University of Asia and the Pacific

Malformations of cortical development (MCDs) are a frequent cause of drug-resistant epilepsy and a common indication for resective epilepsy surgery. As magnetic resonance imaging (MRI) lacks sensitivity for subtle MCDs, supplemental diagnostic tools are needed. This study aimed to characterize scalp electroencephalographic (EEG) patterns in MCDs and investigate their association with surgical outcomes. This was a retrospective case-control study including patients who underwent inpatient video-EEG monitoring at two Australian hospitals. Cases were individuals with MCDs confirmed on MRI or histopathology; controls included patients with other focal epilepsies. Two epileptologists independently reviewed interictal and seizure-onset EEG patterns using a standardized classification framework. Patterns were compared between cases and controls and assessed with respect to postoperative seizure outcomes, adjusting for antiseizure medication reduction. We included 38 cases with MCDs (52.6% females, median age = 34 years) and 114 controls (45.6% females, median age = 41 years). Among interictal patterns, repetitive epileptiform discharges type 1 and type 2 were more prevalent in patients with MCDs than controls (p = .002 and .005, respectively). Focal fast epileptiform discharges were also more frequent in MCD patients, after excluding nonlesional focal epilepsy controls (p = .038). Among seizure-onset patterns, paroxysmal fast activity was more prevalent in MCDs (p < .001). Among 38 patients who underwent surgery, 70.0% of MCDs and 75.0% of controls had favorable outcomes. No EEG pattern predicted postoperative seizure outcomes. Distinct scalp EEG patterns may support differentiation of MCDs from other focal epilepsies. Larger prospective studies are needed to clarify their role in detecting MRI-negative MCD or guiding targeted imaging.

