Nausae and vomiting remains as "the big little problem" in cesarean delivery under spinal anesthesia, attributable to the discomfort from intraoperativeperitoneal manipulations. Recent studies have reported that intrathecal (IT) administration of lipophilic opioids, such as fentanyl, minimizes this discomfort by by improving the qulity ad duration of pain relief when it is combined with 0.5% bupicavaine used for subarachnoid block in cesarean delivery. It ws the objective of this study to determine the efficacy of the addition of intrathecal fentanyl for the prevention of nausea and vomiting during cesarean section under spinal anesthesia. Methods: The comparison of the antiemetic efficacy of 12.5 ug and 25 ug IT and its effects on the onset and duration of hyperbaric bupicavaine induced senory and motor spinal block were observed. Maternal nd fetal adverse effects were, likewise, documented. Forty-five full-term parturients of American Society of Anesthesiologist Physical Status I, scheduled for eective cesarean delivery at the Philippine General Hospital were included in the study. Result: Results revealed that both IT fentanyl 12.5 ug and 25 ug significantly prevented nausea and vomiting during cesarean delivery undr spinal anesthesia i comprison with IT placebo. Furthermore, in comparing the efficacy of the IT fentanyl groups, there was no significant difference between the two groups. There were no notable effects on the co-administration of IT fentanyl on the onset and duration of hyperbaric bupicavaine induced sensory and motor spinal block. Conclusion: Common hemodyamic responses and side effects of spnal anesthesia and addition of low dose IT fentanyl (i.e. hypotension, respiratory depression, shvering pruritus) di not show deleterious effects to the parturients. the low dose IT fentanyl used in the study had no detectable adverse impact on neonatal condition, when assessed by APGAR scoring.
Human ; Female ; CESAREAN SECTION ; ANESTHESIA, SPINAL ; FENTANYL

General Objectives: To determine the biopsychosocial factors among adult Filipino cancer patients the affect their non-compliance to morphine therapy. Specific Objectives: 1) To determine the patient beliefs and misconceptions regarding morphine. 2) To determine the patients' perceived side effects of morphine. 3) To determine the patients' views regarding the accessibility of morphine. 4) To determine the patients' views regarding addiction and fear of tolerance in relation to morphine intake. 5) To determine the patients' concepts on pain relief. 6) To develop a questionnaire that can be used in assessing the patients' attitudes toward morphine treatment.
Human ; MORPHINE ; ADULT ; NEOPLASMS ; PAIN ; PAIN MEASUREMENT ; SUBSTANCE-RELATED DISORDERS

Objective: To determine the accuracy of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters using the Stratus OCT in diagnosing glaucoma among Filipino patients and to determine the validity of the OCT measurements compared with a reference standard. Methods: Glaucoma suspects were recruited consecutively from patients undergoing diagnostic tests. The results of the Stratus OCT fast RNFL protocol were analyzed against the independent assessment by glaucoma experts who were blinded. Outcomes included RNFL thickness values of ≤5 percentile and ≤1 percentile of the normative database for each RNFL sector, quadrant, and for the average RNFL thickness. Estimates of diagnostic accuracy with 95% confidence intervals were calculated. Results: A total of 119 subjects assessed as glaucoma and 397 subjects assessed as normal were included in the analysis. Using the best categorical criterion for abnormality (average RNFL thickness of ≤1 percentile of the normative database), the OCT had a specificity of 98% (95% CI 96 - 99) and a sensitivity of 37% (95% CI 28 - 46). The criterion with the highest sensitivity was the presence of at least one sector with thickness at ≤5 percentile. Conclusion The Stratus OCT demonstrated a specificity of 98% and a sensitivity of 37% for the diagnosis of glaucoma using as a criterion an average RNFL thickness of ≤1 percentile of the normative database. It was a poor screening test for glaucoma suspects, although it showed some promise as a confirmatory test.
Glaucoma ; Tomography, Optical Coherence

Objective: To determine the accuracy of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters using the Stratus OCT in the diagnosis of glaucoma and to determine the validity of these measurements. Methods: Glaucoma suspects undergoing glaucoma diagnostic tests were recruited consecutively. The numerical results of the Stratus OCT fast optic disc and fast RNFL protocols were analyzed against an independent assessment by glaucoma experts who were blinded as to the results of the OCT. An ROC curve analysis was applied to derive estimates of diagnostic accuracy and multi-level likelihood ratios. Results: A total of 119 subjects assessed as glaucoma and 397 subjects assessed as normal were included. All ONH and RNFL OCT parameters showed statistically significant differences in mean values between the 2 groups. The ROC curve identified the vertical integrated rim area (AUC: 0.822), the cup-disc area ratio (AUC: 0.816), and the horizontal integrated rim width (AUC: 0.794) as the best optic disc parameters; and the RNFL average thickness (AUC: 0.827), the superior quadrant (AUC: 0.807), and the inferior quadrant (AUC: 0.804) as the best RNFL parameters. Multi-level likelihood ratios for ONH and RNFL parameters were calibrated using a projected posttest probability of 70% for a positive test result (therapeutic threshold) and a 10% posttest probability for a negative result (diagnostic threshold). Conclusion The results showed that statistically significant mean differences in ONH and RNFL parameters did not translate into a high predictive ability for each individual parameter. Single cut-off value for each OCT parameter based on the best sensitivity and specificity combination did not result in high predictive values for any single parameter. Multi-level likelihood ratios for the best ONH and RNFL parameters were derived to increase the diagnostic capability of the Stratus OCT.
Tomography, Optical Coherence ; Glaucoma ; Optic Disk

