INTRODUCTION

Administration of antenatal corticosteroids (ACS) between 24 and 36 weeks of gestation is recommended to pregnant women at risk of preterm delivery to decrease the risk of respiratory distress syndrome, intra-ventricular hemorrhage and neonatal death. However, it may worsen glycemic profile primarily in those with gestational diabetes mellitus (GDM).

To determine the effects of ACS on maternal glycemia in Filipino women with GDM and to analyze the factors associated with insulin use or increased insulin requirement.

A retrospective study of the medical records of Filipino women with GDM who were admitted and received ACS treatment (betamethasone) between 24- and 36-weeks age of gestation (AOG) for fetal lung maturity from 2017-2019. Clinical characteristics (age, parity, completed ACS dose, AOG at ACS administration and mode of delivery) and glycemic control were retrieved and compared before and after ACS treatment. Data collection began the day or on the day before steroids were given and continued until discharge or delivery.

Included were 42 pregnant women with GDM. Of these, 28 women with GDM were treated by diet alone (Group A) while 14 women with GDM were started on insulin in addition to diet (Group B). After betamethasone therapy was initiated, only three (Group A1; n=3/28) patients had good glycemic control with diet alone and the rest were given insulin treatment (Group A2; n=25/28). In this subpopulation of Group A2, insulin requirement within 24 hours after ACS was at 0.3 units per kg of body weight. There was a steady increase with maximum requirement observed on day 4 and decreased thereafter to 0.33 units per kg of body weight on day 5. For GDM women in Group B, only three maintained their insulin dose (Group B1; n=3/14) while 11 (Group B2; n=11/14) women with GDM previously on insulin, required further increase in insulin from day 1-2 reaching 140% increase in insulin dose on day 2. Thereafter, there was a gradual decrease of insulin dose almost returning to initial dose on day 5.

Insulin initiation was observed among GDM diet-controlled mothers (Group A) who were given ACS therapy at ≥31 weeks age of gestation. Age, parity, family history of diabetes and mode of delivery did not have significant effects on insulin use nor increased insulin requirement. Fasting capillary glucose (FCG) and one-hour post-prandial capillary glucose (PPCG) were elevated within 24 hours after administration of corticosteroid (betamethasone) in 60%-70% of our population. The FCG values remained elevated on day 2-3 in about 70% of patients. While the first hour PPCG was elevated in 85% of patients on day 2 and remained elevated in 70% of women on day 3-4, it reached 53% on day 5. Insulin requirement among Group B2 reached to 140% increase in insulin dose on day 2 followed by a gradual decrease of insulin dose almost returning to initial dose on day 5.

ACS administration caused maternal hyperglycemia in Filipino women with GDM during the first 24 hours and lasting up to five days. Both fasting glucose and post-prandial glucose were elevated, hence intensified monitoring of maternal glucose levels and temporary addition or increase of insulin doses may be necessary. The timing (≥31 weeks AOG) of administration of ACS on GDM women was associated with subsequent insulin initiation but only on patients initially controlled on diet alone.

Humans ; Aged ; Lung Diseases ; Pneumonia/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Administration, Inhalation ; Community-Acquired Infections/drug therapy*

Neuronomodulation refers to the modulation of neural conduction and synaptic transmission (i.e., the conduction process involved in synaptic transmission) of excitable neurons via changes in the membrane potential in response to chemical substances, from spillover neurotransmitters to paracrine or endocrine hormones circulating in the blood. Neuronomodulation can be direct or indirect, depending on the transduction pathways from the ligand binding site to the ion pore, either on the same molecule, i.e. the ion channel, or through an intermediate step on different molecules. The major players in direct neuronomodulation are ligand-gated or voltage-gated ion channels. The key process of direct neuronomodulation is the binding and chemoactivation of ligand-gated or voltage-gated ion channels, either orthosterically or allosterically, by various ligands. Indirect neuronomodulation involves metabotropic receptor-mediated slow potentials, where steroid hormones, cytokines, and chemokines can implement these actions. Elucidating neuronomodulation is of great significance for understanding the physiological mechanisms of brain function, and the occurrence and treatment of diseases.
Ligands ; Neurons/metabolism* ; Synaptic Transmission/physiology* ; Ion Channels/metabolism* ; Hormones/metabolism*

Female ; Humans ; Anti-Mullerian Hormone ; Sexual Development ; Peptide Hormones

Sweet syndrome (SS), or acute febrile neutrophilic dermatosis, is a rare inflammatory disorder characterized by fever, painful raised plaques, and dermal neutrophilic infiltration. Pediatric cases account for only 5% of SS globally, and no report exists of SS in infants in the Philippines. This report documents a unique case of SS in a one-month-old male, one of the first documented in the country. The rarity of this condition in infants and its successful management contribute valuable insights into the understanding and treatment of pediatric SS.

