Background: Inadequately treated postoperative pain can contribute significantly to morbidity in women undergoing cesarean section.  Recent studies showed that nalbuphine and fentanyl has promising result as neuraxial adjuvants in terms of postoperative analgesia and with lower incidents of adverse effect when use in cesarean section. 

Objective: To determine the effectiveness of postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl as neuraxial adjuvants in cesarean section. 

Methods:  A meta-analysis following the PRISMA guidelines was performed.  Articles were searched through the Cochrane Library, PubMed.Gov and Pubmed Central, Google Scholar, HERDIN, WPRIM and ProQuest Guideline Central using different search strategies such as keywords and MeSH term.  Cochrane version 2 risk-of-bias tool for randomized trials (RoB 2) was used to assess for quality.  Quantitative data were pooled and analyzed using Review Manager 5.4. 

Results: A total of four trials, involving 425 full term pregnant women were analyzed. The pooled mean difference showed significantly longer duration of postoperative analgesia (MD=21.12 minutes, 95%CI=11.13,31.11, I2=73%), pooled risk ratio showed lesser risk for pruritus (RR=0.09, 95%CI=0.02,0.50, I2 = 0%) and postoperative nausea and vomiting (RR=0.38, 95%CI= 0.19,0.78, I2 = 11%) who received intrathecal nalbuphine compared to intrathecal fentanyl. 

Conclusions: The results of this meta-analysis demonstrates that the use of intrathecal nalbuphine appears to have a better outcome in increasing the duration of postoperative analgesia and with lesser incidence of PONV and pruritus than fentanyl.  However, due to the presence of heterogeneity it warrants that the results should be treated with caution especially with the possibility of publication bias. 

Recommendations: Better literature search through inclusion of high-quality studies from relevant databases and strict adherence on the uniformity of the dosage and methods used are very crucial to achieve the target clinical outcomes and minimize the publication bias. 

Human ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Cesarean Section ; Nalbuphine ; Fentanyl ; Meta-analysis

Covid-19 which was first documented in the Philippines in January 2020 had spread alarmingly. Severe acute respiratory symptoms were the most common presentation of this novel coronavirus infection. Reports have described neurologic manifestations of this disease involving the central nervous system as well as the peripheral nervous system. However, studies among the pediatric population are limited. In this paper, we present three pediatric patients who were diagnosed with COVID-19, via RT-PCR, presenting with seizures and behavioral changes. Two of these patients have no concomitant respiratory symptoms while the other one had Pediatric Community Acquired Pneumonia. These patients were managed as cases of acute viral meningoencephalitis and were given supportive care.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Pulmonary, Seizures, Pneumonia

Objective: To determine the prevalence of hearing loss and otologic diseases among Filipinos living in the Southern Tagalog Region IV-A: CALABARZON (Cavite, Laguna, Batangas, Rizal and Quezon), Philippines.

Methods:

               Design: Retrospective Review of Community Survey Data

               Setting: Communities in Region IV-A provinces, Philippines

               Participants: 3267 residents of the five provinces aged 0 months and above

 Results: About 71.29% and 74.60% had at least mild hearing loss, in right and left ears, respectively. For disabling hearing impairment, overall prevalence was 26.33%, distributed into 11.87% among 4 to 18-year-olds; 8.97% for 19 to 64-year-olds; and 3.17% for 65-year-olds and above. Absence of prevalent and hearing loss-associated diseases: serous otitis media [OR 0.362, 95% CI 0.167 to 0.782, p = .010], CSOM [OR 0.407, 95% CI 0.236 to 0.703, p = .001] COM [OR 0.229, 95% CI 0.106 to 0.494, p < .001] can decrease the risk for hearing loss development in the region. Prevention of noise-induced hearing loss or delay in the manifestation of presbycusis can reduce the risk of having hearing loss by as much as 75% [OR 0.253, 95% CI (0.180 to 0.355), p < .001]. All pure tone audiometry measurements were obtained with surrounding median ambient noise of 55dB (IQR 46 to 60dB).

