PURPOSE: Patient-relevant outcomes are increasingly used as complementary evidence of effectiveness in the evaluation of treatment options. With the aim of utilization in objectively assessing the symptom's severity and the treatment outcomes of urinary incontinence in Korean population, we translated the Incontinence Quality of Life(I-QoL) instrument into Korean version which subsequently was linguistically validated. MATERIAL, METHODS AND RESULTS: Our study lasted for a period of about 8 months, between November 2001 and June 2002. Two native Koreans speakers, who were also fluent in English, translated the original U.S. English I-QoL into written Korean independently. A panel consisting of aforementioned translators and three bilingual authors reviewed the translations to form a single reconciled forward translation of the Korean I-QoL. Another translator, who had never seen the original I-QoL, back-translated this first draft to English. The back-translation was assessed for equivalence to the original by the Health Research Associates, Inc. (HRA). Discrepancies between the original U.S.-English form and the first draft Korean translation were reviewed by the panel. Cognitive debriefing interviews with five incontinent patients to test the interpretation of the translation were made. Summary of the changes was set to the HRA and the comments from patient interviews were then reflected in the final Korean version. Comparison of the Korean version of I-QoL with the original I-QoL was made to ensure conceptual equivalence during a meeting with professional translators representing many counties involved. Finally, it was proofread to check spelling, grammar, layout and formatting. CONCLUSION: Linguistic validation of Korean version of incontinence measure I-QoL was completed and was internationally approved. It is now ready to use in Korea and further test for psychometric performance of the Korean I-QoL is need.
Humans ; Korea ; Linguistics* ; Psychometrics ; Surveys and Questionnaires ; Translations ; Urinary Incontinence

INTRODUCTION: Colo-cutaneous fistula is a very rare complication of colonic diverticular disease, occurring in approximately one percent of cases either spontaneously or after surgical or drainage procedure. Herein we describe a patient with a colo-cutaneous fistula from the sigmoid to the appendiceal stump in a post-appendectomy patient which also exits to the skin at the post-operative site. CASE PRESENTATION: The patient is a 76-year-old Filipino male who had appendectomy five months earlier and a history of diverticulitis, and presented with a subcutaneous abscess at the post-operative site. The abscess was drained, a colocutaneous fistula was radiographically established, and the surgical site was explored. Intraoperative findings showed the presence of multiple colonic diverticuli and a sigmoidcutaneous fistula on the right lower abdominal quadrant. Interestingly, an incidental descending colon mass was also noted at the splenic flexure measuring approximately 2x3 cm to which frozen section revealed adenocarcinoma which was not seen in pre-operative CT scans. An extended left hemicolectomy was performed, and no postoperative complications were noted. At present three years later, he fares well without any signs and symptoms of the disease. CONCLUSION: Diverticulitis is a common condition in the older age group that needs to be considered in patient management. Colo-cutaneous fistula may be a rare complication of the disease but should be part of our differentials as internists in working up patients presenting with persistently draining superficial wound that either occurs spontaneously or post-operatively. Patients with diverticulitis also have increased risk of colorectal cancer and diagnostic imaging may not always differentiate the two entities, thus colonoscopy should be done if possible.
Cutaneous Fistula ; Diverticulitis ; Colon

BACKGROUND: The Philippines has, mandatory service policies to address the insufficiency and maldistribution of human resources particularly for health services. Despite being perceived as an appropriate intervention to bridge the aforementioned HRH gaps, the past and present implementations of such programs in the country have never been formally studied.

OBJECTIVE: This paper aimed to present the history of mandatory service programs in the Philippines, look at their natures, and see how their different implementations relate to each other.

METHODOLOGY: Using a qualitative document analysis method, administrative issuances and reports relevant to past and current implementations of mandatory service policies in the Philippines were obtained and reviewed.

RESULTS: Mandatory service programs have been implemented in the country by institutions from both the private and public sectors as early as 1968. The focus of such has been mostly for government positions and specialized professions including physicians and scientists. While extensive efforts have been made through the years, the policies demonstrated fragmentation and recurring gaps in implementation. Such gaps include the lack of enabling policy mechanisms, formal monitoring and evaluation, and program institutionalization.

CONCLUSION: The historical narrative of return service programs in the country is a potential source for the development of an overarching mandatory service policy framework for human resources in the Philippines, one that is specific to the context and setting of the country. By articulating policy issues identified, this paper provided a stepping-off point for future mandatory service program policy planning, implementation, evaluation, and institutionalization in the Philippines.

