Factors Affecting Willingness to Report to Work During COVID-19 Pandemic among Health Care Workers in a Tertiary Government Hospital.

Background: Healthcare workers' (HCWs) willingness to report to work despite personal risk is a requisite for an effective pandemic response. At present, there are no local studies that have examined the factors affecting willingness to report to work during the COVID-19 pandemic. Objective: To determine the factors associated with willingness to report to work during COVID-19 pandemic among healthcare workers in a tertiary government hospital. Methods: This was a cross sectional study among the nursing staff (nursing attendants, nurses), doctors (residents, fellows), medical technologists, radiologic technologists, and respiratory technicians in a tertiary government hospital, who were employed from January 2021 to January 2022. Data was collected through an online questionnaire and was analyzed using SPSS. Results: A total of 311 participants included in the study. The median age of the respondents was 34 (29-46) years old. More than a third of the workers were nurses (37%) followed by residents and fellows (34%), nursing attendants (19%), radiologic technologists, medical technologists, and respiratory technicians (10%). Over 4 out of 5 were assigned in a non-COVID area while 11% were assigned in the COVID area. The odds of willingness to report to work is 60% lower among males compared to females. On the other hand, the odds of willingness to report to work was 78% lower among nurses and 84% lower among residents and fellows compared to medical technologist, radiologic technologists, and respiratory therapists. The median rating of the staff on willingness to report to work was 80% (60-90), and 73% of respondents were willing to report to work during the entire COVID-19 pandemic. Conclusion: Factors that were associated with willingness to report to work were female gender and occupation (radiologic technologists, medical technologists, respiratory technicians).

The Effect of the COVID-19 Pandemic on the Family and Community Medicine Residency Training Program: The Philippine Experience.

Background: The COVID-19 pandemic had a profound impact on medical education, particularly in Family and Community Medicine training programs. This study aimed to assess the impact in the Philippines by comparing the number of cases and procedures before and during the pandemic, as well as the adaptations made by these programs. Objective: The objective of this study was to determine the effect of the COVID-19 pandemic on Family and Community Medicine training in the Philippines by comparing the average number of cases and procedures done before and during the pandemic and the changes implemented by the different accredited training programs. Methods: A cross-sectional study utilizing an explanatory sequential mixed methods approach was undertaken. The quantitative portion collected data on cases and procedures from the participating institutions' residents using the standardized checklist of the Philippine Academy of Family Physicians. The qualitative portion was done through a focused group discussion (FGD) following a prepared set of FGD questions. Analysis of variation (ANOVA) was used to compare the average cases seen and procedures across the four years and content analysis for the qualitative data. Results: There was a significant decrease in the average number of adult and pediatric cases during the pandemic years (2020-2021) compared to before (2018-2019). Various organ systems cases such as neurology, ophthalmology, dermatology, and gastrointestinal, showed significant differences (p-value <0.05) in the average number of pediatric cases. For adult cases, significant differences (p-value <0.05) were found for several organ system cases when comparing the years before (2018-2019) and during the pandemic (2020-2021), including neurology, ophthalmology, ENT, dermatology, cardiology, gastrointestinal, genitourinary, reproductive health, musculoskeletal, and endocrinology cases. The trainers adjusted training activities to support the hospital's COVID-19 response and that prompted an abrupt shift to online strategies for patient consultations, teaching sessions, and examinations. Conclusion: The COVID-19 pandemic led to a reduction in the variety of cases and procedures in Family and Community Medicine training, impacting the fulfillment of specialty training requirements. However, it also drove innovation through the integration of technology, including online teaching methods. These experiences underscore the importance of resilience and adaptability in medical education and offer valuable lessons for future training programs, potentially leading to improvements in training and patient care through innovative methodologies.

Gastroduodenal Fistula: A Rare Finding With an Atypical Presentation.

