Acta Medica Philippina最新文献

Myeloid sarcoma is a tumor that demonstrates extramedullary proliferation of myeloid blasts with or without maturation. It may present as an isolated tumor or may have peripheral or marrow involvement. The diagnosis of myeloid sarcoma is highly challenging as it may mimic other tumors. A 71-year-old woman with an Eastern Cooperative Oncology Group (ECOG) performance score of 2 presented with a progressively enlarging right facial mass that had been growing for 18 months. Initially, it appeared as a 1x1 cm erythematous pustular lesion. A core biopsy suggested carcinoma, but COVID-19 delayed immunohistochemical (IHC) testing. As the mass grew, eventually covering more than half of her face, a CT scan revealed a large, multilobulated mass involving the periorbital areas, nose, and upper lip. A repeat biopsy showed atypical round cell proliferation, and immunohistochemical staining confirmed myeloid sarcoma with CD34 and CD117 positivity. Bone marrow aspiration and biopsy ruled out leukemia. The diagnosis of non-leukemic myeloid sarcoma was established. The patient was referred to plastic surgery, ophthalmology, and otorhinolaryngology for co-management of the mass. Initial treatment began with azacitidine, a hypomethylating agent. However, after completing only one cycle of chemotherapy, she declined further treatment for personal reasons, choosing not to continue with the planned therapeutic regimen. Non-leukemic myeloid sarcoma of the face in an elderly patient is rare. Diagnosis was confirmed via biopsy and immunohistochemical studies. Treatment with azacitidine was chosen based on the patient's ECOG score of 2. However, there is no consensus on its management, and the role of systemic chemotherapy remains debated. Continuous monitoring for progression to acute myeloid leukemia (AML) is crucial, as early detection significantly impacts prognosis and informs treatment decisions.

Background: A substantial number of COVID-19 recoverees are working-aged individuals, which makes return-towork (RTW) an essential part of rehabilitation. Many COVID-19 recoverees must deal with physical and mental symptoms of post-COVID conditions such as fatigue, dyspnea, difficulty concentrating, memory lapses, and anxiety. These symptoms coupled with often insufficient support from employers and the government can make the RTW process complicated. Although research related to RTW after COVID-19 has begun to emerge over the years, few primary studies have come out from developing countries.

Objectives: This exploratory study aims to describe perceived work ability and health-related quality of life, lived experiences of the RTW process, and role of rehabilitation in a limited sample of Filipino COVID-19 recoverees.

Methods: Using purposive sampling and a convergent parallel mixed-method design, the study draws on an online survey and group interviews to understand expectations, experiences, and self-rated work ability of working-age adults with post-COVID condition. We report the findings of the questionnaire data using descriptive statistics. From the questionnaire respondents, eight participants were interviewed to explore the RTW experiences from multiple perspectives. The group interview was conducted online, and narrative analysis was used to explore the data. This analytic process involved an iterative and inductive process between data gathering and data analysis.

Results: Findings from our narrative analysis are reported under four themes: 1) The period of liminality; 2) A 'positive' problem; 3) Health as a psychosocial and justice issue; and 4) The reimagination of paid work. The narratives gathered document an overview of how selected Filipinos overcame the COVID-19 infection and their recovery and RTW process.

Conclusion: Results call for a re-examination of the concept of health and paid work for individuals undergoing rehabilitation and recovery.

Background and objective: There is a call for changes in health professions education to help address current and future challenges. For the effective management of change in institutions involved with health professions education, it is important to consider organizational readiness for change and psychological safety. In organizations, the presence of psychological safety facilitates learning that is integral in organizational development, especially those undergoing changes. There are tools available to measure organizational readiness to change and psychological safety but they are separate and tend to be lengthy. The study developed and validated a brief, straightforward tool that integrates psychological safety in the measurement of organizational readiness for change. It can be useful in the assessment of academic organizations undergoing change in order to facilitate implementation and promote effective change.

