Bullous presentation of Acrodermatitis Enteropathica in three female siblings: A case series

@#Acrodermatitis enteropathica is a rare autosomal recessive disease that results from a defect in zinc metabolism. It is clinically characterized by a phenotypic triad of periorificial and acral dermatitis, diarrhea, and alopecia. Oral zinc therapy gives a rapid excellent clinical response and reduces mortality. We report three female pediatric siblings who presented with periorificial and acral dermatitis, diffuse alopecia, nail dystrophy, irritable mood, and stunted growth. A diagnosis of acrodermatitis enteropathicawas confirmed with markedly decreased levels of serum zinc. The patients were successfully treated with oral zinc sulfate at a dose of 5mg/kg/day for the first two weeks then maintained on a dose at 2mg/kg/day.

Exploring job satisfaction and performance of staff nurses in Baguio City, Philippines: A descriptive cross-sectional study

@#<strong>BACKGROUND</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Nursing, as a profession, is a facet where job satisfaction and performance matter. In the changing landscape of nursing practice in the Philippines and the aftermath of the COVID-19 pandemic, it is imperative to revisit and to perform an empirical investigation of the current state of nurses' job satisfaction and performance in the hospital setting. This study aimed to describe the job satisfaction and performance among staff nurses in private and government hospitals in Baguio City.</p><strong>DESIGN</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Using a quantitative descriptive cross-sectional survey design, a sample of 313 randomly selected staff nurses working in two private and two government hospitals in Baguio City were surveyed from March to April 2023, using a questionnaire. This study's protocol was approved by two ethics committees, namely the Saint Louis University Research Ethics Committee and the BGHMC REC. Nominal data was analyzed using the SPSS trial version employing frequencies, percentages, and the Chi-square test.</p><strong>FINDINGS</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">There are more staff nurses in both private and government hospitals who reported satisfactory job satisfaction levels (276 nurses, 87.9%) and had good job performance (303 nurses, 96.5%) in all domains. However, results show that there are more nurses (209 nurses, 90.7% ) in government hospitals who are satisfied with their jobs than in private hospital nurses (67 nurses, 80.1%) in the domains Intra practice Partnership/Collegiality (p=0.010); Challenge/Autonomy (p=0.001); Professional, Social and Community Interaction (p=0.010); Professional Growth (p=0.036); Time (p=0.009); and Benefits (p=0.045). In terms of job performance, more government nurses at 97.3% (224 nurses) rated a higher self-appraisal of job performance. In comparison, only 94.8% (79 nurses) of private staff nurses appraised themselves as having good performance. No significant differences were found in the domains of job performance, namely leadership, teaching, planning, communications, and professional development, except in critical care. In "Critical care," which showed significance, the results suggest that more nurses in government hospitals perceive higher job performance, revealing a significant difference (p=0.011) in the "critical care" domain, indicating that a higher proportion of nurses in government hospitals demonstrate superior performance in this area.</p><strong>CONCLUSION</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Through this study, it was learned that nurses in both private and government hospitals generally experience high job satisfaction and performance, reflecting a fulfilled workforce and indicating commendable competency among the staff nurses. However, more nurses in government hospitals report high satisfaction and perceived performance in critical care compared to those in private hospitals. Thus, the findings of this study can contribute to and serve as a rationale for policy making regarding creating a positive work environment, proper management and leadership, creation of training and skill development for critical care, providing opportunities for professional growth, and conducting regular evaluation and feedback----- all geared towards a satisfied and productive workforce.</p>

Diagnostic accuracy of 68Ga-PSMA PET hybrid imaging in evaluating treatment response to 177Lu-PSMA radioactive ligand therapy in patients with advanced metastatic prostate cancer: A systematic review and meta-analysis

