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CENTRO ESCOLAR UNIVERSITY – MANILA
1
DETERMINATION OF FECAL OCCULT BLOOD AMONG PATIENTS WITH
HELMINTHIC INFECTION IN PATEROS PUBLIC HEALTH DEPARTMENT
An Undergraduate Research Proposal Presented to the
College of Medical Technology
Centro Escolar University
In Partial Fulfillment of the Requirements
of the Degree Bachelor of Science
in Medical Technology
By
Kate Mylene Pacunayen
Abuel, Jasmine
Constantino, Danica
Dris, Nicole
Dela Paz, Katherine
Garcellano, Auwie Gleah
Gruta, Margarette
Lorzano, Josephina
Magtalas, Anna Rose
Medes, Danica Mae
Noveno, Sachiko
March 2015
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TABLE OF CONTENTS
Pages
List of Tables…………………………………………………………………………..IV
List of Figures……………………………………………………………………….…V
Chapter
1. INTRODUCTION AND DEFINITION OF THE PROBLEM..................6
1.1 Introduction…………………………………………………………....….….….6
1.2 Objective of the study.................................................................................7
1.3 Conceptual framework……………………………………….……..… . ..........8
1.4 Background of the study…………………………………….……..…...….......8
1.5 Setting of the study………………………………………………...........…......9
1.6 Statement of the Problem………………………………………....... .............11
1.7 Hypothesis…………………………………………………………… …….......11
1.8 Significance of the study…………………………………………… ……........12
1.9 Scope, Delimitation and Limitation of the Study………...……… .……........12
1.10 Definition of Terms……………………………………………… ……..….....13
2. REVIEW OF RELATED LITERATURE AND STUDIES..…………..14
2.1 Introduction…………………………………………………….... ....................14
2.2 Foreign Literature………………………………………………… ....………...14
2.3 Local literature………………………………………………….......................15
2.4 Foreign Studies……………………………………………………...…..……..16
2.5 Local Studies…………………………………………………………………....18
3. METHODS AND PROCEDURE………………………………………..21
3.1 Introduction………………………………………………………………………21
3.2Methods of Research Used…………………………………………………….21
3.3Sample Collection and Processing………………………………...………….21
3.3.1 Patient Preparation…...……………………………………………..21
3.4 Parasitologic Examination………….…………………………………………..22
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3.4.1 Detection of Diagnostic stage…………………………………………..22
3.4.2 Occult Blood Testing……………………………………………......23
3.4.3 Quality Control……………………………….……………………....23
3.5 Statistical Analysis……………………………………………………………...24
Bibliography………………………………………………..…………………26
Appendices…………………………………………………….…………..…28
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List of Tables
Page
I. Research Time Table…………………………………….....…….45
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List of Figures
Pages
I. Figure 1……………………………………………….........................………10
I.1 Municipality of Pateros as part of Metro Manila, Philippines
II. Figure 2……………………………………………….......................………..25
I.2 Diagram of Research Methodology
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CHAPTER 1
INTRODUCTION AND DEFINITION OF THE PROBLEM
Introduction
Intestinal parasitism involves parasites that can infect the gastrointestinal tract of
humans and other animals. It can be acquired through drinking infected water and
ingestion of undercooked meat. They can live throughout the body but most
preferably in the intestinal walls.
Human intestinal protozoa that include non-pathogenic and pathogenic amoeba,
flagellates, ciliates and human intestinal helmithes such as Ascaris lumbricoides
that causes Ascariasis, Stongyloides steroralis causes Strongyloidiasis,
Enterobiasis by Enterobius vermicularis, hookworm infections, human tapeworm,
and Trichenella worms are harbored in the intestinal area and thus considered
luminal parasites. The infection that causes by these parasites may lead to
ulcerations of the intestines and may result to bleeding which can be attributed to
anemia.
Fecal occult blood (FOB) test determines the presence of hidden or microscopic
blood in the stool specimen. Presence of fecal occult blood can be a sign of a
digestive problem particularly in the obstruction of intestinal walls produced by the
parasites due to its large rate of reproducibility. They tend to look for other locations
to become their habitat. Its early detectability can determine the source of bleeding
that can help the patient in determining the disease so that the problem can be
diagnosed and treated.
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Children from Pateros, as respondents of this study are particularly susceptible
if they are not thoroughly cleaned after coming into contact with infected soil that is
present in the environment, that they may have frequently visited such as
sandboxes, school playgrounds, are well as drinking water from contaminated
sources.
This research study aims to determine if there is correlation between positive
FOB and any of the common intestinal parasitic infection and finding a positive
result can alleviate awareness of the people, the establishments, authorities and
children to be conscious of their day to day exploring activities to maintain
cleanliness of their environment and surrounding.
Objective of the study
The study aims to determine if the cause of positive FOB in patients from
Pateros public health department is indeed due to parasitic infection of
helminths.This study may also prove that fecal occult blood may be used as a
screening examination in detecting intestinal parasitism among infected patients. It
will serve as a preliminary test in detecting human intestinal parasites causing
intestinal ulcerations that lead to gastrointestinal bleeding that may further be
detected in the stool. The presence of fecal occult blood among patients may mean
that the patient is also positive for intestinal parasitism.
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Conceptual Framework
Background of the Study
Many years had passed, a significant amount of scientific data has been
gathered connecting the causal relationship between parasites and diseases in
man, usage of these data helped to make some campaign against parasitic
infection successful. But despite of the medical advances and global initiatives in
eradication programs, infectious parasitic diseases would eventually become a
thing of the past. This parasitic infection becomes the major causes of death in
INPUT Identification of respondents involves informing the patients what the study
is about and its purpose. Researchers are supposed to earn their consent and approval as test subjects.
