Clinic ; upper case pea ; upper case aitch ; upper case gee ; Corneal Diseases

The authors investigated the effects of acupressure on intraocular pressure (IOP) in normal individuals in an uncontrolled trial.The IOP at 30, 60, and 90 minutes post-intervention was compared to that of baseline in 28 eyes of 14 normal individuals.Similarly, the IOP changes on the right and left eye were recorded after applying acupressure on the left foot only.The mean difference in IOP at 30, 60, 90 minutes after acupressure was 1.60, 3.16, 2.79, respectively, which was statistically significant at 60 and 90 minutes only (p=<0.01).The greatest decrease of IOP post acupressure was recorded at 60 minutes.The right eye showed a significantly greater decrease than the left at 60 and 90 minutes with a mean value of 2.58 and 1.98, respectively.
Human ; ACUPRESSURE ; ALTERNATIVE MEDICINE ; GLAUCOMA ; REFLEXOLOGY

Upper case tea ; incidence of cases ; United States ; Hospitals ; Malignant Neoplasms

OBJECTIVE: To compare the maternal and neonatal outcome of vaginal and cesarean breech deliveries at Bulacan Medical Center

MATERIALS AND METHODS: A two-year retrospective descriptive study on all patients who delivered breech by vaginal or cesarean section from January 1, 2012 to December 31, 2013. The maternal and neonatal outcomes were compared and analyzed.

RESULTS: There were 165 deliveries included during the study period. There were 83 cases of vaginal breech delivery and 82 cases of cesarean breech delivery. The incidence and risk of postpartum hemorrhage is higher among cesarean breech delivery (7%). Febrile morbidity (p=0.0223) is significantly lower for vaginal breech births. Cesarean breech delivery is correlated with longer hospital stay (p=<0.0001). There were no significant differences on the incidence of asphyxia (5% vs 2%, RR=0.51, RD=-2%, p=0.4141), birth trauma (2% vs 1%, RR=0.51, RD=1%, p=0.5673) and sepsis (12% vs 9%, RR=0.71, RD=-4%, p=0.4582) for vaginal or cesarean breech delivery. Prolonged hospital stay is 2.10 times more likely to occur for cesarean breech deliveries compared with vaginal breech deliveries. Thus, shorter hospital stay means lesser hospital costs for both mother and babies.

CONCLUSION: There is no significant difference in maternal and perinatal morbidity and mortality between vaginal and cesarean breech delivery except for longer hospital stay and increased febrile morbidity for cesarean births. It is therefore safe to recommend vaginal breech delivery under hospital-specific guidelines for labor management such as strict selection of patients, high quality fetal monitoring and high level of competence among obstetricians to deliver breech.

Human ; Female ; Adult ; Young Adult ; Adolescent ; Breech Presentation ; Cesarean Section ; PREGNANCY ; Pregnancy Complications ; Pregnancy Outcome

Objective: To determine the prevalence of diabetes mellitus among patients admitted for head and neck infections and describe their clinicodemographic features. Methods: Design: Retrospective Case Series Setting: Tertiary Government Training Hospital Participants: Forty-two (42) patients Results: Out of 211 adult patients admitted for head and neck infections during the study period, 42 (20%) were diagnosed to have concomitant diabetes mellitus (DM). Only 6 (14%) were known to have DM before admission while 28 (67%) were found to have DM only after admission. The most common site of infection was the neck (11; 26%). More than half of the patients (24; 57.1%) had infections in the head only, 17 (40.5%) had infections in the neck only, and 1 (2.4%) had infections in both the head and neck regions. Among these, 26 (61.9%) had infection in one site only, 15 (35.7%) had infections in two sites and one (2.4%) had infections in three sites. The majority (28; 66.7%) had an unknown etiology of infection with spontaneous appearance of redness and swelling in the involved area. Six (14.3%) were odontogenic, five (11.9%) were due to skin trauma, and three (7.1%) were due to nasal mucosal trauma. Available cultures in 14 patients revealed 12 (86%) with aerobic microorganisms and two (14%) with anaerobic growths. Half of the aerobic cultures grew K. pneumoniae. All patients were started on empiric intravenous antibiotics and over half of them (52.4%) needed surgical management. More than half (27; 64.3%) suffered from diabetic head and neck-associated complications, categorized into orbital (56%), organ/systemic (26%), local (11%), and neural (7%). Despite these complications, the majority (37, 86%) went home improved while five (12%) expired. Conclusion: This study found that 20% of patients admitted for head and neck infections during the study period had concurrent DM. Guided by known clinicodemographic haracteristics, patients admitted with suspicious head and neck infections must be promptly screened for concomitant DM and properly managed before substantial morbidity and death ensue. Otolaryngologists - head and neck surgeons, endocrinologists, general practitioners and patients alike must be cognizant of diabetic head and neck infections so that they can be prevented or managed early before complications set in.
Diabetes Mellitus ; Communicable Diseases

