Anaplasma and Ehrlichia species are important tick-borne pathogens that cause disease in cattle, dogs, horses and humans; with little information available about these agents in Colombia. The aim of this study was to provide molecular evidence for the presence of Anaplasma sp. and Ehrlichia sp. species in ticks collected from horses, dogs and cattle in Cordoba, Colombia. In this study, 1.105 ticks were removed from 226 zebu cattle (Bos indicus), 87 dogs (Canis lupus familiaris) and 19 horses (Equus caballus), from different localities of Cordoba. Ticks were identified taxonomically and PCR assays were used for the amplification of Anaplasma sp. and Ehrlichia sp. DNA. The amplification products were sequenced and analyzed. From the 1,105 ticks examined, 679 (61.5%) were Rhipicephalus microplus, collected from cattle, 353 (32%) were Rhipicephalus sanguineus from dogs and 73 (6,6%) Dermacentor nitens collected on horses; 332 pools were formed to develop the PCR assay. Anaplasma sp. and Ehrlichia sp. DNA was detected in 5.7% (19/332 pools). Direct sequencing of amplicons showed that seven sequences had similarities between 99–100% with Anaplasma marginale, one sequence showed 100% identical with Anaplasma phagocytophilum, seven sequences showed 100% identity with Ehrlichia ewingii, one sequence had 100% identity with E. chaffensis and three sequences showed similarities of 99% and 95% with Ehrlichia mineirensis and Ehrlichia canis respectively. In conclusion, several tick-borne pathogens identified in this survey suggests that there is a risk for the emergence of tick-borne diseases in domestic animals and humans in Colombia. Our data provides evidence of Ehrlichia and Anaplasma species circulating in ticks from Cordoba.

Leptospirosis is an infectious disease caused by Leptospira bacteria. It is a global public health concern, especially in tropical and subtropical regions. The aim of this review was to summarize some relevant studies that discuss the presence of rodents and the identification of Leptospira bacteria in rodents. This review also presents findings on the potential reassociation of the presence of rodents with Leptospira bacterial infections to leptospirosis cases in humans. A systematic review methodology used to minimize article selection bias that was likely to occur. During the initial search from three science databases (ProQuest, Scopus, and PubMed), 119 articles were retrieved. During the screening process, three articles were excluded due to duplication, 101 articles were excluded based on title and abstract incompatibility with the inclusion criteria, five articles were excluded due to incompatibility of article content with the inclusion criteria, and two articles were excluded because of the ineligibility with the study. In the final screening process, eight articles were chosen to be analyzed. This review found that the presence of rodents infected with Leptospira had the potential to cause leptospirosis in humans through contaminated water and soil or by direct human-to-human contact. The lead factors in the transmission of leptospirosis infection from rodents to humans are activities that take place in wetlands and rice fields, forestry work, and farming activities.

INTRODUCTION: Methoxy polyethylene glycol-epoetin ? has been shown to be effective in the treatment of anemia among chronic kidney disease (CKD) patients on dialysis or pre-dialysis. This study evaluated the effectiveness and safety of this drug in the treatment of renal anemia among Filipino patients, demonstrating relevant clinical experiences in drug administration and dose adjustment.

METHODS: This was an open-label, one-arm prospective clinical series conducted in five renal clinics in Metro Manila, which enrolled 28 (27 evaluable) CKD patients, 18 years old and above with ESA-naive renal anemia who fulfilled the eligibility criteria. All patients gave their informed consent. The protocol was approved by the Philippine Council for Research & Development-National Ethics Committee. Methoxy polyethylene glycol-epoetin ? was given as a subcutaneous injection beginning at 0.6 ug/kg body weight once every two weeks with dose adjustment (25% increments/decrements per month) to keep hemoglobin at 11 to 12 g/dL (not to exceed 13 g/dL), and then maintained once every four weeks on a dose equal to twice the previous once-everytwo-weeks dose, over a 24-week study period. Data analysis was done using STATA version 10.

