INTRODUCTION AND OBJECTIVES: Laparoscopic adrenalectomy is the standard treatment for adrenal tumors.Described here is the authors’ 10-year experience with laparoscopic adrenalectomy in a single center. METHODS: A retrospective chart review was done on all patients who underwent laparoscopicadrenalectomy from January 2006 to January 2016 at the National Kidney and Transplant Institute.The authors determined the patient demographics (age and gender), tumor characteristics (size,functionality and laterality) and surgical outcomes (operative time, estimated blood loss, conversionto open and complications according to the Clavien-Dindo classification). RESULTS: A total of 90 patients underwent laparoscopic adrenalectomy. The female to male ratio was1.4:1. Most tumors were left-sided [48/90 (53%)], with a mean size of 3.0 ± 0.75cm. The operativetime was 145 ± 35 minutes. The mean estimated blood loss was 50 ± 100cc. The length of hospitalstay was 3.0 ± 1 days. Forty six percent (42/90) of the adrenals were functioning: Hyperaldosteronism(26), Pheochromocytoma (14), and Cushing's syndrome (2). Ninety eight percent(88/90) were benign. There were 2 (2.2%) conversions to open. There were 8 complications (8.89%)(all Dindo-Clavien Class II), all of which were managed conservatively. There was no mortality. CONCLUSION The authors’ experience with laparoscopic adrenalectomy shows that it is safe and effectivefor adrenal tumors.
Laparoscopy

Food-borne trematodes (FBTs) are emerging infections and of substantial public health importance but are among the most ignored of the neglected tropical diseases (NTDs) in terms of attention, research and funding. A review of the status of FBTs in the Philippines based on the best available local and national information may provide a basis for the formulation of appropriate prevention and control measures most suitable for its setting. This review presents a summary of the key features of FBTs and the epidemiologic pattern of FBTs in the Philippines and on the current measures being done for infection control and prevention in other countries. Paragonimiasis, echinostomiasis, and heterophyidiasis are still prevalent in the Philippines with food preparation and hygiene practices and presence of infected intermediate hosts as major determinants of epidemiology and disease burden. Control and prevention of food-borne trematodes may be best achieved with political will, coordinated efforts among responsible public sectors, and involvement of relevant communities.
FOOD HANDLING

OBJECTIVES:The main objectives of the Adherence in Schizophrenia (ADHES) survey in the Philippines were to: (1) describe the insights of Filipino psychiatrists on the level of adherence to treatment of patients with schizophrenia; and (2) to identify possible main challenges for treatment adherence in schizophrenia.
METHODOLOGY:The 2012 ADHES Asia Pacific (APAC) survey was a questionnaire-based survey with 4,661responding psychiatrists (24% of recipients) in 13 countries in the Asia-Pacific region, which was administered from January 2012 to April 2012. In the Philippines (n=17), the survey was conducted between March and April 2012 and distributed to psychiatrists by Janssen personnel. The 20-item questionnaire was devised to ascertain psychiatrists' preferred methods of assessing perceptions of the levels of adherence, reasons for non-adherence to treatment in schizophrenia patients, their perceptions of the levels of adherence, reasons for non-adherence and strategies to improve adherence. Gender, age and practice setting of the psychiatrists were also collected for analysis.
RESULTS:A total of 71 psychiatrists responded to the ADHES Survey in the Philippines. The most common approaches used by the psychiatrists in assessing adherence to prescribed doses were asking an informant (e.g. relative, friend, caregiver) (96%) and asking the patient directly (94%). About 48% of the patients were "fully-adherent" or took at least 90% of prescribed doses as assessed by the psychiatrists who were included in the survey. Meanwhile, 23% of the patients were "non-adherent" or took 30% of prescribed doses. According to the psychiatrists, the most were lack of insight (28%) and cognitive impairment (24%). However, the most common reason for stopping medication among the respondents' patients was due to insufficient efficacy of the antipsychotic or having experienced psychotic symptoms with the medication they are taking (30%). Lastly, the most preferred pharmacological strategies used by the respondents to address an adherence problem in patients with schizophrenia were switching to a long-acting anti psychotic medication (27%) and switching to a different oral antipsychotic (23%).
CONCLUSION:Partial or non-compliance to medication is a serious issue in schizophrenia, and insight into illness in schizophrenia, and insight into illness in schizophrenia is the most important reason for treatment non-adherence. Thu, there is a need to continuously assess the level of insight in patients with schizophrenia and institute more pro-active interventions such as direct-observation treatment for oral medications or long-acting injectable antipsychotics. The more wide-spread use objective assessments of medication  compliance can also be explored.

