Concordance of acid-fast stain result and histopathologic vs clinical diagnosis of leprosy: A three-year retrospective study in a Tertiary Government Hospital and Sanitarium in the Philippines

Objectives@#In the Philippines, there has been a lack of information on the concordance between classifications of Hansen’s disease or leprosy clinically, histopathologically, and with AFS results. The study ultimately aimed to determine the concordance between the clinical diagnosis, histopathological results, and AFS results of patients with leprosy seen at the Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium (DJNRMHS). @*Methods@#This is a descriptive, retrospective, single-center study conducted at the DJNRMHS, a tertiary government hospital and one of the last remaining sanitaria in the country located in northern Metro Manila in the Philippines. The study reviewed and included all the patient records from the years 2017-2019 which included skin biopsy results and slit-skin smear with AFS. Leprosy patients were then classified based on the following classifications: World Health Organization (WHO) and Ridley-Jopling classifications; and the concordance of clinical diagnosis vs the histopathologic findings and clinical diagnosis vs AFS results were determined using kappa testing.

Double Whammy: A Case Report of a 71-Year-Old Filipino Female Leprosy Patient Diagnosed With Crusted Scabies (RETRACTED ARTICLE)

@#<jats:p>This is the case of a 71-year-old Filipino female from Caloocan with a history of Hansen’s disease, treated (1980) who presented with generalized crusted plaques. Clinical and histopathological examination revealed crusted (Norwegian) scabies. Crusted scabies is a rare condition and diagnosis is often delayed; this condition is treated with systemic broad spectrum antiparasitic agents. Despite the common prevalence of scabies, its atypical forms are often overlooked and neglected which oftentimes does affect the patients' well-being. Keywords: infection; skin diseases; leprosy; parasitic; crusted scabies; case report</jats:p>

Variations in modern contraceptive uptake and its correlates in South West and North East Nigeria: a comparative analysis

Background: Family planning programs are implemented specifically to address the sexual and reproductive health challenges of women of childbearing age but these interventions are yet to address regional differences in modern contraceptive usage in Nigeria. Hence, this study aimed to examine correlates of modern contraceptive uptake in South West and North Eastern, Nigeria.Methods: A cross-sectional survey data for women aged 15-49 years was extracted from Nigeria demographic and health surveys 2018 (NDHS). Data analyses were based on a weighted sample of 10,907 (North East= 5406 and South West = 5501) women of reproductive age. The outcome variable was modern contraceptive use. The main explanatory variables were age, employment status, religion, Number of living children, education, and marital status. Frequency distribution, Chi-square test, and binary logistic regression were used for data analysis (α=0.05).Results: The result showed the mean age of women of reproductive age in South West and North East to be 32years and 30 years respectively. More women in South West used modern contraceptive than women in North East. About 91.5% and 75.8% of women in North East and South West respectively did not used any modern method. The result showed that, in the South West, number of living children (OR:4.06, CI: 2.794-5.921), education (OR:1.35, CI: 1.045-1.754) and wealth index (OR:1.77, CI: 1.053-2.973) increased the odds of contraceptive uptake, while maternal age (OR:0.52, CI: 0.282-0.965), religion (OR:0.25, CI: 0.184-0.347) and place of residence (OR:0.68, CI: 0.504-0.916) significantly reduced the odds of modern contraceptive uptake in North East.Conclusions: This study concludes that there are regional variations in uptake and predictors of modern contraceptives use in Nigeria. Therefore, sexual and reproductive health interventions that considers the study’s significant variables should be put in place to increase uptake.

Incidence and risk factors of postoperative bacteriuria after transurethral resection of the prostate using distilled water as irrigating fluid: A retrospective cohort study

OBJECTIVE@#To establish the incidence of postoperative bacteriuria (PBU) in patients after undergoing transurethral resection of the prostate (TURP) using sterile distilled water as irrigating fluid, and determine the possible risk factors for its development.@*METHODS@#A retrospective cohort study of patients who underwent TURP using distilled water as irrigating fluid from 2014-2018 at a tertiary government hospital was performed. Included were patients who had urine culture results upon admission, treated with antibiotics or received antibiotic prophylaxis within 24 hours prior to operation, as appropriate, and had a repeat culture prior to discharge. PBU was defined as the presence of significant (≥ 105 CFU/mL) bacteriuria upon catheter removal in patients with either no growth on preoperative urine culture or growth of a different organism from that of the preoperative culture. Chi-square and Student’s T-test were used to compare those with and without PBU and attributable risk (AR) values were determined for identified risk factors.@*RESULTS@#Eighty-four patients with a mean age of 65 (± 6.32) years were included. Sixteen (19%) patients developed PBU. Preoperative catheterization and resection time of more than 30 minutes were found to be associated with the development of PBU (p=0.020 and 0.047, respectively), with AR of 24.24% (95% CI [13.90,34.58]) and 22.86% (95% CI [13.02,32.69]). Age, resected prostate weight, and diabetes mellitus were not found to be associated with PBU.@*CONCLUSION@#Postoperative bacteriuria rate of 19% was noted with the use of distilled water as irrigant during TURP. Significant risk factors for its development included preoperative catheterization and prolonged resection times.

