OBJECTIVE: To determine the prevalence of and factors associated with severe mucosal injury on esophagogastroduodenoscopy (EGD) after caustic ingestion. METHODS: Consecutive patients ?19 years old with history of caustic ingestion were included. Factors considered were age, sex, caustic agent (acid or alkali) and presence of signs/symptoms (oral lesions, drooling, vomiting, abdominal pain, dysphagia).  RESULTS: 320 patients were investigated: 155 (48%) accidental and 165 (52%) intentional case. In accidental intake, majority (84%) were ?6 years old [mean(SD) age: 3.7 (4.3) yrs, 59% males]. 10% had severe mucosal injury. The odds of severe injury increased in the presence of ?2 signs/symptoms: OR=7.0 for 2 and OR=62.2 for >2. In intentional cases, the mean (SD) age was 16 (1.6) years, 74% females. Severe mucosal injury was seen in 5% and associated with acidic agent (OR=54.8). CONCLUSIONS: Severe mucosal injury on EGD occured in 10% and 5% among accidental and intentional cases, respectively. In accidental cases, probability of severe injury increased in the presence of ?2 signs/symptoms. In intentional cases, acid intake was the only factor associated with severe injury. In the local setting, presence of these factors among patients with caustic ingestion will help identify high-risk patients who need EGD-guided management.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Caustics ; Alkalies ; Deglutition Disorders ; Sialorrhea ; Endoscopy, Digestive System ; Abdominal Pain ; Vomiting ; Probability

<p style="text-align: justify;">BACKGROUND: Zinc is now recommended as part of childhood diarrhea case management but there are concerns regarding treatment duration and perceptions of its use when given with ORT.p> <p style="text-align: justify;">OBJECTIVES: This study developed and tested messages on zinc supplementation for childhood diarrhea.p> <p style="text-align: justify;">METHODS: Messages were based on 1) a review of literature and product advertisements, 2) drugstore seller interviews, and 3) focus group discussions (FGDs) among 10 mothers with children six to 59 months old. Subsequent FGDs with 15 mothers consulting at a government hospital helped determine message clarity, comprehension and appeal. A behavioral trial, involving nine mothers whose children had diarrhea, tested recall of and adherence to the messages.p> <p style="text-align: justify;">RESULTS: The trial tested three messages - zinc: 1) strengthens resistance; 2) is a vitamin for the gut; 3) increases the appetite of a child with diarrhea. Seven of nine mothers were able to follow instructions on zinc administration, and demonstrated recall and understanding of these messages. Mothers understood that zinc helps the child with diarrhea, improves appetite, reduces symptoms and hastens recovery, but had concerns regarding the side effects (vomiting), co-morbidities (fever, cough) and consequences of overdose. Standardized counseling cards addressed these concerns. Respondents preferred a simple logo labeled with zinc administration instructions on the packaging. Zinc supplementation did not affect ORT use.p> <p style="text-align: justify;">CONCLUSION AND RECOMMENDATIONS: Messages sufficiently addressed mothers concerns on zinc use during childhood diarrhea, with those on zinc improving and as a vitamin for the gu having the best recall. Results can contribute to introduction and promotion in the public sector.p>
Appetite ; Cough ; Focus Groups ; Aarskog Syndrome ; Dwarfism ; Hand Deformities, Congenital ; Genetic Diseases, X-linked ; Genitalia, Male ; Heart Defects, Congenital ; Diarrhea ; Vomiting

Objective. The main objective of this study is to determine the level of understanding, accessibility and areas of application of Cochrane reviews (CR) among medical practitioners affiliated with a tertiary care medical center in Metro Manila, Philippines. Study Design. Survey using a self-administered questionnaire was conducted. Target Population and Setting. Consultant doctors of the Philippine General Hospital (PGH) were invited to participate. The PGH is the national university hospital of the Philippines and is a tertiary referral center and teaching hospital of the University of the Philippines Manila. Sampling Scheme. 101 doctors were chosen by stratified random sampling with the clinical department as the stratification variable. Strata samples were targeted according to strata size (proportional to size). Measurement Instrument. Eight domains that are important in the understanding of the CR were included in a 25-item multiple-choice questionnaire. In addition, facilitating factors and barriers to the application of CR or systematic reviews (SR) were asked. Data Analysis. Using a 25-point Multiple Choice Questionnaire, the knowledge of the respondents was measured and the mean score was estimated at a 95% confidence level. The percentage of CR awareness was also estimated at 95% confidence level. Facilitating factors and barriers in the use of SR were described. In addition, the following post-hoc analyses were done: descriptions of the total score according to gender, age, year graduated and year of last training. Results. Of 101 consultants invited, 59 participated (58% response rate) within the 6-month data collection period. The mean age was 47.2 years with a standard deviation (SD) of 7.8 years. Forty-five respondents (76%) had their last formal medical-related training from 1991 onwards. The mean score was 14.7 points (SD 6.7) using the 25-item multiple choice questions on concepts and principles of systematic reviews. Of these 59 respondents, 49 (83.0%: 95% CI: 75.2 - 90.9) indicated that they were aware of the existence of CR. Of those who were aware of CR, 42 (85.7%, 95% CI: 75.9 -95.6) have actually used them. The following factors help the respondents use CR: efficient Internet access, working knowledge of research methodology, working knowledge of how to critically appraise the medical literature, and familiarity with the terms used in the review. On the other hand, the following were considered barriers: inefficient access, poor knowledge of general research methodology, poor understanding of the principles of Evidence-based medicine (EBM) and difficulty in understanding the reviews. Conclusion. Practicing physicians in a tertiary university hospital in the Philippines were only able to get about 60% of the principles and concepts of understanding SR. Eighty three percent of them are aware of CR. Access to internet, familiarity with terms and working knowledge of CR and evidence-based medicine are the facilitating factors for application of the results of SR and CR. Although most claimed to use the SR results in literature reviews, only about 60% are able to use them in teaching, clinical practice or health policy development.
Human ; Male ; Female ; PHYSICIANS ; REVIEW

