OBJECTIVE: To determine the effectivity of Chitosan in the reconstruction of conjunctival defect created during surgical removal MATERIALS AND METHODS: Preparation of Chitosan biofilm. Chitin was isolated and purified from giant tiger prawn (Penaeous monodon) exoskeleton waste and converted to a 97 percent deacetylated form by reaction with 40 percent NaOH then dissolved in 0.1M acetic acid forming a chitosan-acetate solution. The solution was poured into a petri dish and dried forming a film. Animal Study. Conjunctival defects were induced by excising the conjunctiva (6 x 6 mm) of 32 rabbit eyes. Sixteen experimental eyes received the chitosan biofilm sutured in continuous fashion using 8-0 conjunctiva, where the previous incision was made, were harvested and sent for histopathology to look for re-epithelialization and fibroblast formation. Wilcoxon Matched-Pairs Signed-Ranks Text was utilized in data analysis RESULTS: Epithelial growth was significantly higher in the Chitosan treated group as compared to the control (p0.05). Fibroblast formation was likewise significantly higher in the Chitosan treated group than in the control CONCLUSION: Chitosan is effective in promoting re-epithelialization and fibroblast formation and can thus be used as a possible alternative in ocular surface reconstruction. (Author)
Animal ; SURGERY

INTRODUCTION: Referrals are the link between primary and specialty care. While the referring provider can be any type of physician, the focus in the literature has been on primary care physicians (PCPs). In their area of expertise, specialists are able to provide evidence-based care, and several studies have shown that specialists’ co-management of care with PCPs results in better health care outcomes for patients with chronic diseases. METHODOLOGY: The research design used was cross-sectional. A validated self-made questionnaire was disseminated to the family physicians (FPs) who are active members of the Philippine Academy of Family Physicians (PAFP) from the National Capital Region (NCR). RESULTS: Majority of FPs refer to dermatologists and more than half are affiliated with a hospital. Twenty percent had dermatology training which was not specified, and 44.2% took continuing medical education/seminars in dermatology. The top 3 most common dermatological diseases among the top ten existing dermatological diseases from January to December 2014 seen at the 11 accredited training institutions of the Philippine Dermatological Society (PDS) ranked by FPs as seen in their private practice were contact dermatitis, atopic dermatitis and acne vulgaris. The primary reason for referral of FPs to a dermatologist was for “treatment” and “difficult cases.” Average referral frequency within a month was two times while within a year it was more than five times. The criteria for choosing a particular dermatologist were good medical skill, geographic consideration and good FP-dermatologist communication. For the manner of referral, majority referred through letter, followed by phone calls and text messages. There were 53.8% FPs who were satisfied with the quality of communication with the dermatologists. Few FPs encountered difficulties in referring patients such as unavailability of the dermatologist, patient’s financial constraints, patient’s refusal, and the patient not being referred back to the primary physician by the dermatolo-gist. According to 68.6% of FPs, their patients followed-up after referral to a specialist. CONCLUSION The existing referral system among FPs and dermatologists, based on the study parameters, is generally properly implemented at the NCR. However, further studies should be done to determine the current state of referral system in the rural areas, where further health care management is needed, due to the unavailability of specialists like dermatologists.

Background: Tinea corporis and cruris are superficial fungal infections mainly caused by dermatophytes. The antifungal effect of carica papaya latex cream has been demonstrated in clinical studies, however, larger population and comparative studies to standard antifungal agents are needed to further strengthen this conclusion. This study determined the efficacy and safety of 1.5% carica papaya latex in cream base as treatment for tinea corporis and/or cruris compared to 1% terbinafine cream. Methods: This is a randomized, double-blind controlled trial wherein subjects with a clinical diagnosis of tinea corporis or cruris confirmed by microscopy applied terbinafine or carica papaya latex cream twice daily for 6 weeks. The efficacy and safety were assessed 2, 4, and 6 weeks using clinical and mycological cure parameters. The incidence of adverse effects was likewise evaluated. Results: 90 subjects were randomized, 45 in carica papaya group and 45 in the terbinafine group. Both groups had statistically comparable improvements based on symptoms and mycological cure rates. Adverse events are significantly higher in the papaya latex cream group. Conclusion Carica papaya latex cream is as effective as terbinafine cream in the treatment of tinea corporis and/or cruris, but it has a higher incidence of adverse events.
Terbinafine ; Tinea cruris ; Tinea

