Electrolytes ; Body Fluids

PURPOSE OF THE STUDY: Basal cell carcinoma (BCC) remains as the most common cutaneous neoplasm in the Philippines consisting of more than 60% of all skin cancers. Anacardium occidentale (Linn.) cashew extract, which had been used successfully in the removal of warts and moles in previous studies, is presented as a therapeutic option in BCC.
METHODS: An open-label prospective study was conducted on 36 patients (mean age of 65 years) with documented BCC lesions on middle third of the face. Cashew nut extract (DeBCC) application was offered to these patients as an alternative option to very unacceptable extirpative surgery offered by general and plastic surgeons as treatment for their lesions. Lesion size ranged from 7.5- 64 mm. (26.26 mm). Topical treatment was applied every 1-2 weeks, as needed. Follow-up examinations with photographic documentation were made every week to evaluate success of the treatment.
RESULTS: After a mean of 7 treatment applications (range of 1-20) all the lesions were undetectable on clinical examinations. Mild tingling sensation, which was reported by all patients during the treatment applications, was tolerable on all occasions. With follow-up ranging from 5-60 months (38.72 months), 16 patients completed the planned 5 - year post-treatment follow-up period. There were no recurrences detected.
CONCLUSIONS: Anacardium occidentale (Linn.) cashew extract (DeBCC) presents a viable and acceptable treatment option in primary BCC. The importance of this treatment option could be stressed in patients with lesions not amenable to the prescribed wide margin of resection needed in surgery.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Aged ; Anacardium ; Carcinoma, Basal Cell ; Humans ; Moles ; Neoplasm Recurrence, Local ; Nevus ; Nevus, Pigmented ; Nuts ; Philippines ; Prospective Studies ; Recurrence ; Sensation ; Skin Neoplasms ; Surgeons ; Warts ;

BACKGROUND: Clonidine, an alpha-agonist has been postulated to produce analgesia centrally by stimulating the post-synaptic activity of norepinephrine through receptors distinct from opioid receptors and peripherally through a mechanism similar to local anesthetics. It has been suggested that the use of a combination of local anesthetics and clonidine both at lower doses may be effective in providing adequate analgesia at the same time minimizing the deleterious side effects of each drug when used alone at higher doses. The objective of the study was the determination of the minimum dosage of clonidine in combination with bupivacaine necessary for epidural administration that would provide optimal intraoperative and postoperative analgesia with the least occurrence of side effects such as hypotension and bradycardia. METHODOLOGY: One hundred randomly selected, healthy ASA l and 2 gynecologic patients undergoing lower abdominal surgery under epidural anesthesia were given bupivacaine 0.5 percent epidurally compounded with either saline as placebo (Group 1), or clonidine in variable doses: 0.5 ug/kg (Group 2), 1.0 ug/kg (Group 3), and 1.5 ug/kg (Group 4) in a randomized, double-blind fashion. The vital signs were noted every 5 minutes. Analgesia was monitored and recorded using the Visual Analog Scale (VAS), Verbal Rate Scoring and the systemic indicators of pain perception (SBP 30 min Hg increase from baseline or heart rate 20 percent from baseline). A top-up dose of Lidocaine 2 percent was given with systemic indications of pain perception noted intraoperatively or rescue doses of opioids were given when the systemic indications of pain perception were noted at the post anesthesia care unit, upon which data collection was terminated Eighty two patients completed the course of data collection while eighteen were dropped out because of sacral sparing, retraction pain and extension of incision. The statistical tool utilized to test significant differences between the groups was the Kruskal-Wallis Analysis of Variance test and the Partitioned Chi-square test. RESULTS: There is prolongation in the duration of analgesia with incremental increase in clonidine dose. Hypotension occurred even without the addition of clonidine with higher incidence as the dose of clonidine increased. The least side effects occurred with doses of clonidine between 0.5 and 1.0 ug/kg. CONCLUSION: The optimal dosage of clonidine for intraoperative analgesia that would extend to the postoperative period in Filipino women would fall between 0.5 to 1.0 ug/kg. (Author)
Human ; ANALGESIA ; BUPIVACAINE ; CLONIDINE ; ANALGESIA, EPIDURAL

Background and Purpose: Gait is one of the outcome measures used in evaluation in the field of rehabilitation and there is a need for reference data of gait parameters primarily to understand the physiological significance of these parameters, describe their changes in pathologic gait for better understanding of pathophysiology and be able to provide the appropriate therapeutic approach. The purpose of this study was: 1) To derive a reference data of spatiotemporal parameters of gait among Filipinos, which include step time, stride time, stance time, swing time, single limb support time, double limb support time, cadence, speed, step length, stride length, and step width; 2) To determine correlation of age, gender, and anthropometric measures with spatiotemporal parameters, and 3) To determine
gait symmetry.

