1.A systematic review on the effectiveness of N-acetylcysteine in children with dengue-associated liver injury
DJ G. Leañ ; o ; Meadina G. Cruz
The Philippine Children’s Medical Center Journal 2024;20(1):46-58
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
2.Cashew nut extract (De BCC) in the treatment of basal cell carcinoma.
Talens Eric SM. ; Ocampo Orlando O. ; de la Paz Daniel A. ; Estrada Horacio R. ; dela Paz Daniel A. ; Tica Porfirio P. ; dela Cruz Rolando C. ; dela Cruz Lydia B. ; dela Cruz Richard B. ; dela Cruz Leonor B. ; dela Cruz Rommel B. ; dela Cruz Lorena B. ; dela Cruz Lelalee B.
Acta Medica Philippina 2010;44(1):4-9
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 ;
3.Pulmonary calcification detected by bone scintigraphy in a pediatric case of acute lymphoblastic leukemia
Dela Cruz Karina Michaela ; Pascual Thomas Neil B ; Conlu Raymund Augustus O ; Magboo Vincent Peter C
The Philippine Journal of Nuclear Medicine 2012;7(1):30-32
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
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Male
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Child Preschool
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PRECURSOR CELL LYMPHOBLASTIC LEUKEMIA-LYMPHOMA
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4.Bechmarking anesthesia-controlled times at a tertiary general hospital in the Philippines.
Cruz Particia Lorna O. ; Prudente Emmanuel S. ; Lapitan Marie Carmela M.
Acta Medica Philippina 2015;49(4):62-68
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
5.Efficiency status of the elective non-cardiac surgery operating rooms of the Department of Surgery of the Philippine General Hospital.
Lapitan Marie Carmela M. ; Buckley Brian S. ; Abalajon Donna D. ; Cruz Patricia Lorna O. ; Raymundo Maria Eliza M.
Acta Medica Philippina 2013;47(4):30-35
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
6.Treatment response as a diagnostic feature in zinc deficiency-associated dermatitis in a three-month-old Filipino male: A case report
Sher Claranza O. Liquido ; Jamaine Melisse L. Cruz-Regalado
Journal of the Philippine Dermatological Society 2022;31(2):52-54
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
7.Incidence of postoperative delirium among elderly patients after elective surgeries under anesthesia in the charity services of the Philippine General Hospital
Rosa Mistica L. Hermoso ; Patricia Lorna O. Cruz
Acta Medica Philippina 2024;58(9):7-21
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
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Aged
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Incidence
8.A study on the knowledge, attitude and behavior regarding mental health of residents in a selected barangay
Richard Dean Clod C. Dela Cruz ; Kelvin Michael G. Dela Cruz ; Micah Jeanne A. Dela Rosa ; Maria Kristina P. Descalzo ; Andrew Carlo F. Dioso ; Angelica Mae Camille P. Dizon ; Ellen Stephanie M. Dizon ; Vince Gabriel B. Dulay ; Justine William T. Duran ; Felicitas Asuncion C. Elago ; Nicole Pauline L. Ereñ ; o ; Angela B. Escobia ; Karl Lorenzo Miguel M. Escovidal ; Miraflor A. Espeleta ; Franciosa Gavino-Collins
Health Sciences Journal 2020;9(2):53-59
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
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Mental health
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Social Stigma
9.Clinical pathway for the diagnosis and management of patients with COVID-19 in family practice
Maria Victoria Concepcion P. Cruz ; Noel L. Espallardo ; Policarpio B. Joves Jr. ; Anna Guia O. Limpoco ; Jane Eflyn Lardizabal-Bunyi ; Nenacia Ranali Nirea R. Palma-Mendoza ; Michael Ian Sta Maria ; Jake Cortez ; Mark Bitong ; Johann Montemayor
The Filipino Family Physician 2021;59(2):128-145
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
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Family Practice
10.Clinical practice guideline and pathways for the evaluation and management of patients with dizziness in family and community practice
Endrik H. Sy ; Haydee D. Danganan ; Anna Guia O. Limpoco ; Ma. Rosario Bernardo-Lazaro ; Jake Bryan Cortez ; Rosemarie I. Galera ; Rosie Ann C. Copahan ; Marco Neoman Dela Cruz ; Leanna Karla Lujero ; Jena Angela Perano ; Noel L. Espallardo
The Filipino Family Physician 2022;60(2):333-352
Background:
Dizziness is a commonly encountered symptom in the primary care which can be caused, most of the time by benign condition and rarely due to serious conditions needing higher level of care.
Objective:
To develop a clinical guideline and pathway that will serve as guide in the diagnosis and management of adult patients with dizziness in primary care and outpatient setting
Methods:
A guideline development team was formed which is composed of family and community medicine specialists from different institutions. Searching, selection and assessment of the latest evidence on dizziness diagnosis and management was done using the search terms: “dizziness”, “diagnosis”, “management”, and “primary care”. Formulation of the recommendation was done using Grade approach and graded with modified GRADEPro and expert panel consensus. External review was also done by an expert in otorhinolaryngology.