A one-month-old male presented with fever, erythematous plaques on the face and extremities, and a rapidly growing nodule on the left lateral neck, along with concurrent fever and cough. Skin biopsy showed dermal neutrophilic infiltration without leukocytoclastic vasculitis, confirming SS. A CT scan revealed a neck abscess and pneumonia. The abscess was treated with incision and drainage, and IV antibiotics. Due to the infection, systemic corticosteroids were contraindicated. Instead, topical hydrocortisone was applied, leading to rapid improvement of the skin lesions. This highlights a successful approach for managing SS when systemic therapy is unsuitable.

This case emphasizes the importance of early diagnosis and individualized treatment in rare pediatric cases of Sweet syndrome. The effective use of topical hydrocortisone in place of systemic steroids demonstrates the potential of alternative therapies, especially when infections preclude standard treatments. This case, one of the first in a neonate in the Philippines, contributes valuable insights to the limited literature on managing this rare condition in infancy.

Palmoplantar psoriasis is a rare subtype of psoriasis. It is a chronic, relapsing, inflammatory, immunologically-mediated disease affecting the palms and soles.

This is a case of a 58-year-old female with multiple, well-defined, yellowish plaques on slightly erythematous base with some fissures on bilateral palmoplantar areas affecting 4% of body surface area. On Dermatology Life Quality Index, she scored 14. She was advised biopsy but deferred. The lesions were also tested with potassium hydroxide for fungal elements, yielding positive results. She was initially managed as tinea pedis et manuum with three pulse doses of oral antifungal medication for three months. With minimal improvement, patient finally consented for biopsy, confirming diagnosis of psoriasis. She was subsequently treated with potent topical corticosteroids and narrowband-ultraviolet B localized phototherapy, leading to a complete clearance of lesions after 16 weeks of steroid treatment and 52 sessions of phototherapy. There was no more erythema, plaques and fissures, with affected BSA down to 0% and DLQI score to 1. Three months post-treatment, there is still no recurrence of lesions.

Palmoplantar psoriasis is an uncommon variant of psoriasis featuring hyperkeratotic plaques and fissures limited to the palms and soles with associated significant functional impairment. It can be difficult to diagnose, often mistaken for other diseases, and is typically resistant to treatment with poor long-term remission. Biopsy plays a crucial part in the effective management especially among patients with refractory disease. There are numerous treatment modalities but psychosocial needs are equally important to be addressed.

Cutaneous pseudolymphoma is a benign reactive lymphoproliferative skin disorder that can mimic cutaneous lymphoma. Clinical features include papules or indurated plaques that commonly affect the head and neck region and upper extremities. Various causative factors such as infectious agents, insect bites, vaccines, foreign bodies such as tattoos and drugs have been identified. Majority of the cases are idiopathic. Diagnosis is made by clinical assessment and careful histopathologic examination. Topical or intralesional steroids are the first-line therapy for persistent localized lesions.

This is a case of a 14-year-old male who presented with an 8-month persistent solitary violaceous to dusky red indurated plaque on the right distal ventral forearm. No trigger factors were identified. A skin biopsy with immunohistochemical staining (positively staining CD68, CD3 and CD20 T and B cells with no loss of CD7) revealed cutaneous lymphoid hyperplasia. Initial treatment with a topical steroid was unsuccessful, leading to the addition of intralesional steroid to the regimen. This resulted in partial improvement but did not prevent further plaque enlargement. Topical medication was then shifted to compounded 5-Fluorouracil cream which was applied twice daily for a duration of 18 months. In the first six months of treatment, the patient noted further decrease in size and flattening of the lesion with no reported adverse effects. A repeat biopsy after 18 months post- treatment revealed a marked reduction in lymphocytic infiltrates, indicating a favorable response to treatment.

The main goal of treatment in Cutaneous Pseudolymphoma is early disease recognition and prompt intervention. Topical 5- fluorouracil (5-FU) belongs to a class of medications known as anti-metabolites and has been used in the treatment of various recalcitrant benign and malignant skin tumors. Treatment efficacy of this case contributes to anecdotal evidence of topical 5-Fluorouracil in treating pseudolymphoma.

BACKGROUND

Psoriasis is an increasingly prevalent chronic disease commonly treated with topical corticosteroids (TCS), though these agents are often misused. There is a need to explore the factors influencing non-adherence to TCS among psoriasis patients in the Philippines.

This study aimed to determine the knowledge, attitude, and practice (KAP) regarding TCS among Filipino patients with psoriasis.

A cross-sectional survey was conducted on 76 Filipino patients with psoriasis in a tertiary hospital using a constructed validated questionnaire.

Patient scores clustered at the upper end of the distribution, indicating a generally good level of KAP regarding TCS. Increasing age was associated with a lower level of knowledge while female respondents had a higher level of knowledge. Higher knowledge levels were associated with better patient attitude, and better patient attitude was associated with better practice.

Predictors of correct KAP regarding TCS are less likely influenced by sociodemographic and clinical factors; rather, these three domains significantly correlate with each other. Physicians can utilize these interrelationships by educating patients regarding their topical treatment to yield more positive attitudes regarding its efficacy and minimize their fear of side effects, which can motivate them to adhere to prescribed therapy.

