Background: Inadequately treated postoperative pain can contribute significantly to morbidity in women undergoing cesarean section.  Recent studies showed that nalbuphine and fentanyl has promising result as neuraxial adjuvants in terms of postoperative analgesia and with lower incidents of adverse effect when use in cesarean section. 

Objective: To determine the effectiveness of postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl as neuraxial adjuvants in cesarean section. 

Methods:  A meta-analysis following the PRISMA guidelines was performed.  Articles were searched through the Cochrane Library, PubMed.Gov and Pubmed Central, Google Scholar, HERDIN, WPRIM and ProQuest Guideline Central using different search strategies such as keywords and MeSH term.  Cochrane version 2 risk-of-bias tool for randomized trials (RoB 2) was used to assess for quality.  Quantitative data were pooled and analyzed using Review Manager 5.4. 

Results: A total of four trials, involving 425 full term pregnant women were analyzed. The pooled mean difference showed significantly longer duration of postoperative analgesia (MD=21.12 minutes, 95%CI=11.13,31.11, I2=73%), pooled risk ratio showed lesser risk for pruritus (RR=0.09, 95%CI=0.02,0.50, I2 = 0%) and postoperative nausea and vomiting (RR=0.38, 95%CI= 0.19,0.78, I2 = 11%) who received intrathecal nalbuphine compared to intrathecal fentanyl. 

Conclusions: The results of this meta-analysis demonstrates that the use of intrathecal nalbuphine appears to have a better outcome in increasing the duration of postoperative analgesia and with lesser incidence of PONV and pruritus than fentanyl.  However, due to the presence of heterogeneity it warrants that the results should be treated with caution especially with the possibility of publication bias. 

Recommendations: Better literature search through inclusion of high-quality studies from relevant databases and strict adherence on the uniformity of the dosage and methods used are very crucial to achieve the target clinical outcomes and minimize the publication bias. 

OBJECTIVES: In this study, the KAP were determined among all medical residents in a tertiary hospital in the Philippines during the pandemic.

METHODOLOGY: Questionnaires were completed by the medical residents which contained 14 questions on clinical characteristics and prevention of COVID-19. Assessments on attitudes and practices included questions on confidence in winning against COVID-19 and wearing masks when going out.

RESULTS: Among the 63 participants, 90.4% were female, 92 % were single and 69.8% younger than 30 years old. The overall correct rate of the knowledge questionnaire was 85.5%. Most did not have confidence (63.5%) on winning the battle against COVID-19 and most had not visited any crowded place (58.7%) and wore masks when going out (95.2%). Logistic regression analysis showed a significant correlation of knowledge scores and practice rates on going to crowded places (OR 1.72, CI (1.02-2.91) P<0.05)

CONCULUSIONS: The medical residents had good knowledge scores on clinical presentation, transmission and prevention control measures on COVID-19. Although attitude rates were poor, practice rates on COVID-19 were good. Furthermore, knowledge on COVID-19 resulted to good practices on not going to crowded places and wearing masks before leaving their houses.

Objective: To describe a makeshift blue light filter for endoscopic visualization of a traumatic cerebrospinal fluid leak repair using intrathecal fluorescein and its application in one patient. Methods: Study Design:Surgical Instrumentation Setting:Tertiary Government Training Hospital Patient:One Results: Intra-operative endoscopic identification of fistulae sites was achieved using intrathecal injection of fluorescein that fluoresced using our makeshift blue light filter in a 43-year-old man who presented with a 3-month history of rhinorrhea due to skull base fractures along with multiple facial and upper extremity fractures he sustained after a fall from a standing height of 6 feet. He underwent transnasal endoscopic repair of cerebrospinal fluid fistulae in the planum sphenoidale, clivus and sellar floor. Post-operatively, there was complete resolution of rhinorrhea with no complications noted. Conclusion Our makeshift blue light filter made from readily available materials may be useful for endoscopic identification of CSF leaks using fluorescein in a low- to middle-income country setting like ours.
Human ; Male ; Adult (a Person 19-44 Years Of Age) ; Skull Fracture, Basilar ; Cranial Fossa, Posterior

BACKGROUND: Increasing incidence of natural and man-made disasters emphasize the need to assess home disaster preparedness of pediatricians.

