BACKGROUND AND OBJECTIVE

Filipino farmers face unique occupational challenges that increase the risk of mental health issues, particularly anxiety. This study aims to determine the different personal, environmental, socioeconomic, occupational, and psychosocial factors associated with anxiety symptoms among Filipino farmers in Central Luzon.

Chain referral sampling method was used to recruit participants for the study, who underwent screening based on the eligibility criteria. Eligible participants were then asked about anxiety symptoms using the Generalized Anxiety Disorder-7 (GAD-7), while the validated, researcher-constructed Data Collection Tool for Factors Associated with Anxiety Symptoms (DCFAAS) was used to determine the farmers’ exposure to a variety of factors. Microsoft Excel was utilized in computing for frequency and percent distribution of participants, in each factor. Binary logistic regression was used to compute crude and adjusted odds ratio of each factor thru IBM SPSS Statistics®.

Among the 113 eligible farmers enrolled in the study, only 19 (16.8%) experienced anxiety symptoms, with excessive worrying, which was seen among 45 participants (39.8%). The mental health of Filipino farmers was significantly affected by the presence of physical illness (OR = 10.70 [95% CI 1.367, 83.773]) and having relatives affecting work completion (OR = 6.45 [95% CI 1.346, 30.896]). 

Despite the low prevalence of anxiety symptoms in this study, the findings suggest government policies to improve mental health service access to farmers, to integrate psychosocial support into agricultural programs, and to address family-related work pressures. By addressing these factors, it can improve farmer productivity and promote overall well-being, putting emphasis on the mental health of the Filipino farmers.

Over-the-counter medications are readily available and convenient. However, intake may result in cutaneous adverse reactions such as acute generalized exanthematous pustulosis (AGEP). The need to differentiate the disease to similar pustular diseases such as pustular psoriasis and subcorneal pustular dermatosis is essential, to give way to proper patient management. Its appearance with psoriasis vulgaris is uncommon.

We highlight a 36-year-old Filipino female with a known case of psoriasis vulgaris, undergoing phototherapy with good compliance and response, who took one dose of mefenamic acid due to headache. Three days after, she presented with multiple, pin-point pustules surrounded by multiple, erythematous plaques and desquamative scales over the body, including non-psoriatic areas.

A skin punch biopsy on the left arm revealed that the epidermis shows a subcorneal pustule with spongiosis and focal vacuolar alteration at the base. The dermis showed edema and was infiltrated mainly of lymphohistocytes and eosinophils, consistent with acute generalized exanthematous pustulosis.

Treatment with cyclosporine of 3.0 mkd was given, with topical corticosteroids of clobetasol 0.05% ointment mixed with petroleum jelly. Gradual tapering every two weeks was done, with 90% improvement. Blood pressure monitoring was done while on treatment. No recurrence of pustular lesions seen thereafter.

Apart from NSAIDs, beta-lactams, and beta-blockers are common causes of AGEP. There have been few published case reports about concomitant psoriasis vulgaris and acute generalized exanthematous pustulosis. To ascertain the diagnosis among subcorneal pustular dermatosis, pustular psoriasis, acute generalized exanthematous pustulosis, clinical and histopathologic correlation should be done.

Acute generalized exanthematous pustulosis (AGEP) and Stevens-Johnson Syndrome (SJS) are uncommon, severe cutaneous drug eruptions with distinct clinical and histopathological features. AGEP-SJS overlap is a rare and complicated cutaneous drug eruption. Neutrophilia, leukocytosis, and elevated liver enzymes can be seen in these patients. Currently, there are no available dermoscopic studies on AGEP overlapping SJS. The pathophysiology of overlapping drug reaction are mediated by T cells and delayed-type hypersensitivity. Management includes removal of offending drug and giving supportive measures like pain management, moist dressing and fluids.

People living with human immunodeficiency virus (PLHIV) are 100 times more at risk for cutaneous adverse drug reactions (ADRs). Acute generalized exanthematous pustulosis (AGEP) is a rare and severe cutaneous ADR associated with systemic involvement in 20% of cases.

