BACKGROUND AND OBJECTIVES

The demographic background, level of knowledge, and attitude of caregivers are pillars of care in dementia. Family and non-family members take on this role. Studies have been done on their knowledge and attitude, but none have focused on them during hospitalization, wherein greater stress is imposed on both the caregiver and the patient. This study aims to determine the profiles, and its association with knowledge, and attitudes of caregivers of hospitalized patients with dementia in a tertiary hospital in Metro Manila.

A single-center descriptive cross-sectional design using Demographic profile Questionnaire, Alzheimer’s Disease Knowledge Scale (ADKS), and Dementia Attitude Scale (DAS) were used on Filipino caregivers of inpatients with dementia in Metro Manila. Simple and multivariable linear regression were used to assess demographic factors in relation to the attitude and knowledge of the caregivers.

Eighteen females with a mean age of 49 (SD=8) years old participated. Ten participants completed college. Six (33.3%) of the respondents were family members, five (27.8%) were occupational caregivers, four (22.2%) were house-helps, and two (11.1%) were nurses. Majority (66%) had 3-10-year duration of caregiving. Mean score of knowledge scale is 21.17 out of 30. Age, education, caregiver role, and attitude were positively associated with knowledge. The mean score for attitude level is 119.83 out of 140. Age, education, duration, caregiving role, patient’s age, and knowledge were positively associated with attitude; with education being statistically significant (p=0.046).

Caregivers exhibited reasonable knowledge for such caregivers to carry out their duties on inpatients with dementia at an adequate level, with several factors correlating positively, indicating areas for improvement. Their attitude scores revealed positive disposition; with education emerging as statistically significant. Continuing education and targeted interventions can further enhance quality of caregiving.

Background: Retinoblastoma is the most common intraocular cancer in childhood in the Philippines. Most data though on demographics, clinical profile, treatment options, and outcomes in the country are from the National Capital Region. Objectives: This study aimed to describe the demographics, clinical profile, treatment done, and outcomes of retinoblastoma patients seen in a public tertiary referral center in Davao from 2011-2020 to make available literature more representative of the status of retinoblastoma in the Philippines. Methods: An analytical cross-sectional study was conducted using the records of retinoblastoma patients seen in a tertiary government hospital located in Davao Region from January 2011 to December 2020. Results: There were 157 patients included in the analysis. Seventy-three (46%) were female with 44% coming from the Davao Region. One hundred seven (69%) patients had unilateral disease. Median age at initial consultation for patients with unilateral disease was significantly older than those with bilateral disease (p<0.003). Tumors were extraocular in 82 (40%) eyes. In the intraocular group, 36% of the eyes belonged to International Classification of Retinoblastoma (ICRB) Groups D and E. Enucleation was the most commonly performed treatment. Survival rate was 28%. This is the first report to provide epidemiologic and clinical data on retinoblastoma in the literature, including survival data, from Mindanao. Advanced stages and extraocular cases of retinoblastoma remain high. Delay of consultation contributed to the prognosis and clinical outcome of the disease. Conclusion. Advanced stages and extraocular cases of retinoblastoma remain significantly high in the country, even in Mindanao.
Retinoblastoma ; Therapeutics ; Survival Rate

Background: There are various attitudes regarding their child's screen usage. However, there are no existing Filipino-translated and culturally appropriate questionnaires or assessment tools that can measure a child's media exposure, screen use, and parental attitude. The Media Exposure Survey is an assessment tool that measures a child’s media exposure, screen use, and parental attitudes regarding their child’s screen usage. Objectives: The study aims to contextualize and translate the questionnaire into Filipino, determine its content validity and internal consistency, and check the translated questionnaire's compatibility and applicability. Methods: The study involves four steps: 1) content validity testing, 2) forward and backward translation and equivalence, 3) pilot testing of the pre-final version, and 4) reliability resting. Data analysis was done to evaluate the content validity and internal consistency of the questionnaire. Thirty-six parents of children aged 0-5 in Metro Manila pilot tested the tool. Results: A cross-culturally adapted version of the Media Exposure Survey has been produced with good content validity. The S-CVI of the questionnaire is 95%, which is excellent. The parental attitude towards childhood media use subscale has an acceptable internal consistency with a Cronbach's alpha of 0.77. Conclusion The translated and adapted Media Exposure Survey has good content validity and acceptable internal consistency and can be used to assess Filipino children’s media exposure, screen use, and parental attitudes toward media use.
Surveys and Questionnaires ; Screen Time ; Psychometrics

