Objective: To evaluate the protective effects of fulvic acid against amoxicillin-clavulanateinduced hepatotoxicity using biochemical, histopathological, immunohistochemical, functional, and bioinformatic analyses. Methods: Twenty-eight male Wistar rats were randomly assigned to 4 groups (n = 7/ group): sham (saline), amoxicillin-clavulanate (10 mg/kg/day), fulvic acid (100 mg/kg/ day), and combined treatment. Treatments were administered orally for 21 days. Liver injury and oxidative stress were assessed by serum alanine aminotransferase, aspartate aminotransferase, malondialdehyde, total antioxidant status, and total oxidant status; tissue injury was assessed histologically. Apoptosis was evaluated by immunohistochemistry for BAX and BCL2. Hepatic detoxification capacity was assessed by a caffeine clearance test.In silico analyses predicted molecular targets of fulvic acid and enriched pathways. Results: Amoxicillin-clavulanate increased transaminases, oxidative stress markers, and proapoptotic signaling and induced vascular congestion and sinusoidal dilatation.Co-treatment with fulvic acid improved serum biomarkers, reduced histological injury, downregulated BAX, and restored BCL2 staining intensity. In silico analysis identified predicted fulvic-acid targets enriched in metabolic and proliferation-related pathways. Conclusions and Relevance: Fulvic acid attenuated amoxicillin-clavulanate-induced hepatotoxicity, consistent with antioxidant and antiapoptotic mechanisms. Further studies are warranted to define dose-response relationships and translational potential.

Purpose: This study aimed to analyze radiographs of dentigerous cysts containing high-density areas within lowdensity areas to identify their characteristic radiographic features. Materials and Methods: This retrospective study included histopathologically confirmed cases of dentigerous cysts inpatients who underwent computed tomography (CT). The analyses included demographic data, the position of the lowdensity area relative to the impacted tooth, and the number, size, and location of the high-density area within the lowdensity region. Group comparisons were performed for each analytical factor. Results: The patients were classified into 550 cases of dentigerous cysts without high-density areas and 34 cases with high-density areas within the low-density regions. In the group with high-density areas, the low-density regions more frequently extended beyond the cementoenamel junction toward the center of the tooth root. In addition, many lesions exhibited high-density areas with a maximum diameter of less than 3 mm, contact with the tooth crown, and involvement of impacted teeth. Conclusion Lesions displaying high-density features, such as a maximum diameter <3 mm, contact with the tooth crown, and association with impacted teeth, are likely dentigerous cysts. These findings suggest that dentigerouscysts containing high-density areas differ from other lesions with calcified components. Although such cases are rare,recognizing them is important for understanding the disease spectrum.

Human ; Case Reports ; Publications

Nonalcoholic fatty liver disease (NAFLD) is a multisystemic clinical condition that presents with a wide spectrum of extrahepatic manifestations, such as obesity, type 2 diabetes mellitus, metabolic syndrome, cardiovascular diseases, chronic kidney disease, extrahepatic malignancies, cognitive disorders, and polycystic ovarian syndrome. Among NAFLD patients, the most common mortality etiology is cardiovascular disorders, followed by extrahepatic malignancies, diabetes mellitus, and liver-related complications. Furthermore, the severity of extrahepatic diseases is parallel to the severity of NAFLD. In clinical practice, aware-ness of the associations of concomitant diseases is of major importance for initiating prompt and timely screening and multidisciplinary management of the disease spectrum. In 2020, a consensus from 22 countries redefined the disease as metabolic (dysfunction)-associated fatty liver disease (MAFLD), which resulted in the redefinition of the corresponding population. Although the patients diagnosed with MAFLD and NAFLD mostly overlap, the MAFLD and NAFLD populations are not identical. In this review, we compared the associations of key extrahepatic diseases between NAFLD and MAFLD.

