BACKGROUND & OBJECTIVE

Scabies, caused by the mite Sarcoptes scabiei var. hominis, is a highly contagious condition with significant public health implications. Standard treatments for scabies can be expensive, particularly in economically disadvantaged areas. This study aimed to determine the efficacy of 1% permethrin shampoo compared to the standard 5% permethrin lotion in treating scabies, assessing Total Lesion Count (TLC), Skin Infection Rating Scale (SIRS), clinical response, adverse events, and treatment acceptability.

This is an open-label, randomized clinical trial conducted in Barangay Malagutay, Zamboanga City, Philippines, involving 28 participants (14 per group). After dermatologic confirmation of diagnosis and a skin irritation test, participants were randomly assigned to receive either 5% permethrin lotion or 1% permethrin shampoo. Outcome measurements included Total Lesion Count (TLC) and SIRS, which evaluated erythema, crusting, purulence, itching, and pain. These were assessed on Days 0, 3, and 7. Clinical response, treatment acceptability, and adverse events were also monitored throughout the 7-day study period.

Results showed both treatments were effective with comparable outcomes on Day 3. Improvement in lesions, SIRS-erythema, crusting, purulence, pain, and itching was observed for both groups from Day 0 to Day 7. No significant difference was noted between the groups (p > 0.05) on Day 3. Both 1% and 5% permethrin treatments showed complete symptom resolution by Day 7, achieving 100% treatment success with 1% permethrin shampoo and 93% with the 5% permethrin lotion.

1% permethrin shampoo offers effective treatment for scabies, with comparable efficacy to 5% permethrin lotion.

Ewing’s sarcoma is a rare cancerous tumor of bone or soft tissue that usually occurs mostly in young adults. The diagnosis of Ewing’s sarcoma in pregnancy, most especially the subtype extraskeletal Ewing’s Sarcoma, is very rare with only few cases published in the literature worldwide. We present a case of a primigravida diagnosed with extraskeletal Ewing’s sarcoma at 6 weeks age of gestation. Currently, because of the rarity of this condition, there is lack of a universal consensus on the recommended therapeutic approach. A multidisciplinary management involving the generalist obstetrician, perinatologist, medical oncologist, and neonatologist was initiated at the outset to provide timely balance between optimal maternal treatment and fetal well-being. The maternal and fetal condition was stable all throughout the course of the chemotherapy using doxorubicin during pregnancy. Close interdisciplinary coordination regarding the treatment plans across these subspecialists resulted in a successful pregnancy outcome.

Objective: To assess the quality of care of telemedicine consultation during the COVID-19 pandemic at the Jose R. Reyes Memorial Medical Center in 2022. : Methods Design: Cross-Sectional Study Setting: Tertiary Government Training Hospital Participants: 210 patients Results: Majority of the respondents were female, less than 40 years of age, unemployed, consulted for the first time, lived < 25km distance from the hospital, consulted because of an ear problem, consulted without symptoms suggestive of COVID-19 and had higher outcomes of face-to-face consultation. The overall satisfaction with teleconsultation was good with majority of patients satisfied and very satisfied with teleconsultation (4.29±1.083). Occupational status, technical problems encountered in the teleconsultation, and those who were bothered by the absence of clinical examination were associated with the perceived quality of care of the ENT teleconsultation (p < .05). Among the population who were satisfied to ENT teleconsultation, 82 (43%) were from the working population (OR 2.2 [1.1-4.7]), 158 (95%) were satisfied with quality of response (OR 23.7 [9.4-59.8]) and 154 (93%) were satisfied with image quality (OR 16.9 [7.3-39.0]). Conclusion Teleconsultation for ENT has proven useful in terms of satisfying the urgent concerns of patients in a pandemic setting.
Telemedicine

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. METHODS: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR). RESULTS: We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR. CONCLUSION Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.
Humans ; Cross-Sectional Studies ; Pandemics ; COVID-19/epidemiology* ; Burnout, Psychological ; Health Personnel

