Purpose: This study evaluated the effects of an 8‑week liquid diets with different carbohydrate contents–64% energy in HINE E‑Gel (ST) and 50% energy in HINE E‑Gel LC (LC)–on glycemic control and nutritional status in a mouse model of type 2 diabetes mellitus (db/db mice). The objective was to determine whether reducing carbohydrate intake within the Dietary Reference Intakes for Japanese people improves glycemic control indices, addressing the evidence gap in regarding the long‑term safety and efficacy of low‑carbohydrate enteral nutrition in patients with diabetes. Methods: db/db mice (n=10 per group) and non‑diabetic db/m mice (n=4) as controls were fed ST, LC, or AIN‑93G diets ad libitum for 8 weeks. The diets primarily differed in carbohydrate content (64% in ST vs. 50% in LC). Blood glucose and glycated hemoglobin (HbA1c), plasma glucose and glycoalbumin, organ weights, and renal function markers were measured weekly or at 4 and 8 weeks. Histopathological examinations of the liver and kidneys were performed at 8 weeks. Results: At 8 weeks, the LC group showed significantly lower plasma glucose (P=0.0051) and glycoalbumin (P=0.0013) levels compared to the ST group, with a trend toward lower HbA1c (P=0.0514). Although body weight was significantly higher in the LC group (P=0.0038), there were no significant differences between the ST and LC groups in caloric intake, renal function, or histopathological findings. Conclusion Reducing carbohydrate intake to 50% of total energy within dietary guidelines may improve glycemic control in diabetic mice, suggesting the need for further long‑term evaluation for clinical applications.

Purpose: This study evaluated the effects of an 8‑week liquid diets with different carbohydrate contents–64% energy in HINE E‑Gel (ST) and 50% energy in HINE E‑Gel LC (LC)–on glycemic control and nutritional status in a mouse model of type 2 diabetes mellitus (db/db mice). The objective was to determine whether reducing carbohydrate intake within the Dietary Reference Intakes for Japanese people improves glycemic control indices, addressing the evidence gap in regarding the long‑term safety and efficacy of low‑carbohydrate enteral nutrition in patients with diabetes. Methods: db/db mice (n=10 per group) and non‑diabetic db/m mice (n=4) as controls were fed ST, LC, or AIN‑93G diets ad libitum for 8 weeks. The diets primarily differed in carbohydrate content (64% in ST vs. 50% in LC). Blood glucose and glycated hemoglobin (HbA1c), plasma glucose and glycoalbumin, organ weights, and renal function markers were measured weekly or at 4 and 8 weeks. Histopathological examinations of the liver and kidneys were performed at 8 weeks. Results: At 8 weeks, the LC group showed significantly lower plasma glucose (P=0.0051) and glycoalbumin (P=0.0013) levels compared to the ST group, with a trend toward lower HbA1c (P=0.0514). Although body weight was significantly higher in the LC group (P=0.0038), there were no significant differences between the ST and LC groups in caloric intake, renal function, or histopathological findings. Conclusion Reducing carbohydrate intake to 50% of total energy within dietary guidelines may improve glycemic control in diabetic mice, suggesting the need for further long‑term evaluation for clinical applications.

Purpose: This study evaluated the effects of an 8‑week liquid diets with different carbohydrate contents–64% energy in HINE E‑Gel (ST) and 50% energy in HINE E‑Gel LC (LC)–on glycemic control and nutritional status in a mouse model of type 2 diabetes mellitus (db/db mice). The objective was to determine whether reducing carbohydrate intake within the Dietary Reference Intakes for Japanese people improves glycemic control indices, addressing the evidence gap in regarding the long‑term safety and efficacy of low‑carbohydrate enteral nutrition in patients with diabetes. Methods: db/db mice (n=10 per group) and non‑diabetic db/m mice (n=4) as controls were fed ST, LC, or AIN‑93G diets ad libitum for 8 weeks. The diets primarily differed in carbohydrate content (64% in ST vs. 50% in LC). Blood glucose and glycated hemoglobin (HbA1c), plasma glucose and glycoalbumin, organ weights, and renal function markers were measured weekly or at 4 and 8 weeks. Histopathological examinations of the liver and kidneys were performed at 8 weeks. Results: At 8 weeks, the LC group showed significantly lower plasma glucose (P=0.0051) and glycoalbumin (P=0.0013) levels compared to the ST group, with a trend toward lower HbA1c (P=0.0514). Although body weight was significantly higher in the LC group (P=0.0038), there were no significant differences between the ST and LC groups in caloric intake, renal function, or histopathological findings. Conclusion Reducing carbohydrate intake to 50% of total energy within dietary guidelines may improve glycemic control in diabetic mice, suggesting the need for further long‑term evaluation for clinical applications.

