<p style="text-align: justify;">The non-specificity of symptoms of pulmonary embolism (PE) makes imaging studies essential. The ventilation-perfusion lung scan (VQ) is the most frequently done nuclear medicine test for PE but the length of imaging time is inconvenient to the patient. The purpose of this study is to evaluate planar and SPECT lung perfusion scans interpreted using the PISA-PED criteria. In determining the sensitivity, specificity, positive and negative predictive values of the two imaging techniques, we also aim to present a simplified imaging method that foregoes the ventilation scan in the diagnosis of PE. This could lead to a change in the standard VQ scintigraphy protocol being used by nuclear medicine centers in the Philippines. This is a prospective study wherein fourteen patients suspected of having PE underwent planar and SPECT perfusion scans and CT pulmonary angiography, which was used as the gold standard for diagnosing PE. Planar and SPECT specificities and positive predictive values were the same at 100%. The sensitivity, negative predictive value, and accuracy of SPECT (85.7%,87.5%,92.8%, respectively) were all higher than planar scans (71.4%, 77.8%, 85.7%, respectively. A SPECT perfusion scan is superior to a planar perfusion scan in detecting pulmonary embolism. This implies that the standard ventilation-perfusion scan used by nuclear medicine centers in the country can be simplified. A ventilation scan can be omitted.p>
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Angiography ; Nuclear Medicine ; Perfusion Imaging ; Philippines ; Prospective Studies ; Pulmonary Embolism ; Radionuclide Imaging ; Tomography, Emission-computed, Single-photon ; Tomography, X-ray Computed ; Respiratory Tract Diseases ; Lung Diseases

<p style="text-align: justify;">OBJECTIVES: To present a case of anti NMDA receptor encephalitis in an adolescent male; to report a case of anti-NMDA receptor encephalitis who showed a rapid response to methylprednisone.
INTRODUCTION: Anti NMDA receptor encephalitis is an inflammatory encephalopathic autoimmune disease frequently affecting young women with teratomas of the ovary. It is also observed in men, children, and females without tumors.
THE CASE: A case of a 14 year adolescent right handed male adolescent presented with fever, hypertension , psychiatric symptom ,aphasia and orofacial dyskinesia. On admission he was highly febrile with dysautonomia, rigidity, catatonia and prominent orofacial dyskinesia. Upper motor signs include hyperreflexia and bilateral clonus. He latter developed Ileus, bladder and bowel incontinence, seizures, chorea, dystonia and dIe orofacial dyskinesia worsened. EEG showed continuous background slowing, Cranial MRI was normal and CSF analysis showed pleocytosis with lymphatic predominance with a normal protein and sugar. Work up for Herpes and Japanese B encephalitis was negative. Work up for tumor was negative. After 5 days of methylprednisone a rapid improvement was noted with resolution catatonia, rigidity hypereflexia and clonus. Results of the anti NMDA receptor antibodies showed positive for anti NMDA receptor encephalitis.
DISCUSSION: Anti NMDA receptor encephalitis presents with fever, headache,or malaise, followed mood and behavioral changes, psychiatric symptoms, decline of level of consciousness, hypoventilation and hyperkinesias. Immunotherapy is the current treatment. In patients with underlying tumor, immunotherapy, enhanced the effectiveness and speed of recovery. In patients without a tumour an additional treatment with second-line immunotherapy is needed but was not noted in this case. The patient showed a rapid recovery after methylprednisone and after 4 months post immunotherapy there was no recurrence of symptoms.
CONCLUSION: Anti NMDA receptor encephalitis is an inflammatory encephalopathic autoimmune disease and can be seen in children without tumors. Behavioral and hyperkinesias are prominent symptoms. Treatment with methylprednisone showed a good response.p>
Human ; Male ; Adolescent ; Anti-n-methyl-d-aspartate Receptor Encephalitis ; Catatonia ; Chorea ; Dyskinesias ; Dystonia ; Electroencephalography ; Encephalitis, Japanese ; Hashimoto Disease ; Hyperkinesis ; Leukocytosis ; Primary Dysautonomias ; Receptors, N-methyl-d-aspartate

<p>Background: There are no established guidelines preferring mannitol over hypertonic saline in managing increased intracranial pressure in children.p><p>Objective: This systematic review aimed to assess the available data on the efficacy of 20% mannitol and 3% hypertonic saline in decreasing intracranial hypertension in the pediatric age group.p><p>Method: Search was done through PubMed/MEDLINE, Cochrane Central Registry of Clinical Trials (CENTRAL) and EMBASE. The search of articles yielded 280 studies. After applying the inclusion and exclusion criteria, a total of 7 articles were deemed eligible for assessment.p><p>Results: Seven studies with a total of 1,892 pediatric patients met the eligibility criteria: three RCTs and four retrospective studies. From these studies, two randomized controlled studies showed statistically significant evidence that 3% hypertonic saline was superior to 20% mannitol in reducing increased intracranial pressure (ICP) while two other studies had results that were insufficient to establish statistical significance. A study showed that Glasgow coma scale (GCS) scores were higher and length of stay was shorter in patients given hypertonic saline than in the mannitol group. Relative risk of mortality was comparable in both groups. While more episodes of hypotension and rebound increase in ICP was seen with mannitol, both agents reported occurrences of acute kidney injury, hemolysis and hyperchloremic metabolic acidosis.p><p>Conclusion: This review showed that while both agents effectively decreased intracranial pressure, 3% hypertonic saline showed better results compared with 20% mannitol. Due to the limited number and heterogeneity of studies, a pooled analysis of the effects in ICP could not be done. Recommendations: Larger prospective controlled studies using 20% mannitol and 3% hypertonic saline in the treatment of increased ICP in the pediatric age group are needed to render valid affirmations.p>
Human ; Male ; Female ; Adolescent (a Person 13-18 Years Of Age) ; Child Preschool (a Child Between The Ages Of 2 And 5) ; Mannitol ; Intracranial Pressure

