The unprecedented increase in HIV cases in the Philippines has not spared healthcare workers. Due to the severe stigma associated with this disease, healthcare workers (HCWs) with HIV face signification discrimination especially if they elect to continue practicing medicine. This article examines the evidence for occupation transmission of HIV from healthcare workers to patients and provides a framework for ethical testing of HCWs and a means to continue practice while preserving patient safety.

Human ; Acquired Immunodeficiency Syndrome ; Health ; Hiv ; Philippines ; Occupational Health ; Hepatitis B ; Hepatitis C

BACKGROUND: Osteogenesis imperfecta is a heritable disorder due to a collagen gene mutation causing a structural abnormality leading to brittle bones and osteopenia. To address the osteopenia, intravenous bisphosphonates (pamidronate) act by temporarily halting the action of osteoclasts giving time for osteoblasts to build bone. To date, there has been no local data regarding the improvement in bone mineral density of filipino patients with osteogenesis imperfecta following treatment.

METHODS: This study is a retrospective review that included six patients aged 1 year and 10months-9 years and 9 months old at the Philippines General Hospital with moderate to severe osteogenesis imperfecta who have undergone six months of pamidronate infusions at 1mg/kg/dose monthly or a total dose of 6mg/kg. Chart review was done. Hand radiographs taken at baseline and after six months of therapy were reviewed by radiologist who was blinded, to determine metacarpal indices.

RESULT: There was an increasing trend in the metacarpal index from baseline to six months post-treatment with a mean difference of 0.053mm (CI -0.0112 to 0.117). However, the increase was not stastically significant (p value 0.0874) when analyzed using the paired t-test at a 95% confidence interval. No adverse events were noted and only one patient reported a fracture after starting therapy.

CONCLUSION: Bisphosphonate infusions among the six pediatric patients with moderate to severe osteogenesis imperfecta are well tolerate and although the increase in the metacarpal index from baseline after six months of treatment is not statistically significant, the trend shows improvement of the osteopenia from baseline.

Human ; Male ; Female ; Child ; Child Preschool ; Osteogenesis Imperfecta ; Bone Density ; Patients ; Osteoblasts

BACKGROUND: Histological assessment is important in evaluating liver disease. We determined the clinical diagnose and predominant histological patterns of children with liver disease and association of histological pattern with outcome.

METHODS: Consecutive patients

RESULT: 470 cases (1month-18years; 65% males; 85% <1year) were included. Most common clinical diagnose were neonatal hepatitis (49%) and biliary atresia (29%). 229 neonatal hepatitis with giant cell pattern had better outcome (96% alive after 1year vs. 136 biliary with obstructive/fibrotic pattern of whom 74% died, p=<0.05). In the other disorders namely alagille's syndrome, bile duct abnormalities, liver tumor and both chronic hepatitis and portal vein thrombosis, the predominant histologies were bile duct paucity ,fibrotic, neoplastic and near normal patterns, respectively. In these cases association with outcome could not be done due to limited patients.

CONCLUSION: Most common clinical diagnoses were neonatal hepatitis and biliary atresia. Predominant histological patterns were giant cell and obstructive type. Histological patterns of giant cell hepatitis seen in neonatal hepatitis resulted in better outcome.

Human ; Hepatitis ; Biliary Atresia ; Hepatitis ; Liver Diseases

OBJECTIVE: This study aims to determine the effectiveness of Evidence-Based Medicine (EBM) and Quality Assurance (QA) lectures and workshops on osteoporosis screening as a teaching strategy in improving the current level of knowledge and appropriate care given by resident physicians of UP-PGH Department of Family and Community Medicine (DFCM) for adults at risk for osteoporosis.

METHOD: A before-and-after educational intervention study was conducted within the residency training program of the UP-PGH DFCM.

RESULT: A total of 28 resident physicians and 300 medical records of adult patients aged >50 years who were considered at risk for osteoporosis were include in the study. There was an overall significant increase in mean knowledge scores of resident physicians on osteoporosis after the four sessions. None of the medical records reviewed documented evaluation and screening for osteoporosis hence the appropriate standard of care was not achieved as a target.

CONCLUSION: Evidence-Based Medicine and Quality assurance workshops conducted for resident physicians of UP-PGH DFCM were effective in improving the current level of knowledge in osteoporosis screening however they were not an effective strategy in improving the level of appropriate care provide for adult patients at risk for osteoporosis.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Osteoporosis ; Physicians ; Medical Records ; Evidence-based Medicine

BACKGROUND: Numerous selection criteria have been developed to assess the appropriate attributes and behavior expected of an Internist. The traditional personal interview format, however, cannot sufficiently evaluate professionalism competency and it has a low reliability and validity.

