Cholesterol granuloma as a rare differential in bone erosion of the orbit: A case report

Objective@#We report a case of orbitofrontal cholesterol granuloma as a rare differential diagnosis of orbital erosion in the diploe of the frontal bone. @*Methods@#This is a case report. @*Results@#A 50-year-old man presented with right eye proptosis. Computed tomography (CT) scan of the orbit showed a fairly delineated homogeneous mass centered in the diploe of the right frontal bone with calcification and rugged erosion of the frontal bone and with expansion into the right superotemporal orbit. The patient was initially diagnosed with malignant lacrimal gland tumor on the right. He underwent orbitotomy with excision of the mass. Histopathologic studies of the excised mass revealed a cholesterol granuloma.@*Conclusion@#Cholesterol granulomas of the frontal bone in the superotemporal orbit are rare benign lesions that present with bone destruction and can be mistaken for lacrimal gland malignancies. Surgical excision has a high success rate with low incidence of recurrence.

Pre-operative glycosylated hemoglobin level and fasting blood sugar as markers for risk of acute kidney injury in the immediate post-operative period among type 2 diabetic patients after elective abdominal surgery

@#<p style="text-align: justify;"><strong>Objectives:</strong> The study aimed to identify whether pre-operative glycosylated hemoglobin level (HbA1c) and fasting blood sugar (FBS) can be used as markers for the development of acute kidney injury (AKI) in the immediate post-operative period of type 2 diabetic patients after elective abdominal surgery.</p><p style="text-align: justify;"><strong>Methods:</strong> This retrospective cohort pilot study included seventy-four diabetic patients who underwent elective abdominal surgery from 2015 to 2018. HbA1c and FBS, demographic data, comorbidities, type and indication of surgery, and treatment history were correlated with the development of AKI using logistic regression analysis.</p><p style="text-align: justify;"><strong>Results:</strong> In this cohort, 12% of subjects developed AKI. Univariate and multivariate logistic regression analysis, however, showed that neither HbA1c and FBS nor other studied factors were predictive for the occurrence of AKI (OR 2.55, p= 0.26 and OR 0.64, p= 0.72 respectively).</p><p style="text-align: justify;"><strong>Conclusion:</strong> Pre-operative HbA1c and one-time FBS values in diabetic patients undergoing elective abdominal surgery procedures were not statistically predictive of AKI in the present data. However, the observed trend towards the risk of AKI among the elevated HbA1c subset of patients should drive further studies with a greater sample size and of a prospective nature looking at other metabolic factors contributing to AKI.</p>

Meta-analysis of effectiveness of community-based interventions in improving physical activity in youth with intellectual disability

Background and Objectives@#The effects of home or community-based interventions in increasing physical activity in youth with intellectual disabilities are yet to be known. Such information is important in designing the care for this population because of their increased susceptibility to lifestyle diseases that affect their quality of life. This study aimed to determine the effectiveness of home or community-based interventions in increasing physical activity levels in youth with intellectual disabilities. @*Methodology@#Eight databases were searched to identify intervention studies available in English that investigated the effects of home or community-based interventions on physical activity levels in youth with intellectual disabilities. Data were analyzed using descriptive statistics and meta-analysis using a random effects model. Effect sizes were calculated as standardized mean differences with 95% confidence intervals. @*Results@#Six randomized controlled trials were included in this review. Home or community-based interventions had a small effect in improving physical activity levels in youth with intellectual disabilities. These effects did not reach statistical significance for physical activity levels (d = 0.33; CI = -0.11 to 0.78; p = 0.14), number of steps per unit of time (d = 0.23; CI = -0.23 to 0.68; p = 0.32), and time spent inactive (d = 0.15; CI = -0.29 to 0.60; p = 0.50). @*Conclusion@#Home or community-based interventions may be effective in increasing physical activity levels in youth with intellectual disabilities. Further research with homogeneous outcome measures and larger sample sizes need to be conducted to build on the results of this review.

