Survival Analysis of Patients with Severe Acute Malnutrition Admitted at the In-patient Therapeutic Care of the Bicol Regional Training and Teaching Hospital.

Background: Severe acute malnutrition (SAM) in children under five years remains a major global health concern. It carries a burden to the overall health of a child, contributes to mortality, and adds financial strain to the family and the hospital. The Philippine Integrated Management of Acute Malnutrition was established to address acute malnutrition in Filipino children. Objective: This study aimed to determine the factors affecting survival of patients admitted at Bicol Regional Training and Teaching Hospital (BRTTH) In-patient Therapeutic Care (ITC). Methods: This is a retrospective cohort study design utilizing survival analysis. Accrual period was from January 1, 2018 to December 31, 2018. Follow-up ended on March 31, 2019. There were 154 admissions and excluded 17 missing charts. Survival analysis was done utilizing STATA 14. Results: The prevalence of SAM requiring ITC admission was 3.0 percent. Majority belonged to 6-59 months of age (63%), with equal predilection for both sexes (1:1) and 71% came from the home province, Albay. Most of patients' caretakers had middle educational attainment. Sixty-eight percent (68%) were new patients, 16% readmitted, 15% transferred from the Out-patient Therapeutic Care (OTC) and <1% relapsed. The top three most common complications and co-morbidities include: pneumonia, low electrolytes, and fever. Sixty-three percent (63%) of patients at the ITC had a desirable treatment outcome, of which, 8% were cured and 55% transferred to OTC. Undesirable outcomes accounted for 37% of the cases which included non-cured, defaulter, and died at 12%, 8%, and 17%, respectively. The risk of dying was higher in SAM patients with parents having middle and low educational attainment as compared to those with high educational attainment (2-5 folds to 100-200 folds). SAM patients presenting with hypovolemic shock were likely to die by 1.5-19 times (1.5-19x) as compared to those without. SAM patients with malignancy were more likely to die 4-44 folds as compared to patients without malignancy. Conclusion and Recommendations: Educational attainment of parents, malignancy, and hypovolemic shock were significant predictors of mortality. We recommend prompt intervention by educating families, strengthen policies targeting socio-economic determinants, capacitate medical staff, refine current clinical practice guidelines and treatment pathways to reduce the number of children who die from severe acute malnutrition.

Development and Preliminary Evaluation of Patient Perceptions on Safety Culture in a Hospital Setting Scale.

Objectives: Majority of the existing patient safety culture tools are designed for healthcare workers. Despite the claims that this patient safety tools are patient-centered, limited attention was given to the patients' perspectives and cultural considerations in the development. Local studies are not available in extant literature that capture patient perspectives on being safe during hospitalization. The goal of the study was to develop and provide preliminary psychometric analysis on a tool that measures patients' perception of safety culture in a hospital setting. Methods: The study was a quantitative methodological study. The instrument was developed in three phases, conceptualization and item generation through literature review, clinical observation, and focus group discussion, two rounds of expert panel review, and pilot testing. The tool was tested on 122 eligible patients admitted in a tertiary hospital. Factor analysis of the items was done to determine the underlying factor under each item. Cronbach's alpha was used to test the degree of internal consistency of the scale. Results: The Patient Perceptions on Safety Culture in Hospital Setting Scale consists of 25 items. The analysis yielded four factors explaining a total of 69.23% of the variance in the data. Items were grouped in four dimensions: Hospital workforce (4 items), Hospital Environment (5 items), Heath Management and Care Delivery (7 items), and Information Exchange (9 items). Each factor registered a Cronbach's alpha of 0.81, 0.78, 0.91, 0.94, respectively. The overall Cronbach's alpha of the scale is 0.95. Conclusion: The study offers preliminary evidence on the psychometric properties of a newly developed tool that measures patient perceptions on hospital safety culture. Subsequent studies on larger samples need to be conducted to determine the reliability and validity of the tool when applied to different population and contexts as well as determining valid cut-off points in scoring and interpretation.

Improving fragility hip fracture care through data: a multicentre experience from a country with an emerging economy during the COVID-19 pandemic.

