OBJECTIVES

his quantitative cross-sectional study aimed to determine the level of knowledge, attitude, and practices
regarding COVID-19 vaccination of unvaccinated adult patients admitted at Region II Trauma and Medical Center
(R2TMC). This may help determine the knowledge gap regarding COVID-19 vaccination, address it, and to achieve
the goal to vaccinate all eligible Filipinos. Furthermore, this may also be a springboard for future researches and
management regarding novel infections needing new vaccinations.

METHODS

Collected data from the sample size of 197 using the formula for finite population with 95% confidence
level, population proportion of 50%, population size of 400, allowing 5% margin of error were summarized in a
Microsoft excel database and tables, then were analyzed using Jamovi version 2.6.22 software. Frequency, mean,
and standard deviation were calculated to measure the knowledge, attitude, and practices; Pearson correlation and
Kendall’s Tau b correlation for its relationship.

RESULTS

There is moderate level of knowledge (MS: 9.80-11.8), a positive attitude (MR: 2.35-2.60), and good preventive
practices (MS: 12.00-13.00) regarding SARS-CoV-2 (COVID-19) vaccination among the unvaccinated adult in-patients
of R2TMC post-pandemic. Knowledge, attitudes, and practices statistically differed (pCONCLUSION

There is a significant correlation among the knowledge of the respondents about COVID-19 vaccination,
their attitude towards it, and their practices, implying that promoting preventive behaviors toward COVID-19 would
require promoting both knowledge and efficacy beliefs among the public.

Human ; Bacteria ; Male ; Female ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Wounds And Injuries ; Population Density ; Cross-sectional Studies ; Forecasting ; Sars-cov-2 ; Sars Virus ; Covid-19

Diffuse infiltrating retinoblastoma is an extremely rare form of retinoblastoma which is characterized by its atypical growth pattern. This unusual presentation adds complexity to the diagnostic process. The purpose of this paper is to report a rare presentation of diffuse infiltrating retinoblastoma presenting after an ocular trauma. We described a 7-year-old Filipino boy presenting with total hyphema following an ocular trauma. Comprehensive ophthalmologic clinical and diagnostic evaluations were performed including visual acuity, slitlamp biomicroscopy, ocular ultrasound, neuroimaging, and histopathology post enucleation to determine diagnosis. The misleading, atypical presentation of diffuse infiltrating retinoblastoma may delay diagnosis. While this dilemma is expected in these scenarios, it should be remembered that timing of diagnosis in retinoblastoma is crucial, as this also equates to optimal management. One should remain vigilant for these uncommon presentations especially in the setting of any intraocular inflammation in children.

Human ; Male ; Child: 6-12 Yrs Old ; Wounds And Injuries ; Visual Acuity ; Retinoblastoma ; Research Report ; Neuroimaging ; Inflammation ; Hyphema ; Contusions

INTRODUCTION

Diffuse cutaneous mastocytosis (DCM) is a rare and severe form of cutaneous mastocytosis which may present in the neonatal period; thus early recognition is essential. Symptoms of mastocytosis are exacerbated by mast cell degranulating agents more commonly from heat, friction, local trauma, drugs and food. This is a case of DCM presenting with bullous eruptions after immunization.

CASE REPORT

An 11-month-old boy presented with generalized erythematous to hyperpigmented macules and patches initially at birth, with progression to bullous eruptions immediately after immunization without any systemic symptoms. Biopsy revealed superficial and deep mixed cell infiltrates consisting of lymphocytes, histiocytes and numerous mast cells. Giemsa stain highlighted the metachromatic mast cell granules. Serum tryptase was elevated by 13 times (130 ug/L). The patient was prescribed oral antihistamines and topical steroids that offered good response. Avoidance of all potential triggers was instructed.

DISCUSSION

The extensive cutaneous involvement in DCM (generalized erythema, diffuse papules that develop pachyderma, darker skin, peau d’orange) are due to the diffuse infiltration of the dermis with mast cells, accompanied with an elevated serum tryptase.

Unique to this local case are exacerbations triggered by vaccination. There is literature to support evidence of vaccination reactions to pentavalent vaccine in children with DCM though the pathway associated with mast cell degranulation after immunization has not yet been specified.

It is advised that patients with DCM follow scheduled immunization guidelines with precautionary measures.

Human ; Male ; Infant: 1-23 Months ; Wounds And Injuries ; Research Report ; Pharmaceutical Preparations ; Mastocytosis, Cutaneous ; Hot Temperature

BACKGROUND AND OBJECTIVES

Natural disasters occur frequently in Indonesia, so the community must understand the impact of these disasters. Nurses, on the other hand, can perform trauma prevention care and carry out interventions in areas prone to natural disasters. The concept of trauma prevention care is not new in nursing. However, it needs to be analyzed further because there are still unclear definitions and inconsistencies in its implementation.

