Management of pilonidal disease in colorectal surgery training programs in the Philippines

In this study, we review the clinical course of patients treated for pilonidal disease in the various colorectal surgery training institutions in the Philippines. As part of this review, we aimed to determine the surgical training practice pattern for this rarely encountered disorder in the Philippines.     

Management of maternal tetanus contracted by an obstetric procedure

A 34-year-old woman from the Philippines showed difficulty in opening the mouth. She had no wounds in the last one mouth, but was treated with an obstetric procedure after stillbirth 16 days before in the Philippines. She showed trismus, rigidity and muscle pain, but no muscle spasms, dyspnea and autonomic dysfunction. In this case, it is supposed that the obstetric procedure is the origin of the injury. In Japan, this is the first report of maternal tetanus.     

Surgery in the Philippines

The Philippines is an archipelago of about 7000 islands, with an area about the size of England, situated just above the equator in Southeast Asia. It has a population of 70 million. The Philippines has had extensive commercial and social contact with Asian neighbors, specifically the Chinese, even before the 377 years of Spanish colonization from 1521 to 1898 and the 48 years of American rule from 1898 to 1946. More than 80% of Filipinos are Catholics; the rest are Muslims and Protestants of various denominations, including those who belong to Filipino church groups. Infectious diseases such as tuberculosis, amoebiasis, typhoid fever, and malaria are still prevalent, and arteriosclerosis, cancer, and stroke are common and on the rise.     

Partner violence as a risk factor for mental health among women from communities in the Philippines, Egypt, Chile, and India

Although studies have documented the associations between Intimate Partner Violence (IPV) and mental health, few have been done in developing countries. In this study, the association between IPV and mental health in women from different developing countries was established. Women, 15 to 49 years old with at least one child 18 years old or younger, were randomly selected from communities in Chile, Egypt, India, and the Philippines (N = 3974). The Self Report questionnaire (SRQ) was used to assess mental health. Women with a score on the SRQ of 8 or more, or who reported ever attempting suicide, were classified as having poor mental health. Physical IPV was defined as being slapped, hit, kicked, beaten or threatened by a male partner during the past year. Psychological violence included being insulted or belittled, threatened or abandoned. Between 22.5% (in Egypt) to 41% (in Chile) of participating women reported a score of eight or more on the SRQ. High score on the SRQ were significantly associated with current physical and psychological IPV in the samples from all participating countries except Chile. Twelve percent of women in Chile, 2.6%, in Egypt, 7.5% in India and 1.6% in the Philippines reported attempting suicide. Suicide attempts were also associated with current physical IPV in the Philippines, Egypt, and India, and with psychological violence in Egypt and India. IPV is significant risk factor for poor mental health in these developing countries. Efforts to reduce IPV should be considered as part of a mental health program.     

The early history of hand surgery in the Philippines and highlights in my experience at the National Orthopaedic Hospital Mandaluyong and the Our Lady of Lourdes Hospital, Manila.

Several years ago, while attending a Philippines Orthopaedic Association (PDA) Annual Convention, held at the Westin Philippine Plaza Hotel, Manila in December, I had the opportunity to meet with Professor Yoshikazu Ikuta, a well-known microsurgery and hand surgeon from Japan and one of the foreign guest speakers. I had been invited to work with him at the Armed Forces of the Philippines (AFP) Medical Center on the case of a high ranking general of the AFP, with a hand contracture disability problem. The case was referred to him by Dr. Evaristo Sanchez, Chief of Orthopaedics and the Commanding General of the AFP Medical Center. He had been pre-scheduled for surgery the next day, a Sunday morning, the day before Prof. Ikuta was due to return to Japan. After a brief examination and evaluation of the generals affected hand, in the operating room with Prof. Ikuta, just before he was placed under general anaesthesia, we performed the operation together. The operation did not involve microsurgery. The procedures done were multiple combined Bunnell-Zancolli pulley advancements and MP-joint volar capsulorraphies plus flexor tendon releases in the volar forearm, which although quite extensive, were only palliative, to minimise and improve on the contracture deformities, in preparation for a final re-evaluation for possible later, more definitive tendon transfers for hand function. However, I never received any further information regarding the results of our surgery. Recently, I have been honoured and invited again by Prof. Ikuta, presently the Editor-in-Chief of the Hand Surgery Journal (Asian Volume), this time to write the history of hand surgery in the Philippines and add to it, "Highlights in my experience at the National Orthopaedic Hospital, Mandaluyong, and the Our Lady of Lourdes Hospital, Manila", the last portion of which is on paralytic disabilities of the Hand. I am deeply grateful to Prof. Ikuta for giving me this honour and opportunity to present the total experience, favourable and unfavourable, of a hand surgeon from a developing country, like the Philippines. Furthermore, this would afford me also, the chance to be able to make known to readers of this now prestigious journal, the philosophical thoughts which led me to unwittingly originate or come up with and develop a few of my own "Long Tendon Rerouting Procedures" which may possibly and hopefully merit as this author's title contribution to surgery of the hands.     