INTRODUCTION: In low-to-middle-income countries (LMIC), the orthogeriatric model of care is still in its early stages of development. This study describes the initial results of the first online fragility hip fracture database to be setup in the Philippines using a modified minimum common dataset to generate outcomes data based on current hospital practices. METHODS: A multicentre prospective cohort study among 12 Philippine hospitals was conducted from June 2020 to February 2021. Thirty-day mortality, morbidity and mobility were measured. Significant factors associated with mortality were determined. RESULTS: 158 elderly patients with fragility hip fractures were included in the study. Nine patients (5.7%) were confirmed or suspected to have COVID-19 infection. Median time of injury to admission was at least 3 days (IQR: 1.0-13.7). Overall, 80% of patients underwent surgical intervention with a median time from admission to surgery of at least 5 days (IQR: 2.5-13.6). Thirty-day mortality and morbidity rates for acute fragility fractures were 3.7%. Factors significantly associated with early mortality were poor prefracture mobility, COVID-19 infection, radiograph of the abnormal chest and conservative treatment. Non-surgical patients had no functional mobility or were wheelchair users and had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%; p=0.031). CONCLUSION: Despite treatment delays unique to an LMIC, short-term outcomes remain favourable for non-COVID-19 fragility hip fracture patients treated with surgery. Prompt admission and multidisciplinary care for elderly hip fracture patients while maintaining protective measures for COVID-19 infection control are recommended. The quality of data collected illustrates how this online database can provide a framework for a sustainable audit or registry as well as provide a platform for the introduction of orthogeriatric concepts at a multiregional scale.

Successful Implementation of Expanded Newborn Screening in the Philippines Using Tandem Mass Spectrometry.

Newborn bloodspot screening (NBS) began as a research project in the Philippines in 1996 and was mandated by law in 2004. The program initially included screening for five conditions, with a sixth added in 2012. As screening technology and medical knowledge have advanced, NBS programs in countries with developed economies have also expanded, not only in the number of newborns screened but also in the number of conditions included in the screening. Various approaches have been taken regarding selection of conditions to be screened. With limited resources, low- and middle-income countries face significant challenges in selecting conditions for screening and in implementing sustainable screening programs. Building on expansion experiences in the U.S. and data from California on Filipinos born and screened there, the Philippine NBS program has recently completed its expansion to include 29 screening conditions. This report focuses on those conditions detectable through tandem mass spectrometry. Expanded screening was implemented in a stepwise fashion across the seven newborn screening laboratories in the Philippines. A university-based biochemical genetics laboratory provides confirmatory testing. Follow-up care for confirmed cases is monitored and provided through the NBS continuity clinics across the archipelago. Pre-COVID-19 pandemic, the coverage was 91.6% but dropped to 80.4% by the end of 2020 due to closure of borders between cities, provinces, and islands.

Successful Implementation of Newborn Screening for Hemoglobin Disorders in the Philippines.

The Philippine newborn bloodspot screening (NBS) program began in 1996 with 24 hospitals and was formalized by legislation in 2004. The NBS panel was recently expanded to include a number of additional hereditary congenital conditions. Expertise and experiences from other NBS programs already screening for hemoglobinopathies were essential to its successful integration into the ongoing dried bloodspot NBS program in the Philippines. Building on clinical experiences and population data from Filipinos born in California, USA, hemoglobinopathies (including thalassemias) were selected for inclusion in the expanded screening panel. Hemoglobinopathy NBS, using high performance liquid chromatography, was implemented in a stepwise manner into the seven regional NBS screening laboratories. A central university laboratory provides confirmatory testing using both capillary electrophoresis and molecular methodologies. NBS results indicating carriers are followed up with educational fact sheets, while results of presumptive disease are referred for confirmatory testing and follow-up with a hematologist. Long-term care is provided through newborn screening continuity clinics across the country. Hemoglobinopathy NBS is now included in the national insurance package and screening uptake continues to increase nationally, exceeding 90% of all newborns in 7400+ hospitals and birthing centers nationwide prior to the COVID-19 pandemic.

Vaccination in the Philippines: experiences from history and lessons for the future.

In anticipation of a potential vaccine for COVID-19, vaccine uptake may be critical in overcoming the pandemic, especially in countries like the Philippines, which has among the highest rates of infection in the region. Looking at the progress of vaccination in the country - its promises, pitfalls, and challenges - may provide insight for public health professionals and the public. The history of vaccination in the Philippines is marked by strong achievements, such as the establishment and growth of a national programme for immunization, and importantly, the eradication of poliomyelitis and maternal and neonatal tetanus. It is also marred by critical challenges which provide a springboard for improvement across all sectors - vaccine stock-outs,strong opposition from certain advocacy groups, and the widely publicized Dengvaxia controversy. Moving forward, with recent surveys having shown that vaccine confidence has begun to improve, these experiences may inform the approaches taken to address vaccine uptake. These lessons from the past highlight the importance of a strong partnership between health leaders and the local community, bearing in mind cultural appropriateness and humility; the engagement of multidisciplinary stakeholders; and the importance of foresight in preparing public health infrastructure for the arrival of a COVID-19 vaccine.