INTRODUCTION@#68Ga-PSMA PET is an effective imaging modality in the evaluation of prostate cancer. However, there is limited data on its use in the evaluation of therapeutic response, particularly in radioligand therapy.@*OBJECTIVE@#Our aim is to investigate the diagnostic accuracy of 68Ga-PSMA PET hybrid imaging in evaluating response to 177Lu-PSMA therapy in patients with mCRPC compared with the standard use of serum PSA.@*METHODOLOGY@#A systematic review was done according to the Cochrane diagnostic accuracy reviews guidelines and the PRISMA checklist of literature from January 2015 to August 2020. Literature search, study selection, and data extraction were conducted by 2 reviewers. Statistical analysis of data was done using Meta-DiSc v1.4@*RESULTS@#A total of 5 studies were included following screening. A total of 128 patients were included in the review. Using PSA response as the reference standard, the pooled sensitivity and specificity of 68Ga-PSMA PET hybrid imaging to evaluate treatment response to 177Lu-PSMA therapy was 85% (Cl: 74 to 92%) and 74% (Cl: 62 to 84%), respectively. The computed diagnostic accuracy was 79.7%.@*CONCLUSION@#68Ga-PSMA PET hybrid imaging is an effective diagnostic procedure in evaluating treatment response to 177Lu-PSMA therapy ligand therapy with good sensitivity, specificity, and diagnostic accuracy.

Roles and functions of rural health midwives in Cordillera Administrative Region: A qualitative pilot study

Background@#Midwives have been frontline health professionals at the grassroots level, especially in rural communities. Their role was expanded from maternal and child healthcare providers to primary healthcare services providers. Despite their expanded functions, there have been limited studies investigating the professional practice of midwifery in the Philippines in a rural setting.@*Objective@#This study aimed to investigate the professional practice of midwives in selected rural areas in the Cordillera Administrative Region, Philippines.@*Methods@#This research is a qualitative pilot study using a semi-structured interview guide to collect the data. Key informant interviews were conducted through mobile phone calls convenient for the participants from September to October 2021. Data were analyzed through qualitative content analysis.@*Results@#A total of seven rural health midwives participated in this study. From the data analysis, six themes emerged related to the professional functions of rural Filipino midwives: 1) antenatal and postnatal care, 2) basic emergency obstetrical and newborn care, 3) health education and counseling, 4) treating common children and adult infections, 5) health promotion, and 6) beyond midwifery role.@*Conclusion@#Rural midwives play a role in providing several primary healthcare services mandated by the government and the profession. They also offer health services beyond their scope as midwives because of geographical difficulties and logistic issues. The findings inform the policymaker to review and amend the expanded roles of practicing midwives so that they will be empowered in providing quality and legal healthcare services. The study results will also be important in preparing midwives for rural midwifery practice.

Telemedicine use and perspectives of municipal health officers in the Cordillera Administrative Region during the COVID-19 pandemic

Background@#Telemedicine has proven essential during COVID-19. However, concerns remain about the rural municipalities in the country such as those from the Cordillera Administrative Region (CAR), wherein perceived barriers by Municipal Health Officers (MHOs) include poor internet connectivity and inadequacy of the current telemedicine service.@*Objective@#This study aimed to assess the extent of Telemedicine use and perspectives in terms of perception, attitudes and perceived barriers among MHOs in CAR during COVID-19.@*Methods@#This is an analytical cross-sectional study that used a validated online questionnaire to 62 MHOs and DTTBs in CAR. Logistic regression analysis was employed to determine the effect of sociodemographic factors and physician perceptions and attitudes on the extent of Telemedicine use.@*Results@#Most MHOs use Telemedicine frequently in their practice for 0-1 year during COVID-19. There is no significant effect of sociodemographic factors to the extent of Telemedicine use except for IT expertise which had a negative influence on the extent of use [prevalence (p=0.011), frequency (p=0.013), length of use (p=0.044)]. Generally, MHOs agree that telemedicine is beneficial for them in performing consults with a positive effect on frequency (p=0.004) and length of use (p=0.009). There is positive attitude towards telemedicine, however, with no significant effect on extent of use (p=0.352, p=1.00, p=0.484). Compromised decision-making and network issues are the most prevalent perceived barriers that limit MHOs to practice Telemedicine. @*Conclusion and Recommendation@#This study showed that during COVID-19, there is good utilization of Telemedicine among MHOs in CAR. MHOs perceive Telemedicine as beneficial in their work and positive attitude remains. However, presence of barriers makes them apprehensive to fully incorporate it in their practice. Study results can contribute to policy-making on telemedicine as it is a key player in e- health to improve access to healthcare services in the attainment of the goal of Universal Healthcare.

