Difficult tracheal intubation can be a major source of morbidity and mortality in clinical practice and unanticipated difficult intubation remains to be a primary concern of the anesthesiologist. Due to the potentially serious consequences of failed tracheal intubation, considerable attention has been focused on attempts to predict patients in whom laryngoscopy and intubation will be difficult. Although several tests have been made, the results are not totally reliable Methodology: One hundred ten patients, aged 16 years old and above, scheduled for elective surgery were enrolled in the study. They were assessed according to oropharyngeal class using the Modified Mallampati Classification (MMC) and the new Upper Lip Bite Test (ULBT). A quantitative seven parameter scale was used to determine difticult endotracheal intubation. Intubation Difficulty Scale (IDS) score of more than 5 (5) was assigned as moderate to major endotracheal difficulty while IDS score of less than or equal to 5 (/-5) as mild to no endotracheal difticulty. The incidence of difficult intubation among the subjects was 22.7 percent, as exhibited by IDS score of 5 Results: The results show that new ULBT technique has a higher sensitivity and negative predictive values than MMC, which suggests that ULBT may be used to screen for patients with difticult intubation. On the other hand, there is also an indication that those patients having both high MMC and ULBT scores are the ones who are more likely to have higher IDS scores. (Author)
Human ; Male ; Female ; Young Adult ; INTUBATION INTRATRACHEAL ; INTUBATION ; SURGERY ;

OBJECTIVE: Advanced cancer pain is associated with pain in two-thirds of patients impairing quality of life. Poor control is often attributed to poor assessment and classification. This study aimed to determine current pain assessment and management for solid tumors in a private tertiary hospital in Davao City.
METHODS: The study utilized a retrospective descriptive cross-sectional study wherein 298 charts with diagnoses of solid tumor were included.
RESULTS: Clinical outcomes of this study include that 28% and 32% died and did not improve due to these solid tumors. This data therefore reflect that 60% of these patients, when combined, may have have advanced diseases. Of these, 19% experienced moderate to severe pain either as a chief complaint or as part of the medical history and review of systems, while 78% have no record or evidence of pain assessment. Only nine percent received opioid therapy while 13%  were given non-opioids. Approximately six percent of these patients' pain responses were monitored or followed-up by medical service versus none of the nursery service after initiation of pharmacotherapy.
CONCLUSION: The present study showed a very big gap as far as pain assessment and management are concerned. These deficiencies may be attributed to non-adherence to the WHO guidelines for pain which includes inadequate pain assessment, recording, management and monitoring. Information dissemination regarding pain assessment and management is of paramount importance as to giving optimal pain management in cancer patients experiencing pain. 

Human ; Male ; Female ; Analgesia ; Quality Of Life ; Analgesics, Opioid ; Cancer Pain ; Cross-sectional Studies ; Death ; Neoplasms ; Pain ; Pain Management ; Pain Measurement ; Philippines ; Retrospective Studies

Squamous cell carcinoma in situ or Bowens disease is a precancerous keratinocyte lesion with the potential to progress into invasive squamous cell carcinoma. Several treatment modalities exist. Imiquimod is a topical immune response modifier with antitumor effects through the induction of local production of cytokines, particularly interferon alfa (IFN-a), interleukins 1, 6, 8, and 12, and tumor necrosis factor-a (TNF-a) This is the case of a 54-year-old female with biopsy-proven, Bowens disease over the right lower quadrant of the abdomen treated with once-daily application of imiquimod 5 percent cream for 9 weeks. Posttreatment biopsy showed no histologic evidence of Bowens disease.

Human ; Female ; Middle Aged ; Aminoquinolines ; Bowen's Disease ; Carcinoma, Squamous Cell ; Cytokines ; Interferon-alpha ; Keratinocytes ; Skin Neoplasms ; Tumor Necrosis Factor-alpha

