*Absorbable Implants ; Biocompatible Materials/*pharmacology ; Bone Regeneration/*drug effects ; Bone Regeneration/physiology ; Bone Substitutes/*pharmacology ; Calcium Phosphates/*pharmacology ; Structure-Activity Relationship

Purpose: To compare the efficacy and safety of Proparacaine 0.35%- Fentanyl 0.0015% solution and Lidocaine 2.8% - Fentanyl 0.0015% solution as topical anesthesia for pharmacoemulfification with intraocular lens implantation. Methods: A prospective randomized, triple- masked clinical study. Ninety six patients with senile cataract were divided into two treatment groups Proparacaine - fentanyl group (PF group) and the Lidocaine Fentanyl group (LF group). Volume of anesthetic required latency and duration of anesthesia were compared. Visual analog pain scale was used to assess intraoperative patient's pain. Preoperative patient anxiety; surgeons and anesthesiologists assessment of the operative condition were also determined. Slit-lamp biomicroscopy was done on the first day postoperatively. Unpaired students T- test and descriptive statistics were employed with level of significance at p<0.05. Results: Similar volume of the anesthetics was used in both groups. Mean latency period for the PF solution was 0.51 minutes +/-0.18 (SD) which was significantly shorter than the LF solution at 3.14 minutes +/- 1.09 (p<0.05). Mean duration of anesthetic effect of the PF group was significantly shorter at 33. 47 minutes +/-4.57 while the LF group lasted 69.09 minutes +/- 16.20 9p<0.05). Majority of the patients in both groups [44 (905) PF group; 40 (85%) LF group] denied any pain or discomfort during surgery. Mean pain score was 0.16 PF group and 0.23 for the LF group. The surgeon noted optimal operative conditions while the anesthesiologist reported significant difference in patients response during surgery with hand squeezing noted in 7 (15%) patients in the LF group 9p<0.05%). There was no significant difference in biomicroscopic findings on day 1 postoperatively. Conclusion: Proparacaine 0.035% - fentanyl 0.0015% solution is as effective and as safe as lidocaine 2.8% - fentanyl 0.0015% solution for topical anesthesia in phacoemulsification with intraocular lens implantation.
Human ; PROXYMETACAINE ; FENTANYL ; LIDOCAINE ; PHACOEMULSIFICATION ; MICROSCOPY, ACOUSTIC ; ANESTHESIA

RATIONALE: In the Philippines, 25% of children < 10 years old are underweight. The use of energy-dense ready-to-use therapeutic food (RUTF) augments caloric intake. No local studies have evaluated RUTF.

OBJECTIVE: To determine the efficacy, safety and acceptability of a modified RUTF (mRUTF) to supplement caloric intake.

METHOD: One hundred (100) children 18 months to 10 years old with mild to moderate malnutrition were randomized to either mRUTF or control group. The treatment arm received mRUTF during weekdays for 5 weeks while controls had no supplementation. Anthropometric measurements were taken at baseline, weekly for 5 weeks and 2 weeks post-supplementation.

RESULTS: The two groups were comparable at baseline. At five weekly intervals, there was no significant difference in weight, height and mid upper arm circumference between groups, although the mean percentage weight gain of the mRUTF group was higher compared with controls (8% vs 2.6%, p=0.15). Cessation of supplementation resulted in weight loss in the mRUTF group. [mRUTF: -0.40 (0.33) vs -0.03 (0.35), p=0.00]. The taste of mRUTF was acceptable.

CONCLUSION: Ready-to-use-therapeutic food is an effective, safe and acceptable alternative supplement for children, 18 months to 10 years old, with mild to moderate malnutrition.