Antibacterial efficacy of methanolic extract of molave (Vitex parviflora A. Juss) leaves against Streptococcus mutans

Background@#Antibacterial drugs are used for suppressing harmful bacteria. However, some are reported to have side effects which led researchers to investigate plants with antimicrobial properties as potential alternatives. One such indigenous plant is the Vitex parviflora A. juss, “molave” or “mulawin” tree. @*Objective@#This study determined and compared the antibacterial efficacy of 50 mg/ml and 100 mg/ml concentrations of fresh local molave leaves methanolic extract with 0.12% chlorhexidine, distilled water, and 95% methanol on growth inhibition of S. mutans. @*Methodology@#Five hundred grams of fresh molave leaves were collected and subjected to methanolic extraction. In vitro antimicrobial susceptibility test by disk diffusion of 50 mg/ml and 100 mg/ml molave extract concentrations, 0.12% chlorhexidine, distilled water, and 95% methanol on 18 Mueller-Hinton agar (MHA) plates inoculated with S. mutans was done. For cost-efficiency, the total sample size of 80 plates was reduced by placing 5 test groups in one plate divided into five portions done in 18 replicates. After 48 hours of incubation in anaerobic conditions, resulting zones of inhibition were measured. Data were analyzed through one-way ANOVA and Bonferroni tests. @*Results@#The mean diameter of inhibition zones produced by 100 mg/ml and 50 mg/ml concentrations of molave methanolic leaves extract and 0.12% chlorhexidine was 15.78 mm, 11.63 mm, and 21.44 mm, respectively. Distilled water and 95% methanol did not inhibit bacterial growth. The 100 mg/ml concentration has stronger antibacterial properties than the 50 mg/ml. @*Conclusion@#The Vitex parviflora A. Juss methanolic leaves extract has the ability to inhibit the growth of S. mutans in vitro. Both concentrations were relatively weaker compared to chlorhexidine.

Knowledge and perceptions regarding immunization among mothers of under five children: a community study from South Kerala

Background: Immunization coverage is undisputedly the most effective health status and outcome indicator.' Though India is effectively organizing vaccination campaigns, a large majority of children are often left out. Strong anti-vaccination propaganda is influencing the decision of parents. This study was initiated in the context of vaccine-preventable disease outbreak rising recently in Kerala to assess the knowledge and practices of mothers of children less than five years regarding immunization.Methods: A cross sectional study was conducted among 140 women with children less than 5 years. Sample was drawn from the rural and urban field practice areas of a tertiary care teaching hospital. A pilot tested interviewer administered questionnaire was used to assess the knowledge and practices of immunization among mothers of under-five children. Chi-Square test was used to find the association between dichotomous variables.Results: In the study group 96.4% of the children were fully immunized. Mean score on knowledge regarding immunization among the study population was 6.45 (SD=1.84). Majority (89%) of the mothers agreed on the importance of vaccination. More than half (57.1%) had heard of anti-vaccination campaign and 24.3% were influenced by it at one time or the other. Higher knowledge score was associated with mothers residing in urban area, better occupation of mother and educational status of father. Age of child, sex, religion, type of family did not influence knowledge level. Factors influencing the perceived importance of vaccination are better occupation of father, higher education status of father and mother.Conclusions: Vaccination was perceived significant for child's health. Immunization coverage in the study population was high. The level of knowledge regarding immunization among the study population was poor. Anti-vaccination campaign has influenced the population at one time or the other.

Assessment of anaemia and iron status among pregnant women in the National Capital District, Papua New Guinea

@#Assessing the prevalence of anaemia, iron deficiency and iron deficiency anaemia among non-pregnant and pregnant women is essential for evidence-based intervention programs. The purpose of this prospective outpatient and community-based cross-sectional study was to assess the prevalence of those conditions among pregnant women resident in the National Capital District (NCD) and attending the Outpatient Antenatal Clinic in Port Moresby General Hospital. Blood samples were collected from 50 non-pregnant and 157 pregnant women who gave consent. HemoCue was used to measure haemoglobin; the serum ferritin, soluble transferrin receptor (sTfR) and C-reactive protein were measured by specialized 96-well enzyme-linked immuno-sorbent assay (ELISA) kits. The ‘sTfR-F index’ was calculated. Mild to moderate anaemia, low serum ferritin and elevated serum sTfR were found in 28% of the non-pregnant women; the sTfR-F index showed that 16% of them had iron deficiency anaemia. Among the pregnant women, 60% had mild to severe anaemia indicating severe public health significance; 48% had low serum ferritin and 38% had elevated serum sTfR; the sTfR-F index showed that 38% of them had iron deficiency anaemia. Mild to severe anaemia was present in 47%, 71% and 62% of the pregnant women in the first, second and third trimesters respectively, while iron deficiency anaemia was present in 20%, 53% and 48% of the pregnant women in the first, second and third trimesters respectively. The sTfR-F index showed that iron deficiency anaemia was present in 36% of primigravida and 40% of multigravida. Social mobilization, intensive and focused education, aggressive awareness campaigns, including all relevant target groups and policy makers, are required to effectively address this major public health issue.

