BACKGROUND

The survival advantage of HER2-positive breast cancer from targeted treatment is commonly undermined by catastrophic health expenditure (CHE), particularly in resource-limited areas. Recognizing that financial catastrophe leads to non-adherence to treatment and dissaving practices, we examined the out-of-pocket (OOP) expenses of patients with HER2-positive breast cancer.

OBJECTIVE

The study aimed to estimate the median total per-cycle out-of-pocket expenditure of HER2-positive breast cancer treatment from the patient perspective, in public and private clinics, evaluate the association of catastrophic health expenditure with non-adherence to treatment, and describe dissaving practices.

METHODS

This was a cross-sectional micro-costing analysis of the treatment of HER2-positive breast cancer from the patient perspective from a tertiary cancer center and select private clinics in the Philippines. Random sampling of patients with HER2-positive breast cancer was done. Using a validated questionnaire, a guided interview was administered. Catastrophic health expenditure was estimated as having OOP of >20% of the household income. OOP costs were assessed retrospectively from the time of confirmed HER2 diagnosis up to the date of survey, while household income referred to the corresponding period. The proportion of patients experiencing catastrophic health expenditure was computed. Fisher's exact was used to assess for any association between CHE and non-adherence to treatment. Descriptive statistics were used to report dissaving practices. All statistical analyses were performed using Stata analytical software version 12.

RESULTS

A total of 101 patients participated in the study. The mean age of participants from the tertiary cancer center and private clinics were 52 and 58 years old respectively. Patients from the private clinics had a median total OOP expenditure of PhP 54,737.06 (IQR = PhP 102,670.00), compared with patients from tertiary cancer center who had a median total OOP expenditure of PhP 13,920.66 (IQR = PhP 20,830.00). The overall prevalence of CHE (90.9%, 95% CI 0.81, 0.95) and nonadherence to treatment with trastuzumab (79%, 95% CI 0.70, 0.87) were high, and similar in both groups. A number of dissaving practices such as resignation from work, borrowing money from friends, selling assets were observed.

CONCLUSION

The high rate of CHE and treatment delay among patients with HER2-positive breast cancer were not addressed by the existing cancer programs. Most OOP expenditure was for trastuzumab. Current cancer support programs have potential to address the financial impact of their treatment.

Human ; Therapeutics ; Survival ; Patients ; Neoplasms ; Philippines ; Health Expenditures ; Breast Neoplasms

INTRODUCTION

Hypertension is a serious public health issue that puts individuals at risk for various morbidity and mortality indicators. One of the most crucial factors in managing blood pressure and preventing complications is medication adherence which is linked to several determinants. This study explored the correlation between medication adherence among middle-aged hypertensive adults and the different domains of quality of life (QOL), which includes physical, psychological, social relationship and environment.

METHODS

This cross-sectional study involved 96 Filipino residents of Brgy. San Jose, Navotas City aged 35 to 65 years old diagnosed with hypertension and prescribed anti-hypertensive medications. Pearson’s correlation coefficient was used to calculate the correlation between different domains of QOL as well as the overall QOL score.

RESULTS

Results revealed a statistically significant but weak positive correlation between overall QOL and medication adherence (r = 0.336, p<0.001). Among the QOL domains, environmental domain had the strongest correlation with adherence (r = 0.446, p = 0.00), followed by physical health (r = 0.443, p = 0.01) and psychological well-being (r = 0.382, p = 0.01). The social relationship domain showed negligible correlation (r = 0.163, p = 0.4).

CONCLUSION

The study demonstrates that while medication adherence is modestly associated with better perceived QOL, especially in physical, psychological and environmental aspects, other factors likely influence both outcomes. These findings highlight the need for holistic, community-based interventions that address not only medication adherence but also environmental and psychosocial barriers to care in managing hypertension.