Materials and Methods: In this cross-sectional study, 374 participants aged 20-69 years (males = 181, females = 193) were included. They were asked to walk in their comfortable speed. Spatiotemporal parameters were obtained using the Vicon motion capture system.

Results: The walking speed, step length, stride length, and step width declined with age. Filipino men demonstrated higher values in all parameters except cadence which is higher in Filipino women. Height and leg length both have positive correlation with all parameters except for cadence. Weight has a positive correlation with all spatiotemporal parameters except for cadence, swing time, single limb support time, and speed. Cadence and stride length were symmetrical between right and left lower extremities.

Conclusion: Spatiotemporal parameters among healthy Filipinos 20-69 years old were presented including their correlations with age, gender, and anthropometric measures. This can serve as a reference for future studies in gait where Filipinos are the participants.

Anthropometric ; Gait Analysis ; Reference Values

BACKGROUND: At the beginning of the COVID-19 pandemic, healthcare professionals including pediatric occupational therapists (OTs) mandatorily had to shift to the practice of telehealth in the absence of a safe in- person setup caused by the outbreak. OBJECTIVE: This study aims to determine the psychosocial experiences encountered by selected pediatric OTs in the Philippines brought by the shift to telehealth practice during the COVID-19 pandemic METHODOLOGY: Purposive sampling was used in the study to gather six (6) licensed pediatric OTs who provide occupational therapy (OT) services via telehealth in the Philippines, and the respondents were not personally connected to any of the researchers. A semi-structured one-on-one interview with the participants through a Zoom call was conducted to obtain their psychosocial experiences. A thematic analysis was used and four (4) themes emerged by the end of the study: consequences of the shift to telehealth practice, changes during telehealth provision, increased resilience, and increased psychological strain. CONCLUSION In conclusion, the transition to provision of telehealth services to pediatric clients has challenged the practices of the selected pediatric OTs in terms of preparing for the session, where one of the main prevalent concerns was toward collaboration and communication with the caregivers; conducting of telehealth sessions, where communication interruption was one of the main concerns; and in ethical considerations, where OTs made it a point that they rectified ethical dilemmas amidst telehealth provision. These experienced challenges also included increased workload and psychological distress, while improved occupational balance and adaptability were most commonly experienced by OTs
COVID-19 Pandemic ; Occupational Therapy ; Telehealth

Water pollution in developing countries continues to be a major health problem due to various anthropological activities that contribute to the spread of many parasitic diseases, including those caused by helminths. The aim of this study is to explore the ability of ozone and peroxone to disinfect drinking water contaminated samples with Toxocara canis eggs. The oxidants used were ozone and ozone-hydrogen peroxide combination. The treatment of Toxocara canis eggs was carried out in a 50 ml reactor with an operating volume of 10 ml. The pH conditions (5, 7 and 10) were varied for each treatment. The treatment effect was calculated by counting eggs and examining the condition of the larvae larval condition (whole, broken and hatched larvae) using an optical microscope. The experiment was carried out by exposing the eggs for 60 and 120 minutes to ozone and peroxone. The best results were obtained for helminths treated with the ozone/hydrogen peroxide combination at pH 10, with an inactivation of 79.2%. The synergistic effect of ozone combined with hydrogen peroxide allows higher helminth egg inactivation rates, demonstrating that advanced oxidation processes are a real alternative to apply in the inactivation of Toxocara canis eggs. The results obtained in this study show that the ozone and peroxone treatment could be a useful disinfection process to destroy or inactivate Toxocara canis eggs in processes commonly applied in water treatment.