Primary Malignant Melanoma of the esophagus in a 39-year-old Filipino male: A case report

@#Primary malignant melanoma of the esophagus (PMME) is an exceptionally rare condition, representing a mere 0.1 to 0.2% of esophageal cancers, and accounting for just 0.1 to 0.5% of all melanomas. This case involves a 39 -year-old Filipino male who sought medical attention after an episode of choking. Subsequently, endoscopy with biopsy revealed a mass in the distal third of the esophagus, ultimately diagnosed as PMME based on histopathology and immunohistochemistry. FDG-PET/CT scan revealed a hypermetabolic distal esophageal mass and a confluent upper paratracheal lymphadenopathy. He was initially treated with Pembrolizumab, Nivolumab, and Ipilimumab immunotherapy. However, post-treatment FDG PET/CT scans unveiled metabolic progression of the esophageal mass with new hypermetabolic cervical lymph nodes, necessitating a shift to carboplatin and paclitaxel chemotherapy. After two cycles, there was a notable metabolic regression of the mass and paratracheal node with metabolic resolution of the cervical lymph node. An additional 2 cycles of chemotherapy were given, aimed to further reduce the size of the tumor, however, a succeeding follow-up study revealed metabolic progression of the mass. Surgical resection of both the esophageal mass and paratracheal nodes became imperative. The aggressive characteristics, metastasis at early diagnosis, and lack of effective treatment have contributed to the poor prognosis of PMME. Total esophagectomy is the preferred method of treatment. Chemotherapy and immunotherapy may be used in advanced diseases but with variable efficacy. The utilization of FDG PET/CT scans plays a crucial role in both the initial staging and the ongoing assessment of treatment response in patients diagnosed with PMME. This advanced imaging modality offers valuable insights into the extent of the disease and aids clinicians in evaluating the effectiveness of the chosen therapeutic interventions. Given the rarity and challenges associated with PMME, a multidisciplinary approach integrating surgical, medical, and imaging strategies is essential for comprehensive patient care.

Role of early dynamic PET/CT scan imaging with 18F-PSMA-1007 in staging and restaging prostate cancer in a tertiary private hospital

Introduction@#18F-PSMA-1007 is a novel prostate-specific membrane antigen (PSMA)-based radiopharmaceutical for imaging prostate cancer. The recommended imaging time is 60 minutes post-injection of the radiotracer. However, during this time there is a physiologic accumulation of the radiotracer in the urinary bladder which sometimes may obscure lesions adjacent to it. @*Objective@#This study aims to determine if early dynamic imaging in addition to the recommended 60-minute postinjection static imaging can improve the detection of PSMA-avid lesions in the staging and restaging of prostate cancer. @*Methods@#This is a retrospective cross-sectional study of the detection rate of early dynamic and static imaging using 18F-PSMA-1007 PET/CT scan in patients with prostate cancer (PCa) who were referred for initial staging or restaging. The McNemar test was used to compare the detection rate between the two imaging. Spearman correlation was used to determine the correlation of Gleason score (GS), PSA, and SUVmax values.@*Results@#18F-PSMA-1007 PET/CT scans of 53 patients with prostate cancer, were referred for either staging (22/53) or restaging (31/53), all of whom had undergone both early dynamic and static imaging. Among the 53 patients, 5 had 2 lesions each, for a total of 58 lesions were included in the analysis. There were 48/58 lesions detected on both early dynamic and static imaging, 2/58 lesions were only detected in the early imaging, 1/58 lesions was only detected in the static imaging, and 7/58 were not detected on both imaging. McNemar the test was not statistically significant (p = 1.000) in the detection rate of the two methods. There is a positive correlation between serum PSA levels and SUVmax measurements for all the patients. Only the correlation between the GS and SUVmax in the static imaging of the staging group was statistically significant. @*Conclusion@#Early dynamic imaging may be an adjunctive procedure in detecting PSMA-avid lesions, particularly in the basal segment of the prostate gland near the urinary bladder. However, it is not recommended as a standard component of the comprehensive protocol for imaging using 18F-PSMA-1007 PET/CT in patients with PCa.