OBJECTIVE: This study will conduct an extensive review and describe the existing interview portion of the residency selection process of the UP-PGH Department of Medicine and attempt to develop an effective structure multiple mini interview to replace the traditional format.

METHODS: Review of Department records and consultant interviews will be conducted prior to the development of new structure situational interview.

RESULTS: An MMI has been developed consisting of 6 domains evaluated in separate stations. Each domain pertains to an attribute or behavior deemed important in the resident's professional career, namely honesty, teamwork, respect for authority, time management, ethical behavior on the use of emerging technologies and in dealing with the pharmaceutical industry. A 5-point evaluation system will determine the interviewee's appropriateness and acceptability of behavior.

CONCLUSION: An MMI has been developed to evaluate appropriateness of behavior when presented with actual situations that may occur on-the-job.

Human ; Interview ; Medicine

OBJECTIVES: To determine the frequency of cutaneous drug reactions (CDRs), thier associated drugs, and morphological presentation min the Philippine General Hospital (PGH) from 2009 to 2011 and to identify new or uncommon drugs causing CDRs.

METHODS: This is a 3-year retrospective record review. The Naranjo algorithm was used to score drug causality.

RESULTS: One hundred and forty-three (143) patient records were retrieved, with 218 associated drugs identified. The most common drug classes were antibiotics (29%), anti-tuberculosis medications (17%), and NSAIDs (9%). The most common drugs were isoniazid, rifampicin, pyrazinamide, ethambutol (HRZE) combination drug (9%); amoxicillin (6%); and cotrimoxazole (5%). A morbiliform reaction (49%) was the most common morphological presentation. There were several identified drugs, including anti-fungals and beta-blockers, which caused a single drug reaction but had a sufficient Naranjo score to warrant inclusion.

CONCLUSION: The most common drug classes, drugs, and cutaneous morphological presentation found in this study are similar to those seen in existing literature. However, there were several drugs identified causing single drug reactions. This may reflect the need for improved documentation, diagnosis, and follow-up of CDR cases in the PGH.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Pharmaceutical Preparations ; Diagnosis ; Isoniazid ; Rifampin ; Pyrazinamide ; Ethambutol ; Amoxicillin ; Trimethoprim-sulfamethoxazole Combination ; Philippines

OBJECTIVES: Birth defects are among the leading causes of infant mortality and morbidity in the Philippines. While affected infants make up a sizable portion of live births in General Santos City (GSC), no information is available about their actual numbers. This study aims to fill the knowledge gap about the prevalence and nature of congenital anomalies (CAs) and congenital metabolic disorders (CMDs) in the city from 2009 to 2012.

METHODS: A retrospective study of in-patient records from six(6) medical facilities was done for CA/CMD cases from 2009-2012. Among the CMDs tested were congenital hypothyroidism (CH), congenital adrenal hyperlasia (CAH), galactosemia (GAL), hyperphenyalaninemia (HPA), phenylkentonuria  (PKU) and glucose-6-phosphate dehydrogenase deficiency (G6PD def).

RESULT: Collected data revealed 109 cases of CAs with limb deformities, oro-facial clefting and neural tube disorders comprising majority of cases. There were 878 reported cases of CMDs with glucose-6-phosphate dehydrogenase deficiency (G6PD def) as the most prevalent at 829 cases. There was also a preponderance of CAs/CMDs in a government hospital for the indigent.

CONCLUSION: These result underscore the emergence of CAs and CMDs as a major health problem among newborns in GSC. Higher incidences of birth defects in one district hospital also reveal a tentative link between CA/CMD incidence and socioeconomic status. It is of paramount importance therefore, to undertake expansion of the newborn screening program and to establish local birth registries so that a more comprehensive and realistic picture of CA/CMD prevalence in the city will be obtained.

Human ; Male ; Female ; Infant Newborn ; Congenital Hypothyroidism ; Galactosemias ; Phenylketonurias ; Congenital Abnormalities ; Patients

OBJECTIVES: To determine the occurrence and antimicrobial resistance of pathogenic vibrios from green mussel, Perna viridis in bacoor bay cavite.

METHODS: Vibrios were isolated using TCBS agar and confirmed using API Identification kit. The relationship between the density of vibrios and environment parameters such as months, harvest sites and other physico-chemical parameters of water was determined. The isolated vibrios were subjected to antibiotic resistance testing to determine the resistance patterns.

