Showing papers by "University of the Philippines Manila published in 2003"

Comparative study of cochlear damage with three perimodiolar electrode designs

Abstract: Objective To describe intracochlear insertion trauma caused by three perimodiolar cochlear implant electrodes. Study Design Descriptive histological study of 15 human cadaver temporal bones. Methods Fifteen cadaver temporal bones underwent surface preparation and were implanted with one of the following perimodiolar electrode arrays: Combi 40+PM (MedEl Corporation), HiFocus II (Advanced Bionics Corporation), or Contour (Cochlear Corporation). A cryosectioning technique was used to study horizontal sections at 200-μm intervals with the electrode in place. Image-enhanced videofluoroscopy and computer-assisted morphometrics were used to assess the mechanism of insertion trauma and to determine electrode position within the modiolus. Results Histological examination revealed varying degrees of damage to the spiral ligament, basilar membrane, and osseous spiral lamina. Using a novel grading system for electrode trauma, there was no statistically significant difference among the three electrodes. A literature search of histological studies of a commonly used “standard” electrode showed damage equal to or greater than that seen in the current study. Conclusions Insertion trauma caused by periomodiolar electrodes occurs to an acceptable degree. Refinement of electrodes based on mechanisms of trauma may be able to further reduce damage.

A comparison of the efficacy of single doses of albendazole, ivermectin, and diethylcarbamazine alone or in combinations against Ascaris and Trichuris spp.

Abstract: Objective To determine the efficacy of single doses of albendazole, ivermectin and diethylcarbamazine, and of the combinations albendazole + ivermectin and albendazole + diethylcarbamazine against common intestinal helminthiases caused by Ascaris and Trichuris spp. Methods In a randomized, placebo-controlled trial, infected children were randomly assigned to treatment with albendazole + placebo, ivermectin + placebo, diethylcarbamazine + placebo, albendazole + ivermectin, or albendazole + diethylcarbamazine. The Kato–Katz method was used for qualitative and quantitative parasitological diagnosis. The w 2 test was used to determine the significance of cure rates, repeated measures analysis of variance for the comparison of mean log egg counts, the Newman–Keuls procedure for multiple comparison tests, and logistic regression for the comparison of infection rates at days 180 and 360 after treatment. Findings Albendazole, ivermectin and the drug combinations gave significantly higher cure and egg reduction rates for ascariasis than diethylcarbamazine. For trichuriasis, albendazole + ivermectin gave significantly higher cure and egg reduction rates than the other treatments: the infection rates were lower 180 and 360 days after treatment. Conclusion Because of the superiority of albendazole + ivermectin against both lymphatic filariasis and trichuriasis, this combination appears to be a suitable tool for the integrated or combined control of both public health problems.

Finite element analysis of the influence of implant inclination, loading position, and load direction on stress distribution.

Abstract: The selection of the appropriate alignment of an implant and the position of implantation are vital for its longterm success. Excessive load is generated around inclined implants, causing microcracks in the bone, which result in implant loosening and eventual failure. This study was designed to analyze the stress distribution caused by varying the degree of inclination of an implant body and varying the loading position and direction, using the finite-element method of stress analysis. Buccal and lingual two-dimensional simulation models of a cylinder implant, embedded in the first molar edentulous cross-section of the mandible, were prepared, and the stress distribution and maximum principal stresses were recorded. Regardless of the point and direction of loading, compressive stresses were relatively greater when the implant was inclined. This tendency became more pronounced when a 45 degrees loading direction and eccentric loading were tested. For the inclined model, with a 45 degrees loading direction, the compressive stress was observed on the cortical bone adjacent to the direction of inclination, while tensile stress was observed on the opposite side.

International survey on variations in practice of the management of the third stage of labour

Abstract: OBJECTIVE: To determine the use of the active management of the third stage of labour in 15 university-based obstetric centres in ten developing and developed countries and to determine whether evidence-based practices were being used. METHODS: From March 1999 to December 1999, the Global Network for Perinatal and Reproductive Health (GNPRH) conducted an observational, cross-sectional survey to assess the use of the practice and its components. Prospective data on patient characteristics and the interventions used in the management of the third stage of labour were collected using standardized methods. Data on approximately 30 consecutive vaginal deliveries in each centre (452 in total) were included. FINDINGS: Significant intracountry and intercountry variation in the practice of the active management of the third stage of labour was found (111/452 deliveries used active management), which confirmed the existence of a large gap between knowledge and practice. CONCLUSION: Areas identified for improvement are the urgent implementation of the evidence-based clinical management practice defined as the active management of the third stage of labour; increased accessibility to systematic reviews in developing countries; and the conduction of clinical trials that assess the impact of this intervention in other settings.

