Showing papers in "Journal of Medicine, University of Santo Tomas in 2022"
TL;DR: In this paper , a descriptive quantitative correlational study is aimed at assessing the knowledge, attitudes and perceptions (KAP), and their relationship among adults aged 18-34 without prior experience in the use of telemedicine in Manila, Philippines during the COVID-19 pandemic.
Abstract: Telemedicine has been an emerging method for delivering healthcare services due to the challenges brought by the COVID-19 pandemic. This descriptive quantitative correlational study is aimed at assessing the knowledge, attitudes and perceptions (KAP), and their relationship among adults aged 18-34 without prior experience in the use of telemedicine in Manila, Philippines during the COVID-19 pandemic. The study had 322 eligible respondents who answered an online survey questionnaire of three parts that asked for their socio-demographic profile, KAP on telemedicine. Descriptive statistics, profile analysis and Spearman’s rho were utilized as statistical tools. The respondents’ knowledge was on an average to low level, and attitude and perception towards telemedicine were both neutral. Results showed no significant difference between the KAP of the respondents when analyzed according to socio-demographic variables. Knowledge and attitude have a weak positive linear relationship while knowledge and perception have a moderate positive linear relationship. A strong positive linear relationship was indicated between attitude and perception. A positive attitude can be attributed to a positive perception towards telemedicine but both do not consequently come from high knowledge levels of it. Keywords: Telemedicine, Knowledge, Attitudes, Perceptions, COVID-19
4 citations
TL;DR: A systematic review synthesizing evidence regarding the effects of BCG in curtailing the spread of the COVID-19 pandemic can ultimately guide health authorities and policy makers create evidence-based decisions regarding BCG vaccination policies and clinical trials related to CO VID-19 control and prevention.
Abstract: Introduction: The bacille Calmette-Guerin (BCG) vaccine is used for the prevention of tuberculosis (TB) worldwide. Evidence reports a much lower incidence of COVID-19 in TB-endemic areas implying a possible protective mechanism of BCG in countries with mandated BCG policies. The objective of the study is to synthesize and critically evaluate the effectiveness of national BCG vaccination policies in reducing infection and severity of COVID-19 in their native population. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search using pre-identified keywords will be done in PubMed, Cochrane, HERDIN Plus, WPRIM, Web of Science and EBSCO databases. After the initial selection of studies based on eligibility criteria, methodological appraisal will be conducted using the Joanna Briggs Institute appraisal instruments and an adapted quality assessment checklist for ecologic studies. Relevant data will be extracted and synthesized including reporting descriptive and inferential statistics to interpret results. Results: The study will generate a systematic review synthesizing evidence regarding the effects of BCG in curtailing the spread of the COVID-19 pandemic. Discussion: The battle against the COVID-19 pandemic is far from over, and as such, further studies must be undertaken to verify the evidence behind initial strategies in battling it. This includes the use of BCG in decreasing COVID-19 incidence and mortality. The results of the review can ultimately guide health authorities and policy makers create evidence-based decisions regarding BCG vaccination policies and clinical trials related to COVID-19 control and prevention. Systematic Review Registration: PROSPERO, CRD42021244060
1 citations
TL;DR: In this paper , an eight-item Clinical Performance Confidence Scale survey was performed at three different time points of fourth-year medical student's rotation in the Department of Medicine: (1) prior to the deployment to the outpatient department (Pre-OPD), (2) after the first-time patient encounter without Target-Oriented Clinical Skill Enhancement (TOCSE), and (3) after a patient encounter with TOCSE workshop (Post-OED with TocSE).
Abstract: Background and Objective: Teaching clinical skills to undergraduate medical students has brought significant challenges during the COVID-19 pandemic. Patient discussion utilized hypothetical cases from history taking to diagnosis and management. Further, everything was delivered online. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates the basic medical sciences, such as anatomy, physiology, pathology, microbiology, and pharmacology, at the clinical level. TOCSE has been proven to improve the clinical performance of fourth-year medical students. However, clinical confidence remains an issue, especially for medical students on pure online mode of learning during the pandemic. Therefore, this study was undertaken to determine if TOCSE also facilitates the development of confidence in the clinical performance of 4th-year medical students during the first-time patient encounter after online undergraduate classes. Methods: Eight-item Clinical Performance Confidence Scale survey was performed at three (3) time points of fourth-year medical student’s rotation in the Department of Medicine: (1) prior to the deployment to the outpatient department (Pre-OPD), (2) after the first-time patient encounter without TOCSE workshop (Post-OPD no TOCSE), and (3) after the patient encounter with TOCSE workshop (Post-OPD with TOCSE). Mean and standard deviations were used to summarize the confidence level of the 4th-year medical students, based on the 10-point differential scale being 0 as not confident at all and 10 as very confident. Wilcoxon Signed Rank assessed improvements of confidence level from Pre-OPD to Post-OPD. Effect sizes were also calculated to compare the improvement in the items. All statistical tests were performed in SPSS