OBJECTIVES: To observe the effects of electroacupuncture (EA) at "Neiguan" (PC 6) and "Zusanli"(ST 36) on the gastric emptying rate, the level of serotonin (5-HT) and the protein expression of motilin (MTL), ghrelin, substance P (SP) and vasoactive intestinal peptide (VIP) in the antral tissue of the rats with functional dyspepsia (FD) and explore the effect mechanism of EA in treatment of FD. METHODS: A total of 21 SPF male SD rat pups were randomly divided into a normal group, a model group and an EA group, with 7 rats in each group. In the model group and the EA group, FD model was prepared by the gavage with 0.1% sucrose iodoacetamide solution combined with the modified small platform method. After the successful modeling, EA was applied to "Neiguan" (PC 6) and "Zusanli"(ST 36) in the rats of the EA group, with disperse-dense wave, 20 Hz/100 Hz in frequency, stimulated for 30 min, once daily, for 7 days consecutively. Before and after intervention, the general condition of the rats was observed in each group. After the completion of intervention, the gastric emptying rate was measured, the morphological changes of gastric antral tissue were observed using HE staining, the level of 5-HT was detected with ELISA method, and the protein expression of MTL, ghrelin, SP, and VIP was determined with Western blot method in the antral tissue of rats. RESULTS: In the normal group, the rats were in a good mental state, with lustrous fur, flexible movement and the increase of food intake and body mass. In the model group, the rats were poor in mental state, lack of lustre in fur, preference for the body curled up, reduced activity and response; and a part of rats had loose stool, obviously enlarged gastric body and gastric food retention. In the EA group, the general condition of rats, e.g. the mental state, food intake and activity, were improved, the gastric body got smaller obviously and the gastric food retention was reduced when compared with the model group. The antral structure was intact, the glands were rich and no injury of the gastric mucosa was found, e.g. inflammatory reaction and edema in the rats of each group. Compared with the normal group, the gastric emptying rate was decreased (P<0.01), 5-HT level was increased (P<0.01), the protein expression of MTL and ghrelin was reduced (P<0.01) and that of VIP was elevated (P<0.01) in the rats of the model group. The gastric emptying rate was increased (P<0.01), 5-HT level was decreased (P<0.01), and the protein expression of MTL and ghrelin was elevated (P<0.05, P<0.01) in the rats of the EA group when compared with those in the model group. CONCLUSIONS Electroacupuncture at "Neiguan" (PC 6) and "Zusanli"(ST 36) may effectively relieve gastric dysfunction, strengthen gastric motility and promote gastric emptying so as to alleviate the symptoms of dyspepsia in FD rats, and its mechanism may be related to the regulation of gastrointestinal hormones in the antral tissue.
Rats ; Male ; Animals ; Electroacupuncture ; Dyspepsia/therapy* ; Rats, Sprague-Dawley ; Ghrelin ; Gastrointestinal Hormones ; Serotonin ; Vasoactive Intestinal Peptide ; Acupuncture Points

OBJECTIVE: To evaluate the efficacy, safety and relapse of cyclosporine A (CsA) and CsA combined with corticosteroid (CS) as the frontline therapy for patients with newly diagnosed acquired pure red cell aplasia (aPRCA). METHODS: The clinical features, treatment responses, relapses and clinical outcomes of patients with newly diagnosed aPRCA in Peking Union Medical College Hospital (PUMCH) from January 2015 to May 2020 were analyzed retrospectively. All the enrolled patients had been treated with either CsA or CsA+CS for at least 6 months and had been followed up for at least 12 months, with complete clinical data and consent forms. RESULTS: 96 patients including 72 treated with CsA and 24 treated with CsA+CS were enrolled. With comparable baseline characteristics and follow-up periods, patients treated with CsA or with CsA+CS had similar overall response rates (ORRs) and complete response rates (CRRs) at the 3rd, 6th and 12th month and at the end of follow-up (P>0.05). Meanwhile, no significant difference was found between the two groups in the optimal ORR, optimal CRR, time to response or time to complete response. CsA+CS and CsA groups had similar adverse event (AE) rates, but CsA+CS group had higher CS-related infection rate (P <0.05). One patient in CsA+CS group died of multiple infections. As for the relapse, the two groups had compatible relapse rates at different time points, time to relapse, overall relapse rate and relapse-free survival (P>0.05). CsA exposure time, rather than different therapy regimens, was the only influence factor for either ORR or relapse rate (P <0.05). CONCLUSION CsA monotherapy has similar efficacy, AE rate and relapse rate as compared with CsA+CS for patients with newly diagnosed aPRCA, and shows less CS-related AEs such as infection.
Humans ; Cyclosporine/therapeutic use* ; Retrospective Studies ; Red-Cell Aplasia, Pure/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Remission Induction ; Treatment Outcome ; Immunosuppressive Agents/therapeutic use*