Outcome of Referrals for Deceased Organ Donation to the Government Organ Procurement Organization

Background

The Human Organ Preservation Effort is a government organ procurement organization that pioneered the Deceased Organ Donation Program in the Philippines. Deceased organ donation comprises only 20% of kidney transplantation in the Philippines in the last 3 years. Various measures were implemented to improve deceased organ donor referrals and organ retrieval.

Objective

To compare outcome of deceased organ donor referrals from 2002 to 2008 and 2009 to 2012 in the Philippines.

Methods

This retrospective study reviewed the deceased organ donor referrals from 2002 to 2008 and 2009 to 2012.

Results

There were 437 referrals for potential deceased organ donors from 2009 to 2012, compared to 434 referrals from 2002 to 2008. Referrals were mainly trauma victims (76%) followed by those with cerebrovascular accidents (12%). In the recent cohort, 81% were approached and 60% consented for donation, but only 23% were retrieved and transplanted. Among those not retrieved, the majority (19%) were medically unsuitable and 6% retracted their consent.

Conclusion

Although there was an increasing trend of organ donation referrals in the last 4 years, only 25% were procured. The reasons for nonprocurement should be addressed.     

Partial left ventriculectomy (Batista procedure) in the treatment of dilated cardiomyopathy: Makati Medical Center Philippine experience

In the Philippines patients with end-stage heart disease refractory to conventional medical and surgical treatment do not have alternative choices. More than 99% of the population cannot afford cardiac transplantation. Partial left ventriculectomy (PLV) is a surgical procedure that improves cardiac function and refractory congestive heart failure (CHF). Between October 1997 and February 1998 eight patients had PLV at the Makati Medical Center, Philippines. All patients had end-stage dilated cardiomyopathy. Six patients had an idiopathic etiology, one was ischemic and one valvular. Seven of eight operations were done with the heart beating and all had transesophageal echo monitoring. An average of a 2-cm reduction in the left ventricle diameter was achieved and ejection fraction improved in all cases. There were no operative deaths. There were three late deaths. Two patients died of refractory CHF and ventricular arrhythmias and one patient died of massive cerebral hemorrhage with coumadin therapy. The five survivors are all doing well with no CHF. Follow-up two-dimensional echo shows stable left ventricular (LV) size and improved ejection fraction. Our initial experience shows that PLV, at least in the short-term, has beneficial effects in the treatment of end-stage dilated cardiomyopathy and might become an alternative to cardiac transplantation.     

Experience with preoperative phlebotomy in a developing country

This report describes the results of preoperative phlebotomy in fifty-six surgical patients. The safety as well as the usefulness of such a procedure, especially in a developing country such as the Philippines, is shown. The minimal requirements for phlebotomy are enumerated.     

Palatovelopharyngoplasty at the same time. Our experience in Philippines

After many surgical charity missions in the same hospital in the Philippines, we have evaluated the child's phonation being operated of cleft palate. We had bad results so we decided to do in the same time an Orticochéa pharyngoplasty and the closure of the palate. These patients were evaluated too, the results were improved.     

Osteoporosis in urban post-menopausal women of the Philippines: prevalence and risk factors

Summary

The prevalence of osteoporosis was assessed among post-menopausal women dwelling in an urban community of Davao, Philippines using quantitative ultrasonic bone densitometry and its predictors were investigated. The prevalence of osteoporosis was 19.8%. Advancing age, lower body weight, and higher educational attainment were identified as the independent predictors of osteoporosis.