Conclusion: The prevalence of hearing loss among surveyed residents of the Southern Tagalog Region IV-A provinces was high compared to the previous nationwide study but low compared to other low- and middle-income countries. The top otologic conditions of this population (ear occlusion with ear wax, chronic suppurative otitis media, chronic otitis media, presbycusis, noise-induced hearing loss) were associated with hearing loss and their absence decreased the risks for hearing impairment.

Human ; Male ; Female ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Prevalence ; Hearing Loss ; Pediatrics ; Adult ; Presbycusis ; Otoscopy ; Otolaryngology

BACKGROUND: The dengue vaccine controversy in the Philippines caused significant public anxiety affecting childhood vaccines, as well as other healthcare programs. An assessment of parental perception and attitude on childhood immunization and other government healthcare programs after the dengue vaccine controversy is lacking

OBJECTIVE: To determine the perception and attitude of parents on childhood immunization and other government health care programs after the dengue vaccine controversy at a tertiary pediatric hospital.

METHODOLOGY: A hospital-based cross-sectional survey was done at a tertiary pediatric hospital. A total of 96 subjects participated in the study. Parents with children ages 9 to 18 years old whose child was either vaccinated or non-vaccinated with dengue vaccine seen in the dengue clinic, outpatient department and private clinics were invited to answer the structured questionnaire. Proportional stratified sampling was employed. Mann Whitney U-test compared the perception and attitude scores between parents of children who were recipients and non-recipients of dengue vaccine. A p-value of

RESULTS: The overall perception and attitude of parents on childhood immunization, deworming and vitamin A supplementation did not differ significantly between parents of non-dengue vaccinated children and dengue-vaccinated children. Sociodemographic factors such as gender, marital status, educational attainment, employment, and economic status did not differ significantly in their perception and attitude in terms of childhood immunization, deworming and vitamin A supplementation.

CONCLUSIONS: The overall perception and attitude of parents in both groups showed no significant difference toward childhood immunization, deworming and vitamin A supplementation. There is no association with the overall perception and attitude of parents on childhood immunization, deworming and vitamin A supplementation and their sociodemographic factors. RECOMMENDATIONS: Future similar studies may be conducted in other regions to determine parental perception and attitude towards the government's immunization program and other health care programs.

Human ; Male ; Female ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Dengue Vaccines ; Immunization

BACKGROUND: Increasing incidence of natural and man-made disasters emphasize the need to assess home disaster preparedness of pediatricians.

OBJECTIVES: To determine degree of family disaster preparedness and association of demographic characteristics of active consultants of a tertiary hospital for children in Quezon City.

METHODS: Cross-sectional study where participants were selected using purposive type of sampling. Fifty-eight active consultants for children answered a self-administered questionnaire on home disaster preparedness. Data was analyzed using SPSS version 24.0.

RESULTS: Total of 36 (62.06%) participants scored 70 and above, indicating family disaster preparedness. A total of 22 (37.94%) participants scored below 70, indicating lack of home disaster preparedness. The age of participants 35 to 40 (OR 108.57), 41 to 45 (OR 36.01), 51 to 55 (OR 11.4) and 56 to 60 (OR 17.93) are more likely to be family disaster ready (p value <0.05). Male participants were 7 times more likely to have higher overall family disaster preparedness.

CONCLUSIONS: This study has shown that 36 consultants in a tertiary hospital for children in Quezon City are prepared for home disasters. Males and younger population are the demographic characteristics associated with an increased degree of family disaster preparedness.

RECOMMENDATIONS: Basics of home disaster management should be included in continuing medical education of the hospital staff. Health education management system should encourage participation of hospital staff in disaster management programs. Bigger sample size of the pediatric society is recommended. Determine association of other demographic variables on home disaster preparedness. Address issues to overcome response bias.

