Magnesium sulfate has been a mainstay in the management of preeclampsia and is associated with a decreased incidence of morbidity and mortality. The hypertensive disorder has an unpredictable course, sometimes rapidly evolving to full-blown disease. In patients with deteriorating status, it is indicated to terminate the pregnancy via cesarean section. The anesthesiologists would prefer to have the procedure done under regional anesthesia; however, there may be cases when neuraxial anesthesia is contraindicated, or a general anesthesia would permit prompt delivery of the fetus.

A patient with severe preeclampsia was given magnesium sulfate intrapartum, wherein a primary cesarean section was indicated for arrest in cervical dilatation, and was performed under general anesthesia. The patient developed acute respiratory failure and the causes of this occurrence were investigated in this report. It was later found out that neither the hypermagnesemia nor the muscle relaxant alone caused the patient's condition but the interaction between the two. The patient was managed expectantly at the intensive care unit (ICU) and was eventually extubated during the first post-operative day. Knowledge of this drug interaction would allow obstetricians to advise their patients and their family about the possibility of prolonged intubation and ICU admission. This would also bring to the anesthesiologists' attention the need to decrease the dose of muscle relaxant and to prepare drugs for immediate decurarisation.

Human ; Female ; Adult ; Pregnancy ; Magnesium Sulfate ; Pre-eclampsia ; Anesthesiologists ; Cesarean Section ; Anesthesia, General ; Anesthesia, Conduction ; Fetus ; Drug Interactions ; Intensive Care Units ; Intubation ; Respiratory Insufficiency

OBJECTIVES: 1. To present a rare case of a true teratoma of the nasopharynx in a Filipino newborn. 2. To present a rational diagnostic and management approach to the case. DESIGN: Case report SETTING: Tertiary Government Hospital PATIENT: One female newborn RESULTS: A newborn presented with a congenital large naso-oropharyngeal mass. She did not present with signs of airway obstruction. The oral mass was found to be attached to the nasopharynx. The initial consideration was a teratoma. The patient also manifested with an incomplete cleft palate and dermoid cyst on the left eye. Contrast CT scan confirmed the attachment of the mass to the left nasopharyngeal wall. The mass was subsequently resected and delivered transorally. The final histopathology showed teratoma. Otorhinolaryngologic management of this case encompassed the following priorities: (1) ensuring vital & vegetative function (airway & feeding), (2) examination of the newborn for concomitant congenital anomalies, (3) resection of the mass after accurate delineation of its extent and dimensions and (4) planning for future repair of the palatal defect. CONCLUSION: True teratomas of the nasopharynx are rare lesions (originating from the 3 embryonic germ cell layers). Airway management is the first priority of the otorhinolaryngologist in these cases because of potential to cause upper airway obstruction. (Author)
CASE REPORTS [PUBLICATION TYPE] TERATOMA NASOPHARYNX NASOPHARYNGEAL NEOPLASMS

OBJECTIVE: To describe the epidemiology of motorcycle related trauma (MCRT) admitted to the Philippine General Hospital (PGH).

METHOD: Restrospective analysis of records of motorcycle crash victims admitted to the Trauma Division, Department of Surgery, PGH from January 1, 2004 to December 31, 2006.

RESULTS: MCRT victims comprised 6.7% of all trauma admissions to PGH. Most were males (83.8%) and young adults (median age 26 years), and 38.6% were road users other than motorcycle drivers or passengers (primarily pedestrians). Two-thirds of victims suffered multiple injuries (68.9%). Common injuries were maxillo-facial (78%), fractures of the lower and upper extremeities (46.9% and 36.1%, respectively) and traumatic brain injuries (40.7%). The median length of hospital stay was 13 days. The in-hospital mortality rate was 5.8%, 43% of fatalities were due to traumatic brain injuries. Based on self-reported information, 88% of the motorcyclist victims were riding under the influence of alcohol, and 13% were wearing helmets at the time of the crash.

CONCLUSIONS: A significant proportion of MCRT victims are not motorcycle users. There is an urgent need to implement effective strategies to prevent MCRT in the Philippines, including the implementation of enforcement of national laws agains drink driving and use of standard helmets.

