Cross-cultural validation of the Cebuano version of a screening questionnaire for Parkinson's disease.

BACKGROUND: In the Philippines, the exact prevalence of Parkinson's disease (PD) has not yet been determined. Although cases can be extrapolated from medical registries, this method may undermine actual case rates. A reliable screening tool for PD is essential for a timely diagnosis and community-based epidemiological studies. The most widely used screening questionnaire for PD diagnosis was developed by Tanner et al., which consists of nine questions about the motor symptoms of PD. Although this questionnaire has been translated to several languages, the translated version must be validated for use in our local setting. OBJECTIVE: To determine the validity of the Cebuano version of a PD screening questionnaire. METHOD: The questionnaire was translated from English to Cebuano by a hired language specialist. Each item was supplied with a yes, no, or don't know answer. A total of 73 patients with PD and 244 control subjects completed the study. RESULTS: The overall Cronbach alpha for internal consistency of the questionnaire was 0.9410. The item on tremor had the highest sensitivity (97.26%), while the item on problems with buttoning had the highest specificity (100.00%). A cut-off score ≥ 3 obtained the best Youden index (99.18%), with a sensitivity of 100.00% and a specificity of 99.18%. The questionnaire had an almost perfect predictive ability to diagnose PD (AUC of 0.9994). CONCLUSION: The translated version of the Tanner questionnaire is a validated instrument to identify PD in a literate Cebuano population.

ANTEDECENTES: Nas Filipinas, a prevalência exata da doença de Parkinson (DP) ainda não foi determinada. Embora os casos possam ser extrapolados dos registros médicos, esse método pode prejudicar as taxas reais de casos. Uma ferramenta de triagem confiável para DP é essencial para um diagnóstico oportuno e estudos epidemiológicos baseados na comunidade. O questionário de triagem mais utilizado para o diagnóstico da DP foi desenvolvido por Tanner et al., que consiste em nove questões sobre os sintomas motores da DP. Embora este questionário tenha sido traduzido para vários idiomas, a versão traduzida deve ser validada para uso em nosso meio. OBJETIVO: Determinar a validade da versão Cebuano de um questionário de triagem de DP. MéTODOS: O questionário foi traduzido do inglês para o cebuano por um especialista em idiomas contratado. Cada item foi fornecido com uma resposta "sim", "não" ou "não sei". Um total de 73 pacientes com DP e 244 controles completaram o estudo. RESULTADOS: Em geral o alfa de Cronbach para consistência interna do questionário foi de 0,9410. O item "tremor" teve a maior sensibilidade (97,26%), enquanto o item "problemas com abotoamento" teve a maior especificidade (100,00%). Um escore de corte > 3 obteve o melhor índice de Youden (99,18%), com sensibilidade de 100,00% e especificidade de 99,18%. O questionário teve uma capacidade preditiva quase perfeita para diagnosticar DP (AUC de 0,9994). CONCLUSãO: A versão traduzida do questionário de Tanner é um instrumento validado para identificar a DP em uma população cebuana alfabetizada.

Cross-cultural validation of the Cebuano version of a screening questionnaire for Parkinson's disease / Validação transcultural da versão Cebuano de um questionário de triagem para a doença de Parkinson

Abstract Background In the Philippines, the exact prevalence of Parkinson's disease (PD) has not yet been determined. Although cases can be extrapolated from medical registries, this method may undermine actual case rates. A reliable screening tool for PD is essential for a timely diagnosis and community-based epidemiological studies. The most widely used screening questionnaire for PD diagnosis was developed by Tanner et al., which consists of nine questions about the motor symptoms of PD. Although this questionnaire has been translated to several languages, the translated version must be validated for use in our local setting. Objective To determine the validity of the Cebuano version of a PD screening questionnaire. Method The questionnaire was translated from English to Cebuano by a hired language specialist. Each item was supplied with ayes, no, ordon't know answer. A total of 73 patients with PD and 244 control subjects completed the study. Results The overall Cronbach alpha for internal consistency of the questionnaire was 0.9410. The item ontremor had the highest sensitivity (97.26%), while the item onproblems with buttoning had the highest specificity (100.00%). A cut-off score ≥ 3 obtained the best Youden index (99.18%), with a sensitivity of 100.00% and a specificity of 99.18%. The questionnaire had an almost perfect predictive ability to diagnose PD (AUC of 0.9994). Conclusion The translated version of the Tanner questionnaire is a validated instrument to identify PD in a literate Cebuano population.