Human ; Male ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Health Education ; Disaster Planning

BACKGROUND: Falls in the hospital are preventable. Prevention of fall requires cooperation from the health care provider, caregivers, as well as the hospital administration. This study was done to utilize standard reminders for fall to increase the awareness of health care providers of a tertiary hospital for children.

OBJECTIVES: To determine the effectiveness of the Patient Fall Prevention Reminder Checklist in increasing the awareness of health care providers of patients admitted at the Philippine Children's Medical Center.

METHODOLOGY: After obtaining permission to use an established Patient Fall Prevention Reminder checklist from the Intermountain Health Care (USA), participants were recruited after giving their informed consent. A pre-test was conducted to gauge the awareness and practices of the participants in preventing falls in the hospital. After the pre-test, the tool was introduced and discussed by the author to the participants. After 7 days, the participantswere followed up to take the post-test. Data collected were encoded then analyzed throughdescriptive statistics.

RESULTS: There were one hundred twenty-one (121) respondents with 42 males and 79 females. There is an increase in awareness in fall prevention amongthe residents and nurses, based on their pre and post-test examination results. The midwives had previous awareness in preventing falls even prior to the study.

CONCLUSIONS AND RECOMMENDATIONS: The checklist served as an effective tool in increasing the awareness of most study participants. We recommend the establishment of an institutionalized Fall Prevention Reminder Checklist at the Philippine Children's Medical Center for use by health care personnel.

Human ; Male ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Accidental Falls

OBJECTIVE: To determine the prognostic value of surgical interventions done among patients with anaplastic thyroid carcinoma (ATC)

METHODS: A five-year retrospective chart review of 25 patients was done and baseline characteristics determined. Patients discharged alive as of the time of last chart entry were followed up by phone interview or personal visit. Overall survival was the main outcome measure which was plotted as Kaplan-Meier estimates and compared via log-rank test. The incidence of complications surrounding tracheostomy and thyroidectomy were also noted.

Methods:

Design: Ambispective Cohort Study

Setting: Tertiary National University Hospital

Participants: All private and public (charity) patients seen at the wards or clinics diagnosed with ATC via fine needle cytology or tissue histopathology.

RESULTS: All patients presented with either stage IV-B or stage IV-C disease. A significant difference in survival curves was noted when comparing between the two stages (p<.05). Subgroup analysis per stage revealed no significant difference in overall survival when comparing patients who did not undergo surgery, those who underwent tracheostomy or those who underwent thyroidectomy for both IV-B (p=.244) or IV-C (p=.165) disease. The incidence of complications for tracheostomy was 60%, the most common being mucus plugging. For thyroidectomy, the incidence of complications was 80% with hypocalcemia being the most common.

CONCLUSION: The current available data fails to demonstrate any significant survival advantage of tracheostomy or thyroidectomy when performed among similarly staged patients.

Human ; Animal ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Anaplastic Thyroid Cancer ; thyroidectomy ; tracheostomy ; survival

A 50-year-old single Filipino woman was referred to our clinic by the Dermatology Department due to multiple large nevi on the face. Her history started 29 years prior to consult when a 0.5 cm by 0.5 cm nevus appeared on her right lower eyelid. Excision of the mass and histopathology revealed basal cell carcinoma of the skin and she ceased followup visits. Meanwhile, progressively enlarging nevi appeared over multiple sites of her face. Some of the lesions developed ulceration and occasionally bled. Finally, she consulted again at our institution due to disfiguring multiple large nevi, and was seen by Dermatology and Ophthalmology services and underwent excision biopsy revealing basal cell carcinoma. She was then referred to us for definitive surgical management

The patient was a non-smoker, non-alcoholic beverage drinker and work did not undergo any prolonged sun exposure. She recalled that her mother had a similar condition and expired due to complications of the disease

