Knowledge, attitudes, and practices in colorectal cancer screening in the Philippines

Background and Objective@#Colorectal cancer (CRC) has the third highest incidence in the Philippines. Currently, there is a paucity in literature that is focused on the knowledge, attitudes, and perceptions of Filipinos regarding CRC screening. This is the first study in the Philippines that describes this. @*Methods@#This is a cross-sectional study that validated a 52-item Filipino questionnaire on the knowledge on colorectal cancer, willingness to undergo CRC screening, and perceived benefits and barriers to fecal occult blood test (FOBT) and colonoscopy. The study enrolled household heads more than 20 years of age residing in both urban and rural communities in the Philippines. @*Results@#The UP-PGH CRC KAP (University of the Philippines – Philippine General Hospital Colorectal Cancer Knowledge, Attitudes, and Practices) and Rawl Questionnaire’s validity and internal consistency were established in a pilot study of 30 respondents. A total of 288 respondents were then enrolled to the main study group with a median age of 54.0. Knowledge scores for prognosis and utility of CRC screening were modest (6.3/12 and 8.4/20, respectively). Perceived benefit scores to FOBT and colonoscopy were high (9.9/12 and 13.9/16, respectively).Median scores to barriers to FOBT and colonoscopy were intermediate (22.5/36 and 35.8/60, respectively). Notably, a vast majority (86.1%) were willing to participate in CRC screening programs initiated by the government, and 46.9% agreed to undergo screening tests even as out-of-pocket expense. @*Conclusion@#The UP-PGH CRC KAP Questionnaire as well as the Filipino translation of the Rawl Questionnaire are reliable and valid tools in extensively assessing the knowledge of Filipinos on CRC and willingness to undergo screening, as well as the benefits of and barriers to FOBT and colonoscopy. Knowledge scores were modest suggesting that directed educational campaigns and awareness programs can aid in increasing awareness about CRC and its screening. Household income and highest educational attainment were significantly positively correlated with knowledge scores, and perceived benefits of and barriers to CRC screening. Scores were generally comparable between urban and rural communities.

Profile of National Center for Mental Health (NCMH) employees‘ dependents on internet use

Objectives@#This study aimed to determine the sociodemographic profile and theprevalence of internet use among the NCMH employees’ dependents.@*Methodology@#This was a descriptive study of NCMH employees’ dependents from10-40 years old who lived in the same household and spoke English, selecting them throughrandom sampling and using the 8 -item Internet Addiction Diagnostic Questionnaire. Onlynon-essential computer / internet usage was evaluated and addiction was consideredpresent if patient answered 5 or ore of the questions over a 6- month period.@*Results@#There were 100 respondents who qualified with 52% females and 48% males.Eighty five percent were 30 years old and below but almost equally distributed betweenthose from 10- 20 years old (45%) and those from 21- 30 years old (40%); but most of them (45%) had reached college though not all graduated (38%). Majority (83% ) wereRoman Catholics and 76% were single. There were 78 (78%) respondents who hadproblematic internet use.@*Conclusion@#The prevalence of problematic internet use among dependents of NCMHemployees was quite high.

2021 clinical practice guidelines in the evaluation and management of pediatric community-acquired pneumonia