Erythema elevatum diutinum (EED) is a rare condition believed to be a form of chronic recurrent leukocytoclastic vasculitis possibly secondary to vascular immune complex deposition. The disease is characterized by symmetrical, red, brownish-purple, and yellow papules, plaques, and nodules distributed mainly over the extensor surfaces of the extremities. We report a 61-year-old male with an atypical presentation of such disease as a giant warty lesion on the heels. Histologically, a spectrum from leukocytoclastic vasculitis to vessel occlusion and dermal fibrosis is seen in EED. These histological findings were present in the histopathological reading of the patient which established its diagnosis and further ruled out verruca vulgaris. The disease is associated with many disease entities, which include human immunodeficiency virus, malignant conditions, chronic infection, and autoimmune and connective tissue disorders. None of these conditions was present in the patient as manifested in the history, physical, and laboratory examinations. However, the patient has a low hemoglobin and a G6PD deficiency which makes him a bad candidate for dapsone therapy which is the main treatment for EED. Tetracycline, niacinamide and plain vaseline + salicylic acid were given initially for 4 weeks but no improvement was noticed. It was then shifted to 10mg intralesional corticosteroid and urea paste 40%. Niacinamide still was given. There was a marked thinning of the lesions. The medications were continued and were slowly tapered. More improvement of the lesions was observed.
Glucosephosphate Dehydrogenase Deficiency ; Niacinamide

This study aims to determine the diagnostic value of a 99mTc-pertechnetate (99m TcO-4) thyroid scan among patients with DTC who underwent thyroidectomy to assess functioning thyroid remnants before radioactive iodine therapy. A retrospective non-experimental cross-sectional design was done to compare the results of the 99m TcO-4 thyroid scan with the patient's post-RAI scan. A review of all our patients' charts was done for eight years, and after excluding those that did not fit the criteria, 70 patients were included in the study. Data collected was analyzed on a "per patient" basis– where patients either had a "positive scan" or "negative scan", and on a "per lesion" basis – where every lesion's presence and size were compared on both modalities. 99m TcO-4 thyroid scan in the "per patient" analysis showed a sensitivity of 73.91%, specificity of 100%, positive predictive value (PPV) or 100%, and accuracy of 74.29%, however, negative predictive value was determined to be 5.26%. In the "per lesion" analysis, the scan had a less favorable performance with the computed sensitivity of 61.69%, PPV of 94.93%, and accuracy at 59.41%. It was then concluded that 99mTc-pertechnetate scan may be useful in determining functioning remnant thyroid tissue and subsequent management of DTC patients after thyroidectomy, but must take note of its low negative predictive value.
Thyroid Neoplasms

Objective: To determine if vitamin supplementation can prevent the development of color vision abnormalities in patients taking ethambutol as part of DOTS for tuberculosis (TB). Methods: A randomized, placebo-controlled, single-blind clinical trial was conducted among newly diagnosed category-1 TB patients enrolled in DOTS health centers in the third district of Manila from June 2011 to August 2012. Before starting therapy, the participants underwent a complete eye evaluation including baseline color vision tests using the Ishihara Color Vision Plates (Ishihara), Farnsworth Panel D-15 (FD 15), and Lanthony Desaturated D-15. Only subjects who passed the three color vision tests were included in the study. They were divided into 2 groups: Group A received vitamin supplementation and Group B received a placebo. Follow-up color vision testing was done monthly for 3 months. Results: There were 105 patients included in the study, 77 males and 28 females, age ranging from 16 to 68 years with a mean of 37 years. Forty three (43) patients received vitamin supplementation (group A) and 62 received placebo (group B). After one month of DOTS, 5 of 43 patients (11. 6%) in group A and 10 of 62 patients (16.1%) in group B developed color vision abnormalities, detected only with the Lanthony Desaturated test. The absolute risk reduction (ARR) of color vision abnormalities by vitamin supplementation was 4.5%, with the number needed to treat (NNT) of 23. After the second month of therapy, ARR was 7.4% and NNT was 14. ARR was highest in the third month at 8.3%, with a corresponding decreased NNT of 12. Among patients who developed color vision abnormalities, reversal of the abnormalities was observed in 80% of 5 subjects in group A, and 40% of 10 patients in group B. By the third month of treatment, all in group A already had normal color vision, while 40% in group B still showed abnormal color vision. Conclusion This study showed that vitamin supplementation was effective in reducing the risk of, and in reversing cases of, color vision abnormalities among patients undergoing DOTS therapy for tuberculosis.
Tuberculosis ; Ethambutol ; Color Vision ; Optic Neuritis