Bladder Cancer and Google Trends: Associations Between US Search Patterns and Disease Outcomes May Show Need for Improved Awareness Strategies.

Interest in and awareness of bladder cancer may translate to better health-seeking behaviors and earlier detection, given modifiable risk factors such as smoking. We assessed bladder cancer interest in the USA over the past 15 years as reflected by Internet search trends, and correlated these trends with epidemiologic patterns in bladder cancer. Google Trends was used to estimate US bladder cancer interest in the unit search volume index (SVI), which estimates the volume of online search activity for a specified period relative to the highest volume of searches within a specified location. Between January 2004 and June 2019, SVIs were collected for the search term "bladder cancer" and other related search terms. To evaluate the effect of public awareness campaigns, the SVIs for the month of May (US bladder cancer awareness month) were compared with the SVIs of all other months. Correlations between "bladder cancer" SVI and incidence, mortality, and mortality-to-incidence ratio (proxy for survival) by state were evaluated. There was no increase in the relative search volumes for "bladder cancer" during the national bladder cancer awareness month compared with all other months (p = 0.27). By state, there were positive correlations between SVIs of "bladder cancer" and incidence (R = 0.72, p < 0.001) and mortality (R = 0.47, p < 0.001). However, there was no correlation between SVIs and mortality-to-incidence ratio (R = - 0.24, p = 0.08). Interest in bladder cancer is positively associated with disease incidence and mortality but not survival, suggesting interest is driven by new diagnoses or deaths, and not early detection that can improve survival. Our findings may show the need for better public education endeavors.

Philippine Performance Evaluation and Assessment Scheme (PPEAS): Experiences in Newborn Screening System Quality Improvement.

Newborn Bloodspot Screening (NBS) has existed for over 60 years, having been initiated by Guthrie in the U.S. In the Philippines, NBS was introduced in 1996 and later was supported by legislation. The NBS program now includes 29 conditions, covering 91.6% of the newborn population in 2019. Program growth and expansion necessitated development of a formal performance evaluation and assessment scheme (PEAS) for monitoring performance and for continuously improving quality. This study's objective was to present the development, implementation, and results to date of the Philippine Performance PEAS (PPEAS). Using the comprehensive listing of laboratory and non-laboratory elements in the model PEAS system in the U.S., PPEAS tools were developed for critical Philippine NBS system components: regional Department of Health (national health agency, Philippines) (DOH) offices (CHDs), NBS laboratories (NSCs), NBS specimen submitters (NSFs), and long-term case management centers (NBSCCs). Data generated from the various PPEAS have been periodically reviewed and analyzed for NBS system impact. PPEAS were developed to facilitate quality improvement at various levels of the Philippine NBS system. PPEAS identified successes, gaps, and challenges to be addressed by NSCs, NSFs, CHDs, and NBSCCs with the assistance of the Newborn Screening Reference Center and the Department of Health.

Recommendations for Intersectoral Collaboration for the Prevention and Control of Vector-Borne Diseases: Results From a Modified Delphi Process.

BACKGROUND: Intersectoral collaboration in the context of the prevention and control of vector-borne diseases has been broadly described in both the literature and the current global strategy by the World Health Organization. Our aim was to develop a framework that will distill the currently known multiple models of collaboration. METHODS: Qualitative content analysis and logic modeling of data abstracted from 69 studies included in a scoping review done by the authors were used to develop 9 recommendation statements that summarized the composition and attributes of multisectoral approaches, which were then subjected to a modified Delphi process with 6 experts in the fields of health policy and infectious diseases. RESULTS: Consensus for all statements was achieved during the first round. The recommendation statements were on (1-3) sectoral engagement to supplement government efforts and augment public financing; (4) development of interventions for most systems levels; (5-6) investment in human resource, including training; (7-8) intersectoral action to implement strategies and ensure sustainability of initiatives; and (9) research to support prevention and control efforts. CONCLUSIONS: The core of intersectoral action to prevent vector-borne diseases is collaboration among multiple stakeholders to develop, implement, and evaluate initiatives at multiple levels of intervention.

