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

OBJECTIVES: In this study, the KAP were determined among all medical residents in a tertiary hospital in the Philippines during the pandemic.

METHODOLOGY: Questionnaires were completed by the medical residents which contained 14 questions on clinical characteristics and prevention of COVID-19. Assessments on attitudes and practices included questions on confidence in winning against COVID-19 and wearing masks when going out.

RESULTS: Among the 63 participants, 90.4% were female, 92 % were single and 69.8% younger than 30 years old. The overall correct rate of the knowledge questionnaire was 85.5%. Most did not have confidence (63.5%) on winning the battle against COVID-19 and most had not visited any crowded place (58.7%) and wore masks when going out (95.2%). Logistic regression analysis showed a significant correlation of knowledge scores and practice rates on going to crowded places (OR 1.72, CI (1.02-2.91) P<0.05)

CONCULUSIONS: The medical residents had good knowledge scores on clinical presentation, transmission and prevention control measures on COVID-19. Although attitude rates were poor, practice rates on COVID-19 were good. Furthermore, knowledge on COVID-19 resulted to good practices on not going to crowded places and wearing masks before leaving their houses.

Human ; Male ; Female ; Adult (a Person 19-44 Years Of Age) ; Pulmonary, Knowledge

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

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 report a case of acute bilateral facial nerve palsy in a 24-year-old woman and to present the differential diagnoses, pathophysiology, management and prognosis.

METHODS:

Design: Case study

Setting: Tertiary Private Hospital

Patient: One (1)

RESULT: A 24-year-old woman with fever, joint pains, cough, chest pain, difficulty ambulating and progressive facial muscle weakness was diagnosed with rheumatic fever. Bilateral facial nerve paralysis was noted, and Electromyography-Nerve Conduction Velocity (EMG-NCV) testing with special facial nerve study revealed abnormal facial nerve and blink reflex studies while EMG-NCV of the upper and lower limbs were normal. Audiometry and MRI of the brain and facial nerve were normal while Schirmer's Test showed decreased tearing in both eyes. The rheumatic fever resolved within 5 days of antibiotics, while Prednisone and physiotherapy resulted in improvement of facial paralysis from House Brackmann V to House Brackmann II-III over a period of 6 months.

CONCLUSION: Idiopathic facial paralysis or Bell's Palsy is the most common cause of acute unilateral facial paralysis while bilateral facial nerve paralysis is a rare condition. Patients with facial palsy should undergo appropriate diagnostics to determine the underlying condition and to facilitate prompt management.

Human ; Male ; Female ; Adult (a Person 19-44 Years Of Age) ; Facial Paralysis, Idiopathic ; Bell’s Palsy

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

BACKGROUND: Human immunodeficiency viruses (HIV) / Acquired immunodeficiency syndrome (AIDS) is one of the most significant public health challenges in Surabaya, Indonesia where the greatest number of people living with HIV/AIDS (PLWHA) among key populations is in areas served by Sememi Public Health Center. HIV-infected persons have a greater risk for developing dental caries, such as salivary gland enlargement, and decreased salivary glands function. Given the fact that PLWHA are at high risk of dental caries, utilization of dental health service among PLWHA are still low.

OBJECTIVE: This study aims to know the factors influencing dental caries in HIV/AIDS patients.

METHODS: This is a descriptive, cross-sectional study conducted on 16 HIV-seropositive individuals. They were asked to complete a WHO questionnaire concerning basic oral health and quality of life. Dental caries was assessed using the Decayed, Missing, and Filled Teeth (DMFT) index. Whole stimulated saliva samples were also collected.

RESULTS: Nine out of 16 respondents had low salivary flow rate (56.3%). One patient had low DMF-T score (6.3%) and eight had high DMFT score (50%). Among seven respondents who had normal salivary flow rate (43.8%), two of whom had low DMFT score (12.5%) and five of whom had high DMFT score (31.3%).

Human ; Male ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Hiv ; Acquired Immunodeficiency Syndrome ; Oral Hygiene ; Dental Caries ; Saliva

BACKGROUND: Population aged 60 years old and above are growing in number; a fact that will have an impact on general and oral health in the future. Oral health is often overlooked in the management of geriatric patients but it is vital to have a knowledged-based practice in order to increase the quality of life of elderly patients.

OBJECTIVE: The purpose of this study is to determine the number and types of oral mucosal lesions in geriatric patients who come to the Universitas Airlangga Dental Hospital.

METHODS: This is an observational descriptive study with cross-sectional design. Intraoral soft tissue examination was performed on geriatric patients coming to the hospital between March and December 2018.

RESULTS: One hundred twenty-four (124) new geriatric patients came to the hospital. A total of 152 oral lesions from 63 geriatric patients (50.81%) were identified.  Overall, coated tongue (55.56%) was the most frequently detected lesion, followed by linea alba buccalis (31.74%) and lingual varicosities (26.98%).

CONCLUSION: Coated tongue or white tongue is the most frequently detected oral mucosal lesion, often caused by poor oral hygiene. The dentist should be able to recognize and differentiate them from the worrisome lesions and decide on the appropriate treatment in geriatric patients.

Human ; Male ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Mouth Mucosa ; Geriatric Dentistry ; Geriatrics

Ovarian cancer is the second most common gynecologic cancer worldwide and the six most common cancer among females. Germ cell tumorbs are the most common ovarian neoplasm in the first two decades of life constituting approximately two-thirds of all ovarian tumors. Malignant germ cell tumors constitute one-third of germ cell origin tutors and two-thirds of all ovarian malignancy in this age-group. This paper presents a case of a 19 year-old nulligravid who presented at the emergency room with abdominal pain, and was intraoperatively diagnosed with yolk sac tutor of the right ovary, stage 1A mature cystic teratoma of the left ovary. She subsequently underwent unilateral salpingooophorectomy and contralateral oophorocystectomy, left. Patient is advised chemotherapy postoperatively, with Bleomycin, Etoposide and Paclitaxel. This paper discusses the incidence, risk factors, prognosis and management of yolk of sac tutor in a young nulligravid.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Yolk Sac Tumor