Work-related quality of life and performance appraisal among nurses at a tertiary hospital in Philippines

Objective:The objective of the study is to describe the work-related quality of life(WRQOL)among nurses and explore its association with performance evaluation ratings.Methods:A cross-sectional design was utilized measuring the WRQOL scale and the previous performance appraisal rating.Multistage sampling approach was utilized with nurses stratified based on their position and then systematically random sampled based on their unit assignment.Results:One hundred and eighty-two nurses were included.About half reported a high quality of work life(101;55.5%).Low scores were noted on the subscale working conditions(100;54.9%),low to average responses for home-work interface(109;59.9%),control at work(100;54.9%),and stress at work(90;49.5%).A higher proportion of nurses reported positive responses toward the areas of general well-being(113;62.1%)and job-career satisfaction(112;61.5%),than in the other subscales.There were notable differences between WRQOL ratings:(1)Head nurses had the highest perceived quality of work life,followed by nurse supervisors and charge nurses(F=6.1,P<0.01)and(2)Nurses in the pay-patient services reported lower quality of working life,while those in office and outpatient services had more positive scores(F=4.6,P<0.01).Conclusion:Only more than half of the nurses reported a high quality of work life,some of its dimensions,particularly job and career satisfaction and working conditions,appeared to vary in the perceived degree across years in service,work hours,and position.The assessment of the quality of work life may serve as an important tool to address staff burnout,absenteeism and other issues that affect job performance among health-care professionals.

Philippine retinoblastoma initiative multi-eye center study 2010-2020

AIM:To provide a comprehensive and more representative national data on the disease,especially on treatment options and outcomes,and to determine access of retinoblastoma patients from Luzon,Visayas and Mindanao to eye care,and determine if access is associated with delay in consultation,staging and outcomes.METHODS:Cohort study of retinoblastoma patients seen in eleven institutions located in the three major areas of the Philippines namely Luzon,Vizayas and Mindanao from 2010-2020.RESULTS:Totally 636 patients,involving 821 eyes,were included.Majority(57%)were from Luzon and were seen in institutions in Luzon(72%).Annually,58±10 new cases were seen with 71%having unilateral disease.Median delay of consultation remained long at 9(3,17)mo,longest in patients with unilateral disease(P<0.02)and those from the Visayas(P<0.003).Based on the International Retinoblastoma Staging System,only 35%of patients had Stage 1 while 47%already had extraocular disease.Enucleation was the most common treatment received by 484 patients while intravenous chemotherapy was received by 469.There were 250(39%)patients alive,195(31%)dead,85(13%)abandoned,17(3%)refused and 89(14%)with no data.CONCLUSION:This study presents the largest cohort of retinoblastoma patients in the Philippines in terms of patients’and participating institutions’number and geographical location and type of institution(private and public).It also presents more comprehensive data on the treatments used and outcomes(survival,globe salvage,and vision retention rates).Delay in consultation was still long among patients leading to advanced disease stage and lower survival rate.Despite increasing capacity to diagnose and manage retinoblastoma in the country,the delay of consultation remains long primarily due to accessibility issues to eye care institutions especially in the Visayas and financial concerns.The delay was still significant that overall survival rate remain low.

Non-alcoholic fatty liver disease in the Philippines:Comparable with other nations?

AIM: To evaluate the prevalence and determined the common characteristics of patients diagnosed with non- alcoholic fatty liver disease (NAFLD) at the Philippine General Hospital, Manila, from January 1999 to December 2004. METHODS: NAFLD was diagnosed in 134 from a total of 1102 patients, based on clinical, ultrasonographic and/or histopathological findings. Patients with conditions associated with secondary NAFLD were excluded. Chart review was done to note demographics, co- morbid illnesses, physical characteristics, hepatomegaly, aspartate/alanine aminotransferase (AST/ALT) levels, albumin, lipid levels, alkaline phosphatase, prothrombin time, and partial thromboplastin time. Data obtained were analyzed using the statistical program SPSS version 10. RESULTS: Of the 134 patients included, 71% were female and 29% male. Mean patient age was 42.2 years. Sixty percent of patients were obese, 56% had hepatomegaly, and 69% had diabetes. AST levels were elevated in 45% of subjects and ALT levels in 64%. CONCLUSION: The prevalence of NAFLD at our institution was 12.2%. Patients diagnosed appear to be younger in age in contrast to previous studies. Female sex, obesity, elevated liver enzymes, and diabetes were characteristic features of our NAFLD patients, which is comparable to previous studies from other countries.