Effects of sweet orange aromatherapy on pain and anxiety during needle insertion among patients undergoing hemodialysis: A quasi-experimental study.

PURPOSE: Patients undergoing hemodialysis experience pain and anxiety during needle insertion, and the scientific interest in aromatherapy in reducing pain and anxiety is increasing. Thus, this study aimed to determine the effects of sweet orange aromatherapy on pain and anxiety during needle insertion in hemodialysis. DESIGN: Quasi-experimental, pretest, and posttest. METHODS: This study was carried out among 50 patients with chronic kidney disease who were non-randomly assigned to either sweet orange aromatherapy or calm breathing in three outpatient hemodialysis centers in the Philippines between July and August 2015. The numeric rating scale and adapted state-trait anxiety inventory were utilized to measure pain and anxiety. RESULTS: After the intervention, both the pain and anxiety scores were significantly lower for patients who received sweet orange aromatherapy than those who received calm breathing. The results obtained modest effect sizes that imply high practical significance. CONCLUSION: The sweet orange aromatherapy can be effective in reducing pain and anxiety. Thus, this can be used by nurses as an alternative and complementary approach to reduce both pain and anxiety in painful procedures like needle insertion.

External validation of machine learning models including newborn metabolomic markers for postnatal gestational age estimation in East and South-East Asian infants.

Background: Postnatal gestational age (GA) algorithms derived from newborn metabolic profiles have emerged as a novel method of acquiring population-level preterm birth estimates in low resource settings. To date, model development and validation have been carried out in North American settings. Validation outside of these settings is warranted.   Methods: This was a retrospective database study using data from newborn screening programs in Canada, the Philippines and China. ELASTICNET machine learning models were developed to estimate GA in a cohort of infants from Canada using sex, birth weight and metabolomic markers from newborn heel prick blood samples. Final models were internally validated in an independent sample of Canadian infants, and externally validated in infant cohorts from the Philippines and China.  Results: Cohorts included 39,666 infants from Canada, 82,909 from the Philippines and 4,448 from China.  For the full model including sex, birth weight and metabolomic markers, GA estimates were within ±5 days of ultrasound values in the Canadian internal validation (mean absolute error (MAE) 0.71, 95% CI: 0.71, 0.72), and within ±6 days of ultrasound GA in both the Filipino (0.90 (0.90, 0.91)) and Chinese cohorts (0.89 (0.86, 0.92)). Despite the decreased accuracy in external settings, our models incorporating metabolomic markers performed better than the baseline model, which relied on sex and birth weight alone. In preterm and growth-restricted infants, the accuracy of metabolomic models was markedly higher than the baseline model. Conclusions: Accuracy of metabolic GA algorithms was attenuated when applied in external settings.  Models including metabolomic markers demonstrated higher accuracy than models using sex and birth weight alone. As innovators look to take this work to scale, further investigation of modeling and data normalization techniques will be needed to improve robustness and generalizability of metabolomic GA estimates in low resource settings, where this could have the most clinical utility.

Factors associated with the willingness of primary caregivers to avail of a dengue vaccine for their 9 to 14-year-olds in an urban community in the Philippines.

To help address the need for preventive measures against dengue fever, a leading cause of child mortality in the Philippines, vaccine trials are ongoing and a tetravalent vaccine (Dengvaxia™, Sanofi Pasteur) has been developed. It is hypothesized that while acceptability would be high among primary caregivers (i.e., parents/guardians), the willingness to have one's child immunized against dengue would be associated with socio-demographic variables, attitudes and knowledge regarding dengue and vaccination, and past experience with dengue. This study aimed to assess the aforementioned factors' association with primary caregivers' willingness to avail of a dengue vaccine for their 9 to 14-year-old children in an urban community in the Philippines. A cross-sectional study utilizing interviews was conducted to determine which factors were associated with willingness-to-avail assuming a free vaccine, and a case study utilizing a focus group discussion was employed to capture some underlying reasons for their willingness. Data were analyzed using multiple logistic regression and thematic analysis. Among the 202 study participants, 193 (95.54%) were willing to avail of the vaccine. There was a high probability of vaccine acceptance by primary caregivers (95.54%), with good attitude towards vaccination (≥12/15 points) [aOR 10.62, 90% CI (1.73-26.28)] and large household size (>5) [aOR 9.63, 90% CI (2.04-45.58)] being positively associated with willingness-to-avail, and good knowledge regarding dengue fever [aOR 0.10, 90% CI (0.03-0.74)] and older age (>44 years) [aOR 0.14, 90% CI (0.03-0.61)] being negatively associated. Crude analysis showed that household size, knowledge regarding dengue, and attitude towards vaccination were significantly associated with willingness. Multivariate analysis revealed that these factors and the primary caregiver's age were associated with willingness. Thematic analysis showed various perceptions regarding dengue and vaccination. Knowing these factors are associated with willingness-to-avail of the vaccine may help in understanding the audience of health promotion projects aimed at increasing immunization coverage.

