Acta Medica Philippina最新文献

Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE. This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion. Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

Bullous hemorrhagic dermatosis (BHD) is a rare cutaneous manifestation characterized by tense hemorrhagic bullae that appear at sites distant from low molecular weight heparin (LMWH) injections, typically within seven days of exposure. As of March 2022, only 94 cases have been reported. It most commonly affects elderly males with predisposing factors for thromboembolism, such as carcinoma, and usually involves the extremities. This case highlights the importance of maintaining a high index of suspicion for bullous hemorrhagic dermatosis (BHD) in patients receiving low molecular weight heparin, even beyond the typical 7-day window and in demographics not commonly affected. Early recognition and prompt discontinuation of the offending agent, as demonstrated in this atypical presentation involving a Filipino elderly woman with multiple comorbidities and no malignancy, can lead to favorable outcomes. Clinicians should be aware of this rare but reversible complication to avoid misdiagnosis and ensure appropriate management.

Background and objective: Barangay Health Workers (BHW) are a crucial part of the local health system. Health services at the barangay level are heavily dependent on BHWs. However, despite their significant role in the local health system, support has been minimal and not commensurate with their contributions. The study aimed to identify the perceived external and internal factors that affect the performance of BHWs.

Methods: The study identified the BHW-perceived external and internal factors affecting performance, through mixed quantitative and qualitative methods. A self-administered questionnaire with a 4-point Likert scale that will assess the factors was given to 561 BHWs from five different upland municipalities of Cavite. A focus group discussion using open-ended questions was conducted to gain an in-depth understanding of their experiences. Emerging themes were reported into narratives.

Results: BHWs maintained a strong level of participation at required health activities, but more than half were often late, owing to their volunteer status and external responsibilities. They were perceived to have a high sense of duty reflected by punctual submission of reports and confidence in delivering health services. Job satisfaction emerged as a substantial motivator while burnout was not a significant demotivator. Leadership and support from local government and health program management were perceived positively by most BHWs. Service delivery confidence was high among BHWs as reflected in their capability to provide expected services. BHWs perceived that challenges were present in terms of the adequacy of medicines and supplies, and on data transmission, although half were generally satisfied with the organization of health records. Human resources were perceived to be sufficient. Financial aspects showed that while most BHWs do not contribute personally to patient care, a significant minority shell out resources for patients, reflecting financial strains within the health system. The study also revealed the varying motivations for volunteering, including community service, staff shortages, knowledge acquisition, and additional income.

Conclusion: External and internal factors affect the performance of BHWs at the local level. These were related to current health systems, political climate, personal household duties, and financial status. Despite facing these challenges, the BHWs showed commendable involvement in local health programs. BHWs remained motivated through training opportunities and positive community feedback but were hindered by a lack of health science knowledge and the need for supplementary income.

Patient's need for endodontic treatment in a short period is on the rise nowadays. Technological developments in instruments and materials are allowing single-visit endodontic treatment to be performed. The success of an endodontic treatment is also influenced by the restoration, in consideration of the remaining tooth structure. This becomes a challenge for the clinician if the cavities are large or if minimal tooth structure remains, so it needs a minimally invasive restoration like morphology-driven preparation technique. This case report aims to describe the single-visit endodontic treatment and minimally invasive indirect restoration of the mandibular first molar. A 13-year-old girl came to the Dental Hospital of Hasanuddin University with complaints of cavities in the mandibular left posterior tooth and pain for one month. The patient had taken analgesic medication but was afforded no relief. Intraoral examination showed tooth #36 with extensive cavities reaching the proximal area, a positive thermal test, and no pain to percussion. The case diagnosis was asymptomatic irreversible pulpitis. The treatment plan was a single-visit endodontic treatment and minimally invasive indirect restoration.

Medical students need the basic skills and techniques in family counseling to holistically manage a family. E-learning as a mode of teaching family counseling was experienced by medical students due to the COVID-19 pandemic. This was a case series of ten medical students in a tertiary training hospital who described their thoughts and feelings about the e-learning platform used. A focused group discussion composed of seven students was conducted independently. The students' perceptions on the use of e-learning were generally negative in nature. The volume of online learning materials to be studied and the poor-quality videos reflected the sudden shift to e-learning due to the pandemic. Limitations on the e-learning format resulted in the inability to recognize non-verbal gestures which was crucial in counseling. The poor internet connectivity within the students' learning environment was a hindering factor as it prolonged the counseling. Positive perception was mainly due to the effectiveness of the instructor in teaching online family counseling. The adeptness in navigating online platforms and guidance to students during the demo-returndemo resulted in the achievement of the expected outcomes of the workshop. The high preference to face-to-face mode may be attributed to the number of negative perceptions by the students.