Human ; Male ; Female ; Child ; Child Preschool ; Infant ; Thinness ; Philippines ; Weight Gain ; Taste ; Arm ; Weight Loss ; Energy Intake ; Dietary Supplements ; Taste Perception ; Malnutrition

A rapid tissue preparation to establish the diagnosis of surgical specimens was reported. The specific reason to request such a preparation usually relates to a suspicion of a neoplastic lesion. This study was conducted to evaluate the role of scrimp technique, a modification of imprint cytology, in the rapid intraoperative diagnosis of tumors as compared with frozen section. Scrape and imprints of tumors were made from 86 unfixed specimens at the time of frozen section. Rapid and permanent staining methods were employed and the accuracy of diagnosis was compared with frozen and paraffin preparations. The results showed that the sensitivity and specificity of scrimp preparation were 95% each as compared with frozen section which has 98% and 100% respectively which manifested a negligible inferiority over frozen section. This technique was simple, fast, easy, and reliable and does not require special instruments or time consuming set-up. While not meant to replace frozen section, it can be an excellent adjunct or alternative especially in remote and secondary hospitals unequipped with sophisticated apparatus. (Author)

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Adolescent ; Child ; Frozen Sections ; Paraffin ; Sensitivity And Specificity ; Cytodiagnosis ; Neoplasms ; Staining And Labeling

Fetal Pleural Effusion is a rare case whose management is still a matter of debate. Its course may spontaneously resolve or lead to pulmonary hypoplasia and result in death in utero or poor neonatal outcome. This paper is a report of 2 cases and their course, from prenatal diagnosis of Pleural Effusion to delivery. This report includes sonographic scans, description of the laboratory work – up and other imaging tests that were done. The 1st case report was successfully managed with Thoraco-amniotic shunting, while the 2nd case was seen late and had an adverse neonatal outcome. This case report was done to increase awareness among obstetricians and sonologists in offering counsel to patients and their families, especially in our low resource set-up, where in in utero interventions are not available.
Humans ; Pregnancy ; Obstetricians ; Pleural Effusion

The first part of the critical care guidelines of the Philippine College of Surgeons (PCS) and supported by Glaxo Wellcome Philippines, Inc. dealt with resuscitation fluids, blood transfusion, assessment of volume resuscitation, nutritional support and cardiovascular support. The second part deals with the last 2 aspects identified by the Technical Working Group (TWG) namely: surgical intensive care units and implementation of guidelines. The literature search, limited to english publications. Used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane Library, Issue 4, 2000; 2) National Library of Medicine - Medline (PubMed, no time limit): and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD. Manual searching of the reference lists of review articles and some important meta-analyses and randomized controlled trials (RCTs) was also done. The search terms used were: 1) Cochrane library: surgical intensive care, guidelines implementation, 2) Medline: surgical intensive care, 3) HERDIN: intensive care. Titles of all articles were printed and all members of the TWG went over the list and checked the titles of articles whose abstracts they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. (Author)

National Library Of Medicine (u.s.) ; Philippines ; Medline ; Pubmed ; Libraries ; Critical Care ; Nutritional Support ; Information Services ; Blood Transfusion ; Surgeons

A protocol of polymerase chain reaction-random amplified polymorphic DNAs (PCR-RAPDs) was established to analyse the gene diversity and genotype identification for clones of Sequoia sempervirens (D. Don) Endl. in Chile. Ten (out of 34) clones from introduction trial located in Voipir-Villarrica, Chile, were studied. The PCR-RAPDs technique and a modified hexadecyltrimethylammonium bromide (CTAB) protocol were used for genomic DNA extraction. The PCR tests were carried out employing 10-mer random primers. The amplification products were detected by electrophoresis in agarose gels. Forty nine polymorphic bands were obtained with the selected primers (BG04, BF07, BF12, BF13, and BF14) and were ordered according to their molecular size. The genetic similarity between samples was calculated by the Jaccard index and a dendrogram was constructed using a cluster analysis of unweighted pair group method using arithmetic averages (UPGMA). Of the primers tested, 5 (out of 60) RAPD primers were selected for their reproducibility and high polymorphism. A total of 49 polymorphic RAPD bands were detected out of 252 bands. The genetic similarity analysis demonstrates an extensive genetic variability between the tested clones and the dendrogram depicts the genetic relationships among the clones, suggesting a geographic relationship. The results indicate that the RAPD markers permitted the identification of the assayed clones, although they are derived from the same geographic origin.
Genotype ; Polymerase Chain Reaction ; methods ; Random Amplified Polymorphic DNA Technique ; methods ; Sequoia ; classification ; genetics

The diagnosis of lymphatic malformations can present problems with diagnosis and treatment. Non-response to a chosen procedure can magnify the initial problems or create new ones. We present such a case.