version 26.0. P-values less than 0.05 indicate a significant increase in the confidence level of 4th-year medical students. Results: There is a significant increase in the clinical confidence of 4th-year medical students from Pre-OPD to Post-OPD no TOCSE (mean ± SD: 6.32 ± 1.02 to 7.06 ± 0.95, p<0.001). Comparing the eight items between Pre-OPD and Post-OPD with no TOCSE, performing a complete physical examination has the most remarkable improvement. Further, there is a significant increase in the clinical confidence of 4th-year medical students from Post-OPD no TOCSE to Post-OPD with TOCSE (mean ± SD: 7.06 ± 0.95 to 7.51 ± 0.89, p<0.001). The performance of a complete history-taking has the most considerable improvement (7.29 + 1.03 to 7.89 + 1.01, p<0.001). Correspondingly, the most significant increase in the clinical confidence of 4th-year medical students was seen among the Post-OPD with TOCSE compared to their Pre- OPD confidence scores (mean ± SD: 6.32 ± 1.02 to 7.51 ± 0.89, p<0.001). Among the eight items between Pre-OPD and Post-OPD with TOCSE confidence scores, the item on performing a complete physical examination has the most remarkable improvement (5.67 ± 1.37 to 7.20 ± 1.22, p<0.001), closely followed by performing a complete history-taking (6.53 ± 1.19 to 7.89 ± 1.01, p<0.001). The most significant improvements in clinical confidence were seen in all the items in the Post-OPD with TOCSE than in the Post-OPD with no TOCSE versus Pre-OPD confidence scores. In addition, with TOCSE, the number of medical students who scored 7.50 and above was amplified more than 3 times (17.4% to 58.7%, p<0.001, Pre-OPD vs. Post-OPD with TOCSE, respectively). Conclusion: Target-Oriented Clinical Skill Enhancement (TOCSE) effectively builds up confidence during first-time patient encounters among fourth-year medical students taught online with hypothetical cases during their undergraduate classes. Key words: Target-Oriented Clinical Skill Enhancement, clinical confidence, clinical skill, fourth-year medical students, medical undergraduate challenge, online teaching in COVID-19 pandemic
1 citations
TL;DR: Early aggressive amino acid therapy proves to have a positive effect in the growth and neurodevelopment outcome among preterm and VLBW infants, however, it is recommended to recommend continued monitoring of neurodevelopment in neonates from this population until 2 years of age.
Abstract: Long-term outcomes of preterm and very low birth weight (VLBW) infants have been the focus of published research due to improved neonatal care. One of the long-term morbidities associated with being born too early or VLBW is postnatal growth failure and neurodevelopment delay. Because of this, different strategies were implemented to address this, one of which is initiating early aggressive amino acid therapy at 3 g/kg/day within 24 hours of life with its goal to improve previously mentioned outcomes. This study aims to determine the growth and neurodevelopment outcome among neonates born preterm and VLBW who were given 3 g/kg/day of amino acid. It is important that such delays are detected early on so that appropriate interventions can be initiated to maximize the infant's capabilities. A total of 34 neonates were included in the study where baseline anthropometrics were taken and followed up at the 6th, 9th, and 12th month of corrected age. Results showed 35.2% of the participants were discharged with their anthropometrics below the target range. By the 6th month of corrected age, only 2.94% were below normal and by the 9th month of corrected age, all participants have normal for age anthropometrics. As for the neurodevelopment aspect, 4 of 34 participants (13.8%) were found to be classified as emerging risk and were referred to a neurodevelopment specialist. By the 9th month of corrected age, only 2 were classified as emerging risk and by the 12th month of corrected age, only 1 remained to be at risk for neurodevelopment delay. In conclusion, early aggressive amino acid therapy proves to have a positive effect in the growth and neurodevelopment outcome among preterm and VLBW infants. However, we would like to recommend continued monitoring of neurodevelopment in neonates from this population until 2 years of age, since some delays can be evident later on in life.
TL;DR: A case of a two and a half-year-old girl who presented with delayed acquisition of developmental milestones with subsequent regression, ataxia, and dyskinesia was presented in this paper .
Abstract: Introduction: Leigh disease and Leigh-like syndrome are a heterogenous group of neurodegenerative disorders involving any level of the neuraxis and may present with a variety of clinical presentations, prominent among them is psychomotor regression. Despite the remarkable number of established disease genes and novel mutations being discovered, many cases of Leigh syndrome remain without a genetic diagnosis, indicating that there are still more disease genes to be identified. Case: Here we present a case of a two and a half-year-old girl who presented with delayed acquisition of developmental milestones with subsequent regression, ataxia, and dyskinesia. Her work-up showed raised blood lactate levels and lactate peak in MR spectroscopy. Mitochondria genome showed absence of mitochondrial DNA mutation, while whole exome sequence analysis revealed a novel dynein gene variant, p.A1577S. Her parents underwent genetic testing as well, and her father also had the same dynein mutation, however, is non-symptomatic. She had an older brother who initially presented with ophthalmoplegia and eventually developed psychomotor regression. He subsequently expired from respiratory failure after almost 2 years from initial presentation. Both siblings were diagnosed with Leigh syndrome. Conclusion: The diagnosis of Leigh syndrome remains based on characteristic clinical and radiologic findings. However, a specific defect must be identified if reliable genetic counseling is to be provided.
