Public interest in cognitive enhancement has driven the widespread availability of dietary supplements claiming to support brain health and memory. This comparative cross-sectional study explores the commercial availability and marketing claims of cognitive-enhancing dietary supplements across offline and online retail platforms. A dual-component design was employed in a comparative cross-sectional study. The first component involved assessing the commercial availability and marketing claims of cognitive-enhancing dietary supplements sold through offline retail outlets in Kuala Lumpur using a purposive sampling approach. The second component consisted of a parallel assessment conducted on online platforms, employing a convenience sampling strategy. A total of 13 products were identified on offline retail platforms in Kuala Lumpur, and 117 products were identified on online platforms. Capsules were the most common dosage form, both offline (46.2%) and online (79.5%). Products sold offline most frequently originated from Singapore (69.2%), whereas online products predominantly came from the United States of America (74.4%). The median prices of offline products were RM 190 (55.5), and online products were RM 196 (183), which are comparable, although the online products exhibited a wider price range (RM14–RM1,147). The most frequent claims were “brain health” for offline products and “memory” for online products. Natural or compound extracts were the most common active ingredients. This study’s findings found significant differences between offline and online dietary supplements in terms of availability, country of origin, price and marketing claims. These inconsistent findings underscore the need for stronger regulation and improved transparency in labelling to safeguard consumer health and ensure product credibility. Future research should focus on dosage accuracy, long-term safety, and mechanisms of action for supplements with cognitiveenhancing claims.

BACKGROUND

Perimyocarditis due to inflammation of the pericardium and myocardium results in myocellular damage. Myocarditis, or myocardial inflammation, occurs after cardiac injury. Gallbladder edema, in the absence of cholecystitis, may occur in numerous conditions including cardiac inflammation.

A 28-year-old previously healthy female presented with chest pain, orthopnea, exertional dyspnea and a history of fever. She also reported intermittent right upper quadrant pain. Physical exam revealed a pericardial friction rub. Electrocardiogram (ECG) showed sinus rhythm with nonspecific ST-T changes; troponin I was elevated. Echocardiography demonstrated segmental wall motion abnormalities, pericardial thickening and preserved systolic function. Initially managed as acute coronary syndrome, she was later diagnosed with perimyocarditis. On the second hospital day, she developed recurrence of right upper quadrant abdominal pain. Abdominal ultrasound revealed gallbladder edema with pericholecystic fluid, but no stones. Liver enzymes were elevated. Acalculous cholecystitis was considered and cholecystostomy offered instead due to aspirin therapy. However, repeat imaging showed resolution of cardiac and gallbladder findings, and surgery was deferred. Cardiac MRI postdischarge was unremarkable.

Perimyocarditis may present with gallbladder edema mimicking acalculous cholecystitis, potentially leading to unnecessary surgical intervention. This case emphasizes the importance of considering cardiac etiologies in atypical abdominal presentations.

BACKGROUND

Takayasu arteritis (TAK) is a rare, chronic large-vessel vasculitis affecting the aorta and its major branches, leading to stenosis, occlusion, or aneurysmal changes. The global incidence is approximately 1.11 cases per million person-years, with a strong female predominance (80%–90%), typically manifesting between 40 and 50 years of age. Although TAK occurs worldwide, its prevalence is highest in Asia with 61 reported cases in the Philippines. Clinical manifestations are heterogeneous, ranging from nonspecific systemic symptoms to severe vascular complications, often delaying diagnosis, particularly in atypical cases.

We report a 43-year-old woman with hypertension, diabetes and chronic ischemic stroke without residuals who presented with a two-month history of easy fatigability, generalized weakness, arthralgia, intermittent claudication with progressive dark discoloration of both lower extremities, undocumented low-grade fever and alopecia. She developed acute respiratory distress with abrupt loss of consciousness requiring emergent intubation. Examination revealed a marked discrepancy in blood pressure between the upper extremities, diminished peripheral pulses and an audible abdominal bruit. Laboratory studies showed elevated Troponin I, ESR and CRP, with borderline ANA and normal complement levels. Neuroimaging demonstrated multiple acute and chronic cortical and cerebellar infarcts. Initially managed as a cerebrovascular accident, she required tracheostomy for ventilatory dependence. Antiplatelet and anticoagulant therapy was started after evidence of myocardial infarction. Progressive ischemia of the left lower extremity necessitated below-knee amputation. CT aortography later revealed diffuse thoracoabdominal aortic and iliac involvement with mural thickening, multiple aneurysms, dissection and unilateral renal artery stenosis. Further immunologic workup showed her to be negative for lupus anticoagulant. Immunosuppressive therapy with corticosteroids and methotrexate was initiated to control vascular inflammation and limit further progression.