Background: The lip trill is a semi-occluded vocal tract exercise found to have positive outcomes on vocal parameters of healthy individuals after a single session. However, the effect of several lip trill sessions has not been studied. Objective: This study investigated the effect of a 3- to 4-week lip trill exercise program on Maximum Phonation Time (MPT), Maximum Phonation Frequency Range (MPFR), Harmonics-to-Noise Ratio (HNR), and mean Speaking Fundamental Frequency (mean SFF). Methods: Three vocally untrained healthy females with perceptually normal voices participated in a multiple-baseline, single-case experimental research. Five to seven direct training sessions were randomly assigned. Self-implementation was encouraged thereafter. Participants were assessed on all outcome measures for 15 sessions. Data were visualized and inspected. Cohen’s d was also derived using Standardized Mean Difference for single-subject research. Results: Visual and statistical analyses revealed a decreased MPT when training was introduced, increased MPFR variability during the training phase, and increased stability in mean SFF post-training. Perceived effects include vocal freedom, decreased laryngeal stress, and vocal conditioning. Vocal outcomes in one participant yielded a significant effect on MPFR and mean SFF and a small effect on HNR. Conclusion There is evidence of lip trill effect on pitch control and vocal conditioning. Findings also revealed that motivation, exercise frequency, and adherence could contribute to positive gains in vocally healthy speakers. Further investigation in consideration of the study findings and limitations is warranted.
prevention

Background. Subacute sclerosing panencephalitis (SSPE) is a fatal neurodegenerative disease caused by prolonged persistent infection of the central nervous system with a measles virus mutant. Though various treatment modalities have been tried, there is no effective treatment to completely cure SSPE and new therapeutic strategies are needed.

Objective. This is a prospective uncontrolled observational open label trial to describe the short-term outcomes and safety of intraventricular ribavirin in combination with oral isoprinosine in Filipino SSPE patients.

Methods. Sixteen (16) unrelated SSPE patients between ages 3-26 years and in various clinical stages were included in this study. Demographic data were described. Intraventricular instillation of ribavirin (1-3 mg/kg/dose) through an Ommaya reservoir was given for a duration of 3-6 months in 13 patients. The duration of follow-up was 48 weeks. The clinical outcome was assessed before, during, and after treatment using the Neurological Disability Index (NDI), Brief Assessment Examination (BAE), and clinical staging using the Jabbour Classification. Adverse side effects from intraventricular ribavirin were enumerated.

Results. Six of 13 (46.15%) patients mostly in Stage III illness had clinical improvement showing decreasing NDI and BAE scores during treatment and the clinical improvement was maintained or improved further during the 48-week follow-up period. Clinical improvement manifested as improved mental alertness, decrease in spasticity and reduction of seizures. The clinical staging of those who improved remained stable during and after treatment was discontinued. Five (38.46%) patients in Stage II disease worsened and progressed to Stage III despite ribavirin therapy including 1 (7.6%) patient who died after the treatment phase due to pneumonia and brainstem failure. The clinical course of two (15.38%) patients remained unchanged. Minor adverse side effects of ribavirin included transient fever, rash, oral sores, seizure episodes, drowsiness, bladder retention and mild increase in transaminases. Ommaya reservoir infection was a serious adverse event in 5 (31.25%) patients.

Conclusion. There is still no definitive cure for SSPE. Although ribavirin may help alleviate some of the symptoms of SSPE and prolong life, it may not reverse or halt the progression of the disease. Long term follow-up of these patients and continuous use of intraventricular ribavirin will better clarify its role in modifying the fatal course of SSPE. The role of ribavirin in Stage I patients and a controlled clinical trial in Stage II SSPE needs further studies.

Objective: To describe a makeshift blue light filter for endoscopic visualization of a traumatic cerebrospinal fluid leak repair using intrathecal fluorescein and its application in one patient. Methods: Study Design:Surgical Instrumentation Setting:Tertiary Government Training Hospital Patient:One Results: Intra-operative endoscopic identification of fistulae sites was achieved using intrathecal injection of fluorescein that fluoresced using our makeshift blue light filter in a 43-year-old man who presented with a 3-month history of rhinorrhea due to skull base fractures along with multiple facial and upper extremity fractures he sustained after a fall from a standing height of 6 feet. He underwent transnasal endoscopic repair of cerebrospinal fluid fistulae in the planum sphenoidale, clivus and sellar floor. Post-operatively, there was complete resolution of rhinorrhea with no complications noted. Conclusion Our makeshift blue light filter made from readily available materials may be useful for endoscopic identification of CSF leaks using fluorescein in a low- to middle-income country setting like ours.
Human ; Male ; Adult (a Person 19-44 Years Of Age) ; Skull Fracture, Basilar ; Cranial Fossa, Posterior