Purpose: This study evaluated the effects of an 8‑week liquid diets with different carbohydrate contents–64% energy in HINE E‑Gel (ST) and 50% energy in HINE E‑Gel LC (LC)–on glycemic control and nutritional status in a mouse model of type 2 diabetes mellitus (db/db mice). The objective was to determine whether reducing carbohydrate intake within the Dietary Reference Intakes for Japanese people improves glycemic control indices, addressing the evidence gap in regarding the long‑term safety and efficacy of low‑carbohydrate enteral nutrition in patients with diabetes. Methods: db/db mice (n=10 per group) and non‑diabetic db/m mice (n=4) as controls were fed ST, LC, or AIN‑93G diets ad libitum for 8 weeks. The diets primarily differed in carbohydrate content (64% in ST vs. 50% in LC). Blood glucose and glycated hemoglobin (HbA1c), plasma glucose and glycoalbumin, organ weights, and renal function markers were measured weekly or at 4 and 8 weeks. Histopathological examinations of the liver and kidneys were performed at 8 weeks. Results: At 8 weeks, the LC group showed significantly lower plasma glucose (P=0.0051) and glycoalbumin (P=0.0013) levels compared to the ST group, with a trend toward lower HbA1c (P=0.0514). Although body weight was significantly higher in the LC group (P=0.0038), there were no significant differences between the ST and LC groups in caloric intake, renal function, or histopathological findings. Conclusion Reducing carbohydrate intake to 50% of total energy within dietary guidelines may improve glycemic control in diabetic mice, suggesting the need for further long‑term evaluation for clinical applications.

Purpose: This study evaluated the effects of an 8‑week liquid diets with different carbohydrate contents–64% energy in HINE E‑Gel (ST) and 50% energy in HINE E‑Gel LC (LC)–on glycemic control and nutritional status in a mouse model of type 2 diabetes mellitus (db/db mice). The objective was to determine whether reducing carbohydrate intake within the Dietary Reference Intakes for Japanese people improves glycemic control indices, addressing the evidence gap in regarding the long‑term safety and efficacy of low‑carbohydrate enteral nutrition in patients with diabetes. Methods: db/db mice (n=10 per group) and non‑diabetic db/m mice (n=4) as controls were fed ST, LC, or AIN‑93G diets ad libitum for 8 weeks. The diets primarily differed in carbohydrate content (64% in ST vs. 50% in LC). Blood glucose and glycated hemoglobin (HbA1c), plasma glucose and glycoalbumin, organ weights, and renal function markers were measured weekly or at 4 and 8 weeks. Histopathological examinations of the liver and kidneys were performed at 8 weeks. Results: At 8 weeks, the LC group showed significantly lower plasma glucose (P=0.0051) and glycoalbumin (P=0.0013) levels compared to the ST group, with a trend toward lower HbA1c (P=0.0514). Although body weight was significantly higher in the LC group (P=0.0038), there were no significant differences between the ST and LC groups in caloric intake, renal function, or histopathological findings. Conclusion Reducing carbohydrate intake to 50% of total energy within dietary guidelines may improve glycemic control in diabetic mice, suggesting the need for further long‑term evaluation for clinical applications.