Introduction

This cross-sectional study assessed the prevalence of osteoporosis among post-menopausal women dwelling in an urban community of the Philippines and investigated the risk factors for osteoporosis using a quantitative ultrasonic bone densitometer.

Methods

The study site was an area with high population density in Davao, the Philippines. Data collection was based on a structured questionnaire interview, and measurements of body size and speed of sound (SOS) at the calcaneus. The SOS T-score was calculated using the young adult mean (YAM) SOS based on data from 905 women aged 20 years and over residing in the community. The data for 339 post-menopausal women were analyzed to identify the prevalence of osteoporosis and its predictors in this study. The predictors of osteoporosis were determined by logistic regression analysis.

Results

The majority of the women lived on low-incomes. The prevalence of osteoporosis was 19.8% in post-menopausal women. Age in 1 year increments (odds ratio [OR] 1.168), body weight (OR 0.954), and duration of education in years (OR 1.132) were predictors of osteoporosis.

Conclusions

This study identified body weight as a modifiable risk factor of osteoporosis for post-menopausal women. Longitudinal observation of the same participants will be necessary to confirm these findings.     

Towards Canine Rabies Elimination in Cebu,Philippines: Assessment of Health Economic Data

Rabies is endemic in the Philippines. In 2010, with support from the Bill and Melinda Gates Foundation, a canine rabies elimination project was initiated in the Philippine Archipelago of Visayan. We conducted an analysis of dog vaccination and human PEP costs for dog bite patients in a highly urbanized area and a low‐income rural municipality in Cebu Province, Philippines, from 2010 to 2012. Our findings indicated that eliminating rabies in dogs through mass vaccination is more cost‐effective than treating rabies exposures in humans. The average costs (in USD) per human life saved through PEP were $1620.28 in Cebu City and $1498 in Carmen. Costs per dog vaccinated ranged from $1.18 to $5.79 in Cebu City and $2.15 to $3.38 in Carmen. Mass dog vaccination campaigns conducted in each village were more cost‐effective than fixed‐site campaigns. The costs of dog vaccination can be reduced further through bulk vaccine purchase by the national government or large donor agency, for example the BMGF. As communities achieve canine rabies elimination, more judicious use of PEP will result in significant public savings. The study affirms the willingness of local governments to invest and reassure donors of their cooperation and resource contribution to sustain disease elimination efforts.     

Postpartum sterilization by mini-incision at Paarl, CP. A multicentre international comparison

Postpartum sterilization at Paarl Hospital, CP, is compared with the situation obtaining in Thailand, India, Cuba, Chile, the Philippines, Australia and Singapore. This international study depoliticizes the issue and emphasizes that voluntary sterilization is a basic service which should be available everywhere. A transumbilical minilaparotomy is a fast and safe procedure, which should be carried out within hours of delivery--even on Saturdays and Sundays. Caesarean section when sterilization is the only indication is completely unjustified.     

Towards canine rabies elimination: Economic comparisons of three project sites

An appreciation of the costs of implementing canine rabies control in different settings is important for those planning new or expanded interventions. Here we compare the costs of three canine rabies control projects in South Africa, the Philippines and Tanzania to identify factors that influence the overall costs of rabies control efforts. There was considerable variation in the cost of vaccinating each dog, but across the sites these were lower where population density was higher, and later in the projects when dog vaccination coverage was increased. Transportation costs comprised a much higher proportion of total costs in rural areas and where house‐to‐house vaccination campaigns were necessary. The association between the cost of providing PEP and human population density was less clear. The presence of a pre‐existing national rabies management programme had a marked effect on keeping infrastructure and equipment costs for the project low. Finally, the proportion of the total costs of the project provided by the external donor was found to be low for the projects in the Philippines and South Africa, but likely covered close to the complete costs of the project in Tanzania. The detailed economic evaluation of three recent large‐scale rabies control pilot projects provides the opportunity to examine economic costs across these different settings and to identify factors influencing rabies control costs that could be applied to future projects.     