Novel excitatory Conus peptides define a new conotoxin superfamily.

Abstract: A new class of Conus peptides, the I-superfamily of conotoxins, has been characterized using biochemical, electrophysiological and molecular genetic methods. Peptides in this superfamily have a novel pattern of eight Cys residues. Five peptides that elicited excitatory symptomatology, r11a, r11b, r11c, r11d and r11e, were purified from Conus radiatus venom; four were tested on amphibian peripheral axons and shown to elicit repetitive action potentials, consistent with being members of the 'lightning-strike cabal' of toxins that effect instant immobilization of fish prey. A parallel analysis of Conus cDNA clones revealed a new class of conotoxin genes that was particularly enriched (with 18 identified paralogues) in a Conus radiatus venom duct library; several C. radiatus clones encoded the excitatory peptides directly characterized from venom. The remarkable diversity of related I-superfamily peptides within a single Conus species is unprecedented. When combined with the excitatory effects observed on peripheral circuitry, this unexpected diversity suggests a corresponding molecular complexity of the targeted signaling components in peripheral axons; the I-conotoxin superfamily should provide a rich lode of pharmacological tools for dissecting and understanding these. Thus, the I-superfamily conotoxins promise to provide a significant new technology platform for dissecting the molecular components of axons.

Heme oxygenases in pregnancy II: HO-2 is downregulated in human pathologic pregnancies.

Abstract: Problem: We previously reported a diminished expression of the heme-degrading enzymes heme oxygenases (HO)-1 and HO-2 in decidua and placenta from mice undergoing Th1-mediated abortion, strongly indicating the protective effect of HO in murine pregnancy maintenance. Here we investigated whether the expression of HO-1 and HO-2 is also reduced at the feto-maternal interface of pathologic human pregnancies. Method of Study: Immunohistochemistry was used to detect HOs expression in placental and decidual first-trimester tissue from patients with: spontaneous abortion (n = 14), choriocarcinoma (n = 14), hydatidiform mole (H-mole) (n = 12), compared with normally progressing pregnancies (n = 15). Further, we investigated early third-trimester decidual and placental tissue from patients with pre-eclampsia (n = 13) compared with fetal growth retardation (n = 14) as age-matched controls. Results: In first trimester tissue, we observed a significant reduction of HO-2 expression in invasive trophoblast cells, endothelial cells, and syncytiotrophoblasts in samples from patients with spontaneous abortion compared with normal pregnancy. H-mole samples showed a diminished expression of HO-2 in invasive trophoblast cells and endothelial cells in comparison with NP, whereas choriocarcinoma samples showed no significant differences compared with the control. In third trimester tissue, HO-2 was also reduced in syncytiotrophoblasts and invasive trophoblast cells from pre-eclampsia compared with samples from fetal growth retardation. HO-1 expression was diminished in all pathologies investigated; however, the differences did not reach levels of significance. Conclusions: Our data indicate that HOs play a crucial role in pregnancy and low expression of HO-2, as observed in pathologic pregnancies, may lead to enhanced levels of free heme at the feto-maternal interface, with subsequent upregulation of adhesion molecules, allowing enhanced inflammatory cells migration to the feto-maternal interface.

Effect of a Multiple-Micronutrient-Fortified Fruit Powder Beverage on the Nutrition Status, Physical Fitness, and Cognitive Performance of Schoolchildren in the Philippines:

Abstract: This study aimed to determine the effect of a multiple-micronutrient-fortified beverage on the micronutrient status, physical fitness, and cognitive performance of schoolchildren. The study was a randomized, double-blind, placebo-controlled trial of schoolchildren assigned to receive either the fortified or nonfortified beverage with or without anthelmintic therapy. Data on hemoglobin level, urinary iodine excretion (UIE) level, physical fitness, and cognitive performance were collected at baseline and at 16 weeks post-intervention. The fortified beverage significantly improved iron status among the subjects that had hemoglobin levels < 11 g/dl at baseline. The proportion of children who remained moderately to severely anemic was significantly lower among those given the fortified beverage. In the groups that received the fortified product, the median UIE level increased, whereas among those who received the placebo beverage, the median UIE level was reduced significantly. Iron- and/or iodine-deficient subjects who received the fortified beverage showed significant improvements in fitness (post-exercise reduction of heart rate) and cognitive performance (nonverbal mental ability score). The study showed that consumption of a multiple-micronutrient-fortified beverage for 16 weeks had significant effects on iron status, iodine status, physical fitness, and cognitive performance among iron- and/or iodine-deficient Filipino schoolchildren. Anthelmintic therapy improved iron status of anemic children and iodine status of the iron-adequate children at baseline but it had no effect on physical fitness and cognitive performance. The results from the clinical study showed that a multiple-micronutrient-fortified beverage could play an important role in preventing and controlling micronutrient deficiencies.