Human ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Quality Of Life ; Public Health ; Medication Adherence ; Antihypertensive Agents ; Blood Pressure ; Interpersonal Relations

Objectives: Indonesia has the second-highest number of tuberculosis (TB) cases globally, after India. The estimated TB incidence in Indonesia is 1 090 000 cases (387 cases per 100 000 population), with an associated mortality of 131 000 deaths (47 deaths per 100 000 population). The 2023–2024 TB Inventory Study in Indonesia aimed to quantify the extent of under-reporting by identifying TB cases that were diagnosed and/or treated but not reported to the National TB Surveillance System (Sistem Informasi Tuberkulosis [SITB]). This study specifically assessed the magnitude of under-reporting of TB cases among children younger than 15 years in Indonesia. Methods: This study used a cross-sectional design and analyzed data from the 2023–2024 TB Inventory Study (SIV-TB) in Indonesia. The sample included all TB cases in children younger than 15 years identified from eligible health facilities. Under-reported cases were defined as those that were diagnosed and/or treated but not reported to the SITB. Descriptive statistics were used to characterize under-reporting. A record-linkage process was performed to compare SIV-TB data with SITB data after deduplication. Results: A total of 12 293 TB cases in children younger than 15 years were identified across health facilities in 31 districts and cities. The overall under-reporting rate for childhood TB was 23.5%. The highest under-reporting rate was observed in Eastern Indonesia (28.0%). Conclusions Under-reporting of childhood TB was significantly associated with both age group and type of health facility

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease of clinical importance in the Philippines. While its actual prevalence in the Philippines is unknown due to a lack of organized cohorts and community-level screening, Filipino females in the second and third decades of life are primarily affected, commonly presenting with mucocutaneous, musculoskeletal, hematologic, and renal involvements. Several risk factors have been described as influencing the development of SLE in Filipinos, including molecular/genetic, clinical, lifestyle, and environmental factors. The diagnosis of SLE in the Philippines still relies on international standards, such as the Systemic Lupus International Collaborating Clinics 2012 and the European League Against Rheumatism/American College of Rheumatology 2019 classification criteria. Similarly, the lack of published local guidelines for SLE requires Filipino practitioners to rely on international management guidelines, which now include the Asia-Pacific League of Associations for Rheumatology recommendations for the Asia-Pacific region, with management goals including the achievement of a low disease activity state, the prevention of organ damage, the prevention of flares, and the promotion of quality of life. Structural barriers still impede comprehensive lupus care in the country, manifesting as poor access to essential drugs and rheumatologists, low capacity for community-level surveillance, lacking research and guidelines in Philippine-specific nuances (i.e., common presentations and comorbidities such as tuberculosis), and education. The medical community in the country must be mobilized to ensure holistic care for SLE patients, as it is one of the most important rheumatologic conditions in the Philippines.

Background: Diet is an important modifiable factor that may influence sleep quality, with several foods, nutrients, and dietary patterns reported to affect sleep-related outcomes. However, evidence regarding the relationship between Halal dietary practices and sleep quality remains limited. This study aimed to determine the association between the frequency of consumption of Halal-certified food groups and sleep quality among adult Filipino Muslims. Methods: An analytical cross-sectional study was conducted among 323 adult Filipino Muslim members of the Greenhills Muslim Traders Association in San Juan City, Philippines. Participants were selected using purposive sampling based on predefined inclusion and exclusion criteria. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while dietary intake was measured using a structured questionnaire on the frequency of consumption of Halal-certified food groups. Descriptive statistics were used to summarize participant characteristics, dietary patterns, and sleep quality. Multivariable logistic regression analysis was performed to determine the association between Halal-certified food group consumption and sleep quality. Results: Halal-certified grain products were the most frequently consumed food group (mean = 2.39), while Halal-certified combination foods were the least frequently consumed (mean = 1.21). The mean global PSQI score was 4.62, indicating generally good sleep quality, and 67.8% of participants were classified as good sleepers (PSQI ≤5). Sleep efficiency had the highest mean component score (1.16), whereas subjective sleep quality had the lowest (0.00). Multivariable logistic regression showed no significant association between the frequency of consumption of most Halal-certified food groups and sleep quality (p > 0.05). However, more frequent consumption of Halal-certified combination foods was significantly associated with lower odds of good sleep quality (OR = 0.697, 95% CI: 0.529–0.919, p = 0.010). Conclusion The frequency of consumption of most Halal-certified food groups was not significantly associated with sleep quality among adult Filipino Muslims. However, increased consumption of Halal-certified combination foods was associated with lower odds of good sleep quality. Further studies should explore other dietary and behavioral factors that may influence sleep outcomes.
Sleep quality ;