Physical examination revealed many large nevi over multiple sites of the face, the largest over the left nasolabial area. (Figure 1A) There were hyperpigmented nevi over the central forehead and left infraorbital area, and the patient's left eye was closed due to scarring from the previous excision in the left medial canthal area. (Figure 1B) An ulcerating lesion that occasionally bled, involved multiple subsites of the nose. (Figure 1C)

Due to the recurrent multiple basal cell carcinoma on the face, we suspected a possible syndromic disease. Complete systemic physical examination revealed multiple nevi over the chest and back as well as plantar and palmar pits. (Figure 2A, B) Chest radiography revealed an incidental finding of a bifid third rib on the left. (Figure 3) With these findings, we diagnosed her condition as Gorlin-Goltz syndrome with multiple basal cell carcinoma on the face.

Our goal of treatment was complete excision of tumors with preservation of function and cosmesis. Following the National Comprehensive Cancer Network (NCCN) Guidelines1 surgical excision with frozen section for adequate margins was performed. (Figure 4) Reconstruction with multiple skin grafts was performed to cover the defects. However, graft failures were noted over multiple sites two weeks post-operatively. (Figure 5) 

Our patient continued to follow-up for a year but declined any offers of reconstructive surgery. She maintained a good disposition and was satisfied with her appearance despite a less than ideal aesthetic postoperative outcome. (Figure 6)

DISCUSSION Nevoid Basal Cell Carcinoma or Gorlin-Goltz Syndrome is a rare autosomal dominant syndrome with near complete penetrance and extreme variable expressivity.2,3 This was first described in depth by Doctors Robert Gorlin and Robert Goltz in 1960. Genetic mutation in PTCH1 and SUFU that are related with the Hedgehog signalling pathway were identified in the pathogenesis of this disease.2 GorlinGoltz syndrome commonly presents with dermatologic, odontogenic and neurologic findings and affected patients have developmental anomalies and predisposition to cancer, specifically basal cell carcinoma (BCC). The incidence of Gorlin-Goltz syndrome ranges from 1 in 50,000 to 1 in 560,0004 with only one published case reported in the Philippines.5

To establish the diagnosis of Gorlin-Goltz syndrome, either one major and two minor criteria or two major criteria must be fulfilled.6,7 Our patient presented with multiple BCC, bifid third left rib and palmar and plantar pits, fulfilling three major criteria.

Only 67% of patients diagnosed with Gorlin-Goltz syndrome present with basal cell carcinoma with an equal male to female ratio.8 The mean age of BCC presentation in Gorlin-Goltz syndrome is roughly 25 years old and the probability of developing increases with age.9 There are racial differences in the occurrence of BCC; higher in Caucasians than in African-Americans and Asians.6,8 However, BCC in patients diagnosed with Gorlin-Goltz syndrome have the same histology and presentation as sporadic cases.

Palmar and plantar pits are among the common dermatologic findings in Gorlin-Goltz syndrome. These lesions are found in 45% to 87% of Gorlin-Goltz syndrome and the percentage rises with age.6 The presence of palmar and plantar pits in a child should prompt a complete physical evaluation due to its association with other diseases.

A bifid or forked rib is a developmental abnormality in which the sternal end is cleaved in two. This may be asymptomatic and is oftentimes an incidental finding, and can be observed as an isolated defect or may be associated with other multisystem malformations. In the general population, it was reported to occur at 3 to 6.3 per 1,000.10 Among the rib anomalies, bifid rib occurs in 28% of cases.11 In GorlinGoltz syndrome, it occurs in 36.4% of cases.12

Gorlin-Goltz Syndrome has a wide spectrum of presentations varying from livable symptoms until adulthood to detrimental complications even during childhood. Since this is a genetic mutation, there is no cure for disease and treatment is symptomatic. In our case, there is higher chance of recurrence or new lesions that may require multiple surgical procedures in the future. Other lesions associated with this syndrome may still appear and immediate consultation is advised to prevent complications. Genetic counselling is highly advised since it has high inheritance.