Introduction: The coronavirus disease 2019 (COVID-19) have spread globally and reached the Philippines in late January 2020. This study is the first local and nationwide research on admitted COVID-19 adult patients: their clinic-demographic profiles, managements, and clinical outcomes. We aim to determine the associated factors with mortality among COVID-19 patients. Methods: This was a retrospective, multicenter, observational cohort study of rt-PCR confirmed and admitted COVID-19 adult patients in 89 hospitals in the Philippines from February to July, 2020. The data on admission of patient’s demographic, clinical, laboratory, pre-hospital and during hospital treatment management and in-hospital clinical outcomes were gathered. The data were described and analyzed using multiple logistic regression analysis. Results: There were 2884 rt-PCR confirmed and admitted COVID-19 adult patients included in the study. Majority were Filipinos (99·4%), with slightly more males (54.4%) than females. 21% were healthcare workers (HCWs). Mortality was higher among non-HCWs at 16% versus 2% among HCWs. 63% of the patients had a co-morbidity, which included hypertension (69%), diabetes mellitus (48%) and chronic kidney disease (26%). The significantly associated factors with mortality in this Philippine cohort were: age >60 years, hypertension as co-morbidity, tachypnea (> 22/minute), WBC count > 10 x 109 /L, and elevated serum lactate dehydrogenase (LDH) (all p<0.05). Elevated serum LDH was the strongest factor associated with mortality (OR of 8.74, p=0.004). Conclusion This study identified that age, hypertension, tachypnea, elevated WBC count, and elevated serum LDH were associated with mortality among COVID-19 adult patients and results were consistent with results from studies done in other countries. We recommend that early detection and awareness of exposures and symptoms will improve the management and clinical outcomes of COVID-19 adult patients. Also, a long follow-up of the outcomes of COVID-19 to determine the effectiveness of treatment is recommended for further study.
Philippines ; Mortality

Objectives: The study aimed to determine the perception of program administrators and students on the implementation of return service agreement (RSA) in the Philippines. It examined the different components of, and opportunities, and challenges in the implementation of RSA of selected institutions. Methods: Key informant interviews using a topic guide were conducted with ten program administrators and student representatives from selected institutions implementing a return service policy. Interviews were transcribed and responses in Filipino were translated to English. Open coding and focused coding were performed to identify categories and themes from the interview transcripts. Results: Addressing human resource for health (HRH) needs of the country is a common rationale behind RSA implementation among the institutions sampled for the study. A notable difference in implementation arrangements is the manner of rendering service. Majority of RSA programs require promisors to be employed in any part of the Philippines in need of health workers, while other RSA programs recruit students from rural areas in order to deploy them later on in their hometowns. There is also an apparent lack of institutionalized mechanisms for job placement for students to fulfill their return service obligations. One challenge in most institutions is the need for a formal monitoring and evaluation scheme for the policy. Conclusion Integration of the voice of stakeholders is critical in the conceptualization, development, and implementation of RSA policies. This will ensure that issues attendant to operationalization are mitigated if not outrightly avoided.

BACKGROUND AND OBJECTIVES: Zehneria japonica belongs to the Cucurbitaceae family which is one of the most important plant families. It is commonly known as "Pipinong-gubat," widely distributed in Central Luzon regions and in areas along streams and clearings at low and medium altitudes in the Philippines. This study aimed to evaluate the potential cytotoxic and angiosuppressive properties of Zehneria japonica (Thunb. ex Murray) S.K. Chen (Cucurbitaceae) leaf extracts.

METHODOLOGY: The Z japonica semi-crude extracts were obtained by sequential extraction using hexane, ethyl acetate, and n-butanol. A modified duck egg chorioallantoic membrane (CAM) assay was aided by AngioQuant, a digital imaging software used to evaluate angiogenic activity. Inhibition of angiogenesis was evaluated by percent increase or decrease in mean length of blood vessels, mean size of blood vessels, and total number of blood vessel junctions. Moreover, the cytotoxic effects of the extracts were determined through MTT Assay. Osteosarcoma (U20s) and hepatocellular carcinoma (HepG2) cells were used as cancer representatives while human umbilical vein endothelial cells (HUVEC) were used as the normal cell control.

