A 65-year-old man consulted with a history of chronic snorting with a sensation of obstruction in the left side of the nasopharynx particularly when in supine position. A few days prior to consult, the patient had blood-tinged nasal discharge, thus this admission. No other symptoms were reported.

Nasal endoscopy showed a sessile exophytic lesion with a vaguely nodular surface, seen as a polypoid nasopharyngeal mass on Computed Tomography scan. (Figure 1)

Excision of the mass was performed. Received in the surgical pathology laboratory was a 1.8 x 1.5 x 0.6 cm red to brown, rubbery to firm, vaguely ovoid mass with a nodular external surface. Cut section showed a light gray solid surface. 

Microscopic examination shows a broad-based exophytic mass with invaginations of the surface epithelium and proliferated glands within the stroma. (Figure 2) The glands are tubular or variably dilated - many are lined by a respiratory-type epithelium with goblet cells and a thickened basement membrane, while the tubular glands are lined by a monolayered cuboidal epithelium. (Figure 3) Based on these features, we signed the case out as a respiratory epithelial adenomatoid hamartoma (REAH).

REAH is a benign proliferation of sinonasal tract glands derived from the surface epithelium.1 It occurs primarily in male adults, with a median age in the sixth decade of life. Most cases arise in the posterior nasal septum, while less common sites of involvement include other parts of the nasal cavity, the nasopharynx, and paranasal sinuses.2 Common symptoms include nasal obstruction, stuffiness, and epistaxis.1,3,4

REAH presents as a polypoid lesion and may measure up to 6 cm in widest diameter.1 Microscopically, there is a proliferation of small to medium-sized glands dispersed in abundant stroma. Invagination of the glands from the surface epithelium may be seen.3 The glands are round to oval, lined by respiratory-type epithelium with admixed goblet cells. Thickened basement membranes surround some of the glands, and smaller seromucinous glands lined by cuboidal epithelium may also be admixed among the latter. Other alterations may include squamous, chondroid, and osseous metaplasia.1,4

Rarely, REAH may occur synchronously with inverting sinonasal papillomas or inflammatory polyps.1 It may be mistaken for these two entities along with sinonasal low-grade adenocarcinomas. Careful attention to the typical morphology including absence of an infiltrative growth pattern and atypia allow distinction from these entities particularly the malignant mimics.3 A related entity is a seromucinous hamartoma with which REAH is believed to form a morphological spectrum.1

REAH is benign and complete excision confers cure.1 Malignant transformation has not been reported.1,3,4

The paper looked into dynamics and variances of the manifestation of gratitude towards the older persons utilizing qualitative survey design. A total of 300 study participants, which include the young millennials, mid-lifers and older generation groups, were interviewed. The tool used was a simple interview guide for a freewheeling interview with storytelling style. Three-level classification of qualitative survey analysis was used. The findings revealed how family, work and societal changes have contributed to the changes in the manifestation of gratitude. The changes in the social structure and the demand to cope with these changes have caused the gap between the desire of the older persons to be respected and how the younger generations have shown this to them. Gratitude, which is manifestation of respect, has evolved and is now shown differently across intergenerational groups and seems to be experienced similarly across nations. The younger generations have a different view on respect in comparison with the older generations.

BACKGROUND. Metabolic Syndrome (MetS) is common in Chronic Obstructive Pulmonary Disease (COPD) patients but their association is still an unsettled issue. The aim of this study was to determine the association of MetS with the severity of airflow obstruction.

METHODOLOGY. This was a cross-sectional analytic study of 157 patients with COPD. They were classified using the Global Initiative for Chronic Obstructive Lung Diseases (GOLD). MetS was assessed using two well-recognized criteria. Demographics, clinical data, lifestyle-related characteristics, fasting blood sugar (FBS) and lipid profile were obtained. Multiple logistic regression was used to determine the association of MetS with the severity of airflow obstruction.

RESULTS. 40.13% and 17.20% of patients had MetS using the NCEP/ATP III-AHA/NHBLI and IDF criteria, respectively. MetS was not associated with severity of airflow obstruction. Of the MetS components, only elevated blood pressure (BP) was significantly associated with severity of airflow obstruction (GOLD II: OR=3.28, p<0.001; GOLD III: OR=4.04, p=0.2; GOLD IV: OR=6.21, p=0.04). Elevated FBS was also associated with GOLD IV (OR=16.09, p=0.02). Significant factors associated with MetS in COPD patients were body mass index, inhaled steroid, number of pack-years, and GOLD II.

CONCLUSION. MetS is not associated with severity of airflow obstruction. Only certain components of MetS showed significant associations such as elevated BP with GOLD II-IV and elevated FBS with GOLD IV.

Background and Objective: Cadavers are the main teaching and learning tools utilized by faculty and students of Gross Anatomy. The conventional procedure of using formalin to preserve cadavers has its limited benefit due to its obnoxious odor, darkened color, indistinguishable small structures, rigid joints, with friable organs and tissues. Using the Thiel Method, cadavers are known to have: life-like presentation, a high degree of suppleness, natural mobilization of various body parts with tolerable odor, natural color, and antimicrobial and antifungal efficacy. The aim of this study was to compare the Thiel soft-embalmed cadaver and the formalin-preserved cadaver for use in Gross Anatomy dissection.

