OBJECTIVES: The study aims to determine and compare the anxiety of children with acute lymphoblastic leukemia and their well siblings based on Child drawing: Hospital manual and to identify factors associated with the level of anxiety. METHODS: A prospective cross-sectional study was done in the hematology-oncology outpatient clinic and private clinics of hema-oncology specialist in tertiary pediatric hospitals. The study included children five to eleven years old diagnosed with Acute Lymphoblastic Leukemia (ALL) and their well siblings. RESULTS: A total of forty dyads of participants were included in the study. ALL patients presented higher anxiety scores than their siblings. However, this was not statistically significant. There is a weak direct correlation between overall anxiety scores of ALL patients and their siblings (p = 0.017). There is insufficient evidence to demonstrate an association between select clinical factors with anxiety scores. The linear regression model showed 49.77% in the variation of the anxiety scores. CONCLUSIONS: There is a direct correlation between overall anxiety scores of ALL patients and their siblings. There is a positive association with larger family size and child’s response to sibling’s illness. A larger families are likely to have a healthier environment. The study showed low to average anxiety levels among participants which may be related to quality of care and support given by the institution and inherent resiliency of the family. RECOMMENDATIONS Future research should aim to develop psychological, emotional and behavioral programs in partnerships with families and other social support groups. Future studies should examine other possible cultural and psychodynamic factors prevalent in Filipino Family.
Human ; Anxiety ; Precursor Cell Lymphoblastic Leukemia-lymphoma

BACKGROUND: The Coronavirus disease 2019 (COVID-19) Is a major health crisis that affected 32 million people to date and caused death to 990,000 individuals. The impact of this pandemic on the healthcare system took its toll especially to the healthcare workers and its effect on their physical and mental health. We aim to assess severity of generalized anxiety, depression and subjective distress among medical, allied and ancillary healthcare workers (HCWs) who handled COVID-19 patients. METHODOLOGY: This is a cross sectional, survey based study done from Julyl to August 31, 2020 involving healthcare workers who handled COVID-19 patients in a tertiary hospital in Pangasinan. The selfadministered questionnaires used were the Generalized Anxiety Disorder- 7 for generalized anxiety, Patient Health Questionnaire (PHQ-9) for depression and Impact of Events Scale-Revised (IES-R) for subjective distress. RESULTS: A total of 417 of 450 contacted individuals completed the survey, with a participation rate of 92.67%. Majority were women (64.57%) and 53.24% were aged 19 to 30 years old. Sixty percent of the respondents were nurses, 25.9% were physicians and the rest were composed of medical technologists (6.47%), radiologic technologists (5 .52%) and respiratory therapists (1.68%). Subjective distress was noted to be present in 253 (60.67%) healthcare workers followed by anxiety 224 (53. 72%) and depression 184 (44.12%). Allied health professionals and male participants experienced anxiety the most as well as subjective distress. Depression was more severe among physicians (2 [1.85%1) and women (3 [1 .1 %1). Physicians and allied health professionals reported more severe degrees of mental health symptoms compared to nurses. CONCLUSION In this study, a significant proportion of HCWs especially physicians and allied health professionals involved in handling and treating suspected and confirmed COVID-19 patients experienced generalized anxiety, depression and distress.
Coronavirus ; depression ; stress ; anxiety ; mental health