Background. Newborn screening for congenital hypothyroidism (CH) in the Philippines was introduced in 1996. It is universally accepted that early detection through newborn screening and timely treatment can improve the physical and neuro-cognitive development of patients. As of December 2010, the prevalence of CH is 1 in 3,324 among 2,389,959 newborns screened. Objective. We sought to evaluate the role of timing of diagnosis, compliance with treatment, and specialist care on growth and development (mental and physical) of patients with congenital hypothyroidism detected through newborn screening. Methods. Of the 326 patients identified through newborn screening between July 1996-December 2008 at the Newborn Screening Center-National Institutes of Health, 86 patients participated in the study. With the parents' or guardians' consent, general physical examination and neuro-cognitive evaluation were done; FT4 and TSH were determined. Prevalence of poor control of disease (high TSH with normal or low FT4 or normal TSH with low FT4), stunting, and cognitive delay were each estimated at 95% confidence level and the associations of early diagnosis, initial and continuing specialist care with these conditions were determined by multiple logistic regression analyses. Results. The prevalences (95% confidence interval) were: poor control of disease 63% (52-73%), stunting 24% (15-34%) and neuro-developmental delay 17% (8-25%). Delay in one aspect of neuro-development was seen in 54% (43-66%). Early diagnosis was protective against poor control of disease (adjusted Odds Ratio, ORa=0.24 [CI: 0.08-0.77]). Trends towards protection were seen for initial and continuing specialist care. For delay in at least one cognetive aspect, early diagnosis was found to be protective (ORa=0.19 [CI 0.05-0.76]); results for specialist care were inconclusive. For stunting, low parent education was found to be a risk factor. (ORa of 5.45 [CI: 1.3-22.7]). Conclusion. Fifty-four percent of the study patients had delay in one aspect of neuro-development. While other factors play a role in the outcome of CH, early diagnosis and treatment were shown to be protective of patients from poor control of disease and cognitive delays. Observed trends of positive benefits of specialist care at onset and continuing medical management, and the association of low parent education with poor growth should be considered in drafting specific guidelines for the long term follow-up care and monitoring of CH patients detected through newborn screening. The low percentage of participation and incomplete retrieval of information are major limitations of this retrospective study. This stresses the need for better monitoring tools that will ensure proper tracking, medical care and evaluation of CH patients.
Infant ; Infant Newborn ; EARLY DIAGNOSIS ; DIAGNOSIS ; CONGENITAL HYPOTHYROIDISM ; NEONATAL SCREENING ; DIAGNOSTIC TECHNIQUES AND PROCEDURES ; CLINICAL LABORATORY TECHNIQUES ; GROWTH AND DEVELOPMENT ; THERAPY ; THERAPEUTICS ; COMPLIANCE

Methods: Patients with and without glaucoma underwent a complete eye evaluation, automated perimetry, scanning laser polarimetry with the GDx 400, and opticdisc photography. Two glaucoma experts graded each study eye. Two-by-two tables were constructed for 5 GDx parameters (average thickness, superior average, inferior average, ellipse average, and ellipse modulation) and the CDx number. Receiver operating characteristic (ROC) curves were generated. Results: The study included 355 patients (171 normal, 184 glaucoma). The mean values of the 5 GDx parameters were lower for the glaucoma than for the normal group. The sensitivity and specificity of the GDx 400 were 45.4 percent and 91.9 percent if the cut off level of the GDx number was 71. Ellipse modulation (EM) measures have the best ROC curve with area under the curve of 0.725. Conclusion: The GDx 400 nerve-fiber analyzer is primarily used as a screening tool to detect the presence or absence of glaucoma. Its accuracy can be improved with use of continuous corneal compensator.
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; GLAUCOMA ; RETINA ; NERVE FIBERS ; SCANNING LASER POLARIMETRY ;