Comparison of the efficacy of metronidazole and metronidazole plus probiotics capsule in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary hospital: A single blind randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginitis. In the Philippines, prevalence of BV is at 28.16%. The mainstay for the treatment of BV is Metronidazole. Although antibiotic therapy has been shown to eliminate BV associated organisms, there is extremely high recurrence rate.OBJECTIVE: To compare the efficacy of metronidazole and metronidazole plus lactobacilli tablet in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary medical center.METHODOLOGY: The population included non-pregnant women ages 15 t0 44 years old, with bacterial vaginosis diagnosed by Amsel's criteria and Nugent's scoring. The participants were randomly assigned to their treatment group, one is Metronidazole only and other received Metronidazole plus Lactobacillus tablet. All participants followed up on day 8,15,22 and 56 from initiation of treatment resolution or persistence of symptoms and collection of vaginal specimen for gram stain and inquire on adverse effects.RESULTS: On day 8 treatment, there were significantly more participant in the metronidazole plus probiotic arm with an estimated lactobacilli count of more than 30/hpf as comapred to metronidazole alone. On day 15 post treatment, there was no statistically significant difference with the estimated Gardnerella vaginalis count, lactobacilli count, presence or absence of malodorous vaginal discharge between the metronidazole plus probiotic and the metronidazole alone arm. With metronidazole plus probiotic group, the proportion of women with less than 30 per hpf Gardnella vaginalis count and absent foul smelling vaginal discharge were accounted among 100% of the participants from day 8 to 56 post treatment. The early reduction in the causative agent and symptoms can be attributed to an increase in the estimated lactobacilli count sustained until 56 days post treatment metronidazole plus probiotic. However, from day 15 to 22 and 56 post- treatment, the proportion of participants who had a nugent's score of less than 4 were greater for both the metronidazole plus probiotic (100%) and metronidazole alone (95%) arm, when compared to day 8 post-treatment. This finding for the metronidazole plus probiotic group is due to sustained reduction in the Gardnella vaginalis count and increase in lactobacilli counts. Potentially , the metronidazole plus probiotic treatment was found to be more favorable in sustaining the normal flora and probiotic can be used as an adjunct may enhance the efficacy of metronidazole in the treatment of BV.CONCLUSION: Metronidazole plus probiotic and metronidazole only treatment are comparable in treating bacterial vaginosis. In terms of restoring and maintaining the normal flora, metronidazole plus probiotic appears to be more significantly efficacious. Probiotic in the form of lactobacilli is a promising adjunct to enhance the efficacy of metronidazole in the treatment of bacterial vaginosis.

End-of-Life planning among older Filipinos

Purpose@#The number of older Filipinos continues to rise resulting in increasing numbers of people who live in a modernized world which offers numerous options to prepare for the End-of-Life (EoL). Henceforth, EoLplanning among older Filipinos and the factors which could potentially influence the propensity to plan ahead needs further investigation. This study ascertained the level of health, relationship, funerary, legal and financial-related EoL planning among older Filipinos, and established the association between EoL planning and sex, chronologic age, religious affiliation, ethnicity, health and financial status.@*Methods@#The study utilized a descriptive survey design, including 400 respondents, chosen through purposive sampling and met the inclusion of Filipino, Baguio residents, aged 60 and above, able to read and understand English, Filipino or Ilokano, and without psychological disturbances or cognitive deficits. The researchers used a self-made questionnaire after establishing validity (0.96) and reliability (0.82). The Saint Louis University Research Ethics Committee ensured the ethical conduct of this research. Data were treated with statistics using frequency, mean and Chi-square test.@*Findings@#The responses indicated moderate levels of EoL planning overall. Moreover, statistical tests revealed that only health status has a significant association with EoLplanning.@*Conclusions@#Based on the findings, the researchers conclude that EoL planning remains not widely used in the Philippines, thus, intensifying the call for more aggressive interventions to make EoL planning salient and acceptable to older people. In addition, health status affects EoL planning considerably, and that knowing the sex, chronologic age, religious affiliation, ethnicity and financial status did not help predict EoLplanning.

