; Retinoblastoma ; Philippines ; Epidemiology ; Treatment ; Therapeutics

OBJECTIVE: To determine the prevalence of hypoglycaemia using continuous glucose monitoring system (CGMS) among insulin-treated pregnant women with diabetes whose glycosylated haemoglobin (HbA1c) were <6.0% and identify the risk factors associated with hypoglycaemia occurrence.

METHODOLOGY: We conducted a cross-sectional study using 6-days CGMS to detect the prevalence of hypoglycaemia in 31 insulin-treated pregnant women with diabetes who achieved HbA1c <6.0%. Patients were required to log-keep their self-monitoring blood glucose (SMBG) readings and hypoglycaemia events.

RESULTS: Eight women experienced confirmed hypoglycaemia with additional seven experienced relative hypoglycaemia, giving rise to prevalence rate of 45.2% (one had both confirmed and relative hypoglycaemia). Nine relative hypoglycaemia and 17 confirmed hypoglycaemic events were recorded. Sixteen (94%) out of 17 confirmed hypoglycaemia events recorded by CGMS were asymptomatic and were missed despite performing regular SMBG. Nocturnal hypoglycaemia events were recorded in seven women. Univariable analysis did not identify any association between conventional risk factors and hypoglycaemia events in our cohort.

CONCLUSION: Insulin-treated pregnant women with diabetes who achieved HbA1c < 6.0% were associated with high prevalence of hypoglycaemia. Asymptomatic hypoglycaemia is common in our cohort and frequently missed despite regular SMBG. Present study did not identify any association between conventional risk factors and hypoglycaemia events in our cohort.

Human ; Female ; Hypoglycemia ; Pregnancy ; Diabetes Mellitus

Introduction: It is important to wean mechanically-ventilated patients as early as possible to avoid complications such as ventilator-associated pneumonia. Supplementing the diet with additional protein may help to stimulate muscle protein synthesis which may enhance respiratory muscle function and ventilator drive. This study aims to determine the effect of whey protein supplementation on the duration of mechanical ventilation in intensive care unit patients of Ospital ng Makati. Methods: We enrolled forty eligible patients in this openlabel randomized controlled trial and were assigned into two groups: Group A (N=20): patients were given enteral feeding using commercial formula with added whey protein, given as one serving every eight hours (equivalent to 18 g of additional protein per day) and Group B (N=20): patients were given enteral feeding using commercial formula alone. Weaning was started as soon as the patient fulfilled the criteria of spontaneous breathing trial and was considered successful if the patient maintained these criteria for 48 hours after extubation. Results: Our study’s results showed that the mechanically intubated patients in Group A have lesser ventilatordependent days with an average of 5.4 days as compared to those in Group B with an average of 7.45 days (p=0.00). Patients in Group A were also noted to have statistically significant higher increase in serum albumin, mid-arm circumference and triceps skin fold from baseline. Twentyfive percent of patients in Group B developed ventilator acquired pneumonia and none in Group A. No mortality was noted in both groups. Conclusion Whey protein supplementation in mechanically ventilated patients can be recommended to facilitate early weaning because of its effect on early muscle protein synthesis leading to improvement of lung function and ventilator drive. It can also help in preventing malnutrition and nosocomial infections during critical illness. With all these benefits of whey protein, its use can potentially lead to shorter duration of mechanical ventilation and hospital stay which can also mean less cost of care delivery.
Whey Proteins ; Weaning ; Respiration, Artificial ; Intensive Care Units ; Randomized Controlled Trial

INTRODUCTIONIncreasing resistance in Escherichia coli and Klebsiella pneumoniae to firstline antibiotics makes therapeutic options for urinary tract infections (UTIs) challenging. This study investigated the in vitro efficacies of 6 antibiotics against multidrug resistant (MDR) uropathogens.

MATERIALS AND METHODSMinimum inhibitory concentrations to ceftibuten, cefpodoxime, fosfomycin, mecillinam, temocillin, and trimethoprim were determined against 155 MDR-isolates of E. coli and K. pneumoniae. The presence of extended-spectrum beta-lactamases (ESBL) and plasmid-borne AmpC enzymes was determined by phenotypic testing with genotyping performed by multiplex polymerase chain reaction.

