University Of The Philippines-Philippine General Hospital Research Articles

Clinical Profile and Outcomes of Pregnant Patients with Congenital Heart Disease at the University of the Philippines Philippine General Hospital

BACKGROUND: Recent advances in the management of congenital heart diseases (CHD) have emerged. However, most CHD patients in a developing nation like the Philippines cannot afford proper treatment. If a CHD patient then desires children, greater problems may arise during pregnancy. Hence, it may be meaningful to describe the clinical profile and management of commonly - seen CHD patients during pregnancy. METHODS: This is a cross-sectional retrospective study of all admitted pregnant patients with CHD diagnosed by 2D-echocardiography at the University of the Philippines-Philippine General Hospital, from July 2009 to October 2011. Data on demographics, type of congenital lesion, common medications, maternal complications and pregnancy outcomes were collected and described. RESULTS: Forty-four patients of CHD in pregnancy were included in this study. The median age of the patients was 24 years old, and the median age of gestation at the time of consult was 37 weeks. The most common reason for consult was labor (64%), with one-fourth of them in preterm labor. Majority of patients (95%) knew about their CHD prior to pregnancy, and half of them noted worsening of failure symptoms during pregnancy. The most common congenital lesions encountered were atrial septal secundum defects (37%) and patent ductus arteriosus (20%). Digoxin was the most frequently prescribed drug (27%). Infective endocarditis prophylaxis was given 55% of the time. Assisted vaginal delivery (41%) was the most common manner of delivery, with continuous epidural anesthesia (82%) as the most common route for anesthesia delivery. Maternal complications occurred in 9% and preterm birth in 25%. A third of all neonates (13) delivered were small for gestational age, and 66% of these babies had moderate to severe pulmonary artery hypertension. CONCLUSION: Pregnancies with CHD carry significant rates of preterm births and SGA babies. Adverse events and maternal complications were observed mostly in patients with moderate to severe pulmonary hypertension. Female CHD patients should be educated about the risks of pregnancy and the benefits of prevention of pregnancy, especially in patients with moderate and severe pulmonary hypertension. KEY WORDS: Cardiovascular disease in pregnancy; High-Risk pregnancies; Congenital Heart Disease

A Randomized Controlled Clinical Trial Comparing the Outcomes of Circumferential Subcuticular Wound Approximation (CSWA) with Conventional Wound Closure After Stoma Reversal: An Interim Report

The creation of a stoma is commonplace in colorectal surgery. Circumferential subcuticular wound approximation (CSWA) is a method of wound closure following stoma reversal proposed by Milanchi, et al. It has been reported to result in decreased wound infection rates and more desirable aesthetic outcomes. The authors aimed to determine the effectiveness of the CSWA method, in terms decreasing wound infection, and cosmesis by comparing the technique with the conventional method of wound closure. Methods: All adult patients who presented for stoma reversal at the outpatient clinic of the Division of Colorectal Surgery at the University of the Philippines-Philippine General Hospital (UP-PGH) were randomized into two groups, CSWA and conventional, and their stomas cloud accordingly. Patients were followed up for one month, with photographic documentation of wound appearance and estimation of wound infections and complications. Patients were asked to complete a satisfaction survey at the end of the follow-up period. Results: Sixty-two patients have been recruited since the start of the study, representing more than one-third of the computed sample size. Fifty-six patients were able to complete the one-month follow-up. No wound infection was documented for the CSWA arm, while 3 (11.11%) patients had a wound infection in the conventional arm (P=0.1055). Patients in the CSWA group had a higher overall satisfaction score (25.3 vs 23.6), but this did not carry statistical significance (P = 0.0749). Conclusion: Performing the CSWA method resulted in a lower wound infection rate as compared to the conventional method of wound closure after stoma reversal. Patients who underwent CSWA were found to be more satisfied with the appearance of their wound. These initial results show that the CSWA method remains a viable option in wound closure after stoma reversal. Conclusions: The level of awareness about the PCS Thyroid Guidelines needs to be improved. The dissemination process needs to be reviewed and ensure that all stakeholders will be reached. Key words: wound infection, ileostomy closure, colostomy closure, circumferential subcuticular wound approximation

P-0236 Indications and Outcomes after Laparoscopic Stoma Creation: The Philippine General Hospital Experience

ABSTRACT Introduction Fecal diversion through an open surgical approach is associated with considerable trauma, stress, and post-operative pain. Laparoscopic stoma creation, on the other hand, has been widely documented to decrease post-operative pain, to reduce adynamic ileus, to hasten post-operative feeding, to improve recovery and to induce earlier commencement of neoadjuvant treatment for patients with locally-advanced rectal cancer. This study aims to describe and evaluate cases of laparoscopic stoma creation in terms of indication, post-operative outcome, length of hospital stay, morbidity and mortality. Methods This is a descriptive, retrospective study. All adult patients admitted by the Division of Colorectal Surgery at the University of the Philippines-Philippine General Hospital (UP-PGH) from January 01, 2007 to December 31, 2011 who underwent laparoscopic stoma creation were included in the study. Results Fifty-one patients underwent laparoscopic stoma creation from 2007 to 2011. Mean operation time was 80 minutes (SD: -20 to 25 minutes). The most common indication was for locally-advanced, obstructing colorectal cancer (88.23%, 45/51). Transverse loop colostomy was the most common type of surgery (65.66%, 34/51). There was only one conversion. Two patients were re-operated on for stoma prolapse, translating to a morbidity rate of 3.92%. No procedure-related mortality was documented. Patients were discharged after two to fifteen days post-operatively (mean 5.54 days). Conclusion Laparoscopic stoma creation is a safe and short surgical procedure with low morbidity and mortality rates.

