A psychological perspective on the development of a VR exposure therapy application for typhoon-related PTSD

Background@#Posttraumatic stress disorder (PTSD) is a condition involving the manifestation of negative biological, behavioral, affective, and cognitive responses to a triggering event or stimulus. In the Philippines, PTSD can be caused by typhoon-related trauma which is borne out of the country's relative proneness to this natural disaster. Research has shown that PTSD can be effectively mitigated through prolonged exposure therapy. Contemporary studies have also shown promise in the utility of virtual reality as a tool for aiding prolonged exposure therapy. @*Objectives@#To address current research gaps, the study intended to discuss the development of an adjunct virtual reality tool (Typhoon VRET) whose elements were mainly derived using data from narrative review and a consultation interview with a Filipino psychotherapy practitioner. @*Methodology@#The study utilized in-depth literature review and consultation interview with a Filipino trauma response specialist as primary sources of data. Key themes and findings were virtually represented through Unity, Blender, and Cardboard SDK. @*Results@#The Typhoon VRET features a relaxation scene, a rescue scene, and a typical Filipino house that showcases cultural elements so as to stimulate clients' traumatic reminders and fear structures. Users are given the option to control the environment, including the strength and volume of the flooding, wind, and rain. @*Conclusion@#Virtual reality could may be an adjunct tool to aid in addressing typhoon-related trauma among Filipinos. Several recommendations are provided in improving the technical features of the tool and integrating it into psychotherapy practice.

Degree of family disaster preparedness and association of demographic characteristics of active consultants of a tertiary hospital for children in Quezon City

@#<p><strong>BACKGROUND:</strong> Increasing incidence of natural and man-made disasters emphasize the need to assess home disaster preparedness of pediatricians.</p><p><br /><strong>OBJECTIVES:</strong> To determine degree of family disaster preparedness and association of demographic characteristics of active consultants of a tertiary hospital for children in Quezon City.</p><p><br /><strong>METHODS:</strong> Cross-sectional study where participants were selected using purposive type of sampling. Fifty-eight active consultants for children answered a self-administered questionnaire on home disaster preparedness. Data was analyzed using SPSS version 24.0.</p><p><br /><strong>RESULTS:</strong> Total of 36 (62.06%) participants scored 70 and above, indicating family disaster preparedness. A total of 22 (37.94%) participants scored below 70, indicating lack of home disaster preparedness. The age of participants 35 to 40 (OR 108.57), 41 to 45 (OR 36.01), 51 to 55 (OR 11.4) and 56 to 60 (OR 17.93) are more likely to be family disaster ready (p value <0.05). Male participants were 7 times more likely to have higher overall family disaster preparedness.</p><p><br /><strong>CONCLUSIONS:</strong> This study has shown that 36 consultants in a tertiary hospital for children in Quezon City are prepared for home disasters. Males and younger population are the demographic characteristics associated with an increased degree of family disaster preparedness.</p><p><br /><strong>RECOMMENDATIONS:</strong> Basics of home disaster management should be included in continuing medical education of the hospital staff. Health education management system should encourage participation of hospital staff in disaster management programs. Bigger sample size of the pediatric society is recommended. Determine association of other demographic variables on home disaster preparedness. Address issues to overcome response bias.</p>

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.

A rare case of persistent jugulocephalic vein and its clinical implication / 대한해부학회지

Persistence of jugulocephalic vein is one of the extremely rare variations of the cephalic vein. Knowledge of such a variation is of utmost importance to orthopedic surgeons while treating the fractures of the clavicle, head and neck surgeons, during surgery of the lower part of neck, for cardiothoracic surgeons and radiologists during catheterization and cardiac device placement. We report the persistent jugulocephalic vein in an adult male cadaver, observed during the routine dissection classes. The right cephalic vein ascended upwards, superficial to the lateral part of the clavicle and terminated into the external jugular vein. It also gave a communicating branch to the axillary vein below the clavicle. We discuss the embryological and clinical importance of this rare variation.

