A systematic review of epidemiologic studies on scabies in the Philippines

Background and Objective@#Scabies is the second most common cause of disability due to skin disease in the Philippines. However, there were no cited studies in Global Burden of Disease 2019 and the disability-adjusted life years (DALY) computations were most likely based on statistical modelling. The Philippine Department of Health has embarked on a program to estimate the disease burden of priority diseases in the country, which include scabies. The last nationwide prevalence survey was 23 years ago. This systematic review aimed to estimate the prevalence or incidence of scabies in the Philippines. @*Methods@#We searched PubMed, Scopus, Herdin, and Philippine Health Research Registry (search date October 2022) for studies on prevalence/incidence (including systematic reviews, cross-sectional studies, cohort studies, case series, registry or census studies) of patients diagnosed with scabies in the Philippines. We excluded narrative reviews, commentaries, and conference proceedings or abstracts. Two reviewers independently screened titles and abstracts, assessed full text reports for eligibility, appraised the quality of included studies, and collected data using a pretested data extraction form. We did not pool studies due to clinical heterogeneity but plotted the individual studies in a forest plot with prevalence estimates and confidence intervals. We reported the median and interquartile range for entire group or relevant subgroups (age, setting) of studies. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence.@*Results@#We included nine studies (N=79,065). Most were clinic-based prevalence studies, retrospective chart reviews, conducted in dermatology outpatient clinics, Metro Manila area, and on pediatric populations. Prevalence of scabies was moderate (i.e., between 2 and 10%), ranging from 2.75% (national prevalence survey) to 6.8% (communitybased review), to high (> 10%) among pediatric patients in clinic-based retrospective chart reviews (29 to 36%) and institution-based surveys (39.0% to 45%), and a tertiary government university training hospital dermatology clinic (22.9%). The most affected age group was from 0 to 14 y/o, while males tended to have a higher prevalence than females. The cooler month of January had higher prevalence than the hotter month of June in one study. @*Conclusion@#Scabies is common in the Philippines, especially among children and elderly in institutional settings, and during the month of January. There is a need to do a national prevalence survey to identify high-risk areas and to monitor the prevalence of scabies, especially in crowded settings and vulnerable populations. This information can be used for estimating the burden of disease for scabies and guide appropriate health resource allocation.

Economic evaluation of oral ivermectin, alone or in combination with permethrin, versus permethrin, in the treatment of classic scabies in the Philippine Setting

Background and Objective@#Oral ivermectin is recommended as an alternative to topical permethrin in Japanese, European, and CDC-STI guidelines for treating classic scabies. The combination of oral ivermectin and topical permethrin is also used in some settings. Partial economic evaluations conducted in India and Egypt have conflicting results, and no cost-effectiveness analysis in the Philippines has compared ivermectin-based regimens to permethrin for scabies treatment. We aimed to determine the cost-effectiveness of oral ivermectin, alone or in combination with permethrin, compared to permethrin, in the treatment of Filipino adult patients with classic scabies.@*Methods@#We used a decision tree model to estimate the cost-effectiveness of two regimens, oral ivermectin alone or in combination with permethrin, compared with permethrin to treat adults and children aged five years and older with classic scabies in the outpatient setting from the household perspective in the Philippines. We estimated total costs and disability-adjusted life years (DALYs) over a one-month follow-up. Input parameters were obtained from secondary data, such as effect estimates for probabilities of clinical outcomes from a network meta-analysis, DALYs from the Global Burden of Disease 2019, and prevailing market cost in the Philippines (DPRI 2022 with recommended markup by DOH, and leading drugstores) as of August 2022. We computed for incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) to determine which of the interventions are cost-effective. Univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to assess the impact of parameter and structural uncertainty.@*Results@#Ivermectin-based regimens are suggested to be likely cost-saving compared to permethrin in the Philippine outpatient setting. Base case analysis showed that oral ivermectin had higher cost-savings (change in cost, -1,039.31; change in DALYS, 0.00027), while combination oral ivermectin/permethrin had higher DALYs averted (change in cost, PhP -1,019.78; change in DALYs, 0.00045), compared to permethrin. Combination oral ivermectin/permethrin (56%) was the most cost-effective, followed by oral ivermectin (44%) compared to permethrin (0%) through probabilistic sensitivity analysis. Estimates for ivermectin were sensitive to risk of cure for ivermectin vs permethrin using 1-way deterministic sensitivity analysis. Oral ivermectin was favored over combination oral ivermectin/permethrin at all thresholds based on the cost-effectiveness acceptability curve.@*Conclusion@#Both ivermectin-based regimens seem to be cost-saving compared to permethrin in the treatment of classic scabies in the Philippine outpatient setting. Clinicians may consider oral ivermectin, alone or in combination with permethrin as an alternative first-line or second-line treatment depending on patient preference, adverse event risk profile, availability, and economic capacity. This needs to be confirmed using primary data from Filipino patients to enhance the robustness of the findings and support evidence-based local decision-making in different settings. Less uncertainty in modelled parameters can give greater confidence in the results, which can be adopted for budget impact analysis and allow more rational resource allocation. Value of information analysis can be done to determine whether the expense of future RCTs or surveys in Filipinos to collect primary data is worth it. The cost of reducing uncertainty, if deemed worth the cost of further studies, may facilitate population-level decision-making and budget planning. Findings may further inform practice guideline development, coverage decisions, and national control program planning by providing the most cost-effective scabies intervention.

