Pub Date : 2022-10-31DOI: 10.35460/2546-1621.2022-0044
Nadine J Endaya, R. Rosales
POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) also known as Crow-Fukase syndrome or Takatsuki syndrome is a rare and disabling paraneoplastic syndrome that frequently occurs in the fifth or sixth decade of life without a known standard first-line therapy. A 34-year-old Filipino male nurse, who presented with gradually progressive distal lower extremity weakness and sharp shooting pain in bilateral legs accompanied by mild joint effusion on the left knee, hypertrichosis, bilateral conjunctival injection, and gynecomastia underwent extensive workup and was diagnosed with POEMS syndrome. Complete blood count revealed erythrocytosis and thrombocytosis with elevated serum VEGF (vascular endothelial growth factor) and elevated monoclonal serum free lambda light chains. The electrophysiologic studies revealed chronic demyelinating sensorimotor polyneuropathy while bone marrow core biopsy and bone marrow aspirate smear immunohistochemical staining showed it to be positive for lambda and CD138. He had an initial unsuccessful treatment course with melphalan and prednisone. Hence, bortezomib and dexamethasone were given which gave significant improvement in symptoms from the overall neuropathy limitation score of 5 to 1.
{"title":"Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin abnormalities (POEMS) Syndrome in a Filipino Nurse Returning to Work Following Bortezomib Treatment: A Case Report","authors":"Nadine J Endaya, R. Rosales","doi":"10.35460/2546-1621.2022-0044","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-0044","url":null,"abstract":"POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) also known as Crow-Fukase syndrome or Takatsuki syndrome is a rare and disabling paraneoplastic syndrome that frequently occurs in the fifth or sixth decade of life without a known standard first-line therapy. A 34-year-old Filipino male nurse, who presented with gradually progressive distal lower extremity weakness and sharp shooting pain in bilateral legs accompanied by mild joint effusion on the left knee, hypertrichosis, bilateral conjunctival injection, and gynecomastia underwent extensive workup and was diagnosed with POEMS syndrome. Complete blood count revealed erythrocytosis and thrombocytosis with elevated serum VEGF (vascular endothelial growth factor) and elevated monoclonal serum free lambda light chains. The electrophysiologic studies revealed chronic demyelinating sensorimotor polyneuropathy while bone marrow core biopsy and bone marrow aspirate smear immunohistochemical staining showed it to be positive for lambda and CD138. He had an initial unsuccessful treatment course with melphalan and prednisone. Hence, bortezomib and dexamethasone were given which gave significant improvement in symptoms from the overall neuropathy limitation score of 5 to 1.","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127042374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-31DOI: 10.35460/2546-1621.2022-0086
{"title":"Fork in the Road: Pick Research and Publication","authors":"","doi":"10.35460/2546-1621.2022-0086","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-0086","url":null,"abstract":"","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125396743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-31DOI: 10.35460/2546-1621.2022-0043
J. Catindig, F. Rasay, M. C. Folloso, R. Abrenica
Background: Disruption of neurocognitive functioning is one of the most frequent complications in patients infected with Human immunodeficiency virus. It manifests as a form of subcortical dementia characterized by psychomotor slowing, changes in mood and anxiety levels and deficits in memory, abstraction, information processing, verbal fluency, decision-making, and attention. The primary objective of this study is to determine the prevalence of neurocognitive impairment among HIV-positive individuals in the Philippines. Methods: This is a cross-sectional study done at the outpatient department of a tertiary infectious disease hospital located in Manila, Philippines conducted from May to July 2015. The Montreal Cognitive Assessment – Filipino (MoCA-P) was used to differentiate non-cognitively impaired and cognitively impaired participants. Demographic data was obtained using structured interviews including the CD4 count. Results: One hundred and twelve HIV positive patients were examined and 56.7% of them were noted to have cognitive impairment while none of them met the criteria for dementia. After logistics regression analysis, only the CD4 count (x=224) was shown to have significant association with cognitive impairment (p=0.0001, OR 0.96). Conclusion: Cognitive impairment was significantly associated with low CD4 count, with a sensitivity of 100% for a count of <224. More than half or 58.7% of subjects with cognitive impairment did not show any neuropsychiatric symptoms. Neurocognitive impairment is still an important component of HIV infection and this study highlights the need to further increase awareness regarding this HIV complication.