Materials and Method: Six formalin-preserved cadavers were compared with six Thiel soft-embalmed ones and were evaluated by 160 first year medical students and 10 faculty members of Gross Anatomy from the University of the Philippines College of Medicine using a visual analogue scale that evaluated the cadaver's presenting color. A Likert scale was utilized to assess the skin and muscle texture, blood vessel integrity, odor, joint flexibility, and state of cadaver preservation. Their perceptions on the ease of the dissection process, distensibility, and differentiation of structures were also elicited through a questionnaire checklist.

Results: Results show that the Thiel Method-preserved cadavers were rated higher compared to the formalinpreserved cadavers in terms of: 1) presenting color; 2) tolerable odor; 3) skin and muscle texture; 4) blood vessel integrity; 5) joint flexibility; and 6) state of cadaver preservation after 1 year. However, the ease of the dissection process, the distensibility of structures, and the differentiation of the various structures were easily managed in the formalin-preserved cadavers while the feasibility of practicing laparoscopy, endoscopy, and intubation were seen in the Thiel soft-embalmed cadavers. Results validate the claims of previous studies on the advantages presented in using the Thiel Method.

Conclusion: Cadavers preserved utilizing the Thiel Method are life-like and can be used for Gross Anatomy dissection. The data gathered support the feasibility of using them also in research and training.

BACKGROUND: The dengue vaccine controversy in the Philippines caused significant public anxiety affecting childhood vaccines, as well as other healthcare programs. An assessment of parental perception and attitude on childhood immunization and other government healthcare programs after the dengue vaccine controversy is lacking

OBJECTIVE: To determine the perception and attitude of parents on childhood immunization and other government health care programs after the dengue vaccine controversy at a tertiary pediatric hospital.

METHODOLOGY: A hospital-based cross-sectional survey was done at a tertiary pediatric hospital. A total of 96 subjects participated in the study. Parents with children ages 9 to 18 years old whose child was either vaccinated or non-vaccinated with dengue vaccine seen in the dengue clinic, outpatient department and private clinics were invited to answer the structured questionnaire. Proportional stratified sampling was employed. Mann Whitney U-test compared the perception and attitude scores between parents of children who were recipients and non-recipients of dengue vaccine. A p-value of

RESULTS: The overall perception and attitude of parents on childhood immunization, deworming and vitamin A supplementation did not differ significantly between parents of non-dengue vaccinated children and dengue-vaccinated children. Sociodemographic factors such as gender, marital status, educational attainment, employment, and economic status did not differ significantly in their perception and attitude in terms of childhood immunization, deworming and vitamin A supplementation.

CONCLUSIONS: The overall perception and attitude of parents in both groups showed no significant difference toward childhood immunization, deworming and vitamin A supplementation. There is no association with the overall perception and attitude of parents on childhood immunization, deworming and vitamin A supplementation and their sociodemographic factors. RECOMMENDATIONS: Future similar studies may be conducted in other regions to determine parental perception and attitude towards the government's immunization program and other health care programs.

This study was conducted to: (1) determine the profile of nurses in various work settings based on available databases; (2) describe the current nursing education and programs in the Philippines; and (3) identify national key issues affecting the nursing workforce. The study utilized descriptive, cross-sectional research design; and employed institutional survey, Delphi survey, and round table discussions. Results showed that the Department of Health has the current number of nurses working in hospitals and communities in the different regions, including information on age and sex distribution, employment characteristics, and type of hospital affiliations. The Professional Regulations Commission Board of Nursing has the results of the national licensure examinations. Commission on Higher Education has information on BSN curriculum and schools. Priority key issues identified are: (1) nursing leadership and nursing role clarity, (2) workplace safety and violence, and (3) shortage of nurses, (4) unjust compensation, and (5) skills mix and geographic maldistribution. PNA is thought to have a big role in helping address these key issues. 

PURPOSE: Cancer constitutes a public health concern and has been an evident universal health problem for the past decade. New treatment options with the goal of finding an absolute cure for the disease are explored by the medical society. This study aims to examine the Health-Related Quality of Life and levels of hope among patients with cancer undergoing adjuvant therapy, and to determine the relationship of these variables, their domains and subscales.

METHODS: The study used a descriptive, cross-sectional, correlational research design. Ninety two respondents from Porac, Pampanga, aged 18 and above, diagnosed with cancer, and are undergoing adjuvant therapy were selected via consecutive sampling. Two instruments were utilized in the study: the EORTC QLQ-C30 and the Herth Hope Index. Pearson's r with a p-value set at

FINDINGS: Results revealed that over a half of the respondents (53.26%) have high HRQoL scores (mean of 68.5) in the EORTC QLQ- C30 questionnaire. On the other hand, the overall level of hope based on the Herth Hope Index was 33.32, which was generally acceptable, where 66.30% of the scores were considered high. Domains of HRQoL namely physical functioning, role functioning, emotional functioning, cognitive functioning and social functioning were all positively correlated with hope subscales specifically:
temporality and future, readiness and expectancy and interconnectedness at varying strengths.

