Factors associated with attrition among residents in pediatrics: A mixed-method study in a single center in the Philippines

@#<p style="text-align: justify;"><strong>Background.</strong> Attrition in residency training can lead to lower workplace morale and increased costs. Finding associated factors can help revise admissions criteria or identify at-risk residents.</p><p style="text-align: justify;"><strong>Objective.</strong> We aimed to determine factors associated with attrition among residents in pediatrics.</p><p style="text-align: justify;"><strong>Methods.</strong> We applied a mixed cross-sectional (survey) and retrospective cohort (records review) study design. Residents who began training in the Philippine General Hospital in 2012-2018 were included. Our primary outcomes were non-completion of training within three years (attrition), completion beyond three years or ongoing training at a delayed year level (off-cycle), and the composite of attrition or off-cycle. Fisher's exact probability test and t-test were used to compare the non-attrition group versus the attrition group, and the non-attrition group versus the attrition or off-cycle group.</p><p style="text-align: justify;"><strong>Results.</strong> The overall attrition rate and off-cycle rate among 162 residents were 7.41% and 4.32%, respectively. The survey response rate was 73.00%. Four factors were significantly associated with attrition: higher age at entry into the program (p = 0.030), advanced degree (p = 0.009), longer interval from internship completion to start of residency training (p = 0.017), and a lower case presentation score (p = 0.048). The proportion of respondents older than 29 years was significantly higher in the attrition group than the non-attrition group (40.00% vs 0.94%, p = 0.031). Higher age at entry was also significantly associated with the composite outcome (attrition or off-cycle).</p><p style="text-align: justify;"><strong>Conclusion.</strong> Older age at entry, advanced degree, a longer interval from internship, and lower-case presentation scores were associated with attrition among residents in pediatrics from a single center.</p>

Validation of the Filipino translated questionnaire on parent attitudes about childhood vaccines

@#<p style="text-align: justify;"><strong>OBJECTIVE: </strong>To determine the content validity and test-retest reliability of the Filipino Translated Questionnaire on Parent Attitudes About Childhood Vaccines.</p><p style="text-align: justify;"><strong>METHODOLOGY:</strong> Eligible parents of patients seen at the Pediatric Outpatient Department, Pediatric Emergency Room and Pediatric Wards of the Philippine General Hospital were recruited into the study. The original survey tool was translated to Filipino by the Sentro ng Wikang Filipino. A focus group of four experts in the field of vaccination rated the content of each item on the questionnaire based on its relevance. Ten Filipino speaking participants were then recruited to check its face validity. This was then implemented to 67 Filipino speaking participants to check its test-retest reliability.</p><p style="text-align: justify;"><strong>RESULTS: </strong>The overall item content validity index of the questionnaire was computed to be 0.95. All items had a 100% rating in terms of clarity and simplicity. The high intraclass correlation coefficient of 0.970 supports the tool's test-retest reliability. However, the test had a low Cronbach's ? coefficient of 0.687 which could be increased to 0.711 with the removal of one item from the question pool.</p><p style="text-align: justify;"><strong>CONCLUSION: </strong>The Filipino Translated Questionnaire on Parent Attitudes About Childhood Vaccines has face and content validity with an acceptable internal consistency. This can serve as a framework for future researches on vaccine hesitancy.</p>

Prophylactic balloon occlusion of the internal iliac arteries in two-cases of placenta accrete syndromes / Philippine Journal of Obstetrics and Gynecology

@#Placenta accreta syndrome results from the abnormal adherence of the placenta to the myometrium due to the absence of the decidua basalis and imperfect development of the Nitabuch layer. It causes serious obstetric morbidity due to the risk of massive hemorrhage. Balloon occlusion of internal iliac arteries has been used prophylactically to decrease hemorrhage in cesarean hysterectomy for placenta accreta. In this paper, two cases of placenta accreta syndromes wherein bilateral internal iliac artery balloon occlusion was done prior to cesarean hysterectomy are presented. Case 1 is a 50-year-old G4P0 (0030) pregnancy uterine who came in at 33 3/7 weeks age of gestation for fetal surveillance. Case 2 is a 38-year-old G4P2 (2012) pregnancy uterine who came in at 33 4/7 weeks age of gestation for decreased fetal movement. Both cases were successfully delivered via cesarean hysterectomy with prophylactic balloon occlusion under a multidisciplinary team in a tertiary care center.