Background and Objectives: The demographic background, level of knowledge, and attitude of caregivers are pillars of care in dementia. Family and non-family members take on this role. Studies have been done on their knowledge and attitude, but none have focused on them during hospitalization, wherein greater stress is imposed on both the caregiver and the patient. This study aims to determine the profiles, and its association with knowledge, and attitudes of caregivers of hospitalized patients with dementia in a tertiary hospital in Metro Manila. Methods: A single-center descriptive cross-sectional design using Demographic profile Questionnaire, Alzheimer’s Disease Knowledge Scale (ADKS), and Dementia Attitude Scale (DAS) were used on Filipino caregivers of inpatients with dementia in Metro Manila. Simple and multivariable linear regression were used to assess demographic factors in relation to the attitude and knowledge of the caregivers. Results: Eighteen females with a mean age of 49 (SD=8) years old participated. Ten participants completed college. Six (33.3%) of the respondents were family members, five (27.8) % were occupational caregivers, four (22.2%) were house-helps, and two (11.1%) were nurses. Majority (66%) had 3-10-year duration of caregiving. Mean score of knowledge scale is 21.17 out of 30. Age, education, caregiver role, and attitude were positively associated with knowledge. The mean score for attitude level is 119.83 out of 140. Age, education, duration, caregiving role, patient’s age, and knowledge were positively associated with attitude; with education being statistically significant (p=0.046). Conclusion Caregivers exhibited reasonable knowledge for such caregivers to carry out their duties on inpatients with dementia at an adequate level, with several factors correlating positively, indicating areas for improvement. Their attitude scores revealed positive disposition; with education emerging as statistically significant. Continuing education and targeted interventions can further enhance quality of caregiving.
dementia ; caregiver burden ; attitude ; knowledge ; Philippines

BACKGROUND

Chronic kidney disease (CKD) poses a global health threat with significant morbidity and mortality. Despite current therapies, there is a need for innovative interventions to slow CKD progression. Probiotic supplementation shows promise due to its positive effects on gastrointestinal health and inflammation. However, existing research is inconclusive, necessitating a meta-analysis to assess probiotics’ impact on CKD outcomes.

To evaluate the existing scientific literature among probiotic supplementation and the improvement in glomerular filtration rate (GFR) among chronic kidney disease (CKD) patients compared to placebo treatment.

A comprehensive search of electronic databases was conducted to identify relevant studies published up to 2023. Studies that meet the predefined eligibility criteria were included. Data extraction was performed, and methodological quality and risk of bias assessment was conducted for each study. Effect measures, such as mean differences or standardized mean differences, were used to quantify the association between probiotic supplementation and GFR improvement. The random-effects model was applied to estimate the overall effect size, and subgroup analyses were performed to explore potential sources of heterogeneity. Publication bias was assessed, and sensitivity analyses was conducted to evaluate the robustness of the findings.

The meta-analysis encompassed three randomized controlled trials (RCTs) conducted from 2017 to 2023, involving 121 chronic kidney disease (CKD) patients. The analysis focused on the impact of probiotic supplementation on CKD, examining Glomerular Filtration Rate (GFR), Blood Urea Nitrogen (BUN), and Urine Protein Creatinine Ratio (UPCR). While no significant distinctions were found in GFR and BUN changes between probiotics and placebos, there was a statistically significant reduction in UPCR associated with probiotic supplementation in one study. Notably, considerable heterogeneity in GFR and significant heterogeneity in UPCR reduction were observed among the trials. Sensitivity analysis, excluding studies with small sample sizes or high bias risk, remained consistent with overall findings.