PURPOSE:This research explored the voices of nurses in contemporary times and unraveled nurses' situations for the purpose of generating a substantive theory to guide and refine nursing practice.
METHOD:The  grounded  theory  methodology  of  qualitative  research  was  utilized patterned mainly in the works of Glaser and Strauss. Criterion sampling was used in the selection of 31 participants and the basis for selection was employment in the hospital, academe, and community and being part of different levels of management (nurses from top, middle, first, and staff levels). Theoretical sampling also informed the final list of study informants and was conducted by snowballing that consisted of 10  participants.  The  data  gathering  procedures  included  the  combination  of interviews, observations, and document and literature analysis.
FINDINGS:The study revealed three major themes: (1)nursing as a profession,(2)Nightingale in the 21st century:life of a nurse in today's context,and (3)the challenges and opportunities to quality of nursing care.
CONCLUSION:Nursing   is   dynamic,   complex,   diverse,   expanding   and   highly contextualized. Nursing is a field that grows with time and nurses are adaptive to the widening demands of their profession. The goal of nursing remains a Nightingale's pledge  and  an  endeavor  amidst  nurses'  constant  battle  between  motivations  and challenges.  The  Integrated  Systems  Approach  to  Nursing  Care  model  was developed to be used as a framework for sound decision-making in nursing practice.Nursing,  nightingale  and  beyond  is  a  picture  of  struggles,  success,  and  potential solutions to the predicaments surrounding the nursing profession.
CLINICAL RELEVANCE:The  study  has  potential  to  help  health  managers  and  policy implementers in providing assistance to nurses in enhancing their knowledge and skills, increasing their emotional and psychological resilience and in revitalizing their commitment to the nursing profession.It may also aid in  the  reconsideration  of institutional policies and set-ups toward collaborative and enabling work environment. In addition, it may serve as a guide in creating proactive health governance, in facilitating nurses' work motivation  and  retention  through  the  due  implementation  of nursing law and other statures for the welfare of health workers, in providing additional plantilla position for nurses in the country, and in increasing funding for health programs to create more learning and practice environment for nurses. Lastly, the utilization of the theory  can  be  used  in  developing  a  more  responsive  nursing practice.

Human ; Male ; Female ; Middle Aged ; Adult ; Motivation ; Organizational Policy ; Resilience, Psychological ; Goals ; Nurses ; Workplace ; Qualitative Research ; Models, Nursing ; Decision Making

Background: Coronavirus disease 2019 (COVID-19) continues to be a pandemic to this time, and chest radiography has been used as a first-line triage tool, due to long turnaround times for real-time reverse transcription polymerase chain reaction (RT-PCR), which remains to be the gold standard in COVID-19 diagnosis. Chest x-ray alone has poor sensitivity to diagnosing COVID-19 and pediatric studies on this are scarce.

Objectives: The main objective is to evaluate the usefulness of a routine chest radiograph as an adjunct to diagnosing suspected pediatric COVID-19, along with its sensitivity, specificity, accuracy, and correlation with the most common pediatric signs and symptoms. In line with this, the radiographic characteristics seen in pediatric COVID-19 patients are presented.

Methods: A cross-sectional study involving a retrospective chart review of 259 pediatric patients admitted in a tertiary hospital with COVID-19 signs and symptoms, with baseline chest x-ray and SARS-CoV2 RT-PCR tests. Correlation of signs and symptoms with chest x-ray findings to RT-PCR positivity was determined using univariate and multivariate logistic regression analysis.

Results: The study was composed of 259 pediatric patients (ages 0-18 years old). Of these, 35 had positive findings with RT-PCR (15%). Sensitivity of a chest radiograph with pneumonia is at 62.9%, while specificity is at 39.3%. Overall accuracy of CXR findings leading to RT-PCR positivity is at 42.5%. Ground glass or hazy opacities was the most common radiographic finding (45.5%), followed by reticular opacities (31.8%). Abnormalities were mostly distributed in the inner lung zone distribution with bilateral lung involvement (90%). Those with difficulty of breathing were more likely to have pneumonia on their CXR, though a finding of pneumonia on CXR did not significantly correlate to a positive RT-PCR.

Conclusions & Recommendations: Findings of pneumonia on a pediatric CXR may not necessarily lead to a positive SARS-CoV2 RT-PCR, but correlating this with the patient's clinical course and symptoms may be beneficial in effective triaging of patients. Reassessment by another radiologist may provide additional strength to this study.

Human ; Male ; Female ; Adolescent (a Person 13-18 Years Of Age) ; Pre-adolescent (a Child 6-12 Years Of Age) ; Child ; Mass Screening ; Sensitivity And Specificity