TL;DR: The USTH Chest Pain Pathway as mentioned in this paper provides guidance based on current guidelines and recommendations on assessing and evaluating acute chest pain, tailored to local needs and institution-specific facilities, and recommends its use to ensure quality patient care in the hospital.
Abstract: This clinical pathway for the diagnosis and risk stratification of patients presenting with acute chest pain, including acute coronary syndromes, provides recommendations and algorithms for clinicians to diagnose, risk stratify, and manage acute chest pain in adult patients. The writing committee reviewed existing international and local guidelines. Modifications to the algorithm following face-to-face and virtual meetings resulted in expert decisions written as recommendations and presented in a flow diagram format. The USTH Chest Pain Pathway provides guidance based on current guidelines and recommendations on assessing and evaluating acute chest pain, tailored to local needs and institution-specific facilities. We recommend its use to ensure quality patient care in the hospital. Key Words: angina pectoris, acute chest pain, acute coronary syndrome, clinical decision pathway, diagnostic pathway, risk stratification, emergency care
TL;DR: In this paper , the authors describe weight changes among NAFLD patients and find that only a third of patients who lost weight initially were able to sustain it, patients who gained weight after the 1st followup were unlikely to lose weight on further follow-up.
Abstract: Background: Weight loss, though difficult to attain and sustain over time, remains the cornerstone of non-alcoholic fatty liver disease (NAFLD) treatment. We aimed to describe weight changes among NAFLD patients. Methods: This was a retrospective, cohort study of consecutively-identified NAFLD patients with >2 clinic visits from March2007–April2018. Weight changes from baseline were categorized into weight gain, weight loss, and no change. Baseline liver and metabolic biochemistries and non-invasive liver fibrosis tests were correlated with the final weight changes. Succeeding weight changes after the initial follow-up visits were used to determine sustainability of weight loss. Results: Of the 240 patients included, 123 (51.2%), 93 (38.8%), and 24 (10%) had weight gain, weight loss, and no change, respectively. Only 12.5% had >5% weight loss. Duration of follow-up was significantly longer for patients with weight loss (p<0.001). None of the baseline demographic and laboratory data were associated with weight loss. Patients with weight loss also did not have significant changes to their biochemistries and non-invasive liver fibrosis tests compared to patients with weight gain/no change. Compared to patients with weight gain after the initial follow-up, where only 11.8% were able to lose weight on the final visit, 73.1% of patients who lost weight after the initial follow-up were able to sustain their weight loss on the final visit. Conclusions: Weight loss is achieved in only a third of NAFLD patients. Although 73% of patients who lost weight initially were able to sustain it, patients who gained weight after the 1st follow-up were unlikely to lose weight on further follow-up. Key words: Non-alcoholic fatty liver disease, weight loss, sustainability
TL;DR: The purpose of this article is to improve management decisions in type 2 diabetes by reviewing its pathophysiology and identifying the optimum insulin regimen that could mimic such and the term Insulin Replacement Therapy (IRT) should be utilized.
Abstract: In 2021, 537 million adults were living with diabetes. Being a progressive disease, there would eventually be failure of oral hypoglycemic agents (OHA) to maintain good glycemic control and a majority will require insulin. However, optimal glycemic control has not been satisfactory in a significant proportion of patients who were on insulin therapy. Patient factors (eg, awareness, compliance, socioeconomic) have been identified but physician-related factors are as important. These include incorrect choice and inappropriate combination of insulin therapy which could be corrected by making the treatment physiologic. The purpose of this article is to improve management decisions in type 2 diabetes by reviewing its pathophysiology and identifying the optimum insulin regimen that could mimic such. Since eventual beta cell failure is central to its pathophysiology, it is but reasonable to replace insulin by mimicking its physiologic secretion. Hence, the term Insulin Replacement Therapy (IRT) should be utilized. This could be provided by the combination of premix insulin (ie, NPH + regular insulin) and rapid-acting insulin which has been reported to provide an initial 17.5% HbA1c reduction and even 18% reduction on 5-year follow-up providing sustainable control. A stepwise approach is an effective tool for insulin intensification. Hypoglycemia in insulin therapy could be prevented with an appropriate dietary regimen through automatic snacking. Keywords: Insulin replacement therapy, type 2 diabetes mellitus, pathophysiology
TL;DR: The universal coronavirus vaccine model has been used as a guide for managing future variants of SARS-CoV-2 and preempting the next COVID-19 surge as discussed by the authors .
Abstract: Globally, now in the third year of the pandemic, COVID-19 deaths have exceeded more than 6 million. As new subvariants emerge and spread, vaccines work to limit the worst of COVID-19 and continue to be important. Restraints are lifted, and COVID-19 may be seen as done for some, but COVID-19 is not yet done with others, no matter how badly everyone wants it to end. The SARS-CoV-2 pandemic has caused considerable morbidity and mortality worldwide. The protection provided by vaccines and booster doses offer a method of mitigating severe clinical outcomes and mortality. As debates over additional booster shots for COVID-19 intensify, many researchers are looking to the universal coronavirus vaccine model as a guide for managing future variants of SARS-CoV-2 and preempt the next COVID-19 surge.