Bacterial community structure of aquaculture and non-aquaculture sediments of Taal Lake (Philippines) using PCR-DGGE of 16S rDNA

@#<p><strong>Background and Objective:</strong> Microorganisms, including bacteria, serve as major players in various processes affecting both the quality of aquatic sediment as well as the fate of pollutants released into such matrix. This study, evaluated the similarity in bacterial community structure between sediments collected from aquaculture and non aquaculture sites of a tropical lake. Describing and comparing the bacterial community present in each site may provide clues on the impact of aquaculture practices on aquatic ecosystems.<br /><strong>Methodology:</strong> Microbial DNA was extracted using PowerSoil® DNA Isolation Kit for all sediment samples. DNA isolates were used as template in the analysis of the hypervariable region of 16S rDNA through nested polymerase chain reaction (PCR) and denaturing gradient gel electrophoresis (DGGE). Excised representative 16S rDNA DGGE bands were sequenced and identified through BLAST analysis.<br /><strong>Results:</strong> Based on the generated mean Dice similarity coefficient of 57.77%, the bacterial community structure between aquaculture and non-aquaculture sediments was highly similar but certain taxa were found unique for each site. Bacteria belonging to Proteobacteria and Firmicutes dominated the aquaculture sediments while Proteobacteria, Firmicutes, and Chloroflexi dominated the non-aquaculture sediments. Certain physicochemical parameters operating in the two sites may have influenced the shift in representative microbes. Shewanella baltica and Trichococcus sp. were found only in aquaculture sediment owing to their ability to tolerate quantities of ammonia and high organic matter from their environment.<br /><strong>Conclusions:</strong> This study described the applicability of 16S rDNA PCR-DGGE as a culture-independent technique for describing and comparing the similarity between bacterial communities in sediment. Based on the generated similarity index, the bacterial community between aquaculture and non-aquaculture sediments of Taal Lake was highly similar but interestingly, harbored unique bacterial populations as seen in the DGGE profiles. The shift in dominant taxa and unique representatives per site may have been influenced by certain differences between each site's physico-chemical parameters.</p>

Antibiotic prescribing patterns of pediatric residents: Do the results of blood cultures make a difference?

Abstract@#The diagnosis of bacteremia relies on the isolation and identification of the bacteria from blood cultures, whether they are community-acquired or nosocomial in origin. However, studies have shown that, in the Philippines alone, physicians have been found to underutilize these laboratory examinations. @*Objectives@#The goal of this study was to determine the influence of positive blood cultures and sensitivity test results on the antibiotic choices of pediatrics residents at the University of the Philippines – Philippine General Hospital (UP-PGH). @*Methods@#A chart review of patients with positive blood cultures, who were 18 years old and below, and admitted initially at the UP-PGH Pediatric Emergency Room (UP-PGH PER) from August 1, 2004 to July 31, 2005 was performed. Excluded were patients who died before the release of the blood culture reports or discharged per request or against medical advice, post-operative patients, patients with presumed polymicrobial sepsis, and patients with contaminated blood cultures. Results: One hundred twenty two (122) patients with positive blood cultures were included: 87 or 71.3% of the isolates were community-acquired, the most common pathogens of which were gram-positive bacteria, Staphylococcus epidermidis (18.3%), followed by gram-negative Salmonella (11.5%). Among the patients diagnosed with bacteremia at the UP-PGH PER, Staph. epidermidis was also the most common pathogen; with 34% of all isolates acquired nosocomially. Other significant isolates included Pseudomonas putida, Pseudomonas aeruginosa, and Klebsiella sp. Prior to the release of the blood culture and sensitivity results, 45 of the 122 patients were already discharged. Therapy at the time of discharge was of questionable efficacy, accounting to 73.3%. Of the 77 patients discharged after the release of blood culture and sensitivity (CS) results, only 21(27%) of the antibiotic therapies were modified, and 56 (73%) were not modified at all. It is imperative to know, however, that 50% of the antibiotic therapies were modified a day after the corresponding blood culture and sensitivity (CS) results came out for patients who presented with nosocomial infection. @*Conclusion@#In general, blood culture and sensitivity test results have a limited effect on the antibiotic choices of pediatric residents at the UP-PGH (University of the Philippines – Philippine General Hospital).