RESULTS: Across the 24 weeks of methoxy polyethylene glycolepoetin ? treatment, there was a mean increase in hemoglobin of >1.0 g/dL from baseline; >60% of patients achieved hemoglobin levels >11 g/dL starting at week 8 (mean time to first target hemoglobin 5.7 weeks) with variability, no blood transfusion, and mean of 1.52±1.25 SD dose adjustments per patient. The manner of dose adjustment can be the main driver of hemoglobin variability. Common adverse events were sudden rise in blood pressure (6 patients), back pain (3), and fever (3). 

CONCLUSION: Methoxy polyethylene glycol-epoetin ? administered once monthly after an initial once every two weeks correction phase can improve hemoglobin levels at target 11 to 12 g/dL, with hemoglobin variability and safety events as expected for a CKD population. 

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Polyethylene Glycols ; Polyethylene ; Blood Pressure ; Epo Protein, Human ; Erythropoietin ; Anemia ; Hemoglobins ; Renal Insufficiency, Chronic ; Injections, Subcutaneous ; Renal Dialysis

Background: The 21-item English version of the Depression Anxiety Stress Scale (DASS-21) has been proposed as a method for assessing self-perceived depression, anxiety and stress over the past week in various clinical and nonclinical populations. Several Malay versions of the DASS-21 have been validated in various populations with varying success. One particular Malay version has been validated in various occupational groups (such as nurses and automotive workers) but not among male clinic outpatient attendees in Malaysia. Objective: To validate the Malay version of the DASS-21 (Malay-DASS-21) among male outpatient clinic attendees in Johor. Methods: A validation study with a random sample of 402 male respondents attending the outpatient clinic of a major public outpatient clinic in Johor Bahru and Segamat was carried out from January to March 2016. Construct validity of the Malay-DASS-21 was examined using Exploratory Factor Analysis (KMO = 0.947; Bartlett’s test of sphericity is significant, p<0.001) through Principal Component Analysis and orthogonal (varimax) rotation with Kaiser Normalization to confirm the psychometric properties of the Malay-DASS21 and the internal consistency reliability using Cronbach’s alpha. Results: Construct validity of the Malay-DASS-21 based on eigenvalues and factor loadings to confirm the three factor structure (depression, anxiety, and stress) was acceptable. The internal consistency reliability of the factor construct was very impressive with Cronbach’s alpha values in the range of 0.837 to 0.863. Conclusions: The present study showed that the MalayDASS-21 has acceptable psychometric construct and high internal consistency reliability to measure self-perceived depression, anxiety and stress over the past week in male outpatient clinic attendees in Johor. Further studies are necessary to revalidate the Malay-DASS-21 across different populations and cultures, and using confirmatory factor analyses.
Anxiety ; Depression

Breast surgery is frequently associated with post-operative nausea, vomiting, pain and painful restricted movement. Paravertebral block may be an alternative to general anesthesia for this type of surgery. We studied the efficacy and safety of paravertebral block technique for the operative treatment of breast cancer and compared post-operative pain relief, length of hospital stay, patient satisfaction, incidence of nausea and vomiting in paravertebral block to general anesthesia. Methods: After written informed consent was obtained from 37 female patients due for modified radical mastectomy, 19 women were randomly allocated to receive paravertebral block, while 18 women received general anesthesia. During monitored sedation, paravertebral blocks opposite spinous processes C6-T7 were performed using bupivacaine 0.5 percent (maximum dose = 3 mgs/kg) with epinephrine, 3-4 ml per segment. Results: Post-operative pain score (VAS) at rest, with deep breathing and coughing; requirement for analgesics; and incidence of nausea were lower in the paravertebral group. There was no difference between groups in the mean length of hospital stay post operation to discharge and incidence of vomiting and other side effects. There was greater patient satisfaction in the paravertebral group. Conclusion: Paravertebral block is an effective and safe alternative to general anesthesia with less pain, less nausea and greater patient satisfaction.
Human ; Female ; ANESTHESIA ; ANALGESIA ; ANESTHESIA, GENERAL ; BREAST NEOPLASMS ; PAIN, POSTOPERATIVE