Preface@#The Clinical Practice Guidelines (CPG) for the Diagnosis and Management of Pediatric Community-Acquired Pneumonia (PCAP) was initiated by the Philippine Academy of Pediatric Pulmonologists, Inc. (PAPP) and the Pediatric Infectious Disease Society of the Philippines (PIDSP), in cooperation with Philippine Pediatric Society, Inc. (PPS) way back in 2004. Several CPG updates were then undertaken by the PAPP PCAP CPG Task Force from 2008 to 2016. Clinically-relevant research questions were answered with recent and current recommendations based on evidence from local and international data. The 2021 PCAP CPG initiative was envisioned in March 2018 upon the recommendations of the 2018 PAPP Board for the purpose of updating the evidence in the PCAP CPG 2016 clinical questions. This led to the collaboration of PAPP and PIDSP to develop this CPG. Individual members were identified from each society as content experts to form the Steering Committee along with a clinical epidemiologist and technical writer as review experts. The committee identified the scope and target end user of the CPG as well as additional clinical questions to be included in the 2021 update aside from the questions on the previous CPGs. Selected members from the two societies formed the Technical Working Group (TWG) who did the literature search, appraisal of evidences, and formulation of recommendations. These recommendations were then presented to the stakeholders who became part of the consensus panel. There was no identified conflict of interest among the CPG developers, TWG members and stakeholders. A survey to determine potential competing interests were conducted during the development of this CPG. This initiative was fully funded by the PAPP and PIDSP societies. The 2021 PCAP CPG significantly differs from the previous CPGs in several aspects. First, the current guideline is a consensus between two pediatric societies. Second, much of the literature review has been centered on meta-analyses or systematic reviews instead of individual studies. Finally, appraisal of published literature was based on Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. Such methodological differences may provide difficulties in defining evolution of care through the years. As identified in the previous CPG updates, there is lack of local data hence most of the evidences gathered came from international studies. The applicability of such data to the local setting needs to be critically assessed for its value and relevance. Corollary to this, several gaps in knowledge are identified and these may serve as a guide for future research.

Deep Brain Stimulation for Cockayne Syndrome-Associated Movement Disorder

Cockayne syndrome (CS) is a rare progeroid disorder characterized by multisystem degeneration, including neurological dysfunction, for which deep brain stimulation (DBS) is a proposed treatment. This study represents only the third case of DBS for CS-associated movement disorder and the first in which both proposed targets had devices implanted, allowing for direct comparison. A case of DBS for CS-associated movement disorder is presented. Previous literature documents two cases with one targeting the ventral intermediate nucleus of the thalamus (VIM) and the other targeting the globus pallidus interna (GPi). Our patient underwent stimulation of GPi nuclei followed by repositioning to VIM nuclei with improved symptom control using VIM stimulation. In all cases, there was a significant clinical benefit without off-target effects. CS-associated movement disorder exhibits phenotypic variability for which DBS is a viable treatment. Target selection should be driven by clinical phenotype.

Cervical screening in foreign domestic workers in Singapore

INTRODUCTION@#Globally, cervical cancer is the fourth most common cancer in women, with about 85% occurring in low-middle income countries (LMIC) and an age-standardised incidence rate of more than 15 per 100,000. It is largely preventable through HPV vaccination and cervical cancer screening. In Singapore, 18% of the foreign domestic workforce hail from Indonesia, the Philippines, Myanmar, and India. However, there is no data on preinvasive cervical disease and cervical cancer in foreign domestic workers (FDWs) and the aim of this pilot programme is to determine the baseline screen positive rate of high-grade intraepithelial in this population.@*METHODS@#A total of 322 FDWs were offered HPV screening through the Helping Our Helper (HOH) pilot programme. Data from this pilot programme were analysed and reported using simple descriptive statistics.@*RESULTS@#Out of the 322 FDWs who registered for HPV screening, 68.6% participated. There was a 22.2% screen-positive rate; 10% of those who screened positive for high-risk HPV had histologically confirmed high-grade cervical intraepithelial neoplasia. This result is similar to other data on cervical cancer screening in Singaporeans. This pilot project screened less than 1% of the eligible FDWs in Singapore.@*DISCUSSION@#The findings of this pilot programme suggest that there is public health value in providing cervical cancer screening to FDWs. Improving cervical cancer screening by increasing awareness and including routine cervical cancer screening as part of the employment medical examination should be studied.