Determinantes de la salud en adultos de la ciudad de Chimbote, Perú: estudio descriptivo / Health determinants in adults in Chimbote, Peru: a descriptive study

Resumen Objetivo Describir los determinantes de la salud en adultos de la jurisdicción de la Red de Salud Pacifico Norte y Sur de la ciudad de Chimbote. Métodos Se realizó un estudio descriptivo no controlado. Los determinantes de la salud fueron descritos mediante las dimensiones: del entorno biosocioeconómico, de los estilos de vida y de las redes sociales y comunitarias. Para el análisis descriptivo de variables categóricas se utilizaron frecuencias relativas y absolutas. Resultados Se incluyeron 1496 adultos. En los determinantes del entorno biosocioeconómico, el 62,2% son mujeres y 53,3% adultos mayores. En determinantes de estilos de vida, el 52,4% no fuma, ni ha fumado nunca de manera habitual, 50,5% no consumen bebidas alcohólicas y 66,9% duerme de seis a ocho horas. En determinantes de apoyo comunitario, el 53% se atendió en estos 12 últimos meses en un puesto de salud, 47,5% considera que el lugar donde se atendió se encuentra a regular distancia desde su vivienda y 64,6% tiene Seguro Integral de Salud del Ministerio de Salud peruano, SIS­MINSA. Conclusión La mayoría de las personas estudiadas culminó estudios secundarios y no accedió a mejores escalas salariales. La mayoría cuenta con vivienda propia y servicios básicos, pero viven en hacinamiento. Predomina el sedentarismo y alimentación elevada en carbohidratos.

Abstract Objetive To describe health determinants in adults of the Jurisdiction of the North and South Pacific Health Network of the city of Chimbote. Methods A non-controlled descriptive study was carried out. Health determinants were described according to bio-socioeconomic environment, determinants of lifestyles, and determinants of social and community networks. For the descriptive analysis of categorical variables, relative and absolute frequencies were used. Results 1 496 adults were included. Among determinants of bio socioeconomic environment, 62.2% were women and 53.3% were older adults. In determinants of lifestyles, 52.4% did not smoke, nor have ever smoked regularly, 50.5% did not consume alcoholic beverages, and 66.9% had 6 to 8 hours of sleep. As for determinants of community support, 53% were treated in a health post in the previous 12 months, 47.5% considered that the healthcare post was mid-distance from their home, and 64.6% had insurance of the SIS-MINSA. Conclusion Most of the participants finished high school and did not reach better salary scales. Most own their homes and have access to basic services, but live in overcrowded conditions. A sedentary lifestyle and a high carbohydrate diet are predominant.

Pioderma gangrenoso vulvar: revisión de la literatura a propósito de un caso causado por rituximab / Vulvar pyoderma gangrenosum: review of the literature on a case caused by rituximab

RESUMEN El Pioderma Gangrenoso (PG) es una enfermedad inflamatoria necrotizante crónica, que pertenece al espectro de las dermatosis neutrofílicas. Histológicamente se caracteriza por mostrar un infiltrado inflamatorio denso de neutrófilos de origen no infeccioso. El PG suele asociarse a enfermedades sistémicas como la enfermedad inflamatoria intestinal, la artritis reumatoide o diversas enfermedades hematológicas. Presenta fenómeno de patergia y suele responder satisfactoriamente a tratamientos inmunosupresores. Su etiología no está bien definida. En la literatura se han publicado 15 casos de pioderma gangrenoso vulvar asociado al uso de rituximab. Nosotros presentamos un nuevo caso, que tuvo lugar en una mujer de 37 años en tratamiento de mantenimiento con rituximab por un linfoma no Hodgkin folicular. El rituximab (MabThera®) es un anticuerpo que reconoce la molécula CD20, que es una proteína no glucosilada que se expresa en la superficie de los linfocitos B. Este fármaco se ha utilizado para el tratamiento de diferentes enfermedades reumatológicas en los últimos años.