Objectives: This study aims to answer the question:How well do the In- Service Examinations predict performance int he Written Diplomate Certification Examination? Methodology: Descriptive statistics and measures of central tendencies were used to described the distribution of the data. Linear regression using the Pearson Product Moment Correlation was used to evaluate data. Results: Of the 50 residents who were in the program from 1999 to 2000, only were included in the study. One did not take the In- Service Examination during his 2nd year of residency while the other has yet to take her WDCE. Conclusion: This study found a high positive correlation of scores in the Philippine Board of Anesthesiology ISEs and the WDCE. The In- Service Examination is a useful tool for gauging the readiness of a resident to perform well in the Written Diplomate Certification Examination. It is also a useful method for assessing the rate of improvement of the anesthesiology resident during his training. The results of this study help to established the ISEs as a mean of determining the strengths and weaknesses of anesthesia trainees and their training programs.
Human ; ANESTHESIOLOGY ; CERTIFICATION ; SCORES, CORRELATION

OBJECTIVE: This is a prospective, randomized open-labeled clinical study to demonstrate the safety and immunogenicity of Purified Vero Cell Rabies Vaccine (PVRV) Freeze-Dried using pre-exposure and post- exposure regimen utilizing Modified Thai Red Cross schedule (Modified TRC) in comparison with Purified Chick Embryo Cell (PCEC) Rabies Vaccine among healthy volunteers in San Lazaro Hospital.
METHODOLOGY: A total of 189 healthy Filipino volunteers were randomized into three groups: Group A received PVRV 0.1 ml intradermally (ID) using the pre-exposure regimen (Day 0, 7, 28). Group B and Group C were given PVRV 0.1 ml ID and PCEC 0.1 ml ID, respectively, using the Modified TRC on days 0, 3, 7 and 30. The statistical tables and graphs were generated using Microsoft® Excel® 2010. SPSS® version 13 for Windows™ was used for descriptive statistics (geometric mean, arithmetic mean, standard deviation and percentages) and inferential statistics (?2 test, one-way ANOVA and two-way mixed factorial ANOVA).
RESULTS: The results revealed that the percentage seroconversion of both PRVR and PCEC post-exposure groups in this clinical study were 100% on days 14 and 90. The PRVR pre-exposure group achieved 96% seroconversion on Day 28 with Geometric Mean titers (GMT) of 1.96 IU/ml (95% CI: 1.45 - 2.65), which is comparable to other similar studies on pre-exposure rabies vaccination. There was no overall difference in all three groups for the whole duration of the study (p = 1.000). The geometic mean titers (GMT) for post-exposure PRVR and PCEC groups on days 14, 30 and 90 were all above 0.5 IU/ml. There was no significant difference between these two post-exposure groups (p = 0.052). The proportion of the subjects in the three groups who experienced local (pain and tenderness at the injection sites, erythema and itching) or systemic reactions (low grade fever, dizziness and headache) during follow-up period were not significantly different (p = 0.134). There were no serious adverse events (SAEs) reported during the follow-up period.
CONCLUSION: The Asian manufactured PVRV is safe, tolerable, immunogenic and comparable with PCEC and therefore, the Asian manufactured PVRV can be an economical alternative for rabies post-exposure treatment using the modified TRC regimen and for pre-exposure prophylaxis.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Rabies Vaccines ; Rabies ; Vero Cells ; Dizziness ; Pre-exposure Prophylaxis ; Seroconversion ; Pruritus ; Vertigo ; Vaccination ; Erythema