CONCLUSIONS: A diagnosis of cancer does not equate to one's loss of hope. Hope may be anchored in Health-Related Quality of Life which involves different domains rather than in the form of treatments for cure. Further studies which focus on comparing outcomes of
patients who decline and those who willingly undergo adjuvant therapy, a repeated measures study to determine continuum levels and lastly, an intervention study focusing on symptom management may be done to gain more in-depth information regarding the effects of adjuvant therapy on the HRQoLand level of hope among these patients.

OBJECTIVE: To develop a locally adapted patient decision aid (PtDA) on treatment intensification among Filipino patients with Type 2 Diabetes Mellitus and to test the feasibility of using PtDAs in a low middle-income country.

METHODOLOGY: A qualitative approach and an iterative process of development of a PtDA were employed for this study. We describe the process of developing a Filipino version of the Diabetes Medication Decision Aid. This PtDA was designed to help the patient choose the appropriate treatment intensification based on his own values and preferences, in consultation with his physician. The process involved decisional needs assessment through focus group discussions and key informant interviews, systematic literature review, iterative process of the development of a PtDA with clinical encounters (pilot testing), and preliminary field testing.

RESULTS: Decisional needs assessment revealed that Filipino patients are open to participate in shared decision-making if given the opportunity, including those with low socioeconomic status who likely have low health literacy. Physicians prefer to have visual aid tools to help them support their patient's decision-making. A PtDA prototype of a set of flash cards in Filipino was created and revised in an iterative method. We developed a more visually appealing tool after inputs from the expert panel and patient advisory group. Its use during clinical encounters provided additional insights from patients and clinicians on how to improve the PtDA. Preliminary field testing showed that its use is feasible in the target patient population.

CONCLUSION: Filipino patients, clinicians, and diabetes nurse educators have contributed to the creation of the first Filipino PtDA for diabetes treatment intensification.

OBJECTIVE: This study has been conducted to determine the prevalence of malnutrition and nutritionally-at-risk community-dwelling older adults in an urban setting through the use of Mini Nutritional Assessment (MNA®).

METHODS: A cross-sectional survey was done among older adults in Barangay Sto. Niño, an urban poor community in Pasay City, Metro Manila to determine the prevalence of malnutrition and older adults using the short and full form of the Mini Nutritional Assessment (MNA®). Anthropometric assessment was done to determine body mass index as well as physical examination to determine presence of nutrient deficiencies.

RESULTS: Using the Asia Pacific cut-off for BMI, it can be noted that 16.5% were classified as underweight. On the other hand, results of the MNA® short form screening showed that less than half (42.6%) of the study respondents have normal nutritional status. Majority of the respondents were either malnourished (14.8%) or at risk of malnutrition (42.6%). Moreover, results of the Full MNA® form showed that almost half of the study respondents were either malnourished (8.2%) or at risk of malnutrition (39.3%). The rest of the study respondents were classified as having normal nutritional status (52.5%).

CONCLUSION: As compared to Body Mass Index, which can only identify prevalence of malnutrition, the MNA®, both short and full form, was not only able to identify malnourished and nutritionally-at-risk older adult as well as provide variables that may screen for possible causes of malnutrition. This is necessary and relevant for timely nutrition intervention for improved nutritional outcome among older adults.

BACKGROUND: Family support is vital and could affect the outcome of many chronic diseases; hence involvement of family members in every patient encounter is important especially among elderly population. Family meeting could help the physician identify the often unmet needs of the family member and to improve care of the elderly patient. Research on families and health demonstrates the influence of the family on health and illness and the benefits of family interventions, yet there are only a few-well constructed randomized control trials.

OBJECTIVE: To determine the effectiveness of family meeting and standard geriatric care versus standard geriatric care alone on outpatient follow up rate, quality of life and satisfaction to the services received at the outpatient department of elderly patients.

METHODOLOGY: The study was an open labelled randomized controlled trial among elderly patients referred to the Family Health Unit of UP-PGH. Patients were randomized to either family meeting and comprehensive geriatric assessment or comprehensive geriatric assessment alone. Patients were advised to follow up at 2,4 and 12 weeks. After the initial meeting, QOL and satisfaction were measured at baseline and done during subsequent follow up.

RESULTS: A total of 110 elderly patients referred to the family health unit for comprehensive geriatric assessment were included in the study. The follow up rate 2,4 and 12 weeks after initial consultation was significantly higher among elderly who received family meeting and comprehensive geriatric assessment versus elderly patients who received the comprehensive geriatric assessment alone, p-value >0.05. Satisfaction to services received, at two weeks follow-up, was likewise significantly higher among elderly who received family meeting plus CGA. There was no significant difference in the quality of life on both groups.

CONCLUSION: Family meeting and comprehensive geriatric assessment are effective in promoting compliance to follow-up and satisfaction to health service provision among elderly Filipinos referred to the Family Health Unit.