This is a case of a 30-year-old male living with HIV admitted for acute gastroenteritis. Eight hours after initiation of intravenous ciprofloxacin and metronidazole, the onset of generalized monomorphic asymptomatic pustules was observed with associated weakness, fever, thrombocytosis, and neutrophilia. Ciprofloxacin was shifted to piperacillin-tazobactam. The patient was managed with intravenous hydrocortisone and oral cetirizine. Thereafter, the lesions remained stable in size and no new lesions occurred. The patient was referred to the dermatology service for further evaluation and management. A diagnostic workup was done which revealed subcorneal pustular dermatitis on histopathology, no fungal elements on periodic acid-Schiff stain, negative Gram stain, and no growth on culture. This case was diagnosed as AGEP secondary to ciprofloxacin. Dermatologic management consisted of oral antihistamines and topical steroids. The patient experienced generalized desquamation and gradual resolution of pustules over a two-week period with the eventual appearance of normal skin.

Ciprofloxacin is commonly used to treat opportunistic infections in the setting of HIV but it has never been documented to cause AGEP in such settings. Decreased CD4+ T-cell count (460 cells/µL) are factors associated with drug eruptions. Despite its toxic presentation, AGEP has a good prognosis with prompt withdrawal of the offending drug and supportive management.

OBJECTIVES: To study the clinical features of children with febrile seizures after Omicron variant infection. METHODS: A retrospective analysis was performed on the clinical data of children with febrile seizures after Omicron variant infection who were admitted to the Department of Neurology, Children's Hospital Affiliated to the Capital Institute of Pediatrics, from December 1 to 31, 2022 (during the epidemic of Omicron variant; Omicron group), and the children with febrile seizures (without Omicron variant infection) who were admitted from December 1 to 31, in 2021 were included as the non-Omicron group. Clinical features were compared between the two groups. RESULTS: There were 381 children in the Omicron group (250 boys and 131 girls), with a mean age of (3.2±2.4) years. There were 112 children in the non-Omicron group (72 boys and 40 girls), with a mean age of (3.5±1.8) years. The number of children in the Omicron group was 3.4 times that in the non-Omicron group. The proportion of children in two age groups, aged 1 to <2 years and 6-10.83 years, in the Omicron group was higher than that in the non-Omicron group, while the proportion of children in two age groups, aged 4 to <5 years and 5 to <6 years, was lower in the Omicron group than that in the non-Omicron group (P<0.05).The Omicron group had a significantly higher proportion of children with cluster seizures and status convulsion than the non-Omicron group (P<0.05). Among the children with recurrence of febrile seizures, the proportion of children aged 6-10.83 years in the Omicron group was higher than that in the non-Omicron group, while the proportion of children aged 3 years, 4 years, and 5 years in the Omicron group was lower than that in the non-Omicron group (P<0.05). CONCLUSIONS Children with febrile seizures after Omicron variant infection tend to have a wider age range, with an increase in the proportion of children with cluster seizures and status convulsion during the course of fever.
Male ; Female ; Humans ; Child ; Infant ; Child, Preschool ; Seizures, Febrile/etiology* ; Retrospective Studies ; Seizures ; Fever ; Epidemics ; Epilepsy, Generalized

OBJECTIVE: To analyze the clinical and genetic characteristics of a Chinese pedigree affected with developmental and epileptic encephalopathy 9. METHODS: N048: epilepsy full version gene detection panel-V2 and genome wide copy number variation analysis were carried out on the genomic DNA extracted from the peripheral blood samples. Amniotic fluid was also sampled for single nucleoticle polymorphism array (SNP-array) analysis. RESULTS: Both the mother and her daughter were found to have loss of heterozygosity at Xq21.31q22.1, with which exons of protocadherin 19 (PCDH19) gene was deleted. SNP-array showed the fetus to be a female and had arr[hg19]Xq21.31q22.1 (89 558 626-99 701 006)x1. The mother, daughter and fetus of this family all had developmental and epileptic encephalopathy 9. CONCLUSION Variant of the PCDH19 gene probably underlay the Developmental and epileptic encephalopathy 9 in this pedigree.
Cadherins/genetics* ; China ; DNA Copy Number Variations ; Epilepsy/genetics* ; Epilepsy, Generalized ; Female ; Humans ; Mutation ; Pedigree ; Protocadherins

Child ; Epilepsy, Generalized ; Family ; GTP-Binding Proteins/genetics* ; Humans ; Infant ; Spasms, Infantile/genetics* ; Tumor Suppressor Proteins/genetics*

