Goal attainment scaling and quality of life of autistic children receiving speech and language therapy in a higher educational institution in the Philippines

Objectives@#This study aimed to describe the demographic profile, intervention sessions, goal attainment scaling (GAS), and health-related quality of life (HRQOL) of autistic children receiving speech and language therapy (SLT) in a higher educational institution in the Philippines.@*Methods@#Deidentified data from 18 autistic children aged 4–16 years (mean=8.2; SD=2.9) who received SLT for two months were analyzed. Their demographic profile, intervention sessions, GAS scores, and generic HRQOL scores were documented. @*Results@#Most participants were school-age children (n=12; 66%) and were boys (n=14; 78%). After two months, the GAS scores of 11 participants (61%) increased by 1–2 points, whereas the scores of the remaining participants decreased (n=6; 33%) or did not change (n=1; 6%). Their mean generic HRQOL scores before and after SLT were 65.6 (SD=15.2) and 61.2 (SD=17.4), respectively.@*Conclusions@#While the GAS scores increased for most participants, their generic HRQOL scores did not show clinically significant changes after two months of SLT. This can be attributed to the few therapy sessions and short follow-up period. The findings highlight the need to provide long-term support to SLT services of autistic children in the Philippines to document more desirable quality of life outcomes.

Clinical, biochemical, and radiologic profiles of Filipino patients with 6-Pyruvoyl-Tetrahydrobiopterin Synthase (6-PTPS) deficiency and their neurodevelopmental outcomes

Background@#Six-pyruvoyl-tetrahydrobiopterin synthase (6-PTPS) deficiency is an inherited metabolic disorder which results in tetrahydrobiopterin (BH4) deficiency causing hyperphenylalaninemia.@*Objective@#This study aimed to describe the clinical, biochemical, and radiologic profiles, and neurologic and developmental outcomes of patients diagnosed with 6-pyruvoyl tetrahydrobiopterin (PTPS) deficiency through newborn screening and confirmed by BH4 loading test, pterin analysis, and gene sequencing who were following-up with the metabolic team.@*Methods@#The research was a single-center descriptive case series study design that was done at the Philippine General Hospital, a tertiary government hospital. The clinical, biochemical, radiologic profiles and neurodevelopmental evaluation of each patient were described.@*Results@#Nine patients from 1 year 2 months to 14 years 5 months of age were enrolled in the study. Clinical manifestations before treatment were hypotonia, poor suck, and seizure. The most common clinical manifestation even after treatment initiation was seizure. The mean phenylalanine level on newborn screening was 990.68 umol/L, but after treatment was started, mean levels ranged from 75.69 to 385.09 umol/L. Two of the patients had focal atrophy of the posterior lobe on brain imaging. Pathogenic variants on molecular analysis were all missense, with two predominant variants, c.155A>G and c.58T>C. Eight of the nine patients had varying degrees of developmental delay or intellectual disability, while the remaining patient had signs of a learning disorder. @*Conclusion@#Newborn screening has played a crucial role in the early identification and management of patients with hyperphenylalaninemia due to 6-PTPS deficiency. Confirmation of diagnosis through determination of DHPR activity, urine pterins and/or molecular analysis is necessary for appropriate management. However, despite early initiation of treatment, neurodevelopmental findings of patients with 6-PTPS deficiency were still unsatisfactory.

Adherence of physicians to local guideline recommendations among patients with COVID-19 in two Tertiary Public Hospitals in Metro Manila, Philippines: A rapid assessment study

Objectives@#Adherence to clinical practice guidelines (CPG) has been shown to reduce inter-physician practice variation and improve quality of care. This study evaluated guideline adherence of physicians in two tertiary public hospitals to local CPG on COVID-19. @*Methods@#This was a multicenter, retrospective chart review, rapid assessment method study. Guideline adherence and non-adherence (overuse and underuse) to 15 strong recommendations in the prevailing Philippine COVID-19 Living Recommendations were assessed among a sample of patients admitted in two centers from July to October 2021. Differences in adherence across COVID-19 disease severities and managing hospital units were analyzed. @*Results@#A total of 723 patient charts from two centers were reviewed. Guideline adherence to dexamethasone use among patients with hypoxemia is 91.4% (95% CI 88.6 to 93.6) with 9.2% overuse. Tocilizumab was underused in 52.2% of patients with indications to receive the drug. There was overuse of empiric antibiotics in 43.6% of patients without suspicion of bacterial coinfection. Lowest adherence to antibiotic use was seen among patients with critical disease severity and those managed in the intensive care unit. None of the other non-recommended treatment modalities were given. @*Conclusion@#Management of COVID-19 in both centers was generally adherent to guideline recommendations. We detected high underuse of tocilizumab probably related to the global supply shortage during the study period and high overuse of antibiotics in patients without suspicion of bacterial coinfection. While the results of this study cannot be generalized in other healthcare settings, we recommend the application of similar rapid assessment studies in guideline adherence evaluation as a quality improvement tool and to identify issues with resource utilization especially during public health emergencies.

