BACKGROUND: Cisatracurium , an R-cis, R-cis isomer of atracurium, is a benzoquinolinium non-depolarizing muscle relaxant with intermediate duration of action that has the advantage of minimal histamine release compared to the parent compound atracurium. Similar studies have described cisatracurium to have cardiovascular stability up to 7 times the ED95 dose. However, few have been conclusive owing to concomitant use of agents that can cause potential histamine release and hemodynamic effects. This study was specifically designed to minimize these variables. The promise of the clinical advantages of the use of cisatracurium merits investigation against its parent compound atracurium in the Filipino population especially in terms of hemodynamic stability when utilized intraoperatively. The study was conducted to evaluate the onset of action, conditions for intubation, duration of neuromuscular block and side effects of cisatracurium compared to atracurium among Filipino surgical patients METHODOLOGY: A prospective, randomized, double-blind study was performed in eighty one (81) healthy patients of ASA Physical Status 1 and 2 undergoing elective surgical procedures treated with either 0.15 mg/kg cisatracurium (3 x ED 95) n=39 or 0.5 mg/kg atracurium (3 x ED 95) n=42 administered over 5 seconds intravenous bolus under adequate anesthesia, before surgical stimulation. We compared the time course of the neuromuscular block and determined whether the muscle relaxants caused cutaneous and systemic evidence of histamine release. Induction of general anesthesia commenced with the use of propofol-fentanyl in oxygen. Stabilization of the Neuromuscular junction was achieved prior to the administration of the muscle relaxants with the use of tetanic stimulation of 50 Hz; for 5 seconds followed by single twitch stimuli for 2 minutes. Neuromuscular transmission was assessed by recording the mechanical twitch response to train-of-four nerve stimulations every 10 seconds. Cutaneous manifestations, blood pressures and heart rates were recorded periodically. RESULTS: Time to 95 percent block were 77.09-155.99 seconds with cisatracurium. and 64.60 - 128.21 seconds with atracurium. The administration of either muscle relaxant resulted in complete neuromuscular block in all patients providing good to excellent intubating conditions. The time to spontaneous recovery (T4:T1 ratio 80 percent) were noted to be within the range of 63.48 - 103.48 minutes for cisatracurium whereas those treated with atracurium recovered within the range of 74.76 - 92.64 minutes and none necessitated reversal from the muscle relaxants. One patient from the cisatracurium group and two from the atracurium group were noted to have cutaneous flush. CONCLUSION: When given a dose of 3 x ED 95, except for onset, cisatracurium group did not differ significantly from the atracurium group with regard to onset, duration, intubating conditions, and hemodynamic stability.
Human ; Middle Aged ; Adult ; Young Adult ; Adolescent ; INTUBATION ; HEMODYNAMIC ; ANESTHESIA ; CISATRACURIUM ; ATRACURIUM ; HISTAMINE ; MUSCLE RELAXANTS, CENTRAL

Background: Child sexual assault has been underreported, more so, those who minor perpetrators have assaulted. Surveillance for these children, victims and perpetrators alike, must be established. Objective: The objective was to describe the characteristic profile of the minor perpetrators who committed child sexual abuse seen in Philippine General Hospital - Child Protection Unit (PGH-CPU) from January 2013 to December 2018. Methodology: This retrospective cohort study was conducted using chart review and data retrieval from the Child Protection Management Information System (CPMIS) of the PGH-CPU. Results: There were 931 minor perpetrators. 55.9% were 15-19 years old and were predominantly male. 12.7% came from Cavite and 9.5% from Manila. Most were neighbors, acquaintances, and cousins of the victims. 39.4% were still students. 14.4% engaged in alcohol consumption. 7.7% have repeatedly abused children. 6.1% already had police blotter records. 7.3% were exposed to pornography. 7.5% are currently in jail, and 4.1% are in the same household as the victim. Conclusion A child’s environment is potentially contributory to their actions. The minor perpetrators reported were observed to have adverse childhood experiences like violence in their families. Although sexual abuse cases focus on the victims, it is equally vital that authorities give attention to minor perpetrators because they are also children. Programs and interventions should be provided for them to grow up to be better individuals in society.
Sex Offenses ; Child