OBJECTIVE: To explore the clinical phenotype and genetic characteristics of two children with developmental epileptic encephalopathy type 66. METHODS: Genomic DNA was extracted from peripheral blood samples of the two children and their parents. Whole exome sequencing (WES) was carried out and suspected variant was verified by Sanger sequencing. RESULTS: The main manifestations of the two children were neonatal onset seizures, hypotonia, global developmental delay, and facial dysmorphisms. Cranial MRI showed delayed myelination in case 1 and cerebellar dysgenesis in case 2. WES has identified a de novo pathogenic variant in the PACS2 gene in both patients, namely c.625G>A (p.Glu209Lys)(NM_001100913.3), which was reported as a pathogenic variant before. This variant was predicted to be pathogenic according to the American College of Medical Genetics and Genomics guideline (PS2+PM2+PP3). The seizures were controlled after combination treatment of sodium valproate and levetiracetam in both cases. At last follow-up, the motor and intellectual development of the 2 cases were improved. Compared with the cases reported, the clinical symptoms and signs of our cases were relatively mild, and the treatment effects were fairly good. CONCLUSION The variant of c.625G>A (p.Glu209Lys) in PACS2 gene is a hotspot variant of developmental epileptic encephalopathy 66. Gene testing can facilitate the clinical diagnosis and treatment.
Child ; Epilepsy, Generalized ; Family ; Genetic Testing ; Humans ; Magnetic Resonance Imaging ; Vesicular Transport Proteins/genetics* ; Whole Exome Sequencing

A boy, aged 66 days, was admitted to the hospital due to subcutaneous nodules for 46 days and abdominal distension for 10 days. The main clinical manifestations were loss of adipose tissue, subcutaneous nodules, insulin-resistant diabetes, hypertriglyceridemia, and hepatic steatosis. The boy was diagnosed with congenital generalized lipodystrophy type 1 (CGL1). His condition was improved after administration of middle-chain fatty acid formula milk and insulin injection or oral metformin. Gene testing revealed a homozygous mutation, c.646A>T, in the AGPAT2 gene, and both his parents were carriers of this mutation. This case of CGL1 has the youngest age of onset ever reported in China and multiple subcutaneous nodules as the initial symptom.
Adipose Tissue ; China ; Fatty Liver ; Humans ; Infant ; Insulin Resistance ; Lipodystrophy ; Lipodystrophy, Congenital Generalized ; Male

OBJECTIVE: To investigate whether the tonic-clonic seizure (TCS) induced by intermittent photic stimulation (IPS)was generalized tonic-clonic seizure (GTCS)or partial secondarily tonic-clonic seizure (PGTCS),and to analyze the relationship between them. METHODS: Video-electroencephalogram (VEEG)database of Peking University First Hospital from March 2010 to October 2018 were reviewed. Fifteen cases with idiopathic epilepsy who had TCS induced by IPS were included in this study, and their clinical and electroencephalogram (EEG)characteristics were retrospectively analyzed. RESULTS: In this study, 4 of the 15 cases were boys and 11 were girls. The age of seizure onset ranged from 1 to 13 years. According to the medical records: 12 cases were considered as GTCS,while the remaining 3 cases were considered as PGTCS. The age at VEEG monitoring ranged from 2.5 to 16.0 years. All backgrounds of the VEEG were normal. Interictal discharges:generalized discharges in 11 cases, of which 4 cases coexisted with posterior discharges, 2 cases coexisted with Rolandic discharges, the other 5 cases merely had generalized discharges; merely focal discharges in two cases, one in the Rolandic area and the other in the posterior area; no interictal discharge in the remaining 2 cases. IPS induced photoparoxysmal response (PPR)results: 2 cases without PPR,the remaining 13 cases with PPR of generalized discharges, and 6 of the 13 cases coexisted with posterior discharges. IPS induced photoconvulsive response (PCR)results: GTCS in one case (contradictory to medical history),PGTCS in 11 cases (consistent with medical history),and GTCS and PGTCS hardly to distinguish in the remaining 3 cases. Of the three conditions above, there were generalized myoclonic seizures induced by IPS before TCS in 7 cases. CONCLUSION The medical history was unreliable in determining whether TCS was generalized or focal. Myoclonic seizures can coexist with PGTCS, and sometimes GTCS was indistinguishable from PGTCS, indicating that the dichotomy of seizure types need to be improved. Photosensitive TCS should be regarded as a continuum between focal and generalized seizures.
Electroencephalography ; Epilepsy, Generalized ; Epilepsy, Tonic-Clonic ; Female ; Humans ; Male ; Retrospective Studies ; Seizures