The identification of key pathogenic cytokines and association of certain immune pathways with distinct inflammatory skin diseases have paved the way for targeted therapies and novel diagnostic tools.1 While bulk transcriptomic analyses represent a cost-effective and accessible method to measure average gene expression within a lesion, this approach obscures key layers of information: cell type heterogeneity and potentially crucial spatial organization. Inflammation is not evenly distributed; rather, it is tightly compartmentalized within skin lesions. These microenvironmental niches can influence which cells interact, which structures are involved, and how accessible they are to therapeutic intervention. Jiang and colleagues contend that lesions should be regarded as collections of inflammatory compartments rather than as uniformly inflamed tissue.2 A niche constitutes more than a mere collection of cells. It reflects a spatially organized circuit, composed of immune cells, vessels, stroma and epithelium, that contributes to disease memory and recurrence and enables chronic disease progression. Using hidradenitis suppurativa and psoriasis as an example, the authors elucidate how spatial transcriptomics and the concept of inflammatory niches help to understand why these two diseases—despite sharing common key inflammatory pathways and pathogenic cytokines—display different response rates to targeted therapies.2 The authors present a persuasive argument that these spatial patterns function as determinants of skin disease. Indeed, this concept is already reshaping our understanding of other inflammatory conditions. Recent spatial data in primary cicatricial alopecia reveal a hostile, follicle-centric environment characterized by immune cells actively compromising epithelial immune privilege.3 These distinctions are not solely superficial; they represent discrete microanatomical circuits. The authors also emphasize the presence of compartmentalized cytotoxic circuits at the dermo-epidermal junction in vitiligo, along with growing neuro-immune influences that modulate dendritic cell function and local CD8+ T cell activity.2 With the identification of Cathepsin S-expressing melanocytes situated within specific compartments alongside antigen-presenting cells,4 this finding transforms the inflammatory niche from a promising discovery into a viable therapeutic target: to identify and interrupt circuits within defined tissue regions. The concept of the inflammatory niche raises the bar for personalized medicine, and spatial transcriptomics provides unprecedented insight into tissue-level heterogeneity in inflammatory skin diseases. By integrating gene expression with tissue localization, spatial transcriptomics enables direct correlation between molecular profile and histopathologic structure, allowing us to accurately map the structural organization of tissue inflammation. However, a note of caution is still warranted. Spatial omics has limitations: low-abundance transcripts may be overlooked, cell identities often rely on marker gene inference, and cost and technical demands remain barriers to broader implementation.5 It will be interesting to see if artificial intelligence-powered analyses can soon reverse the current paradigm and infer specific immune pathways and inflammatory niches from regular histopathology alone, thereby bringing precision medicine closer to everyday clinical routine. Ultimately, whether treatment selection based on niche-specific targets can improve outcomes—and whether the concept of inflammatory niches will evolve into a practical tool for therapeutic decision-making—remains an open and important question. The author(s) received no financial support for the research, authorship and/or publication of this article. JLN: Speaker honoraria—Novartis and Sun Pharmaceuticals. CC: Scientific adviser and/or clinical study investigator—AbbVie, Actelion, Almirall, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galderma, Incyte, Jiangsu Hengrui, Johnson & Johnson, LEO Pharma, MSD, Novartis, Pfizer, Samsung, Sanofi, Takeda and UCB. Not applicable. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Abstract Background The intersection of foreign-born (FB) status and HIV among transgender women (TW) presents public health challenges, especially unmet healthcare needs (UHN). FBTW often encounter barriers like immigration status, language difficulties, and institutional distrust, which may be compounded for those living with HIV. Understanding how FB status and HIV intersect with UHN can guide health equity policies tailored to FBTW.Prevalence of unmet healthcare needs among US-born and foreign-born transgender women by HIV status in 7 U.S. Cities from June 2019 – February 2020Notes: aPR – adjusted prevalence ratios; CI – confidence intervals; * - significant at p&amp;lt;0.05, Models were adjusted for respondent-driven sampling design and confounding factors, including age and racial categories stratified by Hispanic/Latina ethnicity Methods TW in 7 US cities were recruited via respondent-driven sampling, consented, interviewed, and offered HIV testing. Data from people who were ≥18 years, assigned male/intersex at birth, self-identified as women or TW, spoke English/Spanish, and who had valid responses to variables of interest were included. Participants were grouped by FB status: US-born vs. FB. Log-linked Poisson regression models estimated the association between FB status and past-year UHN due to cost. HIV test results and FB status were assessed for effect modification. Models generated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results Among 1561 TW, 1152 (74%) were US-born and 409 (26%) were FB. 520 (42%) US-born TW and 139 (34%) FBTW tested HIV-positive. Overall, FBTW reported higher prevalence of UHN compared to US-born TW (22.2% vs 19.4%; aPR 1.15, 95%CI 1.01-1.46). There was a significant interaction between HIV test result and FB status (p&amp;lt; 0.05) (Figure). Among those HIV-negative, FBTW reported higher prevalence of UHN compared to US-born (29.3% vs 21.4%; aPR 1.34, 95%CI 1.06-1.69); whereas among those HIV-positive, FBTW reported lower prevalence of UHN’s compared to US-born (8.6%; vs 16.9% vs 8.6%; aPR 0.54, 95%CI 0.32-0.89). Conclusion This finding challenge assumptions that HIV-positive FBTW, often at greater risk of comorbidities and requiring more medical care, would face more barriers to healthcare. Instead, HIV-negative FBTW having higher UHN’s may suggest lack of access to HIV prevention. This raises critical questions on underlying factors contributing to these UHN’s and suggests a complex interaction between HIV status and gender identity and its implications on healthcare access. Status-neutral, comprehensive care approaches must be prioritized for FBTW. Disclosures All Authors: No reported disclosures