Mosquito-borne arboviral diseases such as dengue and chikungunya have continuously been a major global public health concern. Introducing the intracellular bacterial endosymbiont Wolbachia into mosquito populations has been proven to reduce dengue virus transmission, and its broader efficacy against other arboviruses has also been investigated. Several Wolbachia strains have been successfully propagated in insect cell lines, highlighting the utility of in vitro systems for studying microbial-host interactions under controlled conditions. This study investigated the initial establishment and replication kinetics of a flea-derived Wolbachia strain (wCfe), which was originally isolated from Malaysian Ctenocephalides felis and maintained in the Ixodes scapularis tick-derived cell line (IDE8), and then transferred into an Aedes albopictus-derived cell line (C6/36). The wCfe strain was semi-purified from IDE8 cultures and inoculated into C6/36 cells in 24-well plates. Replication dynamics were monitored by quantitative real-time PCR targeting the Wolbachia pipientis 16S rRNA gene. Following infection, a lag phase was observed at day 0 to 5 days post-infection (d.p.i.), followed by exponential growth from 6 d.p.i. after which Wolbachia levels remained relatively stable until the end of the observation period at 12 d.p.i. Overall, a 25.30-fold increase in Wolbachia density was detected relative to 0 d.p.i. Across replicates, the estimated generation time of wCfe in C6/36 cells ranged from 1.7 to 2.5 days. These results demonstrate successful initial establishment and replication of the flea-derived Wolbachia strain in the Aedes mosquito cell line. However, longer-term in vivo studies will be necessary to determine the persistence of wCfe infection in C6/36 cells and within the mosquito host.

Background: Numerous studies have shown that air pollution is a serious public health threat and risk worldwide. Mongolia is the world leader in outdoor and indoor air pollution, and the morbidity and mortality caused by it are increasing every year. People spend most of their lives indoors, and it is necessary to regularly assess and study indoor air pollution. Aim: To study the concentration of PM2.5 particles in the indoor air of households in Ulaanbaatar and Darkhan cities in relation to some symptoms of respiratory diseases. Materials and Methods: The study was conducted using an analytical cohort design from October 2023 to July 2025, and the 4 districts of the central Ulaanbaatar city and Darkhan cities were included in the study. A total of 240 households were included in the study, including 48 households living in ger and house, 24 households living in apartments, and 48 households living in ger and house, and 24 households living in apartments from Ulaanbaatar city. A direct measurement device (PurpleAir) was installed in the households for 3-4 weeks to measure PM2.5 particles in the indoor air for 24 hours. After measuring PM2.5 particles in the indoor air of the household, data were collected through questionnaires from the participants aged 18-60 who participated in the study and underwent health examinations. The results were processed using STATA-19.0 and R programs. Result: 213-239 households were selected for the study, including households living in 17-26 apartments, 42-58 houses, and 38-50 houses. The 24-hour average concentration of PM2.5 particles in the ambient air of households in Ulaanbaatar city was measured relatively higher in winter and summer than in households in Darkhan city. Among the districts of Ulaanbaatar city, the highest concentration of PM2.5 particles was measured in Songinokhairkhan district, and the lowest concentration was measured in Bayanzurkh district. Considering the cities by heating type, households with stoves are more polluted than households with centralized heating. In Darkhan city, the lowest concentration was measured in apartments (22.78-31.53 μg/m³), houses (44.53-68.17 μg/m³), and the highest concentration was measured in traditional felt houses (houses) (63.20-68.25 μg/m³). In Ulaanbaatar, PM2.5 concentrations were relatively high in all types of housing, including apartments (41.61-58.37 μg/m³), houses (79.22-92.50 μg/m³), and traditional felt dwellings (76.69-86.31 μg/m³). In the summer, PM2.5 concentrations in Darkhan were 3.10-10.03 μg/m³ in apartments, 7.67-14.37 μg/m³ in houses, and 7.98-17.90 μg/m³ in traditional felt dwellings (houses). The concentration of PM2.5 particles in the ambient air of the settlement is statistically significantly associated with shortness of breath, fatigue, weakness, muscle pain, nausea, palpitations, sneezing, runny nose, conjunctivitis, pain in the eye socket, tearing of the eyes, headache, fever, nasal congestion, cough, loss of appetite, sore throat, phlegm, wheezing, and chest pain. Conclusion The 24-hour average concentration of PM2.5 particles in indoor air in households in Ulaanbaatar and Darkhan cities is higher than the Mongolian standard during winter and is statistically significantly associated with some symptoms of respiratory diseases.