OBJECTIVE: In-depth understanding of endoscopic anatomy of the skull base is the cornerstone of the development of endoscopic endonasal skull base surgery. The purpose of this study is to explore the anatomical landmarks of the clivus for endoscopic endonasal skull base surgery. METHOD: Eight silicon-injected adult cadaveric heads (16 sides) were dissected performing endoscopic endonasal approach. The clivus and adjacent structures were exposed; and their anatomy shown in detail. High-quality pictures were produced. RESULT: The clivus was subdivided into the upper, the middle and the lower clivus. Extracranial soft tissue landmarks and bony landmarks were presented. Intradural landmarks of the upper clivus were the interpeduncular cistern, posterior cerebral artery, posterior communicating artery, superior cerebellar artery, cranial nerve III and cerebral peduncle; intradural landmarks of the middle clivus were the prepontine cistern, basilar artery, cranial nerve VI and pons; intradural landmarks of lower clivus were premedullary cistern, vertebral artery, cranial nerve XI and medulla oblongata. Surgical routes to the clivus were the upper clivus approach, middle clivus approach, lower clivus approach and panclival approach. CONCLUSION An understanding of the complex anatomy of the clivus is paramount for surgically dealing with the disease involved clivus and adjacent region.
Adult ; Cadaver ; Cranial Fossa, Posterior ; anatomy & histology ; surgery ; Endoscopy ; Humans ; Nose ; Skull Base

PURPOSE: Since the outbreak of the unprecedented COVID-19 health crisis, Filipino nurses are one of the vital health workers in fighting its devastation in the Philippines. The study aimed to describe the lived-experiences of Filipino next generation nurses as frontliners in the midst of COVID-19 pandemic. DESIGN: The paper espoused the qualitative research design of inquiry exclusively Husserlian descriptive phenomenology. Study participants were selected using non-probability, purposive sampling design. The sample (N=19) was consisted of Filipino nurses with less than 10 years of practice experience, referred to as next-generation nurses, who function as frontline healthcare workers in healthcare settings, both male and female. The study was conducted in the national capital region (NCR), which has the most COVID-19 cases in the country. Due to the community quarantine imposed by the national government, the corpus of data was collected through virtual semi-structured interviews and from the participants' testimonies posted in social-media. METHOD: An adaptation of Colaizzi's empirical phenomenological research approach was utilized to obtain an in-depth understanding and analysis of study participants' experiences. FINDINGS: The profound, life-changing experiences of a select group of Filipino next- generation nurses were unified in three interesting themes, namely,: acclimatization to the challenges of the novel clinical situation, affirmation of the spirit of resiliency, and actualization of the valued calling. CONCLUSION: The contagion has demanded a new way of working, and these nurses have risen to the challenge, and demonstrated how capable they are at responding to new situations and uncertainty. Despite facing dire challenges, they demonstrate the spirit of resiliency. This health crisis enables them to impart the value of the nursing vocation. As they navigate this unprecedented contagion, their experiences and status could likely alter at different phases of the pandemic. Hence, the provision of long-term and holistic support for them is necessary to preserve their welfare.
COVID-19 ; Pandemics ; Family Characteristics

Preoperative perforator marking for deep inferior epigastric artery perforator flaps is vital to the success of the procedure in breast reconstruction. Advances in imaging have facilitated accurate identification and preselection of potentially useful perforators. However, the reported imaging accuracy may be lost when preoperatively marking the patient, due to 'mapping errors', as this relies on the use of 2 reported vectors from a landmark such as the umbilicus. Observation errors have been encountered where inaccurate perforator vector measurements have been reported in relation to the umbilicus. Transcription errors have been noted where confusing and wordy reports have been typed or where incorrect units have been given (millimetres vs. centimetres). Interpretation errors have also occurred when using the report for preoperative marking. Furthermore, the marking process may be unnecessarily time-consuming. We describe a bespoke template, created using an individual computed tomography angiography image, that increases the efficiency and accuracy of preoperative marking. The template is created to scale, is individually tailored to the patient, and is particularly useful in cases where multiple potential suitable perforators exist.
Angiography ; Breast Neoplasms ; Breast* ; Epigastric Arteries* ; Female ; Free Tissue Flaps ; Humans ; Mammaplasty* ; Mastectomy ; Perforator Flap* ; Tomography, X-Ray Computed ; Umbilicus