 

 

Human ; Male ; Female ; Antipsychotic Agents ; Asia ; Caregivers ; Cognitive Dysfunction ; Medication Adherence ; Philippines ; Psychiatry ; Psychotic Disorders ; Schizophrenia ; Surveys And Questionnaires ; Patient Compliance ; Patients

Objective: To describe the clinical and demographic profile of patients who underwent pediatric Endoscopic Sinus Surgery (ESS) and the indications for which the procedure was performed. Methods: Design: Cross-sectional Study Setting: Tertiary Government Hospital Subjects: Using the medical record registry, all patients below 18 years of age who underwent ESS under the Department of Otorhinolaryngology – Head and Neck Surgery of a tertiary government hospital in Metro Manila between December 31, 1999 and January 1, 2008 were reviewed. The age, sex, clinical presentation indications for doing ESS and extent of surgery done were described. The Lund MacKay Grading for nasal polyposis and Scoring for sinusitis were also applied and cross-referenced. Results: Twenty-seven children aged 7 to 17 years underwent ESS. The mean age was 12.9 years with most (15 patients) belonging to the adolescent age group (13-17 years). Male to female ratio was 1.45:1. The mean interval from onset of symptoms to the first outpatient consultation was 1.5 years; the most common presenting symptoms were nasal obstruction (85.2%) and discharge (59.3%). All of the patients who underwent pediatric ESS had chronic rhinosinusitis: either with nasal polyposis (85.2%), an antrochoanal polyp (11.1%) or both (3.7%). The Lund Mackay Grading for nasal polyps and sinusitis scores were cross-referenced: patients with larger, grade III nasal polyps tended to have more extensive sinus disease than those with grade II polyps. On their first consultation, the patients tended to present with extensive nasal polyp and sinus disease indicating the need for surgery. All patients with CRS and nasal polyposis underwent polypectomy with ethmoidectomy, uncinectomy and maxillary antrostomy, with additional frontal sinusotomy for a 17-year-old male and a 17-year-old female, both with grade 3 polyposis. The three patients who had antrochoanal polyps underwent polypectomy with uncinectomy and maxillary antrostomy. There were no operative complications such as cerebrospinal fluid leak and orbital injury reported.

BACKGROUND: Several Philippine studies on selected neglected parasitic diseases cite major challenges in laboratory diagnosis that require review of standards, policies and practices.
OBJECTIVES: This review aims to: (1) describe the epidemiology of selected neglected parasitic diseases in the Philippines; (2) describe the current status of laboratory diagnosis of these diseases in terms of standards, policies and practices; and (3) identify challenges and opportunities for improvement of laboratory diagnosis.
METHODS: Epidemiologic data were collected from published scientific papers and monographs. International standards were gathered from journal articles and the World Health Organization (WHO). Philippine policies were obtained from interviews with the Department of Health (DOH) and other agencies. Recommendations for policy and practice were formulated based on evidence and feasibility.
RESULTS: High prevalence of neglected parasitic diseases in the country, coupled with lack of national policies on diagnosis and quality assurance guidelines specific to parasitology, pose significant challenges to accurate diagnosis.
CONCLUSION: Results of this review merit the development of a comprehensive Philippine policy on a quality assurance scheme for parasitology laboratories and stronger licensing standards. This policy should be supported through a network of reference centers that coordinate parasitology training, staff certification, and laboratory accreditation.

Human ; Animal ; Male ; Female ; Parasitic Diseases ; Laboratories ; Diagnosis ; Epidemiology ; Quality Control ; Parasitology

A 41-year-old man from Occidental Mindoro was diagnosed with intestinal capillariasis at the Philippine General Hospital after a year of diarrhea and multiple hospital admissions. The patient was noted to be harboring Capillaria philippinensis, Strongyloides stercoralis, Entamoeba histolytica, Mycobacterium tuberculosis, and Candida albicans in his stool. He was treated with albendazole, metronidazole, diloxanide, fluconazole, and antiiKoch's. This case was reported to the Department of Health to pursue this site as a potential area for epidemiologic investigation.

Human ; Male ; Adult ; Strongyloides Stercoralis ; Capillaria ; Albendazole ; Fluconazole ; Entamoeba Histolytica ; Candida Albicans ; Metronidazole ; Diloxanide Furoate ; Mycobacterium Tuberculosis ; Diarrhea ; Furans

Objective: To determine the antibiogram of tracheal aspirate cultures (TACS) among intubated children aged 2 months to 5 years old with very severe community acquired pneumonia (CAP). Methodology: A retrospective chart review using total enumerative sampling. Results: 66 out of the 343 patients had positive TACS. The top 5 most common isolates were Klebsiella pneumoniae(37.8%), Pseudomonas aeruginosa (25.7%), Acinetobacter baumanii (15.1%), Enterobacter cloacae (12.1%) and Methicillin Resistant Staphylococcus aureus (MRSA) (6%). The gram-negative isolates were highly sensitive to amikacin and carbapenems. Majority of these patients (92.42%) had history of Pentavalent immunization. Majority of patients who were TACS positive had history of antibiotic use prior to admission (92.42%), mostly second-generation cepahalosporin (cefuroxime, 32.42%). High rates of resistance to ampicillin and gentamicin were noted for patients with Klebsiella pneumoniae and Enterobacter cloacae isolates. Majority of patients with Klebsiella pneumoniae, Acinetobacter baumanii and MRSA expired. Conclusion/Recommendation Majority of those patients with positive isolates had MDR organisms thus for patients with very severe CAP who already received antibiotic as outpatient, broad spectrum antibiotics should be considered as empiric therapy and TACS be done on all patients with very severe CAP.
Pneumonia