RESULTSTemocillin demonstrated highest susceptibility rates for both E. coli (95%) and K. pneumoniae (95%) when breakpoints for uncomplicated UTIs were applied; however, temocillin susceptibility was substantially lower when "systemic infection" breakpoints were used. Fosfomycin demonstrated the best in vitro efficacy of the orally available agents, with 78% and 69% of E. coli and K. pneumoniae isolates susceptible, respectively. The next most effective antibiotics were ceftibuten (45%) and mecillinam (32%). ESBL and ampC genes were present in 47 (30%) and 59 (38%) isolates.

CONCLUSIONThis study demonstrated few oral therapeutic options for MDR-uropathogens, with fosfomycin demonstrating the best in vitro activity.

Amdinocillin ; pharmacology ; Anti-Bacterial Agents ; pharmacology ; Bacterial Proteins ; genetics ; Ceftizoxime ; analogs & derivatives ; pharmacology ; Cephalosporins ; pharmacology ; Drug Resistance, Multiple, Bacterial ; genetics ; Escherichia coli ; drug effects ; genetics ; Escherichia coli Infections ; microbiology ; Fosfomycin ; pharmacology ; Genotype ; Humans ; In Vitro Techniques ; Klebsiella Infections ; microbiology ; Klebsiella pneumoniae ; drug effects ; genetics ; Microbial Sensitivity Tests ; Multiplex Polymerase Chain Reaction ; Penicillins ; pharmacology ; Singapore ; Trimethoprim ; pharmacology ; Urinary Tract Infections ; microbiology ; beta-Lactamases ; genetics

Temporal bone squamous cell carcinoma (TBSCC) is rare and poses difficulties in diagnosing, staging and management. We describe a case series with six patients who were diagnosed TBSCC, from January 2009 to June 2014, with median age of 62 years old. All patients presented with blood-stain discharge and external auditory canal mass, showing that these findings should highly alert the diagnosis of TBSCC. Three patients staged T3 and another three with T4 disease. High-resolution CT (HRCT) temporal findings were noted to be different from intraoperative findings and therefore we conclude that MRI should be done to look for middle ear involvement or other soft tissue invasion for more accurate staging. Lateral temporal bone resection (LTBR) and parotidectomy was done for four patients with or without neck dissection. Patients with positive margin, perineural invasion or parotid and glenoid involvement carry poorer prognosis and postoperative radiotherapy may improve the survival rate. One patient had successful tumor resection via piecemeal removal approach in contrast with the recommended en bloc resection shows that with negative margin achieved, piecemeal removal approach can be a good option for patients with T2-3 disease. In general, T4 tumor has dismal outcome regardless of surgery or radiotherapy given.

INTRODUCTIONAnti-thyroid antibodies are associated with extra-thyroid diseases such as Graves' ophthalmopathy and Hashimoto's encephalopathy. Some evidence suggests that anti-thyroid antibodies are also associated with depression. Interleukin (IL)-17 appears to play an important role in autoimmune thyroid disease. This study investigated whether specific thyroid autoantibodies and IL-17 distinguished persons with depression from non-depressed controls.

MATERIALS AND METHODSForty-seven adult females with non-psychotic, current major depressive disorder and 80 healthy female controls participated in this study. Thyroid peroxidase antibodies, thyroglobulin antibodies, thyroid-stimulating hormone (TSH) receptor antibodies, free T3 and T4, TSH and IL-17 were measured from the serum. Measurements were repeated to assess test-retest reliability. Receiver operating characteristic (ROC) curves were used to estimate discriminatory values of the measurements. Differences between groups and associations between the clinical and biochemical assessments were analysed.

RESULTSMedian TSH receptor antibody concentration was significantly higher in the depressed than control group (P <0.001). Area under the ROC curve was 0.80 (95% CI, 0.73 to 0.88). Higher TSH receptor antibody titres were associated with greater depression severity scores (r = 0.33, P <0.05). IL-17 levels were not associated with TSH receptor antibody levels or depression severity scores. Thyroid function and other thyroid autoantibodies were not associated with depression severity.

CONCLUSIONTSH receptor antibodies might be a biomarker of immune dysfunction in depression.