Human ; Male ; Female ; Adult ; Motorcycles ; Head Protective Devices ; Hospital Mortality ; Pedestrians ; Hospitalization ; Brain Injuries, Traumatic ; Multiple Trauma

Mosquito eggs laid within two hours are necessary for transgenic (injection) studies, because mosquito eggs become hard after that period. Thus, in order to have eggs available within this two-hour window, it is important for transgenic studies to understand the ovipositional behavior of Anopheles gambiae s.s.. In the present study, the ovipositional behavior of An. gambiae s.s. (Kisumu) was investigated in several different conditions: age of mosquitoes, time post blood meal to access oviposition substrate, and light conditions. Two groups of mosquitoes, 3–5 day old and 9–11 day old mosquitoes were blood-fed. For those mosquito groups, an oviposition dish was set either at 48 hours or 72 hours after the blood meal either in a light condition or in an artificial dark condition. The number of laid eggs was compared among different conditions. The 3–5 day old mosquitoes apparently produced a higher number of eggs than 9–11 day old ones, while there was no significant difference between the 2 groups. The number of laid eggs per one surviving blood-fed mosquito in the dark condition was significantly higher than that in the light condition (p = 0.03). Providing an oviposition dish at 72 hours after blood meal resulted in a significantly higher number of laid eggs per one surviving blood-fed mosquito compared to providing an oviposition dish at 48 hours after blood meal (p = 0.03). In conclusion, the optimal condition to have readily available egg supply in the present study for transgenic analysis was as follows: 3–5 days old mosquitoes with an oviposition dish placed at 72 hours after the blood meal in a dark environment.

This is the case of a 71-year-old Filipino female from Caloocan with a history of Hansen’s disease, treated (1980) who presented with generalized crusted plaques. Clinical and histopathological examination revealed crusted (Norwegian) scabies. Crusted scabies is a rare condition and diagnosis is often delayed; this condition is treated with systemic broad spectrum antiparasitic agents. Despite the common prevalence of scabies, its atypical forms are often overlooked and neglected which oftentimes does affect the patients' well-being. Keywords: infection; skin diseases; leprosy; parasitic; crusted scabies; case report
Infections ; Skin Diseases ; Leprosy

Background: Radiofrequency has seen an increase in use in orthopedics including cartilage lesion debridement in the hip and knee as well as many applications in arthroscopic shoulder surgery. The purpose of this systematic review is to evaluate the safety and usage of radiofrequency in the shoulder. Methods: This systematic review was registered with PROSPERO (international registry) and followed the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines. Embase and PubMed were searched using: “shoulder,” “rotator cuff,” “biceps,” “acromion” AND “monopolar,” “bipolar,” “ablation,” “coblation,” and “radiofrequency ablation.” The title and abstract review were performed independently. Any discrepancies were addressed through open discussion. Results: A total of 63 studies were included. Radiofrequency is currently utilized in impingement syndrome, fracture fixation, instability, nerve injury, adhesive capsulitis, postoperative stiffness, and rotator cuff disease. Adverse events, namely superficial burns, are limited to case reports and case series, with higher-level evidence demonstrating safe use when used below the temperature threshold. Bipolar radiofrequency may decrease operative time and decrease the cost per case. Conclusions Shoulder radiofrequency has a wide scope of application in various shoulder pathologies. Shoulder radiofrequency is safe; however, requires practitioners to be cognizant of the potential for thermal burn injuries. Bipolar radiofrequency may represent a more efficacious and economic treatment modality. Safety precautions have been executed by institutions to cut down patient complications from shoulder radiofrequency. Future research is required to determine what measures can be taken to further minimize the risk of thermal burns.

OBJECTIVE: Glaucomatous optic neuropathy (GON), defined as definitive damage to the optic-nerve head (ONH) and retinal-nerve-fiber layer (RNFL), involves structural changes in the ONH and RNFL and functional losses in the central visual field. Due to the unique anatomic distribution of the nerve fibers as they enter the ONH, there are specific changes in the ONH correlated with specific findings in the visual-field characteristic of GON. The evaluation of these changes is discussed. METHODS: There are qualitative and quantitative methods in the structural examination of the ONH and RNFL, and quantitative techniques in the functional assessment of the central visual field. They are correlated to one another their strengths and limitations are discussed. RESULTS: Clinical evaluation of the ONH and RNFL consists of five basic rules: (1) identify the limits of the optic disc and determine its size, (2) identify the s of the neuroretinal rim, (3) examine the RNFL, (4) examine the region for parapapillary atrophy, and (5) look for retinal and optic-disc hemorrhages. These steps are simple to use and comprise a portion of the comprehensive eye evaluation. Without proper documentation of the changes in glaucoma progression may be missed. Computer-based digital-imaging technology exemplified by the HRT II, GDx, OCT, provides fast, reproducible, objective measurements of the ONH and RNFL, allowing for more precise diagnosis and monitoring of glaucoma. These changes have good correlation to functional assessments exemplified by the standard automated perimetry (SAP) and the selective perimetry (FDT, SWAP). Typical glaucomatous visu field defects include nasal step, paracentral scotoma, and arcuate defects which follow the RNFL pattern. Progression of these defects is monitored over time and needs to be differentiated from long-term fluctuation. CONCLUSION: The clinician should perform both structural and functional assessments to diagnose and monitor glaucoma. Both examinations provide complimentary information and each has its own place in the clinical care of glaucoma patients. The newer imaging devices and selective perimetry augment the diagnostic armamentarium of the clinician and should, therefore, be used appropriately.
GLAUCOMA ; OPTIC NERVE ; VISUAL FIELDS ; VISUAL FIELD TESTS ; OPTIC DISK