 

CASE REPORT

            A 9-year-old boy initially presented with a 3-year history of soft upper eyelid mass with red-violet discoloration after hitting his head on a wooden post. About 2 years before this presentation, progressive enlargement in size of the mass with extension to the left maxillary and left scalp region prompted an ophthalmologic consult, and Magnetic Resonance Imaging (MRI) of the orbit and Magnetic Resonance Angiography (MRA) of intracranial vessels revealed a venous-lymphatic malformation. (Figure 1) He was then referred to our institution for further management.

            The patient was noted to have a 4x2 cm reddish vascular mass over the left eyelid with no thrill or bruit and a surrounding 9x9 cm bluish left facial swelling in the periorbital region extending to the maxillary area corresponding to the MRI images. A repeat MRI/MRA showed a prominent branch of the left external carotid artery coursing towards the mass. (Figure 2)

An angiogram of the neck for possible coil insertion into the prominent vessel from the external carotid artery was performed by interventional radiology. However, the left common carotid, left external carotid, and left vertebral arteries showed no evidence of high- or low-flow arteriovenous malformation. (Figure 3) This favored a hypovascular, space-occupying lesion consistent with a cystic lymphatic malformation and the boy was referred back to our service for possible surgery.

Meanwhile, the mass continuously increased in size and by the time he was seen again in our clinic, the mass measured 15x15x20 cm occupying the left hemifacial area from the midportion of the parietal bone superiorly to the body of the mandible inferiorly, with violaceous skin discoloration and verrucous infraorbital lesions. (Figure 4) The patient was not considered a good candidate for surgical excision due to the size of the mass relative to his body, and initial sclerotherapy was planned to possibly decrease the size of the mass enough for excision of any residuals.

Percutaneous Sclerotherapy was performed using a guidewire-catheter replacement technique. An initial drainage of 800mL of non-clotting serosanguinous fluid was followed by infusion of 3% sodium tertradecyl sulfate, followed by 99% ethanol infusion. There was gross decrease in the size of the mass after the procedure. (Figure 5) A pigtail drainage catheter was maintained to continuously drain fluid from the lesion. On the 10th hospital day, the boy had febrile episodes associated with enlargement of the left hemifacial mass. Blood cultures showed no bacterial growth. Culture of the pigtail catheter tip grew Morganella morganii. Amikacin 170mg IV every 8 hours was started but fever was unrelenting. Wound cultures grew Methicillin Resistant Staphylococcus Aureus, and Co-trimoxazole 40mg/200mg per 5ml Pediatric Suspension, 10ml every 12 hours and Metronidazole 200mg/5mL oral suspension, 5mL every 8 hours were initiated.

During this month-long post-operative period, the mass continued to expand to its preoperative size. (Figure 6) Due to lack of funds, the antibiotics were given by mouth and the patient was discharged. On 3-month follow up, the mass had grown to even larger than the pre-embolization stage.

