OBJECTIVE: To design a cost effective, handy, easy to fabricate, ergonomic nasal speculum with a built-in light source. DESIGN: Instrumentation SETTING: Tertiary Government Hospital MATERIALS AND METHODS: Two 3cc syringes were mounted on each side of a nasal speculum to serve as battery cases for the two 1.5 volts battery. A laryngoscope bulb, connected to a metallic plate, made from the two long arms of a paper fastener, was then suspended from the speculum screw, with the bulb positioned in between the speculum blades. An electric wire connected the batteries and the metallic plate. The upper negative pole wire was connected to a ballpen spring and was glued near the fulcrum. The device illuminates automatically with opening of the speculum blades. RESULTS: Nasal speculite provided comparable visualization of the nasal cavity as that with a nasal speculum with head mirror and light source. The illumination was adequate and there was no more need for light focusing. There were no complaints of discomfort from the subjects. CONCLUSION: The Nasal speculite is a cost effective, handy, easy to fabricate ergonomic instrument that can be used by the ENT specialist at his/her own convenience, obviating the need for head mirrors and light source, in the examination of the nasal cavities. (Author)
NASAL CAVITY SURGICAL INSTRUMENTS

OBJECTIVE: To measure macular and peripapillary retinal-nerve-fiber-layer (RNFL) thickness in normal Filipinos using optical coherence tomography (OCT). METHODS: This observational, cross-sectional study included 362 normal eyes of 181 Filipino participants, 16 to 55 years old, who underwent a detailed ophthalmic examination, automated perimetry, and digital image scanning of the macula and the optic disc by OCT. The macula and RNFL thickness were measured using standard protocols. Paired t-test and linear-regression analyses were used to analyze the data. Conclusion: Macular thickness in Filipinos follows the general patterns of age- and gender-related differences among other racial groups. The data also suggest that Filipino RNFL is thinner compared with those of other racial groups.
Human ; Middle Aged ; Adult ; Adolescent ; TOMOGRAPHY ; TOMOGRAPHY, OPTICAL ; TOMOGRAPHY, OPTICAL COHERENCE ; RETINA ; MACULA LUTEA ; FOVEA CENTRALIS

Background: The coexistence of acute kidney injury (AKI) in sepsis contributes significantly to morbidity and mortality rates. Traditional diagnostic markers still pose variable limitations in early AKI prediction. The use of renal angina index (RAI) as a clinical predictive tool for AKI is an emerging concept. Objectives: To determine the diagnostic accuracy of RAI in predicting AKI in patients with sepsis Methodology This is a five-year retrospective cohort study conducted at the Philippine General Hospital (PGH). Records of eligible patients with sepsis were reviewed. RAI was calculated based on the composite of risk factors and clinical evidence of injury on day 0 of admission stratifying subjects into two groups: RAI (-) and RAI (+) for those with scores ≥ 8. Prediction of AKI with the RAI was analyzed.
Acute Kidney Injury ; Sepsis

Objectives. This study aimed to describe baseline and follow-up prevalence and intensity of soil-transmitted helminth (STH) infections, nutritional status and school performance of school-age children in Cebu City. By measuring these parameters, it also aimed to monitor the progress of a local government unit-led, school-based, schoolteacher-assisted deworming initiative. Methods. Grade three and grade four pupils from two selected school districts in Cebu City were chosen as participants. Kato-Katz technique was used to assess helminth infections. All positive slides and 10% of all negative slides were re-examined blindly by a reference microscopist for quality control. Secondary anthropometric and school performance data were also obtained from the Department of Education. Results. Baseline results showed cumulative prevalence and prevalence of heavy intensity infection of 73.1% and 44.3%, respectively, which were significantly lower during follow-up at 56.5% (p < 0.0001) and 26.5% (p < 0.0001), respectively. School performance improved in District B, with an 8.8% increase in mean percentage score from baseline to follow-up. There was no marked difference between baseline and follow-up proportions of pupils with below normal weight-for-age and height-for-age. Conclusions. The positive results merit continuation of the school-based STH control initiative in Cebu City. Improvements in water supply and sanitation, promotion of good hygiene and health education are important in minimizing risks of infection and re-infection.
Human ; Male ; Female ; Child ; INTESTINAL HELMINTHIASIS ; ENVIRONMENT AND PUBLIC HEALTH ; PUBLIC HEALTH ; SANITATION ; SANITARY ENGINEERING ; WATER SUPPLY

Objective: To measure the levels of environmental noise in the medical intensive care unit, surgical intensive care unit, and adult ward of the Makati Medical Center for the morning, afternoon, and evening shifts, on weekdays and weekends, and to compare noise levels across shifts, and between weekdays and weekends. Methods: Design: Environmental Noise Survey. Setting: Tertiary Private Training Hospital. Participants: None. Results: The overall mean environment noise levels in all the areas surveyed (medical intensive care unit, surgical intensive care unit and adult ward) exceeded World Health Organization recommendations by more than 20 dB across different working shifts on both weekdays and weekends. There was no significant difference in noise levels between weekdays and weekends across shifts in all areas, except for the afternoon shift in the Medical ICU. Using Repeated Measures ANOVA, results showed that there is no sufficient evidence to conclude that at least one shift has significantly different mean noise level in any of the 3 areas (MICU: F(2)=4.73, p-value=.1124; SICU: F(2)=7.91, p-value=.0540; WARD: F(2)=2.73, p-value=.1948) Conclusion The overall environmental noise levels in the different areas of MICU, SICU and Adult ward exceeded the WHO recommendation. It is recommended that a change in strategy is needed for prevention of environmental noise, setting guidelines and policies to assure quality health care and noise control. Further investigations to ascertain exact sources may give rise to feasible solutions.
Noise ; Hospitals ; Sound ; Intensive Care Units