Resumo Antedecentes Nas Filipinas, a prevalência exata da doença de Parkinson (DP) ainda não foi determinada. Embora os casos possam ser extrapolados dos registros médicos, esse método pode prejudicar as taxas reais de casos. Uma ferramenta de triagem confiável para DP é essencial para um diagnóstico oportuno e estudos epidemiológicos baseados na comunidade. O questionário de triagem mais utilizado para o diagnóstico da DP foi desenvolvido por Tanner et al., que consiste em nove questões sobre os sintomas motores da DP. Embora este questionário tenha sido traduzido para vários idiomas, a versão traduzida deve ser validada para uso em nosso meio. Objetivo Determinar a validade da versão Cebuano de um questionário de triagem de DP. Métodos O questionário foi traduzido do inglês para o cebuano por um especialista em idiomas contratado. Cada item foi fornecido com uma resposta "sim", "não" ou "não sei". Um total de 73 pacientes com DP e 244 controles completaram o estudo. Resultados Em geral o alfa de Cronbach para consistência interna do questionário foi de 0,9410. O item "tremor" teve a maior sensibilidade (97,26%), enquanto o item "problemas com abotoamento" teve a maior especificidade (100,00%). Um escore de corte > 3 obteve o melhor índice de Youden (99,18%), com sensibilidade de 100,00% e especificidade de 99,18%. O questionário teve uma capacidade preditiva quase perfeita para diagnosticar DP (AUC de 0,9994). Conclusão A versão traduzida do questionário de Tanner é um instrumento validado para identificar a DP em uma população cebuana alfabetizada.

Autoimmune encephalitis in a tertiary hospital in the Philippines.

BACKGROUND: Autoimmune encephalitis (AE) is an emerging disorder in adults and children. Due to its potentially reversible nature, prompt recognition and intervention are of utmost importance. OBJECTIVE: To describe the clinical and paraclinical features, as well as treatment outcomes of patients with AE admitted in a Philippine tertiary hospital. METHODS: Retrospective case series of patients with definite AE. RESULTS: Eighteen (18) patients were included (12 adults, 6 children), majority of whom had anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. The median age of onset was 32 (IQR: 10.8) years old and 13 (IQR: 4.8) years old in the adult and pediatric population, respectively. In both age groups, most presented with psychiatric symptoms and normal imaging findings. Cerebrospinal fluid (CSF) pleocytosis was detected in 8/12 (66.7%) adults and 2/6 (33.3%) children, while CSF protein elevation was only seen in 6/12 (50%) adults. Most patients presented with seizures, and the most frequent electroencephalography (EEG) abnormality detected was slow activity (70.5%). A high proportion of patients received high dose steroids, alone (35.3%) or in combination with intravenous immunoglobulin (IVIG, 52.9%). Overall, 66.7% had improved outcomes, mostly seen in the pediatric population. CONCLUSION: This study highlighted the broad clinical phenotype, as well as the similarities and differences of AE manifestations in adults and children. It demonstrated the limited but supportive role of laboratory investigations in the diagnosis of AE. It also underscored the importance of early intervention in AE and highlighted factors influencing treatment practices and discharge outcomes in the local setting.

Long-term outcomes of pallidal deep brain stimulation in X-linked dystonia parkinsonism (XDP): Up to 84 months follow-up and review of literature.

INTRODUCTION: X-linked dystonia-parkinsonism (XDP/DYT3/Lubag) patients had improved dystonia and parkinsonism with bilateral pallidal deep brain stimulation (DBS) in the literature. METHOD: We reviewed eleven XDP patients who underwent bilateral pallidal DBS from October 2009 to September 2018. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Unified Parkinson's Disease Rating Scale (UPDRS)-III scores were reviewed from baseline up to the longest follow-up together with the demographic and clinical data. The published case reports on DBS in XDP were also reviewed. RESULTS: The mean age was 39 ±â€¯9.2 years with a mean disease duration of 3 years (range 1-9 years). An immediate response for dystonia post-DBS (1 month) was seen in all cases, with a mean BFMDRS score of 23.3 ±â€¯12.12 [from a mean baseline of 36.3 ±â€¯12.1] and a small change in the mean UPDRS-III score of 20 ±â€¯10.39 [from a mean baseline of 24.04 ±â€¯8.74]. At 12 months (n = 10), the mean BFMDRS score was 13.7 ±â€¯10.63 and the mean UPDRS-III score was 19 ±â€¯13.19. There was improvement in the clinical and functional stage of the patients, with majority in Stage 1 (n = 3) and Stage 2 (n = 5) at their last follow-up. CONCLUSION: Bilateral pallidal DBS should be considered as a treatment option for XDP. It is effective in the first 12 months in controlling dystonia with variable response in controlling parkinsonism. It may be effective in up to 72-84 months, as seen in three patients.