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is a metabolic disorder with a wide clinical continuum of liver diseases like focal hepatic steatosis, steatohepatitis, advanced fibrosis, and cirrhosis that usually progress in a rectilinear fa sh ion. Through this course, NAFLD endure certain hemodynamic changes in the hepatic arterial blood flow. Thus, identification of patients with advanced liver fibrosis is indispensable. PURPOSE: To determine the concordance of Hepatic Artery Resistive Index (HARi) and Bard Fibrosis Score in the assessment of advanced liver fibrosis among patients with NAFLD and across its different disease severity. MATERIALS AND METHODS: Observational descriptive study design was used. 94 NAFLD patients without history of excessive alcohol consumption were invited and voluntarily participated in the research investigation. Ultrasound scanning of the liver to include color Doppler parameters (Peak systolic volume [PSV], end diastolic volume [EDV] and HAR/) and determination of BARD Fibrosis score (Body mass index [BM/], fasting blood sugar [FBS] and AST/ ALT ratio) were done. Different grading across NAFLD was established. RESULTS: The HARi of NAFLD with BARD Fibrosis scores of 1, 2, 3, and 4 has an average index of 0.84, 0.75 0.54 and 0.52, respectively. There is an unwavering inverse correlation between HARi to BARD Fibrosis scoring system (r=-0.84). Across the different severity of NAFLD, grade Ill (severe) has the lowest mean HARi at 0.53 followed by grade 11 (moderate) at 0.76 and grade I (mild) at 0.81. Correspondingly, the BARD Fibrosis score showed inverse ranking pattern across the different severity of NAFLD. Grade I (mild) has the lowest BARD fibrosis score followed by grade II (moderate) and grade Ill (severe), which yielded having a mean score of 1.00, 3.29 and 3.56, respectively. CONCLUSION The HARi has demonstrated a significant negative correlation with advanced liver fibrosis when correlated with BARD fibrosis score. Thus, this study showed that the conventional Doppler US with hepatic artery indices and laboratory variables are helpful in detecting fibrous tissue accumulation in the course of NAFLD.

This Randomized Controlled Trial sought to determine whether mothers who underwent Cesarean delivery had better postoperative outcomes when subjected to the Enhanced Recovery After Surgery (ERAS) protocol compared to mothers who also underwent Cesarean section as a mode of delivery but were under the Standard operative protocol. The research concentrated on evaluating the postoperative outcomes of the patients in the study through the following factors: length of hospitalization, efficiency and cost-effectiveness of hospital expenses, early resumption of diet and early ambulation, breastfeeding initiation and continuation. A total of 72 subjects were included in the study. Two were not included due to conversion to general anesthesia. Thirty two (44.4%) were randomized to the ERAS protocol while 40 (55.6%) patients were randomized to Standard postoperative procedure. Demographic characteristics were recorded and comparable between the two groups. Mothers randomized to the ERAS protocol had significantly shorter length of stay compared to mothers in the standard operative procedure with a mean of 53.01 hours (2.21 days) and 78.86 hours (3.29 days) respectively. Mothers randomized to the ERAS protocol spent significantly lower hospitalization cost compared to mothers in the standard operative procedure. There was no significant difference noted in the proportion of mothers with fever between the two groups (p=0.25). Mothers randomized to the ERAS protocol had significantly lower post-operative pain compared to mothers in the standard operative procedure. The time from end of OR until general liquids was also significantly shorter among mothers randomized to the ERAS protocol compared to mothers in the standard operative procedure. Similarly, the time from end of OR to flatus and bowel movement was also significantly shorter among mothers randomized to the ERAS protocol compared to mothers in the standard operative procedure. The time from end of OR to removal of foley catheter and time to void after foley catheter removal was also significantly shorter among mothers randomized to the ERAS protocol compared to mothers in the standard operative procedure. Finally, there was a significant difference noted in the length of time from end of OR to breastfeeding as proven by all p value of 0.02. Mothers randomized to the ERAS protocol had significantly shorter length of time from end of OR to breastfeeding compared to mothers in the standard operative procedure with a mean of 30.67 hours and 43.09 hours respectively. Ultimately, the study concentrated on Emergency or Elective Cesarean deliveries of Low risk patients as well as patients with controlled gestational or overt diabetes mellitus, thyroid disorders in euthyroid state, and hypertensive disorders not complicated with eclampsia. This study did not seek to generalize the benefit of ERAS protocol on all Cesarean deliveries. ERAS protocol showed better postoperative outcomes compared to the Standard operative protocol in terms of shorter length of hospital confinement, lower cost of hospitalization, no occurrence of post-operative infections and complications, shorter length of time from operation to diet progression tolerance, passage of flatus, bowel movement, shorter length of time from end of OR to removal of foley catheter and time to void and finally shorter time from operation to initiation of breastfeeding and continuation.
Cesarean Section