HMG-CoA Reductase Inhibitory Activity of Leaf-associated Fungi

Background@#Cholesterol is an important biomolecule for cells. However, because of certain lifestyle, the amount of cholesterol can increase beyond what our bodies can consume. Increased intake may result in the accumulation of cholesterol in the blood leading to atherosclerosis that can lead to congestive heart failure. With the use of statins, cholesterol levels are reduced therefore lowering the risk for this disease. It does so by inhibiting the hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase, the first committed enzyme in cholesterol biosynthesis. In light of the increasing cases of hypercholesterolemia, there is a need to discover novel classes of HMG-CoA inhibitors. @*Objective@#The primary objective of this study was to screen extracts of leaf-associated fungi for their capacity to inhibit hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase, the first committed enzyme in cholesterol biosynthesis. @* Methods@#Eight (8) plants were sampled for the fungal epiphytes and endophytes on their leaves. The fungal isolates were identified by sequencing the internal transcribed region (ITS) of the 18S rDNA. All fungal isolates were cultured in 20 flasks containing 300 mL potato dextrose broth at 30°C for 14 days. The culture broths were then subjected to reduction in volume using a rotary evaporator. HMG-CoA reductase inhibition assay was carried out using the ethyl acetate extracts from the culture broths. Reagent grade pravastatin was used as the positive control. @* Results@#There were a total of sixty-six (66) fungal taxa that were tested for their capacity to inhibit the enzyme HMG-CoA reductase. Of the 50 that tested positive, there were 25 families represented and 5 isolates were of uncertain status taxonomically (incertae sedis). There were also nine classes that were represented and the class with the most number of isolates was Sordariomycetes. The highest percentage inhibition was observed in Pestalotiopsis lespedezae with 65.01 % inhibition. The other fungi with notable inhibitory activities were Colletotrichum cymbidiicola (64.16%) and Schizophyllum commune (57.85%). @*Conclusions@#This study may be the first report of production of HMG-CoA reductase inhibitors in the genus Colletotrichum and in the other leaf-associated fungal taxa that tested positive for HMG-CoA reductase inhibition. It is therefore very promising that a novel statin compound, or even a new class of substances with antihypercholesterolemic bioactivity may be discovered from these leaf-associated fungal isolates. The crude extracts of these fungi are prime candidates for downstream fractionation for the subsequent isolation and structure elucidation of the bioactive compound.

Utility of Urine KOH in Detecting Candiduria in Infants

Background@#Candida species are common cause of urinary tract infection in infants requiring medical care. Candida fungal elements may be demonstrated in urine using microscopic examination with potassium hydroxide (KOH). However, detection of these elements does not always correlate with candiduria. @*Objectives@#To establish the utility of urine KOH in identifying candiduria and to determine the risk factors, as well as urinalysis and CBC parameters associated with candiduria. @*Methods@#This prospective cross-sectional study included admitted infants 1 year and below with urine culture and with any risk factor/s for candiduria. Additional urine KOH testing was done using clean catch or catheter method. Urine culture was used as the gold standard. @*Results@#Among the 90 study participants with both urine culture and urine KOH, 13 (14%) had candiduria. The use of indwelling catheter, presence of urinary tract anomalies, positive leukocyte esterase in urinalysis, and increased monocyte counts in CBC are all associated with candiduria. Urine KOH has sensitivity of 100%, (CI 75.2-100%), specificity 59.7%, (CI 47.9-70.7%), PPV 29.5%, (CI 17.7-45.2%), and NPV 100%, (CI 92.2-100%) in detecting candiduria.@*Conclusions@#Negative urine KOH has excellent negative predictive value, while positive urine KOH result may warrant further investigation. Urine KOH results should be interpreted with caution depending on patient’s risk factors, clinical status, and other laboratory results prior to initiation of empiric antifungal therapy. Positive urine KOH may not always require treatment.