TL;DR: In this paper , a 60-year-old male Filipino presented with bilateral loss of range of motion of the middle, ring, and little finger of both hands in both hands.
Abstract: Dupuytren’s disease (DD) is a heritable, benign, chronic fibroproliferative process which affects the connective tissue of the palmar fascia. DD is rare among Asians with a prevalence of 0.004 to 0.032 percent. There are only 74 cases of DD among Asians identified in literature, and there are no published cases from the Philippines. We discuss a rare case of DD in a 60-year-old male Filipino presenting with bilateral loss of range of motion of the middle, ring, and little finger of both hands.
TL;DR: In this paper , the use of antibiotics and proton pump inhibitors (PPI) may result in false-negative rapid urease test (RUT) results, and the authors aimed to determine the sensitivity and specificity of RUT compared with histology and assess the detection rate of combined RUT and histology for HP infection.
Abstract: Significance: Accurate detection of Helicobacter pylori (HP) is essential for the diagnosis of HP infection. The use of antibiotics and proton pump inhibitors (PPI) may result in false-negative rapid urease test (RUT) results. We aimed to determine the sensitivity and specificity of RUT compared with histology and assess the detection rate of combined RUT and histology for HP infection. Methodology: Retrospective data collection was performed on 192 patients who were tested for both RUT and histology at the time of upper endoscopy from 2017 to 2018. At least two gastric biopsies (1 from corpus, 1 from antrum) were taken each for RUT and histology. The endoscopy was performed by a single gastroenterologist and a single pathologist was responsible for interpreting the histology with hematoxylin and eosin (H&E) and Giemsa stain. The gold standard test for the diagnosis of HP infection was histology. Demographic profile, RUT and histology results were reviewed. Tests for diagnostic accuracy were computed using SPSSv23. Results: 192 patients were tested for RUT and histology. 52(27.1%) were males and 140(72.9%) were females with a mean age of 54±17 years. Epigastric pain was the most common indication (42.7%). 24(12.5%) patients tested positive for HP infection. Among these; 16(8.3%) tested positive for both RUT and histology(true-positive), while 8(4.2%) tested negative for RUT but had positive histology(false-negative). 6 out of 8(75%) patients with false negative results had PPI use. The sensitivity and specificity of RUT for the diagnosis of HP infection were 66.7 and 98.2%, respectively. While the positive and negative likelihood ratio were 37.3 and 0.34, respectively with a diagnostic odds ratio of 110. Conclusion: The HP detection rate of RUT combined with histology increased by 33% compared with RUT alone. RUT is a highly specific test for diagnosing HP infection. Given its modest sensitivity, histology plays an important role in the diagnosis of HP infection, especially in patients taking PPIs. We recommend doing histology when RUT is negative to increase the HP detection rate. Key words: retrospective, helicobacter pylori, rapid urease test, histology, RUT, giemsa stain
TL;DR: In this paper , the authors explore medical professionalism: its meaning, its core values and challenges in the time of Covid-19 pandemic, and help doctors and medical students improve their professionalism, and mature into more dedicated physicians who derive joy and pride in what they do.
Abstract: The Coronavirus-19 (Covid-19) pandemic disrupts our medical world. There are substantial demands on our overstretched, understaffed, and under-resourced health systems. Physicians continuously adjust to “crisis standard of care” and new skills for on-line or face to face restricted practice. Physician health and well-being suffer stress, burn-out and moral injury. Many get sick and some die. They ask: “How should I behave as a medical professional in a time of the Covid-19 Pandemic and Beyond?” This article explores medical professionalism: its meaning, its core values and challenges in the time of Covid-19. Its aim is to help doctors and medical students improve their professionalism, and mature into more dedicated physicians who derive joy and pride in what they do.
TL;DR: A 34-year-old Filipino male nurse was diagnosed with POEMS syndrome as discussed by the authors , which is a rare and disabling paraneoplastic syndrome that frequently occurs in the fifth or sixth decade of life without a known standard first-line therapy.
Abstract: POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) also known as Crow-Fukase syndrome or Takatsuki syndrome is a rare and disabling paraneoplastic syndrome that frequently occurs in the fifth or sixth decade of life without a known standard first-line therapy. A 34-year-old Filipino male nurse, who presented with gradually progressive distal lower extremity weakness and sharp shooting pain in bilateral legs accompanied by mild joint effusion on the left knee, hypertrichosis, bilateral conjunctival injection, and gynecomastia underwent extensive workup and was diagnosed with POEMS syndrome. Complete blood count revealed erythrocytosis and thrombocytosis with elevated serum VEGF (vascular endothelial growth factor) and elevated monoclonal serum free lambda light chains. The electrophysiologic studies revealed chronic demyelinating sensorimotor polyneuropathy while bone marrow core biopsy and bone marrow aspirate smear immunohistochemical staining showed it to be positive for lambda and CD138. He had an initial unsuccessful treatment course with melphalan and prednisone. Hence, bortezomib and dexamethasone were given which gave significant improvement in symptoms from the overall neuropathy limitation score of 5 to 1.
TL;DR: A systematic review and meta-analysis examined the effect of myo-inositol on pregnancy rate, menstrual cycle, and adverse effects from randomized controlled trials (RCTs) as discussed by the authors .