Background: Allergic contact dermatitis (ACD) is a common skin inflammatory reaction occurring at the site of challenge with a contact allergen in sensitized individuals and one of the most common causes for consultation in dermatology clinics. Patch testing is a method for detecting the causative component in suspected cases of ACD. Awareness about the causative allergen aids in reducing morbidity and can significantly minimize the impact of ACD in the affected people. Objectives: The study aimed to measure the number of relevant positive reactions in patch tests being performed in our institution in patients with ACD to cosmetic products. Methods: A total of 60 patients who were diagnosed with ACD to cosmetics and underwent patch testing were reviewed to identify the clinico‑epidemiological and patch test profiles of these patients. Results: The study showed that the mean age of patients was 42 comprising mostly of females. Most of the patients were unemployed, office workers, and medical workers. The most common cosmetic products that caused ACD include soaps, shampoos, lotions, and moisturizers. Nickel is still the most tested positive among these patients, followed by fragrance mixes and 4‑phenylenediamine base. They are widely distributed in cosmetic products, especially in soaps and lotions. The pattern of dermatitis revealed facial dermatitis to be the most common reason for consult of these patients. Conclusion Patch test is valuable in the setting of establishing the etiology of ACD to cosmetic products.
Dermatitis, Allergic Contact ; Cosmetics ; Patch Tests