Perceptions and experiences of infant massage among caregivers of infants 2-6 months old consulting at two public health centers in Quezon City, Philippines, before and after infant massage training

Background@#The benefits of infant massage in hospital and community settings have been documented in literature: better weight gain of preterm and low birthweight infants, shortened hospital stay, slightly better scores on developmental tests, fewer postnatal complications, and effects on physical and mental health. @*Objectives@#This study described the perceptions and experiences of infant massage among caregivers of infants 2-6 months old consulting in two public health centers in Quezon City before and after infant massage training. @*Methods@#This qualitative study assessed perceptions and experiences at baseline and after infant massage training of mothers and caregivers taking care of infants 2-6 months old. Pre-training interviews were conducted, as well as immediately after, and seven days after training on infant massage delivered by the Philippine League of Government and Private Midwives, Inc. (PLGPMI). Training consisted of lectures and demonstrations, after which mothers/caregivers gave their babies the massage under the trainer's supervision. Post-training interviews were conducted immediately after the training and seven days after. Responses to the interviews were transcribed. The transcripts and interview notes were analyzed independently by two research team members. Qualitative Content Analysis (QCA) was done. Disagreements were settled by discussion. @*Results@#The infant’s mother was identified as the best person to perform infant massage. Infant massage was a new concept to many participants before the training. In general, the perception was positive. It was believed to promote the baby's physical development and bonding with the mother/caregiver. These same benefits were reported after the training. Post-training, all 11 participants who returned for follow-up interviews reported having massaged their babies at home. They were also able to describe the process and timing of massage as taught to them. The participants’ responses centered on seven (7) identified themes, identified at baseline and after training: 1) general concepts of infant massage, 2) benefits of infant massage, 3) methodologies, materials, and considerations, 4) persons credible to perform infant massage, 5) application/performance of infant massage, 6) intentions and 7) infant massage as a public health measure. @*Conclusion@#There was a positive perception of infant massage among mothers and caregivers of infants 2-6 months old, whether or not they had prior knowledge. The sharing of information and the training given enhanced this. Participants showed good reception and retention of infant massage's basic concepts and process and improved their confidence in handling their babies and massaging them.

Adherence of physicians to local guideline recommendations among patients with COVID-19 in two tertiary public hospitals in Metro Manila, Philippines: A rapid assessment study

Objectives@#Adherence to clinical practice guidelines (CPG) has been shown to reduce inter-physician practice variation and improve quality of care. This study evaluated guideline adherence of physicians in two tertiary public hospitals to local CPG on COVID-19. @*Methods@#This was a multicenter, retrospective chart review, rapid assessment method study. Guideline adherence and non-adherence (overuse and underuse) to 15 strong recommendations in the prevailing Philippine COVID-19 Living Recommendations were assessed among a sample of patients admitted in two centers from July to October 2021. Differences in adherence across COVID-19 disease severities and managing hospital units were analyzed. @*Results@#A total of 723 patient charts from two centers were reviewed. Guideline adherence to dexamethasone use among patients with hypoxemia is 91.4% (95% CI 88.6 to 93.6) with 9.2% overuse. Tocilizumab was underused in 52.2% of patients with indications to receive the drug. There was overuse of empiric antibiotics in 43.6% of patients without suspicion of bacterial coinfection. Lowest adherence to antibiotic use was seen among patients with critical disease severity and those managed in the intensive care unit. None of the other non-recommended treatment modalities were given. @*Conclusion@#Management of COVID-19 in both centers was generally adherent to guideline recommendations. We detected high underuse of tocilizumab probably related to the global supply shortage during the study period and high overuse of antibiotics in patients without suspicion of bacterial coinfection. While the results of this study cannot be generalized in other healthcare settings, we recommend the application of similar rapid assessment studies in guideline adherence evaluation as a quality improvement tool and to identify issues with resource utilization especially during public health emergencies