Abstract: Background: Polycystic ovarian syndrome (PCOS) is a common, reproductive endocrinopathy associated with ovarian dysfunction, cardiovascular disorders, obesity, and infertility. Myo-inositol is a novel treatment for women with PCOS that claimed to have improved fertility rate in this population. This systematic review and meta-analysis examined the effect of myo-inositol on pregnancy rate, menstrual cycle, and adverse effects from randomized controlled trials (RCTs). Methods: RCTs that evaluated the efficacy of myo-inositol in improving pregnancy rate and regulation of menstrual cycle in women with PCOS. Electronic databases were searched and studies published up to October 24, 2021 were included in the systematic review and meta-analysis. Study selection and assessment of quality were conducted independently by two review authors. Results: Seven studies with 729 patients treated with myo-inositol and 677 patients treated with placebo and/or metformin were included in the analysis. The research groups did not diverge significantly in terms of basic characteristics, such as age, adnexal or uterine pathology, body mass index, and duration of infertility. In the myo-inositol group, regulation of the normal menstrual cycle is at 20%, significantly higher than the metformin group at 12%, (p<0.001). However, there is no significant difference in the pregnancy rate between myoinositol and placebo (p=0.42) and/or metformin (p=0.17). Conclusion: This systematic review and meta-analysis showed that myo-inositol can be an alternative treatment for PCOS in terms of regulation of menses and may improve the success of spontaneous pregnancies. However, additional randomized, double-blind controlled trials with larger sample sizes, low heterogeneity, and uniform inclusion criteria are recommended to establish the effects of myo-inositol on PCOS treatment and pregnancy rate.
TL;DR: In this paper, a cross-sectional study done at the outpatient department of a tertiary infectious disease hospital located in Manila, Philippines conducted from May to July 2015 was conducted to determine the prevalence of neurocognitive impairment among HIV-positive individuals in the Philippines.
Abstract: Background: Disruption of neurocognitive functioning is one of the most frequent complications in patients infected with Human immunodeficiency virus. It manifests as a form of subcortical dementia characterized by psychomotor slowing, changes in mood and anxiety levels and deficits in memory, abstraction, information processing, verbal fluency, decision-making, and attention. The primary objective of this study is to determine the prevalence of neurocognitive impairment among HIV-positive individuals in the Philippines. Methods: This is a cross-sectional study done at the outpatient department of a tertiary infectious disease hospital located in Manila, Philippines conducted from May to July 2015. The Montreal Cognitive Assessment – Filipino (MoCA-P) was used to differentiate non-cognitively impaired and cognitively impaired participants. Demographic data was obtained using structured interviews including the CD4 count. Results: One hundred and twelve HIV positive patients were examined and 56.7% of them were noted to have cognitive impairment while none of them met the criteria for dementia. After logistics regression analysis, only the CD4 count (x=224) was shown to have significant association with cognitive impairment (p=0.0001, OR 0.96). Conclusion: Cognitive impairment was significantly associated with low CD4 count, with a sensitivity of 100% for a count of <224. More than half or 58.7% of subjects with cognitive impairment did not show any neuropsychiatric symptoms. Neurocognitive impairment is still an important component of HIV infection and this study highlights the need to further increase awareness regarding this HIV complication.
TL;DR: The question of medicine being a profession or a business arises as mentioned in this paper , and the question of whether medicine should be considered as a trade-off between a profession and a business is raised.
Abstract: Thus, the question of medicine being a profession or a business arises. The share of health expenditure in the GDP of the Philippines is 5.6%; health spending of Filipino household has been increasing recently, mostly spent for drugs and other medical goods. Could this be one of the reasons why more businessmen engage in building and operating a hospital? And some doctors turning to become health entrepreneurs too?
TL;DR: In the summer heat of 1966, racial tensions between African Americans and whites in Cleveland erupted into a riot that left four people dead, 30 critically injured, and 240 homes and businesses burned in the Hough community as mentioned in this paper .
Abstract: In the summer heat of 1966, racial tensions between African Americans and whites in Cleveland erupted into a riot that left four people dead, 30 critically injured, and 240 homes and businesses burned in the Hough community. In October, 1966, the Black Panthers, founded " to serve the needs of the oppressed people in our communities and defend them against their oppressors (www.blackpanther.org), " adopted their party platform and program. " What We Want & What We Believe " demanded housing, education, military exemption for black men, an immediate end to police brutality and murder of black people, jury trials of blacks by their peers, release of all black prisoners, and the establishment of a black colony in the United States under the auspices of the United Nations that would empower black people to determine their own national destiny societal oppression. Subsequently, its focus shifted to the creation of community programs to address poverty and improve health. The late Larry Slaughter was a Black Panther. I met him in the decade that followed the Hough riots in Cleveland at Myron T. Herrick Junior High School. He was a well-established presence in the building; I had recently arrived from an across town senior high school. He taught industrial arts; I taught English, but most importantly, we both taught children. Within weeks of my arrival in the school, Mr. Slaughter confronted me and tried to dissuade me from making home visits in the neighborhood. I was determined to contact the parents of truant/disruptive students; he was equally determined that I would not
TL;DR: This is the case of a 71-year-old Filipino female from Caloocan with a history of Hansen’s disease, treated (1980) who presented with generalized crusted plaques who revealed crusted (Norwegian) scabies.