背景:神经认知功能破坏是人类免疫缺陷病毒感染患者最常见的并发症之一。它表现为皮层下痴呆的一种形式，其特征是精神运动减慢、情绪和焦虑水平的变化以及记忆、抽象、信息处理、语言流利、决策和注意力的缺陷。本研究的主要目的是确定菲律宾艾滋病毒阳性个体中神经认知障碍的患病率。方法:这是一项横断面研究，于2015年5月至7月在菲律宾马尼拉一家三级传染病医院的门诊部进行。蒙特利尔认知评估-菲律宾(MoCA-P)被用来区分非认知受损和认知受损的参与者。通过结构化访谈获得人口统计数据，包括CD4计数。结果:共检查了112例HIV阳性患者，56.7%的患者存在认知功能障碍，但均不符合痴呆标准。经logistic回归分析，只有CD4计数(x=224)与认知障碍有显著关联(p=0.0001, OR 0.96)。结论:认知障碍与CD4计数低显著相关，CD4计数<224的敏感性为100%。超过一半或58.7%的认知障碍患者没有表现出任何神经精神症状。神经认知障碍仍然是HIV感染的一个重要组成部分，这项研究强调了进一步提高对这种HIV并发症的认识的必要性。
{"title":"Cognitive Impairment Among HIV-positive Individuals in a Tertiary Infectious Disease Hospital in the Philippines","authors":"J. Catindig, F. Rasay, M. C. Folloso, R. Abrenica","doi":"10.35460/2546-1621.2022-0043","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-0043","url":null,"abstract":"Background: Disruption of neurocognitive functioning is one of the most frequent complications in patients infected with Human immunodeficiency virus. It manifests as a form of subcortical dementia characterized by psychomotor slowing, changes in mood and anxiety levels and deficits in memory, abstraction, information processing, verbal fluency, decision-making, and attention. The primary objective of this study is to determine the prevalence of neurocognitive impairment among HIV-positive individuals in the Philippines. Methods: This is a cross-sectional study done at the outpatient department of a tertiary infectious disease hospital located in Manila, Philippines conducted from May to July 2015. The Montreal Cognitive Assessment – Filipino (MoCA-P) was used to differentiate non-cognitively impaired and cognitively impaired participants. Demographic data was obtained using structured interviews including the CD4 count. Results: One hundred and twelve HIV positive patients were examined and 56.7% of them were noted to have cognitive impairment while none of them met the criteria for dementia. After logistics regression analysis, only the CD4 count (x=224) was shown to have significant association with cognitive impairment (p=0.0001, OR 0.96). Conclusion: Cognitive impairment was significantly associated with low CD4 count, with a sensitivity of 100% for a count of <224. More than half or 58.7% of subjects with cognitive impairment did not show any neuropsychiatric symptoms. Neurocognitive impairment is still an important component of HIV infection and this study highlights the need to further increase awareness regarding this HIV complication.","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133939131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-31DOI: 10.35460/2546-1621.2022-0051
Mary Suzette R Cody
The Covid-19 pandemic challenged every healthcare system, and the disruption of clinical trials was not the least of it. Many clinical trials halted or did not activate as sponsors and investigators grappled with the risk of infection if patients involved in clinical trials visited trial sites. The clinical studies that managed to continue and complete were those that immediately adopted decentralized clinical trials (DCT) technologies such as eSource. Patients were engaged from the comfort and convenience of their homes during the clinical trials with the use of DCT technologies. The flexibility in recruitment, engagement, and monitoring of clinical trial participants are among the reasons why DCTs are here to stay.