Tobacco cessation outcomes in a cohort of patients attending a chest medicine outpatient clinic in Bangalore city, southern India.

Background & objectives: Nicotine dependence is a widely prevalent and harmful chronic addictive disorder. Quitting tobacco use is however, uncommon in India. We present long-term treatment outcomes of out-patient, tobacco cessation treatments from a specialty clinic setting in southern India. Methods: Patients seen in a tobacco cessation clinic were characterized for tobacco use, nicotine dependence and motivation for quitting and offered pharmacologic/non-pharmacologic treatment. They were subsequently contacted telephonically at a mean (±standard deviation) of 24 (±9.1) months to assess tobacco cessation outcome defined as ‘point prevalence of 1-month abstinence’ by self-reporting. Results: The mean age of participants was 48.0 ±14.0 yr. Tobacco use distribution was: beedis only (22%), cigarettes only (49%), beedis and cigarettes (18%), chewing only (2%), and smoking and chewing (9%). Two-thirds had high level of nicotine dependence. Of the 189 patients enrolled, only 15 per cent attended follow up clinics. Only 106 (56%) patients were successfully contacted telephonically and 83 (44%) were lost to follow up. Self-reported point prevalence abstinence was 5 per cent by ‘intent-to-treat’ analysis and 10 per cent by ‘responder’ analysis. Two clinical parameters – high level of nicotine dependence [estimated by the heaviness of smoking index (HSI)] and the absence of vascular or other chronic disease were found to be associated with successful quitting; these were however, not significant on multivariate analysis. Interpretation & conclusions: Our study has identified low quit-rates in a cohort of patients attending a hospital-based tobacco cessation clinic. In the absence of clear-cut predictors of cessation with low quit-rates, there should be continued efforts to improve cessation outcomes and identify predictors for action.

Unusual morphology of the superior belly of omohyoid muscle / 대한해부학회지

Though anomalies of the superior belly of the omohyoid have been described in medical literature, absence of superior belly of omohyoid is rarely reported. Herein, we report a rare case of unilateral absence of muscular part of superior belly of omohyoid. During laboratory dissections for medical undergraduate students, unusual morphology of the superior belly of the omohyoid muscle has been observed in formalin embalmed male cadaver of South Indian origin. The muscular part of the superior belly of the omohyoid was completely absent. The inferior belly originated normally from the upper border of scapula, and continued with a fibrous tendon which ran vertically lateral to sternohyoid muscle and finally attached to the lower border of the body of hyoid bone. The fibrous tendon was about 1 mm thick and received a nerve supply form the superior root of the ansa cervicalis. As omohyoid mucle is used to achieve the reconstruction of the laryngeal muscles and bowed vocal folds, the knowledge of the possible anomalies of the omohyoid muscle is important during neck surgeries.

A rare case of concurrent prolapses of the vaginal vault and rectum / Philippine Journal of Obstetrics and Gynecology

Vaginal vault prolapse occurs in 0.2% to 1.0% of menopausal women with prior hysterectomy. Even rarer is the development of concurrent rectal prolapse seen in 0.03% to 0.1% of cases. This paper aimed to 1) present a rare case of concurrent prolapses of the vaginal vault and rectum in an 87-year old grandmultipara, 2) evaluate factors predisposing to vault prolapse and rectal prolapse and their manifestations, 3) introduce the new quantitative staging system of pelvic organ prolapse by the International Continence Society, 4) discuss the options of management, and 5) emphasize the need for multidisciplinary management approach. An 87-year old grandmultipara presented with two distinct prolapsing masses at the introitus and anus. Implicated factors such as prior hysterectomy, advanced age, multiple vaginal deliveries, menopausal state and history of heavy lifting were identified. Diagnosis was made clinically. The vaginal vault prolapse was categorized quantitatively according to the Pelvic Organ Prolapse Quantification System wherein she was diagnosed to be at stage IV C. Based on such stage, treatment options, both conservative and surgical, were discussed. She underwent perineal surgery for both lesions. Effective therapy for concurrent prolapses of vaginal vault and rectum requires in-depth knowledge of pelvic anatomy and physiology, a thorough physical examination, adequate preoperative planning and prudent selection of surgical procedures that will achieve the most anatomically complete repair that will prevent recurrence.