Objectives: There is limited information on the demographics of female perpetrators of child abuse hence its profile was described utilizing the records collected at the University of the Philippines – Philippine General Hospital Child Protection Unit from January 2008-December 2018. Methods: A retrospective review of the electronic records using the Child Protection Management Information System (CPMIS) database was done using descriptive and inferential analyses. Total enumeration was done for the descriptive analysis and categorical data was analyzed using frequencies and percentages. Inferential analysis using chi-squared analysis or Fisher’s exact probability test was used using a minimum sample size computed using power analysis Results: A total of 983 female perpetrators were reported, mostly belonging to the age group of 25-34 years old (23%). They were more frequently a close relative to the victim (47.3%). Half (50%) of the perpetrators had history of substance abuse, and 65.5% witnessed family violence. Criminal history (99.8%) and occupation (46.7%) were mostly unknown. The types of abuse committed were mostly physical (36%) followed by sexual abuse (34.9%). Inferential analysis of the data suggested that the demographic variables associated with physical abuse were age group, relationship, and history of substance abuse. Meanwhile, age group, relationship, and occupation were associated with sexual abuse. Conclusion Although we see a greater number of male perpetrators, it cannot be denied that female perpetrators can also cause harm to the vulnerable population. It is alarming to note that majority of them are close relatives to the victim. Data from the study can help raise awareness and increase vigilance on possible at-risk population.
Child Abuse

Objectives: This paper presents the development of a local sexual assault investigation kit (SAK) that doctors in the Philippines could use to collect biological samples from victims of sexual abuse, including child patients, that would be used for DNA testing. The study also reports on a management system via courier service to protect the integrity of the samples that could be eventually used as evidence in court from the collection site to the laboratory with sufficient backup measures. Methods: Women and Child Protection Units (WCPU) from Manila, Baguio, Cebu, and Davao partnered with the DNA Analysis Laboratory, Natural Sciences Research Institute of UP Diliman (NSRI-UPD) DNA Analysis Laboratory in testing the utility of a prototype SAK for the collection of biological samples from child patients. From January 2002 to March 2006, samples were collected from patients who went to WCPU within 72 hours post-contact and consented to participate in the study. WCPU doctors collected biological samples guided by the patient’s narratives and packaged the samples while following detailed documentation and chain of custody procedures. SAKs were then sent via a designated courier service from WCPU to the NSRI-UPD DNA Analysis Laboratory for DNA testing. The WCPU kept half of the samples collected, following recommendations made during sectoral consultations that included members of the Research Group of the Philippine Judicial Academy, prosecutors, and defense counsels. Case samples were packed well by the WCPU and received at the NSRI-UPD DNA Analysis Laboratory. Due to budget limitations, only the internal genitalia and patients’ reference buccal swabs were subjected to DNA tests as reported by Maiquilla et al.1 The remaining SAK components and case records were kept in a dedicated and secure storage facility. DNA testing reports were sent to the WCPU, which released them to the child patients and their legal guardians. Results: One hundred fifty-four female children aged 2-18 years old and their legal guardians agreed to participate in the study. Based on the initial interviews of the social workers who conducted the evaluation, all the participants came from families with very low socioeconomic status. The WCPU doctors then complied with prescribed procedures. To date, NSRI-UPD DNA Analysis Laboratory records show that a subpoena for expert testimony had been issued in only one case out of the 63 cases (1.6%) that were positive for male DNA. No further information was available on the final decision in this case due to the absence of any order from the judge granting the laboratory access to court records. Likewise, WCPUs did not have any information on the remaining 62 cases that could have used the DNA test results as evidence if a case had been filed in court. Conclusion This study is the first to report the development and validation of a sexual assault investigation kit in the Philippines aimed at helping medical doctors in collecting and preserving critical biological samples for DNA testing. Using a dedicated courier service to send SAK from collecting agencies to the laboratory for DNA testing was successfully tested and resulted in faster delivery and significantly reduced overall cost. While DNA testing remains the most powerful tool for human identification and the technology has been available in the Philippines since 1997, certain factors have prevented it from being used routinely in sexual assault investigations, including those involving children.
Women and child protection units ; Sex Offenses