INTRODUCTION: Okra is reported to have anti-diabetic effects, but the literature shows conflicting results. The experiment aimed to determine the efficacy of three doses of okra seed powder suspension as a glucose lowering agent on streptozotocin-induced diabetic rats and its cellular effects on the liver and pancreas. METHODS: Twenty-five Sprague Dawley rats that were given streptozotocin 60 mg/kg intraperitoneally were randomly allocated to one of five treatment groups: okra seed powder at 100 mg/kg, 150 mg/kg and 200 mg/kg, acarbose (positive control) and vehicle only (negative control). The treatments were given as a 1.5 mL oral gavage daily for 21 days. Significant differences in blood glucose were determined between treatment groups in terms of relative change from baseline, using One-Way ANOVA with Dunnett’s method with acarbose as the referent group. Repeated measures ANOVA was used to analyze the blood glucose levels across the time point collections (baseline, T1 and T2). Histopathologic changes on the liver and pancreas were described using counts and proportions. RESULTS: Mean blood glucose values increased from baseline to T2 in all treatment groups. Increasing trend was observed only up to T1 in the 150 mg/kg and the 200 mg/kg okra seed treatment groups. Comparing okra treatment groups to acarbose, the percentage increase of mean blood glucose from baseline to T2 was lowest in the 200 mg/kg okra group (p = 0.040). The okra-treated rats had no fatty change and a dose-dependent decrease in cellular degeneration in the liver and none for the 200 mg/ kg treatment group. CONCLUSION The 200 mg/kg okra suspension has a potential lowering effect on blood glucose and a hepatoprotective effect. A longer period of observation with higher doses of okra suspension is recommended to study these effects further.

Soil-transmitted helminth (STH) infections, mainly caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms, are among the most common intestinal parasites that infect humans. The infections are widely distributed throughout tropical and subtropical countries, including Malaysia, particularly in underprivileged communities. Microscopic and culture techniques have been used as a gold standard for diagnostic techniques. However, these methods yield low sensitivity and specificity, laborious and time-consuming. Therefore, simple, rapid, and accurate alternative methods are needed for the simultaneous detection of STH infections. Although advanced technologies such as real-time multiplex PCR have been established, the use of this technique as a routine diagnostic is limited due to the high cost of the instrument. Therefore, a single-round multiplex conventional PCR assay for rapid detection of four STH species in the fecal sample was developed in this study. To perform the single-round multiplex PCR, each pair of species-specific primers was selected from target genes, including Ancylostoma duodenale (Internal Transcribed Spacer 2; accession No. AJ001594; 156 base pair), Necator americanus (ITS 2; accession No. AJ001599; 225 base pair), Ascaris lumbricoides (Internal Transcribed Spacer 1; accession No. AJ000895; 334 base pair) and Trichuris triciura (partial ITS 1, 5.8s rRNA and partial ITS 2; accession No. AM992981; 518 base pair). The results showed that the newly designed primers could detect the DNA of STH at low concentrations (0.001 ng/μl) with no cross-amplification with other species. This assay enables the differentiation of single infections as well as mixed infections. It could be used as an alternative and is a convenient method for the detection of STHs, especially for the differentiation of N. americanus and A. duodenale.

Objective. The study evaluates the clinical profile of patients who underwent coronary artery bypass graft surgery (CABG) under the Philippine Health Insurance Corporation (Philhealth) Z Benefit Package (PZBP), as well as time intervals between PZBP screening, approval, and timing of surgery. Methods. A review of medical records was done to collect data on time intervals between the screening process and Philhealth approval in CABG patients under PZBP. The clinical profile and surgical outcomes of patients were also evaluated. Results. Sixty-three patients were included from March 2017 to December 2018. Most patients were under 61-70 years old. Hypertension was the most commonly observed comorbidity. Time intervals were analyzed including identification for surgery to eligibility screening (2–217 days, median 25 days), Philhealth approval (8–266 days, median 20 days), and surgery (9-403 days, median 33 days). Postoperative atrial fibrillation was seen in 22.58%. The most commonly observed complication prolonging hospitalization was pneumonia. Conclusion. This is the first local study which evaluated the timelines of PZBP. Results may be use as basis of follow up study in the future for identification of an acceptable timeline intervals. Several modifiable factors affecting time intervals were identified for further improvement of healthcare services. The leading cause of increase length in hospitalization were HAP and AF.
Coronary Artery Disease ; Vascular Diseases ; Vascular Surgical Procedures ; National Health Programs