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Introduction The habit of consuming energy drinks is a life-threatening risk, because it can produce a syndrome characterised by a muscle necrosis. This promotes the release of enzymes and myoglobin from inside the myocyte into the circulation, creating lipid peroxidation and leading to acute kidney injury, and hyperkalaemia, together producing rhabdomyolysis. Rhabdomyolysis can be expected to be found within 24–48 h after strenuous activities, even more so with a modified BORG index greater than or equal to 5 points. However, energy drinks, due to their high content of caffeine and other components, can generate this little known adverse event. Clinical case A 37-year-old patient admitted to the emergency department due to clinical symptoms of myalgia, and dark urine that appeared 24 h after four days of low-intensity muscular exercises, and was associated with daily consumption of an energizing drink for 2 years. The diagnosis of rhabdomyolysis was confirmed by increased creatine kinase and transaminases. It was not possible to measure myoglobin levels. The patient was treated with aggressive fluid therapy. He never presented with any renal or electrolyte complications. Conclusion This case highlights the appearance of acute rhabdomyolysis in patients taking low intensity exercises, and not ruling out long-term consumption of energy drinks as the main cause. There are few cases currently reported in the literature. Owing to the timely treatment, progression to acute kidney injury was avoided.

Resumen Introduccion Un riesgo potencialmente mortal es el habito de consumo de bebidas energizantes, porque puede producir un sindrome caracterizado por la necrosis muscular que promueve la liberacion de enzimas y mioglobina proveniente del interior del miocito hacia la circulacion, creando una peroxidacion lipidica llegando a generar lesion renal aguda e hiperkalemia; conocido como rabdomiolisis. La rabdomiolisis la esperariamos encontrar entre 24 y 48 h despues de actividades extenuantes, aun mas con un indice de Borg modificado mayor o igual a 5 puntos; sin embargo, las bebidas energizantes por su alto contenido de cafeina y otros componentes pueden generar este evento adverso poco conocido. Caso clinico Paciente de 37 anos, obeso, que ingreso al servicio de urgencias por cuadro clinico de mialgia y orina oscura que aparecio 24 h despues de 4 dias de ejercicio muscular de baja intensidad, asociado a consumo diario de bebida energizante por 2 anos. El diagnostico de rabdomiolisis se confirmo por hiperCKemia e hipertrasaminemia; no fue posible medir los niveles de mioglobina. El paciente fue tratado con fluidoterapia agresiva. Nunca presento complicaciones renales ni hidroelectroliticas. Conclusion Nuestro caso destaca la aparicion de rabdomiolisis aguda en pacientes sometidos a ejercicios de baja intensidad no descartando como causa principal el consumo cronico de bebidas energizantes. Son pocos casos actualmente reportados en la literatura. Gracias al tratamiento oportuno se evito la progresion a lesion renal aguda.

Background The efficacy of a combination of nimotuzumab, a humanized monoclonal antibody to the epidermal growth factor receptor, with chemoradiation in locally advanced head and neck squamous cell carcinoma (HNSCC) was evaluated in a phase II study. Methods Patients with stage III/IV HNSCC received 3-weekly cisplatin 100 mg/m2 for three cycles and weekly nimotuzumab 200 mg for 8 weeks concurrently with radiotherapy. Primary endpoint was best overall response (BOR) and secondary endpoint was progression-free survival (PFS). Results Thirty-seven patients were included; the majority were Chinese (76%), male (89%), and had stage IVA/IVB HNSCC (92%). BOR of complete and partial response was seen in 22/37 (59%) and 10/37 (27%) patients, respectively. Median PFS was 17.5 months (95% CI: 11.1-54.5) and 3-year PFS was 40.4% (95% CI: 24.3-55.9). The frequency and type of adverse events observed were similar to standard chemoradiation. Conclusion The combination of nimotuzumab with cisplatin and radiotherapy was safe and achieved high response rates in HNSCC.