Management of phimosis as a risk factor of urinary tract infection: An Asian perspective

Many studies have been published to examine whether circumcision has any advantageous effect on the prevention of urinary tract infection (UTI), especially in male infants with vesicoureteral reflux (VUR). Colonization of bacteria in the inner prepuce and its reduction by circumcision has been documented, and circumcision may reduce the risk of febrile UTI (fUTI) in males. Circumcision is described as a therapeutic choice against VUR in the current American Urological Association and European Association of Urology/European Society for Pediatric Urology guidelines. In countries where neonatal circumcision is routinely performed, there may exist no clinical problems with regard to this issue. However, in Asian countries, there is a sharp division in the prevalence of circumcised males; for example, it is > 80% in Islamic countries, South Korea, and the Philippines, but its prevalence is < 20% in the majority of the other countries, including China, India, Japan, and Taiwan. In countries where neonatal circumcision is routinely performed, no clinical problem exists with regard to using it as a treatment for VUR. By contrast, in countries where circumcision is not routinely performed for children, strong objection exists against using this procedure for this purpose. Thus, treatment for fUTI among uncircumcised boys in these countries should be further studied in a separate context from the countries where circumcision is highly prevalent. In countries such as Korea and the Philippines where circumcision is performed during childhood, but not as a routine procedure in neonates, one may have an obligation to present circumcision as a choice of treatment for male infants with fUTI and/or VUR, and setting an appropriate age for circumcision could be an important clinical question.     

Other forms of schistosomiasis

SCHISTOSOMA INTERCALATUM: Endemic in central Africa, S. intercalatum is the causal agent of this intestinal bilharziasis, which is similar to Mansoni's disease but with a characteristic lower localization (rectum and sigmoid). The principal clinical signs are digestive disorders: abdominal pain, diarrhea or dysentery, straining, tenesmus, rectal bleeding. The moderately enlarged liver is smooth and hard but not painful, especially observed in adolescents. ORIENTAL BILHARZIASIS: Schistosoma japonicum (found in lakes in China, Thailand, Philippines, Indonesia) and Schistosoma mekongi (Melong valley) are the principal agents. Both lead to major liver fibrosis producing severe portal hypertension and growth retardation in children.     

Incidence of adenocarcinoma of the prostate in Asian immigrants to the United States and their descendants

PURPOSE: We characterize the incidence of adenocarcinoma of the prostate among Chinese, Japanese and Filipino immigrants to the United States and their descendants. MATERIALS AND METHODS: Subjects included 1,511 Asian and 16,000 white residents of Hawaii, San Francisco/Oakland and western Washington diagnosed with primary adenocarcinoma of the prostate during 1973 through 1986, and identified from the Surveillance, Epidemiology and End Results program. The size and composition of the population at risk were provided by a special tabulation of the 1980 United States Census. RESULTS: Among Asian-Americans 45 to 69 years old the annual rate per 100,000 for Chinese (24.0), Japanese (29.6) and Filipino (56.8) men born in China, Japan and the Philippines, respectively, was approximately half that of United States born Chinese, Japanese and Filipino men (44.4, 42.2 and 111.3, respectively). For Japanese Americans 70 to 84 years old at diagnosis differences in incidence persisted between those born in Japan (238.0) and the United States (446.4), while for older Chinese Americans incidence rates were nearly the same for those born in China (428.3) and the United States (425.0). In contrast, older Filipino men born in the Philippines had a higher rate (400.1) than their United States born counterparts (264.9) but the latter rate was based on a small number of men. Among United States residents the annual incidence for all generations of Asian-Americans was roughly half that of white men born in the United States (215.9). CONCLUSIONS: These results suggest that, irrespective of birthplace or age, Asian-American men retain 1 or more genetic or lifestyle characteristics that make their risk of prostate cancer less than that of white residents of the United States.     

An Asian perspective on the management of distal radius fractures

There is limited data regarding the epidemiology, pathology, and management of distal radius fractures from centers in Asia. The advanced economies in Asia include Hong Kong, Japan, Korea, Singapore, and Taiwan, whereas the prominent emerging economies are China, India, Malaysia, Philippines, and Thailand. This article examines the available epidemiological data from Asia, compares the management of distal radius fractures in the advanced and emerging Asian economies and how they compare with the current management in the west. It concludes by offering solutions for improving outcomes of distal radius fractures in Asia.     