Recommendations:
Clinical Assessment •Recommendation1.Askforthepatient’sdescriptionofdizzinessandclassifythepatientintooneofthefourtypes: vertigo, presyncope, disequilibrium, and lightheadedness and classify as acute/episodic or chronic/sustained. (Strong Recommendation, Low Quality Evidence) •Recommendation2.Obtainamedicalhistoryfocusingonthetiming,triggers,associatedsymptoms,riskfactorsfor atherosclerotic vascular disease, and functional status or quality of life. (Strong Recommendation, High Quality Evidence) •Recommendation3.Performaphysicalexaminationfocusingonvitalsigns,HEENT(includingotoscopy),cardiovascular and neurologic examination. (Strong Recommendation, High Quality Evidence) •Recommendation4.PerformspecialphysicalexaminationslikeDix-Hallpikemaneuverforacuteepisodictriggeredvertigo to check for BPPV (most common cause of peripheral vertigo), HINTS plus test for spontaneous episodic vertigo to check for stroke and hyperventilation provocation test for patients suspected of anxiety (Strong Recommendation, High Quality Evidence) •Recommendation5.Elicitredflagsthatshouldwarrantreferrallikeseveredizzinessandassociated,alteredmentalstatus, loss of consciousness and abnormal vital signs. Other symptoms like chest pain, palpitations, dyspnea, neurologic deficit may warrant referral for evaluation and management. (Strong Recommendation, High Quality Evidence) •Recommendation6.Forpatientsconsultingviatelemedicine,obtainamedicalhistoryfocusingonthetiming,triggers, associated symptoms, risk factors for atherosclerotic vascular disease, and functional status or quality of life, and observe and conduct self-physical examination (vital signs, mental status, ocular and facial nerve) (Strong Recommendation, Low Quality Evidence) Diagnostic •Recommendation7.Laboratorytestingisnotroutinelyrecommendedamongpatientswithdizziness.However,testingmay be requested if there is a need to identify a definite etiology to guide treatment and should be guided by the classification of dizziness, possible etiology, and the medical history and physical examination. (Strong Recommendation, High Quality Evidence).Recommendation8.Forpatientswithvertigoandwithauditorysymptoms(i.e.,hearingloss,tinnitusandauralfullness, etc.), pure tone audiometry speech test may be requested if available. (Strong Recommendation, High Quality Evidence) •Recommendation9.Forpatientswithpresyncope/syncopeandachronicmedicalconditionisbeingconsidered,complete blood count may be requested for those with probable blood dyscrasia, serum blood glucose may be requested for those with diabetes, electrocardiogram and lipid profile may be requested for those with cardiovascular disease. (Strong Recommendation, High Quality Evidence) •Recommendation10.Forpatientswithdisequilibriumandwithanabnormalneurologicphysicalexaminationfinding,CT scan may be requested. (Strong Recommendation, High Quality Evidence) Pharmacologic •Recommendation11.Empirictrialofshortcourse(7days)pharmacologictreatmentforsymptomreliefshouldbeoffered. Referral should be considered if the dizziness become more severe or it did not improve in 7 days. (Strong Recommendation, High Quality Evidence) •Recommendation12.Forpatientswithmildtomoderatevertigo,offerhistamineanalogue(betahistine)orantihistamine (meclizine, diphenhydramine, dimenhydrinate or cinnarizine) for symptom relief. (Strong Recommendation, High Quality Evidence) •Recommendation13.Forpatientswithmildtomoderatevertigoassociatedwithmigraine(vestibularmigraine),aside from symptom relief, offer any of the triptans as preventive medication. (Strong Recommendation, High Quality Evidence) •Recommendation14.Forpatientswhosedizzinessisdescribedasdisequilibrium(gaitimbalance)orpresyncope(near faintness) or dizziness with anxiety attack, offer symptomatic treatment and intervention based on the underlying cause or consider referral to appropriate specialist. (Strong Recommendation, High Quality Evidence) Non-pharmacologic •Recommendation15.Allpatientsshouldbeprovidedwithhealtheducationoncauses,triggersandfollowup.(Strong Recommendation, Low Quality Evidence) •Recommendation16.Allpatientsshouldbeadvisedonappropriatedietandlifestylemodification.(StrongRecommendation, Low Quality Evidence) •Recommendation17.Dependingonthenatureofvertigo,educateandtrainthepatientoncanalrepositioningmaneuver and vestibular rehabilitation. Referral to rehabilitation medicine may be considered. (Strong Recommendation, High Quality Evidence) •Recommendation18.Thepatient’sfamilymustalsobeprovidedwithhealtheducationandidentifyacaregivertoassist and promote compliance to management. (Strong Recommendation, Low Quality Evidence) •Recommendation19.Encouragecommunity-basedvestibularrehabilitationactivitiessuchasgroupbalancetraining exercise. (Strong Recommendation, Low Quality Evidence) Patient Outcomes •Recommendation20.Thepatientshouldknowthenatureofdizziness,causesandpotentialcomplicationsanddevelop skills in postural exercises. (Strong Recommendation, Moderate Quality Evidence) •Recommendation21.Decreaseinfrequencyandseverityshouldexpectedwithin48hoursandresolutionisexpectedwithin a month. (Strong Recommendation, Moderate Quality Evidence) •Recommendation22.Improvedqualityoflifeshouldalsobeelicited.(StrongRecommendation,ModerateQualityEvidence) •Recommendation23.Referraltoappropriatespecialtyshouldbedoneifnoresolutionorprogressionofsymptomsor impaired quality of life for more than a month. (Strong Recommendation, Expert Opinion)
Implementation
The committee shall disseminate the guidelines through presentations and via journal publications. The QA committee shall be in charge of implementation of the guideline and pathway.
Community Health Services
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Dizziness
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Partnership Practice