Feedback regulation of MAPK signalling by an RNA-binding protein.

Abstract: Mitogen-activated protein kinases (MAPKs) are evolutionarily conserved enzymes that convert extracellular signals into various outputs such as cell growth, differentiation and cell death. MAPK phosphatases selectively inactivate MAPKs by dephosphorylating critical phosphothreonine and phosphotyrosine residues. The transcriptional induction of MAPK phosphatase expression by various stimuli, including MAPK activation, has been well documented as a negative-feedback mechanism of MAPK signalling. Here we show that Rnc1, a novel K-homology-type RNA-binding protein in fission yeast, binds and stabilizes Pmp1 messenger RNA, the MAPK phosphatase for Pmk1 (refs 10, 11). Rnc1 therefore acts as a negative regulator of Pmk1 signalling. Notably, Pmk1 phosphorylates Rnc1, causing enhancement of the RNA-binding activity of Rnc1. Thus, Rnc1 is a component of a new negative-feedback loop that regulates the Pmk1 pathway through its binding to Pmp1 mRNA. Our findings--the post-transcriptional mRNA stabilization of a MAPK phosphatase mediated by an RNA-binding protein--provide an additional regulatory mechanism for fine-tuning of MAPK signalling pathways.

INTERLEUKIN-8, TUMOR NECROSIS FACTOR-α, AND LACTOFERRIN IN IMMUNOCOMPETENT HOSTS WITH EXPERIMENTAL AND BRAZILIAN CHILDREN WITH ACQUIRED CRYPTOSPORIDIOSIS

Abstract: To examine the importance of intestinal inflammation in the diagnosis and pathogenesis of human cryptosporidiosis, stools of healthy adult volunteers before and after experimental infection were tested for fecal lactoferrin, interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha). Stool samples of Brazilian children with well-defined Cryptosporidium infection, with or without diarrhea, were also tested for IL-8 and TNF-alpha. Only one of the 14 volunteers challenged with Cryptosporidium had increased fecal lactoferrin. However, of 17 stool specimens from children with only Cryptosporidium infection from a previous study, 12 had mild to moderately elevated lactoferrin despite negative work-up for inflammatory enteritides. One of 10 adult volunteers who developed diarrhea with experimental cryptosporidiosis and three of 11 children with cryptosporidiosis and diarrhea had detectable fecal IL-8. The level of TNF-alpha was increased only in one of 14 volunteers and in none of the children. Although considered relatively non-inflammatory. cryptosporidiosis is often associated with mild inflammation, especially in children in an endemic area.

A study to evaluate the pain knowledge of two sub-populations of final year nursing students: Australia and Philippines

Abstract: A study to evaluate the pain knowledge of two sub-populations of final year nursing students: Australia and Philippines Background. Pain management is an essential and important aspect of nursing care. Deficits in pain knowledge and attitudes continue to be reported despite a growth of educational programmes. A lack of basic knowledge of pain at an undergraduate level may limit nurses from effectively developing their knowledge after graduation. Aim of the study. To assess the type and level of knowledge of basic aspects of pain mechanisms and treatment principles in complete classes of final year nurses, at three nursing schools. Method. Data were collected in 1999, from 150 students (81 Australian and 69 Philippine) via a 23-item pain knowledge test questionnaire, previously used to assess undergraduate health professionals including nurses. Results. The mean score of concordant answers for all students was 38.6%, scores ranged from 0% to 70%, 95% Confidence Interval of the mean was 36-41%. There were few significant differences between the groups for individual questions and no significant difference in overall mean scores. Common questions answered poorly included those related to complex regional pain syndrome, pharmacology and central sensitization. Most students perceived their undergraduate pain education to he minimal. Thirty-six percent of Australian students compared with 50% Filipino students perceived their pain knowledge was adequate for their clinical needs. Additionally, most students believed that graduating doctors should be able to answer the test questions correctly. Conclusion. The results demonstrate consistently low levels of knowledge and also knowledge gaps about basic pain mechanisms, terms and treatment amongst these three final year nursing classes. Such information is useful to define levels of basic knowledge about this topic, and can be explored further as to whether some or all of these facts are deemed necessary for inclusion in nursing curriculum by reference to documents such as the International Association for the Study of Pain curriculum.

Distribution of immunocompetent cells in decidua of controlled and uncontrolled (choriocarcinoma/hydatidiform mole) trophoblast invasion.