Knowledge, attitudes, and practices on teledermatology among dermatologists in the Philippines

Background@#Teledermatology has been widely used during the coronavirus disease 2019 (COVID-19) pandemic to overcome barriers in access to care. The objective of this study was to assess the current knowledge, attitudes, and practices regarding teledermatology among dermatologists in the Philippines.@*Materials and Methods@#This was a cross-sectional and analytical study conducted from January 2022 to April 2022, among Filipino dermatologists using a self-administered online questionnaire. Descriptive statistics was used to summarize the demographics of the participants. The two-sample t-test, Chi-square test, and multiple logistic regression model were used to analyze the data.@*Results@#Out of 113 respondents, 108 (95.5%) had adequate knowledge and a positive attitude toward teledermatology. The majority (110/113, 97.35%) practiced teledermatology. The most commonly used platform was instant messaging applications(78/100, 70.91%), and the most common factor that influenced their practice was patient demands or needs(74/110, 67.27%). Those who did not practice teledermatology cited technological difficulties as the main reason.@*Conclusion@#Teledermatology was widely used by Filipino dermatologists to provide remote care during the COVID-19 pandemic. However, to fully utilize its potential and limit potential issues associated with its use even after the pandemic, continuous training and education among dermatologists and a more enabling technological environment may be needed.

The Department of Anatomy in the University of the Philippines College of Medicine: Dissecting the history

@#The history of the Department of Anatomy of the College of Medicine of the University of the Philippines can be chronicled from its humble beginnings in 1907 to its continued existence through the COVID-19 pandemic. This article briefly describes its historical development, current undertakings, and future directions in relation to its mission and vision.

Perceptions on the use of dissection videos in learning gastrointestinal anatomy among medical students

Background and Objective@#Lockdowns due to COVID-19 pandemic led to a shift to online learning in the University of the Philippines-College of Medicine. The study of gross anatomy is difficult in itself but was compounded by the lack of cadaveric dissection. To bridge this learning gap, medical students had a limited face-to-face activity with cadaveric prosection. As a supplement, dissection videos on gastrointestinal anatomy were viewed prior to the activity. This study aimed to determine the perceptions and experiences of students on the use of dissection videos.@*Methods@#We described the perceptions of students on the dissection videos based on their evaluation form responses after rotating in the OS 206 course module on gastrointestinal anatomy. A 5-item evaluation form was rated using a 4-point Likert scale. Categorical variables were described by frequency and percentages using Microsoft Excel.@*Results@#A large majority (97% to 99%) strongly agreed that the videos were easy to access and had good audio-video quality. Around 68%-70% strongly agreed that the videos enhanced their understanding and made their learning experience pleasant and enjoyable. Around 70% would recommend the videos to fellow students. Only a few (<3%) had negative perceptions on the videos.@*Conclusion@#Dissection videos on gastrointestinal anatomy prior to cadaveric prosection laboratory sessions were perceived by medical students as accessible, good quality, and helpful aids in the study of gross anatomy.

The rotator cuff footprint in Filipinos: A cadaveric study

Introduction@#Rotator cuff tears are one of the common etiologies of shoulder pain. Rotator cuff repair is recommended for a patient who failed conservative treatment. Proper knowledge of the rotator cuff footprint is needed in restoring correct anatomy during the repair. The size of the footprint is important in determining the kind of repair.@*Objective@#This study aimed to define the average measurements of the rotator cuff footprint on the humerus in Filipino cadavers.@*Methods@#This is a descriptive, cross-sectional study of preserved human cadaver upper extremity specimens. We measured the length, width, and shape of the supraspinatus, infraspinatus, subscapularis, and teres minor.@*Results@#We obtained 27 upper extremity specimens. The median age of the source cadavers was 50.5 years with the equal male-to-female distribution. The mean measurement of the supraspinatus is 22.92 mm in length and 10.17 mm in width. The shape of the supraspinatus was found to be trapezoidal. The infraspinatus length was found to be 17.20 mm and the width at 10.72 mm. Its shape was found to be trapezoidal. The teres minor length was measured at 15.15 mm and the width at 11.04 mm. The shape was mostly trapezoidal but some were triangular. Finally, the subscapularis length was 17.68 mm while the width was 11.26 mm. The shape was trapezoidal or comma-shaped.@*Conclusion@#The average measurement of the rotator cuff footprint was found to be smaller in our study than reported in terms of length and width. The footprint shape was similar to the studies reported.