Methods: The study used a sequential exploratory mixed methods design. A conceptual framework on organizational readiness to change which included psychological safety was developed from a review of literature. Relevant constructs were defined and corresponding questions were constructed and scaled. Five content experts qualitatively assessed the scale and removed items which were redundant, lacked clarity, or were irrelevant. The items were then reviewed by selected participants to ensure face validity. Finally, the questionnaire was administered to members of a unit (N=89) which was undergoing organizational change to ensure construct validity. Construct validity, internal consistency, convergent validity, and discriminant validity were determined using PLS-SEM and yielded acceptable results.

Results: The scale developed addressed components of organizational readiness to change and psychological safety. The scale was deemed to have good content validity by five experts, good face validity as tested by a small pilot group, and acceptable construct validity, internal consistency, convergent validity, and discriminant validity.

Conclusion: The quantitative scale developed for measuring readiness to change was assessed qualitatively and quantitatively, and deemed to have relevance and validity. It can be used by academic units embarking on change initiatives to assess organizational readiness with due consideration for psychological safety. Quantitative results from the tool can be supplemented with qualitative measures such as observations, interviews or focused group discussions to better identify and address areas needing attention. The study has the potential to make a significant contribution to both the theory and practice of change management.

Background and objective: Proper documentation of patient safety events is important to be able to provide changes that can prevent events from occurring again. The Philippine General Hospital launched an online platform for reporting patient safety events in 2017. This paper aimed to describe the patient safety events, initial response to the event, and preventive actions done in the institution.

Methods: This is a retrospective descriptive study of patient safety event records from August 2017 to April 2022. General data of the patients, details surrounding the events, response to the event, and preventive measures done after the event were documented. Descriptive analysis was performed.

Results: There was a total of 625 events reported with 525 total unique reports. There was an increased rate of patient safety event reports from 2021 to 2022. The average rate was 23.8 and 25.7 reports per month, respectively. Most reports were for in-patient cases and were type 3 preventable adverse events. The general initial response of healthcare personnel to the adverse events is to provide the appropriate clinical care. Preventive measures include re-orientation and event specific actions.

Conclusion: Documentation is crucial for patient safety events to provide solutions and prevent reoccurrence of these events that can cause harm to patients.

Background and objectives: Mouth retractors are essential in ensuring efficient yet safe exposure of the oral cavity and oropharynx. However, when applied improperly or haphazardly, retractors can cause tissue injuries and compromise patient safety. In addition, there are gaps in the usability of existing designs. This study aimed to identify the issues encountered by otorhinolaryngology surgeons in the use of commercially available mouth retractors, design and fabricate an improved retractor, and explore the use of additive manufacturing (popularly known as 3D printing) for retractor prototyping.

Methods: The study used the United States Food and Drug Administration (US FDA) Design Control as its framework. End-user requirements from otorhinolaryngologists were collected through key informant interviews. Results were organized into a Design Input template which was used to guide the design and development process. Prototype designs were iteratively created using computer-aided design software and 3D printing. Once design specifications were satisfied, a beta prototype was fabricated and given to another cohort of otorhinolaryngologists. The participants assessed the usability of the beta prototype. System Usability Scale (SUS) was used to quantify participant's feedback.

Results: Five designs were created in the course of the study. The final prototype was fabricated using a Stereolithography (SLA) 3D printer. Several features were developed to address user requirements. The primary modification was to make the retractor modular to facilitate easier and shorter mounting and assembly. Gingival injury was addressed with the replacement of the maxillary alveolus hook with support bars. Five participants evaluated the beta prototype which received a mean SUS score of 75, well above the 50^th percentile threshold.

Conclusion: This study demonstrates the applicability of the US FDA Design Control Process in the local setting to improve the mouth retractor design. Clinical and ergonomic issues were identified and design solutions were proposed and some have been implemented in a low-fidelity prototype. Results of the small-scale usability test suggest that the present form factor can be the basis for further iterations. Future studies can implement the proposed features to address other clinical and ergonomic needs.