ABSTRACT Pyoderma Gangrenosum is a chronic necrotizing inflammatory disease that belongs to the spectrum of Neutrophilic Dermatoses. Histologically, it is characterized by a dense inflammatory infiltrate of non-infectious neutrophils. Etiology is not yet well defined. It is usually associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis or hematological diseases. It presents pathergy phenomenon and usually respond satisfactorily to immunosuppressive treatments. There have been published only 15 cases of vulvar pyoderma gangrenosum associated with the use of rituximab. We present a new case, which occurred in a 37-year-old woman on maintenance treatment with rituximab for a follicular non-Hodgkin's lymphoma. Rituximab (MabThera®) is an antibody that recognizes the CD20 molecule, which is a non-glycosylated protein that is expressed on the surface of B lymphocytes. This drug has been used for the treatment of different rheumatic diseases in recent years.

Why Does C5 Palsy Occur After Prophylactic Bilateral C4-5 Foraminotomy in Open-Door Cervical Laminoplasty? A Risk Factor Analysis.

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the efficacy of bilateral C4-5 foraminotomy in preventing occurrence of postoperative C5 palsy and to identify possible risk factors for its development. METHODS: A total of 70 consecutive patients who underwent open-door laminoplasty with bilateral C4-5 foraminotomy were included. Clinical, radiographic, and operative data was reviewed. Development of postoperative C5 palsy was analyzed. RESULTS: A total of 54 males and 16 females were reviewed. Mean age was 56 years (range, 30-86 years). The primary pathology was spondylosis in 76% of cases and ossified posterior longitudinal ligament in 21%. Radiographic evidence of C4-5 foraminal stenosis was seen in 81% of the patients. The mean duration of preoperative symptoms was 7 ± 19 months. Four (5.7%) out of 70 patients developed C5 palsy after open-door laminoplasty with bilateral C4-5 foraminotomy. Multivariate analysis showed that a long duration of preoperative symptoms (>12 months) and the presence of preoperative C4-5 T2-MRI cord signal change were statistically significant risk factors for the development of C5 palsy even after bilateral C4-5 foraminotomy in open-door laminoplasty (P < .0001 and P = .036, respectively). CONCLUSIONS: Prophylactic bilateral C4-5 foraminotomies do not completely eliminate the occurrence of C5 palsy. Prolonged duration of symptoms and presence of preoperative T2-MRI cord signal change increase the risk for developing postoperative C5 palsy despite foraminotomy.

Efecto del contenido de sal en la calidad sensorial de pan / Salt content and sensory quality of bread

The aim of this investigation was to evaluate the effects of the salt content in the sensorial quality of the bread. Samples of bread with and without salt, fresh and with one day of storage were analyzed. The intensity test of sensorial attributes was used with any non-structured scale with 15 cm for the attributes smell, flavor and firmness, by an 8 persons trained panel. The typical smell was more pronounced in the bread with salt, fresh and with one day of storage (8.6 and 4.8 points respectively), compared with the bread without salt (7.7 and 4.4 points). The characteristic flavor was significantly more pronounced on the bread with salt compared to bread without salt, both fresh (8.4 and 3.5 points respectively) and with one day of storage (7.3 and 3.8 points respectively). Fresh bread with or without salt, was firm (4 and 4.2 points respectively), with firmness increasing after one day of storage, especially unsalted bread (7 and 9.7 points). We conclude that the bread with salt presents better sensorial quality than the bread without salt. The salt is important in the sensorial profile of the bread, improving the smell, flavor and texture.