Nonalcoholic fatty liver disease (NAFLD) is a multisystemic clinical condition that presents with a wide spectrum of extrahepatic manifestations, such as obesity, type 2 diabetes mellitus, metabolic syndrome, cardiovascular diseases, chronic kidney disease, extrahepatic malignancies, cognitive disorders, and polycystic ovarian syndrome. Among NAFLD patients, the most common mortality etiology is cardiovascular disorders, followed by extrahepatic malignancies, diabetes mellitus, and liver-related complications. Furthermore, the severity of extrahepatic diseases is parallel to the severity of NAFLD. In clinical practice, aware-ness of the associations of concomitant diseases is of major importance for initiating prompt and timely screening and multidisciplinary management of the disease spectrum. In 2020, a consensus from 22 countries redefined the disease as metabolic (dysfunction)-associated fatty liver disease (MAFLD), which resulted in the redefinition of the corresponding population. Although the patients diagnosed with MAFLD and NAFLD mostly overlap, the MAFLD and NAFLD populations are not identical. In this review, we compared the associations of key extrahepatic diseases between NAFLD and MAFLD.

Purpose: Ischemia and reperfusion (I/R) can cause significant functional impairments in cells and tissues depending on the duration of ischemia. To date, many alternative treatments have been utilized to address this damage. We aimed to research the protective efficacy of taxifolin (Tax), a natural antioxidant, against liver I/R injury in terms of biochemical, histopathologic, and immunohistochemical parameters. Methods: The rats utilized in our study were randomly chosen and divided into four equal groups. Group 1 (n = 7), sham group received 1 mL saline orally; group 2 (n = 7), Tax group; Group 3 (n = 7), I/R group; group 4 (n = 7), Tax + I/R group as designated. The entire study was performed under general anesthesia with protection of animal welfare. Malondialdehyde (MDA) and interleukin-6 (IL-6) were analyzed from blood samples. Proapoptotic (B-cell lymphoma 2 [Bcl-2]-associated X protein [Bax]) and antiapoptotic (Bcl-2) amendments in cells were reviewed. Results: MDA grades were lower in the Tax+I/R group compared to the I/R group. Likewise, IL-6 grades were lower in the Tax + I/R group, histologic examinations showed that Bax proteins were less expressed in the Tax + IR group, and Bcl-2 proteins were intensely expressed in the Tax group. Conclusion Taxifolin applied before liver I/R demonstrated favorable effects on inflammation, oxidative stress, and proapoptotic changes.

Background: This study investigated the risk of frailty in older adults with differentiated thyroid cancer (DTC) and the effect of thyroid- stimulating hormone (TSH) levels on frailty. Methods: This single-center, cross-sectional study included 70 DTC patients aged ≥60 years with stable TSH levels during the previous year while receiving levothyroxine. Frailty was assessed using the fried frailty phenotype (FFP). Anterior thigh muscle thickness was measured by ultrasound, and the sonographic thigh adjustment ratio (STAR) index was calculated. Muscle strength was measured using a hand dynamometer. Physical activity was determined by the physical activity scale for the elderly (PASE). Results: The median (interquartile range) age and follow-up time were 65 years (62 to 71) and 11 years (7.0 to 14.2), respectively. The median TSH level was 1.10 μIU/mL (0.49 to 1.62), and 58.6% of patients were prefrail/frail. Muscle mass and strength were reduced in 35.7% and 17.2% of patients, respectively. TSH levels were lower in those with prefrailty/frailty (P=0.002), low muscle mass (P=0.014), and low strength (P=0.037) than in their normal counterparts. TSH levels correlated negatively with FFP (P= 0.001) and positively with the STAR index (P=0.034). TSH below 1.325 μIU/mL was associated with an increased frailty risk (area under the curve=0.719; P=0.001). Low TSH, female sex, low handgrip strength, and low PASE leisure time scores emerged as independent predictors of frailty (P<0.05). Conclusion Older adults with lower TSH levels due to DTC are at high frailty risk and have low muscle mass and strength. Therefore, TSH targets should be set based on a comprehensive evaluation with consideration of the risk-benefit ratio.