Background: Since the implementation of the community quarantine by the Philippine government last March 17, 2020 the country has been living in constant fear of possibly contracting the virus. Even as vaccines have been developed and tested, not everyone is confident in having themselves vaccinated against COVID-19. This is true even for healthcare professionals who are at increased risk of exposure to the virus Objective: This study aimed to determine the acceptance rate of COVID-19 vaccination among Health Care Workers from a primary care setting during the COVID-19 pandemic Methods: A cross-sectional study was conducted from April to June 2021 with 101 healthcare workers from all active clinics of Healthway Family Clinics at the time of the study. The participants were given self-administered questionnaires containing 15 items regarding socio-demographic data as well as willingness to receive and perception of COVID-19 vaccination Results: Overall, 97% of the 101 total participants are willing to receive the COVID-19 vaccine once it is made available to them, while 3%, displaying vaccine hesitancy, would like to wait before getting vaccinated. Most participants in the study were female (66.3%) and single (72.3%) with a mean age of 30.82 years. Majority of the participants were doctors (56.4%), followed by nurses (25.7%), clinic assistants (7.9%), pharmacists (7.9%) and radiology technicians (2.1%). There was no significant association between vaccination acceptance with sociodemographic variables and perceptions about the vaccine Conclusion and Recommendation Once the COVID-19 vaccine is available to them, majority of the healthcare workers in the study’s primary care community-based clinics will immediately avail of the vaccination and while the remaining displays vaccine hesitancy. This is encouraging because it is important for health workers to protect themselves from the risk of COVID-19 infection by getting immunized as well as be in the forefront of encouraging our patients to have themselves immunized as well. Future researchers may use this study and its recommendations to analyze possible trends and associations with regards to COVID-19 vaccine acceptance and uptake

OBJECTIVES: To train and evaluate the performance of a detector for pulmonary tuberculosis and pulmonary cavity, using the Faster Region Convolutional Neural Network model. STUDY DESIGN: A cross-sectional study design was employed to describe the sensitivity, specificity, and accuracy of the Faster Region Convolutional Neural Network model for the detection of pulmonary tuberculosis and pulmonary cavity. SUBJECTS: Radiographs for the training dataset and testing dataset were acquired from the Picture Archiving and Communication System of the a general public hospital in Quezon City. SETTING: The setting of the study is a general public hospital in Quezon City, Philippines. OUTCOMES: The detector for pulmonary tuberculosis and pulmonary cavity was trained with the training dataset using the TensorFlow machine learning library, with the Faster-RCNN-lnception-V2 used as the base model. Detector findings on the testing dataset were compared and analyzed against findings of three board-certified radiologists. RESULTS: The detector achieved 92.11 % sensitivity, 87.1 % specificity, and 89% accuracy as a screening tool, and 84.04% sensitivity, 98.04% specificity, and 95.87% accuracy, as a locator of pulmonary tuberculosis and cavity. CONCLUSION This study is the first of its kind to demonstrate the feasibility of training a detector for pulmonary tuberculosis and pulmonary cavities using the Region Convolutional Neural Network model. Limitations and improvements to the detector may be addressed in future research.
Tuberculosis, Pulmonary ; Sensitivity and Specificity ; Neural Networks (Computer) ; Software