Pioneering and implementing new technology successfully in a radiation oncology clinic requires hard work, team effort and management support. Over the last 15 years, we have pioneered the clinical implementation of intensitymodulated radiation therapy (IMRT) as well as combined radio-gene-therapy in the treatment of cancer. The entire department including physicists, dosimetrists, therapists, nurses, managers, data managers, radiation oncologists and residents in training, other medical specialists e.g. neurosurgeons, urologists, pathologists, radiologists, molecular biologists and many others have joined forces and contributed to the success. IMRT has transitioned from an initial experimental approach to a standard of care approach now in various disease sites. We are entering a new era of imageguided radiation therapy (IGRT) and molecular-targeted therapy and we continue to strive to implement these new technologies in the clinics. Frameless stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) have now become a clinical reality. Again, all these require a tremendous amount of efficient management and cooperation among all departmental staff. Five fundamental principles which can help the successful pioneering and implementation of innovative radiation oncology approaches will be discussed. These include identifying a project champion(s), pursuing a multi-disciplinary approach, showing clinical efficacy and return on investment (ROI), ability to articulate the project and celebrating the successful implementation.

BACKGROUND: Anti-N-Methyl-D-Aspartate receptor (anti-NMDAR) Encephalitis is the most common type of autoimmune encephalitis that affects children, adolescents and young adults. Since its discovery in 2007, there is still a paucity of data on the disease and factors affecting its outcome. OBJECTIVES: To describe the clinical characteristics of children and adolescents with anti-NMDAR encephalitis and to analyze factors that may affect its outcome. METHODS: Forty-three patient records of diagnosed anti-NMDAR Encephalitis were included. The outcome was evaluated using the modified Rankin Scale (mRS), and Clinical Assessment Scale for autoimmune Encephalitis (CASE). RESULTS: Ages ranged from 2 years to 18 years old, majority in the 12-18 years age range. Sixty percent were female. First line treatment using immunotherapy was given to all patients: 37% as monotherapy and 84% combination therapy (MPT only 23%, IVIg only 4%, MPT + IVIg or TPE 21-26%, and MPT + IVIg + TPE 16%). Clinical outcomes on discharge and on follow-up were assessed using the mRS and CASE. On discharge the proportion of the patients who had mild impairment (mRS<2, CASE<9) was more than 50%. On median duration follow-up of 31 weeks (range 24-40 weeks), 96.8% had significant improvement (mRS<2, CASE<9). Among the possible factors that were assessed to affect outcome, only severity of the illness at the start of the treatment influenced clinical outcome. CONCLUSION Early diagnosis and initiation of treatment before the progression of the disease will promote faster recovery and more optimal clinical outcome. CASE may be used as an additional tool in assessing response to treatment.

Purpose: The number of older Filipinos continues to rise resulting in increasing numbers of people who live in a modernized world which offers numerous options to prepare for the End-of-Life (EoL). Henceforth, EoLplanning among older Filipinos and the factors which could potentially influence the propensity to plan ahead needs further investigation. This study ascertained the level of health, relationship, funerary, legal and financial-related EoL planning among older Filipinos, and established the association between EoL planning and sex, chronologic age, religious affiliation, ethnicity, health and financial status. Methods: The study utilized a descriptive survey design, including 400 respondents, chosen through purposive sampling and met the inclusion of Filipino, Baguio residents, aged 60 and above, able to read and understand English, Filipino or Ilokano, and without psychological disturbances or cognitive deficits. The researchers used a self-made questionnaire after establishing validity (0.96) and reliability (0.82). The Saint Louis University Research Ethics Committee ensured the ethical conduct of this research. Data were treated with statistics using frequency, mean and Chi-square test. Findings: The responses indicated moderate levels of EoL planning overall. Moreover, statistical tests revealed that only health status has a significant association with EoLplanning. Conclusions Based on the findings, the researchers conclude that EoL planning remains not widely used in the Philippines, thus, intensifying the call for more aggressive interventions to make EoL planning salient and acceptable to older people. In addition, health status affects EoL planning considerably, and that knowing the sex, chronologic age, religious affiliation, ethnicity and financial status did not help predict EoLplanning.
Ethics Committees, Research ; Surveys and Questionnaires

Background: The mental health and well-being of PhilHealth frontline workers were investigated to inform decision-makers and organizations in developing policies and programs to promote welfare of employees, thereby subsequently improving productivity and service delivery. Objectives: The study aimed to describe the demographic profile of participants and their level of mental health and well-being as well as to determine if a significant relationship exists between the said variables. Methodology: This is descriptive research that gathered respondents’ socio-demographic data. The target population was PhilHealth frontline workers all over the Philippines. Two existing self-report scales were used to measure the mental health and well-being of respondents. Statistical tools were then used to interpret data. Results: The majority of demographic factors were related to mild anxiety levels. The mean scores suggest that ages 20-29 are more anxious than those aged 50 and above. Other findings noted that the position title of Administrative Aide III and place of assignment in PhilHealth Regional Office II and XII showed a severe level of anxiety. Mean scores also showed mild anxiety as the length of years working in the corporation increased. In conclusion, age, years in service and place of assignment have a significant negative impact on participants’ mental health. Conclusion In conclusion, age, years in service and the place of assignment were the variables found to have a statistically recognizable impact on mental health and well-being of PhilHealth frontline workers. These findings were considered in proposing Mental Health Programs for PhilHealth employees.
Mental Health