This case highlights the diagnostic complexity of TAK with atypical, multi-organ ischemic presentations, emphasizing the importance of clinical vigilance, comprehensive vascular imaging and timely immunosuppressive therapy to mitigate complications and improve outcomes.

Mục tiêu: Đánh giá kiến thức, thái độ đối với người cao tuổi và một số yếu tố liên quan ở sinh viên điều dưỡng Trường Đại học Đại Nam. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang trên 252 sinh viên điều dưỡng từ năm thứ nhất đến năm thứ tư. Dữ liệu thu thập bằng bảng hỏi tự điền trực tuyến, sử dụng thang đo kiến thức FAQ (2015) đã điều chỉnh và thang đo thái độ KAOP. Phân tích số liệu bằng thống kê mô tả và kiểm định χ² với p<0,05. Kết quả: 28,2% sinh viên có kiến thức đạt về người cao tuổi; 71,8% chưa đạt. 96% sinh viên có thái độ tích cực. Mong muốn làm việc trong lĩnh vực chăm sóc người cao tuổi sau tốt nghiệp liên quan có ý nghĩa đến kiến thức và thái độ. Kết luận: Kiến thức về người cao tuổi của sinh viên điều dưỡng còn hạn chế, dù thái độ nhìn chung tích cực. Cần tăng cường nội dung lão khoa và trải nghiệm thực hành chăm sóc người cao tuổi trong chương trình đào tạo.

Cervical canal dimensions vary according to neck posture, and conventional magnetic resonance imaging (MRI) performed in a neutral position may underestimate the degree of cervical spinal cord compression. We report a patient with progressive cervical myelopathy in whom clinical deterioration was discordant with findings on static MRI. Dynamic MRI performed during cervical extension demonstrated significant multilevel spinal canal stenosis, which prompted timely surgical intervention. This case highlights the diagnostic value of dynamic MRI in situations of clinical-radiological mismatch and underscores its role in informing an appropriate surgical strategy.

Purpose: Maintaining the quality of Single Best Answer (SBA) questions remains a challenge in medical education, especially as artificial intelligence (AI)-generated items become more common. While considerable attention has been paid to AI question generation, the vetting process is under-explored and difficult to scale. Methods: This study investigates the feasibility and reliability of using a large language model to support the vetting of SBA questions. An AI-based reviewer, QA-bot, was developed using custom GPT and embedded with 25 criteria aligned with Bloom’s taxonomy (Levels 1–3). QA-bot and two experienced educators independently evaluated 32 AI-generated SBA questions using the shared evaluation rubric. Results: The rubric showed high internal consistency (Cronbach’s alpha=0.878), and strong inter-rater reliability between human reviewers (intraclass correlation coefficient [ICC]=0.893). QA-bot demonstrated good alignment with human raters (ICC=0.861 and 0.840). While the AI performed well on objective, rule-based criteria, it was less consistent in detecting irrelevant complexity and accurately judging difficulty. Conclusion These findings suggest that AI can function as an efficient first-pass reviewer, improving consistency and reducing workload, with human oversight remaining essential for educational and clinical relevance.

Coronary CT-derived fractional flow reserve (CT-FFR) is a noninvasive alternative to invasive FFR for assessing the hemodynamic significance of coronary artery stenosis. CT-FFR uses routinely acquired coronary CT angiography (CCTA) with artificial intelligence and computational fluid dynamics to estimate pressure gradients, thereby supporting clinical decisionmaking without procedural risk. Adoption and implementation vary widely across regions. In Asia, South Korea exclusively uses HeartMedi+, which enables rapid analysis, streamlined workflow integration, and high user satisfaction. Japan relies primarily on FFR CT, which has national reimbursement and significantly influences treatment strategies, reducing unnecessary invasive procedures. Hong Kong, Singapore, Taiwan, Thailand, and Vietnam remain in early or exploratory phases due to cost, reimbursement, and infrastructure barriers. In the United States, CT-FFR is guideline-endorsed and reimbursed, where HeartFlow is the most widely used, supported by robust clinical validation and outcome data. Despite regional variability, CTFFR offers a noninvasive solution that enhances patient management, reduces unnecessary invasive testing, and is poised for broader clinical integration as technology and validation advance.