{"title":"Viewpoint: Decentralized Clinical Trials Have Arrived and Staying for Good","authors":"Mary Suzette R Cody","doi":"10.35460/2546-1621.2022-0051","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-0051","url":null,"abstract":"The Covid-19 pandemic challenged every healthcare system, and the disruption of clinical trials was not the least of it. Many clinical trials halted or did not activate as sponsors and investigators grappled with the risk of infection if patients involved in clinical trials visited trial sites. The clinical studies that managed to continue and complete were those that immediately adopted decentralized clinical trials (DCT) technologies such as eSource. Patients were engaged from the comfort and convenience of their homes during the clinical trials with the use of DCT technologies. The flexibility in recruitment, engagement, and monitoring of clinical trial participants are among the reasons why DCTs are here to stay.","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124041029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.35460/2546-1621.2022-0033
Maria Minerva P. Calimag, Allan B. de Guzman
Background – Exercising discretion is vital when making decisions. While decision‐making implies having to choose between predefined alternatives, discretion requires sifting through several solutions and critically choosing the desired one that implies a choice between many alternatives without rigid guidelines pointing to one direction or the other. While previous studies have constantly investigated the nature and dynamics of creative insubordination or discretionary insubordination in primary and secondary education little is known as to how such a construct operates in higher education. Purpose – This study was undertaken to address the central question: “What attributes define creative insubordination as a decision‐making strategy among Philippine medical school deans?” Design – Anchored on descriptive phenomenology, 21 medical deans who have been in the position for at least 4.5 years (range 4.5‐26 years) were purposively selected for in‐depth semi‐structured interviews. Guided by the rules of cool and warm analyses, transcribed texts were phenomenologically reduced and interpreted, and validated via member checking procedure. Findings – Five interesting elements that typify the modes of behavior in the practice of creative insubordination surfaced, namely: cognitional elasticity, emotional sensitivity, conational sincerity, relational mobility and axiological reflectivity. Conclusion – This study provides eidetic images of the multidimensional facets of individual attributes necessary for the praxis of discretionary decision‐making by a select group of Philippine medical deans in varied instances. Keywords: creative insubordination; discretionary decision-making; prosocial rule-breaking; medical deans; higher education
{"title":"‘When all think alike, then no one is thinking’: Understanding the Praxis of Creative Insubordination as a Decision-Making Strategy in Philippine Medical Schools","authors":"Maria Minerva P. Calimag, Allan B. de Guzman","doi":"10.35460/2546-1621.2022-0033","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-0033","url":null,"abstract":"Background – Exercising discretion is vital when making decisions. While decision‐making implies having to choose between predefined alternatives, discretion requires sifting through several solutions and critically choosing the desired one that implies a choice between many alternatives without rigid guidelines pointing to one direction or the other. While previous studies have constantly investigated the nature and dynamics of creative insubordination or discretionary insubordination in primary and secondary education little is known as to how such a construct operates in higher education. Purpose – This study was undertaken to address the central question: “What attributes define creative insubordination as a decision‐making strategy among Philippine medical school deans?” Design – Anchored on descriptive phenomenology, 21 medical deans who have been in the position for at least 4.5 years (range 4.5‐26 years) were purposively selected for in‐depth semi‐structured interviews. Guided by the rules of cool and warm analyses, transcribed texts were phenomenologically reduced and interpreted, and validated via member checking procedure. Findings – Five interesting elements that typify the modes of behavior in the practice of creative insubordination surfaced, namely: cognitional elasticity, emotional sensitivity, conational sincerity, relational mobility and axiological reflectivity. Conclusion – This study provides eidetic images of the multidimensional facets of individual attributes necessary for the praxis of discretionary decision‐making by a select group of Philippine medical deans in varied instances. Keywords: creative insubordination; discretionary decision-making; prosocial rule-breaking; medical deans; higher education","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123829073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.35460/2546-1621.2022-0032