Objective: This study reported the demographic profile, clinical presentation, treatment, and outcomes of retinoblastoma (RB) patients seen at Jose R. Reyes Memorial Medical Center (JRRMMC) from January 2011 to December 2020. Methods: This was a single-center, retrospective study. Medical records of patients diagnosed with RB at JRRMMC from January 2011 to December 2020 were reviewed. Descriptive statistics were used to summarize the characteristics of the participants. Results: A total of 31 confirmed RB cases were seen, with almost half residing outside Metro Manila (52%). The median age at diagnosis was 2 years, with a slight male predominance (55%). Majority (81%) of patients had unilateral presentation, with leukocoria as the most common sign (19%) prompting consult. Nearly half (43%) of 37 eyes were diagnosed as Group E using the International Classification of Retinoblastoma (ICRB) system. Majority were in the advanced stage; 57% of eyes underwent enucleation and 29, 3 and 3% of patients required additional treatments such as chemotherapy, laser, and radiotherapy, respectively. RB was confirmed in 20 eyes (54%) through histopathology. Survival outcomes showed that 4 patients (13%) were alive, with either completed or ongoing treatment, and 19 (61%) did not complete prescribed management or were lost to follow-up. There were 8 (26%) known deaths. Conclusion Majority of cases were unilateral and at an advanced stage needing enucleation which may indicate low levels of awareness and screening efforts. Survival rates are difficult to ascertain due to patients abandoning treatment that may be attributed to limited social service support. The study reflects the 10-year data prior to the establishment of a collaborative, multispecialty RB team in the institution and exposes various areas that need to be addressed to improve clinical outcomes.
Retinoblastoma ; Enucleation ; Chemotherapy ; Epidemiology

BACKGROUND: Cisatracurium , an R-cis, R-cis isomer of atracurium, is a benzoquinolinium non-depolarizing muscle relaxant with intermediate duration of action that has the advantage of minimal histamine release compared to the parent compound atracurium. Similar studies have described cisatracurium to have cardiovascular stability up to 7 times the ED95 dose. However, few have been conclusive owing to concomitant use of agents that can cause potential histamine release and hemodynamic effects. This study was specifically designed to minimize these variables. The promise of the clinical advantages of the use of cisatracurium merits investigation against its parent compound atracurium in the Filipino population especially in terms of hemodynamic stability when utilized intraoperatively. The study was conducted to evaluate the onset of action, conditions for intubation, duration of neuromuscular block and side effects of cisatracurium compared to atracurium among Filipino surgical patients METHODOLOGY: A prospective, randomized, double-blind study was performed in eighty one (81) healthy patients of ASA Physical Status 1 and 2 undergoing elective surgical procedures treated with either 0.15 mg/kg cisatracurium (3 x ED 95) n=39 or 0.5 mg/kg atracurium (3 x ED 95) n=42 administered over 5 seconds intravenous bolus under adequate anesthesia, before surgical stimulation. We compared the time course of the neuromuscular block and determined whether the muscle relaxants caused cutaneous and systemic evidence of histamine release. Induction of general anesthesia commenced with the use of propofol-fentanyl in oxygen. Stabilization of the Neuromuscular junction was achieved prior to the administration of the muscle relaxants with the use of tetanic stimulation of 50 Hz; for 5 seconds followed by single twitch stimuli for 2 minutes. Neuromuscular transmission was assessed by recording the mechanical twitch response to train-of-four nerve stimulations every 10 seconds. Cutaneous manifestations, blood pressures and heart rates were recorded periodically. RESULTS: Time to 95 percent block were 77.09-155.99 seconds with cisatracurium. and 64.60 - 128.21 seconds with atracurium. The administration of either muscle relaxant resulted in complete neuromuscular block in all patients providing good to excellent intubating conditions. The time to spontaneous recovery (T4:T1 ratio 80 percent) were noted to be within the range of 63.48 - 103.48 minutes for cisatracurium whereas those treated with atracurium recovered within the range of 74.76 - 92.64 minutes and none necessitated reversal from the muscle relaxants. One patient from the cisatracurium group and two from the atracurium group were noted to have cutaneous flush. CONCLUSION: When given a dose of 3 x ED 95, except for onset, cisatracurium group did not differ significantly from the atracurium group with regard to onset, duration, intubating conditions, and hemodynamic stability.
Human ; Middle Aged ; Adult ; Young Adult ; Adolescent ; INTUBATION ; HEMODYNAMIC ; ANESTHESIA ; CISATRACURIUM ; ATRACURIUM ; HISTAMINE ; MUSCLE RELAXANTS, CENTRAL