Background: Reduction of immunosuppression (ROI) remains the mainstay of treatment for BK virus infection (BKVI) in kidney transplantation (KT). This review explored the role of intravenous immunoglobulin (IVIG) and mammalian target of rapamycin inhibitor (mTORi) regimens as alternative therapies for KT recipients with BKVI, focusing on viral clearance and graft-related outcomes. Methods: An electronic search was conducted for articles examining IVIG or mTORi use in treating BKVI among adult and/or pediatric KT recipients. Meta-analyses of proportions were performed for relevant outcomes. Results: Twenty-seven studies (13 evaluating IVIG and 14 evaluating mTORi) were included; all but three enrolled only adult participants. In IVIG studies, the pooled viral clearance rate was 76.4% (95% confidence interval [CI], 64.2%–85.5%), with numerically higher clearance for IVIG after ROI compared to IVIG with ROI (87.0% vs. 66.1%). Overall graft survival was 84.7% (95% CI, 70.7%–92.7%), with numerically higher survival in IVIG after ROI than in IVIG with ROI (93.6% vs. 78.4%). Pooled histological clearance and graft rejection rates were 82.8% and 14.5%, respectively. In mTORi studies, the pooled viral clearance rate was 68.0% (95% CI, 58.0%–76.7%) and overall graft survival was 89.1% (95% CI, 82.7%–93.4%), with no significant difference between patients with and without prior ROI. Histological clearance and graft rejection rates were 59.8% and 8.6%, respectively. Conclusions IVIG and mTORi regimens appear to be feasible alternatives to ROI in KT recipients with BKVI, achieving viral clearance while maintaining graft survival. Future randomized controlled trials are needed to further define their role and strengthen current evidence with higher-quality data.

Vascularized composite allotransplantation (VCA) has transformed reconstructive surgery for patients with severe tissue defects. Nonetheless, donor shortages remain a major limitation. Cross-sex VCA (CS-VCA) has been proposed as a means of expanding the donor pool, but concerns persist regarding potentially heightened rejection risks in sex-mismatched transplants. This review examines published adult CS-VCA cases up to May 2025. The primary outcomes analyzed were acute rejection episodes, allograft survival, immunological complications, and sequelae affecting form and function.Nine CS-VCA cases were identified (six upper extremity, one lower extremity, and two abdominal wall transplants). Eight involved female donors (median age, 47 years) and male recipients (median age, 30 years). Acute rejection occurred in five of nine cases;however, 11 of 13 allografts remained viable at follow-up (6–41 months) under immunosuppressive therapy. Two cases developed vascular complications, resulting in technical failure and partial amputation, respectively. Higher human leukocyte antigen (HLA) mismatches (mean, 5) were associated with complications, while fewer mismatches (mean, 3) correlated with better outcomes. In contrast to trends in solid organ transplantation, female-to-male CS-VCA demonstrated relatively favorable outcomes in the limited cases reported. These findings suggest that CS-VCA may be a feasible strategy to expand the VCA donor pool, provided that patient selection is careful, ABO/Rh and HLA compatibility are prioritized, and rigorous immunological monitoring is maintained.Further studies should investigate sex-specific immune mechanisms to optimize longterm success rates.

INTRODUCTION

Urinary stone disease remains a significant global and national health concern. This underscores the need for measures to improve disease outcomes. The development and implementation of clinical practice guidelines for urolithiasis was deemed essential due to variations in practice, the evolving urologic field with its emerging interventions, which may have significant cost implications.

The CPG was developed following the GRADE Adolopment method, the CORE GRADE Approach and the GRADE Evidence to Decision framework, and utilized the Technical Manual for Clinical Practice Guideline Development of the Department of Health (2nd edition). The guideline development group was organized after review and management of the members' conflict of interest declarations. Clinical questions were prioritized and a systematic search and synthesis of the relevant literature to answer the questions was done. Considering the balance of benefits and harms, certainty of the evidence, cost and cost effectiveness, accessibility, acceptability and feasibility of the interventions, the guideline panel developed recommendations by consensus.

The CPG addresses eleven priority clinical questions involving diagnosis and treatment of acute flank pain due to suspected urolithiasis among adults, minimally invasive treatment of nephrolithiasis measuring 1-2 cm and the use of alpha blockers after ESWL through twelve recommendations and one good practice statement.

The Philippine CPG on the management of urolithiasis in adults provides actionable recommendations to address important clinical questions on the diagnosis and management of urinary stone disease. The full text of the clinical practice guideline may be viewed and downloaded from https://doh.gov.ph/dpcb/doh-approved-cpg/