Abstract: Problem: Pregnancy has been considered as a model of successfully controlled tissue invasion where trophoblast cells infiltrate the maternal decidua without being rejected or without destroying the tissue. In choriocarcinoma (CC) and hydatidiform mole (HM), a dysregulation of invasive (malignant/benign) trophoblast cells is present. Immunocompetent cells (IC) are known to be involved in rejection pathways of malignant cells and can also be identified in early pregnancy decidua. The aim of the present study was to identify the phenotype of IC in decidua of women with normal pregnancy (NP), CC and HM. Methods: Immunocompetent cells were detected by immunohistochemistry in decidual tissue from first trimester NP (n = 10), CC (n = 12) and HM (n = 11) using antibodies against CD8+, CD3+, CD56+, CD68+ cell surface markers and mast cell tryptase (MCT). A scaled eye piece was used for cell counting to obtain semiquantitative results. Statistical analysis was performed using Wilcoxon rank/Mann–Whitney tests. Results: We observed a significantly increased number of lymphocytes positive for CD8, CD3 and MCT positive granulocytes in CC and HM compared with the samples from NP (all P ≤ 0.001). Lymphocytes positive for natural killer (NK) cell marker CD56 were significantly decreased in CC and HM versus NP (P ≤ 0.001). The number of CD68 positive cells (macrophages) were not significantly different among the tissue pools. Conclusion: The increase of CD8/CD3 T cells and mast cells in CC and HM and the decrease of CD56 cells, compared with NP, suggests the necessity of a balance between T and NK cells in controlling trophoblast invasion.

Infections in International Pregnancy Study: Performance of the Optical Immunoassay Test for Detection of Group B Streptococcus

Abstract: We evaluated the Strep B optical immunoassay (OIA; ThermoBiostar, Inc.) for detecting light and heavy group B streptococcus colonization in 1,306 pregnant women. The women were examined at 20 to 32 weeks gestation and were from six countries. Compared to culture, the sensitivity and specificity of OIA were 13.3 and 98.4%, respectively, for light colonization and 41.5 and 97.7%, respectively, for heavy colonization.

Coordination of international multicenter studies: Governance and administrative structure [Coordinación de estudios multicéntricos internacionales; estructura administrativa y reglamentación ]

Abstract: A well-conducted multicenter study needs to assure standardization, uniformity of procedures, high data quality, and collaboration across sites. This manuscript describes the organization and dynamics of multicenter studies, focusing on governance and administrative structures among countries of diverse cultures. The organizational structure of a multicenter study is described, and a system for oversight and coordination, along with roles and responsibilities of participants in the multicenter study, are presented.The elements of a governance document are also reviewed, along with guidelines and policies for effective collaboration.The experience of an ongoing multi-country collaboration, the World Studies of Abuse in the Family Environment (World-SAFE), illustrates the implementation of these guidelines. It is essential that multicenter studies have an objective coordinating center and that the investigators jointly develop a written governance document to enable collaboration and preserve collegiality among participating investigators.TheEnglish version of this paper is available too at: http://www.insp.mx/salud/index.html

Coordination of international multicenter studies: governance and administrative structure

Abstract: A well-conducted multicenter study needs to assure standardization, uniformity of procedures, high data quality, and collaboration across sites. This manuscript describes the organization and dynamics of multicenter studies, focusing on governance and administrative structures among countries of diverse cultures. The organizational structure of a multicenter study is described, and a system for oversight and coordination, along with roles and responsibilities of participants in the multicenter study, are presented. The elements of a governance document are also reviewed, along with guidelines and policies for effective collaboration. The experience of an ongoing multi-country collaboration, the World Studies of Abuse in the Family Environment (WorldSAFE), illustrates the implementation of these guidelines. It is essential that multicenter studies have an objective coordinating center and that the investigators jointly develop a written governance document to enable collaboration and preserve collegiality among participating investigators.

Screening for glucose-6-phosphate dehydrogenase deficiency using a modified formazan method: a pilot study on Filipino male newborns.

Abstract: Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency has increased prevalence rates in tropical Africa, tropical and subtropical Asia and some parts of the Mediterranean. Earlier studies on G6PD deficiency in the Philippines have shown prevalence rates of 4.5% to 25.7%. Methods: In the present study, 3278 male newborns were screened for G6PD deficiency using the modified formazan method, a simple screening procedure affordable in the setting of a developing country. Subjects with positive screening results were recalled for confirmatory testing using a commercial assay kit for quantitative enzyme determination. Results: Of the 3278 boys studied, 186 revealed positive screening results. Of the 186, 65 boys had confirmatory testing. Of these 65 boys, 45 were confirmed to have G6PD deficiency and 20 had normal results. This study reveals an incidence of G6PD deficiency of 3.9% among male Filipinos. Conclusion: This study recommends the inclusion of G6PD deficiency in the panel of disorders for newborn screening among Filipino newborns.

