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.

OBJECTIVE

To assess the diagnostic accuracy of point-of-care screening using Medios™ Artificial Intelligence (AI) in the diagnosis of diabetic retinopathy (DR).

This is a multi-center, cross-sectional, instrument validation study among adult Filipinos with Type 2 diabetes seen at Endocrine specialty clinics from May to November 2021. Retinal images were captured by a minimally trained nurse using the Remedio Fundus on Phone (FOP). Images were interpreted separately by the Medios™ AI and three retina specialists. The primary outcome measure is the accuracy of Medios™™ AI in diagnosing DR compared to retina specialists’ findings using sensitivity and specificity, predictive values, and likelihood ratios.

A total of 182 subjects with Type 2 diabetes were included in the study. The sensitivity and specificity of the Medios™ AI in diagnosing any DR were 73.68% (95%CI, 57.99-85.03) and 83.74% (95%CI, 79.35-87.35), respectively, compared with the retinal specialists’ findings using the same images. The positive and negative predictive values were 34.57% (95%CI, 25.12-45.41) and 96.47% (95%CI, 93.62-98.07). The positive and negative likelihood ratios were 4.53 (95%CI, 4.26 4.82) and 0.31 (95%CI, 0.26-0.38). The overall diagnostic accuracy of Medios™ AI in detecting DR was 82.69% (95%CI, 78.47-86.23).

The Medios™ AI system showed acceptable diagnostic accuracy when used as a point-of-care screening tool in detecting DR among patients with Type 2 diabetes seen at Endocrine specialty clinics. This technology can be a useful screening tool for endocrinologists as it is relatively inexpensive, safe, and easily performed. It can also shorten the lead time from screening to referral and intervention.

BACKGROUND

The COVID-19 pandemic brought insurmountable changes, leading to work demands and resource limitations that placed additional physical and occupational stress.

This study aimed to determine the change in the occurrence and intensity of musculoskeletal discomfort among selected university faculty members. It also determined the association of sociodemographic and anthropometric factors, workplace conditions, and involvement in physical activity with musculoskeletal pain.

This is an analytical cross-sectional study conducted from June 2022 to May 2023 that surveyed university faculty members from Metro Manila and Metro Cebu. Outcome measures include sociodemographic data, anthropometric measures of weight, height, body mass index, workplace conditions, exercise participation, and musculoskeletal discomfort using the Cornell Musculoskeletal Discomfort Questionnaire.

Data from 120 participants, mostly female, with an average BMI of 27.78 ± 12.09 kg/m2 and 11.82 ± 10.39 years of teaching experience revealed increased computer usage and reduced teaching hours during the Pandemic lockdown. There was also prevalent musculoskeletal discomfort (MSD), particularly in the neck, shoulder, and upper back. Factors associated with increased MSD were female gender, longer computer use, and pre pandemic MSD history.

This study underscores the significance of addressing ergonomic factors and work conditions to mitigate MSD risks among educators during challenging situations.

INTRODUCTION

Psoriasis is a chronic, immune-mediated polygenic skin disorder characterized by epidermal hyperplasia. Cardinal histopathological features are as follows: hyperkeratosis, parakeratosis, neutrophils in the stratum corneum and spinous layer, hypogranulosis with suprapapillary thinning, acanthosis, clubbed rete ridges, dilated capillaries, and perivascular lymphocytes. As histopathology may be more definitive compared to clinical manifestations, being able to diagnose psoriasis accurately through histopathology may enable early diagnosis and treatment. This could ideally mean a decrease in its progression, prevention of complications, and improvement of quality of life for psoriatic persons.

To examine, grade, and compare histopathologic f indings of psoriatic lesions with established parameters from previous literature.

This is a retrospective descriptive study that will examine, grade, and compare all histopathologic findings of psoriatic lesions of patients who have accessed care at Ospital ng Manila Medical Center from 2010-2015 with established parameters from previous literature.

All 41 cases (100%) showed parakeratosis, followed in decreasing order by 19 cases (46.34%) with Munro's microabscesses, 15 cases (36.59%) with pustules of Koga, 15 cases (36.59%) with hypogranulosis, and 11 cases (26.83%) with spongiosis. Using the visual analogue scale of Moorchung Net al (2013), 28 cases (68.29%) showed mild inflammatory infiltrates, followed in decreasing order by 19 cases (46.34%) with mild epidermal hyperplasia, 12 cases (29.27%) with mild capillary proliferation, and 4 cases (9.77%) with mild suprapapillary thinning.

Findings of the current study showed histopathologic features of both early and fully developed lesions based on established psoriasis histopathological parameters. Recognized histopathological features were not consistently found in well-developed lesions.