N. A. B. Luna, L. Mercado-Asis
In 2021, 537 million adults were living with diabetes. Being a progressive disease, there would eventually be failure of oral hypoglycemic agents (OHA) to maintain good glycemic control and a majority will require insulin. However, optimal glycemic control has not been satisfactory in a significant proportion of patients who were on insulin therapy. Patient factors (eg, awareness, compliance, socioeconomic) have been identified but physician-related factors are as important. These include incorrect choice and inappropriate combination of insulin therapy which could be corrected by making the treatment physiologic. The purpose of this article is to improve management decisions in type 2 diabetes by reviewing its pathophysiology and identifying the optimum insulin regimen that could mimic such. Since eventual beta cell failure is central to its pathophysiology, it is but reasonable to replace insulin by mimicking its physiologic secretion. Hence, the term Insulin Replacement Therapy (IRT) should be utilized. This could be provided by the combination of premix insulin (ie, NPH + regular insulin) and rapid-acting insulin which has been reported to provide an initial 17.5% HbA1c reduction and even 18% reduction on 5-year follow-up providing sustainable control. A stepwise approach is an effective tool for insulin intensification. Hypoglycemia in insulin therapy could be prevented with an appropriate dietary regimen through automatic snacking. Keywords: Insulin replacement therapy, type 2 diabetes mellitus, pathophysiology
{"title":"Giving Insulin Is Not a Guessing Game: Insulin Replacement Therapy in Type 2 Diabetes Mellitus","authors":"N. A. B. Luna, L. Mercado-Asis","doi":"10.35460/2546-1621.2022-0032","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-0032","url":null,"abstract":"In 2021, 537 million adults were living with diabetes. Being a progressive disease, there would eventually be failure of oral hypoglycemic agents (OHA) to maintain good glycemic control and a majority will require insulin. However, optimal glycemic control has not been satisfactory in a significant proportion of patients who were on insulin therapy. Patient factors (eg, awareness, compliance, socioeconomic) have been identified but physician-related factors are as important. These include incorrect choice and inappropriate combination of insulin therapy which could be corrected by making the treatment physiologic. The purpose of this article is to improve management decisions in type 2 diabetes by reviewing its pathophysiology and identifying the optimum insulin regimen that could mimic such. Since eventual beta cell failure is central to its pathophysiology, it is but reasonable to replace insulin by mimicking its physiologic secretion. Hence, the term Insulin Replacement Therapy (IRT) should be utilized. This could be provided by the combination of premix insulin (ie, NPH + regular insulin) and rapid-acting insulin which has been reported to provide an initial 17.5% HbA1c reduction and even 18% reduction on 5-year follow-up providing sustainable control. A stepwise approach is an effective tool for insulin intensification. Hypoglycemia in insulin therapy could be prevented with an appropriate dietary regimen through automatic snacking. Keywords: Insulin replacement therapy, type 2 diabetes mellitus, pathophysiology","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131944370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.35460/2546-1621.2020-0056
Mary Joeline D Arada, John Armand E Aquino, Redmond Benigno S Aquino, Miguel Arkoncel, Belisarius Arandia, I. M. Tabangay-Lim
Research Question: What is the current status of self-efficacy beliefs towards research and research utilization (RU) of University of Santo Tomas Faculty of Medicine and Surgery (UST-FMS) graduates who had Clinical Epidemiology in their basic medical education curriculum? Significance of the Study: There is an increase in research and RU trends globally as adherence to practice based on evidence results in improved patient outcomes. Limited studies are available in describing research and RU of Filipino physicians and there is no study available specific for UST-FMS graduates. Objectives: The study aims to describe self-efficacy beliefs towards research and RU of UST-FMS graduates’ batches 2012-2016 who had Clinical Epidemiology in their basic medical education. Study Design: A single-center, quantitative