Anatomic landmark approach to reconstruction of asymmetric midline cleft lip due to Pai syndrome

Midline clefts of the upper lip are rare, and it is therefore important that surgeons have access to a methodical approach for when these presentations are encountered. We adapted principles of the anatomic subunit approximation for unilateral cleft lip, to the repair of midline clefts. The overt use of anatomic landmarks to define the repair results in a design that inherently adjusts to varying degrees of clefts and can accommodate asymmetries. The “measure twice, cut once” style is an advantage to new surgeons and to surgeons who seldom encounter this presentation. We describe the details of surgical repair in the context of a patient with Pai syndrome and associated nasal hamartomas that resulted in nasolabial asymmetry. This is the first report of surgical outcome following treatment of Pai syndrome and includes early and 5-year follow-up. The system of repair that we describe is applicable to both symmetric and asymmetric midline clefts.

Boerhaave’s syndrome presenting with hematemesis: Case report

@#The clinical presentation of Boerhaave’s syndrome (BS), a rare condition of the gastrointestinal tract characterized by a spontaneous rupture of the esophagus most often caused by vomiting after excessive alcohol drinking or after consuming a large meal, mimics other less serious illnesses, often leading to a missed or delayed diagnosis. The Mackler triad, which is rare and pathognomonic of BS, includes lower thoracic or chest pain, subcutaneous emphysema, and vomiting. Diagnosis is made through computed tomography scan and esophageal contrast studies. Treatment of BS is geared towards control of mediastinitis and sepsis, and repair of the perforation or reestablishment of the continuity of the gastrointestinal tract. We report the case of a 46-year-old male with BS, who was initially managed with a conservative resection of the perforated esophagus 48 hours after the onset of symptoms. When the mediastinitis persisted we decided to do a subtotal esophagectomy and subsequent esophageal reconstruction.

Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway

OBJECTIVE: Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consultation between emergency physicians and cardiologists would be most impactful if the resultant disposition is discordant with the HEART pathway. We therefore evaluate discordance between actual disposition and that suggested by the HEART pathway in patients presenting to the ED with chest pain for whom cardiology consultation occurred exclusively by phone and to assess the impact of phone-consultation on disposition.METHODS: We performed a single-center, retrospective study of adults presenting to the ED with chest pain whose emergency physician had a phone consultation with a cardiologist. Actual disposition was abstracted from the medical record. HEART pathway category (low-risk, discharge; high-risk, admit) was derived from ED documentation. For discharged patients, major adverse cardiac events were assessed at 30 days by chart review and phone follow-up.RESULTS: For the 170 patients that had cardiologist phone consultation, discordance between actual disposition and the HEART pathway was 17%. The HEART pathway recommended admission for nearly 80% of discharged patients. Following cardiologist phone-consultation, 10% of high-risk patients were discharged, with the majority having undergone a functional study recommended by the cardiologist. At 30 days, discharged patients had experienced no episodes of major adverse cardiac events or rehospitalization for cardiac reasons.CONCLUSION: For patients presenting to the ED with chest pain, cardiology phone-consultation has the potential to safely impact disposition, primarily by facilitating functional testing in high-risk individuals.

A young patient with metastatic prostate adenocarcinoma: A case report and review of literature

@#Prostate cancer is extremely rare in men under 40 years old, and current guidelines recommendagainst screening in this patient population. However, recent data show poorer prognosis in youngermen with prostate cancer, especially in those with advanced stage disease. Presented and discussed isthe case of a 38-year-old Filipino male diagnosed with prostate adenocarcinoma Gleason 9 (4+5)with bone metastasis presenting with urinary retention, suspicious rectal exam findings, and a markedlyelevated PSA. The patient underwent transurethral resection of the prostate and concurrent bilateralorchiectomy. With reports of cases such as this one, biopsy might still be indicated to confirm or ruleout cancer in a younger patient with a very high suspicion of prostate cancer based on clinical andlaboratory findings. Further studies are needed to identify risk factors for development of prostatecancer in this population to achieve early diagnosis and treatment.

Surgery in Brazilian Health Care: funding and physician distribution / Cirurgia no Sistema Brasileiro de Saúde: financiamento e distribuição de médicos

ABSTRACT Objective: to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. Methods: data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Results: Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. Conclusions: A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce.