Background: The quick Sequential Organ Failure Assessment (qSOFA) score was introduced by Sepsis-3 or the Third International Consensus Definitions for Sepsis and Septic Shock to help physicians in identifying patients outside the intensive care unit with suspected infection who are at high risk for in-hospital mortality. However, sepsis is not a homogenous entity and the outcomes vary based on several factors. This study aimed to determine the predictive accuracy of qSOFA in identifying those at high-risk of in-hospital mortality among adult patients with sepsis secondary to urinary tract infection. Methodology: A retrospective cohort study was done involving the use of qSOFA score to predict in-hospital mortality of adult patients with a diagnosis of sepsis secondary to urinary tract infection, admitted in the hospital from January 1, 2013 to December 31, 2020. qSOFA is computed based on the following independent variables: systolic blood pressure (SBP), respiratory rate (RR), and Glasgow Coma Scale (GCS). Results: Of the 128 charts retrieved, 121 patients were included in the study. Fifteen (12.40%) died while 106 (87.60%) survived. Mean age was 60.76 years old, with more females (71.90%) than males (28.10%). Hypertension and Diabetes Mellitus Type 2 were the most frequent comorbidities. Complicated UTI was the most frequent source of infection. Mean length of stay was 8.29 days. Forty (33.06%) patients had qSOFA ≥ 2 wherein 11 (27.5%) died. Diagnostic performance results revealed: sensitivity (73.33%), specificity (72.64%), positive (27.5%) and negative (95.06%) predictive values, and positive (2.68) and negative (0.37) likelihood ratios. qSOFA accuracy was 72.73% with an AUROC of 0.76. Conclusion Among the admitted adult patients with sepsis secondary to a UTI, qSOFA had a good prognostic accuracy for in-hospital mortality.
Sepsis ; Urinary Tract Infections ; Hospital Mortality

OBJECTIVES: To assess the validity of the Filipino-translated version of the Michigan Neuropathy Screening Instrument(MNSI) in screening for diabetic neuropathy among Filipino patients with diabetes mellitus using nerve conduction velocity(NCV) as gold standard and to determine the most accurate cut-off score for the diagnosis of neuropathy using MNSI.
METHODOLOGY: A cross-sectional analytic study was done among adult diabetic patients. The original MNSI Questionnaire was translated and back-translated to the Filipino language. Each patient answered the Filipino version of MNSI Questionnaire followed by a lower extremity examination done by the investigator. All patients underwent NCV as reference standard. Sensitivity and specificity of MNSI were determined.
RESULTS: We studied a total of 150 subjects. Eighty-seven (58%) were diagnosed to have diabetic neuropathy based on NCV. The sensitivity and specificity of the MNSI Questionnaire improved to 73.6% and 52.4% respectively when the cut off was reduced to ?4, whereas for the MNSI Examination, the sensitivity and specificity improved to 86.2% and 55.6% respectively when the cut off was reduced to ?1. Combining both MNSI Questionnaire and MNSI Examination further improves the sensitivity to 95.4% whereas specificity is at 39.7%.
CONCLUSION: The analyses in 150 subjects confirm that the Filipino-version of MNSI is a valid screening tool for diabetic neuropathy when compared with NCV as gold standard.