The meta-analysis indicated no significant impact of probiotic supplementation on GFR and BUN, but there was a notable reduction in Urine UPCR. The observed heterogeneity among the studies calls for cautious interpretation due to variations in study designs, patient populations, and probiotic formulations. While the results suggest a potential role for probiotics in reducing proteinuria in chronic kidney disease (CKD) patients, the need for further research with larger sample sizes and standardized methodologies is emphasized to establish definitive conclusions.

OBJECTIVE

This study compared the demographics, clinical profile, treatment, and outcomes of retinoblastoma patients seen at medical institutions in the Philippines between two time periods: 2010 to 2015 and 2016 to 2020.

This was a multicenter, analytical, cohort study using review of medical charts and databases of retinoblastoma patients seen in 11 medical institutions from 2010 to 2020.

There were 636 patients (821 eyes) included in this study: 330 patients were seen in 2010 to 2015 while 306 in 2016 to 2020. More cases per annum were seen in the latter timeline. The number of patients with unilateral disease was not significantly different between the two time periods (p=0.51). Age at onset of symptom, age at initial consultation, and delay in consult were also not significantly different between the two time periods (p > 0.05). Patients had significantly different distributions of intraocular grades (p < 0.0001) and systemic staging (p < 0.0001) between the two time periods. Enucleation was the most common surgical treatment performed in both timelines. There was significant difference in the status of patients based on the need for systemic chemotherapy (p < 0.01). There was significant difference in outcome between the two time periods, including the proportions of living and deceased patients.

This study compared the most comprehensive data on retinoblastoma patients in the country. There was no improvement in early health seeking behavior based on similar age at initial consult and delay in consult. Enucleation remained the most common treatment mode as opposed to chemotherapy due to similar percentage of patients with unilateral disease, an indication for enucleation rather than chemotherapy.

After cutaneous and neurological manifestations, bone and joint involvement are the most common manifestations in Hansen’s disease (HD). Sometimes, these are undiagnosed and rarely reported.

A 68-year-old Filipino, male, presented with an 8-month history of digital joint swelling on both hands. He was initially managed by Rheumatology for arthritis, partially responsive to Methotrexate and Prednisone. Immunology and lupus panel tests were unremarkable. Skin biopsy done on a solitary erythematous plaque on the back revealed granulomatous dermatitis, tuberculoid type. Fite-Faraco, AFB, PAS stains were negative. Four weeks later, he developed multiple erythematous papules and plaques on the face, ears, lower back, gluteal area, and lower extremities. Arthritis was persistent but hypoesthesia, hypohidrosis or alopecia were not reported. A repeat skin biopsy showed epithelioid to macrophagic cell granulomatous reaction compatible to HD. AFB stain and slit skin smear were positive. He was managed as a case of Borderline (BB) to Borderline Lepromatous (BL) leprosy and was started on multibacillary drug treatment (MDT) of Rifampicin, Clofazimine and Dapsone. One month later, the patient reported resolution of skin lesions and arthritis.

Approximately 75% of individuals with HD experience arthritis, which can be one of the early signs of disease. A high index of suspicion is required as it closely mimics other rheumatologic conditions.

Diabetic hand syndrome, also known as diabetic cheiroarthropathy, is a disorder marked by limited joint movement and features resembling scleroderma. Scleroderma-like skin changes are frequently linked to uncontrolled diabetes, in contrast to limited scleroderma, which typically manifests with a prior history of Raynaud’s phenomenon. This underscores the fact that scleroderma-like is often underdiagnosed and can mimic both autoimmune and microvascular disorders.