: Pachydermoperiostosis (PDP) or primary hypertrophic osteoarthropathy (PHO) is a rare genetic disorder that affects mainly skin and bones. Its main clinical features are pachyderma (thickening of the skin), periostosis ~excessiv~ bone formation) and clubbing of fingernails. The d1sea~e is more common among males with a 7:1 ratio, starts during adolescence and stabilize and cease progression after 5 - 20 years. OBJECTIVE: To discuss the summary of the case, new management options, and outcomes of the management options. CASE SUMMARY (METHODS): A 28-year-old male presents with a 9-year history of wrinkling of his facial skin. Other associated symptoms were seborrhea, acne, clubbed fingers, and occasional minimal knee joint pain. Histopathology results showed thickened dermis, fibrosis of the papillary dermis and around the folliculosebaceous units, hyalinized collagen bundles involving the fibrous trabeculae of the subcutis, and prominence of sebaceous and eccrine glands. The patient was given oral isotretinoin at 0.5 mg/kg/day, underwent fractional CO~ laser f?r rhytides and large pores, and given botuhnum toxin A injection (total of 16 U) on 5 sites at the glabellar region. The patient was referred to plastic surgery for frontal rhytidectomy, and orthopedic surgery for management of joint pains. RESULTS: The patient noted 80% improvement from baseline. CONCLUSION Treatment of pachydermoperiostosis is mainly symptomatic and requires a multi-spec~alty approach. Because of its rarity, treatment options for pachydermoperiostosis have yet to_ be standardized. In this particular case, all available options in the institution were utilized which led to satisfaction of the patient of the outcome.

INTRODUCTION: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare disease, accounting for less than 1 % of non-Hodgkin's lymphomas that is characterized by infiltration of T-cells in the subcutaneous adipose tissue. CASE PRESENTATION: A 21-year-old Filipino female presented with intermittent fever which eventually was associated with multiple eruption of cutaneous lesions. The serum antinuclear antibody (ANA) titer and pattern revealed negative results. Further clinical investigation prompted a skin lesion punch biopsy revealing atypical lymphoid infiltrates with lobular panniculitis consistent with SPTCL. lmmunohistochemical studies stained strongly posItIve for CD3, CDS, granzyme B and negative for CD20, CD4, and CD56. The case was also compounded with the existence of hemophagocytic syndrome having fulfilled five of the eight criteria . She was given prednisone (1 mg/kg/day) with gradual resolution of cutaneous lesions leaving marked hyperpigmentation and lipoatrophy. DISCUSSION: SPTCL presents with a myriad of systemic symptoms but will always present with skin lesions. The biopsy for histopathological interpretation is commonly performed as a first diagnostic step followed by immunohistochemical staining. Clinical presentation, histo-pathological findings, and 1mmunohistochemical results together clinched the diagnosis of SPTCL. CONCLUSION Patients with history of intermittent fever associated with cutaneous lesions and systemic clinical findings, SPTCL should be a differential diagnosis. However, lupus erythematosus panniculitis (LEP) must be ruled out first as its closest mimicker. This case report along with other large case series provides further evidence that monotherapy with oral prednisone can be an initial choice of therapy.