Monitoring the concentration of antibiotics in body fluids is essential to optimizing the therapy and minimizing the risk of bacteria resistance,which can be made with electrochemical sensors tailored with appropriate materials.In this paper,we report on sensors made with screen-printed electrodes(SPE)coated with fullerene(C60),reduced graphene oxide(rGO)and Nafion(NF)(C60-rGO-NF/SPE)to determine the antibiotic metronidazole(MTZ).Under optimized conditions,the C60-rGO-NF/SPE sensor exhibited a linear response in square wave voltammetry for MTZ concentrations from 2.5×10-7 to 34×10-6 mol/L,with a detection limit of 2.1×10-7 mol/L.This sensor was also capable of detecting MTZ in serum and urine,with recovery between 94％and 100％,which are similar to those of the standard chromatographic method(HPLC-UV).Because the C60-rGO-NF/SPE sensor is amenable to mass pro-duction and allows for MTZ determination with simple principles of detection,it fulfills the requirements of therapeutic drug monitoring programs.

Aneurysm, Dissecting/surgery* ; Aorta, Thoracic/surgery* ; Aortic Aneurysm, Thoracic/surgery* ; Blood Vessel Prosthesis Implantation ; Humans ; Hypnotics and Sedatives ; Treatment Outcome

Background: Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, causing a pandemic. The Philippines ranks 3rd in Southeast Asia with more than 15,000 confirmed cases, and a case fatality rate of 6.01%, close to the global average of 6.33%. Objective: This clinical pathway was developed to guide family and community physicians on the diagnosis and initial management of COVID-19 in terms of 1) clinical history and physical examination; 2) laboratory and ancillary procedures to be requested; 3) pharmacologic interventions; 4) non-pharmacologic interventions, and 5) patient outcomes to expect. Method: The PAFP Clinical Pathways Group reviewed the published medical literature to identify, summarize, and operationalize the evidence in clinical publication on the management of patients with COVID-19 in family and community practice. Recommendations: The recommendations are time-bound tasks on patient care processes, in terms of history and physical examination, laboratory tests, pharmacologic and non-pharmacologic interventions. The recommendations are presented as a table and algorithm. Implementation At the clinic level, self-audit using the recommendations of this clinical pathway as the standard may be done. At the organizational level, the PAFP should establish a new model of quality improvement initiative where self-practice audits are included as part of the program.
COVID-19 ; Family Practice

Objective: Excess mortality is an indicator of the impact of the coronavirus disease (COVID-19) pandemic. This study aims to describe excess mortality in the Philippines from January 2020 to December 2021 using an online all-cause mortality and excess mortality calculator. Methods: All-cause mortality datasets from 2015 to 2021 from the Philippine Statistics Authority were obtained and analysed using the World Health Organization Western Pacific Regional Office All-Cause Mortality Calculator. Expected mortality, excess mortality and P-scores were obtained using two models, 5-year averages and negative binomial regression, for total deaths and by administrative region. Results: Reported national all-cause mortality exceeded the expected mortality in August 2020 and from January to November 2021, peaking in September 2021 at 104 per 100 000. Total excess mortality using negative binomial regression was -13 900 deaths in 2020 and 212 000 deaths in 2021, peaking in September 2021. P-scores were -2% in 2020 and 33% in 2021, again peaking in September 2021 at 114%. Reported COVID-19 deaths accounted for 20% of excess deaths in 2021. In 2020, consistently high P-scores were recorded in the National Capital Region from July to September and in the Bangsamoro Autonomous Region in Muslim Mindanao from June to July. In 2021, most regions recorded high P-scores from June to October. Discussion: Tracking excess mortality using a robust, accessible and standardized online tool provided a comprehensive assessment of the direct and indirect impacts of the COVID-19 pandemic in the Philippines. Furthermore, analysis by administrative region highlighted the key regions disproportionately affected by the pandemic, information that may not have been fully captured from routine COVID-19 surveillance.

Context: Vulvar cancers are rare gynecologic tumors. Ultrasound can characterize primary tumors and guide the biopsy of suspicious nodes. Currently, there are no studies on the sonologic features of different vulvar cancer types. Aims: The aim is to determine the sonologic features of different vulvar malignancies. To compare the accuracy of ultrasound in identifying lymph node status. Settings and Design: This is a retrospective descriptive study. Subjects and Methods: Patient records, ultrasound images, and reports of vulvar cancer with long‑ and short‑axis (L/S) ratio of inguinal nodes were reviewed from the year 2010 to 2019. Statistical Analysis Used: The accuracy of ultrasound to detect lymph nodes and the correlation of L/S ratio to histopathology were done. Results: The study included 49 patients. The most common histopathologies were squamous cell carcinoma (SCCA), vulvar melanoma (VM), and adenocarcinoma (ADCA). Most tumors were > 4 cm, unifocal, and lateral in location. SCCA, verrucous carcinoma, VM, ADCA, adenosquamous carcinoma (ASCA), eccrine carcinoma (ECCA), and carcinosarcoma (CS) were irregular heterogeneous masses. Leiomyosarcoma (LMS) and proximal‑type epithelioid sarcoma (PES) were regular, heterogeneous masses. Paget’s disease of the vulva (PDV) was hypoechogenic with regular borders. Vascularities were absent in PDV and LMS, minimal in ECCA, moderate in ASCA and PES, moderate to abundant in CS, and variable in VM. The accuracy of ultrasound in detecting lymph nodes was 78%; the accuracy of the L/S ratio was 75%. Tumor border and FIGO stage showed significant association with histopathologic type. Conclusions Sonologic features and accuracy of ultrasound in predicting lymph node status help prognostication in vulvar cancer. Nodal morphometric studies are recommended for future researches.
Vulvar Neoplasms