Rocuronium for control of muscle spasms in a tetanus patient with chronic methamphetamine use disorder.

This is a case of a 31-year-old Filipino man with chronic methamphetamine use disorder who developed tetanus from a necrotic skin graft over his left calcaneus, which was fractured after a motor vehicular accident. During the course of his illness, the patient's muscle spasms were unusually refractory to benzodiazepine, which is the first-line drug used in the management of muscle spasms. The muscle spasms were successfully controlled on the seventh day of illness with rocuronium at a dose of 10 µg/kg/min and midazolam at 0.30 mg/kg/hour. Both infusions were tapered off until the 23rd day of illness. The patient was discharged on the 30th day of illness, improved and stable.

Factors Associated with Mild Cognitive Impairment among Elderly Filipinos with Type 2 Diabetes Mellitus.

OBJECTIVES: This study aims to identify factors associated with mild cognitive impairment (MCI) among elderly Filipinos with Type 2 diabetes mellitus. METHODOLOGY: This is an analytic cross-sectional study involving 133 elderly (≥60 years old) with Type 2 diabetes mellitus consecutively sampled from the General Medicine and Diabetes Clinics of the Philippine General Hospital. Eligible subjects were interviewed to gather demographic and clinical data. Body mass index, waist-hip ratio and mean blood pressure were computed. HBA1c, lipid profile, creatinine and urine proteinuria were tested or recorded if done recently. Dilated fundus examination via indirect ophthalmoscopy and 10-gram monofilament test were performed to detect retinopathy and neuropathy. The Montreal Cognitive Assessment-Philippines tool was administered to detect patients with probable MCI using a cutoff score of ≤21. Multivariate logistic regression analysis was performed to determine the associated factors. RESULTS: Using MoCA-P tool, MCI has a rate of 45% among elderly Filipino diabetics. Having more than 12 years of education is significantly associated with lower odds of MCI. (OR 0.38 CI 0.18, 0.80, p value 0.010). CONCLUSION: The rate of MCI among Filipino elderly diabetics is high. Higher education is associated with lower odds of having MCI. Case-control or prospective cohort studies involving larger sample and non-diabetic population are recommended.

Factors and issues on treatment adherence among Filipino patients with epilepsy and their caregivers

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Non-adherence to treatment in epilepsy is considered as a worldwide problem ranging from 30-50% of patients. Despite its striking magnitude, only a few studies tried to explain the factors affecting it. Moreover, a standard method to measure adherence to treatment among patients is still lacking. An in-depth analysis on adherence to treatment of patients with epilepsy, taking into factor their values, beliefs, and culture, is deemed necessary.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> The purpose of this qualitative study is to investigate the contributory factors and issues on treatment adherence faced by Filipino patients with epilepsy and their caregivers. This study also aimed to serve as a catalyst to further stimulate local researches on treatment adherence in epilepsy.</p><p style="text-align: justify;"><strong>METHODS:?</strong>Four focus group discussions were conducted with patients and caregivers who voluntarily agreed to participate and share their experiences on dealing with epilepsy. A total of 39 participants were included. The focus group discussions, facilitated by skilled moderators, were composed of an ice breaker and a discussion on the experiences and issues faced by the participants. The discussions were transcribed and analyzed using thematic coding.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Three main content categories were identified from the focus group discussions, namely, 1) accepting a life with epilepsy, 2) dealing with the disease, and 3) ensuring freedom from seizure attacks, which were further sub-categorized. From these, a number of factors affecting treatment adherence were identified and a conceptual framework was developed by the investigators.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This study was able to demonstrate that conducting a focus group discussion was an effective means of eliciting the experiences and issues in patients and their caregivers. Several factors affecting treatment adherence such as patient-doctor relationship, financial resources, government support, adverse medication effects, religious belief, trigger avoidance, frequent reminders, and safety precautions were elucidated in this study.</p>