Objective: The aim of this study was to determine the comorbid sleep disorders on Polysomnography (PSG) of patients complaining of insomnia symptoms. Methodology: This is a retrospective study among patients who underwent diagnostic and split-night polysomnography from April 2014 to February 2019. Those who had at least one of the following insomnia symptoms of difficulty initiating sleep, difficulty maintaining sleep and early morning awakening with or without a history of sleep aide use were identified as patients with insomnia. Polysomnography sleep parameters and outcome were tabulated and statistical analysis was done using SPSS v 20.0. Results: Out of the 302 patients who were included in the study, 34.4% of subjects had a family history of sleep disorder and 70.4% had a history of sleep aide use. Among the medical comorbidities, 47.7% of the subjects were diagnosed with hypertension while 10.65% were diagnosed with psychiatric disorder. Most of the patients complained of both difficulty initiating sleep and early morning awakening. PSG sleep parameters showed that patients did not experience excessive daytime sleepiness or delayed sleep latency. On the other hand, poor sleep efficiency could be due to increased arousal index. Half of the patients turned out to have severe obstructive sleep apnea (52%) while 2.3% of the patients had periodic limb movement disorder. Among those diagnosed with severe OSA, 53.3% had a history of sleep aide use. Conclusion The study showed the importance of screening patients with insomnia for underlying comorbid sleep disorders. The American Academy of Sleep Medicine (AASM) treatment guidelines for chronic insomnia emphasized the need to have a high index of suspicion for this population in order to recommend diagnostic procedures such as polysomnography. Diagnosing a patient with insomnia to have an underlying sleep apnea and/or periodic limb movement disorder would change the course of management among patients with chronic insomnia and eventually avoid prescribing medications that could actually worsen the patient’s condition.
Sleep Initiation and Maintenance Disorders ; Sleep Wake Disorders ; Polysomnography ; Comorbidity

Background: Acute bacterial meningitis is a medical emergency which warrants early diagnosis and aggressive therapy. It is important to know the regional bacterial etiology in semitropical countries like India along with their sensitivity profi le to allow optimum management of such patients with least possible mortality. This study was undertaken to study the trends in etiology and the antimicrobial resistance pattern of the pathogens prevalent in North India over a period of 8 years. Methods: The study was performed from June 2001 to June 2009. CSF and blood samples were collected from all patients suspected of meningitis and inoculated on chocolate agar, blood agar and MacConkey agar. Antimicrobial susceptibility testing was done using Kirby Bauer disc diffusion method. Detection of methicillin resistant Staphylococcus aureus (MRSA), high level aminoglycoside resistance (HLAR) in Enterococcus species, extended spectrum β lactamases (ESBL), Amp C and metallo-betalactamases was also done. Results: 403 samples were positive on culture. S. aureus was the most common pathogen. Among the gram positive cocci as well as the gram negative bacilli, a gradual decline in the antimicrobial susceptibility was seen. The aminoglycosides had the best spectrum of antimicrobial activity. Towards the end of the study, an alarming rise of MRSA to 69.4%, HLAR among the Enterococci to 60% was noted. Among the Enterobacteriaceae, ESBL and Amp C production was found to be 16.7% and 42% respectively. No vancomycin and imipenem resistance was observed. Conclusion: An entirely different trend in etiology in bacterial meningitis was observed in the semitropical region of North India. The high prevalence of drug resistant pathogens is a cause for worry and should be dealt with by rational use of antimicrobials. Frequent revision in drug policy may be necessitated for optimum management of patients.

An endoscopically guided primary catheterization under local anesthesia was performed as an initial management of 11 patients with ant. urethral rupture, beginning Dec., 1985. According to the degree and extent of the trauma, endoscopically viewed, the duration of indwelling of the catheter varied from 8 to 30 days. Of the 9 partial ruptures, 7 have excellent results without stricture and 2 have short urethral stricture of 3mm length. Of the 11 ruptures, 2 were complete and resulted in 5mm length of short stricture, which can be easily treated with Endoscopic Internal Urethrotomy.
Anesthesia, Local ; Ants ; Catheterization* ; Catheters* ; Constriction, Pathologic ; Humans ; Rupture* ; Urethral Stricture

The authors experienced one case of interstitial keratitis due to congenital syphilis, which showed interstitial keratitis, positive serologic test for syphilis(VDRL) and typical Hutchinson's teeth but no deafness. Syphilitic interstitial keratitis is characterized by wide spread infiltrative inflammation of corneal stroma. chronic course and benign tendency. A brief review and relating literatures are presented.
Corneal Stroma ; Deafness ; Inflammation ; Keratitis* ; Serologic Tests ; Syphilis, Congenital

Extramammary Paget's disease is a rare malignant disease associated with underlying adenocarcinoma, or not. Two cases with a unique clinical presentation are described and we wish to call attention to the malignant potential of chronic scaly and erythematous lesions of perianal and genital area.
Adenocarcinoma ; Male ; Paget Disease, Extramammary* ; Penis* ; Scrotum*