Single enantiomer compounds like levobupivacaine appear to be safe alternative to racemic agents, like bupivacaine for postoperative analgesia. This double-blind randomized dose ranging trial amed to compafe the efficacy sna safety of three concentration of continuous epidural infusion of levobupivacaine for postoperative analgesia after lower extremity orthopedic surgery. After informed consent, 63 eligible patients were randomized to receive levobupivacaine 0.0625%, 0.125%, or 0.25% as a continuous postoperative epidural infusion. Intraoperatively,vital signs, oxygenation, sensory block level, motor block, and abnormal signs and symptoms were monitored. on and a half (1 1/2) hours after the last intraoperative bolus of levobupivacaine, the epidural infusion was started at a rate of 6/ mL/h for 24 24 hours. Pain intensity and pain reliefscores, using the 10-cm visul analog scale, were assessed postoperatively. The time to first request for analgesia (with morphine or tramadol) and the total rescue doses gicen were recorded. Twenty patients were randomized to Goup A (0.0625%), 22 to Group B (0.125%), and 21 to Group C (0.25%). All three group were similar as to age, gender distribution and baseline physical findings. Pain scores, pain relief, and ie to the first rescue does were not significant different among the three groups. The most common adverse events were fever (8%), hypotensy (3%), and vomiting (2%). one patient developed severe hypotensio probably secondary to inadequately replaced intraoperative blood loss. Levobupivacaine is effective and safe for postoperative analgesia as an epidural infusion at 0.0625%, 0.125%, and 0.25%.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; LEVOBUPIVACAINE ; ANALGESIA ; ORTHOPEDICS ; ANESTHETICS, LOCAL ;

Objectives: This study aimed to describe the demographic profile, intervention sessions, goal attainment scaling (GAS), and health-related quality of life (HRQOL) of autistic children receiving speech and language therapy (SLT) in a higher educational institution in the Philippines. Methods: Deidentified data from 18 autistic children aged 4–16 years (mean=8.2; SD=2.9) who received SLT for two months were analyzed. Their demographic profile, intervention sessions, GAS scores, and generic HRQOL scores were documented. Results: Most participants were school-age children (n=12; 66%) and were boys (n=14; 78%). After two months, the GAS scores of 11 participants (61%) increased by 1–2 points, whereas the scores of the remaining participants decreased (n=6; 33%) or did not change (n=1; 6%). Their mean generic HRQOL scores before and after SLT were 65.6 (SD=15.2) and 61.2 (SD=17.4), respectively. Conclusions While the GAS scores increased for most participants, their generic HRQOL scores did not show clinically significant changes after two months of SLT. This can be attributed to the few therapy sessions and short follow-up period. The findings highlight the need to provide long-term support to SLT services of autistic children in the Philippines to document more desirable quality of life outcomes.
Quality of Life ; Autistic Disorder ; Child