Risk factors associated with the activity and severity of Graves’ Ophthalmopathy among patients at the University of the Philippines Manila-Philippine General Hospital / Journal of the ASEAN Federation of Endocrine Societies

Background@#Asians with Graves’ ophthalmopathy (GO) may have earlier compressive features due to narrower orbital apex and increased orbital volume. @*Objective@#To determine the risk factors associated with activity and severity of GO among adults. @*Methodology@#This was a cross-sectional analytical study of 163 adults with Graves’ disease (GD) from the outpatient clinics of the Philippine General Hospital. Demographics, clinical data, thyrotropin receptor antibody (TRAb) and urine iodine (UIE) levels were obtained. All participants were evaluated for activity and severity of GO by a single ophthalmologist. @*Results@#The population was predominantly composed of females (81%) and nonsmokers (69%), with a mean age of 35 + 11 years and median GD duration of 2 years. Median TRAb was 8.9 U/L while UIE was 171 mcg/L. Eight percent exhibited active GO, with 85% having mild disease. Multivariate analysis showed male sex to be associated with severe disease (OR 3.71, p=0.041), while elevated TRAb was associated with both active (OR 1.03, p=0.002) and severe GO (OR 1.02, p=0.007). @*Conclusion@#Lower rates of active and severe GO were seen compared to previous reports. In this population of predominantly nonsmokers, elevated TRAb emerged as a risk factor for active and severe GO.

Comparison of the efficacy of metronidazole and metronidazole plus probiotics capsule in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary hospital: A single blind randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginitis. In the Philippines, prevalence of BV is at 28.16%. The mainstay for the treatment of BV is Metronidazole. Although antibiotic therapy has been shown to eliminate BV associated organisms, there is extremely high recurrence rate.OBJECTIVE: To compare the efficacy of metronidazole and metronidazole plus lactobacilli tablet in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary medical center.METHODOLOGY: The population included non-pregnant women ages 15 t0 44 years old, with bacterial vaginosis diagnosed by Amsel's criteria and Nugent's scoring. The participants were randomly assigned to their treatment group, one is Metronidazole only and other received Metronidazole plus Lactobacillus tablet. All participants followed up on day 8,15,22 and 56 from initiation of treatment resolution or persistence of symptoms and collection of vaginal specimen for gram stain and inquire on adverse effects.RESULTS: On day 8 treatment, there were significantly more participant in the metronidazole plus probiotic arm with an estimated lactobacilli count of more than 30/hpf as comapred to metronidazole alone. On day 15 post treatment, there was no statistically significant difference with the estimated Gardnerella vaginalis count, lactobacilli count, presence or absence of malodorous vaginal discharge between the metronidazole plus probiotic and the metronidazole alone arm. With metronidazole plus probiotic group, the proportion of women with less than 30 per hpf Gardnella vaginalis count and absent foul smelling vaginal discharge were accounted among 100% of the participants from day 8 to 56 post treatment. The early reduction in the causative agent and symptoms can be attributed to an increase in the estimated lactobacilli count sustained until 56 days post treatment metronidazole plus probiotic. However, from day 15 to 22 and 56 post- treatment, the proportion of participants who had a nugent's score of less than 4 were greater for both the metronidazole plus probiotic (100%) and metronidazole alone (95%) arm, when compared to day 8 post-treatment. This finding for the metronidazole plus probiotic group is due to sustained reduction in the Gardnella vaginalis count and increase in lactobacilli counts. Potentially , the metronidazole plus probiotic treatment was found to be more favorable in sustaining the normal flora and probiotic can be used as an adjunct may enhance the efficacy of metronidazole in the treatment of BV.CONCLUSION: Metronidazole plus probiotic and metronidazole only treatment are comparable in treating bacterial vaginosis. In terms of restoring and maintaining the normal flora, metronidazole plus probiotic appears to be more significantly efficacious. Probiotic in the form of lactobacilli is a promising adjunct to enhance the efficacy of metronidazole in the treatment of bacterial vaginosis.

Visual profile of motorcycle-related ocular trauma in a tertiary hospital

Objectives@#To provide a representative data on the local profile of motorcycle-related ocular trauma seen in a tertiary hospital over a period of one year.@*Methodology@#A retrospective case review of all motorcycle-related trauma patients seen at the emergency room of the Philippine General Hospital (PGH) by the Trauma Service of the Department of Surgery and referred to the Department of Ophthalmology and Visual Sciences (DOVS) for eye injuries was conducted. Descriptive statistics were used to determine the prevalence and types of injuries, and the factors affecting these injuries. @*Results@#Thrity-four charts were reviewed; 9 (26.5%) patients had bilateral ocular involvement and 25 (73.5%) unilateral, a total of 43 eyes. The patients were mostly males in their productive age, belonged to the lower economic bracket, and came from nearby Southern Luzon provinces and the National Capital Region (NCR). Most of the injuries incurred were mild and involved the external surface of the eye. Night motorcycle driving, fair weather, and alcohol use were risks identified for motorcycle-related ocular injuries. Helmet use was the only identifiable risk indirectly correlated with severity of ocular injury. @*Conclusion@#Although majority of the ophthalmic injuries were classified as mild, and eyes involved had generally good visual potential, helmet use was the only identifiable risk associated with the severity of the ocular injury