Background and objectives: Many patients have received acupuncture treatment to address various health problems and it has been presented in several studies to be effective. However, stories of patients on the use of acupuncture may present some additional information including contextual factors about acupuncture treatment. This study was conducted to explore experiences of patients in a community-based acupuncture clinic on the impact of acupuncture as a treatment modality. In particular, this study aimed to understand how acupuncture has changed patients' lives through a life stories approach, describe how the treatment affected their perceptions about their well-being, and to elicit their views of the acupuncture as an alternative or complementary treatment.

Methods: A narrative inquiry was done using in-depth interviews individually conducted among eight participants, who were selected purposively based on having had at least 12 consecutive acupuncture sessions at a community-based acupuncture clinic. All the interviews were audio-recorded and later transcribed by a professional external interviewer following written informed consent from all the participants. The research protocol was submitted and approved by the Ethics Review Committee of the University Research Institute for Health Sciences. The researchers analyzed the interview transcripts using Murray's narrative analysis approach.

Results: Participants' stories highlighted their personal experiences of how they had come to know about acupuncture, how their experiences have changed their perceptions of the treatment, and how the outcomes of acupuncture treatment have affected their lives. The findings emphasize four narratives: pain relief, acupuncture being complementary to Western medicine, social support, and advocacy.

Conclusion: This study emphasizes qualitative findings that are essential to be considered in the implementation of community-based acupuncture clinics that may help make acupuncture care accessible to community residents as well as maximize the potential of this treatment modality.

Objective: Preterm birth is a major cause of complications leading to death of children under 5 years old. Infections are important to be identified because antimicrobial treatment may prevent or delay progression to preterm delivery. This study determined if routine screening tests of infections are useful in the clinical management of preterm labor.

Methods: A cross-sectional (descriptive) study was done involving 417 pregnant patients who had preterm labor and was subsequently admitted from 2015 to 2019 at a tertiary hospital in the Philippines, using review of past medical records, inpatient charts, and admission charts.

Results: Majority of the patients delivered at less than 34 weeks, most of the culture results turned out negative, and urine tests were more commonly employed as screening tests for preterm labor. The endocervical and rectovaginal swab studies had no significant growths. Asymptomatic bacteriuria was diagnosed in 1 out of 10 patients and they were subsequently started on antibiotic treatment. Majority of the patients who were given antibiotics delivered within 48 hours from admission.

Conclusion: The routine use of cultures in the assessment of preterm labor is costly and is unlikely to be helpful in the clinical management of patients in preterm labor.

Background: The social determinants of health refer to an individual's social, political, and economic situation and environment, which can have an impact on their health. On the other hand, disability-adjusted life years (DALYs) reflect the mortalities and morbidities incurred due to disease and injury.

Objectives: This study aims to analyze the social determinants of health indicators and their association with communicable, non-communicable, and injury-related DALYs and deaths.

Methods: Data from World Health Organization, World Bank, and International Labor Organization were used and considered for the 17 Social Determinants of Health categories. Logistic regression was used to determine the relationship of social determinants of health indicators with communicable, non-communicable, and injury-related DALYs and deaths.

Results: Results show that an increase in the population, monetary poverty, adult illiteracy, and fine particulate matter increase IPNN DALYs. This study also found correlations of socioeconomic factors to NCD deaths and DALYs attributable to the environment. NCD DALYs and deaths are found to increase with the number of poor living with 3.10 dollars a day, while median daily per capita income, and increase in persons above retiring age receiving pension decrease NCD DALYs attributable to the environment. Focusing on injury DALYs and deaths, an increase in the number of poor living at 3.10 dollars a day, non-agricultural informal employment, and total average concentration of fine particulate matter increases injury DALYs while the latter is observed to decrease when there is an increase in the medial daily per capita income, agricultural employment outside the formal sector, and vulnerable persons covered by social assistance.

Conclusion: Socio-economic factors such as income, employment, education, and social welfare program affect morbidity, disability, and mortality.