Increasing prevalence of HIV antibody among blood donors monitored over 9 years in one blood bank.

To determine the time trend of HIV infection among non-professional blood donors at the Christian Medical College and Hospital, Vellore, the annual HIV prevalence among them for the years 1993-1997 was compared with that of the previous 5 yr. Since confirmed number of HIV positive blood donors is required for calculation of prevalence, the serum samples which were reactive for HIV 1/2 antibody by ELISA, were confirmed by Western blot. The annual prevalence of HIV antibody gradually increased from 1.6 per 1000 in 1988-1989, to 3.8 per 1000 in 1996-1997. The mean tri-annual prevalences for the years 1988-91, 1991-94 and 1994-97 were 1.3, 2.7 and 3.6 per 1000 respectively, suggesting a slow but steady increase in HIV prevalence over time. Our findings provide an insight into the dynamics of HIV infection in the general population of our country, whom the nonprofessional blood donors at our hospital represent.

Childhood portal hypertension in Jamaica

Portal hypertension and bleeding from oesophageal varices in children remain a difficult medical problem. The clinical course and management of children with portal hypertension seen over a 14-year period was reviewed. There were 5 females and 2 males with a mean age of 3.6 years at presentation. Five patients presented with severe upper gastrointestinal bleeding and two with severe hypersplenism. All patients had extra-hepatic portal hypertension. Five patients were treated with endoscopic sclerotherapy, including one who had bleeding five years post-splenectomy. A mean of 9 sclerotherapy sessions was performed in each patient. Complete obliteration of varices was not achived in any patient and a single rebleeding episode occurred in four. Three children underwent operative management consisting of splenectomy in two and splenectomy and central spleno-renal shunt in one. There was no mortality in either group after a mean follow-up of 4.3 years. Sclerotherapy may not be totally successful in long-term management of childhood portal hypertension. Surgical therapy or a combination of sclerotherapy and surgery may be the best approach

Tratamiento de la enfermedad de chagas con nifurtimox durante los primeros meses de vida / Treatment of chagas disease with nifurtimox during the first months of life

Se analiza la respuesta terapéutica al nifurtimox (15mg/kg/día) en 48 de 51 niños con infección chagásica, todos menos uno hijos de madres con serología positiva. Los resultados obtenidos parecen indicar que los mismos no dependen del tiempo de ingestión de la droga (3 y 2 o menos meses) sino que están realcionados con la edad al iniciar el tratamiento. Los 43 pacientes tratados precozmente ( menores de 16 meses de edad) negativizaron su parasitemia y su serología en forma persistente, salvo un caso de reinfección. En los 5 pacientes restantes mayores de 17 meses de edad al inicar nifurtimox, las respuestas fueron variables: negativización serológica luego de 3 años de controles positivos y positividad serológica luego de controles negativos (la reinfección no pudo descartarse). En 3 pacientes que no realizaron tratamiento los estudios parasitológicos y serológicos fueron positivos a los 7, 10 y 7 años. Las reacciones adversas a la droga en 31 niños estudiados fueron: anorexia (58,5%), irritabilidad (46,3%) y vómitos (21,9%). Un 19,5% de los niños no presentaron ninguna manifestación. En aquellos en que se estudió la evolución ponderal durante el tratamiento, se observó una marcada disminución de la curva de peso en el grupo comprendido entre los 6 y 9 meses de edad, siendo menos marcada entre los 3 y 6 meses e imperceptible antes de los 3 meses. La experiencia obtenida resalta la necesidad de un diagnóstico precoz sobre todo en aquellos cuyas madres sean serológicamente positivas o habiten en zonas endémicas