Newborn screening in the Philippines.

Abstract: The Newborn Screening Study Group first introduced newborn screening in the Philippines in 1996. This group of pediatricians and obstetricians from 24 hospitals in the metropolitan Manila area developed a newborn screening program: (1) to establish the incidence of six metabolic conditions--congenital hypothyroidism, congenital adrenal hyperplasia, galactosemia, phenylketonuria, homocystinuria and glucose-6-phosphate dehydrogenase deficiency, and (2) to make recommendations for the adoption of newborn screening nationwide. Newborn screening developed in three phases: (1) routine screening for 5 disorders excluding G6PD deficiency in the 24 member hospitals in Metro Manila, (2) addition of screening for G6PD deficiency to the 5-disorder screening panel, and (3) program evaluation with subsequent reduction in the time of sample collection to 24 hrs of age or older (from the initial requirement of 48 hrs. or older) and discontinuation of screening for homocystinuria as a cost cutting measure (due to non-detection of cases). Data from 201 participating hospitals reported in September 2001 confirmed 48 cases of congenital hypothyroidism, 21 cases of congenital adrenal hyperplasia, 2 cases of galactosemia, 4 cases of hyperphenylalanemia and 1,495 cases of glucose-6-phosphate dehydrogenase deficiency. The Department of Health has recognized the significance of the initial data and efforts are now being undertaken to ensure the nationwide implementation of newborn screening.

Birth defects ascertainment in the Philippines.

Abstract: In the Philippines, congenital anomalies rank among the top 20 causes of death across the life span and are already the third leading cause of death in the infancy period (Philippine Department of Health, 1996). Despite the magnitude of the problem, no formal systematic registration of birth defects has been done in the country up until 1999. Various attempts have been made by different study groups to gather data but there was never a formal effort to consolidate the information and establish a centralized registry. Data from various modes of ascertainment are hereby presented: 1) Philippine Birth Defects Registry Project, 2) Hospital In-Patient and Out-Patient Registries, 3) Prenatal Inventory and Neonatal Outcome Study Group, 4) Hospital Pathology Reports, and 5) Community Outreach Programs. Birth Defects Registry Project had the largest reporting of the different methods presented here. The most common birth defects were multiple congenital anomalies, congenital malformations of the tongue, mouth, and pharynx (ankyloglossia), cleft palate with cleft lip, Down Syndrome, congenital deformities of the feet (talipes equinovarus), anencephaly, other congenital malformations of the face and neck, congenital malformations of the musculoskeletal system (diaphragmatic hernia, gastroschisis), hypospadias, congenital hydrocephalus, polydactyly, syndactyly, and cleft lip.

Neonatal hearing screening in a neonatal intensive care unit using distortion-product otoacoustic emissions.

Abstract: Objective – To determine pass and refer rates, and identify risk factors relating to refer responses, in neonates screened using distortion-product otoacoustic emissions (DPOAEs). Material and Methods – A total of 435 neonates admitted to the neonatal intensive care unit (NICU) of the Philippine General Hospital between May and October 2000 were screened using DPOAEs within 48 h of admission. Results – The male:female ratio in the sample was 1.05. In total, 56% of neonates were born preterm, the mean birthweight was 2428.39±710.39 g and 8.9% weighed <1500 g. In total, 47.9% were delivered by Caesarian section and 44.9% were delivered vaginally. Almost 14% of neonates had 1-min Apgar scores of <6, and 4% had 5-min Apgar scores of <7. Approximately 95% of neonates had a poor perinatal history. Using pediatric aging it was noted that 46% of these neonates were born preterm, and 30.4% were small for gestational age. At least one neonatal disease was found in 42% of neonates, whilst 95.7% had to be given medic...

Cost-benefit analysis of newborn screening for galactosemia in the Philippines.

Abstract: To determine the incidence of galactosemia (GAL) in the Philippines and to determine whether newborn screening for GAL is cost-beneficial from a societal perspective, cost-benefit analysis was performed. Newborn screening for GAL was done after the 24th hour of life using the Beutler test. Patients screened positive were recalled for confirmatory testing. Using incidence rates obtained from the different participating hospitals of the Philippine Newborn Screening Program (PNSP), the costs for the detection and treatment of GAL were compared to the expected benefits by preventing mental retardation, cataracts and other physical disabilities caused by the disorder that would lead to a loss of productivity for the individual. Sensitivity analyses for incidence and discount rates were also included. Of the 157,186 newborns screened by the PNSP since its inception in 1996, 8 screened positive results. Confirmatory testing of these patients showed that 2 had galactosemia. The incidence of galactosemia in this population therefore, is 1 in 106,006 (95% CI= 1:44,218 - 1:266,796). Projecting the figures to the actual birth rate (1.5M newborns/year), the total costs of the screening program amounted to $1.1M, while the total benefits amounted only to $0.2M, yielding net cost of $0.9M. A cost-benefit analysis of the screening program for galactosemia using the incidence 1 in 106,006 demonstrated that the costs of the program outweigh the benefits. The true incidence of galactosemia in the Philippine population may yield an incidence rate that will result in greater net benefits for the program.