I96) Prevalence of Burnout among Emergency Department Staff of the University of The Philippines Philippine General Hospital

Introduction:The emergency department is the frontline of care in any hospital. Quality of work is affected by the skills and knowledge of the medical staff and the stress in their daily grind. The emergency department cannot perform its primary function if its personnel continue to feel the burden of their jobs.Methods:This is a descriptive study of the emergency department staff at the University of the Philippines-Philippine General Hospital. A self-administered questionnaire with socio-demographic and occupational variables using the 22-item Maslach Burnout Inventory (MBI) Scale assessing emotional exhaustion, depersonalization, and professional accomplishment was used.Results were analyzed according to the major subscales of the MBI Scale. The percentage having severe, moderate, and low burnout levels were determined and analyzed based on demographic data (e.g., gender, age, marital status, years of experience, and qualification).Results:Eighty-seven qualified emergency personnel were surveyed. Of them, 41 were nurses, 13 were emergency medicine residents, 11 worked for Medical Social Service (MSS), 11 were emergency medical services (EMS) personnel/paramedics, and 11 were emergency department records personnel. Only 64 respondents were able to return the questionnaires (73.5%). Most of the male respondents had low burnout in emotional exhaustion and loss of empathy. They also scored low burnout at the professional level, which indicates that males were more satisfied with their professional achievements. The majority of the respondents 21—40 years of age had low and moderate burnout in the three subscales. Those in the 41–60 year and >61 year age groups experienced low burnout on all subscales. The unmarried showed moderate burnout in emotional exhaustion, but the majority of married respondents had low burnout in loss of empathy and professional fulfillment. Working in the emergency department for six months or six months-one year showed that the majority experienced moderate burnout, but revealed low burnout in professional fulfillment.Conclusions:The emergency medicine residents reported to have severe burnout in emotional exhaustion, but scored moderate burnout in loss of empathy and professional fulfillment. The EMS personnel had the lowest burnout level of all three subscales

Resiliency in Sexually Abused Children and Adolescents seen at the Child Protection Unit of a Tertiary Government Hospital

Resiliency is “the capacity to withstand, recover, and even growfrom negative experiences.” (Banaag, 1997) This study examines thedemographic characteristics and most common resiliency factorsseen in sexually abused pre-adolescents and adolescents screenedfor mental illness at the University of the Philippines-PhilippineGeneral Hospital (UP-PGH) Child Protection Unit. The subjects of thestudy were all sexually abused children and adolescents screened atthe Child Protection Unit from January to April 2009 who were notfound to have any behavioral problems or mental disorders. Of the28 subjects, 19 were adolescent and 9 were pre-adolescent. Sixteensubjects were legitimate children and seventeen were not enrolledin school during the interview. Seven of the subjects only completedgrade 3 while seven completed grade 6; and fourteen students werein high school. Among the children who had parents who werenot married, they had more than four household members. All thesubjects had low socioeconomic backgrounds and were mostly beingcared for by their mothers. Using the resiliency scale translated byCadao, Rubia and Banson ( Cadao, et al. 2008), 36 items were foundto contribute to their resiliency. The items that were also the mostcommon resiliency factors in the order of importance were: verbalability as part of interpersonal skills; spirituality; adult support; thechild’s use of her talents; and opportunities for major life changes. Thisstudy differs in some aspects compared with other studies done in thePhilippines and will be helpful in mapping out resiliency modules forsexually abused adolescents.

Laboratory diagnosis and susceptibility profile of Helicobacter pylori infection in the Philippines

BackgroundHelicobacter pylori diagnosis and susceptibility profile directs the applicability of recommended treatment regimens in our setting. To our knowledge, there is no published data on the culture and local susceptibility pattern of Helicobacter pylori in the Philippines.Methods52 dyspeptic adult patients undergoing endoscopy from the Outpatient Gastroenterology clinic of the University of the Philippines-Philippine General Hospital underwent multiple gastric biopsy and specimens were submitted for gram stain, culture, antimicrobial sensitivity testing, rapid urease test and histology. Antimicrobial susceptibility testing was done by Epsilometer testing (Etest) method against metronidazole, clarithromycin, amoxicillin, and tetracycline.ResultsSixty percent (60%) of the study population was positive for H. pylori infection (mean age of 44 years ± 13), 70% were males. H. pylori culture showed a sensitivity of 45% (95% CI [29.5–62.1]), specificity of 98% (95%CI [81.5–100%]), positive likelihood ratio of 19.93 (95% CI [1.254–317.04]) and a negative likelihood ratio of 0.56 (95% CI [0.406–0.772]). All H. pylori strains isolated were sensitive to metronidazole, clarithromycin, amoxicillin and tetracycline.ConclusionKnowledge of the antibiotic susceptibility patterns in our setting allows us to be more cautious in the choice of first-line agents. Information on antibiotic susceptibility profile plays an important role in empiric antibiotic treatment and management of refractive cases.

PB4 Economic burden analysis of osteoarthritis in the university of the philippines-philippine general hospital

PB4 Economic burden analysis of osteoarthritis in the university of the philippines-philippine general hospital