Student evaluation of a Learning Enhancement in Anatomy Program (LEAP) during the COVID-19 pandemic: A retrospective study

Background and Objective@#The pandemic acted as an accelerator for the development of online teaching formats in anatomy and histology worldwide. The authors introduce a bridging program that reinforces the knowledge and understanding of gross and correlative anatomy and histology acquired in a virtual environment in preparation for its future clinical application. The study aims to evaluate the Learning Enhancement in Anatomy Program (LEAP) conducted among first-year medical students at the College of Medicine, University of the Philippines Manila. @*Methods@#This descriptive cross-sectional study aims to determine the initial experience of implementing a learning enhancement program and assess areas for its improvement. An internally validated questionnaire was given to students after the program to gauge students’ reactions (Kirkpatrick Level 1 evaluation). Pre- and post-tests were administered to evaluate knowledge acquisition (Kirkpatrick Level 2 evaluation). Short-term behavioral peer evaluation (Kirkpatrick Level 3 evaluation) was also instituted. @*Results@#One hundred fifty-two (152) students participated in the study. General reactions from students to the LEAP were consistently positive, with a steady majority of the students rating ‘5’ or a ‘Strongly Agree’ to positive statements regarding the program. Higher ratings for more traditional teaching methods, such as cadavers, formalinized specimens, and bones, compared to virtual systems were apparent. However, inter-student variation in preference for teaching modalities was observed. All stations of the LEAP were evaluated satisfactorily, with most gross anatomy stations rated higher than histology stations. A significant increase was noted in the total post-test scores compared to pre-test scores. This improvement in test scores was observed in the anatomy and histology subcategories and in six of the seven organ system modules. Perceived behavioral outcomes were also generally positive. @*Conclusion@#The LEAP is a worthwhile endeavor, garnering overwhelmingly positive reactions and a significant improvement in test scores. Future studies are necessary to fine-tune teaching and training in a blended learning environment.

Comparative efficacy and safety of oral ivermectin, topical permethrin, and its combination in the treatment of scabies: A systematic literature review

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Oral ivermectin is an approved first-line option to topical permethrin in Europe and Japan for the treatment of classic scabies, while combination oral ivermectin and topical permethrin is used in clinical practice for extensive or recurrent cases. There is unclear evidence on comparative efficacy and safety.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> To review the evidence on efficacy and safety of oral ivermectin versus topical permethrin or its combination in the treatment of classic scabies.</p><p style="text-align: justify;"><strong>METHODS:</strong> We searched PubMed from January 1, 2016 up to August 7, 2021 for systematic reviews that included RCTs comparing oral ivermectin versus topical permethrin or its combination in the clinical treatment of scabies. We described the characteristics of included studies, assessed reporting quality, and summarized results and conclusion.</p><p style="text-align: justify;"><strong>RESULTS:</strong> We included five systematic reviews. Permethrin did not differ from oral ivermectin in cure rate at the 3 to 6-week time point but had an earlier cure at 1-2 weeks. Adverse effects did not significantly diff er and were few, mild, and transient with both treatments. The evidence ranged widely from low to high certainty and mainly came from three moderate-to-high quality systematic reviews. Combination oral ivermectin and topical permethrin was ranked higher in efficacy but lower in safety compared to either drug alone in one moderate validity network meta-analysis.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> There is varying certainty of evidence suggesting comparable efficacy and safety of oral ivermectin versus topical permethrin. Limited evidence suggest higher efficacy and lower safety of combination oral ivermectin and topical permethrin compared to either drug alone. An updated systematic review and network meta-analysis is warranted.</p><p style="text-align: justify;"><strong>KEYWORDS:</strong> scabies, ivermectin, permethrin, effectiveness, efficacy, safety</p>