descriptive survey design was used. Methodology: Participants were graduates of UST-FMS batches 2012-2016, currently working at the University of Santo Tomas Hospital. Evidence-based Practice Confidence Scale (EPIC scale) and Edmonton Research Orientation Survey (EROS) were used to assess the research and RU of the participants gathered through snowball sampling. Statistical Analysis: Descriptive statistics such as means and standard deviations were used to analyze the EPIC and EROS scores. Results: The UST-FMS graduates value research and are generally confident in their ability to participate in evidence-based medicine. However, they rarely conduct research and have a low understanding of statistics. Conclusion: The self-efficacy beliefs of UST-FMS graduates towards research and RU may be attributed to several factors. Clinical epidemiology as a subject may be improved by adding more lectures on statistics while hospitals should create avenues to support the conduct of research. Keywords: self-efficacy belief, research and research utilization, Clinical Epidemiology, medical education curriculum
{"title":"Self-efficacy of Filipino Physicians Towards Research and Research Utilization: A Single-Center Quantitative Descriptive Survey","authors":"Mary Joeline D Arada, John Armand E Aquino, Redmond Benigno S Aquino, Miguel Arkoncel, Belisarius Arandia, I. M. Tabangay-Lim","doi":"10.35460/2546-1621.2020-0056","DOIUrl":"https://doi.org/10.35460/2546-1621.2020-0056","url":null,"abstract":"Research Question: What is the current status of self-efficacy beliefs towards research and research utilization (RU) of University of Santo Tomas Faculty of Medicine and Surgery (UST-FMS) graduates who had Clinical Epidemiology in their basic medical education curriculum? Significance of the Study: There is an increase in research and RU trends globally as adherence to practice based on evidence results in improved patient outcomes. Limited studies are available in describing research and RU of Filipino physicians and there is no study available specific for UST-FMS graduates. Objectives: The study aims to describe self-efficacy beliefs towards research and RU of UST-FMS graduates’ batches 2012-2016 who had Clinical Epidemiology in their basic medical education. Study Design: A single-center, quantitative descriptive survey design was used. Methodology: Participants were graduates of UST-FMS batches 2012-2016, currently working at the University of Santo Tomas Hospital. Evidence-based Practice Confidence Scale (EPIC scale) and Edmonton Research Orientation Survey (EROS) were used to assess the research and RU of the participants gathered through snowball sampling. Statistical Analysis: Descriptive statistics such as means and standard deviations were used to analyze the EPIC and EROS scores. Results: The UST-FMS graduates value research and are generally confident in their ability to participate in evidence-based medicine. However, they rarely conduct research and have a low understanding of statistics. Conclusion: The self-efficacy beliefs of UST-FMS graduates towards research and RU may be attributed to several factors. Clinical epidemiology as a subject may be improved by adding more lectures on statistics while hospitals should create avenues to support the conduct of research. Keywords: self-efficacy belief, research and research utilization, Clinical Epidemiology, medical education curriculum","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128273548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.35460/2546-1621.2019-0045
Rodeo V Navarroza, S. Navarra
Objective: Determination of the prevalence of severe hematologic manifestations among Filipino patients with systemic lupus erythematosus (SLE) and analysis of any association with organ involvement and serology. Methods: This cross-sectional study included SLE patients 19 years old and above seen at the UST Hospital from 2012 to 2017. Patients with severe hematologic manifestations (severe hemolytic anemia, severe thrombocytopenia, and ES[ES]) were identified and their prevalence determined. Independent t-test was used to compare continuous variables. Categorical variables were measured using the chi-square test; odds ratios (OR) with their corresponding 95% confidence interval were calculated using the SPSS software version 21. This study has been approved by the Institutional Review Board. Results: Of the 253 patients (238 females, 94.07%), the mean age at diagnosis was 27.04 (SD 9.96) years. Severe hematologic involvement was noted in 12.26% (n=31); severe hemolytic anemia was the most prevalent (14, 5.53%), followed by severe thrombocytopenia (13, 5.14%) and ES (4, 1.58%). Higher prevalence of major organ involvement was observed among patients who manifest with severe hematologic disease. Severe thrombocytopenia was more likely to have cardiac involvement (OR 7.39, 95% CI 1.90 to 28.81, p=0.004). A higher prevalence of negative baseline anti-dsDNA serology was seen among patients who developed ES. Conclusion: Severe hematologic involvement was noted in 12.26% of Filipino SLE patients, with hemolytic anemia as the most frequently recorded. Severe thrombocytopenia was associated with cardiac involvement among these patients. Patients developing ES tend to have a negative anti-dsDNA serology. Keywords: systemic lupus erythematosus, severe hematologic manifestations, hemolytic anemia, thrombocytopenia
