INTRODUCTION: Seizures are the most common neurologic emergency in the neonatal period. Phenobarbital and levetiracetam are the most commonly used anti-epileptic agents. However, there is conflicting evidence regarding their efficacy and safety. This review aims to synthesize data from randomized trials evaluating levetiracetam versus phenobarbital as a first-line antiepileptic drug for seizures in the newborn. METHODS: A systematic review and meta-analysis following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was performed. The review considered randomized clinical trials (RCTs) providing information about the efficacy and safety of levetiracetam vs phenobarbital as first line treatment of neonatal seizures. Medline by PubMed, CENTRAL by Cochrane, Embase, Google Scholar, and grey literature for RCTs were searched. RESULTS: Four randomized controlled trials met the criteria for inclusion. A total of 312 neonates (levetiracetam n=167, phenobarbital n=145) comprised the pooled sample. Seizure freedom did not significantly favour one particular drug. This was also seen throughout subgroup analysis comprising clinical determination of seizure onset and cessation and neonates with hypoxic-ischemic encephalopathy. Significant heterogeniety was seen throughout the analyses. Hypotension was seen more in patients given phenobarbital. No significant association of either drug was seen for respiratory abnormalities and requirement for ventilation. Mortality was not significantly associated with either drug. CONCLUSION This meta-analysis combined and synthesized data from four randomized controlled trials comparing levetiracetam and phenobarbital in efficacy and safety for neonatal seizures. The statistical analysis did not lend evidence to support the use of one drug over the over. More studies that employ stringent techniques to minimize bias are needed for a more robust conclusion.

OBJECTIVE: The study aimed to collect data on the occupational health systems implemented across selected healthcare facilities in the Philippines, including: (1) governance system for occupational health and safety (OHS), (2) OHS information systems, (3) OHS financing systems, (4) technology and related systems for OHS, (5) the OHS workforce, and (6) the delivery of OHS services.
METHODS: The data were collected through a walkthrough survey of the selected facilities as well as through the review of records and relevant documents found in the facilities.
RESULTS: Governance and financing systems for OHS are not present in any of the facilities. 3 out of the 13 hospitals studied have employee medical records, accident/incident reports while none of the 19 facilities have Workplace Environment Monitoring Reports (WEM), implying the lack of OHS information systems. Due to the lack of a financing mechanism for occupational health services, there is a lack of OHS technology in the facilities which include but are not limited to the presence of an Immunization and Post-Exposure Program (present in 7 out of 13 hospitals and none of the 6 RHUs studied). 1 out of 19 facilities reported to having personnel delegated for OHS activities in their facility. Lastly, 1 out of 19 facilities have emergency treatment and medical facilities for their employees, indicating inadequate OHS service delivery in the facilities studied.
CONCLUSIONS: Standards and laws such as the Philippine OHS Standards and Department of Health (DOH) Administrative Order (AO) 2012-0020 have provisions with regard to OHS in these facilities, and stricter implementation of these provisions could help in filling in the gaps in the OHS systems in these facilities. This will provide a healthy workforce capable of giving better healthcare services to the general population.

Human ; Occupational Health Services ; Occupational Health ; Workplace ; Rhus ; Safety ; Immunization ; Vaccination ; Hospitals ; Medical Records ; Emergency Treatment

PURPOSE: The study was a survey study to identify the Activities of Daily Living (ADL) and nursing needs of the elderly in the nursing home and derive the fundamental data for offering the better quality of nursing service to them. METHODS: The subjects were the 111 elderly aged over sixty five living in the nursing home located in Seoul. Measures were the nursing needs scale and ADL scale. The data were analyzed by SAS 11.0. RESULTS: First, with regard to the nursing needs, the general need was scored average 3.0, and the emotional d social need was 3.7, and the physical need was 3.1, and the informational need was 2.7. Second, the ADL was scored at the average of 2.7, bathing 1.9, eating 3.1. Third, In correlation between the nursing needs by area, the informational nursing needs showed the sheer correlation with the physical nursing needs, emotional.social nursing needs. The physical nursing needs showed the sheer correlation with the informational.social nursing needs, and the inverse correlation with the ADL. CONCLUSION: It is necessary that it should improve the service to meet the emotional and social nursing needs and develop the extensive nursing programs satisfying their desires based on the general traits of the elderly.
Activities of Daily Living* ; Aged* ; Baths ; Eating ; Humans ; Nursing Homes* ; Nursing Services ; Nursing* ; Seoul