In vitro susceptibility of Plasmodium falciparum isolates to chloroquine and mefloquine in southeastern Mindanao Island, the Philippines

Abstract: Although the presence of multi-drug-resistant falciparum malaria has been reported in the Philippines, the distribution of drug-resistant malaria parasites has not yet been determined in Mindanao Island. In vitro susceptibility of P. falciparum to both chloroquine and mefloquine was assessed to forecast the spread of drug-resistant parasites in various foci in southeastern Mindanao Island. Of the 33 isolates of P. falciparum successfully tested, 10 (30%) were susceptible, 12 (36%) showed de- creased susceptibility (80 nM ≤ IC 50 < 114 nM), and 11 (33%) were resistant (IC 50 ≥ 114 nM) to chloroquine. Ten (91%) of the resistant isolates and 9 (75%) of those with decreased susceptibility were from northern and northwestern Davao del Norte Province. Chloroquine-susceptible isolates were found among patients in the eastern parts of Davao del Norte and Davao Oriental provinces. Seven isolates from several foci in the study area were all mefloquine- susceptible (IC 50 < 10 nM). This is the first report indicating the potential emergence of chloroquine-resistant P. falciparum on Mindanao Island, which is presently regarded as a drug-susceptible area.

Risk Factors for Low Back Pain Among Filipino Manufacturing Workers and Their Anthropometric Measurements

Abstract: This study looked into the prevalence of and risk factors for low back pain among workers in manufacturing industries in the Philippines. Anthropometric measurements were also done to establish the design principles of the working equipment, protective equipment, and tools of the Filipino worker to prevent musculoskeletal disorder. This was a cross-sectional study using a stratified random sampling technique. Thirty-one industries were selected. Various workstations were sampled from each industry where subjects were selected. There were 495 workers surveyed for the symptoms questionnaire and 544 for the anthropometric measurements. Results showed that 5.1 percent experienced discomfort, 2 percent had trunk rigidity, and 1.4 percent had both limitations of trunk motion and activities of daily living. Logistic regression showed that low back pain was significantly associated with leaning, bending, and carrying for 2-8 hours (p at.05), and with standing for 2-8 hours (p at.001). It was also found to affect work performance and more likely to occur 14 times as often after work as during the initial work sessions. Anthropometric measurements of the workers showed that the mean height is 159.96 cm, mean chest height is 115.70 cm, waist height is 96.95 cm, and knee height is 47.37 cm. Anthropometric data between sexes was also presented. This anthropometry can be used for the design of working equipment of Filipino workers. It is recommended that risk factors for low back pain be understood and equipment be designed according to the body proportions of the workers identified in this study.

Microcirculation: target therapy in cardiovascular diseases – A clinical perspective

Abstract: Microcirculation conduit, distribution, exchange and reception vessels usually retain a demand-dependent vascular-tissue match as well as a nutrient friendly capillary-matrix tissue match. Various stimuli can initiate a vascular-capillary matrix-tissue mismatch. Counter-regulatory mechanisms result in hyperplasia or apoptosis. Microvascular disease (MVD) as a consequence or outcome of supply-demand mismatch has clinical therapeutic and prognostic implications in the hypertensive syndrome and coronary artery disease (CAD) cases. Recognition of the role of apoptosis and MVD may initiate a paradigm shift in clinical practice. Digitalis and other anti-hypertensive agents have anti-apoptotic action and MVD blunting effects that can control LVH development to reduce congestive heart failure (CHF) progression.

Newborn screening for congenital hypothyroidism in early discharged infants.

Abstract: A study of newborn thyroid stimulating hormone (TSH) levels was undertaken to determine whether a quantitative relationship exists between TSH values obtained between the 12th to 24th hours of life and the 48th to 72nd hours of life. The study was designed to: (a) measure TSH levels in full term newborns between the 12th - 24th hours of life, (b) measure TSH levels in the same set of newborns at 48 - 72 hours of life, (c) correlate TSH values obtained during the two time periods of specimen collection, (d) determine whether TSH results at 12 to 24 hours are predictive of TSH levels at 8 to 72 hours, and (e) determine the effects of other factors on TSH 48-72. One thousand three hundred seventy full term normal infants delivered at the Philippine General Hospital and at the Rizal Medical Center from August 1999 to March 2001 participated in the study. Eighty-three percent were from Metro Manila and the rest from the provinces. Although there was a significant association between TSH12-24 and TSH48-72, the magnitude of association could not account for all of the variance in the TSH48-72 values. By itself, TSH12-24 cannot clinically predict 48-72 hour TSH levels. Multiple regression analysis showed that sex and mode of delivery by cesarean section were significant factors affecting TSH levels at 48-72 hours.