A 45-year-old female came to our clinic due to multiple pustules on her fingers. The lesions first appeared when she was 15 years old, starting as a few erythematous macules on her left thumb that eventually developed into painful pustules. The patient claimed that no relief was provided by analgesics and oral antibiotics. Over the next 11 years, the lesions on her left thumb gradually spread to all her fingers including those on her right hand, accompanied by the development of erosions, fissures, and scales, as well as intermittent joint pains and swelling. These symptoms remained unresponsive to multiple topical products, the names of which the patient could not recall. At 24 years old, the patient experienced onycholysis in the first to third digits of her left hand, which progressed to anonychia and eventually affected all the fingers in her left and right hands. When the patient was 38 years old, similar pustules, erosions, fissures, and scaling appeared on several toes. Due to increasing discomfort from lesions spreading to her toes, making it difficult to put on footwear, the patient sought consultation at our dermatology clinic. No symptoms related to pulmonary, gastrointestinal, and genitourinary systems were reported. The patient denied pain or immobility in other joints of her right hand, hair or scalp changes, and oral mucosal lesions. There was no family history of psoriasis, hypertension, peripheral arterial diseases, or other conditions with similar lesions. The patient denied any history of cigarette smoking, chronic alcohol intake, or illicit drug use. On physical examination, the patient appeared comfortable with no signs of distress. We observed multiple erythematous pustules, some coalescing into pus-filled lakes, and thick white hyperkeratotic plaques with scales located on the distal interphalangeal joints, extending to the tips of all digits on both hands. Similar pustules and plaques with scales were seen on the first metatarsophalangeal joint of the right foot and the first digit of the left foot, sparing only the patient’s palms and soles (Figure 1). Anonychia affected all fingers, and there was shortening of all digits on both hands. No hair changes, oral mucosal lesions, or lymphadenopathies noted. The rest of the physical examination findings were unremarkable. Based on the history and clinical findings, we initially assessed the patient as having a form of acropustulosis. Differential diagnoses included infections (e.g., herpetic whitlow, staphylococcal felon, candidal paronychia), which were ruled out due to finger involvement and lack of systemic symptoms. Malignant conditions (e.g., squamous cell carcinoma, acrometastasis) were excluded from the differential diagnoses due to the absence of other typical indicators like trauma, chronic paronychia, exposure to radiation or arsenic fumes, a history of cigarette smoking, or a primary tumor.1 2 Inflammatory conditions (e.g., dyshidrotic eczema, chronic hand contact dermatitis) were also ruled out due to the lack of prominent pruritus, burning sensation, and exposure to common irritants.3 4 Immune-mediated conditions (e.g., palmoplantar pustulosis, palmoplantar psoriasis) were considered but eventually ruled because the patient's lesions did not involve her palms and soles.4 At the time of our evaluation, the patient had normal results in hematology, lipid panel, and liver and kidney function tests. Radiography of the hands showed shortening of the distal phalanges on the first to third digits on both hands, good alignment of osseous structures, intact outlines and trabecular patterns, and normal joint spaces and soft tissue shadows. These findings are consistent with brachydactyly, frequently observed in cases of psoriasis manifesting with dactylitis. Gram stain of the pustules yielded negative results. Histopathology from a skin punch specimen taken from an erythematous plaque on the third digit of the left hand showed focal parakeratosis overlying a spongiotic epidermis with hypogranulosis and psoriasiform hyperplasia. The dermis showed superficial dermal edema and moderately dense perivascular inflammatory infiltrates composed predominantly of lymphocytes and some neutrophils (Figure 1). The final histopathologic impression was psoriasiform dermatitis, ruling out other possible differential diagnoses, including infectious, malignant, and inflammatory conditions. Given the histopathologic consistency with psoriasis, coupled with the clinical presentation of multiple pustules on the tips of the digits and nail changes, the clinicopathologic final diagnosis was acrodermatitis continua of Hallopeau. We initiated oral methotrexate at 10 mg/week for 3 weeks, followed by an increase to 15 mg/week for 7 weeks, reaching a cumulative dose of 135 mg. The patient also received oral folic acid 5 mg daily on days without methotrexate and topical clobetasol propionate 0.05% ointment applied twice daily with occlusion at night. We provided counseling and education about the chronic nature of her condition, emphasizing the need for follow-up every 3 to 6 months. Most pustules resolved, and no new lesions were observed during the tenth week of treatment. No adverse events were reported, and erythema and scaling were significantly lessened. Acrodermatitis continua of Hallopeau (ACH) is a rare form of localized pustular psoriasis characterized by recurrent chronic eruptions of sterile pustules, especially affecting the distal regions of the fingers and toes, and occasionally the nail beds.4 5 The pathophysiology remains poorly understood, but a few authors attribute it to mutations in the interleukin-36RN gene.6 7 8 Diagnosis of ACH can be established based on clinical features. Histopathologic examination and laboratory tests may be helpful in difficult cases, but they are not necessarily performed in all patients.4 6 9 ACH is associated with a wide range of differential diagnoses including infectious paronychia of viral, bacterial, or fungal etiology, dishydrotic eczema, and infected contact dermatitis.4 10 11 Rarely, osteitis and osteolysis of the phalanges may occur in persistent or severe cases.4 6 12 Due to its chronic and relapsing nature, long-term therapeutic control of ACH is necessary to prevent complications.<13 Cirone et al> ACH is recalcitrant to available therapies, with no clear management guidelines or drugs achieving lasting remission.5 Progression to severe disease with irreversible complications is common, and even with treatment, ACH often recurs, affecting patients' physical and psychological well-being.

Cutaneous metastases are uncommon dermatologic manifestations, occurring in 0.7–0.9% of cancer patients. They typically originate from malignancies of the breast, lung, or gastrointestinal tract, with only a few reported cases arising from malignant cardiac tumors. Herein, we present a rare case of cutaneous metastasis from a primary cardiac myxofibrosarcoma (MFS). Based on available literature, this is the first documented case in the Philippines.

A 26-year-old man presented with rapidly enlarging nodules on the mandible and left thigh following the early recurrence of a previously excised cardiac myxoma. A biopsy of the skin lesions demonstrated a bottom-heavy distribution of atypical spindle cells in a myxoid stroma, raising suspicion of either a primary spindle cell neoplasm or cutaneous metastasis. This prompted a multidisciplinary investigation into the underlying malignancy. Histopathology and immunohistochemical staining of both the cardiac mass and skin lesions confirmed a diagnosis of cardiac MFS with cutaneous metastasis. The aggressive nature of MFS, combined with the presence of metastasis and the patient’s decision to decline further treatment, led to rapid clinical deterioration and ultimately, death.