Abstract: This is the case of a 71-year-old Filipino female from Caloocan with a history of Hansen’s disease, treated (1980) who presented with generalized crusted plaques. Clinical and histopathological examination revealed crusted (Norwegian) scabies. Crusted scabies is a rare condition and diagnosis is often delayed; this condition is treated with systemic broad spectrum antiparasitic agents. Despite the common prevalence of scabies, its atypical forms are often overlooked and neglected which oftentimes does affect the patients' well-being. Keywords: infection; skin diseases; leprosy; parasitic; crusted scabies; case report
TL;DR: In this paper , the impact of online learning during internal medicine rotation among graduating medical students was evaluated during the COVID 19 pandemic, and the study aimed to gauge acceptability of a self-directed learning, recognize frustrations, identify coping mechanisms, assess rate of learning, evaluate study habits and appraise level of readiness in handling actual patients later in practice among medical clerks.
Abstract: Background: The impact of online learning during internal medicine rotation among graduating medical students was evaluated during COVID 19 pandemic. Objectives: The study aimed to gauge acceptability of a self-directed learning, recognize frustrations, identify coping mechanisms, assess rate of learning, evaluate study habits and appraise level of readiness in handling actual patients later in practice among graduating medical clerks. Methodology: An ambispective cohort design study involving both retrospective and prospective follow-up of respondents. The retrospective component involved blended learners with clinical experience (Group 1). The prospective component included online learner with clinical experience (Group 2) and online learner without clinical experience. Results: Group 1 showed that they favor pure traditional learning over pure online learning in contrast to the other 2 groups which rated acceptability of online learning high. All groups had high levels of frustration with their inability to experience actual patient exposure, had moderate to high level of coping mechanisms, and rated high the traditional learning and blended learning methodologies. In contrary, all groups rated low to moderate contributions of online learning to their learning. Group 3 had a significantly higher mean overall readiness score compared to the two other groups. Conclusion: The study showed the different levels of impact of online learning to the different population of medical clerks in terms of its acceptability as an alternative way of learning. Actual patient exposure is of main concern while different coping mechanisms maximize knowledge acquisition. Key words: Online learning, self directed, COVID 19 pandemic, Medical clerks
TL;DR: In this paper , an individualized institutional approach to curricular integration guided by the American Geriatrics Society's minimum required competencies for the undergraduate will circumvent the challenges of compact pre-existing curriculum, attitudes of teachers and students, and shortage of teaching geriatricians.
Abstract: Geriatrics is a branch of medicine concerned with diagnosing, treating, and preventing diseases in older people and problems specific to aging. The World Health Organization (WHO) has reported that the number of people aged 65 or older is projected to grow from an estimated 524 million in 2010 to nearly 1.5 billion in 2050. The burden of diseases in the aging population will dramatically impact healthcare expenses in low- and middle-income countries and even developed ones. A preventive approach is essential. The role of medical institutions and inclusion of geriatrics in the medical curriculum have become important. However, incorporating geriatrics into the medical curriculum is associated with various issues and challenges: compact pre-existing curriculum, attitudes of teachers and students, and shortage of teaching geriatricians. An individualized institutional approach to curricular integration guided by the American Geriatrics Society’s minimum required competencies for the undergraduate will circumvent these challenges.
TL;DR: In this paper , a decentralized clinical trial (DCT) with 46 participants was started and completed at the height of the Covid-19 pandemic with the use of DCT methodologies.
Abstract: A clinical study with 46 participants was started and completed at the height of the Covid-19 pandemic with the use of decentralized clinical trial (DCT) methodologies. All participants and the study team remained safe and were able to conduct the study efficiently. Patients were able to provide consent electronically, received experimental supplements and were given the option to provide feedback through the system’s telemedicine feature.
TL;DR: The Department of Medicine of the University of Santo Tomas Faculty of Medicine and Surgery was first formally organized by Dr. William J. Burke, who served as the head of the department until 1939 as mentioned in this paper .
Abstract: The Department of Medicine of the University of Santo Tomas Faculty of Medicine and Surgery was first formally organized by Dr. William J. Burke, who served as the head of the department until 1939.
TL;DR: The Journal of Medicine of the University of Santo Tomas (JMUST) as discussed by the authors has published a special issue dedicated to the 95th anniversary of its publication, which contains a total of seventeen original articles which include five clinical research articles, six medical education research articles and three perspective articles and two reviews.
Abstract: We are happy and elated to report to you that in commemoration of our 95th anniversary, we will be proudly showcasing the works from our distinguished faculty and staff through a special issue of the Journal of Medicine of the University of Santo Tomas (JMUST). This issue contains a total of seventeen original articles which include five clinical research articles, six medical education research articles, three perspective articles and two reviews. We are deeply thankful to the editorial team and the members of our peer review committee, and to all authors who contributed to this issue. This is our tribute to you and to all the luminaries and leaders who followed you and led us to where we are today and who will lead us into the next ninety five years.