Demographic and socioeconomic barriers and treatment seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty

Purpose: To understand demographic and socioeconomic barriers and treatment-seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty (TPK) in a developing country. Methods: This prospective non-comparative questionnaire- based study included all patients presenting to Aravind Eye Hospital, Madurai with infectious keratitis that eventuated to TPK between November 2015 and October 2016. A structured questionnaire was administered on post-operative day 3 to collect data on the demographic details, predisposing factors, prior treatment received, and treatment expenditures. Results: In total, 227 patients underwent TPK between November 2015 and October 2016 for infectious keratitis. The majority of patients were males (n = 132, 58.1%), illiterate (n = 129, 56.8%), and had a family monthly income of less than INR 6000 (n = 142, 62.5%). Most of the patients (n = 163, 71.8%) had prior treatment with an ophthalmologist before presenting to our hospital. The mean distance travelled to reach our centre was 269.2 ± 298.5 km. The mean duration of disease before the presentation was 20.3 ± 21.1 days. Corneal smear was positive for fungus in 163 (88.1%) and Aspergillus was the most commonly isolated fungi in 55 (41.3%) cultures. The mean total cost of treatment was INR 8752.87 ± 7615.39 per patient. There was a positive correlation between the duration of the disease (rho 0.19, P = 0.0034) and the costs of treatment (rho 0.2, P = 0.0024) with the distance travelled by the patient. Conclusion: Patients who travelled a farther distance had a delayed onset of presentation and spent significantly more than their respective counterparts.

Synchronous double malignancy of lip and submandibular salivary gland with rare histology

In the modern era, there is an increase in the incidence of double malignancies owing to the remarkable improvement in cancer diagnostics and patient survival. Double malignancies can be either synchronous or metachronous. Synchronous double malignancy can present either at the same time or within 6 months of diagnosis of the first one. We present a case of double malignancy of lip and submandibular salivary gland, diagnosed in a 55-year-old male, who presented with ulceroproliferative lesion of the upper lip and a hard swelling in the right submandibular gland. The tissue diagnosis was suggestive of squamous cell carcinoma of the lip and mucoepidermoid carcinoma of the submandibular gland. The patient underwent successful wide local excision of the lip and submandibular gland along with prophylactic supraomohyoid neck dissection. This case is reported for the rarity in site and histopathology of double malignancy

A Systematic Review of Factors Associated with both Bilateral and Recurrent Anterior Cruciate Ligament Disruption

Background:Numerous studies have reported factors associated with recurrent or subsequent contralateral anterior cruciate ligament disruption, but a comprehensive review of the literature has not been performed. Purpose: This study attempts to systematically review the literature and provide an overview of the currently reported risk factors for recurrent and subsequent contralateral ACL reconstructions in order to allow for more efficient identification and intervention of high-risk patients. Study Design:Systematic Review.Methods:The Pubmed and Embase databases were searched using a combination of keywords such as “ACL reconstruction” and “bilateral or recurrent” and “risk factors” and medical subject headings. All studies were screened by two independent reviewers, and articles that met inclusion criteria (non-contact ACL injury, study analyzed risk factors for contralateral ACL injury or graft rupture) were downloaded and read. Results:The initial search yielded 129 articles, of which 36 met inclusion criteria. After duplicates

Utility of urine KOH in detecting candiduria in infants

BACKGROUND@#Candida species are common cause of urinary tract infection in infants requiring medical care. Candida fungal elements may be demonstrated in urine using microscopic examination with 10-20% KOH. However, detection of these elements does not always correlate with candiduria. @*OBJECTIVES@#The main objective of this study was to establish the utility of urine KOH in identifying candiduria in terms of sensitivity, specificity, PPV, and NPV. The study also aims to determine the risk factors, as well as urinalysis and CBC parameters associated with candiduria.@*METHODS@#This prospective study included admitted infants 1 year and below with urine culture request and with any risk factor for candiduria. Additional urine KOH testing was done using clean catch or catheter method (for those with indwelling catheter). @*RESULTS@#Among the 90 study participants, 13 had candiduria (14%). The use of indwelling catheter, presence of urinary tract anomalies, leukocyte esterase in urinalysis, and increased monocyte counts in CBC are all associated with development of candiduria. Urine KOH had a sensitivity of (100%; CI 75.2- 100%), specificity (59.7%; CI 47.9-70.7%), PPV (29.5%; CI 17.7-45.2%), and NPV (100%; CI 92.2- 100%) in detecting candiduria. @*CONCLUSIONS@#A negative urine KOH has excellent negative predictive value, while a positive result does not always mean true infection.@*RECOMMENDATIONS@#This study recommends that urine KOH results be interpreted with caution depending on patient‘s risk factors clinical status and other laboratory tests such as urine culture and that a positive urine KOH result will not always require prompt treatment.