PURPOSE: To define the events surrounding mobility change in frail ambulatory elderly. METHODS: We retrospectively studied a cohort of 87 ambulatory residents of a chronic care hospital. Demographic data, medication, chronic condition, the Charlson Comorbidity Index(CCI), and ADLs were recorded. Mobility change was measured by the Timed Up & Go Test(TUGT) at baseline in July 1993 and follow-up in July 1996. This study determined the outcome status(dead, mon-ambulatory, ambulatory) and determined the reasons for ambulatory decline in individual subjects. RESULTS: During this period 31(36%) expired; 16(18%) became nonambulatory(wheel-chair dependent or bed-ridden) and 40(46%) remained ambulatory. Of those remaining ambulatory, TUGT performance was maintained in 26(30%), declined by 2X in 10(11%) and 4(5%) could not follow the test due to mental or behavioral problems. In the 16 nobambulatory subjects, 5(31%) lost mobility after an acute event, 11(69%) lost their mobility by slow decline. Factors associated with becoming nonambulatory include baseline CCI(p=0.01), frequency of medication change(p=0.009) and falls(p=0.004). CONCLUSION: CCI, medication change and falls were found to be associated with loss in mobility. The identification of risk factors for mobility change may be useful to target preventive measure.
Activities of Daily Living ; Aged* ; Cohort Studies ; Comorbidity ; Follow-Up Studies ; Frail Elderly ; Humans ; Nursing Homes* ; Nursing* ; Retrospective Studies ; Risk Factors

The study retrospectively reviewed 1,029 general surgery operations performed from September 1, 1991 to May 31, 1993 to find out the association between the occurrence of surgical site infection (SSI) and the Centers for Disease Control-National Nosocomial Infection Surveillance (CDC-AWS) surgical patient risk index scores. The index assigned 1 point for each of 3 risk factors: 1) American Society of Anesthesiologists (ASA) preoperative assessment class 3, 4 or 5; 2) an operational classified as either contaminated or dirty-infected; 3) an operation with a duration longer than a specified increased with increasing contamination (p=0.000) as well as increasing index scores (p=0.000). Looking at operations within the same category of contamination, SSI rates also increased with increasing scores among clean operations (p=0.944), clean-contaminated operations (p=0.000), contaminated operations (p=0.559), and dirty operations. SSI rates in this hospital series were compared to the 44-hospital CDC-NNIS report.

Human ; Male ; Female ; Surgical Wound Infection ; Cross Infection ; Anesthesiologists

To determine the prognostic factors such as age, diagnosis, number of cycle attempts and semen parameters on the pregnancy rate of controlled ovarian hyperstimulation (COH) /intrauterine insemination (IUI). Three hundred and seventeen women who underwent 507 consecutive COH/IUI cycles were recruited from 1st January 2002 to 31st December 2005 inclusively. This retrospective study was done in University Malaya Medical Centre, a tertiary care academic centre. The main outcome measure was pregnancy rate according to age, infertility diagnosis, duration of infertility, semen parameters, and the number of treatment cycles. The overall pregnancy rates were 16.9% per cycle and 25.9% per couple. Pregnancy rates decreased with advancing maternal age. Pregnancy rate was also significantly lower in patient with postwash total motile sperm count (TMSC) < or = 20 million/ml compared to those with TMSC >20 million/ml. The cumulative pregnancy rates varied greatly by diagnosis from 16% for patients with male factor infertility to 60% for patients with ovulatory disorder. Pregnancies among patients with male infertility, tubal factors infertility and endometriosis were achieved during the first three cycles. There is a clear age-related decline in fecundity associated with COH/IUI treatment. Women of > 40 years old, couple with postwash TMSC < or = 20 million/ml, severe endometriosis and tubal factors have a particularly poor prognosis.
Pregnancy ; Infertility ; Intrauterine artificial insemination ; /mL ; Diagnostic