The effect of fast food calorie labels on calories ordered by college students in Quezon City

Background@#There is an increasing trend of obesity in the Philippines with approximately 28.8% of adults considered overweight and 9.6% obese. This is presumably due to a shift in eating patterns towards dining out in restaurants and fast food chains for their convenience. Excess fast food consumption results in diets that are calorie dense yet nutritionally deficient due to their high levels of fat, sugar, and salt leading to increased prevalence of associated diseases such as Type 2 diabetes and cardiovascular diseases. @*Objective@#The researchers determined the effect of presenting the caloric information of fast food items on the total calories ordered among college students in private and public higher education institutions in Quezon City. @*Methodology@#A double-blind experimental research was performed with 179 students by convenience sampling. The participants were randomly assigned to a control group (without caloric labels) and an experimental group (with caloric labels). An online questionnaire was sent to each subject containing their menu and order form along with questions on their demographical data (age, sex, food allowance, BMI, physical activity). @*Results@#Using single linear regression, none of the demographic characteristics were found to be confounding variables. Using multiple linear regression analysis, it was found that the experimental group ordered significantly less calories (p-value = 0.013). @*Conclusion@#The results of the study conclude that those presented with calorie labels ordered less calories than the control.

Antenatal care utilization of mothers in selected cities in Bicol Region: A quantitative study

Background@#Antenatal Care (ANC) is an essential mandatory preventive care service freely given to pregnant women by the Philippine government. Despite the available ANC services in the country, not all pregnant women still avail of the service. @*Objective@#The study determined the socio-demographic profile of mothers, their ANC services utilization, and the different problems encountered during their antenatal care. @*Methods@#A descriptive research design was used. Purposive sampling was employed to identify the population of the study: women of reproductive age, 18-45 years old, and who had a live birth for the last three years regardless of utilization, partial utilization, or non-utilization of ANC services. Mothers who were currently pregnant and had a history of abortion or stillbirth delivery were excluded from participation. Proportionate sampling was computed to get the sample size: 334 mothers from Iriga City and 392 from Tabaco City. The survey questionnaire was based on the ANC guidelines of the DOH. The statistical treatment used was frequency counting, percentage, and ranking in data analysis. @*Results@#The mothers in Iriga City and Tabaco City were ages 23-27 years old who had 1-3 children, were single but living with partners, and in a nuclear type of family with 4-6 members, were unemployed/housewives, and belonged to a low-income family with >P7,890 family income. In Iriga City, the majority were high school graduates, while in Tabaco City, most were graduates of vocational courses; and elementary and high school undergraduates. There were excellent assessments for history-taking, physical examination, and care provisions in both cities, except for oral health care examination, tests for syphilis, stool examination, acetic acid wash, safe sex education, and oral health checkups and prophylaxis. The identified problems were financial constraints, lack of support system, busy taking care of the kids, sickness, forgetfulness, unwanted pregnancy, drunkard husband, difficult first trimester, bad attitude of midwives, nurses, doctors, and unequal treatment of poor patients. @*Conclusions@#Mothers in both cities were young adults with a low education level who lived with their partners in a poor small nuclear family. Not all ANC services were excellently utilized. Among these were the poor utilization of the tests for syphilis, stool, acetic acid wash; oral health care examination; safe sex education; and oral health checkups and prophylaxis. There were various problems that mothers encountered when seeking ANC services, the most common of which were financial and personal issues.

Effects of brain games on global cognition among older Filipinos

Objective@#This study ascertained the effects of brain games on global cognition among older Filipinos.@*Methods@#A quasi-experimental design was used. The participants were 60 elderly Filipinos, aged 60 to 93 years, residing in Baguio City, and were not engaging in any physical or nutritional interventions to improve cognitive function. None have subclinical cognitive impairments as screened using the Mini-Cognitive Examination. The Addenbrooke's Cognitive Examination-III (ACE-III) tool which correlated significantly with standard neuropsychological tests, and provided a high internal reliability score of 0.88, was used. Data were analyzed using descriptive and inferential statistics.@*Results@#Pretest mean scores of both active control and experimental groups increased in the posttest. Additionally, both coloring and brain games had extremely significant effects on global cognition (p=0.0001). Lastly, the unrelated t-test revealed extremely significant difference between the effects of brain games and coloring on global cognition (p=0.0001).@*conclusions@#Based on the results, brain games showed evidence of effectiveness in improving global cognition, and that compared to coloring, it is more effective in improving global cognition among older Filipinos. Variables like motivation and expectancy effects influence the improvement in global cognition among older Filipinos. Lastly, cognitive training using brain games show promise as a non-pharmacologic intervention to address cognitive decline.