A comprehensive district-level laboratory intervention after the ebola epidemic in Sierra Leone

Background: The 2014­2016 Ebola outbreak exposed the poor laboratory systems in Sierra Leone. Immense needs were recognised across all areas, from facilities, diagnostic capacity, supplies, trained personnel to quality assurance mechanisms.Objective: We aimed to describe the first year of a comprehensive intervention, which started in 2015, in a public hospital's general laboratory serving a population of over 500 000 in a rural district.Methods: The intervention focused on (1)supporting local authorities and healthcare workers in policy implementation and developing procedures to enhance access to services, (2) addressing gaps by investing in infrastructure, supplies, and equipment, (3) development of quality assurance mechanisms via mentorship, bench-side training, and the introduction of quality control and information systems. All work was performed alongside counterparts from the Ministry of Health and Sanitation.Results: We observed a strong increase in patient visits and inpatient and outpatient testing volumes. Novel techniques and procedures were taken up well by staff, leading to improved and expanded service and safety, laying foundations for further improvements.Conclusion: This comprehensive approach was successful and the results suggest an increase in trust from patients and healthcare workers

Diagnostic accuracy of ultrasound for rotator cuff tears

Ultrasonography (US) is an inexpensive, convenient, and effective tool that can be used to evaluate the shoulder. It does not expose the patient to harmful radiation and can be used to evaluate the musculoskeletal system dynamically. Additionally, US is not subject to metal artifacts when evaluating patients with previously placed hardware. Over the years, US has been found to be reliable and accurate for diagnosing rotator cuff tears (RCTs), despite its operator-dependence. The usage of US for diagnosing RCTs in orthopedic practice varies depending on practitioners' familiarity with the exam and the availability of experienced technicians. The purpose of this article is to review the diagnostic accuracy of US for identifying RCTs.

Evaluation of the Antimicrobial Effect of Carboxymethyl Cellulose versus Silver with Saline Dressing in Diabetic Ulcers.

Background: The diabetic foot ulcer is a major complication of diabetes mellitus. (1) It occurs in 15% of all patients with diabetes and precedes 84% of all lower leg amputations. (2) Diabetes mellitus impedes wound healing by prolonging the inflammatory phase. Increased glucose in the tissue precipitates infection. (3) Diabetic microangiopathy which affects microcirculation. Increased glycosylated hemoglobin decreases the oxygen dissociation. Increased glycosylated tissue protein decreases the oxygen utilization. This study is intended to show the efficacy of carboxymethyl cellulose (CMC) dressing for a faster healing of diabetic ulcers when compared with the conventional saline dressing. Materials and Methods: This study was a prospective case–control comparative study conducted at the Department of General Surgery and Gastroenterology, father Muller Medical College, Mangalore, from August to July 2016. 80 consenting patients who met the predefined criteria were taken for the study and divided into two groups, 40 patients each is put in the CMC with silver dressing group and the conventional saline dressing group. Results: There was no statistically significant difference between the two groups in terms of gender, age, glycemic control, and site of ulcer P < 0.001. In our study, we found that there was statistically significant difference in the rate of infection between the two groups. Conclusion: Silver impregnate dressings have a role in the management of diabetic ulcers by reducing the local burden of infection which is an important cause for non-healing ulcer analgesia.

Percutaneous transgastric stenting of proximal jejunal obstruction secondary to direct invasion of a pancreatic carcinoma

Pancreatic cancer has been identified as one of the most common malignant causes of upper gastrointestinal obstruction. Most common sites of obstruction include the pyloric region and second and third portions of the duodenum. If surgical gastrojejunostomy is not a viable option, metallic stent placement may be performed either by transoral or transgastric approach. Transgastric technique is considered to be more invasive and is often employed only in failed attempts to insert a stent using transoral technique. This report presents a 70-year-old patient with pancreatic cancer involving the proximal jejunum. Although this is a rarely described location for stenting, the patient was successfully treated using transgastric technique.