Objective: The mandible is the most common fractured craniofacial bone of all craniofacial fractures in the Philippines, with the mandibular body as the most involved segment of all mandibular fractures. To the best of our knowledge, there are no existing guidelines for the diagnosis and management of mandibular body fractures in particular. General guidelines include the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAOHNSF) Resident Manual of Trauma to the Face, Head, and Neck chapter on Mandibular Trauma, the American Association of Oral and Maxillofacial Surgeons (AAOMS) Clinical Practice Guidelines for Oral and Maxillofacial Surgery section on the Mandibular Angle, Body, and Ramus, and a 2013 Cochrane Systematic Review on interventions for the management of mandibular fractures. On the other hand, a very specific Clinical Practice Guideline on the Management of Unilateral Condylar Fracture of the Mandible was published by the Ministry of Health Malaysia in 2005. Addressing the prevalence of mandibular body fractures, and dearth of specific guidelines for its diagnosis and management, this clinical practice guideline focuses on the management of isolated mandibular body fractures in adults. Purpose: This guideline is meant for all clinicians (otolaryngologists – head and neck surgeons, as well as primary care and specialist physicians, nurses and nurse practitioners, midwives and community health workers, dentists, and emergency first-responders) who may provide care to adults aged 18 years and above that may present with an acute history and physical and/or laboratory examination findings that may lead to a diagnosis of isolated mandibular body fracture and its subsequent medical and surgical management, including health promotion and disease prevention. It is applicable in any setting (including urban and rural primary-care, community centers, treatment units, hospital emergency rooms, operating rooms) in which adults with isolated mandibular body fractures would be identified, diagnosed, or managed. Outcomes are functional resolution of isolated mandibular body fractures; achieving premorbid form; avoiding use of context-inappropriate diagnostics and therapeutics; minimizing use of ineffective interventions; avoiding co-morbid infections, conditions, complications and adverse events; minimizing cost; maximizing health-related quality of life of individuals with isolated mandibular body fracture; increasing patient satisfaction; and preventing recurrence in patients and occurrence in others. Action Statements The guideline development group made strong recommendationsfor the following key action statements: (6) pain management- clinicians should routinely evaluate pain in patients with isolated mandibular body fractures using a numerical rating scale (NRS) or visual analog scale (VAS); analgesics should be routinely offered to patients with a numerical rating pain scale score or VAS of at least 4/10 (paracetamol and a mild opioid with or without an adjuvant analgesic) until the numerical rating pain scale score or VAS is 3/10 at most; (7) antibiotics- prophylactic antibiotics should be given to adult patients with isolated mandibular body fractures with concomitant mucosal or skin opening with or without direct visualization of bone fragments; penicillin is the drug of choice while clindamycin may be used as an alternative; and (14) prevention- clinicians should advocate for compliance with road traffic safety laws (speed limit, anti-drunk driving, seatbelt and helmet use) for the prevention of motor vehicle, cycling and pedestrian accidents and maxillofacial injuries.The guideline development group made recommendations for the following key action statements: (1) history, clinical presentation, and diagnosis - clinicians should consider a presumptive diagnosis of mandibular fracture in adults presenting with a history of traumatic injury to the jaw plus a positive tongue blade test, and any of the following: malocclusion, trismus, tenderness on jaw closure and broken tooth; (2) panoramic x-ray - clinicians may request for panoramic x-ray as the initial imaging tool in evaluating patients with a presumptive clinical diagnosis; (3) radiographs - where panoramic radiography is not available, clinicians may recommend plain mandibular radiography; (4) computed tomography - if available, non-contrast facial CT Scan may be obtained; (5) immobilization - fractures should be temporarily immobilized/splinted with a figure-of-eight bandage until definitive surgical management can be performed or while initiating transport during emergency situations; (8) anesthesia - nasotracheal intubation is the preferred route of anesthesia; in the presence of contraindications, submental intubation or tracheostomy may be performed; (9) observation - with a soft diet may serve as management for favorable isolated nondisplaced and nonmobile mandibular body fractures with unchanged pre - traumatic occlusion; (10) closed reduction - with immobilization by maxillomandibular fixation for 4-6 weeks may be considered for minimally displaced favorable isolated mandibular body fractures with stable dentition, good nutrition and willingness to comply with post-procedure care that may affect oral hygiene, diet modifications, appearance, oral health and functional concerns (eating, swallowing and speech); (11) open reduction with transosseous wiring - with MMF is an option for isolated displaced unfavorable and unstable mandibular body fracture patients who cannot afford or avail of titanium plates; (12) open reduction with titanium plates - ORIF using titanium plates and screws should be performed in isolated displaced unfavorable and unstable mandibular body fracture; (13) maxillomandibular fixation - intraoperative MMF may not be routinely needed prior to reduction and internal fixation; and (15) promotion - clinicians should play a positive role in the prevention of interpersonal and collective violence as well as the settings in which violence occurs in order to avoid injuries in general and mandibular fractures in particular.
Mandibular Fractures ; Jaw Fractures ; Classification ; History ; Diagnosis ; Diagnostic Imaging ; Therapeutics ; Diet Therapy ; Drug Therapy ; Rehabilitation ; General Surgery

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.