Assignment of Real-World Projects: An Economical Method of Building Applications for a University and an Effective Way to Enhance Education of the Students

Abstract: Introduction The University of the Philippines Manila (UPM) is the premiere state university in the Philippines that specializes in courses for the health professions and is regarded as a health campus in the University of the Philippines System. It is composed of seven colleges consisting of the Arts and Sciences, Medicine, Nursing, Pharmacy, Allied Medical Professions, Public Health, Dentistry, the National Teacher Training Center--Health Profession, and the School of Health Sciences. At the heart of the University is the Philippine General Hospital, the premiere tertiary hospital in the country that serves as training ground for students. In 1996, the College of Arts and Sciences, through the Department of Physical Sciences and Mathematics (DPSM), launched the BS Computer Science program in line with the demand for more IT professionals in the health sciences. The program was initially adopted from an existing program at the University of the Philippines Los Banos. Although the subjects are basically the same for both degree programs, the degree program at UPM focused on addressing the problems of the health sector. Because of this, the BS Computer Science program of UPM is considered unique as there is no university in the Philippines that specializes in the development of computer specialists for the health sector. Each year only 30 students are accepted due to limited slot availability. A Need for Collaboration Due to budget cuts from the government, UP Manila's budget is centered mainly on maintenance of operations and salaries of employees. There is hardly any budget left for improvement of operations through application of information technology. The lack of resources paved the way for DPSM to pursue an active role in developing applications for UP Manila through its BS Computer Science program. Furthermore, DPSM believes that the BS Computer Science students will become more knowledgeable in their field by immersing them in the development of real world projects rather than working with case studies. Thus there is a need for collaboration between DPSM and the health profession colleges. Through this collaborative scheme, the health professional colleges will provide the necessary project requirements while DPSM will supervise the students in the construction of the software project. It is agreed that the students will be producing an evolutionary software prototype only since the project is still a part of the students' initial training. However, the resulting prototype may be used by the colleges in order to see a snapshot of their envisioned software project. Additionally, changes in the set of requirements can be made as well as installation of new features and functions can be determined. This collaboration strategy is similar to the one proposed by Mathieu (1993), Longo (1998), Harris (1995), Mehic and Al-Soufi (1999), Surendran and Young (2000) and Abbott et al. (2001; 1998) the main difference being in our strategy, the client is also from the same University and not from the industry. Our strategy aims not only to expose students to actual hands-on experience in developing information systems but also to bring technology to the academe with the least cost to the University as proposed by Van Over and Dangerfield (1993). The software prototype can later be enhanced by another group of students during their Practicum Class on the following term, by the same group of students working as student assistants but functioning as software developers, or by another group of students as main coursework for their Special Problem (Thesis). Setting the Foundations The strategy is implemented in the software engineering subject, a junior subject in the BS Computer Science curriculum. Software engineering as implemented in UP Manila is credited as a 3-unit subject comprising of a two-hour lecture and three-hour laboratory. It emphasizes "Software Engineering in the Large" or the application of software engineering principles to the development of a software product by a team equivalent to a small or moderate industry project as specified in the Guidelines for Software Engineering Education Version 1. …

Monitoring congenital adrenal hyperplasia using blood spot 17-hydroxyprogesterone assay.

Abstract: Blood spots taken by finger prick collected on filter paper cards can provide an option to venous blood extraction in monitoring 17-OHP levels in children with Congenital Adrenal Hyperplasia (CAH). This study was done to evaluate the usefulness of blood spot 17-OHP in monitoring disease control in pre-pubertal children with CAH, to correlate it with simultaneously extracted venous 17-OHP levels, and to compare blood spot levels of children with CAH with that of normal non-virilized children. Nine pre-pubertal children with CAH (1 male; 8 females) were enrolled in the study. Age, sex, growth velocity, height age and bone age were determined. Simultaneous venous and blood spot specimens were taken between 0800 and 0900 hours. Nine pre-pubertal, age- and sex-matched normal non-virilized children served as controls. COAT-A-COUNT was used to measure venous 17-OHP levels, and AutoDELFIA Neonatal 17alpha-OH-progesterone was employed for blood spot specimens. Mean age of patients with CAH was 42.78 months (SD= 21.45214). Four had simple virilizing form and five were salt-losers. Venous 17-OHP levels ranged from 7.5 to 800nmol/l. Blood spot 17-OHP levels ranged from < or =0.5000nmol/l to 355.5nmol/l. There was a strong positive correlation between the venous and blood spot determination, with a correlation coefficient gamma= 0.947 (p < 0.001). All of the children in the control group had a blood spot 17-OHP level < or =0.5000nmol/l. Taking blood spot 17-hydroxyprogesterone levels is a simple, acceptable, convenient, and less costly alternative to venous 17-OHP determination in monitoring treatment response of children with CAH. The decision to make treatment modification, however, should be made on random blood spot 17-OHP interpretation in conjunction with clinical history and evaluation of growth parameters.