Eleven years of data on the Jefferson scale of Empathy Medical student version [JSE-S]: proxy norm data and tentative cutoff scores

Objective: This study was designed to provide typical descriptive statistics, score distributions and percentile ranks of the Jefferson Scale of Empathy-Medical Student version [JSE-S] of male and female medical school matriculants to serve as proxy norm data and tentative cutoff scores

Subjects and Methods: The participants were 2,637 students [1,336 women and 1,301 men] who matriculated at Sidney Kimmel [formerly Jefferson] Medical College between 2002 and 2012, and completed the JSE at the beginning of medical school. Information extracted from descriptive statistics, score distributions and percentile ranks for male and female matriculants were used to develop proxy norm data and tentative cutoff scores

Results: The score distributions of the JSE tended to be moderately skewed and platykurtic. Women obtained a significantly higher mean score [116.2 +/- 9.7] than men [112.3 +/- 10.8] on the JSE-S [t[2,635] = 9.9, p < 0.01]. It was suggested that percentile ranks can be used as proxy norm data. The tentative cutoff score to identify low scorers was

Conclusions: Our findings provide norm data and cutoff scores for admission decisions under certain conditions and for identifying students in need of enhancing their empathy

La ketamina mejora la supervivencia en lesión por quemadura severa en ratas, a través de la expresión de la proteina de choque 70 / Ketamine improves survival in severe burn injury in rats via the expression of heat shock protein 70

Se ha demostrado que la ketamina, una anestésico general, produce una respuesta de choque térmico (HSR) en algunos animales experimentales. Examinamos si la ketamina mejora la supervivencia en lesión por quemadura severa en ratas, a través de la expresión de la proteína de choque 70. Un total de 124 ratas Wistar machos se dividieron aleatoriamente en 3 grupos: un grupo de control (grupo C, n = 20), un grupo quemado (grupo B, n = 52) y un grupo quemado + ketamina (grupo K, n = 52). Las ratas de los grupos B y K presentaban quemaduras de espesor completo en el 30% del total de su superficie corporal. Las ratas del grupo K se trataron con ketamina (40mg/kg, i.m.) a los 15min después de la lesión y las del grupo B se inyectaron con igual volumen de solución salina. Luego de practicar la eutanasia a las ratas, se examinó la expresión de HSP70 en muestras del miocardio y del cerebro con análisis Western blot. En las ratas que no se sacrificaron se evaluó el estado de supervivencia. Luego de 10 días, la tasa de supervivencia en las ratas del grupo K era superior a las del grupo B (70% versus 30%). Los análisis Western blot mostraron que la expresión de proteína HSP70 en el miocardio en respuesta a la administración de ketamina es más fuerte que en respuesta a la administración de solución salina a las 3 h (158% versus 65%) y a las 6h (165% versus 68%). En comparación con el grupo B, la ketamina aumentó marcadamente el nivel de expresión de la proteína HSP70 en tejido cerebral a las 3h y a las 6 h (79% versus 51% a las 3 h; 123% versus 98% a las 6 h). Concluimos que el tratamiento con ketamina mejora la supervivencia en lesión por quemadura severa, mediante la expresión de la proteína de choque 70 en los tejidos del miocardio y del cerebro.