OBJECTIVES: To determine degree of family disaster preparedness and association of demographic characteristics of active consultants of a tertiary hospital for children in Quezon City.

METHODS: Cross-sectional study where participants were selected using purposive type of sampling. Fifty-eight active consultants for children answered a self-administered questionnaire on home disaster preparedness. Data was analyzed using SPSS version 24.0.

RESULTS: Total of 36 (62.06%) participants scored 70 and above, indicating family disaster preparedness. A total of 22 (37.94%) participants scored below 70, indicating lack of home disaster preparedness. The age of participants 35 to 40 (OR 108.57), 41 to 45 (OR 36.01), 51 to 55 (OR 11.4) and 56 to 60 (OR 17.93) are more likely to be family disaster ready (p value <0.05). Male participants were 7 times more likely to have higher overall family disaster preparedness.

CONCLUSIONS: This study has shown that 36 consultants in a tertiary hospital for children in Quezon City are prepared for home disasters. Males and younger population are the demographic characteristics associated with an increased degree of family disaster preparedness.

RECOMMENDATIONS: Basics of home disaster management should be included in continuing medical education of the hospital staff. Health education management system should encourage participation of hospital staff in disaster management programs. Bigger sample size of the pediatric society is recommended. Determine association of other demographic variables on home disaster preparedness. Address issues to overcome response bias.

BACKGROUND: Falls in the hospital are preventable. Prevention of fall requires cooperation from the health care provider, caregivers, as well as the hospital administration. This study was done to utilize standard reminders for fall to increase the awareness of health care providers of a tertiary hospital for children.

OBJECTIVES: To determine the effectiveness of the Patient Fall Prevention Reminder Checklist in increasing the awareness of health care providers of patients admitted at the Philippine Children's Medical Center.

METHODOLOGY: After obtaining permission to use an established Patient Fall Prevention Reminder checklist from the Intermountain Health Care (USA), participants were recruited after giving their informed consent. A pre-test was conducted to gauge the awareness and practices of the participants in preventing falls in the hospital. After the pre-test, the tool was introduced and discussed by the author to the participants. After 7 days, the participantswere followed up to take the post-test. Data collected were encoded then analyzed throughdescriptive statistics.

RESULTS: There were one hundred twenty-one (121) respondents with 42 males and 79 females. There is an increase in awareness in fall prevention amongthe residents and nurses, based on their pre and post-test examination results. The midwives had previous awareness in preventing falls even prior to the study.

CONCLUSIONS AND RECOMMENDATIONS: The checklist served as an effective tool in increasing the awareness of most study participants. We recommend the establishment of an institutionalized Fall Prevention Reminder Checklist at the Philippine Children's Medical Center for use by health care personnel.

OBJECTIVE: To report a case of acute bilateral facial nerve palsy in a 24-year-old woman and to present the differential diagnoses, pathophysiology, management and prognosis.

METHODS:

Design: Case study

Setting: Tertiary Private Hospital

Patient: One (1)

RESULT: A 24-year-old woman with fever, joint pains, cough, chest pain, difficulty ambulating and progressive facial muscle weakness was diagnosed with rheumatic fever. Bilateral facial nerve paralysis was noted, and Electromyography-Nerve Conduction Velocity (EMG-NCV) testing with special facial nerve study revealed abnormal facial nerve and blink reflex studies while EMG-NCV of the upper and lower limbs were normal. Audiometry and MRI of the brain and facial nerve were normal while Schirmer's Test showed decreased tearing in both eyes. The rheumatic fever resolved within 5 days of antibiotics, while Prednisone and physiotherapy resulted in improvement of facial paralysis from House Brackmann V to House Brackmann II-III over a period of 6 months.