This study aims to describe the concept of trauma prevention care using the Walker & Avant analysis method.

METHODS

The Walker and Avant concept analysis method was used which consists of eight systematic steps. Information sources include electronic databases such as ScienceDirect, PubMed, EBSCO, and SAGE, for articles published from January 2006 to June 2024. Embase was searched for the terms "trauma prevention," AND "trauma prevention care," AND "trauma prevention natural disasters."

RESULTS

The literature search identified 80 articles in the fields of medicine, nursing, sociology, and psychology. After analysis, 13 articles were selected for this study. Data extraction and analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Trauma prevention care is defined as 1) knowledge, 2) recognition, 3) caring, 4) respect, and 5) communication. The idea of antecedents includes trauma, education, and skills, while consequences comprise assessment, safety, resources, psychological stress, unidentified trauma, and limitations of nurses.

CONCLUSION

Understanding the attributes of trauma prevention care, along with its antecedents and consequences, can facilitate development in nursing practice. This concept of trauma prevention care can be used to conduct trauma assessment and prevention in natural disaster-prone areas to minimize the impact that will occur.

Natural Disasters ; Wounds And Injuries

BACKGROUND

Burn injuries remain a significant global public health problem, causing substantial morbidity, mortality, and economic burden, particularly in low- and middle-income countries where nearly 90% of cases occur. Despite the importance of timely and appropriate first aid in reducing complications, community responses to burn injuries in many settings continue to rely on traditional or non-evidence-based practices.

OBJECTIVES

This qualitative phenomenological study explored community-based knowledge and responses related to the causes and first aid of burn injuries.

METHODS

The study involved ten (10) purposively selected informants residing in South Mangga Dua Urban Village, Central Jakarta, Indonesia. Data collection methods included semi-structured interviews, direct observations, and focus group discussions (FGDs). Thematic analysis was used.

RESULTS

Three (3) core domains were identified: (1) community perceptions of burn causes and classifications, (2) indigenous first aid practices used in domestic settings, and (3) sources of knowledge and information pathways related to burn first aid. Participants commonly attributed burns to incidents involving fire, hot liquids, and electrical faults. Their understanding of burn severity was limited to superficial assessments, with little awareness of clinical classifications. First aid responses were largely based on traditional practices such as the application of toothpaste, honey, or aloe vera, while evidencebased practices like using running water were rarely mentioned. Notably, most participants relied on familial teachings and informal community experiences as their primary sources of knowledge, with limited exposure to health professionals or verified media content.

CONCLUSION

Community knowledge is culturally rooted but misaligned with medical standards, potentially leading to unsafe practices. Culturally sensitive health education integrating traditional beliefs and accurate information is essential to improve outcomes in burn injury management.

Wounds And Injuries ; Residence Characteristics ; Public Health ; Mortality ; Insemination, Artificial, Heterologous ; Income ; Financial Stress ; Burns ; Health Education ; Attitude ; First Aid ; Medicine ; Health Communication ; Urban Population

BACKGROUND

Penetrating brain injury (PBI) is a leading cause of combat mortality but local outcome data is limited. The authors examined combat-related PBI cases to describe patient characteristics and identify clinical and radiologic predictors of functional recovery

METHODS

This is a retrospective cohort study of military personnel aged 18–56 years with combat-related PBI referred to VLGH AFPMC between January 2017 to June 2022. The authors collected demographics data, injury mechanism, pre-hospital and transfer details, admission clinical and radiologic findings, treatments, and follow-up outcomes. The Glasgow Outcome Scale (GOS), dichotomized into unfavorable (GOS 1–3) and favorable (GOS 4–5), was used to assess functional status. Associations were tested with Fisher’s Exact Test.

RESULTS

Thirty-seven patients met inclusion criteria: 31 survivors with follow-up and 6 who died in hospital. All were male; gunshot wounds accounted for 81% of injuries. At a median follow-up of 27 months, among survivors, 74% had a Glasgow Coma Scale (GCS) of 15 and 45% achieved good recovery (GOS 5). Pre-hospital timing measures (evacuation time, interval to surgery, and transfer delays) were not significantly associated with outcome. Favorable outcomes correlated strongly with higher admission GCS (p < 0.001), preserved baseline motor function (p < 0.001), smaller hemorrhage volume (p = 0.01), and injury limited to a single lobe (p < 0.001). Unfavorable outcomes were associated with intracranial infection, post-traumatic seizures, and need for multiple surgeries (all p < 0.001).