In the Philippines, approximately 13 million adults smoke. Policies to raise cigarette taxes, increase health warning label (HWL) size, and restrict menthol could reduce smoking. We conducted an online discrete choice experiment (DCE) in November 2023 to assess hypothetical policy responses among 886 Filipino adults who smoke across three regions of the Philippines (Luzon, Visayas, Mindanao). The DCE included ten choice sets of three cigarette packs. Packs varied on excise tax [60 (ref.), 70, 80, 90 pesos (PHP)], packaging [domestic packs: 50% HWL branded (ref.), 50% HWL plain, 85% HWL branded, 85% HWL plain; foreign pack, no HWL], and flavor [tobacco (ref.), menthol]. Participants were randomly assigned to see one choice set using a programmed 1:1 randomization ratio and asked to select which pack: 1) they would choose, 2) would make them most consider quitting, and 3) would be less harmful. Participants had lower odds of choosing packs with a 70 (adjusted odds ratio, AOR=0.58; 95% CI: 0.45-0.74), 80 (AOR=0.33; 95% CI: 0.25-0.43), or 90 (AOR=0.24; 95% CI: 0.18-0.33) PHP excise tax, and higher odds (AOR=4.02; 95% CI: 2.86-5.66) of choosing the foreign branded pack with no HWL. For quitting, participants had higher odds of selecting packs with an 80 (AOR=1.53; 95% CI: 1.18-1.99) or 90 (AOR=1.94; 95% CI: 1.50-2.51) PHP tax and 3.40 (95% CI: 2.58-4.46) and 3.30 (95% CI: 2.42-4.49) higher odds of selecting a branded or plain pack with 85% HWL coverage, respectively. Participants had lower odds of thinking packs with a 70 (AOR=0.69; 95% CI: 0.52-0.92), 80 (AOR=0.73; 95% CI: 0.56-0.96), or 90 (AOR=0.67; 95% CI: 0.50-0.89) PHP excise tax were less harmful and higher odds (AOR=5.21; 95% CI: 3.70-7.32) of thinking the foreign pack was less harmful. Results suggest raising the excise tax to at least 80 PHP and implementing 85% HWLs may encourage smoking cessation in the Philippines. Our findings can be used by policymakers and advocates in the Philippines to implement strong tobacco control policies to protect public health.

Background. Proximal phalangeal joint (PIPJ) dorsal fracture-dislocations (DFD) of the proximal interphalangeal joint are complex injuries that are challenging to treat. Hemi-hamate arthroplasty (HHA) is an excellent option in cases when the volar fragment is large and severely comminuted.Objective. The objective of this study was to present the clinical outcome of patients with PIPJ-DFD treated with HHA.Methodology. This case series was a retrospective chart review of all adult patients with PIPJ-DFD treated with HHA between 2015 and 2024. Inclusion criteria included patients with PIPJ-DFD treated with HHA. Patients with multiple digit injuries, open injuries, and associated soft tissue damage were excluded. Primary outcomes measured were the PIPJ arc of motion and the presence of flexion or extension deficits. Secondary outcomes observed include graft healing and post-operative complications.Results. A total of five patients were included in the study. All were male with a mean age of 33.8 years. Four patients had middle finger injuries, and one patient had a ring finger injury. The mean delay to surgery was 2.8 months (range, one week to six months), and the median follow-up was 32 months (range, two to 72 months). The mean volar lip involvement/fragmentation was 50% (range, 40 to 60%). All grafts healed, with a mean PIPJ extension deficit of 25.8° and a mean flexion deficit of 94°. The mean PIPJ arc of motion was 68°. No sensory deficits or pain were reported during use. One case developed radial collateral ligament insufficiency with ulnar subluxation.Conclusion. This case series confirms that HHA is an effective treatment for PIPJ-DFD, yielding satisfactory functional outcomes and reliable graft healing.

In this cyberethnography and computer-mediated discourse analysis, I explored the common digital deathscapes on Facebook and how they (re)configure death and mourning in the absence of rituals in physical spaces. I also investigated social realities, worldviews, and identities constructed by the virtual semiotic resources. Results of the transdisciplinary investigation illustrate that digital mourners resort to seven repertoires of semiotic digital deathscapes, with candles and text being the most prevalent. Avoidance of death discourse emerged as a common social reality, and belief in God and the afterlife constitute the grievers’ worldviews. In terms of computer-mediated communication, two interesting impressions were uncovered. First, Facebook appears to be a platform for women, as seen in their predilection for social media engagement and virtual mourning. Conversely, men are less engaged in virtual mourning. The results highlight gender-based differences in digital grief expressions. Additionally, they underscore the prominent role of women in emotionally charged social and family events such as death and memorialization. Findings have theoretical implications on semiotics and critical discourse analysis in the context of digital mourning while also offering rare Facebook data on the subject.

