Objective: This study determined the efficacy and safety of three different concentrations of ropivacaine hydrochloride via patient controlled epidural analgesia (PCEA) for ambulatory pain. Specifically, labor analgesic efficacy, manifestation of motor block, frequency of demand dosing, adverse side effects, incidence of spontaneous, instruments, and surgical deliveries, parturient and obstetrician satisfaction of the pain regimen, and neonatal outcome were assessed. Design: A randomized, double-blind controlled trial. Setting: University of Santo Tomas Hospital, a tertiary teaching hospital. Populations: Fifty-eight parturients of mixed parity, 18-40 years of age. ASA Physical Status I and II, for vaginal delivery were randomly divided into 3 parallel treatment groups. Methods: Group I (21 patients) received PCEA Ropivacaine 0.1 percent. Group II (18 patients) PCEA Ropivacaine 0.05 percent. and Group III (19 patients) PCEA Ropivacaine 0.025 percent. After placement of lumbar epidural catheter, PVEA was started: continuous infusion at 8ml/hour, demand bolus of 4 ml, with lockout period of 15 minutes, and an hourly limit of 12 ml were set. After labor relief was achieved (VAS score 0-3), with a block height of at least T10; ambulation under close supervision was allowed if patient has normal motor assessment using straight leg raising test and Bromage scale, intact joint proprioception and vibration sense, and negative orthostatic hypotension. Results: Uterine contraction pain score using the Visual Analogue Scale showed significant difference between the VAS scores before and after the study drug was started (p=0.01). the degree of pain relief was comparable between the three groups (p+0.09). But time-to-onset pain relief was faster in Group I with a mean of 15.5 minutes and slowest in Group III with a mean of 24.68 minutes. Group one had the least mean demands for more analgesic of 13.55 and accepted boluses 2.89 compared to Group III (mean demands 33.21; accepted boluses 8.42). seven percent of the population who require supplemental IV analgesics all belonged to Group III. No motor block and adverse materno-fetal side effects were noted in all three groups. Eighty-eight percent of the patients delivered spontaneously, 10 percent required instrumental deliveries, and one underwent cesarean delivery, with good neonatal outcomes. Conclusions: PCEA Ropivacaine is effective and safe for ambulatory labor pain. Ropivacaine 0.1 percent and 0.05 percent were comparable in their analgesic efficacy, onset of pain relief, patient analgesic demands, with high patient and obstetrician satisfaction. (Author)
Human ; Adult ; Young Adult ; Adolescent ; ANALGESIA, EPIDURAL ; ROPIVACAINE ; ANESTHESIA

BACKGROUND: Health-related quality of life is an important aspect of cancer research. Studies in the Philippines documenting this among survivors are limited in scope and number.
OBJECTIVE: To document quality of life indicators of Filipino cancer survivors starting at 12 months from diagnosis and identify predictors of these changes.
METHODS: The ACTION study is a prospective longitudinal study examining the economic and health impact of cancer in the Southeast Asian Region. A country-specific analysis for Filipino patients was conducted.
RESULTS: Of the 909 Filipinos included in the study, 462 survived month 12 and had health-related quality of life (HRQoL) data. HRQoL data showed significant improvement from baseline (0.73, SD: 0.15) to month 12 (0.79, SD: 0.24) as measured by the EQ-5D weight score. Similar trends were seen in the EQ5D VAS Scores and the QLQ30 Global function scores. There was, however, an increase in the proportion of respondents experiencing significant problems related to EQ5D domains by month 12. Data disaggregated according to cancer type showed a decrease in QLQ30 GF scores from baseline to month 12 for all types except breast cancer. Individuals at risk of anxiety and depression increased from 15.37% to 25.54% and 18.83% to 32.25%, respectively. Predictors of worsening HRQOL include experiencing economic hardship, progression of disease, and higher stage at baseline.
CONCLUSION: HRQOL scores were found to increase despite experiencing more difficulties in function among Filipino cancer survivors one year after diagnosis.

Human ; Male ; Female ; Adult ; Depression ; Quality Of Life ; Survivors ; Anxiety ; Surveys And Questionnaires ; Depressive Disorder ; Breast Neoplasms

Sex-linked dystonia parkinsonism (XDP, DYT3, "Lubag") is an adult-onset, progressive, debilitating movement disorder first described in Filipino males from Panay Island in 1975. XDP manifests predominantly as torsion dystonia, later combined with or sometimes replaced with parkinsonism. Within the Island of Panay, the preva-lence rate is highest in the province of Capiz, where 1:4000 men suffer from the disorder. There is a high degree of penetrance and generalization. While women often serve as carriers, XDP is not limited to men. An updated XDP Philippine registry (as of January 2010) has identified 505 cases, with 500 males and 5 females. While some report that females may carry a milder form of the disorder, in our experience, both sexes generally follow a similar progressive clinical course.