Management of angle closure glaucoma.

Primary angle closure glaucoma (PACG) is equally prevalent in Indian in Asian population as the primary open angle glaucoma. Eighty-six percent of people with PACG are in Asia, with approximately 48.0% in China, 23.9% in India and 14.1% in southeast Asia. To understand PACG, it is mandatory to understand its classification and type of presentation with the underlying pathophysiology. The treatment options are medical, laser and/or surgical. The present article provides an overview of PACG.

Papel da tomografia computadorizada no diagnóstico da diverticulite de Meckel: relato de caso e revisão da literatura / Computed tomography findings in Meckel's diverticulitis: a case report and review of the literature

O divertículo de Meckel é o resultado da atrofia incompleta do ducto enfalomesentérico. É a anomaliacongênita mais prevalente do trato gastrintestinal, afetando de 0,3% a 3% da população em geral. A ocorrência de tecido ectópico pancreático e gástrico é freqüente. Ocorre diverticulite em 20% dos pacientes com divertículo de Meckel. Relatamos um caso de diverticulite de Meckel com mucosa gástrica ectópica no seu interior e revisamos os principais aspectos tomográficos.

The Meckel's diverticulum is the result of an incomplete atrophy of the omphalomesenteric duct. It is the most prevalent congenital anomaly of the gastrointestinal tract, affecting from 0.3% to 3% of the general population. The occurrence of ectopic gastricand pancreatic tissue is frequent. Diverticulitis occurs in 20% of the patients with Meckel's diverticulum. We reported a case of Meckel's diverticulitis, with ectopic gastric tissue inside and reviewed the computed tomography findings.

Mammalian cell invasion and intracellular trafficking by Trypanosoma cruzi infective forms

O agente etiológico da doença de Chagas, Trypanosoma cruzi, ocorre como cepas ou isolados que podem ser agrupados em duas grandes linhagens filogenéticas: T. cruzi I associada ao ciclo silvestre e T. cruzi II ligada à doença humana. No hospedeiro mamífero o parasita tem que invadir células, e vários estudos relacionam as formas flageladas tripomastigotas neste processo. Diferentes componentes de superfície dos parasitas e alguns dos respectivos receptores foram identificados. Em nosso trabalho temos procurado compreender como amastigotas, que normalmente são encontrados crescendo no citoplasma, podem invadir células de mamíferos com infectividade comparável às dos tripomastigotas. Encontramos diferenças nas respostas celulares induzidas por amastigotas e tripomastigotas em relação a componentes de citoesqueleto e projeções de membrana ricas em actina. Amastigotas de cepas de T. cruzi I gerados extracelularmente, podem apresentar infectividade maior que tripomastigotas metacíclicos para linhagens celulares e células com expressão alterada em diferentes classes de componentes celulares. Células albergando a bactéria Coxiella burnetii tem nos permitido obter novos enfoques sobre as propriedades de tráfego intracelular das diferentes formas infectivas do T. cruzi, revelando requerimentos inesperados para o parasita transitar entre seu vacúolo parasitóforo até seu destino final no citoplasma da célula hospedeira.

A phacoemulsification chopping technique that attacks the posterior plate

Surgical Technique: The technique involves creating a central crater, flipping the nucleus out into the supracapsular space, and creating another crater through the posterior surface that will eventually connect with the anterior crater to produce a central hole. The donut-shaped nucleus is then chopped and the fragments are aspirated with greater ease. Results: The technique was performed successfully in seven eyes of six patients with only minor problems. Phacoemulsification times were longer than usual because of the additional sculpting, but clinical results were not adversely affected. Conclusion: For dense or hard cataracts for which the surgeon anticipates a tough posterior plate, this technique is a safe alternative to the usual chopping techniques.