Facilitating factors and barriers to newborn screening uptake in the Cordillera administrative region and region V

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Republic Act 9288 or the Newborn Screening Act of 2004 was enacted. A multi-sector effort towards systematic screening of newborn disorders and built-in systems for subsequent confirmatory tests for positively screened as well as treatment for confirmed cases was likewise implemented. Despite multi-sector efforts and continuous quality improvement mechanisms, national newborn screening coverage remained low for several years.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study determined factors that influence Newborn Screening (NBS) uptake from various perspectives: mothers, health providers, and program administrators.</p><p style="text-align: justify;"><strong>METHODS:</strong> Framework analysis of NBS program documents, 25 focus group discussions and 37 key informant interviews of mothers, health providers and program administrators were done in purposively selected communities in the Cordillera Administrative Region and Region V.</p><p style="text-align: justify;"><strong>RESULTS AND CONCLUSIONS:</strong> Findings showed the need to disseminate correct NBS procedures, especially upon obtaining positive results. Financing issues were addressed innovatively, but system administrators and health providers required a common understanding of program implementation. Monitoring geographically hard-to-reach areas remained a challenge. Barriers outside the system adversely affected filter cards availability, specimen transport, and release of results. Improved online and paper-based educational campaign, greater local government unit support, streamlined PhilHealth processes, a workload-based manpower complement for monitoring, and continuity clinics to handle positive findings can increase NBS uptake.</p>

Levodopa+carbidopa in x-linked dystonia parkinsonism (XDP/DYT3/Lubag): A randomized, double-blind, placebo-controlled trial

@#<p><strong>OBJECTIVE:</strong> X-linked dystonia parkinsonism (XDP) is an adult-onset, progressive and debilitating movement disorder described among Filipino males from Panay Island. The available oral medications have been ineffective. While chemodenervation with botulinum toxin A works and deep brain stimulation surgery is promising, these are not affordable for the vast majority of patients. Thus, we decided to look into the efficacy, safety and tolerability of levodopa+carbidopa (levodopa) versus placebo among patients with XDP.</p><p><strong>METHODS:</strong> This was a double blind, randomized, placebo-controlled clinical trial. Patients were randomized to receive levodopa or placebo for 6 months. The dose was increased gradually until 1000 mg levodopa/day is reached or until side effects appear.</p><p><strong>RESULTS:</strong> A total of 86 out of 94 randomized patients (91.5%) were included in the intention-to-treat cohort for the primary efficacy analysis. Nineteen patients (9 in levodopa, 10 in placebo) dropped out or were lost to follow up. There was no significant difference in the baseline and last visit Burke Fahn Marsden Dystonia Rating Scale and the part III of the Unified Parkinson's Disease Rating Scale scores between levodopa and placebo. The most common adverse events in the levodopa group were increased movements, pain and nausea/ vomiting.</p><p><strong>CONCLUSION:</strong> While levodopa is safe and well-tolerated, it does not have any effect in alleviating the dystonia or parkinsonism in XDP.</p>

Reliability analyses of the GDx nerve-fiber analyzer

Objectives: The scanning laser polarimetry, exemplified by the GDx 400 (Laser Diagnostic Technologies, San Diego, CA, USA) nerve-fiber analyzer, allows noninvasive quantitative assessment of the retinal nerve-fiber layer. This study determined the reliability of the GDx 400 in taking repeat measurements by different operators and at different sessions in a sample of normal and glaucoma patients Methods: Patients with and without glaucoma underwent a complete eye evaluation, automated achromatic perimetry, scanning laser polarimetry, and optic-disc photography. Retinal nerve-fiber layer (RNFL) measurements were obtained for each group of patients by two trained operators who were masked as to the status of the study eye. Four measurements were obtained for each study eye in the same session and in another session. Reliability measures using intraclass correlation coefficient of five preselected GDx parameters were obtained Results: The study recruited 355 patients (171 normal, 184 glaucomatous) ages 30 to 78 years. Intraclass correlation coefficients within operator same session (0.84-0.95), within operator different sessions (0.78-0.93), between operators same session (0.79-0.94), and between operators different sessions (0.80-0.94) were excellent. The reliability measures for the second session (0.79-0.94) were higher than for the first session (0.79-0.87) even for measurements taken by the same operator Conclusion: The GDx 400 nerve-fiber analyzer has good reliability measures and can be used to monitor changes in the RNFL thickness over time. Change in measurements exceeding 20 percent from baseline should be considered as possible progression. (Author)