Background: Dysregulation of inflammation underpins chronic cardiovascular, metabolic, neurodegenerative, and neoplastic conditions. Traditional medicine has long utilized medicinal plants to alleviate and treat systemic inflammation. Specifically, Rhodiola rosea L. and Rhodiola quadrifida (Pall.) Fisch. & C.A.Mey. possess anti-inflammatory, antitumor, antioxidant, and anti-angiogenic properties. Saposhnikovia divaricata (Turcz.) Schischk. has been shown to exert anti-inflammatory effects, support musculoskeletal function, and enhance tissue regeneration. Furthermore, Salsola laricifolia Litv. has been studied for its antioxidant, immunomodulatory, and anti-inflammatory activities. Although the individual anti-inflammatory, antioxidant, and antitumor activities of these plants are established, research evaluating the combined effect of their combined extract remains scarce, providing the rationale for this study. Aim: To evaluate the in vitro effects of a combined extract derived from these medicinal plants on the expression of selected pro-inflammatory cytokines. Materials and Methods: A dry combined extract consisting of Rhodiola rosea, Rhodiola quadrifida, Salsola laricifolia, and Saposhnikovia divaricata was prepared at the Chemistry and Technology Sector of the Institute of Pharmaceutical Research, Monos Group. An in vitro inflammation model was established using murine RAW264.7 macrophage-like cells stimulated with lipopolysaccharide (LPS, 100 ng/mL). Cell viability was assessed using the CCK-8 assay, while the output of pro-inflammatory cytokines TNF-α and IL-6 was measured via Enzyme-Linked Immunosorbent Assay (ELISA). Statistical analysis was performed using one-way ANOVA. Result: The combined plant extract demonstrated no cytotoxic effects on RAW264.7 cells across the tested concentration range. In LPS-stimulated RAW264.7 macrophages, the composite extract dose-dependently and significantly suppressed the production of the pro-inflammatory cytokines TNF-α (p<0.001) and IL-6 (p<0.0001). Conclusion 1. The combined extract of Saposhnikovia divaricata, Rhodiola rosea, Rhodiola quadrifida, and Salsola laricifolia exhibited no cytotoxicity in vitro within the range of 50–400 µg/mL. 2. The combined herbal extract significantly suppressed the production of pro-inflammatory cytokines TNF-α (p<0.01) and IL-6 (p<0.001) in LPS-induced RAW264.7 macrophages in a concentration-dependent manner.