Zinc as an adjunct treatment for COVID-19 patients

Objective@#To present the current evidence on the effect of zinc as adjunct therapy on COVID-19 related outcomes. @*Methods@#A literature search among peer-reviewed, non-peer-reviewed, and guideline practice databases was done until December 26, 2020, with an updated search done on February 13, 2021. Evidence was synthesized among studies that fulfilled the inclusion criteria, and the quality of evidence was determined using GRADEpro.@*Results@#This review used two randomized controlled trials and three retrospective cohort studies. Pooling of the retrospective cohort studies showed that adjunct zinc therapy significantly reduces the risk of mortality or transition to hospice care among COVID-19 patients (OR 0.56, 95% CI 0.38-0.81; I2=p=0.002; very low quality of evidence). However this was not supported by one RCT (N=191) which showed no significant difference in death (RR 0.99, 95% CI, 0.30-3.31; p=0.99], need for mechanical ventilation (RR 0.66, 96% CI, 0.19-2.26; p=0.58] and recovery after 28 days (RR 0.94, 95% CI 0.55-1.62; p=0.83) in patients with COVID-19 given zinc as adjunct treatment together with hydroxychloroquine (HCQ) and azithromycin (AZT) versus HCQ and AZT alone (moderate quality of evidence). A second RCT (N=108) showed no significant difference in the hospitalizations (RR 1.44, 95% CI 0.36, 5.71; p=0.61) and meant several days needed to reach a 50% reduction in symptoms in ambulatory patients with COVID-19 given adjunct zinc gluconate versus standard of care alone (mean difference of -0.80, 95% CI, -2.55-0.95, p=0.37; low quality of evidence). In this study, there were 10 participants in the zinc group with adverse effects, mostly gastrointestinal in origin. @*Conclusion@#There is still insufficient evidence to support the use of Zinc as an adjunct therapy in patients with COVID-19 both in inpatient and outpatient settings due to inconsistent benefits and potential adverse effects.

Validation of a Filipino translation of the children's dermatology life quality index text version

Background@#Skin diseases that are longstanding or highly symptomatic can have devastating consequences in the quality of life of children. There is a need to have a validated Filipino translation of a dermatology quality of life tool for young patients with skin diseases. @*Objectives@#To assess the validity and reliability of the Indeks ng Kalidad ng Buhay Pang-dermatolohiya ng mga Bata (IKPaB), a Filipino translation of the Children’s Dermatology Life Quality Index (CDLQI).@*Methods@#This cross-sectional study was conducted among children aged 4 to 16 years at a tertiary hospital outpatient department. The IKPaB was pretested and revised using focus group discussion until it was approved by the original developers for validation. Face validity was determined through cognitive debriefing interviews. Construct validity was determined by comparing IKPaB scores of participants with skin disease and without skin disease using Mann-Whitney U test. Criterion validity was determined by comparing IKPaB with a validated Filipino-translated PedsQL as the criterion, using Spearman rank correlation. Internal consistency reliability was determined using Cronbach’s coefficient. Multiple regression was used to correlate age, sex and disease duration.@*Results@#The IKPaB was assessed to be comprehensible, clear, and culturally appropriate. Among 288 participants, it showed satisfactory construct validity (U = 8849, Z= 0.87; P = 0.89) and internal consistency reliability (α = 0.89), with a negative but weak correlation with the PedsQL® (rho= -0.300, P = 0.000). @*Conclusion@#The IKPaB is a valid and reliable Filipino translation of CDLQI. We recommend further validation for use in clinical practice and research.

Validation of a Filipino version of the cardiff acne disability index

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study assessed the reliability and validity of a Filipino version of the Cardiff Acne Disability Index.<br /><strong>METHODS:</strong> In Phase 1, the Cardiff Acne Disability Index (CADI) was translated into Filipino as the Cardiff Indeks ng Kapansanan ng may Tigyawat (CIKT) following international guidelines on translation and cultural adaptation, and passed a cognitive debriefing test (a form of face validity testing). In Phase 2, the CIKT was administered to 400 public high school students (11-18 years old). Cronbach's ? was used to measure reliability while construct validity was determined by comparing 1) the CIKT scores of adolescents with acne and those without acne and 2) the CIKT scores with the scores of the Taluntunan ng Kalidad ng Buhay na Hinggil sa Dermatolohiya (TKBD), which is a validated Filipino version of the Dermatology Life Quality Index.<br /><strong>RESULTS:</strong> Cronbach's ? showed an adequate internal consistency of 0.7. The linear regression coefficient for those with and without acne was 0.98 (CI 0.59, 1.37) (p = 0.00) while the Spearman correlation showed a positive correlation between the CIKT and the TKBD (0.58, p=0.00), both indicating validity.<br /><strong>CONCLUSION:</strong> The CIKT is a reliable and valid Filipino translation of the CADI.</p>