Gastroduodenal fistula (GDF) or double pylorus is a rare, often asymptomatic condition with a prevalence of approximately 0.02-0.08%. The reported cases have been mainly in Asian countries and more prevalent in males than females. Although the etiology is unclear, Helicobacter pylori and nonsteroidal anti-inflammatory drug use have been associated with the formation of GDF. We present the case of a 65-year-old female with alcoholic cirrhosis and recurrent vomiting who was found to have an antral ulcer. The case includes the serial endoscopic examinations over the period of 7 years and shows the antral ulcer which fistulized into the duodenal bulb creating double pylorus.

Ultrastructural variation and adaptive evolution of the ovipositor in the endemic Hawaiian Drosophilidae.

Ecological diversification of the endemic Hawaiian Drosophilidae has been accompanied by striking divergence in egg morphology, and ovarian structure and function. To determine how these flies successfully oviposit in a variety of breeding substrates, we used Scanning Electron Microscopy to examine the ultrastructure of the ovipositor of a sample of 65 Drosophila species and five Scaptomyza species of this hyperdiverse monophyletic group. The Drosophila species analyzed included representatives of the fungus-breeding haleakalae group, the leaf-breeding antopocerus and modified tarsus groups, the modified mouthparts species group, the nudidrosophila, and the picture wing clade; the latter sample of 41 species from four species groups included stem- and bark-breeders, as well as tree sap flux-breeders. Ovipositor length was found to vary more than 12-fold among Hawaiian drosophilids, with the longest ovipositors observed in the bark-breeding species and the shortest among the Scaptomyza and fungus-breeders. More noteworthy is the striking variation in overall shape and proportions of the ovipositor, in the shape of the apical region, and in the pattern of sensory structures or ovisensilla. Ultrastructural observations of the pair of long subapical sensilla on the ventral side identify these, for the first time, as taste bristles. Ovipositor form correlates strongly with the oviposition substrate used by the species, being of a distinctive shape and size in each case. We infer that the observed morphological divergence in the ovipositor is adaptive and the product of natural selection for successful reproduction in alternate microhabitats. The array of ovipositor forms that have evolved among the Hawaiian Drosophila species represent a series of ecomorphs that along with other divergent traits of the female reproductive system, have contributed to the successful adaptive radiation of this remarkable fauna.

The role of molecular analysis in the diagnosis and surveillance of pancreatic cystic neoplasms.

CONTEXT: Molecular analysis of pancreatic cyst fluid obtained by EUS-FNA may increase diagnostic accuracy. We evaluated the utility of cyst-fluid molecular analysis, including mutational analysis of K-ras, loss of heterozygosity (LOH) at tumor suppressor loci, and DNA content in the diagnoses and surveillance of pancreatic cysts. METHODS: We retrospectively reviewed the Columbia University Pancreas Center database for all patients who underwent EUS/FNA for the evaluation of pancreatic cystic lesions followed by surgical resection or surveillance between 2006-2011. We compared accuracy of molecular analysis for mucinous etiology and malignant behavior to cyst-fluid CEA and cytology and surgical pathology in resected tumors. We recorded changes in molecular features over serial encounters in tumors under surveillance. Differences across groups were compared using Student's t or the Mann-Whitney U test for continuous variables and the Fisher's exact test for binary variables. RESULTS: Among 40 resected cysts with intermediate-risk features, molecular characteristics increased the diagnostic yield of EUS-FNA (n=11) but identified mucinous cysts less accurately than cyst fluid CEA (P=0.21 vs. 0.03). The combination of a K-ras mutation and ≥2 loss of heterozygosity was highly specific (96%) but insensitive for malignant behavior (50%). Initial data on surveillance (n=16) suggests that molecular changes occur frequently, and do not correlate with changes in cyst size, morphology, or CEA. CONCLUSIONS: In intermediate-risk pancreatic cysts, the presence of a K-ras mutation or loss of heterozygosity suggests mucinous etiology. K-ras mutation plus ≥2 loss of heterozygosity is strongly associated with malignancy, but sensitivity is low; while the presence of these mutations may be helpful, negative findings are uninformative. Molecular changes are observed in the course of cyst surveillance, which may be significant in long-term follow-up.