Highlights • COVID-19 pandemic has disrupted our normal healthcare system. • To separate cancer patients undergoing chemotherapy from the main hospital, a religious facility was used in the interim. • The use of a religious facility is feasible as long as standard infection control polices are enforced., The advent of the COVID-19 pandemic has stretched most healthcare systems to the point that if no adaptations are made, failure will most likely happen. The Philippine healthcare system, with its meager resources, is very much vulnerable to this. During the start of the pandemic, Bataan General Hospital and Medical Center has been converted to a COVID-19 hub, leaving cancer care and treatment displaced. We describe our experience in the feasibility of using a religious facility as an interim place for continuing oncology treatment. An outpatient chemotherapy unit was set up using the main hall of the Residencia Sacerdotal, a religious facility, in Bataan. General practices for infection control, workflow and service delivery were in accordance with existing guidelines. A total of 56 adult patients and 22 pediatric patients were seen for chemotherapy during the period of April 28 to July 15, 2020. A total of 144 chemotherapy sessions for adults and 190 sessions for pediatric patients were done. Fifty nine patients (43 adults and 16 pediatric) were tested for COVID-19 RT PCR (GeneXpert®), as baseline prior to chemotherapy, and all were negative. During the course of treatment, adverse events were noted including infusion reactions, hematologic complications which resolved without any complications. No nosocomial infection was recorded both for patients and healthcare workers. To conclude, in the COVID-19 Pandemic Era adapting to the situation is the best way forward. In our setting, continuing cancer care in a religious facility is a feasible alternative.

Objectives: Malnutrition is prevalent among cancer patients, and maybe correlated with altered quality of life. The objective of this study is to determine whether quality of life among cancer patients on chemotherapy at the National Kidney and Transplant Institute- Cancer Unit differs from patients with normal nutrition based on the Subjective Global Assessment scale.Methods: A cross sectional study was conducted among cancer patients admitted for chemotherapy at the National Kidney and Transplant Institute-Cancer Unit from January to May 2011. Demographic profile, performance status by Eastern Cooperative Oncology Group performance scale, nutritional status assessment by Subjective Global Assessment, and quality of life assessment by the European Organization for Research and Treatment of Cancer QoL-30 core module were obtained. Descriptive statistics and ANOVA were performed for analysis of quality of life parameters and nutritional status.Results: A total of 97 subjects were included in this study, 66 subjects (68.04%) were females and 31 (31.96%) were males. Mean age was 54.55 ± 11.14 years, while mean performance status by the Eastern Cooperative Oncology Group classification was 0.88 ± 0.83 with a range of 0-3. According to the Subjective Global Assessment, there were 58 patients with SGA A, classified to have adequate nutrition, and 39 patients (40.21%) were considered malnourished. Among these 39 patients, 32 were classified SGA-B (moderately malnourished) and 7 were classified SGA C (severely malnourished) mean global quality of life was 68.73 ± 19.05. Results from ANOVA test revealed that patients were statistically different across the Subjective Global Assessment groups according to global quality of life (p

Five tamarins (four Saguinus mystax and one S. labiatus) died with wasting syndrome characterized by chronic diarrhea at the Center for Reproduction and Conservation of Non-Human Primates in Iquitos, Peru. At necropsy, the terminal ileum of all affected tamarins was found to be markedly thickened. Histologically, the terminal ileal mucosa was completely ulcerated, and effaced by debris and mononuclear inflammatory cells. The submucosa and serosa were thickened by fibroplasia, mononuclear cell infiltrates and variable edema. No infectious agent was observed. The lesions were similar to those described previously for Crohn disease. This is to our knowledge the first report of terminal ileitis resembling Crohn disease in non-human primates.

Clinical and pathologic data were reviewed for 72 owl monkeys that died between January 1987 and May 1990 at the Center for Reproduction and Conservation of Nonhuman Primates in Iquitos, Peru. Tissue samples from 39 animals were examined. Hypertrophic cardiac disease (51% of animals examined), dilative cardiomyopathy (26%), and nephropathy (87%) were the most common diagnoses. The incidence of all three diseases appeared to increase with time in captivity. Nephropathy was less severe in colony-born animals.

From January 1987 to November 1990, 125 adult Saguinus mystax died at the CRCP. Enteritis/colitis (26%), hypoglycemia/cachexia (19%), and parasitic enteritis (13%) were the most common causes of death. Less common were purulent peritonitis (9%), lobular pneumonia (8%), and hemorrhagic gastroenterocolitis (6%). These results confirm the high frequency of gastroenteric lesions reported in Callitrichidae in captivity.

The purpose of this study was to determine serum reference values for creatine kinase (CK), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) in captive-born and wild-caught owl monkeys to assess their usefulness for diagnosing myocardial disease.Blood samples were collected for CK, AST and LDH determinations. In addition, urine samples were collected and semiquantitative tests performed.There was no statistically significant difference between CK, AST and LDH when comparing both groups. However, when comparing monkeys with proteinuria to those without proteinuria, a statistically significant difference in CK value was observed (P = 0.021). In addition the CK/AST ratio revealed that 29% of the animals included in this study had values suggesting cardiac infarction. Grossly, cardiac concentric hypertrophy of the left ventricle and small, pitted kidneys were the most common findings. Microscopically, myocardial fibrosis, contraction band necrosis, hypertrophy and hyperplasia of coronary arteries, medium-sized renal arteries and afferent glomerular arteriolae were the most significant lesions, along with increased mesangial matrix and hypercellularity of glomeruli, Bowman's capsule and peritubular space fibroplasia.These findings suggest that CK, AST and LDH along with urinalysis provide a reliable method for diagnosing cardiomyopathies in the owl monkey. In addition, CK/AST ratio, proteinuria and the observed histological and ultrastructural changes suggest that Aotus vociferans suffer from arterial hypertension and chronic myocardial infarction.