El objetivo del trabajo fue evaluar el efecto del contenido de sal en la calidad sensorial del pan. Para ello se analizaron muestras de pan con sal y pan sin sal, frescos y con un día de almacenamiento. Se aplicó una prueba de intensidad de atributos sensoriales con escala no estructurada de 15 cm para los atributos de aroma, sabor y firmeza, con un panel entrenado de 8 personas. El aroma típico era más pronunciado en el pan con sal, tanto fresco como de un día de almacenamiento (8,6 y 4,8 puntos respectivamente), comparado con el pan sin sal (7,7 y 4,4 puntos). El sabor característico fue más pronunciado en el pan con sal, siendo significativamente mayor respecto al pan sin sal, tanto fresco (8,4 y 3,5 puntos respectivamente) como de un día de almacenamiento (7,3 y 3,8 puntos respectivamente). El pan fresco, con y sin sal, era blando (4 y 4,2 puntos respectivamente), con un día de almacenamiento aumenta la firmeza, sobre todo en el pan sin sal (7 y 9,7 puntos). El pan con sal presentó mejor calidad sensorial que el pan sin sal. La sal juega un importante rol en el perfil sensorial del pan, mejorando el aroma, sabor y textura.

Versatility of percutaneous pedicular screw fixation in metastatic spine tumor surgery: a prospective analysis.

BACKGROUND: Posterior percutaneous spinal fixation (PPSF) has evolved to address the problems associated with metastatic spinal disease (MSD). This study was designed to evaluate the feasibility and spectrum of application of PPSF in the management of MSD, highlighting its clinical advantages. METHODS: Twenty-seven consecutive patients with MSD treated with PPSF in our institution from January 2011 to June 2014 were studied. After a multidisciplinary assessment, all patients were considered for surgical intervention due to clinical presentation of either neural deficit, skeletal instability, or both. Some of these patients belonged to the poor prognostic category based on survival prognostic scoring systems. The patients were categorized into seven groups depending on the modality of PPSF used. Demographic data, operative details, and clinical outcomes were investigated for each category and compared pre- and postoperatively. RESULTS: The median age was 60 years (range 49-78 years). Generally, all patients either maintained or improved their neurological status and achieved pain alleviation. Ambulatory status and Eastern Cooperative Oncology Group (ECOG) scores were improved using any modality of PPSF. The pure-stabilization group had the lowest amount of mean blood loss, shortest operative time, and intensive care unit (ICU) and hospital stays, while the long-construct group was observed to have the greatest amount of blood loss, and longest operative time and ICU stay. CONCLUSIONS: For patients with MSD, even with predicted poor prognosis on survival prognostic scoring systems, it is possible to improve functional outcomes and quality of life with PPSF, keeping surgical morbidity to a minimum. PPSF allows patients with pure spinal instability to be addressed successfully with least morbidity.

Association between leptospirosis-related knowledge and practices of male pedicab drivers in Manila

OBJECTIVE: The study aimed to determine whether or not an association exists between leptospirosis-related knowledge and the practices of pedicab drivers in Manila. METHODS: An analytic, cross-sectional study was done among 174 male pedicab drivers. Face-to-face interviews were conducted using an interview schedule containing 12 questions covering knowledge of transmission and prevention, and 8 questions covering preventive occupation-related practices against leptospirosis. Logistic regression was employed to examine association while controlling for the confounding effects of other variables. RESULTS: Forty-nine percent were found to have good knowledge on the transmission and prevention of leptospirosis while 21% had satisfactory preventive and health-seeking practice. After controlling for the confounding effect of pedicab ownership, the odds of having unsatisfactory practices among those with low knowledge were found to be 13 times higher than those with good knowledge. Education was found to be an effect measure modifier. CONCLUSION: The results suggest that a low level of education combined with poor leptospirosis-related knowledge has a magnified effect on practices. Increasing the knowledge of pedicab drivers especially those with a low level of education is necessary to improve their practices. Information dissemination on leptospirosis should be further intensified. Collaboration between health workers and organizations of pedicab drivers can be done to organize health information seminars.

Cultural beliefs on disease causation in the Philippines: challenge and implications in genetic counseling.

The provision of culturally competent health care is an important professional issue recognized by the pioneer genetic counselors in the Philippines. Being an archipelago consisting of 7,107 islands, the Philippines has approximately 175 ethnolinguistic groups with their own unique cultural identity and health practices. The emphasis on culture in our genetic counseling training recognizes its crucial role in molding an individual's conceptualization of health, as well as other life aspects, especially since the Filipino culture is a mixture of indigenous as well as imported and borrowed elements. As part of this endeavor, we will describe in this paper seven common Filipino cultural beliefs: namamana, lihi, sumpa, gaba, pasma, namaligno, and kaloob ng Diyos. We will also share examples on how these common beliefs provide explanation as cause of illness and its implications in our genetic counseling profession.