Pallative medicine is the study and management of patients with active, progressive, far-advanced diseases for whom the prognosis is limited and focus of care is quality of life.
PALLIATIVE MEDICINE

Sharon is 47-year old, married, Roman Catholic, Filipino, female from northern Samar. She was brought in the medical consultation due to lower extremity weakness.
BIOETHICS

A systematic review in 2007 on truth-telling in discussing prognosis in terminally ill cases revealed that patients frequently have misunderstandings about their illness prognosis and goals of treatment as a result of poor disclosure practice. A common reason is the reluctance of physicians to communicate bad news, due in part to apprehension as to patient wishes on disclosure and its after-effects. Without proper disclosure, families cannot move towards appropriate decision making on end-of-life care. As physician lack of awareness to patients' desires is the rate-limiting step in communicating bad news, this study aimed to clarify if primary healthcare providers perception coincide with patients' general preferences on death and disclosure of poor prognosis. Comparison of primary health care perspectives and patient preferences were based on the following issues on death and disclosure of poor prognosis: acceptance of death as a natural part of the circle of life, desire to accept news of poor prognosis, preference as to the more appropriate person to deliver bad news, desire whether to be told of poor prognosis at the earliest possible time, desire to postpone the discussion of death, and views on maintaining hope in the face of poor prognosis. Methodology: A cross sectional study was done. The patient population were recruited from those who sought consult at the Family Medicine Clinic. Primary health care providers were represented by PGH residents from the FM and IM departments. One hundred four patients and 52 resident physicians based on the conservative estimate of 1:2 ratio of resident trainee to patients was the calculated sample size. A self-administered survey questionnaire was developed from extensive literature review of various references on end-of-life care. Content validation was done through review of the questionnaire items by an expert panel. Descriptive statistical analysis was done. Coefficient of variation was used to compare patient and primary healthcare provider perceptions. Association of preferences to socio-demographic variables was measured using chi-square test. Results: A total of 200 patients and 73 primary healthcare physicians were included in the study. Mean age was 46 for patients and 29 for primary health care physicians. Majority of the respondents in both groups were female and of the Catholic faith. Most of the patient respondents were married whereas majority of the physicians were single. Highest educational attainment of the patients is mainly high school. Physician respondents were 37 FM residents and 35 IM residents almost equally distributed by year level. Comparison of patient and primary healthcare provider perspectives revealed significantly different results for accepting death as a natural part of the circle of life and perception that disclosure will destroy hope. This means that the respondents answers to these 2 questions were varied. As opposed to the similar computed values for patients prefer disclosure from a doctor and patients prefer to postpone discussion of death. Association of patient preference to socio-demographic profile is statistically significant for age, gender and educational attainment. Results show that older patients prefer family members to disclose poor prognosis. Male patients do not want to know that they are terminally-ill or dying and patients who only received elementary education do not want to know their prognosis and prefer to avoid discussion of death. Civil status and religion of primary healthcare providers affect their perception. Single physicians believe that patients do not want to know that they are dying, and are less likely to choose family members to deliver bad prognosis. Conclusion: The study showed that in PGH, primary healthcare providers, perceptions generally coincide with patient preferences, specifically with regards to patients' desire to accept news of poor prognosis, the more appropriate person to deliver bad news, and the desire for disclosure but with preference to postponing discussions of death as much as possible. Varied responses were seen in the question of death being a natural part of the circle of life, reflecting some issues on acceptance of death and dying among patients. Physicians had a diverse response to maintaining hope in the face of poor prognosis, contrary to the almost homogenous patient response that disclosure will not destroy hope. Based on socioodemographic factors: Older patients prefer family members or loved ones to disclose poor prognosis. Male patients prefer not to know that they are terminally-ill or dying. Those who only received elementary education do not want disclosure of poor prognosis and are more likely to postpone discussions of death. It is recommended that these results be kept in mind when disclosure of poor prognosis and death is warranted. The following are also recommended: to correct the misperception of physicians that disclosure of poor prognosis destroy patient hope and more in-depth investigation of the issues tackled, particularly, patient issues behind the acceptance of death as a natural part of the circle of life and the circumstances surrounding patient desire to accept disclosure of poor prognosis and at the soonest time yet wanting to postpone discussions of death as much as possible.
DEATH