目的:确定菲律宾系统性红斑狼疮(SLE)患者严重血液学表现的患病率，并分析其与器官受累和血清学的关系。方法:本横断面研究纳入2012年至2017年在UST医院就诊的19岁及以上SLE患者。发现有严重血液学表现(严重溶血性贫血、严重血小板减少和ES[ES])的患者并确定其患病率。采用独立t检验比较连续变量。分类变量采用卡方检验;比值比(OR)及其相应的95%置信区间使用SPSS软件版本21进行计算。这项研究已经得到了机构审查委员会的批准。结果:253例患者中，女性238例，占94.07%，平均诊断年龄27.04岁(SD 9.96)。12.26% (n=31)的患者存在严重的血液学病变;重度溶血性贫血发生率最高(14.5.53%)，其次为重度血小板减少症(13.5.14%)和ES(4.1.58%)。在表现为严重血液病的患者中观察到较高的主要器官受累率。严重血小板减少症更可能累及心脏(OR 7.39, 95% CI 1.90 ~ 28.81, p=0.004)。在ES患者中，基线抗dsdna血清学阴性的发生率较高。结论:12.26%的菲律宾SLE患者存在严重的血液学损害，其中溶血性贫血最为常见。在这些患者中，严重的血小板减少与心脏受累有关。发生ES的患者往往有阴性的抗dsdna血清学。关键词:系统性红斑狼疮，严重血液学表现，溶血性贫血，血小板减少症
{"title":"Severe Hematologic Manifestations Among Filipino Patients With Systemic Lupus Erythematosus: a 5-Year Retrospective Cohort Study","authors":"Rodeo V Navarroza, S. Navarra","doi":"10.35460/2546-1621.2019-0045","DOIUrl":"https://doi.org/10.35460/2546-1621.2019-0045","url":null,"abstract":"Objective: Determination of the prevalence of severe hematologic manifestations among Filipino patients with systemic lupus erythematosus (SLE) and analysis of any association with organ involvement and serology. Methods: This cross-sectional study included SLE patients 19 years old and above seen at the UST Hospital from 2012 to 2017. Patients with severe hematologic manifestations (severe hemolytic anemia, severe thrombocytopenia, and ES[ES]) were identified and their prevalence determined. Independent t-test was used to compare continuous variables. Categorical variables were measured using the chi-square test; odds ratios (OR) with their corresponding 95% confidence interval were calculated using the SPSS software version 21. This study has been approved by the Institutional Review Board. Results: Of the 253 patients (238 females, 94.07%), the mean age at diagnosis was 27.04 (SD 9.96) years. Severe hematologic involvement was noted in 12.26% (n=31); severe hemolytic anemia was the most prevalent (14, 5.53%), followed by severe thrombocytopenia (13, 5.14%) and ES (4, 1.58%). Higher prevalence of major organ involvement was observed among patients who manifest with severe hematologic disease. Severe thrombocytopenia was more likely to have cardiac involvement (OR 7.39, 95% CI 1.90 to 28.81, p=0.004). A higher prevalence of negative baseline anti-dsDNA serology was seen among patients who developed ES. Conclusion: Severe hematologic involvement was noted in 12.26% of Filipino SLE patients, with hemolytic anemia as the most frequently recorded. Severe thrombocytopenia was associated with cardiac involvement among these patients. Patients developing ES tend to have a negative anti-dsDNA serology. Keywords: systemic lupus erythematosus, severe hematologic manifestations, hemolytic anemia, thrombocytopenia","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134468615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.35460/2546-1621.2022-0021
John Benjamin B Gochoco
This is the case of a 71-year-old Filipino female from Caloocan with a history of Hansen’s disease, treated (1980) who presented with generalized crusted plaques. Clinical and histopathological examination revealed crusted (Norwegian) scabies. Crusted scabies is a rare condition and diagnosis is often delayed; this condition is treated with systemic broad spectrum antiparasitic agents. Despite the common prevalence of scabies, its atypical forms are often overlooked and neglected which oftentimes does affect the patients' well-being. Keywords: infection; skin diseases; leprosy; parasitic; crusted scabies; case report
{"title":"Double Whammy: A Case Report of a 71-Year-Old Filipino Female Leprosy Patient Diagnosed With Crusted Scabies","authors":"John Benjamin B Gochoco","doi":"10.35460/2546-1621.2022-0021","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-0021","url":null,"abstract":"This is the case of a 71-year-old Filipino female from Caloocan with a history of Hansen’s disease, treated (1980) who presented with generalized crusted plaques. Clinical and histopathological examination revealed crusted (Norwegian) scabies. Crusted scabies is a rare condition and diagnosis is often delayed; this condition is treated with systemic broad spectrum antiparasitic agents. Despite the common prevalence of scabies, its atypical forms are often overlooked and neglected which oftentimes does affect the patients' well-being. Keywords: infection; skin diseases; leprosy; parasitic; crusted scabies; case report","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"74 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133291854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.35460/2546-1621.2020-0046