To enhance quality management practices, a digital transformation of human resources was proposed as a key strategic initiative. This study centered on developing a cloud-based data transaction system for HR management, specifically focusing on learning and development, and incorporating AI-powered document authentication tailored for particular LUCs in NCR. The shift from traditional HR systems to a cloud-enabled platform offered improved precision, security, and accessibility. This transition aligns with the progressive developments in artificial intelligence, machine learning, and cloud computing, generally leading to more streamlined HR processes, particularly in document verification, data management, and quality assurance. Employing Agile methodologies, the HR cloud data transaction system was developed through iterative sprints, addressing user authentication, document management, automated workflows, and AI-driven verification using convolutional neural networks (CNN). The system's evaluation, based on the ISO 25010 software quality model, involved gathering feedback from HR professionals and administrators in specified NCR LUCs, assessing various aspects including functionality, performance, and security. The research combined descriptive and developmental approaches to examine current HR practices, identify challenges, and determine system requirements. The resulting HR cloud data transaction system successfully met the LUCs' specific needs, enhancing HR business processes by minimizing manual interventions while bolstering document authentication security through AI. The AI and CNN-based document authentication system demonstrated effectiveness in validating digital signatures and improving data transactions within HR environments. Users noted significant improvements in data accuracy and usability, coupled with enhanced accessibility.

To identify the clinical features of sensorineural tinnitus patients who achieved complete symptom resolution or "cure" after tinnitus retraining therapy (TRT) and to determine significant factors that influence tinnitus resolution duration after TRT. A retrospective analysis of sensorineural tinnitus patients who underwent TRT and achieved a cure between January 2017 and January 2022 was performed. Cure of tinnitus was defined as patients experiencing symptoms for less than 5 minutes of awareness per day. Clinical information, including demographics, tinnitus duration, audiometric results, and therapeutic response, was examined. A total of 1,027 patients who achieved a cure for tinnitus were included, with more females (65.4%, n = 672) than males (35.6%, n = 355). The median age was 57 years (range, 12-92), with most having unilateral tinnitus (73.3%, n = 753). More than half had tinnitus with hearing loss (53.3%, n = 549), and the majority was under Jastreboff's tinnitus category 2 (38.7%, n = 397). The median duration of tinnitus before consult was 12 months in range (range, 1-480), whereas the median duration before tinnitus resolution after TRT was 17 months (range, 1-96). In Jastreboff's tinnitus categories, category 4 had the longest resolution time (median, 18 months) and category 1 the shortest (median, 15 months), but the difference was not statistically significant. A moderate correlation was observed between age and tinnitus resolution duration (Spearman correlation coefficient = 0.391, p < 0.05) and between tinnitus duration before consult and tinnitus resolution duration (Spearman correlation coefficient = 0.355, p < 0.05). TRT seems to be a promising treatment option for patients with sensorineural tinnitus. The time to achieve this cure may range from a few months to years after TRT, indicating the heterogeneity of the mechanism and therapeutic response. The younger patients and the earlier management after the onset of tinnitus seem to be good prognostic factors for a shorter tinnitus cure time after TRT.

Objective: To describe the radiologic dimensions of the Eustachian tube (pre-tympanic diameter, tubo-tympanic angle, and Eustachian tube angle) among normal ears, ears with chronic otitis media (COM) with and without cholesteatoma, in a sample of Filipino adults with COM; and to compare the dimensions of the three variables. Methods:Design: Retrospective Review of RecordsSetting: Tertiary Government Training HospitalParticipants: The study included 69 CT scans of adults with COM, with images of 23 ears for each variable (normal ears, COM with and without cholesteatoma formation). Results: In normal ears, the average pre-tympanic diameter was 3.976 ± 0.78 mm, the average tubo-tympanic angle was 41.529 ± 5.85 degrees, and the average Eustachian tube Angle (Reid Plane) was 27.077 ± 4.62 degrees. In patients with COM without cholesteatoma, the mean pre tympanic diameter was 4.002 ± 1.13 mm, the mean tubo-tympanic angle was 141.994 ± 6.30 degrees, and the mean measurement of the Reid plane was 24.649 ± 3.10 degrees. In ears with COM with cholesteatoma, the mean pre-tympanic diameter was 4.1993 ± 0.50mm, the mean tubo-tympanic angle was 138.789 ± 7.13 degrees, and the mean Reid plane was 26.483 ± 3.86 degrees. P-values for the pre-tympanic diameter, tubo-tympanic angle, and ET angle were .617, .198, and .098 respectively, indicating that there were no statistically significant differences in the ET dimensions of the ears with COM with cholesteatoma, without cholesteatoma and normal ears. Conclusion: In our investigation, we found no statistically significant differences in Eustachian tube dimensions among individuals with normal ears and COM with or without cholesteatoma. This suggests that the Eustachian tube dimensions may not serve as a primary etiological factor for COM among our patients.