亚洲地区肺炎支原体和肺炎衣原体在成人社区获得性肺炎中的流行病学研究

目的由Malaya大学医学中心牵头进行的非典型病原在亚洲社区获得性肺炎(CAP)患者中的流行病学研究。结果显示,肺炎支原体和肺炎衣原体分别占成人病原的11.4%和5.8%。本研究将对这2种病原所致感染的临床和实验室资料进一步总结分析。方法亚洲7个国家12个研究中心采用统一的检测方法(DNA检测及血清学方法)和判断标准,对16岁以上的CAP患者进行肺炎支原体和肺炎衣原体的检测。结果在急性肺部感染者中,肺炎支原体和肺炎衣原体肺炎的临床表现与其他病原所致者非常相似,并无特征性。肺炎支原体和肺炎衣原体在男性和女性中检出率相仿,但肺炎支原体感染在16至44岁患者中更为多见(22.2%),而肺炎衣原体感染者重症患者相对较多。88例在病程中血清抗体显著增高的肺炎支原体感染者中,48例(54.5%)患者急性期抗体阴性,如果未检测恢复期血清抗体,上述患者则会漏诊;51例肺炎衣原体感染者中急性期血清抗体阴性则较为少见(21.6%)。肺炎支原体和肺炎衣原体既往感染和(或)病原携带率分别为5.7%和7.9%。结论肺炎支原体肺炎和肺炎衣原体肺炎发病率高,诊断困难,因此在亚洲成人CAP抗感染经验治疗时宜选用对这2种病原亦有效的药物。

Management of esophageal caustic injury

Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and p H of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.

Duodenal tuberculosis presenting as gastric outlet obstruction:A case report

Gastric outlet obstruction is commonly associated with malignancies and peptic ulcer disease. However, when no malignancy is seen and the patient is nonresponsive to conventional peptic ulcer treatment, other etiologies need to be explored. We report a case of gastric outlet obstruction due to duodenal tuberculosis. The patient is a 31 year old male who presented with 1 year history of recurrent epigastric pain and an a cute episode of vom iting. Endoscopy revealed duodenal stricture. Computed tomography scan showed pyloro antral thickening. The patient was referred to the surgery service and underwent an exp lor atory laparotomy and gastrojejunostomy. A duodenal mass and calcified lymph nodes were noted on exploration and biopsy revealed a tuberculous origin. The patient was started on anti-tuberculosis medications and had impro ved on discharge. Gastroduodenal tuber culosis is rare and pyloric stenosis resulting from tuber culosis is even rarer. This, however, should be consid ered in patien ts who come from areas where the dise ase is endemic.

菲律宾、马尼拉、菲律宾总医院结核病人的耐药特征和多种药物耐药结核病的预测指标

背景:本研究在菲律宾、马尼拉、菲律宾大学—菲律宾总医院(UP-PGH)进行。目的:确定肺结核病人耐药特征和多种药物耐药结核病的临床预测指标。设计:前瞻性分析描述。方法:对结核分支杆菌培养阳性的病人进行会面,了解有关抗结核治疗既往史,卡介苗接种史,胸部X线检查及家庭接触情况,从299名病人中分离的结核杆菌应用浸没纸片比例法,进行了利福平、异烟肼(INH),乙胺丁醇和链霉素的敏感性测定。用标准实验室粉剂在7H10培养基中测定吡嗪酰胺(PZA)的敏感性。结果:在299名分离的结核杆菌中17％对五种主要药物全敏感,54％对二种或二种以上药物耐药(多种药物耐药结核病,MDR-TB)。初始耐药率乙胺丁醇(39％)和INH(17％)是高的,MDR-TB明显地与既往抗结核治疗史相关(优势比[OR]2.44,95％可信限)。不正规抗结核治疗超过三个月增加MDR-TB的可能性(OR4.6,P<0.0001)。结论:高的MDR-TB率与既往抗结核治疗情况有关,当不正规的先期抗结核治疗超过三个月时发生MDR-TB的机会明显增加。

Dual histologic variants of schwannomas in orbital schwannomatosis

Dear Editor,We present an extremely rare case of orbital schwannomatosis with dual histologic variants.Schwannomas are tumors resulting from the slow proliferation of Schwann cells located in peripheral nerve sheaths[1].They are commonly seen in middle-aged individuals but had been reported in patients 20-70 years of age.