RESUMO Objetivo: analisar dados demográficos do Sistema Único de Saúde (SUS) brasileiro, que promove cobertura de saúde universal a toda população, e discutir os problemas revelados, com particular ênfase nos cuidados cirúrgicos. Métodos: os dados foram obtidos a partir dos bancos de dados de saúde pública da Demografia Médica, do Conselho Federal de Medicina, do Instituto Brasileiro de Geografia e Estatística e do Cadastro Nacional dos Estabelecimentos de Saúde. A densidade e a distribuição do trabalho médico e dos estabelecimentos de saúde foram avaliadas, e as regiões geográficas foram analisadas usando o índice de desigualdade público-privado (IDPP). Resultados: o Brasil tem, em média, dois médicos por 1000 habitantes, que são desigualmente distribuídos no país. Tem 22.276 cirurgiões gerais certificados (11,49 por 100.000 habitantes). Existem no país 257 escolas de medicina, com 25.159 vagas por ano, e apenas cerca de 13.500 vagas de residência médica. O índice de desigualdade público-privado é de 3,90 para o país e varia de 1,63 no Rio de Janeiro até 12,06 na Bahia. Conclusão: uma parte significativa da população brasileira ainda encontra muitas dificuldades no acesso ao tratamento cirúrgico, particularmente na região norte e nordeste do país. Médicos e, particularmente, cirurgiões são escassos no sistema público de saúde e incentivos devem ser criados para assegurar uma força médica igual no setor público e no setor privado em todas as regiões do país.

Association of cumulative dissipated energy and postoperative foveal thickness among patients with age-related cataract who underwent uncomplicated phacoemulsification

@#<p style="text-align: justify;"><strong>PURPOSE:</strong> Cumulative dissipated energy (CDE) is a phacoemulsification unit parameter designed to monitor the amount of energy delivered during phacoemulsification. Studies have already shown that lower CDE levels have better surgical outcomes, specifically in corneal recovery. However, few literature exists regarding the correlation between CDE and foveal thickness.</p> <p style="text-align: justify;"><strong>METHODS:</strong> In this prospective study, subjects with age-related cataract underwent cataract surgery by phacoemulsification. Central subfield thickness (CST), cube volume (CV), and cube average thickness (CAT) of the macula were measured by spectral-domain optical coherence tomography (OCT) at three separate time-points: preoperative, 1 day, and 14 days after cataract surgery. To determine the correlation between parameters, Pearson's correlation coefficients and degree of association, and coefficient of determination (r2 ) were used.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> One hundred eyes from 93 subjects were analysed. Preoperatively, mean CST was 247.71 ± 21.44 µm, CV was 9.38 ± 0.82 mm3 , and CAT was 262.94 ± 22.15 µm. At 12.42 + 11.05 of mean CDE exposure, the fovea increased in thickness in all measured parameters. The relationship between CDE and the change in foveal thickness values from baseline to postoperative Day 1 and Day 14 were examined. The correlation coefficients obtained for CST, CV, and CAT had low association to CDE. Furthermore, only the correlation coefficients of the difference between baseline and Day 1 of CST, and the difference between baseline and Day 14 observations of CV were significant (0.279 and -0.206, p=0.005 and p=0.040, respectively) but still with a low degree of association.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> There is a low, significant, direct association of the difference of CST on Day 1 from baseline with CDE, and a low, significant, indirect association of the difference of CV on Day 14 from baseline with CDE after routine phacoemulsification.</p>

Review of Current Laser Therapies for the Treatment of Benign Prostatic Hyperplasia

The gold standard for symptomatic relief of bladder outlet obstruction secondary to benign prostatic hyperplasia has traditionally been a transurethral resection of the prostate (TURP). Over the past decade, however, novel laser technologies that rival the conventional TURP have multiplied. As part of the ongoing quest to minimize complications, shorten hospitalization, improve resection time, and most importantly reduce mortality, laser prostatectomy has continually evolved. Today, there are more variations of laser prostatectomy, each with several differing surgical techniques. Although abundant data are available confirming the safety and feasibility of the various laser systems, future randomized-controlled trials will be necessary to verify which technique is superior. In this review, we describe the most common modalities used to perform a laser prostatectomy, mainly, the holmium laser and the potassium-titanyl-phosphate lasers. We also highlight the physical and clinical characteristics of each technology with a review of the most current and highest-quality literature.

Behavioral and ecological interactions between reintroduced golden lion tamarins ( Leontopithecus rosalia Linnaeus, 1766 ) and introduced marmosets ( Callithrix spp, Linnaeus, 1758 ) in Brazil's Atlantic Coast forest fragments

Callithrix jacchus e spp (micos estrela) tem sido introduzido no estado do Rio de Janeiro em áreas designadas para a reintrodução do Leontopithecus rosalia (mico leão dourado). Os objetivos deste estudo foram estimar a população de sagüis em dois fragmentos particulares, e caracterizar a interação entre as espécies. A densidade de sagüis (0.09 a/ha) foi maior que a de mico-leão (0.06 a/ha). O grau de associação entre mico-leão e o sagüi variou entre grupos e estações do ano (inverno= 61%, verão =35%). Foram observados sinais de competição durante o inverno quando a presença do mico estrela está associada a mudanças no forrageio do mico-leão e aumento de comportamentos territoriais. No verão, sinais de benefícios foram uma diminuição da vigilância por parte dos adultos de micos leões. Além disso, os micos leões foram observados se alimentando de goma proveniente dos buracos feitos pelos micos estrela. Estes resultados sugerem que o mico estrela é uma ameaça para a conservação do mico-leão, no entanto.