A wild-caught male Aotus vociferans died spontaneously during quarantine. Histologic examination of the heart showed several small myocardial arteries replaced with fibrinoid necrosis and adjacent inflammation that included lymphocytes and large histiocytic cells. Less often, similar inflammatory foci were observed in the myocardium interstitium. The lesions observed in the heart of the owl monkey resembled Aschoff bodies.

e20696 Background: Cancer-related symptoms are less investigated but frequently reported patient-experienced symptom clusters. In palliative oncology, focus is on recognizing and addressing these symptoms, and giving quality of life. The purpose of this study is to determine the severity of cancer related symptoms among metastatic cancer patients on palliative chemotherapy using the MD Anderson Symptom Inventory (Filipino) [MDASI-F]. Methods: A cross-sectional study among metastatic cancer patients undergoing palliative chemotherapy at the National Kidney and Transplant Institute, Philippines, was performed using MDASI-F. Results: A total of 114 patients were included with a mean age of 55.5 years. 61% were female, and 39% were male. 81.6% were married, while 14% were single and 4.4% were widowed. Highest educational level attained were college (78.1%), high school (19.3%) and primary school (2.6%). Average Body Mass Index fall on 23 kg/m2. Majority of the patients have an Eastern Cooperative Oncology Group (ECOG) Performance Status of 1 (54.4%), followed by ECOG 2 (19.3%), ECOG 0 (18.4%), and ECOG 3 (7.9%). The most common cancer site is breast (30.7%), followed by colon (21.9%), and lungs (16.7%), while the remaining 30.7% belong to other cancer sites. Majority of the patients have one metastatic site (68.4%), 22.8% have two, while 8.8% have 3 metastatic sites. Mean duration of illness from the time of diagnosis was 13.67 months. The most severe cancer related symptoms were sleep disturbance (mean 3.48), fatigue (mean 3.36) and pain (mean 3.14). Interestingly, all Filipino metastatic cancer related severity symptoms and interference items belong to the mild severity score (scores of 0-3) using the MDSAI-F. Conclusions: Among Filipino metastatic cancer patients on palliative chemotherapy, cancer-related symptom severity items and interference items were shown to have mild severity scores based on the MDASI-F.

Of the 232 tamarins (133 Saguinus mystax and 99 Saguinus labiatus) that died at the Center for Reproduction and Conservation of Nonhuman Primates in Iquitos, Peru from January 1987 to December 1990, 23 monkeys (9.9%) were diagnosed as having chronic colitis. Typically, the cecal and colonic mucosa was greyish and small yellowish cysts, measuring 1-4 mm, were found randomly distributed bulging the mucosa. Microscopically, colitis cystica profunda was diagnosed additionally in six more animals, giving a total of 29 cases (12.5%). This is the first report to our knowledge that describes colitis cystica profunda in a nonhuman primate.

An adult male Aotus nancymae maintained for breeding purposes was submitted for surgery and the left testicle was removed. The surgically removed mass was about two to three times the size of a normal adult owl monkey testicle. Grossly, on cut surface, the mass was soft, white to pale gray, and bulged above the adjacent tissue. Microscopically, the morphology of the tumor cells was consistent with a seminoma.

To determine the main causes of death in "owl monkeys" (Aotus nancymae and A. vociferans) in captivity, 115 necropsies were performed. According to the macroscopic findings and clinical data, results are as follow: acute lobular pneumonia (25.2%), chronic nephropathy (10.4%), acute catarrhal enteritis (8.7%), acute hemorrhagic enteritis (7%), acute toxic hepatitis (5.2%), trauma (5.2%), and others.

An adult male Callimico goeldii died spontaneously. At necropsy, small whitish foci were found randomly distributed on the liver surface. Histologically, the foci were composed of mixed inflammatory cells with predominant polymorphonuclear cell infiltration and central areas of necrosis. Microbiological cultures revealed a Gram-negative coccoid-bacilli with bipolar staining. Biochemical analysis revealed that the microorganism was Pasteurella haemolytica.

A wild-caught adult female Saguinus mystax died after 54 months in captivity. At necropsy, a small reddish zone in the renal cortex of one kidney was shown histologically to be a hemangiosarcoma.