RATIONALE: The liver is the most common site of metastasis from colorectal cancer. Curative intent liver metastasectomy has shown improvement in overall survival. This manuscript will present the long-term oncologic outcomes of hepatic metastasectomy for colorectal cancer with resectable liver metastasis. METHODS: Data of patients with resectable liver metastases from colorectal cancer who underwent hepatic resection at the Philippine General Hospital over a 10-year period was reviewed. The primary outcome investigated was overall survival. RESULTS: Thirty patients were included in the study. The median overall survival was 20 months, with a 2-year and 5-year overall survival rate of 40% and 6.67% respectively. Eleven (36.67%) patients had disease recurrence, with a median disease-free survival of 16 months. A significant difference in survival was seen between patients with synchronous and metachronous liver metastasis (20.38 and 36.78 months respectively, p=0.0393) and in patients given adjuvant chemotherapy at any time in relation to the occurrence of the liver metastases versus patients who did not receive any adjuvant treatment (34.08 and 18.59 months respectively, p=0.0349). Trends towards improved overall survival were seen in patients 50 years old or less (36.86 versus 21.78 months, p=0.0837) and in patients with a clinical risk score of 2 or less (29.65 versus 19.62 months, p=0.1823), which may show significance in a higher powered study CONCLUSION Improved overall survival was observed among patients with colorectal liver metastases undergoing hepatic metastasectomy compared to no liver resection.
Metastasectomy ; Philippines

The objectives of the present study were to compare the in vitro maturation (IVM), fertilization and early embryonic development of bovine oocytes recovered from ovaries during the follicular, metestrus and diestrus stages of the estrous cycle and at anestrus and pregnancy after maturation in a serum free culture medium. Cumulus oocyte complexes (COCs) collected from ovaries at different reproductive statuses were matured in medium 199 supplemented with 10 g/ml FSH, 10 g/ml LH, 1.5 g/m estradiol, 75 g/ml streptomycin, 100 IU/ml penicillin and 10 mM HEPES. COCs were incubated in 200 microliter droplets of maturation medium 199 under oil for 24 h at 39degrees c and 5% CO2. Matured oocytes were exposed to frozen-thawed TALP swim up, heparin capacitated sperm from two bulls separately in each replicate (20 h, 39C, 5% CO2). After fertilization, the presumptive zygotes were cultured in medium 199 containing 8 mg/ml BSA-V, 100 IU/ml penicillin-G, 75 g/ml streptomycin and 10 mM HEPES for 144 h at 39C and 5% CO2 without medium freshening or change. Oocytes/embryos were fixed, stained with DAPI and evaluated under fluorescent microscope. The IVM rates were almost similar among oocytes from all reproductive statuses (range: 89.8 to 95.4%). However, IVM rates for oocytes from the metestrus (90.6%) and pregnant (89.9%) phases were lower than the other groups. The fertilization rates were lower (p<0.05) for oocytes from the diestrus phase (72.4%) than from the other phases (range: 81.1 to 86.6%). Oocytes, recovered during the metestrus phase of the estrous cycle, resulted in the highest cleavage rate (60.0%), while oocytes from the diestrus phase had the poorest embryonic development (39.8%: p<0.05). Majority of the embryos from all reproductive phases showed a developmental arrest around 8-cell stage. Although the developmental competence of oocytes from pregnant and anestrus animals was lower than that from the other reproductive stages, they could be potentially used as oocyte donors. Long term, in vitro embryo culture without medium freshening or change was hypothesized to have caused the failure to overcome the 8-cell block to development.
Animals ; Cattle/*embryology/*physiology ; Ectogenesis/physiology ; Embryonic and Fetal Development ; Estrous Cycle/*physiology ; Female ; Fertilization in Vitro ; Male ; Oocytes/*growth&development/*physiology ; Pregnancy

STUDY DESIGN: Retrospective study. PURPOSE: The aim of this study was to evaluate the clinical management and outcomes of patients who underwent surgical intervention for metastatic colorectal adenocarcinoma of the spine. OVERVIEW OF LITERATURE: Gastrointestinal (GI) cancer metastasis to the spine are relatively rare and represent later manifestations of the disease. Studies and reports on the outcomes of patients who undergo surgery for spinal metastasis of GI origin are scarce. METHODS: A retrospective chart review of all patients who underwent surgery for spinal metastasis of colorectal origin was performed. Four patients were identified. Patient characteristics, outcomes, and survival were analyzed. RESULTS: Two patients experienced improvement in pain or myelopathic symptoms. Although the mean survival was 15.3 months, this average included a patient still living at 57.1 months. The mean survival was just 1.3 months for the 3 patients who expired. CONCLUSIONS: In certain cases, symptomatic improvement with prolonged survival is possible after surgery for metastatic spinal lesions of colorectal origin; however, survival is poor in the majority of cases.
Adenocarcinoma ; Humans ; Neoplasm Metastasis* ; Retrospective Studies ; Spine

Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.
Cholangiopancreatography, Endoscopic Retrograde* ; Hemorrhage ; Intestinal Perforation ; Pancreatitis ; Risk Factors ; Risk Reduction Behavior