Objectives: This study aimed to determine the effectiveness of N-acetylcysteine (NAC) in reversal of liver enzyme abnormalities among pediatric patients with dengue induced liver injury. Materials and Methods: The preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P 2020) declaration was used to create this systematic review. The study population included children (<18 years old) diagnosed with dengue-associated Liver Injury and given NAC. The outcome of interest was full recovery. A search was performed in PubMed/MEDLINE, EMBASE, Google Scholar, HERDIN PLUS, WPRIM, clinicaltrials.gov, and Cochrane databases on March 2023. The New Castle-Ottawa Quality Assessment Scale was adapted for risk of bias assessment for cohort studies. Results: Three case series and one pre-post cohort study published from 2013 to 2022 were included. The studies were of acceptable quality. In two studies with overall 10 pediatric patients given NAC for dengue-related ALF, all recovered without adverse events. In one study with 4 patients given NAC, half survived with their liver function tests returning to normal values. Finally, in one comparative study, the durations of time before the liver function tests returned to normal levels, and the mortality rates between those treated with and without N-acetyl cysteine were not significantly different. All studies reported no occurrence of adverse drug reaction related to NAC. Conclusion This systematic review shows limited evidence on the effectiveness of NAC in the reversal of liver enzymes among pediatric patients because of the low incidence of dengue induced liver injury seen in observational studies. Given that NAC is reported by all four studies to be accessible, effective, and with no attributable adverse events, its use can be considered. However, clinicians must still be cautioned given the limited available evidence.
Acetylcysteine

PURPOSE OF THE STUDY: Basal cell carcinoma (BCC) remains as the most common cutaneous neoplasm in the Philippines consisting of more than 60% of all skin cancers. Anacardium occidentale (Linn.) cashew extract, which had been used successfully in the removal of warts and moles in previous studies, is presented as a therapeutic option in BCC.
METHODS: An open-label prospective study was conducted on 36 patients (mean age of 65 years) with documented BCC lesions on middle third of the face. Cashew nut extract (DeBCC) application was offered to these patients as an alternative option to very unacceptable extirpative surgery offered by general and plastic surgeons as treatment for their lesions. Lesion size ranged from 7.5- 64 mm. (26.26 mm). Topical treatment was applied every 1-2 weeks, as needed. Follow-up examinations with photographic documentation were made every week to evaluate success of the treatment.
RESULTS: After a mean of 7 treatment applications (range of 1-20) all the lesions were undetectable on clinical examinations. Mild tingling sensation, which was reported by all patients during the treatment applications, was tolerable on all occasions. With follow-up ranging from 5-60 months (38.72 months), 16 patients completed the planned 5 - year post-treatment follow-up period. There were no recurrences detected.
CONCLUSIONS: Anacardium occidentale (Linn.) cashew extract (DeBCC) presents a viable and acceptable treatment option in primary BCC. The importance of this treatment option could be stressed in patients with lesions not amenable to the prescribed wide margin of resection needed in surgery.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Aged ; Anacardium ; Carcinoma, Basal Cell ; Humans ; Moles ; Neoplasm Recurrence, Local ; Nevus ; Nevus, Pigmented ; Nuts ; Philippines ; Prospective Studies ; Recurrence ; Sensation ; Skin Neoplasms ; Surgeons ; Warts ;

This is a case report of a pediatric patient with acute lymphoblastic leukemia and presenting with a rare finding of bilateral pulmonary calcification. The patient's pulmonary calcification was detected as an incidental finding during a routine bone scan performed to evaluate the patient's bone pains. Bone scintigraphy is one of the most sensitive and efficient modalities for detecting extra-osseous calcification.
Human ; Male ; Child Preschool ; PRECURSOR CELL LYMPHOBLASTIC LEUKEMIA-LYMPHOMA ;

The need to measure and improve quality in the health care management setting necessitates the development of performance standards. The drive for operating room (OR) efficiency has led administrators to investigate the anesthesia-controlled times (ACTs), which are the specific periods of anesthesia task completion including preparation for anesthetic induction, anesthetic induction itself and the wake up time or time to emergence from anesthesia.
OBJECTIVES: This study aims to conduct an internal benchmarking of ACTs using a secondary analysis of the data collected in a cross sectional survey of randomly selected elective surgical cases from October 2011 to January 2012, looking into the efficiency status of the operating room under the Department of Surgery of the Philippine General Hospital (PGH).
METHODS: Mean observed times for each of the milestone comprising the ACT were calculated taking in consideration the various anesthetic techniques, type of surgical procedures, duration of the operation and the anesthesiologist's experience. Analysis of variance and Fisher's exact test were used to determine the association of these factors with length of the ACT. For those where an association was noted, a multivariate analysis was done to determine its impact on the actual ACT.
RESULTS: Based on data from 539 cases, a set of benchmarks for ACT that better reflects the local setting, is proposed for the different surgical procedures and anesthetic techniques. This includes times for anesthesia preparation of 5 mins, anesthesia induction of 10 minutes and emergence times of 10 mins for total intravenous anesthesia; 20,15 and 15 mins for inhalational anesthesia; 15,10, 10mins for spinal anesthesia; 20, 25, 10 mins for epidural anesthesia and 10, 25, and 15 minutes for combined general-regional anesthesia.
CONCLUSION: It is imperative to standardize ATCs in order to reduce variability and improve efficiency. The first step in achieving this goal is to describe the standards in a particular institution, which in turn may be used as a benchmark by other institutions in a similar setting.