Initial versus confirmatory thyroid stimulating hormone (TSH) levels: is there a correlation?

Abstract: Newborn screening for congenital hypothyroidism (CH) in the Philippines began in 1996. The screening method used is the fluoroimmunometric assay of thyroid stimulating hormone (TSH) from dried blood spot. In the past five years (June 1996--Sept 2001), 176,548 newborns have been screened. Of these, 237 had elevated TSH levels and 51 (22%) were confirmed to have CH. One hundred forty-six (61%) had normal TSH levels on confirmatory testing; five (2%) expired; 25 (11%) were lost to follow-up, while 10 (4%) were being recalled at the time of this study. Thirty-three out of 51(65%) CH patients are female. Only 38 of 51 patient charts were available for data analysis. Thirteen of 51 CH patients were lost to follow-up after confirmation of the disorder. The mean age at which levo-thyroxine was initiated is 1 1/2 months at a modal dosage of 25 microg OD. The initial TSH levels as determined by the Philippine Newborn Screening Laboratory directly correlates with the confirmatory TSH levels done in other endocrine laboratories (Spearman's rho=0.57, p value=0.0002, at a=0.05). However, the time of heel prick on the newborn was independent of the TSH levels, (Spearman's rho=-0.16, p value=0.377 at a=0.05) hence there was no significant difference with respect to the initial TSH level of blood samples taken at 48 hours, less than one week, one to two weeks; or even more than two weeks after birth (Kruskall Wallis test, p value=0.064 at a=0.05). Using Fisher's exact test, there is no sufficient evidence to say that there is an association between gender and the incidence of CH among screened newborns whose TSH levels were initially elevated (p 2-tailed=0.183, p 1-tailed=0.113 at a=0.05).

Impact of HIV/AIDS on an overseas Filipino worker and his family

Abstract: JD was a 42-year-old male from Cavite, the Philippines who was referred to the Research Institute for Tropical Medicine (RITM) for further management of progressive dyspnea secondary to pulmonary tuberculosis (PTB). As part of the Family and Community Medicine Residency Training Program in our institution, I underwent a rotation at the RITM, where I first met JD on 21 April 2002. JD was previously diagnosed to have, and treated for PTB, in September 2001. Symptoms resolved during the 6-month treatment period, only to recur 2 weeks after termination of treatment despite good compliance. He developed cough paroxysms with anorexia, fever, and progressive dyspnea 2 weeks prior to this admission. Personal/social history revealed that JD worked as an overseas Filipino worker (OFW) in Saudi Arabia (1981–1984) and in East Africa (1991–1994). He revealed for the first time to a medical personnel that he was screened to have a positive HIV antibody test in 1995 while trying to renew his OFW contract. JD refused further medical consults. Upon admission, JD was in mild respiratory distress, with rales on both lung fields. Supportive management was instituted. Further work-up was done to exclude other possible opportunistic infections and for HIV confirmatory testing which was subsequently confirmed positive. He was managed as a case of recurrent PTB; HIV infection category C (or AIDS); and Pneumocystis carinii pneumonia. Recurrent PTB was given as assessment due to the recurrence of the PTB symptoms (cough paroxysms, anorexia, weight loss, fever, night sweats and chills) after completion of the 6-month treatment for PTB with symptom resolution. An assessment of HIV infection category C was given on the basis of a positive HIV confirmatory test and having AIDS indicator conditions (i.e., PTB and Pneumocystis carinii pneumonia,Tables 1,2). 1

Universal neonatal hearing screening: applications for a developing country in the Asia-Pacific region.

Abstract: Various centers around the world have implemented and evaluated universal hearing screening programs as a response to the US National Institute of Health policy statement on early identification of hearing loss. Several well conducted clinical trials have been devised to examine and evaluate various factors relevant to establishing a UNHS program. This paper aims to describe some of these factors and analyze their applications and implications for a UNHS program for a developing country in the Asia-Pacific Region. Specifically, three main issues will be discussed: hospital vs community based programs, choice of technology, and choice of screening protocol.