CONCLUSION: Idiopathic facial paralysis or Bell's Palsy is the most common cause of acute unilateral facial paralysis while bilateral facial nerve paralysis is a rare condition. Patients with facial palsy should undergo appropriate diagnostics to determine the underlying condition and to facilitate prompt management.

Ovarian cancer is the second most common gynecologic cancer worldwide and the six most common cancer among females. Germ cell tumorbs are the most common ovarian neoplasm in the first two decades of life constituting approximately two-thirds of all ovarian tumors. Malignant germ cell tumors constitute one-third of germ cell origin tutors and two-thirds of all ovarian malignancy in this age-group. This paper presents a case of a 19 year-old nulligravid who presented at the emergency room with abdominal pain, and was intraoperatively diagnosed with yolk sac tutor of the right ovary, stage 1A mature cystic teratoma of the left ovary. She subsequently underwent unilateral salpingooophorectomy and contralateral oophorocystectomy, left. Patient is advised chemotherapy postoperatively, with Bleomycin, Etoposide and Paclitaxel. This paper discusses the incidence, risk factors, prognosis and management of yolk of sac tutor in a young nulligravid.

Primary ovarian ectopic pregnancy, is one of the rarest forms of ectopic pregnancy. Ovarian ectopic pregnancy may occur with or without the essence of any of the classical risk factors or signs and symptoms. The diagnosis is made often at surgery and required histologic confirmation. This is a case of a primary ovarian pregnancy in a 36-year old elderly primigravida who presented with abdominal pain and subsequently underwent ovarian wedge resection. Diagnosis of ovarian pregnancy was later confirmed using the Spiegelberg criteria. This paper presents a review of literature regarding ovarian pregnancy's clinical presentation, risk factors, and the possibility of a conservative management.

PURPOSE: The study purported to explore the lived experience of a select group of Filipino mothers who had undergone water birth delivery.

DESIGN: A qualitative, descriptive phenomenology research design was used to investigate the phenomenon. The sample (N=10) was comprised of women who had undergone water birth, 25-45 years old, primiparous and multiparous. A self-report method using face-to-face, in depth, semi structured interviews guided by an aide memoire abetted the data collection procedure. The principles of beneficence, respect for human dignity, and justice were observed throughout the research process.

MODE OF ANALYSIS: Significant statements were culled from the field text and analyzed using Colaizzi method. The validation techniques of members checking and critical friends were utilized.

FINDINGS: The findings revealed that mothers found the experience extraordinary and the warmth and buoyancy of the water used in such mode foster comfort and ease of delivery while enabling them to manage their pains positively. Four themes emerged namely: (1) In her own private world; (2) At her fullest power; (3) To her ease and comfort; and (4) At her own course.

CONCLUSIONS: Research in recent times has provided limited evidence in making water birth a prevalent alternative for women to welcome their babies into this world. It is vital to focus on the experience of water birth from the mother's lens. Water birth has potential benefits to both mother and neonate and promotes maternal satisfaction; however, it remains the responsibility of health practitioners to provide credible evidence of its safety to prove that water birth is a valuable option to conventional delivery.

A 34-year-old Filipino with Graves' disease on methimazole came in due to fever, sore throat and jaundice. Patient was initially diagnosed with methimazole induced agranulocytosis and drug induced liver injury. She was treated with intravenous broad spectrum antibiotic and granulocyte colony stimulating factor. On day 4 of admission, patient had pancytopenia and was managed as methimazole induced aplastic anemia and was started on steroid therapy and 1 unit of packed red blood cell was transfused. The jaundice also increased hence she was given ursodeoxycholic acid. On day 9 of admission, with the consideration of "lineage steal phenomenon," biopsy was done and eltrompobag was started. Patient was discharged stable at 12th day of hospital admission. This case presents the 3 rarest, life threatening complication of methimazole: agranulocytosis, aplastic anemia and hepatitis.