Adult ; Autoantibodies ; blood ; Biomarkers ; blood ; Depressive Disorder, Major ; diagnosis ; immunology ; Female ; Humans ; Immunoglobulins, Thyroid-Stimulating ; blood ; Interleukin-17 ; blood ; Middle Aged ; Psychiatric Status Rating Scales ; ROC Curve ; Statistics as Topic ; Thyroid Gland ; immunology

This is a case report of a 22-year-old Filipino male, morbidly obese, not known to have diabetes mellitus (DM) who presented with diabetic ketoacidosis on initial diagnosis. He had a phenotype of type 2 DM (T2D) but an initial presentation consistent with type 1 DM (T1D). Insulin therapy was eventually discontinued but he maintained good glycemic control with diet alone. C-peptide showed adequate increase after a mixed-meal diet and GAD65Ab was negative, thus he was diagnosed with ketosis-prone DM (KPDM). The increasing prevalence of obesity challenges the classic phenotype of patients with DM, with many patients presenting as an obese type T1D, and being diagnosed with T2D at a younger age. This complicates how to classify the patient’s diabetes, and the clinical profile is sometimes insufficient to make the proper diagnosis. In these cases, immunologic markers and assessment of β-cell function are important tools to differentiate between T1D and T2D, to direct management plans and to anticipate complications.
Diabetes Mellitus, Type 1 ; C-Peptide

Introduction: Infantile haemangioma (IH) is a common benign vascular tumour which is characterised by rapid proliferation in early infancy period followed by slow involution for years. The initial rapid growth and the location of haemangioma may result in significant morbidity. The introduction of oral Propranolol for the treatment of IH in recent years has seen many promising results though with potential risks. Objective: To review the demography, clinical pattern, management and outcome of patients with IH treated with propranolol in a paediatric dermatology referral centre. Methodology: A retrospective observational study of medical records of patients with IH treated with oral propranolol (maximum dose 2mg/kg/day) from May 2009 to May 2011 in Paediatric Institute, Kuala Lumpur Hospital. Results: A total of 17 patients (14 girls, 3 boys) were studied. They were 12 Malays (70.6%), 2 Chinese(11.8%), 2 Indians(11.8%) and 1 Indonesian (5.9%). Mostly term babies (88%). The age of presentation is from birth to 2 months old. The location of haemangiomas involve periocular (35.3%), perioral (17.6%), facial segmental (17.6%), nasal (5.9%), multiple (17.6%) and spinal (5.9%). They were started on Propranolol at a mean age of 5 months old except one at 2 years old. Five patients had concurrent adjunctive therapies. 70.6% had significant reduction of the size and colour of haemangiomas, 11.8% not significant, 11.8% unclear, and one patient defaulted follow up. Some patients developed wheezing episodes (29.4%), diarrhoea (17.6%), regurgitation (5.9%); but no serious consequences. Conclusion: Low dose oral propranolol is a safe and effective treatment with minor side effects from our experience.

Introduction: Infantile haemangioma is the most common tumor in infancy. They are extremely heterogenous clinically. Established risk factors for infantile haemangioma include female sex, white ethnicity, prematurity, low birth weight and multiple gestation. There is a lack of demographic studies in the Asian population especially in the Malay ethnic group. Objective: To describe the demographics and clinical characteristics of infantile haemangioma in a tertiary centre in Malaysia. To describe associated complications and the need for therapeutic intervention. To determine whether there is any difference in demographics and clinical characteristics of infantile hemangiomas in a Malaysian population comprising predominantly Malay ethnic group with published reports of Western population. Design Retrospective review of patients with infantile haemangioma referred to the Paediatric Dermatology unit, Kuala Lumpur Hospital between January 2009 and May 2011. Main Outcome Measures: Demographic and clinical characteristics were summarized and compared with data from previous studies. The study included 50 patients (38 females and 12 males) with a mean age of 6.23 months (range 0.1 to 16 months) at presentation. 11(22%) patients were premature. The mean age of onset was 20 days (range 0 to 5 months). 18(37%) patients had a premonitory mark at birth. Of 62 hemangiomas in 50 patients, 45(72.5%) were localized, 5(8.1%) were segmental, 11(17.7%) indeterminate and 1(1.6%) multifocal. The most frequent location of the haemangiomas was in the face with 29(46.8%) lesions, followed by 10(16.1%) lesions in the head and neck, 10(16.1%) lesions in the extremities, 8(12.9%) lesions in the trunk and 5(8.1%) in the perineum. Complications that occurred included ulceration in 8(16%) patients, threat to vision in 7(14%), infection in 2 (4%) and bleeding in 6(12%) patients. Of the 50 patients, 24(48%) patients required interventions. These interventions included propranolol only in 12(24%) patients, prednisolone only in 4(8%), both propranolol and prednisolone in 5(10%), wound care in 2(4%) and pulse dye laser in 1(2%). Conclusion: The demographics and clinical characteristics of infantile haemangiomas in Malaysia are similar to published reports.