Background: This study investigated the risk of frailty in older adults with differentiated thyroid cancer (DTC) and the effect of thyroid- stimulating hormone (TSH) levels on frailty. Methods: This single-center, cross-sectional study included 70 DTC patients aged ≥60 years with stable TSH levels during the previous year while receiving levothyroxine. Frailty was assessed using the fried frailty phenotype (FFP). Anterior thigh muscle thickness was measured by ultrasound, and the sonographic thigh adjustment ratio (STAR) index was calculated. Muscle strength was measured using a hand dynamometer. Physical activity was determined by the physical activity scale for the elderly (PASE). Results: The median (interquartile range) age and follow-up time were 65 years (62 to 71) and 11 years (7.0 to 14.2), respectively. The median TSH level was 1.10 μIU/mL (0.49 to 1.62), and 58.6% of patients were prefrail/frail. Muscle mass and strength were reduced in 35.7% and 17.2% of patients, respectively. TSH levels were lower in those with prefrailty/frailty (P=0.002), low muscle mass (P=0.014), and low strength (P=0.037) than in their normal counterparts. TSH levels correlated negatively with FFP (P= 0.001) and positively with the STAR index (P=0.034). TSH below 1.325 μIU/mL was associated with an increased frailty risk (area under the curve=0.719; P=0.001). Low TSH, female sex, low handgrip strength, and low PASE leisure time scores emerged as independent predictors of frailty (P<0.05). Conclusion Older adults with lower TSH levels due to DTC are at high frailty risk and have low muscle mass and strength. Therefore, TSH targets should be set based on a comprehensive evaluation with consideration of the risk-benefit ratio.

Erythema elevatum diutinum (EED) is a rare, chronic leukocytoclastic vasculitis characterized by erythematous to violaceous plaques and nodules, typically on extensor surfaces like the hands, elbows, and knees. It results from immune complex deposition in blood vessels, leading to inflammation and fibrosis. EED is often associated with infections, autoimmune disorders, or hematologic malignancies, but can also occur idiopathically. Although globally documented, EED is extremely rare in the Philippines, particularly in adolescents, highlighting its significance in local literature.

A 14-year-old Filipino female presented with a 5-month history of asymptomatic, skin-colored papules on her right elbow, gradually spreading to both elbows and knees, with occasional mild pruritus and knee joint pain. Past medical and family history were unremarkable. After temporary relief from an unrecalled cream prescribed by a private dermatologist, she was referred for skin punch biopsy, which revealed spongiotic epidermis with papillary dermal edema, moderate inflammatory infiltrates, eosinophilic inclusion bodies, and nuclear dusts surrounding the blood vessels, consistent with EED. The patient was treated with dapsone 50 mg/day, clobetasol propionate ointment twice daily for two weeks, and cetirizine 10 mg as needed for pruritus, resulting in clinical improvement.

This case highlights the extreme rarity of EED in the Philippines, particularly in adolescents. It emphasizes the need to consider EED in chronic papular eruptions and demonstrates the effectiveness of dapsone and topical steroids in managing the condition. Early diagnosis and timely intervention are crucial for preventing disease progression and improving patient outcomes, as seen in this case.

BACKGROUND

Skin diseases and mental disorders are often correlated. However, the prevalence of this association among outpatients is not well-documented, especially in the Philippines. This study investigated the complex relationship between skin conditions and potential mental disorders, aiming to enhance patient care through a more comprehensive, integrated treatment approach.

To determine the relationship between skin diseases and probable mental disorders among outpatients seen at the dermatology department of a tertiary government hospital in the Philippines.

This descriptive, cross-sectional study included 298 participants. Socio-demographic and clinical profiles were gathered, and a validated screening tool was used to identify probable mental disorders. Analytical statistics were employed to assess the relationship between socio-demographic and clinical profiles, skin diseases, and symptoms suggestive of a mental disorder.

The study results revealed no significant association between specific skin diseases and mental disorders. However, significant correlations were noted between certain sociodemographic and clinical factors—such as employment status, residence, educational attainment, birth order, disease severity, and disease duration—and the presence of probable mental disorders.

The results emphasized the critical role of clinical and sociodemographic factors in determining mental health outcomes in dermatology settings. Incorporating mental health screenings into standard dermatological care enables healthcare providers to greatly improve patient outcomes, providing a more comprehensive and holistic treatment approach.