Anesthesia ; Multivariate Analysis ; Anesthesia, Epidural

INTRODUCTION: The operating room (OR) is one of the most cost-intensive units of any health care facility. Hence, OR effeciency has become a priority of many institutions. Delays in the OR lead to poor cost effectiveness and cause frustration both to patients and to OR staff.
OBJECTIVES: This study aims to describe the efficiency of the Philippine General Hospital Department of Surgery elective non-cardiac surgery operating room services using established parameters and identify causes of delays.
METHODS: A cross-sectional survey was conducted of randomly selected elective cases from October 2011 to January 2012. A framework of elements in the OR process and timing milestones were defined. These times were recorded during the OR process. Mean and median observed times for these elements were calculated and compared with target times based on previous research. Causes of delay were recorded.
RESULTS: Once anesthesia was started, target times for most parameters were met in the majority of cases. Delays were most notable between patient entry to the OR complex and start of anesthesia, particularly for first cases. Only 3.9% of cases started at or before the scheduled time; 49.7% of cases started more than one hour late. 54.3% of late starts were caused by surgeons not being in the OR complex on time. Errors in estimating case duration were commonplace: more than one third of cases took more than an hour longer or shorter than estimated. While the mean delay in start for first cases was nearly one hour, the mean delay for second and third cases was nearly two hours.
CONCLUSION: The majority of cases start late. The most common cause of delay is the surgeon's tardiness. Considerable discrepancy between the predicted and actual case duration was also observed.

Human ; Operating Rooms ; Cost-benefit Analysis ; Frustration ; Anesthesiology ; Anesthesia ; Efficiency ; Surgeons ; Hospital Departments

Background: Due to the increasing number of elderly patients being referred to anesthesia for surgical procedures, there is a growing interest with regard to the incidence of postoperative delirium and its contributing factors. Objectives: The primary objective of this study is to determine the incidence of postoperative delirium in the charity elderly patients at the Philippine General Hospital (PGH). Methods: The incidence of postoperative delirium was assessed in an analytic prospective study conducted at the PGH among elderly patients undergoing elective surgeries. Through interviews and chart reviews, the collected data focused on baseline intellectual status, age, gender, ASA classification, level of education, comorbidities, vices, previous surgeries, maintenance medications, preoperative diagnostics, duration of surgery, duration of anesthesia, type of anesthetic technique, and pain scores at the recovery room and 24 hours postoperatively. Responses to the Short Portable Mental Status Questionnaire (SPMSQ), the Preoperative and Postoperative assessment forms and the Confusion Assessment Method (CAM) instrument were analyzed. Results: It was observed that there was a 2.5% incidence of postoperative delirium in the study population and among the risk factors assessed, polypharmacy and presence of moderate to severe pain scores on the first day following surgery were significant contributors in its occurrence. Conclusion In this preliminary study, the incidence of postoperative delirium as well as the significant contributing factors were described. In succeeding investigations, it is recommended to extend the observation and follow-up periods.
Emergence Delirium ; Aged ; Incidence

Introduction: Zinc deficiency is of high magnitude in developing countries such as the Philippines. Zinc deficiency dermatitis is recognized through characteristic cutaneous presentation supported by diagnostic workups which may not be feasible or practical in low-resource settings. Case report: A three-month-old Filipino male was brought in for erosions of three (3) weeks duration that were unrespon- sive to topical and systemic antimicrobial treatment. On examination, he had multiple erythematous erosions with yellowish to brownish, crusted borders with predilection on the face, inguinal and gluteal areas, flexures of the extremities, and digits. Workup revealed normal zinc levels, decreased alkaline phosphatase, and bacterial growth in cultures. Histopathology revealed intraepidermal vesiculobullous dermatitis. Given the clinicopathologic presentation, a diagnosis of zinc deficiency-associated dermatitis was made. Along with antimicrobials and topical care, oral zinc sulfate with elemental zinc at 3 mg/kg/day was started, with remarkable improvement within three (3) days and near-resolution after eight (8) days of zinc therapy. Zinc supplementation was administered for three (3) months with gradual tapering. The skin remained clear despite the withdrawal of zinc supplemen- tation. Response to treatment supported the impression of zinc deficiency, while sustained skin clearance upon withdrawal verified an acquired etiology. Conclusion Zinc deficiency-associated dermatitis is more common in areas where costly diagnostic modalities are not readily available. In clinically suspected zinc deficiency, response to treatment can serve as a retrospective diagnostic feature, and sus- tained clearance upon withdrawal may aid in identifying etiology. Trial of therapy may then be considered in optimizing the cost-ef- fective management of zinc deficiency-associated dermatitis.
Malnutrition