In summary, our experience taught us that a high index of suspicion for syndromic disease and a complete physical examination are especially important in such cases. The diagnosis and management are challenging, and should consider the biopsychosocial context of the patient. As long as full disclosure of the condition is made and all options are clearly communicated, the patient's wishes should be respected.

 

Human ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Gorlin Goltz Syndrome

Background and Objective: Cadavers are the main teaching and learning tools utilized by faculty and students of Gross Anatomy. The conventional procedure of using formalin to preserve cadavers has its limited benefit due to its obnoxious odor, darkened color, indistinguishable small structures, rigid joints, with friable organs and tissues. Using the Thiel Method, cadavers are known to have: life-like presentation, a high degree of suppleness, natural mobilization of various body parts with tolerable odor, natural color, and antimicrobial and antifungal efficacy. The aim of this study was to compare the Thiel soft-embalmed cadaver and the formalin-preserved cadaver for use in Gross Anatomy dissection.

Materials and Method: Six formalin-preserved cadavers were compared with six Thiel soft-embalmed ones and were evaluated by 160 first year medical students and 10 faculty members of Gross Anatomy from the University of the Philippines College of Medicine using a visual analogue scale that evaluated the cadaver's presenting color. A Likert scale was utilized to assess the skin and muscle texture, blood vessel integrity, odor, joint flexibility, and state of cadaver preservation. Their perceptions on the ease of the dissection process, distensibility, and differentiation of structures were also elicited through a questionnaire checklist.

Results: Results show that the Thiel Method-preserved cadavers were rated higher compared to the formalinpreserved cadavers in terms of: 1) presenting color; 2) tolerable odor; 3) skin and muscle texture; 4) blood vessel integrity; 5) joint flexibility; and 6) state of cadaver preservation after 1 year. However, the ease of the dissection process, the distensibility of structures, and the differentiation of the various structures were easily managed in the formalin-preserved cadavers while the feasibility of practicing laparoscopy, endoscopy, and intubation were seen in the Thiel soft-embalmed cadavers. Results validate the claims of previous studies on the advantages presented in using the Thiel Method.

Conclusion: Cadavers preserved utilizing the Thiel Method are life-like and can be used for Gross Anatomy dissection. The data gathered support the feasibility of using them also in research and training.

Human ; Male ; Female ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age)

BACKGROUND: In 2017, there were sixty people who identified themselves as lesbian, gay, bisexual and transgender/ transsexual (LGBT) people in Sememi Public Health Center, and seven of them were known to be people living with HIV/AIDS (PLWHA). People who are at high risk for HIV infection, especially the LGBT people and Female Sex Workers, are at even greater risk of developing a number of severe periodontal diseases. Periodontal problems, such as periodontitis, in HIV patients, are more severe and occur more frequently than uninfected patients. However, data on dental visit in Sememi Public Health Center as the primary health center in Sememi district is still limited, and there is still no data regarding periodontal health status among HIV patients.

OBJECTIVE: The aim of this study is to investigate the relationship between HIV/AIDS and periodontal health status among the population who are at high risk of HIV/AIDS in Sememi Public Health Center area.

METHOD: This study was conducted with a cross-sectional design. The sample size was determined using a total sampling technique and came up with 30 participants.

CONCLUSION: Population with a high risk of HIV/AIDS in Sememi Health Center area in Surabaya City has poor periodontal status, due to a large number of bleeding on probing (BOP), periodontal pocket depth, and loss of attachment (LOA). There is no significant difference between BOP results and pocket depth between the HIV and non-HIV groups. But a significant difference was found between LOA in the HIV and non-HIV groups. On the contrary, we found that there is no significant relationship between HIV/AIDS and xerostomia in this study.

Human ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Periodontitis ; Hiv ; Acquired Immunodeficiency Syndrome