 DISCUSSION

            Lymphatic malformations (LM) are made up of variously dilated lymphatic channels or cysts, lined by endothelial cells with a lymphatic phenotype.1  Histologically, LM is classified into the macrocystic type, consisting of cysts larger than 2 cm with clear boundaries, and the microcystic type consisting of cysts smaller than 2 cm that appear diffuse and sprouted without clear boundaries. The two types coexist in the combined type.2  

            A 5-stage clinicoradiologic staging system has been devised by de Serres et al. based on cervical LM laterality and relationship to the hyoid bone predicting operative risk and surgical outcome.3 The higher the clinicoradiologic stage, the greater the potential risk of intraoperative and postoperative complications.  In general, bilateral microcystic suprahyoid LMs are more difficult to treat than infrahyoid LMs, especially when there are microcystic LMs involving the oral cavity, tongue, and/or pharynx. In this case, confirming whether it was a high-flow or a low-flow disease presented a dilemma early on. We relied on the initial MRI/MRA findings of a possible arterial feeding vessel, considering that MRI/MRI is more than 90% accurate in the diagnosis of high-flow vascular anomalies.4 However, during angiography for coil insertion, there were no feeding vessels found and a low-flow disease was considered. Thus, there were further delays in management associated with these procedures.

            In our case, the patient had a unilateral suprahyoid LM that has a complication rate of 41% with an average of 1.5 procedures to treat and cure the disease.3 The possible complications that were considered included facial nerve palsy, seroma, exsanguination and most importantly, functional compromise due to the projected large post-operative defect and location of the mass which could affect function of the left eye, feeding problems and long term facial disfigurement.5

            Considering these possible complications, we planned to attempt initial sclerotherapy before considering surgery. However, we encountered infection of the pigtail site and wound, and sclerotherapy failed to decrease the size of the mass. At the moment, subjecting the patient to repeat sclerotherapy may have a higher chance of failure.

            Noting that the treatment of lymphatic malformation should be directed towards preservation of functional and aesthetic integrity,5 we present our case for consideration.

Human ; Male ; Child Preschool (a Child Between The Ages Of 2 And 5) ; Methicillin ; Staphylococcus

We present a human infection with the canine whipworm, Trichuris vulpis, in a child suffering from rhinitis with a diagnosis of rhinitis. T. vulpis eggs resemble those of T. trichiura but they can be differentiated based on their morphological features and egg size, using micrometry with an ocular micrometer. T. vulpis eggs measured an average of 90 microm by 44 microm (range 86-99 microm by 38-47 microm). Prevalence of hookworms (28.1%), Toxocara canis (11.8%), and Trichuris vulpis (3.5%) was found in 292 fecal samples of dogs collected at the peri-domicile, which showed that the risk of infection was not only fortuitous. The treatment of canine whipworm infections is similar to that of T. trichiura infection. We recommend differentiation of the 2 species for their epidemiological and prevention implications.
Animals ; Child ; Feces/parasitology ; Female ; Humans ; Trichuriasis/diagnosis/*parasitology ; Trichuris/*isolation & purification/physiology

OBJECTIVE: The study aims to describe factors that contribute to the Length of Stay (LOS) in the Emergency Department (ED) patients of a Tertiary Private Hospital in Philippines.

METHODS: This is a retrospective descriptive study from September 1, 2015 to March 31, 2016 on the factors of ED consultations specifically on demographics (age and sex), payment schemes (Out of Pocket (OOP) and third party payer), shift times (morning, afternoon and night) and triage-levels were associated with LOS.

RESULTS: Our ED consultations with age (mean 40.75 years, SD 16.8, N 20,687, range 95) were dominated by females (56%), two age-range, 21-30 (28.4%) & 31-40 and third party payer (57%). LOS (mean of 4,40 hours, SD 3,89, N 18540, range 68) was significantly higher (p<0.001) on OOP patients, older age-range; 71-80, (3.5%) and 81-90, (2.3%). Emergent cases had higher incidence (X2= 30.2, p<0.001) on morning shift, urgent cases on afternoon shift and trauma cases on evening shift. Non-urgent cases were consistent on all time frames. LOS was significantly higher (X2=p<0.001) on urgent and emergent cases and on morning and afternoon shifts and significantly lowest, (p<0.001) on night shifts.

CONCLUSION: Higher LOS was associated on the following: urgent and emergent triage- levels, older age range, OOP, and morning and afternoon shifts.

Emergency Service, Hospital ; Length Of Stay ; Triage