Current Trends of Leprosy in a Tertiary Care Centre in North Kerala: A 10 Year Observational Retrospective Study

After the declaration of elimination of leprosy as a public health problem, leprosy services in India have been integrated with General Health-Care System, possibly resulting in readuced focus. This study was conducted to analyze the trends in the disease over a 10-year period in a tertiary care hospital in North Kerala in post elimination era. Of the 133 Hansen’s disease (HD) cases, HD-BT (borderline tuberculoid) was the most common type, followed by, HD-LL (lepromatous lepromatous). Leprosy reactions were seen in 37.59% cases, and deformities were noticed in 19 (13.53%) cases, of which 13 (66.67%) had grade 2 disability. While analyzing slit skin smear results, 25.56% were AFB (Acid Fast Bacilli) positive. On histopathological evaluation of 129 biopsied cases, 115 (89.13%) cases were consistent with clinical diagnosis. The presence of a significant number of smear-positive cases in a post elimination era, particularly lepromatous spectrum, is a matter of serious concern. Community based studies will be necessary to understand the reality at population level and for devising appropriate strategy to break the chain in transmission.

A cross-sectional study on the knowledge, attitude and practices (KAP) of mothers and caregivers on immunization in Quezon City / The Health Sciences Journal

INTRODUCTION@#Despite establishing immunization as an effective approach, the number of deaths from immunizable diseases among 0 to 14 years old remained high in 2012. This prompted the researchers to determine the knowledge, attitude and practices of mothers/caregivers regarding the immunization of their children. @*METHODS@#The research utilized a descriptive cross-sectional design. An interviewer-guided validated questionnaire was administered to mothers and caregivers with at least one child 12 months or younger who was eligible for immunization. @*RESULTS@#Around half of the 211 respondents were aged 20-35 years old, married and living in their own home. A large percentage were unemployed, and the highest educational attainment was high school. Most respondents had one child in care undergoing immunization, mostly in a health center. Results showed that all respondents scored below the MPL for knowledge. For attitude, all scored above the MPL. Only 45.02% of mothers/caregivers scored above the MPL for practices.@*CONCLUSION@#Despite poor knowledge, mothers and caregivers displayed good attitude towards immunization, however this did not translate into bringing their children for vaccination.

A historical perspective of the mandatory service policy in the Philippines: A document analysis

@#<p><strong>BACKGROUND</strong>: The Philippines has, mandatory service policies to address the insufficiency and maldistribution of human resources particularly for health services. Despite being perceived as an appropriate intervention to bridge the aforementioned HRH gaps, the past and present implementations of such programs in the country have never been formally studied.</p><p><strong>OBJECTIVE</strong>: This paper aimed to present the history of mandatory service programs in the Philippines, look at their natures, and see how their different implementations relate to each other.</p><p><strong>METHODOLOGY</strong>: Using a qualitative document analysis method, administrative issuances and reports relevant to past and current implementations of mandatory service policies in the Philippines were obtained and reviewed.</p><p><strong>RESULTS</strong>: Mandatory service programs have been implemented in the country by institutions from both the private and public sectors as early as 1968. The focus of such has been mostly for government positions and specialized professions including physicians and scientists. While extensive efforts have been made through the years, the policies demonstrated fragmentation and recurring gaps in implementation. Such gaps include the lack of enabling policy mechanisms, formal monitoring and evaluation, and program institutionalization.</p><p><strong>CONCLUSION</strong>: The historical narrative of return service programs in the country is a potential source for the development of an overarching mandatory service policy framework for human resources in the Philippines, one that is specific to the context and setting of the country. By articulating policy issues identified, this paper provided a stepping-off point for future mandatory service program policy planning, implementation, evaluation, and institutionalization in the Philippines.</p>