Background and objective: The WHO advises the detection of cases of pulmonary tuberculosis (TB) in household contacts (HHCs). This activity allows for testing family members of TB patients for latent tuberculosis infection (LTBI) and detecting factors associated with LTBI. The purpose of this study is to identify LTBI and its associated factors among HHCs of TB patients.

Methods: An analytical cross-sectional study was conducted in Medan, Indonesia. Subjects were family members living in the same household as pulmonary drug-sensitive tuberculosis (DS-TB) patients and met the inclusion and exclusion criteria. Data collection involved interviews, chest X-rays, blood collection for Interferon-Gamma Release Assay (IGRA) analysis, and, if necessary, the Xpert MTB/RIF test to examine sputum. Subjects were classified as having LTBI if the IGRA test was positive, the chest X-ray results were normal or did not suggest TB, and there were no clinical symptoms indicative of tuberculosis.

Results: A total of 90 HHCs of TB patients were included; 30 subjects (29.41%) had LTBI, and 60 subjects (58.82%) did not have LTBI. The majority of subjects were female (76.6%), with a mean ± SD age and body mass index (BMI) of 41.17 ± 15.33 years and 24.65 ± 4.72, respectively. Variables such as gender, age, educational level, employment type, comorbidities, BMI, smoking, alcohol intake, and length of contact were not significantly associated with LTBI (p>0.05).

Conclusion: To achieve TB eradication, it is crucial to investigate household contacts of pulmonary TB patients. Individuals with LTBI can benefit from education and management of preventive TB treatment.

Background: First-aid is the effort to help and temporarily care for accident victims before receiving further assistance. Providing quick and appropriate aid to victims prevent their condition from worsening.

Objectives: This study aims to explore the knowledge and experiences of the heads of neighborhood units (RWs) of first-aid in accidents in Cempaka Putih Tengah Subdistrict Jakarta, Indonesia.

Methods: This is a qualitative research with a phenomenological design that aims to explore the community's knowledge of first-aid in greater depth. Data collection was carried out through in-depth interviews and observations. The study had six participants which were selected using purposive sampling technique. All participants are male, based on the understanding that men often serve as heads of households and play a crucial role within their families or communities; all participated in the Focus Group Discussion (FGD). The data analysis was conducted using categorization and thematic analysis, and was manually analyzed using the Collaizi method.

Results: This study identified three main themes regarding the public's knowledge and experience in providing first-aid during accidents: 1) limited public knowledge of effective first-aid actions in accident situations; 2) lack of practical experience in providing first-aid, leading to panic and confusion; and 3) limited understanding of accident prevention, which increases the risk of injury in the surrounding environment.

Conclusion: The limited knowledge and practical experience among the public, despite some having attended first-aid training, leads to unpreparedness and panic when faced with accidents. Additionally, the limited understanding of accident prevention contributes to an increased risk of injury in the surrounding environment. Therefore, it is crucial to provide more comprehensive training, including practical simulations, to improve the public's knowledge and skills in managing and preventing accidents.

Background and objectives: Hepatobiliarypancreatic tuberculosis (HBPTB) is a less common form of tuberculosis that often presents as malignancy or lithiasis. Advances in diagnostics and minimally invasive procedures have led to the detection of more patients with milder forms of TB requiring surgical management. Due to the low incidence rates and lack of standardized approaches, additional studies are needed to improve patient outcomes. This study examined the risk factors, diagnostic methods, and treatments for HBPTB patients at the University of the Philippines - Philippine General Hospital (UP-PGH) from January 1, 2014 to December 31, 2021.

Methods: This retrospective descriptive study utilized our institutional database to identify patients who underwent a surgical procedure for HBPTB and their associated risk factors. Inclusion criteria required biopsy or microbiologic proof of tuberculous involvement of the biliary tract or nearby structures.