Objective:: To describe a unique case of extrapulmonary tuberculosis (TB) of the temporomandibular area focusing on its insidious and destructive course over a 2-year period with insights into the diagnostic and therapeutic pitfalls encountered throughout its clinical development. Methods:: Study Design: Case Report. Setting: Tertiary Government Hospital. Patient: One. Results: A 33-year old man initially presented with right pre-auricular swelling and trismus that were unresponsive to antibiotic therapy. On subsequent follow-ups, initial symptoms were accompanied by a non-healing right pre-auricular wound, right ear discharge, trismus, and right facial paralysis (House-Brackmann III). Cranial and temporal bone computed tomography scans revealed osteolytic destruction of the right temporomandibular region extending to the auditory canal and of the right mastoid bone extending to the right mandibular condyle and parotid. Infected malignancy of the parotid, mandible and temporal bone were considered, but definitive diagnosis from an incision biopsy revealed caseating granulomatous inflammation consistent with tuberculosis. He was started on anti-tuberculosis medications with significant resolution of pre-auricular swelling, non-healing pre-auricular wound, facial paralysis and ear discharge but minimal improvement in mouth opening. Conclusion Tuberculosis of temporomandibular region is rare and is associated with nonspecific manifestations. Delay in diagnosing and initiating appropriate treatment can lead to morbidity and serious complications involving destruction of the temporal bone, middle ear, mandible and parotid gland over its progression. A high index of suspicion by the physician and awareness of the patient’s health seeking behaviors could have aided in the early diagnosis and treatment of this extrapulmonary TB.
Human ; Male ; Tuberculosis ; Trismus ; Facial Paralysis ; Temporomandibular Joint Disorders

A 27‑year‑old primigravida at 26 weeks’ age of gestation presented with difficulty of breathing, nonproductive cough, and generalized body malaise. Coronavirus disease‑19 (COVID‑19) infection was confirmed by a positive reverse transcription‑polymerase chain reaction. She was diagnosed with severe COVID‑19 pneumonia with progressive oxygen desaturation requiring intubation and intensive care unit admission. The management and bioethical dilemma involved the use of investigational therapeutic interventions for compassionate use, with unknown effects to the fetus, namely remdesivir, tocilizumab, dexamethasone, and hemoperfusion to manage the cytokine storm and prolong pregnancy or to terminate the pregnancy hoping that it might improve the deteriorating condition of the patient. A multidisciplinary approach and family conference to solve the dilemma resulted in a successful outcome.
COVID-19 ; Hemoperfusion

INTRODUCTION

Malignant melanoma is most commonly found on the skin and rarely occurs in the rectal region. This case illustrates that rectal melanoma can be misdiagnosed as hemorrhoids. It also aims to add knowledge to possible treatment options for rectal melanoma.

CASE PRESENTATION

We report a case of a 77-year-old Filipino adult presenting with rectal bleeding for three weeks. He underwent sigmoidoscopy that showed thrombosed hemorrhoids; however, subsequent surgical excision biopsy histopathology and immunohistochemistry revealed features compatible with malignant melanoma (HMB45, Melan A, and Cytokeratin positive; CDX2 negative). Staging workup done, including abdominal magnetic resonance imaging (MRI) with IV contrast and chest computed tomography (CT), showed distant metastases. He was then started on pembrolizumab but follow up imaging showed recurrence of the rectal melanoma and progression of metastases. Molecular testing done revealed c KIT/ CD117 positive results, hence, treatment was shifted to imatinib.

DISCUSSION AND RECOMMENDATION

It was seen that rectal melanoma is an aggressive disease; therefore, multidisciplinary management is crucial to yield the best possible outcome, despite its poor prognosis. Such as in this case, using immunotherapy (Pembrolizumab) and targeted therapy (Imatinib) still have inconsistent outcomes, thus, further studies should be pursued. In this patient, both pembrolizumab and imatinib post-surgery resulted to recurrence of the rectal tumor and progression of hepatic and osseous metastases.

Rectal Neoplasms ; Melanoma