Optimization of ibuprofen hydrogel-based matrix tablet formulation for oral delivery

OBJECTIVE: Ibuprofen, a nonsteroidal anti-inflammatory drug, is poorly soluble leading to its slow systemic absorption. This study aimed to optimize the formulation of an ibuprofen hydrogel-based matrix tablet to improve its dissolution for better oral bioavailability.METHODS: Raw material of ibuprofen was subjected to quality control test and compatibility test with the excipients. Six trial formulations were performed, with polyethylene glycol (PEG) 6000 as the matrix for the first three trial formulations and carbopol for the remaining trial formulations. Finished product quality control (FPQC) tests were conducted to choose the best formulations to be compared against the marketed products using comparative dissolution and stability studies.RESULTS: Among the trial formulations, Formulation 3 and Formulation 4 displayed highly satisfactory results from FPQC. The results of disintegration tests, comparative dissolution, and stability studies suggested carbopol as the better polymer over PEG 6000 which made Formulation 4 as the best.CONCLUSION: Based on the percent drug release and similarity factor, it was concluded that the formulation optimized in this study was considered to be similar with the standard liquigel.

Accuracy of fine needle aspiration biopsy in diagnosing parotid gland malignancy

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of FNAB in detecting parotid malignancies in our institution.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Restrospective Chart Review<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Participants:</strong> Postoperative records of seventy six (76) patients with tumors of the parotid gland preoperatively diagnosed by FNAB. <br /><strong>RESULTS:</strong> The sensitivity of FNAB was 46%. The specificity and positive predictive value were both 100% and negative predictive value was 90%. Overall accuracy in diagnosing malignant parotid tumor was 91%.<br /><strong>CONCLUSION:</strong> FNAB in this institution is a poor predictor of malignancy, having a sensitivity rate of only 46%. While this may serve as a basis for not recommending pre-operative FNAB for patients with parotid tumors in the interim, other factors should also be considered, including concerns with the actual performance and interpretation of FNAB in our institution.<br /><br /> </p>

Chemodectoma and tetralogy of fallot

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To describe a rare case of chemodectoma, its clinical features and management, and to discuss its relationship chronic hypoxia from Tetralogy of Fallot.<br /><br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><br /><strong>Setting:</strong> Tertiary Government Hospital<br /><br /><strong>Patient:</strong> One<br /><br /><strong>RESULTS:</strong> A 23-year-old woman presented with a painless, slow growing, movable right submandibular mass, initially diagnosed as a lipoma by fine needle aspiration biopsy.  Computed tomography scan showed a solid nodule with ill-defined margins from the angle of the mandible to the level of the hyoid bone along the carotid sheath. There was also an incidental finding of patent ductus arteriosus and Tetralogy of Fallot on pre-operative clearance. Excision of the mass under general anesthesia revealed adherence to the posterior portion of the carotid trunk enveloping both the internal & external carotid artery. Final histopathological diagnosis was chemodectoma.<br /><br /><strong>CONCLUSION:</strong> Although rare, chemodectoma should be considered as one of the differentials in a patient with a submandibular mass. Hyperplastic chemodectoma may result from chronic hypoxia due to Tetralogy of Fallot.  Surgical excision is the treatment of choice.</p>

Polymorphous low-grade adenocarcinoma

@#A 60-year-old woman with a 3-year history of a gingivoalveopalatal mass underwent an incision biopsy. Microscopically, the lesion centered in the stroma is infiltrative (Fig. 1) and architecturally diverse, having cystic (Fig. 2), linear or “Indian file” (Fig. 3), solid, and tubular (Fig. 4) patterns. The cells are uniform in size, round to oval, and have bland cytologic features, with vesicular nuclei and inconspicuous nucleoli (Figure 4). The clinical data and histomorphologic features characterized by architectural diversity yet cytologic blandness lead us to the diagnosis of polymorphous low-grade adenocarcinoma. Polymorphous low-grade adenocarcinoma (PLGA) is a malignant epithelial tumor characterized by cytologic uniformity, morphologic diversity, an infiltrative growth pattern, and low metastatic potential.1 It is the second most common intraoral malignant salivary gland tumor 1 following mucoepidermoid carcinoma. The tumor is found almost exclusively in minor salivary glands and is rare in extraoral locations, including major salivary glands.2 The tumor affects a wide age range (16 – 95 years; mean 60 years), with only 2 pediatric cases reported,1 and has a female predilection.3,4 It usually presents as a painless mass located within the oral cavity,3 60% of which are located in the palate.1 They are characteristically unencapsulated, although well-circumscribed.