Methods such as real time (RT)-PCR have not been developed for the rapid detection and diagnosis of Dermatophilus (D.) congolensis infection. In the present study, a D. congolensis-specific SYBR Green RT-PCR assay was evaluated. The detection limit of the RT-PCR assay was 1 pg of DNA per PCR reaction. No cross-reaction with nucleic acids extracted from Pseudomonas aeruginosa, Mycobacterium tuberculosis, Staphylococcus aureus, or Austwickia chelonae was observed. Finally, the RT-PCR assay was used to evaluate clinical samples collected from naturally infected animals with D. congolensis. The results showed that this assay is a fast and reliable method for diagnosing dermatophilosis.
Actinomycetales/*isolation & purification ; Actinomycetales Infections/diagnosis/microbiology/*veterinary ; Animals ; Cattle ; Cattle Diseases/*diagnosis/microbiology ; Fluorescent Dyes/*diagnostic use ; Horse Diseases/*diagnosis/microbiology ; Horses ; Limit of Detection ; Real-Time Polymerase Chain Reaction/*methods/veterinary ; Reproducibility of Results ; Sheep ; Sheep Diseases/*diagnosis/microbiology

Background: Among Filipino females, breast cancer is the leading malignancy which warrants palliative care that includes spiritual care to help improve quality of life and well-being.

Objective: Determine the associations of perceived spiritual beliefs and spiritual practices with perceived spiritual well-being among breast cancer patients consulting at the University of the Philippines - Philippine General Hospital (UP-PGH).

Methods: This was an analytical cross-sectional study using non-probability convenience sampling of adult females with breast cancer at the UP-PGH Breast Cancer Clinic (BCC). The survey utilized a self-administered questionnaire with sections on general demographics, spiritual beliefs, spiritual practices, and spiritual well-being. Descriptive statistics were used and analysis of associations was done through Fisher's exact test at a 5% level of significance.

Results: Among 219 study participants, almost all reported having perceptions of strong spiritual beliefs, adequate spiritual practices, and good spiritual well-being. Associations were found between perceived spiritual beliefs and spiritual well-being (F=51.2, p<0.001; R=0.4, p<0.001) and between perceived spiritual practices and spiritual well-being (F=62.0, p<0.001; R=0.4, p<0.001).

Conclusion: The associations found of perceived spiritual beliefs and spiritual practices with perceived spiritual well-being should be considered in providing spiritual care as part of the comprehensive management and palliative care for Filipino breast cancer patients.

Key Words: spirituality, well-being, cancer

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been associated with multiple entities and several types of cancers. They can be assumed as markers of inflammatory imbalance. The objective of this study is to evaluate the NLR and PLR in Peyronie's disease (PD) and to establish a comparison of its values in the acute and chronic stages. We recruited patients with PD from March 2018 to March 2019. The patients enrolled underwent medical and sexual history as well as a physical examination. The values of blood count of each patient were collected both in the acute and chronic stages. Wilcoxon test was used to compare the acute and chronic stage ratios. Kruskal-Wallis test was carried out to evaluate the impact of treatments on the ratios. To identify cutoff values, we used sensibility and specificity tables and receiver operating characteristic (ROC) curves. A total of 120 patients were enrolled. Their mean age was 55.85 (range: 18-77) years and the mean penile curvature was 48.43° (range: 10°-100°). In the acute stage, the mean NLR was 2.35 and the mean PLR was 111.22. These ratios, in the chronic stage, were 1.57 and 100.00, respectively. Statistically significant differences between acute and stable stages for both indices were found (NLR: P< 0.0001; PLR: P= 0.0202). The optimal cutoff for classification in acute or stable stage was 2 for NLR and 102 for PLR. According to our results, with an ordinary blood count, we could have important indications regarding the disease stage of the patient, and consequently on the most appropriate type of therapy to choose.