Severe intraoperative hypotension has been reported in patients on angiotensin-converting enzyme inhibitors and angiotensin II receptor subtype 1 antagonists. We describe a patient on lisinopril who developed refractory intraoperative hypotension associated with increased serum tryptase level suggesting mast cell activation (allergic reaction). However, allergology workup ruled out an allergic etiology as well as mastocytosis, and hypotension recalcitrant to treatment was attributed to uninterrupted lisinopril therapy. Elevated serum tryptase was attributed to our patient's chronic renal insufficiency.
Anaphylaxis ; Angiotensin-Converting Enzyme Inhibitors ; Humans ; Hypotension ; Lisinopril ; Mast Cells ; Mastocytosis ; Receptors, Angiotensin ; Renal Insufficiency, Chronic ; Tryptases

Background: Intertrochanteric hip fractures are among the most common and most expensive diagnoses in the Medicare population. Liposomal bupivacaine is a novel preparation of a commonly used analgesic agent that, when used intraoperatively, decreases narcotic requirements and hospital length of stay and increases the likelihood of discharge to home. The purpose of this investigation was to determine whether there was an economic benefit to utilizing intraoperative liposomal bupivacaine in patients with fragility intertrochanteric hip fractures in comparison to a group of patients who did not receive liposomal bupivacaine. Methods: This is a retrospective observational study performed at two academic medical centers. Fifty-six patients with intertrochanteric hip fractures treated with cephalomedullary nail implant who received standard hip fracture pain management protocol were compared to a cohort of 46 patients with intertrochanteric hip fractures who received additional intraoperative injections of liposomal bupivacaine. All other standards of care were identical. A cost analysis was completed including the cost of liposomal bupivacaine, operating room costs, and discharge destination. Statistical significance was set at p < 0.05. Results: Although the length of hospital stay was similar between the two groups (3.2 days vs. 3.8 days, p = 0.08), patients receiving intraoperative liposomal bupivacaine had a lower likelihood of discharge to a skilled nursing facility (84.8% vs. 96.4%, p = 0.002) and a longer operative time (73.4 minutes vs 67.2 minutes, p = 0.004). The cost-benefit analysis indicated that for an investment of $334.18 in the administration of 266 mg of liposomal bupivacaine, there was a relative saving of $1,323.21 compared to the control group. The benefit-cost ratio was 3.95, indicating a $3.95 benefit for each $1 spent in liposomal bupivacaine. Conclusions Despite the increased initial cost, intraoperative use of liposomal bupivacaine was found to be a cost-effective intervention due to the higher likelihood of discharge to home during the postoperative management of patients with intertrochanteric hip fractures.

Background: Medication adherence is important to mitigate complications of NCDs. Hypertension and diabetes clubs were intended to make essential medications accessible to club members. Despite these efforts, patients avail treatment and management in acute care with noted complications. To address this problem, it is important to identify factors that affect patients’ adherence medication. Objectives: This study aimed to determine the factors affecting adherence to medications of members enrolled in the Hypertension and Diabetes Club in the district health centers in the city of Baguio. Methods: This is a cross-sectional study with a total of 374 respondents from the 16 different district health centers in the City of Baguio, obtained through random sampling. A validated questionnaire was utilized for the collection of data and was presented using percentage and frequency tables. A chi-square test was used to find the association of clinic-demographic data with respondents’ medication adherence. Results: Hypertension and Diabetic Club members overall reported good adherence to medication. Majority of the respondents are female and are older than 61 years old while comorbidities show significant association with level of adherence. On the other hand, lack of finances, feeling that the drug is not effective, multiple medications, taking medications for many years, interference with meal plan, feeling the dose is too high, and complexity of drug regimen are noted to be associated factors for non-adherence. Conclusion Hypertension and Diabetes Club a community-based management in the City of Baguio shows a good impact on patients’ medication adherence. Comorbidities, chronicity, good family support as well as good physician-patient relationship can positively affect adherence to medications. On the other hand, factors affecting medications non-adherence are: complexity of medications, subjective report that medication is too high, interference to meal, having medications for many years and having multiple medications. Identifying factors affecting adherence and nonadherence are important to decrease further complications of the common NCDs.
Non-communicable disease ; medication adherence