Objective: One key factor found to be related to creativity is creative self-efficacy. Creative self efficacy (CSE) refers to one’s own conviction in their own ability to produce creative work effectively. The study aims to explore on the predictive values of time management and reading habit on CSE, as well as on the significant difference between gender and CSE. Method: This study (n = 313) is a cross-sectional survey design. The inclusion criteria for the participants are full-time university students studying in Malaysia and aged between 18-25 years old. Data collected was analysed by linear regression, multiple linear regression and independent sample t-Test. Results: Reading habit is a significant positive predictor of CSE. Both daily planning and confidence in long-range planning in time management are significant positive predictors of CSE. However, there is no significant difference between gender in terms of male and female and CSE. Conclusion This study provided evidence on the role of reading habits and time management on creative self-efficacy amongst undergraduate student in Malaysia.
Gender Identity ; Time Management

BACKGROUND

Ahigh-quality measurement tool is essential to accurately assess the innovative teaching strategies in health professions education. The Blended Teaching Assessment Tool (BTAT) aims to evaluate quality blended teaching or instructional delivery in Philippine health science programs. However, there is a lack of studies examining students' cognitive processes to support the validity of questionnaires.

Cognitive interviewing (CI) was employed to determine whether students interpreted and responded to the items correctly. Content analysis was done using Tourangeau's Cognitive framework. Four CIs were conducted by an expert moderator and note-taker with a total of 8 health science students (2 groups with 3 members, and 2 one-on-one interview) for around 1 to 2 hours via Zoom following a retroactive approach with verbal and spontaneous probing, guided by a semi-structured interview questionnaire.

Various issues related to comprehension, retrieval, judgment, and response were identified, leading to significant revisions of the tool from 82 items across 8 dimensions to 53 items across 5 dimensions. The challenges included unfamiliar terminology, ambiguous phrasing, complex statements, inconsistencies and irrelevance to students' real-life experiences. These findings emphasize the importance of students' feedback in enhancing the validity and reliability of assessment tools.

The Cognitive Interview identified crucial issues in comprehension, retrieval, judgment, and response, making it essential for developing the Blended Teaching Assessment Tool and ensuring valid responses on the quality of blended teaching and learning delivery.

BACKGROUND

Non-Alcoholic Fatty Liver Disease (NAFLD) is common in Type 2 Diabetes Mellitus (T2DM). The FIB-4 index is one of the most-studied non-invasive biomarkers that combines age and laboratory parameters (platelet count, alanine-and aspartate- aminotransferase) to evaluate underlying hepatic fibrosis. This study aims to determine the diagnostic value of Fibrosis-4 (FIB-4) index scoring in screening for non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus, which is a high-risk population in development of advance fibrosis.

A single center, analytical cross-sectional study was conducted among adult T2DM patients with and without NAFLD seen at the Out-Patient Department (OPD) and those with NAFLD enrolled under the Liver Disease Databank of the Liver Disease and Transplant Center in collaboration with Research and Biotechnology Division at St. Luke’s Medical Center, Quezon City. Medical history was obtained by reviewing charts of eligible patients using data collection form. Liver ultrasound was used as the reference standard in the diagnosis of NAFLD. The FIB-4 index was calculated with this formula: age (years) x AST (U/L)/(platelets (10^9/L) x ALT (U/L)^1/2.

A total of 305 adult patients with type 2 diabetes mellitus were included in the study. The prevalence of non-alcoholic fatty liver disease based on ultrasound among diabetic patients is 76.07%. The median age (p = 0.0204), AST (p < 0.00001), ALT (p < 0.00001) were significantly higher in patients with NAFLD than those without. Platelet count (p = 0.0002) was significantly lower in patients with NAFLD than those without. The proportion of patients with low platelet count, high AST and high ALT were significantly higher in patients with NALFD than those without. In this study, the FIB-4 index cutoff score for screening of NAFLD is ≥0.76, which has an accuracy of 66.23%, sensitivity of 75%, specificity of 38.3%, PPV of 79.46% and NPV of 32.56% in detecting fatty liver.

A FIB-4 index value of ≥0.76 has an acceptable sensitivity for screening NAFLD even in the absence of fibrosis among patients with T2DM. However, due to its low specificity, additional tests to establish NAFLD diagnosis may be required.

Miliary tuberculosis (TB) is a disseminated form of TB resulting from the lymphohematogenous spread of Mycobacterium tuberculosis (MTb). Since pregnancy-related TB lacks the typical respiratory symptoms, clinicians might overlook the condition, complicating early diagnosis and treatment. This is a case of a 39-year-old multigravida, who presented with vaginal bleeding in the second trimester. She was admitted for tocolysis and correction of severe anemia. On the 6th hospital day, there was a note of febrile episodes accompanied by productive cough. Chest X-ray revealed miliary spread, eventually detecting MTb on sputum GeneXpert. At 19-week age of gestation, she delivered to an abortus. Histopathology of the endometrial tissues revealed caseating granulomas, consistent with tuberculous etiology. The disease’s severity, stage of the pregnancy at the time of diagnosis, and the existence of extrapulmonary dissemination might influence the outcome of pregnancy.