INTRODUCTION: Stigmatizing attitudes are barriers to treatment of mental health disorders. The burden of stigma has not been established locally. This study aimed to assess the stigma in the community by determining the knowledge, attitudes and behaviors of barangay residents towards mental health and persons with mental health illness. METHODS: A total of 422 participants were included using convenience sampling. Participants were given self-administered questionnaires that consisted of the Mental Health Knowledge Schedule (MAKS), Community Attitudes Towards the Mentally Ill (CAMI), and Reported and Intended Behavior Scale (RIBS) tools. The mean scores and percentages were computed and compared across the sociodemographic data of the respondents. RESULTS: Knowledge levels were relatively high with a mean score of 26.63. Depression, stress, bipolar disorder and drug addiction were recognized as mental illnesses by the majority of the participants. Scores in the stigmatizing ideologies authoritarianism (3.07) and social restrictiveness (2.58) were low, while the positive ideologies benevolence (3.76) and community health ideology (3.85) had higher scores. Participants were reluctant to work with mentally-ill people (3.18) but were willing to be friends with them (3.87). CONCLUSION This study concludes that the respondents were generally knowledgeable about mental health illness. There was a general acceptance and less stigmatizing attitude, and a willingness to interact with people with mental illness.
psychiatry ; Mental health ; Social Stigma

OBJECTIVE

This study described the ophthalmic symptoms and signs in patients with nasopharyngeal carcinoma (NPCA).

METHODS

This was a retrospective, cross-sectional, descriptive study involving patients with histologically-confirmed NPCA seen in two subspecialty eye clinics in a single referral hospital from January 2014 to December 2018. Chart review obtained data on symptoms and ophthalmic findings of patients with NPCA on the first visit. Descriptive statistics was used to analyze the data.

RESULTS

There were 36 patients in the study. There were 27 males (75%) and mean age was 47 years (Range: 13 - 83). Delay to consult was marked, with 28 patients (78%) presenting later than three months; 19 (53%) had invasion to distant sites on presentation. Almost all of the patients (35/36 or 97%) had either diplopia or blurring of vision, with nasal symptoms as the most common extra-ophthalmic accompanying symptom. Multiple cranial nerve palsies, particularly optic nerve plus at least one ocular motor nerve, was a prominent feature. The combination of nasal symptoms with ophthalmoparesis was noted in 24 patients (67%) and was identified as a red flag for NPCA.

CONCLUSION

Blurred vision and diplopia were the most common ocular complaints of patients with NPCA who were evaluated at the ophthalmology department of a tertiary hospital. Blurred vision is frequently from optic nerve involvement while diplopia is due to ophthalmoparesis secondary to multiple ocular motor cranial nerves involvement. Male patients in their 40s who present with combination of optic neuropathy or ocular motor palsies should be probed for presence of otologic or nasal symptoms as well as neck masses as these are the common presentation of NPCA in the ophthalmology clinics.

Human ; Nasopharyngeal Carcinoma ; Ophthalmoplegia ; Ophthalmoparesis ; Diplopia

We report a 39-year-old male who had generalized tonic-clonic seizure with loss of awareness. Investigations led to a diagnosis of a left temporal lobe tumor. He underwent resection of the mass with consequent loss of brain tissue in the temporal lobe and was found to have a complete right homonymous hemianopia in the immediate postoperative period. Macular ganglion cell analysis on optical coherence tomography (OCT) showed homonymous thinning affecting the inferonasal sector in the right eye and inferotemporal sector in the left eye. This case demonstrates transsynaptic retrograde degeneration through the interruption of the inferior optic radiation, and its corresponding effect on the structure and function of the affected retinal field. Temporal lobe lesions may cause not only a homonymous visual f ield defect contralateral to the side of the lesion but also result to homonymous sectoral thinning of the macular ganglion cell complexes in both eyes located ipsilateral to the side of the lesion.
Human ; retinal ganglion cells ; hemianopsia ; temporal lobe