Pilot Study Comparing the Efficacy,Safety, Convertibility,and Tacrolimus Trough Levels of Twice-Daily Tacrolimus (Prograf) to Once-Daily Tacrolimus (Advagraf) Among Standard-Risk Kidney Transplant Patients at the National Kidney and Transplant Institute

BackgroundRecently, a once-daily formulation of tacrolimus (Advagraf) was released in the Philippines. Studies have shown that these 2 formulations are bioequivalent at a 1:1 conversion. This study aims to determine the efficacy, safety, convertibility, and tacrolimus trough level of once-daily tacrolimus at the end of 6 months post transplant.MethodsThis is a randomized study among standard-risk primary kidney transplant patients performed at the National Kidney and Transplant Institute, Philippines. A total of 40 patients completed the 6-month follow-up. Patients in Group A who failed to meet the criteria for conversion to once-daily tacrolimus were considered to have reached the end of the study, while patients who satisfied the conversion criteria will be followed up for an additional 6 months.ResultsBaseline characteristics were similar in both groups. The area under the curve, maximum concentration, time to achieve the maximum concentration, and the coefficient of variation were similar. The twice-daily tacrolimus (Prograf) group patients had significantly higher mean tacrolimus trough levels than the Group B once-daily tacrolimus patients. An increase of a once-daily tacrolimus mean dose of 8% was required to achieve a therapeutic drug level post conversion. The graft and patient survival were 100%. There was no biopsy-proven acute rejection noted either both group.ConclusionIn conclusion, conversion from twice-daily tacrolimus to once-daily tacrolimus in kidney transplant in both de novo and converted patients after KT is safe, ensuring greater stability of drug blood concentrations than the standard form. The results also suggest an 8% increase when converting stable KT patients from twice-daily tacrolimus to once-daily tacrolimus.     

Beneficial behavioural effects of lamotrigine in traumatic brain injury

Anti-convulsant medications have been employed to treat behavioural disorders resulting from traumatic brain injury (TBI). However, there is a paucity of literature investigating the use of lamotrigine to treat aggression and agitation in patients with TBI. In a single case study design, the present study examined the effectiveness of lamotrigine to treat aggressive and agitated behaviour in a 40-year-old male who sustained a severe TBI. A substantial decrease in problematic behaviours and a significant improvement in neurobehavioural functioning were observed after lamotrigine treatment. This case study provides some support for the use of lamotrigine to treat aggression and agitation in patients with a TBI. Further research is needed to examine the relationship between lamotrigine and functional outcome after TBI.     

Anti-pig antibody levels in non-human primates of various origin

BACKGROUND: Natural anti-porcine antibodies play a major role in hyperacute solid organ xenograft rejection in the pig-to-non-human primate model. Work from other groups and our experience in transplantation experiments has shown that antibody levels are highly variable between non-human primate species, and that extremely high levels can mediate hyperacute rejection even if organs from animals transgenic for human decay-accelerating factor are used. METHODS: Sera were obtained from cynomolgus monkeys wild-caught in Mauritius, captive-bred in the Philippines, captive-bred in Indonesia (Indonesia-Ind), and originating from Indonesia but colony-bred in USA (Indonesia-USA), from baboons wild-caught in Kenya, and from rhesus monkeys originating from India but colony-bred in USA (10 animals in each group). Antibody levels were determined using assays for haemolytic antibody (APA), IgM and IgG class anti-Galalpha1-3Gal antibody, and IgM and IgG class anti-endothelial cell antibody. RESULTS: Cynomolgus monkeys from the Philippines and Indonesia-USA and rhesus monkeys showed median APA and IgM antibody levels in the same range as a pooled human serum standard, and median IgG levels well below the level in this standard. Cynomolgus monkeys from Mauritius and Indonesia-Ind showed extremely high APA levels (median seven to 10 times the human serum standard): IgM class antibodies were also higher, while IgG class antibodies were in the range of the level in the human serum standard. Antibody levels in baboons were in between these two categories. The results of the APA assay showed a highly statistically significant correlation with the assays of IgM antibody, and this was also the case for the IgM antibody assays, indicative of the assessment of the same antibodies in these assays. The same was observed for the assays for IgG antibody. Taking body weight as an indicator for age, there was no relationship between body weight and levels of antibodies. CONCLUSIONS: Natural antibody levels show a significant variation between various groups of non-human primates, with levels in some groups well above those in a human serum standard.