Ketamine, a general anesthetic, has been shown to elicit the heat-shock response (HSR) in some of the animal models. We examined whether ketamine improves survival in severe burn injury in rats via the expression of heat shock protein 70. 124 male Wistar rats were randomly divided into three groups: a control group (group C, n = 20), burned group (group B, n = 52), and burned + ketamine group (group K, n = 52). The rats in groups B and K had full-thickness burns of 30% of their total body surface. The rats in group K were treated with ketamine (40 mg/kg, i.m.) 15 min after injury, and those in group B were injected with saline at the same volume. After the rats were euthanized, HSP70 expression in myocardium and brain samples was examined by Western blot analysis. Survival status was evaluated for the rats not euthanized. After 10 days, survival rate of rats in group K was higher than that of group B (70% versus 30%). Western blot analyses revealed that HSP70 protein expression in myocardium in response to ketamine administration is stronger than that in response to saline administration at 3 h (158% versus 65%) and 6 h (165% versus 68%). Compared with that in group B, ketamine strongly increased HSP70 protein expression level in cerebral tissue at 3 h and 6 h (79% versus 51%, at 3 h; 123% versus 98%, at 6 h). We concluded that ketamine therapy improves survival in severe burn injury via the expression of heat shock protein 70 in myocardial and cerebral tissues.

Diabetes mellitus in patients withAlzheimer´s disease: clinical descriptionand correlation with the APOEgenotype in a sample population from the province of Antioquia, Colombia / Diabetes mellitus en pacientes con enfermedad de Alzheimer: descripción clínica y correlación con el genotipo APOE en una muestra de población del departamento de Antioquia, Colombia

Introduction. Alzheimer´s disease is a multifactorial disease affecting approximately twenty million people worldwide. Numerous variables are associated with increased risk of developing this severe neurological disorder. Among the risk factors, diabetes mellitus, and the ε4 isoform of the APOE gene have been amply demonstrated as increasing the risk of developing this disease. Objective. To determine if a correlation exists between APOE genotype, diabetes mellitus and Alzheimer´s disease. Materials and methods. Clinical studies were carried out by surveying the clinical histories in a group of patients in the province of Antioquia, Colombia. Forty-three Alzheimer´s patients were compared with 43 control subjects, paired by age and gender. Commercially available methods were used to determine whether the patients had diabetes, and restriction enzyme-based genotyping was used to determine the APOE genotypes. Results. The most common non-neurological comorbidities were: arterial hypertension, acute myocardial infarction, chronic obstructive pulmonary disease and hypothyroidism. From the many variables investigated, two were conclusive: (1) the presence of Alzheimer´s disease was higher in patients with diabetes mellitus, and (2) no correlation between late-onset sporadic Alzheimer´s disease and APOE was found in the target population. Conclusions. To detect any association with the APOE genotype, a study involving much a larger population samples must be undertaken.

Introducción. La enfermedad de Alzheimer es compleja y afecta, aproximadamente, a 20 millones de personas en todo el mundo. Muchas variables parecen aumentar el riesgo de desarrollar esta alteración neurológica. Entre los factores de riesgo, se ha demostrado ampliamente que la diabetes mellitus y la isoforma ε4 del gen APOE tienen incidencia positiva en el desarrollo de la enfermedad. Se reporta un estudio en el cual se investigó la posible correlación entre APOE, diabetes mellitus y la enfermedad de Alzheimer, en un grupo específico de pacientes del departamento de Antioquia, Colombia. Objetivo. Determinar si existe una correlación entre APOE, diabetes mellitus y la enfermedad de Alzheimer, en un grupo de pacientes de Antioquia, Colombia. Materiales y métodos. Se buscaron y analizaron las historias clínicas de los pacientes con diagnóstico de enfermedad de Alzheimer. Se seleccionaron aquellos que cumplían los criterios de inclusión. Se utilizaron métodos comercialmente disponibles para confirmar la presencia de diabetes mellitus. La genotipificación de APOE se hizo con un método basado en la PCR y la digestión con enzimas de restricción, en muestras de todos los participantes en el estudio. Resultados. En este estudio se analizan 43 casos de enfermedad de Alzheimer y 43 individuos sanos controles, pareados por edad y sexo. Las enfermedades concomitantes no neurológicas más comunes fueron: hipertensión arterial, infarto agudo del miocardio, enfermedad pulmonar obstructiva crónica e hipotiroidismo. Conclusiones. De las diferentes variables investigadas, dos arrojaron resultados concluyentes: i) la presencia de la enfermedad de Alzheimer es más frecuente en pacientes con diabetes mellitus, y 2) no se encontró correlación entre la enfermedad de Alzheimer de inicio tardío esporádico y el genotipo de APOE. Es importante indicar que debe llevarse a cabo un estudio con un tamaño de población mayor, para determinar cualquier posible correlación o inferencia con el genotipo de APOE.