Human ; Male ; Female ; Aged ; Adult ; Dystonia ; Dystonia Musculorum Deformans ; Dystonic Disorders ; Genetic Diseases, X-linked ; Islands ; Parkinsonian Disorders ; Penetrance

Background: Acupressure may stimulate oxytocin release from the pituitary gland, which in turn regulates uterine contractions to improve the progress of labor; hence, studies have shown that acupressure on the Spleen 6 (SP6) point may be a complementary strategy for augmenting labor and/or shortening the first stage of labor without causing adverse effects to the mother or the newborn. Objective: To compare contractions produced by acupuncture technique from the contractions produced by conventional method using oxytocin in terms of: intensity, duration and interval of the uterine contractions and to determine if acupuncture technique at Sanyinjiao (spleen 6) and Hegu (Large Intestine 4) can be used as alternative method in establishing uterine contractions in Contraction Stress Test (CST) as a means of fetal surveillance. Methodology: This is a Randomized Controlled Trial done in University of Santo Tomas Hospital. This included 54 term pregnant patients who met the inclusion criteria and were randomized into two groups: 27 patients in Acupuncture group and 27 patients in Oxytocin group (control group). All recruited patients were hooked to electronic fetal monitor to obtain baseline strips for 20 minutes. Acupuncture needles were applied bilaterally at Sanyinjiao (spleen 6) and Hegu (Large Intestine 4) for 20 minutes to the study subjects. Results: Subjects who received acupuncture had greater intensity (p=0.551) and significant longer duration (p=0.001) of uterine contractions than the oxytocin group. However, there was significant shorter interval of uterine contractions after oxytocin treatment (p=0.013) than acupuncture. Furthermore, subjects who were in the acupuncture group obtained initial uterine contractions and achieved desirable uterine contractions faster than oxytocin. Conclusion Application of acupuncture in Spleen 6 (Sanyinjiao SP6) and Large Intestine 4 (Hegu LI4) can initiate and induce uterine contractions faster. Acupuncture technique when compared to the conventional method using oxytocin, produces stronger and longer contractions. Furthermore, there is shorter mean time to achieve initial and adequate contractions thru acupuncture technique. Contractions also disappear in a much shorter time in acupuncture technique than in oxytocin group hence ideal for outpatient setting.
Pregnancy ; Female ; Uterine Contraction ; Oxytocin ; Acupuncture Therapy

Background/Introduction: As the world face health-system shocks from COVID-19, Obstetrician-Gynecologists become perplexed by the uncertainties these bring to the vulnerable pregnant and gynecologic population. The country's capacity for diagnosis via RTPCR consists of only a tiny proportion of the population. With the intent of coming up with a less expensive fast point of care test kits, antibody-based lateral flow assays were developed. Aims and Objectives: Determine the diagnostic accuracy of a lateral flow immunoassay for the detection IgM/IgG antibodies to SARS-CoV2 using RT-PCR as gold standard among symptomatic and asymptomatic high risk OBGYN population. Materials and Methods: This is a multicenter cross-sectional prospective study performed on 147 asymptomatic and symptomatic high risk OBGYN patients who underwent both RTPCR and RAT. Test results were entered using a two by two table to compute for the sensitivity (Sn), specificity (Sp), positive and negative predictive value (PPV/NPV), likelihood ratios (LR) comparing RT-PCR with IgM/IgG using Medcalc statistical software. Results: The RAT for IgG/IgM was not found to be sensitive in both groups. It was able to identify only one of the five patients who had COVID-19 based on RT-PCR. Moreover, the (PPV) was found to be only 20% since only one patient tested positive in the RAT for IgM/IgG that was also positive in the RT-PCR. The (LR+ and LR-) for the symptomatic group was close to 1 implying a slightly higher probability of a true positive compared to that of a false positive test and a negative test result given the absence of the disease respectively. (Sp) and (NPV) of the RAT for IgM/IgG is high for both groups. This means that RAT for IgM/IgG does well in identifying patients who truly do not have COVID-19. Conclusion With a very low sensitivity of 5% in this study, RAT for COVID-19 cannot be used for screening purposes.
Pregnancy

BACKGROUND: Cancers are among the top causes of mortality in the Philippines. The treatment regimens are also costly and put Filipinos at risk of financial catastrophe. The economic impact, however, has not been documented.

OBJECTIVE: This analysis aimed to describe the economic impact of cancer in the Philippines and analyze predictors of financial catastrophe among Filipino cancer patients.

METHOD: The analysis used the dataset from the ASEAN costs in oncology study, a prospective study of adult cancer patients in Southeast Asia. Cancer patients were recruited at time of diagnosis and were monitored in terms of health outcomes, costs, and quality of life. Multinomial regression models were generated to assess predictors of death and financial catastrophe.

RESULTS: Information from 909 respondents in the Philippines was included in the analysis. Overall, 240 (26.4%) of the cohort were dead at the end of the study while 40.6% were still alive at Month 12 but had experienced financial catastrophe. Mean combined Month 3 and Month 12 out-of-pocket expenditure was PhP181,789.00 (n = 458, sd = 348,717.47). Belonging to higher income groups (vs. belonging to the lowest two) was significantly associated with lower risk of financial catastrophe. Insurance did not confer significant change in risk of death or financial catastrophe.

CONCLUSION: Cancer can be a significant economic burden for Filipinos leading to financial catastrophe. Insurance mechanisms at the time of study failed to protect against catastrophe.

Human ; Neoplasms ; Cohort Studies ; Healthcare Financing ; Philippines