The Looi suture technique for anchoring the lateral tarsal strip to the lateral orbital wall

<p><b>INTRODUCTION</b>The lateral tarsal strip procedure (LTS) was first reported by Anderson and Gordy in 1979 for the management of paralytic or senile eyelid laxity. Since its description, the LTS procedure has been subject to several modifications by various authors. In this study, we described the Looi suture technique, a small modification in the technique of suturing the LTS to the lateral orbital wall periosteum. Using this technique, the surgeon achieves a larger area of contact between the anterior surface of the tarsal strip and the lateral orbital wall periosteum, promoting a stronger adhesion. With a double-armed suture, the technique also allows for adjustment of the lower lid tension to avoid over- or under-correction of horizontal lid laxity. This study aimed to evaluate the technique.</p><p><b>MATERIALS AND METHODS</b>This was a retrospective non-comparative case series of 39 eyelids of 31 patients who underwent LTS with Looi suturing technique for the correction of involutional lower lid laxity which had resulted in either entropion or ectropion. In this procedure, a novel technique utilising a double armed 5/0 Ethibond suture is used to secure the LTS to the lateral orbital rim, with the aim of increasing appositional contact between the LTS and periosteum.</p><p><b>RESULTS</b>In 36 eyelids with entropion, the procedure was combined with lower lid retractor repair, and in 3 eyelids with ectropion, with medial tarsoconjunctivoplasty. Surgery was successful in 37 of 39 eyelids (94.87%) after one procedure. The remaining 2 eyelids required repeat procedures to achieve anatomical success. Both cases had been performed by trainee surgeons under supervision. Postoperative follow-up period ranged from 1 day (in a visiting overseas patient) to 2 years.</p><p><b>CONCLUSION</b>This study described the Looi suturing technique in performing the LTS procedure and we found it a simple and effective modification when dealing with lower lid laxity.</p>

Clinical profile and histopathologic diagnoses of childhood peripheral lymphadenopathy: An MMC experience

Peripheral lymphadenopathy is a common clinical problem wherein surgery is performed, especially, when malignancy cannot be eliminated as a differential diagnosis. In the Philippine setting, there is a paucity of data on the incidence of lymphadenopathy in children. Objectives: This descriptive study aims to describe the clinical profile and histopathologic diagnoses of peripheral lymphadenopathy requiring biopsy in children aged one-to-eighteen years seen at the Makati Medical Center (MMC) from 1998 to 2008. Methods: Patients' charts were reviewed and 22 patients were included in the study; 17 were male and 5 were female. All patients underwent excision biopsy, except for one who had fine needle aspiration biopsy. Results: The most common sites of peripheral lymphadenopathy were cervical (78%) and inguinal (14%). The most common histopathologic diagnoses were benign etiology (46%), tuberculous (TB) adenitis (32%), and malignancy (23%). Of the malignant cases, three were Hodgkin's lymphoma and two were non-Hodgkin's lymphoma. Clinical profile included the findings that patients with benign etiology were younger, presented more frequently with fever; and males were more commonly affected; whereas children with malignant etiology were older, had a shorter duration of lymphadenopathy, which were of a larger size, and with accompanying weight loss. Conclusion: The following occurred more often in patients with malignancy: children more than 12 years old, cervical location of lymph nodes, shorter duration of lymph node enlargement, the lack of response to initial antibiotic treatment, and the presence of certain signs and symptoms such as fever and weight loss. Excision biopsy was the predominant surgical procedure used despite extensive invasiveness and the requirement of general anesthesia.