CONCLUSION

Functional recovery after combat-related PBI in this cohort was principally determined by initial neurologic status, injury extent, and subsequent complications The lack of association with pre-hospital timing possibly reflects survivorship bias and incomplete capture of early fatalities.

Human ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Wounds, Gunshot ; Brain Injuries, Traumatic

BACKGROUND

Traumatic peripheral nerve injury (TPNI) is a debilitating condition that may result in significant disability. There is variability in the epidemiology, clinical profile, and mechanism of injury worldwide, but data for low- and middle-income countries (LMICs) such as the Philippines are sparse.

OBJECTIVE

We aimed to determine the demographic and clinical characteristics, management, and outcomes of patients who sustained TPNI in our center.

METHODS

We performed a retrospective cohort study of all patients referred for TPNI at our institution from 2013 to 2019. Data on demographics, clinical features, etiology, surgical management, and status on last follow-up were collected.

RESULTS

Forty-four patients with injuries to 62 peripheral nerves were included in the cohort, which had a strong male predilection (98%). The mean age at diagnosis was 35.5 years, with 78% of patients aged between 16-45 years. The most common etiologies were laceration due to sharp objects (39%), stab wound (23%), hacking injury (14%), and vehicular crash (14%). In terms of mechanism of nerve injury, the most common was sharp laceration (80%), followed by stretch injury/nerve injury in continuity (14%). The most commonly injured nerves were the ulnar (36%) and median nerves (32%), more often on the right side (66%). Nerve repair surgery was performed in 80% of cases.

CONCLUSION

TPNIs in a tertiary center in the Philippines most commonly involved young males in the working age group and were caused by occupational and domestic accidents. Appropriate surgical management of TPNI is feasible in low resource settings.

Human ; Peripheral Nerve Injuries ; Trauma ; Wounds And Injuries ; Philippines

INTRODUCTION

Burn wound infection is a significant risk factor in the morbidity and mortality of burn wound patients. Previous studies in our institution showed bacterial colonization in burn patients seen beyond 24 hours post-injury. The microbiological profile of burn wounds seen within 24 hours, including the presence and risk factors for wound colonization, has not been determined in our Burn Center.

OBJECTIVES

To identify the presence and risk factors for burn wound colonization in burn patients seen less than 24 hours after injury and determine the microbiological profile and antibiotic susceptibility patterns in colonized burn wounds.

METHODS

One hundred eighty-nine burn patients who were seen at and admitted to the UP Philippine General Hospital ATR Burn Center within 24 hours of the burn injury from June 2021 until July 2023 were included in the study. Demographic and clinical data were collected upon admission. A total of 635 swab samples were collected from 189 patients and were sent for identification of aerobic organisms by standard culture methods and antibiotic sensitivity tests using the Kirby-Bauer disc diffusion method. Association of patient characteristics (area of injury, time received post-injury, previous hospital care, place of injury, percent burn injury, etiology, mode of transport, and type of dressing prior to admission) were determined using Chi square test of independence.

RESULTS

Out of 189 burn patients seen within 24 hours after injury included in the study, 58.73% (n = 111) of patients, and 49.29% (n = 313) of swabs showed bacterial colonization. Burn wound colonization was associated with area of injury/body region (χ2 5 = 16.29, p = .0061), time received post-injury (χ2 3 = 24.62, p < 0.0001, post hoc Fisher’s test for 6-12 hours vs. within the first 6 hours: p < 0.0001), place of burn injury (χ2 2 = 18.17, p = 0.0001, post hoc Fisher’s test work vs. home: p = 0.0006, work vs. outdoors: p = 0.0015), percent burn injury (χ2 4 = 21.40, p = 0.0003, post hoc Fisher’s test 25-49% vs. 0-9%: p = 0.004, 50-75% vs. 0-9%: p = 0.002), and etiology of burn injury (χ2 2 = 37.05, p < 0.0001, post hoc Fisher’s test scald vs. flame: p = 0.0012, electrical vs. flame: p < .0001). From 313 positive samples, 357 isolates were identified. Staphylococcus (58.8%) was the most common organism isolated. It was noted that out of the total isolates, 15 (4.2%) were identified to be methicillin-resistant S. aureus (MRSA) while 5 isolates (1.4%) were methicillin-resistant S. epidermidis (MRSE). Streptococcus (10.4%) and Acinetobacter (6.2%) were the second and third most common organisms, respectively. Other groups identified were Aeromonas, Bacillus, Enterobacter, Pseudomonas, Klebsiella, and diphtheroids. Frequency of bacterial isolates differed across body regions, time received post-injury, percent burn injury, and etiology of burn injury. Resistance to one antibiotic was observed in 36.84%, 6.25%, and 63.64% of Staphylococcus, Streptococcus, and Acinetobacter isolates tested, respectively. Resistance to more than 1 antibiotic was observed in 48.68% of Staphylococcus isolates and 50.0% of Streptococcus isolates tested. Among the 51 S. aureus isolates, 29.1% were methicillin-resistant S. aureus (MRSA).