Tear and ocular surface profile in adult anophthalmic sockets

Objective@#To determine the tear and ocular surface profile of the anophthalmic socket in relation to the contralateral normal eye.@*Methods@#Twenty-five adult patients with unilateral anophthalmic sockets were included into the study. They were at least 2 months post-enucleation or post-evisceration and without any topical medications on the anophthalmic socket and control eye for at least 2 weeks. Assessment was performed using the following parameters: (1) meibomian gland evaluation, (2) ocular surface staining, (3) degree of conjunctival inflammation, (4) Schirmer I and II, and (5) conjunctival impression cytology. @*Results@#Mucoid discharge (52%) was the most common complaint in anophthalmic sockets, followed by itchiness (40%), tearing (36%), and dryness (4%). Compared to control eyes, the anophthalmic sockets had more pronounced and statistically significant lid wiper epitheliopathy, conjunctival staining, and bulbar inflammation. Meibomian gland dysfunction, Schirmer I and II, and conjunctival impression cytology showed no difference between the 2 groups. There was a correlation between the symptoms complained and the ocular staining patterns of the anophthalmic sockets.@*Conclusion@#Anophthalmia predisposes to various ocular surface problems, such as a change in the composition of tears, specifically an increase in the mucin component and a decrease in the aqueous and lipid components, resulting to increased tear viscosity.

Use of autologous-fat graft in postenucleation-socket syndrome

Objective@#To describe the use of autologous-fat grafting in postenucleation-socket syndrome.@*Methods@#This is a case report.@*Results@#There was marked improvement in the gross appearance of the treated orbit of the patient. There was relief in enophthalmos and superior-sulcus deformity. Bilateral orbital symmetry was achieved. Postoperatively, only minimal bruising and swelling both in the orbit and source site were observed, which resolved in 4 weeks.@*Conclusion@#The use of autologous-fat graft is a novel but highly effective technique and a good alternative in treating patients with postenucleation-socket syndrome.

Beyond the informed consent procedure: continuing consent in human research

An ethnographic field study about informed consent in hepatitis C clinical trials provides insight into how changes in protocol requirements and patient health status triggered the actions and decisions of researchers and human subjects during the conduct of these trials. U.S. federal guidelines recommend that informed consent should be conceptualized as more than a one-time event. Rather, a process of continuing consent should be the standard but little is understood about how exactly this process should unfold. We used a proposed typology of continuing consent to frame our analysis and were able to document that only some of the proposed types took place at the site of our study. The most frequent practice involved the researchers' re-consent of their subjects for major protocol revisions. Only one subject dissented and chose to withdraw even though he was technically eligible to continue in the study. Two other types of continuing consent were not observed. We discovered an additional type of continuing consent not described in the typology whereby subjects gave implied consent through their cooperation and adherence to the on-going requirements of the protocols. Implications for the informed consent process and the need for further research are presented.

Um estudo etnográfico sobre o consentimento informado em pesquisas clínicas sobre Hepatite C permite compreender como as mudanças no protocolo e estado da saúde do paciente influenciam as ações e decisões dos pesquisadores e sujeitos durante estas pesquisas. As diretrizes federais americanas recomendam que o consentimento informado deva ser entendido como algo mais do que um evento único. Mais precisamente, deve-se seguir um processo de consentimento contínuo como padrão, mas pouco se sabe sobre como exatamente esse processo deve ser desenvolvido. Usamos uma tipologia de consentimento contínuo para nortear a análise e documentamos que só alguns dos tipos propostos ocorreram em nosso campo de estudo. A prática mais freqüente tratava do re-consentimento dos sujeitos para as principais revisões do protocolo. Só um sujeito não consentiu e escolheu sair da pesquisa, apesar de ser tecnicamente elegível para o estudo. Dois outros tipos de consentimento contínuo não foram observados. Descobrimos um tipo adicional de consentimento contínuo, não descrito na tipologia, no qual os sujeitos deram um consentimento implícito por meio de sua cooperação e adesão aos protocolos em andamento. São apresentadas algumas implicações para o processo de consentimento informado e a necessidade de outras pesquisas.