TL;DR: In this paper , the authors look at the gain first and show that higher university rankings are likely to translate into opportunities for larger international research collaborations and funding, and that higher resources become available for research, higher is the chance to participate in ground-breaking studies.
Abstract: No pain in academic and research endeavours, no gain in university rankings. Let us look at the gain first. Any university worth its salt has a high caliber faculty who are experts in their fields of study and are effective teachers or mentors to their students. Their effectiveness in teaching are mostly informed by their continuing research activities and strong academic performance of students. As more faculty publish their studies, the higher the probability of citations. Reputation and university rankings elevate with academic and research excellence of its faculty and students. Improved university rankings are likely to translate into opportunities for larger international research collaborations and funding. As more resources become available for research, higher is the chance to participate in ground-breaking studies.
TL;DR: In this paper , the authors investigated the nature and dynamics of creative insubordination in higher education and provided eidetic images of the multidimensional facets of individual attributes necessary for the praxis of discretionary decision-making by a select group of Philippine medical deans.
Abstract: Background – Exercising discretion is vital when making decisions. While decision‐making implies having to choose between predefined alternatives, discretion requires sifting through several solutions and critically choosing the desired one that implies a choice between many alternatives without rigid guidelines pointing to one direction or the other. While previous studies have constantly investigated the nature and dynamics of creative insubordination or discretionary insubordination in primary and secondary education little is known as to how such a construct operates in higher education. Purpose – This study was undertaken to address the central question: “What attributes define creative insubordination as a decision‐making strategy among Philippine medical school deans?” Design – Anchored on descriptive phenomenology, 21 medical deans who have been in the position for at least 4.5 years (range 4.5‐26 years) were purposively selected for in‐depth semi‐structured interviews. Guided by the rules of cool and warm analyses, transcribed texts were phenomenologically reduced and interpreted, and validated via member checking procedure. Findings – Five interesting elements that typify the modes of behavior in the practice of creative insubordination surfaced, namely: cognitional elasticity, emotional sensitivity, conational sincerity, relational mobility and axiological reflectivity. Conclusion – This study provides eidetic images of the multidimensional facets of individual attributes necessary for the praxis of discretionary decision‐making by a select group of Philippine medical deans in varied instances. Keywords: creative insubordination; discretionary decision-making; prosocial rule-breaking; medical deans; higher education
TL;DR: In this article , the agreement of blinded musculoskeletal sonologists in identifying the double contour sign (DCS) among asymptomatic hyperuricemic patients was determined.
Abstract: Objective. Double contour sign (DCS) is considered part of the new gout classification. This study aims to determine the agreement of blinded musculoskeletal sonologists in identifying the double contour sign among asymptomatic hyperuricemic patients. Methods. Participants with asymptomatic hyperuricemia (n=65) underwent a gray-scale ultrasound assessment of both of their 1st metatarsophalangeal joints (MTPJs) done on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 independent blinded sonologists for presence of double contour sign. Results. Among the 130 1st MTPJs, the sonologists were able to positively identify DCS on 48R and 52L, negative in 10R and 10L, with discordant readings in 7R, 3L. The overall kappa agreement was statistically significant at 0.674 (substantial agreement) and 0.842 (almost perfect agreement) on the right and left respectively, (both p<0.001). Conclusion and Recommendation. There is a high proportion of positive double contour sign seen among persistently asymptomatic hyperuricemic patients. It might be prudent to perform musculoskeletal ultrasound early on to detect monosodium urate crystal deposits in similar patients. A close follow up to monitor clinical gouty arthritis may be necessary or consider utility of urate lowering drugs in crystal dissolution in prospective studies.
TL;DR: In this article , the authors conducted a qualitative research-case study among junior physicians in the field of Internal Medicine with or without subspecialty who graduated from training in 2013 to 2018, what were the issues and challenges that they faced as they established their clinical practice in the urban or mixed setting?
Abstract: Background: The field of medicine is constantly changing. Notable changes occur in the patterns of clinical practice, business of medicine, shift in demographics/generation of the health care workforce, emergence of sub-specialization; and advances in research and technology. These changes can affect the way young physicians establish their practice and this is an area not addressed by the medical education and training. Purpose: There is little data in the literature regarding the experience of young physicians in establishing clinical practice. This study was undertaken to answer the central question: Among physicians in the field of Internal Medicine with or without subspecialty who graduated from training in 2013 to 2018, what were the issues and challenges that they faced as they established their clinical practice in the urban or mixed setting? Methodology: Qualitative research-case study; Key informant interview was conducted among junior Internal Medicine consultants who satisfied the inclusion criteria. Data analysis used thematic analysis consisting of reading, writing notes, describing, and classifying transcripts according to categories and themes. Results: After a comprehensive analysis of narratives, five emergent themes surfaced: “Tough Days” (Period of figuring out the system; Need for Self-introduction; Few patients and Feelings of frustration and depression); “Torn and Divided” (Unpredictable work schedule and workload; Lack of time for issues outside career); “Temporary Debt” (Large start-up cost; Expensive maintenance); “Difficult but Tolerable” (Family support; Call-a-colleague; Debt of gratitude to mentors) and lastly “Dreams and To-do’s”. Conclusions: Our respondents have experienced substantial challenges in starting clinical practice. Learning the ways of the healthcare business, effectively promoting oneself to the community, dealing with the emotional turmoil of having few patients, coming up with a strategic schedule and area of practice, and looking for funds and paying it back, were the challenges and experiences of these young medical specialists as they establish their careers in the urban and/or rural setting. Key words: clinical practice, challenges, start-up, establishing practice
TL;DR: In this paper , the authors evaluated the effectiveness of combining flipped classroom on pulmonary ultrasound instruction in first-year medical students with traditional classroom-based instruction and compared it to traditional classroombased instruction alone.