Ana Kristina Garcia-Sobrevega, Wilfredo R. Santos
Long-term outcomes of preterm and very low birth weight (VLBW) infants have been the focus of published research due to improved neonatal care. One of the long-term morbidities associated with being born too early or VLBW is postnatal growth failure and neurodevelopment delay. Because of this, different strategies were implemented to address this, one of which is initiating early aggressive amino acid therapy at 3 g/kg/day within 24 hours of life with its goal to improve previously mentioned outcomes. This study aims to determine the growth and neurodevelopment outcome among neonates born preterm and VLBW who were given 3 g/kg/day of amino acid. It is important that such delays are detected early on so that appropriate interventions can be initiated to maximize the infant's capabilities. A total of 34 neonates were included in the study where baseline anthropometrics were taken and followed up at the 6th, 9th, and 12th month of corrected age. Results showed 35.2% of the participants were discharged with their anthropometrics below the target range. By the 6th month of corrected age, only 2.94% were below normal and by the 9th month of corrected age, all participants have normal for age anthropometrics. As for the neurodevelopment aspect, 4 of 34 participants (13.8%) were found to be classified as emerging risk and were referred to a neurodevelopment specialist. By the 9th month of corrected age, only 2 were classified as emerging risk and by the 12th month of corrected age, only 1 remained to be at risk for neurodevelopment delay. In conclusion, early aggressive amino acid therapy proves to have a positive effect in the growth and neurodevelopment outcome among preterm and VLBW infants. However, we would like to recommend continued monitoring of neurodevelopment in neonates from this population until 2 years of age, since some delays can be evident later on in life.
{"title":"Growth and Neurodevelopment Outcome Among Preterm and Very Low Birth Weight Neonates Given Early Aggressive Amino Acid Therapy Admitted in the NICU of a Tertiary Hospital","authors":"Ana Kristina Garcia-Sobrevega, Wilfredo R. Santos","doi":"10.35460/2546-1621.2020-0046","DOIUrl":"https://doi.org/10.35460/2546-1621.2020-0046","url":null,"abstract":"Long-term outcomes of preterm and very low birth weight (VLBW) infants have been the focus of published research due to improved neonatal care. One of the long-term morbidities associated with being born too early or VLBW is postnatal growth failure and neurodevelopment delay. Because of this, different strategies were implemented to address this, one of which is initiating early aggressive amino acid therapy at 3 g/kg/day within 24 hours of life with its goal to improve previously mentioned outcomes. This study aims to determine the growth and neurodevelopment outcome among neonates born preterm and VLBW who were given 3 g/kg/day of amino acid. It is important that such delays are detected early on so that appropriate interventions can be initiated to maximize the infant's capabilities. A total of 34 neonates were included in the study where baseline anthropometrics were taken and followed up at the 6th, 9th, and 12th month of corrected age. Results showed 35.2% of the participants were discharged with their anthropometrics below the target range. By the 6th month of corrected age, only 2.94% were below normal and by the 9th month of corrected age, all participants have normal for age anthropometrics. As for the neurodevelopment aspect, 4 of 34 participants (13.8%) were found to be classified as emerging risk and were referred to a neurodevelopment specialist. By the 9th month of corrected age, only 2 were classified as emerging risk and by the 12th month of corrected age, only 1 remained to be at risk for neurodevelopment delay. In conclusion, early aggressive amino acid therapy proves to have a positive effect in the growth and neurodevelopment outcome among preterm and VLBW infants. However, we would like to recommend continued monitoring of neurodevelopment in neonates from this population until 2 years of age, since some delays can be evident later on in life.","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133454193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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