Cutaneous metastasis from cardiac tumors is exceedingly rare and difficult to diagnose given the paucity of reported cases. This case highlights the pivotal role of dermatologists in recognizing these dermatologic manifestations, prompting further investigation into the underlying malignancy. Dermatologists must maintain a high index of suspicion when evaluating skin lesions of patients with a history of malignancy, given the significant treatment and prognostic implications.

Introduction: Nosocomial contaminants such as Pseudomonas aeruginosa and Serratia marcescens are increasingly developing resistance to many antibiotics. One of the promising alternatives that may complement, if not substitute, the use of antibiotics is quorum quenching, the process of interfering with chemical signals that mediate communication between microorganisms. Eleusine indica, a ubiquitous grass used traditionally to treat infections, has been shown to contain metabolites, such as fatty acid derivatives and p-coumaric acid, capable of quorum quenching. To date, there has been no study on the quorum quenching activity of E. indica.

Objectives: This study aimed to determine the in vitro activity of crude ethanolic extract of E. indica leaves against selected quorum-sensing regulated virulence factors of P. aeruginosa and S. marcescens.

Methodology: E. indica leaves were collected, washed, air-dried, and homogenized. Following ethanolic extraction and rotary evaporation, the extract was screened for antimicrobial activity through disk diffusion test and broth microdilution assay. The quorum quenching activity of the extract against P. aeruginosa was measured through swarming motility assay, while the activity against S. marcescens was measured through swarming motility and pigment inhibition assays. The quorum quenching assays were conducted in triplicates, and analysis of variance (ANOVA) was performed to identify differences among the treatment groups.

Results: Disk diffusion test revealed that no zones of inhibition formed against both P. aeruginosa and S. marcescens for varying concentrations of up to 200 mg/mL of the crude extract. Likewise, the MIC of the extract against both P. aeruginosa and S. marcescens was determined to be >200 mg/mL. However, it was shown that the extract, at 50 mg/mL, has statistically significant activity (p<0.05) against the swarming motility of P. aeruginosa, and it is 71.6% as effective in reducing the swarming area of the bacteria compared to cinnamaldehyde. This was not observed when the extract was tested against the swarming motility of and pigment production by S. marcescens.

Conclusion: In this study, the quorum quenching activity of the crude ethanolic extract of E. indica leaves was found to be effective against P. aeruginosa but not against S. marcescens. The compounds that will be identified by further studies may conceivably be used as an adjunct therapy in P. aeruginosa infections and as coating agents in medical devices.

Introduction. Migraine is a common, debilitating primary headache. Memantine is a non-competitive N-methyl D-aspartate (NMDA) antagonist that lowers neuronal excitability that could prevent migraine attacks. This study aimed to determine the efficacy and safety of memantine in patients with episodic migraine attacks using a systematic review and meta-analysis.

Methods. We searched CENTRAL, MEDLINE, Scopus, Cochrane, LILACS, ClinicalTrials.gov, HERDIN and Google Scholar for relevant studies until July 31, 2020. Prespecified screening and eligibility criteria for inclusion were applied. Included studies underwent methodological quality assessment. Study design, patient characteristics, interventions given, and relevant outcomes were extracted and synthesized.

Results. This review included five relevant articles - two randomized controlled trials (RCT) and three non randomized studies (one retrospective records review and survey, two prospective open-label single-arm trials). There were 109 patients included in the RCTs and 197 patients reported in the non-randomized studies. Pooled data from the two RCTs showed that memantine at 10 mg/day significantly decreased the monthly number of migraine days at 12 weeks compared to placebo with a mean difference of -1.58 [95% confidence interval (CI) -1.84, -1.32]. Non-randomized studies also showed a decrease in migraine days per month with memantine (5 to 20 mg/day) after 12 weeks [95% CI]: -9.1 [-11, -7.23], -7.2 [-8.85, -5.55], and -4.9 [-6.29, -3.51]. Adverse drug events (ADE) did not differ significantly between patients treated with memantine compared to placebo.

Conclusion. Memantine may be effective and well-tolerated as prophylaxis for episodic migraine.