RESULTS: Analysis with AngioQuant revealed that treatment of the duck egg CAM with Z. japonica semi-crude extracts suppressed angiogenesis with ICso values of 1,810.00 ug/mL, 192.50 ug/ml, and 147.70 ug/mL for hexane, ethyl acetate, and n-butanol, respectively, with Celecoxib (20 ug/mL) as the positive control. For MTT assay, Z. japonica extracts exhibited strong cytotoxic effect against U2Os with an ICso values of 19.65 ug/mL, 9.89 ug/ml, and 31.04 ve/mL for the hexane, ethyl acetate, and n-butanol extracts, and no cytotoxic effects against HepG2 with IC50 values of 770.90 ug/mL, 130.10 ug/mL and 231.60 ug/mL for the hexane, ethyl acetate, and n-butanol extracts. Doxorubicin (0.544 ug/mL) was used as the positive control. The extracts also inhibited the growth of the normal cells, with IC50 values of 69.46 ng/mL, 42.23 ug/mL and 63.44 ug/mL for the hexane, ethyl acetate, and n-butanol extracts. There were no mortality and toxic symptoms observed for 14 days after the administration of the crude butanolic extract of Z. japonica in six female Sprague Dawley rats.

CONCLUSION: Z. japonica crude leaf extracts exhibited angio-suppressive activity through CAM assay. In MTT assay, the extracts exhibited strong cytotoxicity in U20s (IC50 S20 ug/mL), no cytotoxic effect in HepG2 (ICso >100 ug/mL) cells, and mild cytotoxic effect in HUVEC (IC50 40-60 ug/mL). Phytochemical screening through TLC revealed that the extracts contain alkaloids, anthrones, flavonoids, and sterols. 

Background and Objectives: Tuberculosis (TB) continues to be a public health concern in the Philippines. Vulnerable populations in congregate settings such as drug abuse treatment and rehabilitation centers (DATRCs) have higher risks of TB transmission and infection. With the Duterte administration’s intensified campaign against illegal drugs, government-retained DATRCs are filled to capacity. There is an identified need to profile drug users and dependents living in DATRCs. Furthermore, national guidelines for TB management specific to this population is absent. A study was conducted to determine the profile of admitted clients diagnosed with TB, TB prevalence, treatment outcomes and choice of TB diagnostic modalities in six (6) Luzon-based DATRCs from 2013-2015. Methods: All medical records of drug users admitted in this period were reviewed. Information on the total patient census was sought from DATRC heads and used to compute for prevalence. Results: A total of 347 records were obtained. Overall TB prevalence in the study sites was 7,216 per 100,000 population. The typical individual diagnosed with TB in a DATRC was male, with a mean age of 35 years, with at least high school education, and unemployed. Weight loss and fatigue were the most common symptoms reported. The majority (79.83%) completed TB treatment in the DATRCs. Sputum microscopy and chest x-ray were both used for TB diagnosis in 92.80% (322) of the cases. Conclusion The high burden of TB in Luzon-based, government-retained DATRCs is alarming and underscore the critical need for standards and guidelines in the National Tuberculosis Control Program addressing the unique context of these facilities.
Substance Abuse Treatment Centers ; Prevalence ; Philippines ; Tuberculosis ; Psychiatric Rehabilitation ; Behavior Therapy

Background and Objectives: Tuberculosis (TB) remains a public health problem in the Philippines despite trends indicating a decline in the burden of disease. Persons who use drugs who are confined in government-retained drug abuse treatment and rehabilitation centers (DATRCs) face an increased risk for TB because of the congestion in the facility coupled with the absence of guidelines on TB management specific to DATRCs. Thus, this study was conducted to document the current case finding and case holding practices as well as TB treatment pathway in six (6) Luzon-based, government-retained DATRCs.

Methods: Key informant interviews were conducted with DATRC personnel involved in TB diagnosis and management in six selected DATRCs in Luzon, Philippines. Interviews were transcribed and coded for thematic analysis. We compared the DATRC practices with the provisions of the 2014 National TB Control Program (NTP) Manual of Procedures. Results were validated through a workshop with (a) a group of physicians and rehabilitation practitioners assigned in other DATRCs; and (b) a group of experts who have experience in managing or overseeing DATRCs in the country.

Results: Two physicians and four nurses participated in the interviews. Variations in case finding and case holding practices in six DATRCs have been found. National guidelines exist for congregate settings but are more specific to jails/prisons, which are administratively and operationally different from DATRCs.

Conclusion: Development of special guidelines for TB case finding and case holding in DATRCs as well as staff training on the latest NTP Manual of Procedures are recommended. However, gaps and inequities posed by the current set-up underscore the need to address health system-wide factors affecting the practice and performance of these facilities.

Key Words: tuberculosis, case finding, case holding, drug abuse treatment and rehabilitation centers, Philippines