Objective: To design an instrument for steadying instrument handling during microlaryngeal surgery using an operating laryngoscope. Method: Our device design takes its cue (pun intended) from professional billiards players like our very own Efren "Bata" Reyes. The laryngeal tiririt (bridge or rake) draws inspiration from the billiards bridge (locally known as tiririt) used to extend the player's reach when the cue ball is too far to make an accurate shot. Setting: The laryngeal tiririt was used and tested by senior residents in microlaryngeal surgeries done in our institution. Result: The laryngeal tiririt greatly improved the accuracy required in laryngeal surgeries without adding up huge set up or expensive equipment. (Author)
LARYNGOSCOPES LARYNX

BACKGROUND:?There is a critical relationship of time to treatment and myocardial salvage in the patient with acute myocardial infarction (AMI). As the proven beneficial management options for AMI have been extensively studied, the challenge lies in developing a process that minimizes pre-hospital delays, delays in assessment and initiation of reperfusion therapy. A greater emphasis on pre-hospital care has more potential in reducing mortality from acute MI than further development of hospital based treatments.

OBJECTIVE:?This study identifies the socio-demographic risk factors in patients with acute coronary syndrome and correlate them with pre-hospital delay. This response time to treatment is then correlated with the clinical outcome.

STUDY DESIGN:?Clinical Descriptive Study

METHODS:?Adult patients with diagnosis of acute coronary syndrome at the ICU setting of the USTH were sampled. Charts were reviewed and socio-demographic profiles identified. Pre-hospital delay from the onset of chest pain were correlated with these socio-demographic factors using multiple regression logistic regression. Chi square test was used to determine association between pre-hospital delay and clinical outcome.

RESULTS:?The study sample consisted of 220 patients with acute coronary disease. The sample population included 63% Non ST Elevation Myocardial Infarction (NSTEMI), 4% ST Elevation Myocardial Infarction (STEMI) and 33 percent with unstable angina. Male population accounted for 54% of the population. Thirty eight?percent(38%) of the population belonged to the 61.70 age group with mean age of 65 years old. The prevalence of hypertension (70%) and DM (41%) was high and about 30% of the population had prior history of coronary artery disease (CAD). About 35% reported family history of CAD and 41% had family history of DM. More than half of the population are smokers (55%). Majority of the patient population live within 10 kilometers from USTH (70%) while 28 patients (13%) came from the province. Thirty-eight percent (38%) sought consultation after two pain events, while only 4% came after more than 4 chest pain events. A significant number of population in the present series presented to the hospital delayed by more than four hours. Majority of the patients (40%), came in more than 6 hours. Twenty one percent (21%) came 2-4 hours while 30 percent came 4-6 hours from the onset of chest pain. The most common reason for the delay in seeking medical attention is financial limitation (36%), 31% had relief of chest pain by nitrates. Of the 220 included in the group, 50% had morbidity (such as development of acute renal failure, congestive heart failure), 41% had unremarkable outcome while there was 10% mortality noted. However in this study, we were not able to associate any socio-demographlc factors and the delay in time to treatment with the clinical outcome using available data and statistical.

CONCLUSION:?The results of this study demonstrate that patients with acute coronary event continue to exhibit prolonged delay in seeking medical care. This paper, Likewise, demonstrated that certain demographic and socioeconomic characteristics are associated with pre-hospital delay such as age, sex, history of CAD, hypertension and DM, proximity to the hospital, pain events prior to consultation and educational attainment. However, no correlation can be made between delay in time to treatment and clinical outcome.

Human ; Male ; Female ; St Elevation Myocardial Infarction ; Acute Coronary Syndrome ; Coronary Artery Disease ; Myocardial Infarction ; Hypertension ; Heart Failure

Introduction: Tibial plateau fractures are due to high energy trauma brought about by axial compression forces and associated varus or valgus component. Objective: Patients diagnosed with tibial plateau fractures from January to December 2018 treated with internal vs. external fixation will be described according to their Schatzker classification. The study further aims to compare the functional outcomes between the two groups in terms of surgery done. Methods: A chart review determined the distribution of demographics. The Modified Rasmussen Score (MRS) was used to determine the clinical and radiographic parameters after taking a new knee radiograph and assessment from the rehabilitation department. The MRS determined the functional outcomes of the said patients. Ethical considerations and proper informed consent were upheld after being reviewed by the hospital’s research committee. Results: Out of 48 patients, 35 underwent internal fixation via open reduction using plates and/or screws, while 13 underwent external fixation using hybrid external fixator. The demographic profile showed mostly males between ages 20 to 49 years old. Most cases were due to vehicular accidents affecting the left lower extremity. In terms of Schatzker classification, the most common was type VI. The computed mean MRS of the internal fixation group was 30.43 while the external fixation group was 30.00, generally showing no significant difference. Conclusion Surgical intervention of tibial plateau fractures aims for anatomic reduction using internal or external fixation. There was no significant difference on the functional outcome of the two groups despite classifying the respondents according to Schatzker type, hence we can conclude that external fixation be chosen as the treatment of choice for tibial plateau fractures when properly indicated.