INTRODUCTION: Fungal balls are commonly associated with the Aspergillus species. The hyaline hyphae is not diagnostic of a fungus ball's causative organism hence the need for fungal culture. Systemic fungal infections are rarely seen in immunocompetent persons. CASE: A 45-year-old male presented with a nine month history of nonproductive cough progressing to hemoptysis. His chest tomography with contrast revealed a mass measuring 6.5cm x 5.5cm x 6.9cm located in the left upper lobe, with a smooth lining and air crescent sign consistent with aspergilloma. Serum galactomannan assay was positive. Patient was treated medically for Aspergillus sp infection with voriconazole and itraconazole for six months with no response. A left upper lobectomy was done. Lung tissue biopsy and histopathologic examination showed hyphal elements with branching short lateral necks. Culture studies revealed a rare microorganism namely Coniochaetta hoffmannii. Post-operatively, our patient improved and was eventually discharged. DISCUSSION: Coniochaetta hoffmannii is a rare human pathogen and is only implicated in those immunocompromised. Thorough clinical investigation led to the identification of this organism. Literature review reveals scant inconclusive treatment approaches. Surgical intervention proved therapeutic for our patient. CONCLUSION Not all fungal balls are caused by Aspergillus sp. Culture studies remains the gold standard in identifying specific organism causing fungus balls. Rare micro-organisms such as Coniochaeta hoffmanii. can be isolated. Invasive fungal infection can occur in an immunocompetent host. The outcome of this study will contribute to the limited pool of information on the diagnosis and management of similar cases.

INTRODUCTION Alopecia areata incognita is a rare form of alopecia areata which was first reported in 1987. The prevalence of this disease is unknown but it is more common in women. The usual presentation of alopecia areata incognita is acute, diffuse hair thinning. In most cases, it lacks the typical alopetic patches seen in alopecia areata. It may resemble telogen effluvium and androgenetic alopecia. The prognosis of this disease is favorable and recovery is rapid and spontaneous. Case: A 19- year-old Filipino female presents with a two-month history of alopecia areata incognita. She initially had a solitary round patch of hair loss on the scalp with proximally tapered hair, rapidly evolving into diffuse hair thinning. CBC, TFTS, FBS, HBA 1 c, ANA and VDRL were unremarkable. Histopathology demonstrated dense peribulbar lymphocytic infiltrate, miniaturized hair and increased catagen hair consistent with alopecia areata. There was gradual hair growth after treatment with minoxidil 5% lotion and topical betamethasone dipropionate 0.05% lotion.

INTRODUCTION Impetigo Is a common, contagious, superficial skin infection most commonly presenting as erythematous crusting papules and pustules on the face and or extremities. The pathogens usually implicated in this skin disease are gram- positive organisms including Staphylococcus aureus, and less frequently, group A β-hemolytic Streptococcus pyogenes. In JRRMMC, Department of Dermatology, this disease always ranks in the top 1 O most common skin diseases annually. Treatment options for this disease include topical and oral antibiotics depending on the condition's severity. Mupirocin and Fusidic acid are considered as gold standard in the treatment of impetigo.

A predetermined endotracheal tube depth prior to intubation ensures correct tube placement relative to the carina. The objective of this study was to determine if the topographic measurement from the middle fingertip (MFT) to Rascette line (RL) or "wrist line" correlates with acceptable endotracheal tube (ET) depth during orotracheal intubation. This was a prospective, analytical cross-sectional pilot study of 54 adult Filipino patients who underwent general anesthesia with orotracheal intubation. The middle fingertip to Rascette line measurement was utilized as the basis for endotracheal tube depth with ET secured on the right corner of the mouth. After intubation, a chest x-ray was performed to measure the distance from the endotracheal tube tip to the carina. The study showed that the average middle fingertip to Rascette line measurement among Filipinos was 18.79cm (± 1.08) which resulted in 85.19% of patients with ET tip to carina within the acceptable distance of 2-Scm, with a mean value of 3.17cm. The mean MFT to RL measurement in females was 18.28cm and 19.81 cm in males. The mean distance of ET tip to carina in females was 2.91 cm and 3.66cm in males. There was a significant positive correlation between the middle fingertip to Rascette line measurement and height. This study also documented the total length from the right corner of the mouth to carina, by adding middle fingertip to Rascette line measurement and the distance from ET tip to carina, resulting in a mean value of 23.46cm (±2.06) in males and 21.19 cm (±1 .73) in females. In conclusion, middle fingertip to Rascette line measurement is an acceptable technique to determine individualized endotracheal tube depth during orotracheal intubation. This topographic measurement resulted in 96.29% of ET tip :?: 1 cm above the carina.