Niveles de satisfacción de los familiares de pacientes pediátricos con la atención médica en consulta externa / Satisfaction levels in relatives of pediatric patients attended in the outpatients medical care

Introducción. Con el objetivo de medir la calidad de la atención se investigó el nivel de satisfacción de los familiares de pacientes pediátricos que acudieron como externos en relación a la atención brindada por los diferentes grupos de personal y los aspectos específicos de insatisfacción en 1993 y 1994. Material y métodos. Se diseño un estudio prolectivo con una encuesta que contestaron 5,000 familiares al terminar la consulta subsecuente; se seleccionaron 1,000 con una tabla de números aleatorios. El cuestionario fue autoaplicable, anónimo y contenía 24 preguntas. Las variables estudiadas fueron: satisfacción con el grupo médico, de enfermería, trabajo social, asistentes médicas, personal de laboratorio, imagenología y neurofisiología; además, la información proporcionada, limpieza, oportunidad de la atención y el tiempo de espera. La satisfacción global fue identificada con un índice (satisfecho con 81 por ciento de los aspectos interrogados) 0.132. Resultados. Los resultados mostraron un alto grado de satisfacción (92 por ciento). Conclusión. La comparación de las insatisfacciones reveló algunas diferencias significativas

Characterization of & induction of immune response to anti-idiotypic antibodies for JE virus.

Anti-idiotypic antibodies (anti-Ids, Ab2s) were prepared by immunizing rabbits with two murine monoclonal antibodies (Ab1) having specificities for two independent haemagglutinin (HA) epitopes on JE virus [viz., Hs-1, monoclonal antibody (MAb) specific for Japanese encephalitis virus (JEV) and Hx-1, MAb common to flaviviruses]. Anti-Hs-1 (S-Ab2) and Anti-Hx-1 (X-Ab2) reacted specifically with the immunizing Ab1. In addition, they could react with other MAbs whose reactivity was similar to their immunizing homologous Ab1. The paratope inhibition assay indicated that both anti-idiotypes recognized paratope related idiotopes on their respective Ab1 and could therefore be designated as Ab2 beta. Experimental animals (Swiss mice, Balb/c mice and guineapigs) immunized with S-Ab2 or X-Ab2 produced anti-JE virus antibodies (Ab3) which could be detected by enzyme linked immunosorbent assay, immunofluorescence, haemagglutination inhibition and neutralization tests. The anti-idiotypes were also found to stimulate a cellular immune response in vitro as assessed by 3H thymidine incorporation by lymphocytes from JE vaccinated individuals and experimentally immunized Balb/c mice. The findings of the present study suggest that both the anti-Id antibodies are homobodies which may act as surrogate antigens to manipulate the immune response against JEV.

Epitope analysis of strains of Japanese encephalitis virus by monoclonal antibodies.

Twenty one strains of Japanese encephalitis (JE) virus, including 16 from India, were compared antigenically on the basis of their reactivity in immunofluorescence (IF), haemagglutination inhibition (HI), ELISA with captured antigen (ECA), and neutralization (N) tests with JE monoclonal antibodies (MAbs). These MAbs represented three domains of distinct epitopes on the envelope protein, designated as Hs-1 to 4 (JE specific in HI), Hx-1 to 5 (flavivirus cross reactive in HI) and NHs-1 to 2 (non-HI JE virus specific). Fifteen of the 21 strains studied were placed in group I. These reacted with MAbs representing the three domains in all the tests indicating presence of the three types of epitopes with full functional activity. The remaining six strains were placed in group II and showed loss in HI reactivity with Hs MAbs but not with Hx MAbs. All the group II strains also reacted in IF and ECA with NHs-1. Hs epitopes in three strains, G9473 (Tamil Nadu), 641686 (Tamil Nadu) and 822199 (Karnataka), appeared to have mutated partially, indicating loss in HI reactivity with Hs MAbs only, while there was retention of other reactivities, viz., IF, ECA and to some extent N test with G9473 and 641686. The remaining three strains, 691004 (Sri Lankan), 755468 (West Bengal) and Yoken (Japan) of group II showed almost complete loss of Hs-1 and Hs-2 epitopes as there was absence of reactivity in IF, ECA and N test in addition to HI. However, Hs-3 MAb showed reactivity in IF with these strains.(ABSTRACT TRUNCATED AT 250 WORDS)