Results: Among a total of 45 patients, the most common admitting diagnosis were HBP tuberculosis (37.8%) and malignancy (35.6%). 47.6% of patients had a previous or concurrent TB exposure. Sixty percent had subclinical malnutrition indicated by normal weight and low albumin. The liver (37.8%) and the bile ducts (33.3%) were the most common organs involved. The most common surgical procedures done were ultrasound-guided liver biopsy, biliary enteric anastomosis, percutaneous transhepatic biliary drainage (PTBD), and endoscopic retrograde cholangiopancreatography with or without stenting (ERCP).

Conclusions: This study provides additional data for clinicians to tailor diagnostic and treatment plans accordingly. Striking a balance between surgical procedures and appropriate anti-tuberculous therapy (ATT) is essential for successful treatment. Local data can be useful to help identify tuberculosis patterns unique to Filipinos and highlight socio-economic factors contributing to this rare presentation of TB.

Background: Turmeric (Curcuma longa Linn, synonym Curcuma domestica Val.) is a plant from Southeast Asia which has been consumed as a complement to cooking spices, herbal medicine, or as a medicine to maintain health and beauty such as skin and facial care.

Objective: The study aimed to determine the effect of turmeric extract on the testicular weight of rats.

Methods: This is an experimental research. After going through an adaptation period of two weeks, the animals were given turmeric extract orally for 30 days. The testicles were weighed, and sperm was taken from the vas deferens of male rats.

Results: Normality test (Kolmogorov-Sminorv) and homogeneity test (Homogeneity of Variances) were done. A significance value of P>0.05 was obtained, indicating that the data on the proportion of testicular weights at all test doses compared to the control were not statistically significant.

Conclusion: The administration of 96% ethanol turmeric extract at a dose of 25 mg/KgBW, 50 mg/KgBW, and 100 mg/KgBW for 30 days did not affect the weight of rat testicles. It is necessary to isolate compounds in the 96% ethanol extract of turmeric to determine its antifertility effect.

Background: Social determinants of health are wider set of forces and systems that greatly influence an individual's health outcomes.

Objective: This study aims to determine the socio-economic indicators that influence certain health indicators focusing on maternal and children under-5 health.

Methods: Selected data from from the World Health Organization (WHO), World Bank, and International Labor Organization (ILO) were primarily used to model health outcomes such as mortality rates, disability-adjusted life years, and deaths and injuries due to occupational injuries. A total of 194 countries were considered as respondents in this study. Linear hierarchical multiple regression was used to determine the relationship of social determinants of health on life expectancy at birth, maternal mortality ratio (per 100,000 live births), under-5 years mortality ratio, prevalence of overweight in children under-5 years, and death rate (per 100,000 population).

Results: Data from 194 countries shows that the global average life expectancy is 55.7 years. The global average maternal mortality ratio is 1119.509 per 100,000 live births, and maternal mortality is significantly increased by factors such as increase in total vulnerable employment, total unemployment, and CPIA gender equality rating. Focusing on children's health outcomes, the global average under-5 mortality rate was 102.247 per 100,000 live births. Mortality rate for children under-5 increases with total vulnerable employment and total unemployment, while adult literacy rate, 1 medical doctor per 10,000 population, and food safety level decreases under-5 mortality rates. The global overweight prevalence in children under-5 is 10.389%. The increase in average monthly earnings of employees working in service and sales increases its prevalence. For death rate, the global average is 682.818 per 100,000 population. This is further positively affected by an increase in rural population and total unemployment. On the other hand, adult literacy rate decreases death rate.

Conclusion: Socio-economic factors such as income, education, employment, and government support influence maternal and children under-5 health indicators. Thus, programs, projects, and activities that aim to positively affect the health of the public should be holistic and should also focus on positively altering the health behavior of the public.