IgG subclass responses to proinflammatory fraction of Brugia malayi in human filariasis.

Background & objectives: Earlier we demonstrated that immunization with F6, a proinflammatory molecular fraction isolated from the human filarial parasite Brugia malayi, protected the host and eliminated the infection in Mastomys coucha by a Th1/Th2 response including IgG2a antibody response. Whether F6 molecules become accessible to human host during natural course of infection and elicit similar response is not known. The present study was undertaken to determine the profile of IgG subclasses specifically reactive to F6 in different categories of bancroftian filariasis cases to infer any relationship between the levels of a particular F6-specific IgG subclass and the infection or disease status. Methods: Serum samples of normal individuals from filariasis non-endemic regions of India like Jammu & Kashmir, Uttarakhand, and Chandigarh [(NEN-W; n=10), healthy subjects from USA (NEN-U; n=10) and three categories of bancroftian filariasis cases from endemic areas: endemic normals (EN; n=10) with no symptoms and no microfilariae, asymptomatic microfilaremics (ASM; n=10) and chronic symptomatic amicrofilaremics (CL; n=10) were assayed for F6-specific IgG1, IgG2, IgG3 and IgG4 by ELISA using SDS-PAGE-isolated F6 fraction of B. malayi adult worms. Results: Significantly high levels of F6-specific IgG1, IgG2 and IgG3 were found in CL (P<0.001) and EN (P<0.01-0.001) bancroftian filariasis cases compared to NEN-U. Significant levels of F6-specific IgG1 (P<0.01) and IgG2 (P<0.01) but not IgG3 were found in ASM cases compared to NEN-U. The most abundant was IgG2 which when compared to NEN-U, was significantly high in CL (P<0.001) and EN cases (P<0.001), followed by ASM (P<0.01). F6-specific IgG4 response in EN, ASM and CL subjects was not significantly different from the levels of NEN-U. Among the non-endemic normals, the NEN-W subjects showed significant reactivity with IgG2 (P<0.001) but not with IgG1, IgG3 and IgG4 as compared to NEN-U subjects. IgG subclass levels were different in different categories. Interpretation & conclusions: The high levels of F6 reactive IgG1, IgG2 and IgG3 in endemic normals and chronic symptomatic bancroftian patients, and IgG1 and IgG2 in asymptomatic microfilaraemics, suggest that F6 molecules of parasite are accessible in these subjects for IgG subclass-specific immune response and IgG2 may be related to pathogenesis. Studies using individual F6 molecules will be done to identify the molecule(s) involved in infection and protective immunity.

An orbital metastasis of prostate adenocarcinoma: A rare case report

A patient with known prostatic cancer presented with left supraorbital swelling with proptosis and restricted eye movements on left eye. Contrast enhanced computed tomography scan revealed dural and bone metastases with soft tissue component extending to the left orbit. Serum prostate specific antigen was markedly elevated at >100 ng/ml. Incision biopsy of the orbital tumor revealed only lymphocytic inflammatory cells within the fibrous stroma attributed mainly to the deeper location of the tumor or shallow locus of the biopsy. Incisional biopsy of the frontal bone revealed atypical looking cells in sheet cluster with nuclear enlargement, hyperchromatic in irregularity confirming the diagnosis of orbital metastasis of prostate carcinoma.Metastasis of prostate cancer to the orbit is rare. One should have a high index of suspicion of orbital metastasis when presented with an elderly patient with ocular symptoms and a history of prostate adenocarcinoma. A thorough clinical, radiological and histological evaluation is necessary to establish the diagnosis.