Abstract: Background and Objectives of the Study The study aimed to determine the effectiveness of combining flipped classroom on pulmonary ultrasound instruction in first-year medical students with traditional classroom-based instruction and compared it to traditional classroom-based instruction alone. The insights of the teachers and the students on the implementation of both interventions were also evaluated. Research Methodology This is a mixed qualitative (concurrent triangulated) and quantitative research. Baseline procedural knowledge and skills of a total of 282 students on the lung ultrasound scanning using pre-test 20-item summative test, multiple-choice question type of examination, and a pre-test narrative test on lung ultrasound were obtained. A post-intervention summative assessment and narrative test were administered. Statistical analyses were done to compare the scores. A thematic analysis was done to evaluate the responses to the survey. Results 138 students were randomly assigned to the classroom-based instruction group, while 144 students in the combined flipped and classroom-based instruction group. The number of students who passed the summative (MCQ) test and were given flipped classroom and classroom-based instruction increased (6.3% to 79.9%; p<0.001) and the number of students given classroom-based instruction only, significantly increased (4.3% to 79.9%; p<0.001). The number of students who passed the narrative test and were given flipped classroom and classroom-based instructions increased (2.1% to 84.0%; p<0.001) and the number of students given the classroom-based instruction only, also significantly increased (3.6% to 84.2%; p<0.001). The students appreciated the classroom-based instruction because of the knowledgeable facilitators, the very concise approach, that is understandable and done in real-time. In addition, the flipped classroom was likewise helpful and a good introduction before the classroom-based instruction. The facilitators have noticed that the ease in instruction was influenced by the student’s enthusiasm and willingness to learn. Conclusion Flipped classroom in addition to classroom-based instruction, and classroom based instruction were effective in teaching pulmonary ultrasound to First-year medical students Key words: flipped classroom, lung ultrasound, pulmonary ultrasound, medical school, medical students, medical education, blended classroom, classroom-based instruction, ultrasound, ultrasound medical education, video-based instruction
TL;DR: In this paper , the authors investigated the relationship between aeroallergen sensitization and asthma severity, pulmonary function, and bronchodilator response among pediatric patients with bronchial asthma.
Abstract: Background: Allergen sensitization, symptom severity, pulmonary function test, and bronchodilator response are important in the diagnosis and treatment of asthma. However, the relationship between these factors remains unclear. Objective: The objective of this study was to investigate the relationship between aeroallergen sensitization and asthma severity, pulmonary function, and bronchodilator response among pediatric patients with bronchial asthma. Methods: This was a prospective study where 155 pediatric patients aged 7–18 years old with bronchial asthma were recruited from Outpatient Clinics. Patients who met the inclusion criteria proceeded with spirometry and aeroallergen skin prick test. Results: There was a significant degree of sensitization, wherein 100% of the patients had sensitization to one or more aeroallergens. Among these children, 106 (68%) were polysensitized. The polysensitized group had more severe and persistent asthma severity profile (p<0.001) and worse pulmonary function (p<0.001). The frequency of abnormal pre-bronchodilator lung function of the polysensitized group was higher than the monosensitized group (p<0.001). A positive bronchodilator response was higher among polysensitized children as compared to monosensitized children (p<0.001). Sensitization to Dermatophagoides farinae, Dermatophagoides pteronyssinus and dog correlated with impairment of both the large airways and distal small airways while sensitization to cat, cockroach, and horse correlated only with impairment of the large airways (p<0.05). Patients sensitized to D. farinae, D. pteronyssinus, cat and dog had significant bronchodilator response (p<0.05). Conclusion: Polysensitized asthmatic children had a more persistent and severe asthma profile, worse pulmonary function, and higher bronchodilator reversibility compared to the monosensitized group.
TL;DR: The history of physical diagnosis started with Hippocrates and his school as mentioned in this paper , where history taking, inspection, palpation, and sometimes immediate auscultation and examination of the urine are fundamental diagnostic tools.
Abstract: The history of physical diagnosis started with Hippocrates and his school. History taking, inspection, palpation, and sometimes immediate auscultation and examination of the urine are fundamental diagnostic tools. The Hippocratic Corpus and Galen’s authoritative theoretical writings dominate medical thinking for over 1000 years. Clinical examination advances through Vesalius and Morgagni’s discoveries of human dissection (1543) and pathologic anatomy (1761) respectively. The Vienna school through Auenbrugger introduces percussion in 1760. The Paris school formally establishes physical diagnosis with the invention of the stethoscope by Laennec in 1816.