The Benefits of Pulmonary Rehabilitation Program on Post-Tuberculosis Bronchiectasis

Pulmonary rehabilitation has emerged as a recommended standard of care for patients with chronic lung disease. As in chronic obstructive pulmonary disease (COPD), persons with other forms of chronic respiratory disease commonly experience deconditioning and decreased quality of life. The aim of this prospective study is to determine the effect of a 4-week pulmonary rehabilitation program (PRP) on patients diagnosed with post-pulmonary tuberculosis bronchiectasis in the Philippines. The participants were above 18 years of age, diagnosed to have stable Post-Pulmonary tuberculosis bronchiectasis with chest computerized tomography (CT) scan or chest radiograph showing bronchiectatic changes, consented to attend the PRP sessions and be included in the study. The subjects underwent PRP for 4 weeks with a total of 8 sessions and determination of Forced expiratory volume at 1 second (FEV1), forced vital capacity (FVC), quality of life determination using the Saint George Respiratory Disease Questionnaire (SGRQ), and exercise endurance using the 6-minute walking test (6 MWT), before and after the PRP. A total of fourteen patients, six males and eight females, aged from 28 - 72 years old, completed the 4-week pulmonary rehabilitation program. There were four ex-smokers and ten non-smokers with concomitant asthma and COPD in some patients. There was significant improvement in the 6-minute walk test and quality of life after 4 weeks of rehabilitation program among the subjects with p value for 6 MWT at p = 0.0001 and p = 0.008 for SGRQ. Conclusion: Pulmonary rehabilitation program led to a significant improvement in exercise capacity and health related quality of life among patients with post-pulmonary tuberculosis bronchiectasis.

Single nucleotide polymorphism(SNP)in genes of lupus:A Philippine study(SIGLA-PH)

Background:Systemic lupus erythematosus(SLE)is a complex prototypic autoimmune disease,with a prevalence of 20–150 per 100,000,most commonly affecting women at child-bearing age.Genome-wide association studies and fine mapping of candidate regions have paved the way for greater understanding of SLE as a disease of genetic–environmental susceptibility and the functions of the genes involved.Method:This study was conducted to determine the association of selected single nucleotide polymorphisms(SNPs)from established genomic databases based on theoretical risk and protective odds ratios>2.5 or<0.40)to susceptibility of developing SLE among Filipinos.Results:We analyzed data from 310 SLE patients and 318 controls.We identified eight significant SNPs namely rs9271100,rs9271366,rs9272105,rs9275328,rs2647087,rs12734338,rs17885098,and rs3883013 to be associated with an increased risk of developing SLE among Filipinos.Conclusion:Eight SNPs were found to be associated with the development of SLE among Filipinos.Similar to previous genetic studies in lupus patients,majority of the SNPs were found in the major histocompatibilty complex genes in the HLA region.Our study identified two unique SNPs that will be validated as potential diagnostic markers for SLE.The findings of this study may contribute to the development of a polygenic risk score in determining susceptibility to SLE among Filipinos.

The Surgical Treatment and Outcome of Nonmetastatic Extremity Osteosarcoma with Pathological Fractures

Background：Recent studies have suggested that the presence of a pathological fracture does not impact on oncologic outcomes and the feasibility of limb salvage surgery （LSS） in appropriately selected patients when combined with neoadjuvant chemotherapy.These have largely been single institutional studies with limited numbers.The Eastern Asian Musculoskeletal Oncology Group reviewed the data from three large volume Asian orthopedic oncology centers to determine whether the presence of a pathologic fracture affected outcomes in osteosarcoma patients.Methods：A retrospective review of the data was conducted.Ninety-five cases ofnonmetastatic extremity osteosarcoma with a pathological fracture and 887 cases without fracture treated during the same period were compared.Results：In the fracture group,the LSS rate was 62.1％,and the rate of amputation was 37.9％.In the nonfracture group,the LSS rate was 74.7％,and the amputation was 25.3％.In patients with a pathologic fracture,the rate of local recurrence for LSS and amputation groups was 8.5％ and 2.8％,respectively.In this group,the 5-year survival in the LSS group was 66％ as against.46.8％ in the amputation group.Conclusions：Our study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture.Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage,appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.