In this report, we presented a case of a 58-year-old diabetic female with a 1-year history of gradual stiffening of the fingers with frequent episodes of white-blue discoloration. Physical examination revealed multiple ulcers on sausage-shaped fingers, erythematous thick plaques topped with crust on the palms with associated induration, thickening, and a positive prayer sign. Biopsy of the palms and digits shows thickened collagen bundles in the superficial to deep dermis. Alcian blue was positive. Blood chemistry showed elevated glycosylated hemoglobin and fasting glucose. Immunoassays were negative for ANA, RF, anti-dsDNA, anti-RNP, anti-SM, anti-SSA, SCL70, and anti-CENP. Treatment with potent corticosteroid twice daily was started concurrently with the initiation of insulin by the endocrinologist.

Our case highlights the importance of early recognition of scleroderma-like cutaneous manifestations, whose close relationship to diabetes mellitus affects its overall morbidity. Prompt screening for endocrinopathy will help in early treatment initiation and prevent further complications.

Congenital syphilis is a worldwide public health concern. This occurs when an infected mother transmits the infection to the fetus during pregnancy or at birth.

We present a case of a 6-day-old male, term, born to a mother with secondary syphilis, via normal spontaneous delivery. Upon birth, patient was well and not in cardiorespiratory distress. However, cutaneous examination revealed multiple, well-defined vesicles and pustules on an erythematous background, some topped with erosions and crusts on the scalp, face, extremities, and trunk. Laboratory work-up and imaging were done which revealed congenital syphilis. He was managed with intravenous Penicillin (100,000iu) 160,000 IV for ten days, and wound healing was hastened by use of a coconut-based cellulose wound dressing on the erosions. He was then referred to a multispecialty team to assess and co-manage possible complications. Regular interval follow-up and repeat laboratory tests were advised for observation and for monitoring.

Congenital syphilis is caused by the bacterium Treponema pallidum. Sequelae include preterm birth, low birth weight, skin lesions, bone deformities, hepatosplenomegaly, anemia, and neurological problems. Diagnosis can be made on clinical suspicion combined with Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL). Aside from Penicillin G, wound care, nutritional build up, and close monitoring of growth and development with regular follow-ups are essential aspects in the management of congenital syphilis. With timely and adequate treatment, infants have a higher likelihood of complete resolution of symptoms, prevention of long-term complications, and improved overall health outcomes.

Introduction: The Hearing for Life (HeLe) is a novel newborn hearing screening device initially designed according to specifications of clinicians of the Philippine National Ear Institute (PNEI). Unfortunately, targeted end-users, rural health workers, had difficulty using it. This research applied the user-centered design (UCD) methodology involving rural health workers in recommending design, content, and function requirements for HeLe. Objectives: This study aims to 1) describe how UCD was applied in a time-limited and resource-constrained environment, 2) assess the usability of the design prototypes, and 3) recommend design, content, and function requirements for HeLe. Methods: This research is a descriptive study using mixed methods. Six rural health units (RHU) involved in the HeLe research program were purposively selected for the study. There were 30 participants included, five health care workers per RHU. Applying the UCD method, the study had three phases: 1) user profiling (where participants accomplished a survey questionnaire, 2) inspiration phase (focus group discussions, workflow analysis, and interviews with a technical expert were conducted), and 3) ideation phase (designing and assessment of prototypes were done). Results: Participatory methods and structured procedures (i.e., card sorting, MoSCoW matrix prototyping, etc.) were applied to help determine and prioritize user requirements and elicit user feedback. These methods were chosen considering the time and resource constraints in the RHU. The prototype's System Usability Scale (SUS) score (81.94) was higher than the SUS score previously obtained (68) from the older version of the interface. Accuracy, durability, in-app instructions, feedback, and an easily understood interface were the most requested requirements for the telemedicine device. The need for the technology to be aligned with the RHU's workflow and available resources was highlighted in the focus group discussions. Conclusions The study documents practices and lessons learned in applying UCD methodology in design and development that have been demonstrated to improve usability of the device. The involvement of the users surfaced in the design, content, and functional requirements which can guide future iterations of HeLe and contribute to better understanding of ways to develop user-friendly telemedicine devices in the Philippines. This paper emphasizes that users should be involved in the entire process and not just recipients of the technology.
User-Centered Design ; Digital Technology ; Telemedicine