BACKGROUND AND OBJECTIVES<p style="text-align: justify;" data-mce-style="text-align: justify;">The Department of Clinical Epidemiology (DCE) of the University of the Philippines Manila is the only higher education institution in the Philippines offering graduate studies in clinical epidemiology. The Master of Science Epidemiology (Clinical Epidemiology) was first offered in 1992, while the Diploma in Epidemiology (Clinical Epidemiology) was offered in 1998. While the courses of the programs are continuously updated based on students’ feedback and advances on topics covered, the point of view of the students and alumni on the program as a whole has not been done. This study aimed to determine 1) self-reported current positions and affiliations, work areas where clinical epidemiology (CE) training is useful, and skills gained from CE training; 2) research studies completed and deemed by respondents to have considerable impact; and 3) strengths, weaknesses, and areas of improvement of the DCE graduate programs.p>METHODS<p style="text-align: justify;" data-mce-style="text-align: justify;">This is an online survey of students and alumni of the DCE graduate programs. We sent email invites to all 287 students and alumni. We collected data on their profession, institutional affiliations, positions, skills gained from their training, areas of clinical epidemiology applications, important research involvement, reasons for recommending or not recommending the programs, and how the graduate programs can be improved. Responses were summarized by frequencies and percentages. An analyst performed qualitative content analysis (QCA) to generate strengths and weaknesses of the program. We validated the results of the QCA through 1) presentation to the research team, 2) sending the survey report to study participants and other students and alumni for feedback, and 3) presentation to the DCE faculty and staff.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">We received 159 responses (55.4% of the total study population)—145 (91.2%) were from the MSc program and 11 (6.9%) were from the Diploma program. Majority of the respondents were physicians (93.7%), had hospital affiliations (81.8%), and were affiliated with the academe (61%). Majority of the respondents used clinical epidemiology in their research endeavors (87.4%), clinical practice (85.5%), and teaching (78%). Majority (93.1%) would recommend the program they have taken. Eleven (6.9%) respondents were hesitant due to the possible mismatch with the students’ career path, challenging thesis work, and potential conflicting personal responsibilities. Several strengths of the programs were identified, including excellent and well-implemented programs, supportive faculty and staff, and relevant course work. While completing the course work had not been a problem in general, the main challenge encountered by students is the completion of their thesis, leading to a low graduation rate in the Master of Science program. Suggestions to improve the Master of Science and Diploma programs include 1) Improvement in program implementation, including thesis policies and support, smoother transition from Diploma to MSc Program and vice-versa, and implementation of a blended learning platform; 2) Curricular improvements such as wider choices for electives and tracking towards specialty areas; 3) Innovations in conduct of courses; and 4) Personnel and infrastructure development.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">This survey reiterated the importance of clinical epidemiology graduate programs in research capacity building of health care professionals. Students and alumni occupied diverse positions in academic, research, clinical, and pharmaceutical setting, and majority accomplished research studies with considerable impact. A major challenge leading to a low graduation rate in the Master of Science program is the completion of thesis work. The survey identified several initiatives towards continuous quality improvement of clinical epidemiology programs, including improvement of thesis policies and support, updating the curriculum content and materials, increasing allotment of hours for hands-on activities, exploring possibilities of offering electives in partnership with other institutions, offering a blended learning platform, maintaining an efficient administrative support for students, and continuing education for alumni. Strong institutional support for personnel and infrastructure development is essential for these initiatives to succeed.
p>
Cross-sectional Studies

<p>OBJECTIVE: X-linked dystonia parkinsonism (XDP) is an adult-onset, progressive and debilitating movement disorder described among Filipino males from Panay Island. The available oral medications have been ineffective. While chemodenervation with botulinum toxin A works and deep brain stimulation surgery is promising, these are not affordable for the vast majority of patients. Thus, we decided to look into the efficacy, safety and tolerability of levodopa+carbidopa (levodopa) versus placebo among patients with XDP.p><p>METHODS: This was a double blind, randomized, placebo-controlled clinical trial. Patients were randomized to receive levodopa or placebo for 6 months. The dose was increased gradually until 1000 mg levodopa/day is reached or until side effects appear.p><p>RESULTS: A total of 86 out of 94 randomized patients (91.5%) were included in the intention-to-treat cohort for the primary efficacy analysis. Nineteen patients (9 in levodopa, 10 in placebo) dropped out or were lost to follow up. There was no significant difference in the baseline and last visit Burke Fahn Marsden Dystonia Rating Scale and the part III of the Unified Parkinson's Disease Rating Scale scores between levodopa and placebo. The most common adverse events in the levodopa group were increased movements, pain and nausea/ vomiting.p><p>CONCLUSION: While levodopa is safe and well-tolerated, it does not have any effect in alleviating the dystonia or parkinsonism in XDP.p>
Human ; Dystonia ; Parkinsonian Disorders ; Levodopa ; Carbidopa ; Parkinson Disease

<p style="text-align: justify;">BACKGROUND: Republic Act 9288 or the Newborn Screening Act of 2004 was enacted. A multi-sector effort towards systematic screening of newborn disorders and built-in systems for subsequent confirmatory tests for positively screened as well as treatment for confirmed cases was likewise implemented. Despite multi-sector efforts and continuous quality improvement mechanisms, national newborn screening coverage remained low for several years.p><p style="text-align: justify;">OBJECTIVE: The study determined factors that influence Newborn Screening (NBS) uptake from various perspectives: mothers, health providers, and program administrators.p><p style="text-align: justify;">METHODS: Framework analysis of NBS program documents, 25 focus group discussions and 37 key informant interviews of mothers, health providers and program administrators were done in purposively selected communities in the Cordillera Administrative Region and Region V.p><p style="text-align: justify;">RESULTS AND CONCLUSIONS: Findings showed the need to disseminate correct NBS procedures, especially upon obtaining positive results. Financing issues were addressed innovatively, but system administrators and health providers required a common understanding of program implementation. Monitoring geographically hard-to-reach areas remained a challenge. Barriers outside the system adversely affected filter cards availability, specimen transport, and release of results. Improved online and paper-based educational campaign, greater local government unit support, streamlined PhilHealth processes, a workload-based manpower complement for monitoring, and continuity clinics to handle positive findings can increase NBS uptake.p>
Neonatal Screening ; Attitude