RESULTS: Pathogenic vibrios were isolated in all of the 90 mussel samples. Of the 183 vibrio isolates, 75 strains were V. alginolyticus and 53 strains belonged to V. cholerae wherein 18 (34%) of these were V. cholerae serotype O1. Forty nine (49) strains belonged to V. parahaemolyticus and six were V. vulnificus. Using the regression analysis, salinity, water temperature and ph have significant correlation on the density of vibrios (p=0.0309), with regression model, total vibrios = -16990763 + 145858 Salinity + 186808 Temperature + 1037886 pH. In the antimicrobial resistance assay,ampicillin had the highest drug resistance (37.8%) followed by nalidixic acid (10.4%), tetracycline (10.4%) and co-trimoxazole (9.3%).

CONCLUSION: Pathogenic vibrios were isolated in mussel of Bacoor, Cavite and can be predicted using salinity, temperature and pH of the water. Thirty six percent (36%) of Vibrio isolates were resistance to ampicillin.

Animal ; Salinity ; Temperature ; Ampicillin ; Drug Resistance ; Nalidixic Acid ; Tetracycline ; Trimethoprim-sulfamethoxazole Combination

BACKGROUND: Cushing's syndrome is a state of hypercortisolism manifesting non-specific clinical; features where its diagnosis entails biochemical confirmation of cortisol excess. this study aims to validate the efficacy of midnight salivary cortisol as a screening test for Filipino suspected with Cushing's syndrome and determine the cut-off value applicable in the local setting.

METHODS: This is a cross-sectional study of Filipinos suspected with endogenous Cushing's syndrome seen at a tertiary hospital. Modification of plasma cortisol measured by RIA was used to measure salivary cortisol. The sensitivity, specificity, positive predictive curve, negative predictive curve and area under the screening tests were estimated and compared using 48 hour low dose dexamethasone suppression test (LDDST) as the reference standard.

RESULTS: The determine cut-off value (? 7.0 nmol/L) for salivary cortisol showed a relatively high sensitivity (91.3%) and specificity (89.5%) in detecting cases suspected of Cushing's syndrome. One milligram (1mg) dexamethasone suppression test had the highest sensitivity (100%) but had the lowest specificity (68.4%) as a screening test. The area under the curve of the three diagnostic test appeared to be similar when compared with the low dose dexamethasone suppression test.

CONCLUSIONS: Using a cut-off value of 7nmol/L, local utility if late-night salivary cortisol has a high sensitivity and specificity in detecting Cushing's syndrome. It has a similar efficiency with 24-hour urine free cortisol and 1mg dexamethasone suppression test as a screening test for Cushing's syndrome. Salivary cortisol may be considered as a valid initial screening test for Filipinos suspected of cushing's syndrome.

Human ; Hydrocortisone ; Saliva ; Cushing Syndrome ; Urine ; Dexamethasone ; Serum

The need to measure and improve quality in the health care management setting necessitates the development of performance standards. The drive for operating room (OR) efficiency has led administrators to investigate the anesthesia-controlled times (ACTs), which are the specific periods of anesthesia task completion including preparation for anesthetic induction, anesthetic induction itself and the wake up time or time to emergence from anesthesia.
OBJECTIVES: This study aims to conduct an internal benchmarking of ACTs using a secondary analysis of the data collected in a cross sectional survey of randomly selected elective surgical cases from October 2011 to January 2012, looking into the efficiency status of the operating room under the Department of Surgery of the Philippine General Hospital (PGH).
METHODS: Mean observed times for each of the milestone comprising the ACT were calculated taking in consideration the various anesthetic techniques, type of surgical procedures, duration of the operation and the anesthesiologist's experience. Analysis of variance and Fisher's exact test were used to determine the association of these factors with length of the ACT. For those where an association was noted, a multivariate analysis was done to determine its impact on the actual ACT.
RESULTS: Based on data from 539 cases, a set of benchmarks for ACT that better reflects the local setting, is proposed for the different surgical procedures and anesthetic techniques. This includes times for anesthesia preparation of 5 mins, anesthesia induction of 10 minutes and emergence times of 10 mins for total intravenous anesthesia; 20,15 and 15 mins for inhalational anesthesia; 15,10, 10mins for spinal anesthesia; 20, 25, 10 mins for epidural anesthesia and 10, 25, and 15 minutes for combined general-regional anesthesia.
CONCLUSION: It is imperative to standardize ATCs in order to reduce variability and improve efficiency. The first step in achieving this goal is to describe the standards in a particular institution, which in turn may be used as a benchmark by other institutions in a similar setting.

Anesthesia ; Multivariate Analysis ; Anesthesia, Epidural