Background: Globally, research on identifying bioactive compounds from medicinal plants and characterizing their in vitro and in vivo pharmacological activities is progressing rapidly. Plants native to Mongolia have adapted to unique, extreme continental climatic conditions, accumulating distinct phytochemicals, and have historically been utilized in traditional medicine and dietary practices. Establishing the non-cytotoxic safety threshold of these wild and cultivated plant extracts in RBL-2H3 mast cells a universally accepted model for type I hypersensitivity and inflammation is a vital prerequisite. Determining these baseline non-toxic dose ranges provides the essential scientific foundation for subsequent cellular allergy models, animal studies, and the elucidation of molecular mechanisms underlying their therapeutic efficacy. Aim: To determine the cytotoxicity profile and establish the non-cytotoxic dose ranges of extracts from four selected Mongolian plant species (wild and cultivated) in RBL-2H3 cells. Materials and Methods: Plant samples including lingonberry (Vaccinium vitis-idaea), strawberry (Fragaria orientalis), black radish (Raphanus sativus), and blue-berried honeysuckle (Lonicera caerulea L.) were standardly collected, authenticated, and cataloged as herbarium specimens at the Botanic Garden and Research Institute, Mongolian Academy of Sciences. A total of 12 distinct extracts were prepared from plant leaves, stems, and fruits using water and ethanol extraction, followed by concentration via rotary evaporation and freeze-drying. Rat basophilic leukemia (RBL-2H3) cells were maintained in EMEM growth medium and utilized during the exponential growth phase. Cell viability and non-cytotoxic concentration thresholds were evaluated using the MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay. Result: Ethanolic extracts of strawberry leaves, black radish, and honeysuckle leaves (≥6.25 µg/mL), as well as aqueous extracts of honeysuckle fruits (≥6.25 µg/mL) and stems (≥25 µg/mL), exhibited dose-dependent cytotoxicity. Conversely, aqueous extracts of lingonberry leaves (≤200 µg/mL), strawberry leaves (≥100 µg/mL), and black radish (≤200 µg/mL), alongside ethanolic extracts of lingonberry leaves (≥50 µg/mL), demonstrated non-cytotoxic profiles. Furthermore, ethanolic extracts of honeysuckle stems (≤300 µg/mL) and fruits (≥12.5 µg/mL), as well as the aqueous extract of honeysuckle leaves (≤50 µg/mL), significantly enhanced RBL-2H3 cell viability. Conclusion The tested plant extracts influenced RBL-2H3 cell viability in a solvent polarity and plant organ dependent manner. Ethanolic extracts of strawberry leaves, black radish, and honeysuckle leaves, along with aqueous extracts of honeysuckle fruits and stems, demonstrated relatively high cytotoxicity, reducing cell viability by >40% starting at concentrations of 12.5, 25, and 50 µg/mL. In contrast, aqueous extracts of strawberry leaves and black radish, as well as both aqueous and ethanolic extracts of lingonberry leaves, maintained low cytotoxicity at concentrations below 200 µg/mL. Notably, ethanolic extracts of honeysuckle stems and fruits (>12.5 µg/mL) and its aqueous leaf extract (<100 µg/mL) enhanced cell viability, exhibiting significant cell proliferation promoting activity.

Background: Polymyositis (PM) is a rare idiopathic inflammatory myopathy characterized by symmetric proximal muscle weakness, elevated muscle enzyme levels, dysphagia, and respiratory muscle weakness. Rhabdomyolysis is a potentially life-threatening condition caused by extensive skeletal muscle breakdown, resulting in myoglobinuria and an increased risk of acute kidney injury and multiorgan complications. The coexistence of rhabdomyolysis in patients with polymyositis is uncommon and may complicate both diagnosis and management. Case Presentation: A 65-year-old man was admitted with fever up to 39°C, generalized skin rash, dysphagia, progressive muscle weakness, dyspnea, decreased urine output, and dark tea-colored urine. Physical examination revealed symmetric proximal muscle weakness, with muscle strength graded 3/5 in both upper extremities and 4/5 in both lower extremities. Neck muscle strength was 4/5. Dysphagia and a generalized skin rash were also present. Laboratory investigations showed markedly elevated creatine kinase (CK) at 9,943.1 U/L, alanine aminotransferase (ALT) at 449.1 U/L, aspartate aminotransferase (AST) at 222.1 U/L, lactate dehydrogenase (LDH) at 1,342.9 U/L, and C-reactive protein (CRP) at 70.6 mg/L. Urinalysis showed blood 3+ and protein 2+, while no erythrocytes were detected on urine sediment microscopy. Electromyography demonstrated myopathic changes, and muscle biopsy revealed inflammatory infiltrates and necrotic muscle fibers. Conclusion Comprehensive assessment of clinical manifestations, laboratory findings, autoantibody testing, electrophysiological studies, and muscle biopsy is essential for the diagnosis of polymyositis complicated by rhabdomyolysis. An integrated diagnostic approach facilitates confirmation of the diagnosis, differentiation from clinically similar disorders, and appropriate treatment selection. Early recognition of rhabdomyolysis and other potentially life-threatening complications is crucial for preventing organ damage and improving patient outcomes.