CONCLUSION

In burn patients seen within 24 hours after injury, about half of burn wounds and more than half of patients showed the presence of microbial growth. Potential risk factors for positive microbial growth in a burn wound during this timeframe were area of injury/ body region, place of injury, time received post-injury, percent TBSA burn, and etiology of burn injury. The most common isolate was Staphylococcus spp. More than half of Staphylococcus isolates showed antibiotic resistance, with a significant number showing multidrug resistance. More than a quarter of S. aureus isolates were methicillin-resistant S. aureus (MRSA). These results suggest that bacterial isolates can colonize burn wounds even within 24 hours post-injury and may exhibit antibiotic resistance.

Human ; Burns ; Wounds And Injuries ; Wound Infection ; Methicillin ; Klebsiella ; Methicillin-resistant Staphylococcus Aureus ; Drug Resistance, Multiple

RATIONALE

Wound care practices are documented using wound registries to record wound types and characteristics, track wound status, assess impact of interventions, evaluate outcomes, and cost effectiveness. Data from wound registries may also be used for research in wound care and healthcare resource planning. However, a standardized wound registry in the Philippines is lacking, necessitating the creation and development of our own Wound Registry Form, tailored to our experience.

METHODS

This study involved the development and validation of a Wound Registry Form. An initial survey and focus group discussion with wound care practitioners were done to develop the items included in the form. The form underwent content validation with a panel of experts. Pilot data collection with 75 patients was performed to determine the interrater reliability between General Surgery (GS) and Plastic Surgery (PS) residents in a tertiary hospital when assessing patients with wounds.

RESULTS

A Wound Registry Form containing 36 variables was developed. It demonstrated a high content validity index (1.0), and good interrater reliability. The General Surgery residents and Plastic Surgery residents did not differ significantly in describing the wound, and generally agree on the choice of wound dressing, and other treatment related characteristics –such as frequency of dressing changes, antibiotic use, and septic studies done. However there was a significant difference among the two groups in two aspects –1) wound exudate consistency, with majority of GS residents rating exudates to have high viscosity, while majority of PS residents rating the exudates as of low consistency (p < 0.01), and, 2) rationale for the type of dressing use – there is a higher percentage of GS residents considering price and availability primarily, whereas PS residents tend to weigh their dressing choices on the clinical indication for it (p < 0.01). No other significant differences were observed between the two groups in terms of other parameters.

CONCLUSION

The Wound Registry Form demonstrated high content validity, and good interrater reliability. The form is a reliable data collection instrument that may be used in monitoringwound status and response to treatment, identifying trends in wound healing and management, analyzing interplay of patient and wound factors, determining effectiveness of wound care practices, and may contribute to wound care research and public health in the Philippines. Data from this tool may be used by multiple end users: by clinicians to provide evidence based wound care, by researchers who wish to explore factors contributing to the burden of wounds, by administrators who want to create an enhanced health record systems with standardized documentation of wound data, and by the public, including patients and their families, who wish to be more informed, and more proactive towards their healing.

Human ; Wounds And Injuries ; Wound Healing ; Surgery, Plastic ; General Surgery ; Exudates And Transudates ; Philippines

A 31-year-old man diagnosed with type 2 chronic rhinosinusitis with nasal polyps, initially presenting with a 1-year history of nasal blockage and anosmia, was refractory to medical therapy and had been advised to undergo endoscopic sinus surgery (ESS). Bilateral frontal sinusotomy and complete ethmoidectomy were needed to ensure adequate delivery of post-operative topical steroids. During this portion of ESS, the anterior skull base would be vulnerable to iatrogenic injury. How could the surgeon prepare pre-operatively to avoid such a complication?

Despite advances in imaging technology, instrumentation and surgical techniques for ESS, complications may still happen. Iatrogenic injury to the anterior skull base causing a cerebrospinal fluid (CSF) leak is one of the dreaded complications of ESS. The anterior skull base is composed of the cribriform plate and the fovea ethmoidalis or ethmoid roof. These bony structures are connected by the lateral lamella of the cribriform plate (LLCP) which delineates the lateral border of the olfactory fossa. The LLCP is known as the most vulnerable structure of the anterior skull base during ESS especially during ethmoidectomy and frontal sinusotomy.

Human ; Male ; Adult: 25-44 Yrs Old ; Paranasal Sinuses ; Cerebrospinal Fluid Leak