OBJECTIVE: To determine the correlation between the average retinal nerve fiber layer (RNFL) thickness and optic nerve head rim area (RA) measured with a spectral-domain optical coherence tomography (OCT) with the visual field index (VFI) using the Humphrey Visual Field Analyzer in glaucoma patients.
METHODS: Eighty-five consecutive patients diagnosed with glaucoma underwent spectral-domain OCT of the optic disc and Humphrey perimetry. A glaucoma specialist confirmed the presence of glaucomatous optic neuropathy based on findings in the optic nerve head photographs, OCT measurements of the RNFL and optic disc, and standard automated perimetry. The correlation of the average RNFL thickness and rim area with the VFI was determined using the Spearman's correlation coefficient analysis.
RESULTS: A total of 121 glaucomatous eyes of 85 patients were included in the study. There were 47 males and 38 females, ages ranging from 12 to 94 years. The average RNFL thickness, RA, and VFI were 67.9 ± 12.3 ?m, 0.65 ± 0.3 mm2, and 56 ± 32%, respectively. The average RNFL thickness (r = 0.35) showed a stronger positive correlation with VFI than RA (r = 0.15), but the difference was not statistically significant.
CONCLUSION: The average RNFL thickness and rim area of the spectral-domain OCT demonstrated a positive correlation with the VFI of the Humphrey Visual Field Analyzer. The OCT parameters, exemplified by average RNFL and RA, were not good indicators for VFI.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Optic Disk ; Visual Field Tests ; Optic Nerve Diseases ; Glaucoma ; Retina ; Tetrahymenina ; Nerve Fibers

Objective: To determine the correlation between average peripapillary retinal nerve fiber layer (RNFL) thickness measured with time domain optical coherence tomography (TD-OCT) in normal and glaucoma eyes. Methods: This was a cross-sectional study of 281 eyes randomly selected from a previous study. Assessment of glaucomatous damage was done by glaucoma specialists who based their diagnosis on the visual field tests and optic disc photos, independent of OCT results. Eyes were classified into the following groups: normal, mild, moderate, or severe glaucoma. Severity of glaucoma was based on visual field abnormalities following a modified HodappAnderson-Parish criteria for staging. Average RNFL thickness of normal and glaucoma subgroups, as measured with STRATUS–OCT, were analyzed using single ANOVA test. Association between average RNFL thickness and severity of glaucomatous visual field loss was evaluated using the Pearson’s correlation coefficient analysis. Results: 183 eyes had no glaucoma; 27 had mild, 32 had moderate, and 39 had severe glaucoma. Mean average peripapillary RNFL thickness (μm) in the normal, mild, moderate, and severe glaucoma groups were 98.05(±13.46), 76.27(±11.79), 76.42(±16.01), and 56.17(±14.92) respectively. Significant differences were seen in the average RNFL thickness among the groups (P<0.05), except in eyes with mild to moderate glaucoma. A moderately strong correlation of -0.57 (P<0.05) was observed between average RNFL thickness and the stage of glaucoma. Conclusion TD-OCT showed moderately strong correlation between the average RNFL thickness and perimetric stages of glaucoma. Average RNFL thickness is a good parameter to discriminate normal from glaucoma eyes.
Tomography, Optical Coherence ; Glaucoma ; Visual Field Tests

OBJECTIVE: To describe the demographic and clinical characteristics of patients with glaucoma managed at private and government institutions in the Philippines between 2009 and 2014.

METHODS: A research team from two private and two government institutions in the Philippines reviewed the case records of 1246 patients seen who met the following criteria: intraocular pressure of >21 mmHg, optic nerve and nerve fiber layer abnormalities, and visual field defects. For bilateral cases, we selected the eye with worse glaucoma parameters.

RESULTS: There were 600 and 646 patients in the private and government groups (mean age at presentation, 60.51 and 55.88 years), respectively, with the majority being Filipino (91%). Patients with visual acuity (VA) of 20/20 to 20/40 were more frequently observed in private centers (58.7% vs. 41.3%), while a VA worse than counting fingers was more frequently observed in government centers (66.1% vs. 33.9%). Within-group analysis showed that primary angle-closure glaucoma was the most frequent glaucoma subtype in both private (27.3%) and government institutions (37.8%). In between-group analysis showed the following to be more common in private than government centers: primary open-angle glaucoma (61.3% vs. 38.7%), normal-tension glaucoma (63.9% vs. 36.1%), ocular hypertension (92.3% vs. 7.7%), and glaucoma suspects (80.4% vs. 19.6%) while government institutions registered a larger number of primary angle-closure glaucoma (59.8% vs. 40.2%) and secondary glaucoma (70.3% vs. 29.7%) cases. Medical treatment using a single drug and multiple drugs was employed for 245 (23%) and 825 (77%) patients, respectively. Within-group analysis showed that laser iridotomy and trabeculectomy were the most commonly performed laser and surgical procedures in both institution types.

CONCLUSION: There is a contrasting profile of glaucoma between clinical institutions in the Philippines with openangle glaucoma being more predominant in private centers while closed-angle glaucoma and secondary glaucoma being more frequent in government centers. Our findings may provide important preliminary information that can aid future health studies or training programs.

Human ; Glaucoma ; Patients