The subjects are comprised of mid-age adults particularly children that are positive for intestinal worms and they will be subjected for fecal occult blood
testing.
PROCESS Fecal Screening is where the positive patients with intestinal parasitism
are to be identified. It is done by performing direct fecal smear. During fecal occult blood testing, the collected positive samples are
screened with proper instructions and protocols including confidentiality, insurance that the patient followed the doctors’ instructions.
OUTPUT Positive or negative results in fecal occult blood testing will be noted and
will indicate possible diseases in the long term run. Suggested medication and awareness for affected individuals follows.
A health awareness program will follow where possible ways on how to prevent intestinal parasitism will be discussed.
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human and in addition it complicates and contributes to other illnesses. The burden
of these diseases often rests on the communities in the tropics and subtropics.
However, developed countries may also be affected. WHO estimates that one
person in every four harbors parasitic worm (WHO, 2013).
One of the disease that the parasite may cause is occult gastro intestinal
bleeding. By definition, occult Gastro Intestinal bleeding is hidden or unseen. It
may be surprising, but we all lose blood through our GI tract daily. Occult bleeding
is not present or absent but rather occurs along a continuum from normal
physiologic bleeding to abnormal bleeding. This physiologic blood loss averages
less than 2 ml a day. However, levels above a 2 ml a day threshold occur in 5 %
and are considered abnormal. If blood loss chronically exceeds 5 ml a day, iron
deficiency ensues.
Setting of the Study
The performance of the sample and stool collection will be held in Pateros
Public Health Department. Before 1770, Pateros was only a barrio of Pasig until the
Spanish Governor-General in the Philippines issued a decree making Pateros an
independent municipality. The town was then composed of five barangays
(villages), namely, Aguho, San Roque, Sta. Ana, Sto. Rosario and Mamancat (now
a portion of Fort Bonifacio). On March 29, 1900, Pateros became one of the towns
in the newly created province of Rizal. Then on October 12, 1903, Taguig City and
Muntinlupa City into a single municipality under Pateros.
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The municipality was renamed Taguig and on February 29, 1908 separates
Pateros from Taguig. Pateros then regained its independent status as a
municipality on January 1, 1909. Pateros became a part of the new Metropolitan
Manila Area.
Municipality of Pateros is a first-class municipality in Metro Manila, Philippines.
This small town is famous for its duck-raising industry and especially for producing
balut, a Filipino delicacy that is boiled duck egg. Pateros is also known for the
production of red salty eggs and "inutak", a local rice cake. Moreover, the town is
known for manufacturing of "alfombra", a locally-made footwear with a carpet-like
fabric on its top surface. Pateros is bordered by Pasig City to the north, Makati City
to the west, and Taguig City to the south.
Fig. 1 Municipality of Pateros as part of Metro Manila, Philippines
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Pateros is the only municipality and the smallest, both in population and in land
area, in Metro Manila, but it is the second most densely populated at around 29
thousand people per square kilometer after Manila.
Statement of the Problem
The aim of the study is to determine if the cause of positive FOB in patients of
Pateros public health department is indeed due to Parasitic infection of helminths.
Analytically, the study seeks to determine if there is/are significant difference/s
in the levels of fecal occult blood in patients with intestinal parasitism vs patients
without intestinal parasitism.
Specifically, it sought to answer the problem:
1. What is the percentage of patients positive and negative to FOB?
Hypothesis
The presence of fecal occult blood among patients with intestinal parasitism
may be due to gastrointestinal bleeding caused by human intestinal parasites
primarily the helminthes that tend to ulcerate the intestine, because of increased in
number.
Parasites travel towards other parts of the body and escaping from the intestine
by ulceration for the parasite to get out and find another organ that can serve as
habitat. Gastrointestinal bleeding may be produced and it can be shown in the stool
that gives a positive result for fecal occult blood.
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Significance of the study
Intestinal parasitism is a widespread condition here in the Philippines. It may be
caused by a poor hygiene, environment and a lot more instances like food and
water contamination. It must be diagnosed as soon as possible to prevent further
complications.
Presence of fecal occult blood in the sample may serve as a step in detecting
intestinal parasitism. Detection of blood in the stool will show a positive result.
Intestinal parasitism may lead to different effects. The researchers conducted an
experimental observation with the use of a simple and reliable technique that may
help in the diagnosis of intestinal parasitism among individuals.
Scope, Delimitation and Limitation of the Study
This study will determine the fecal occult blood in specimens positive with
parasitic infection among all enrolled patients in Pateros Public Health Department.
Fecal specimen tested negative for parasitic infection will not be considered.
The respondents are children, adolescents, and mid-age adults. Study is limited
to those who are positive in intestinal parasitism, and the team will only be dealing
with helminthes and not protozoans.
As per the exclusion criteria, patients who are found to have carcinoma,
inflammatory, ulcerative and erosive conditions and vascular disorders involving
gastrointestinal tract are excluded from the study. Parents who did not allow their
children to join in the study are also excluded. Stool specimens must not be
contaminated with urine or toilet water otherwise it would be rejected.
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Definition of Terms
a. Fecal occult blood test – A test that determines the presence of hidden blood
in the fecal sample.
b. Fecal specimen – Stool sample used in the test.
c. Gastrointestinal Tract – The tract consists of the stomach and intestines, and
is divided into the upper and lower gastrointestinal tracts.
d. Helminth – A parasitic worm; a fluke, tapeworm, or nematode.
e. Intestinal parasitism – a case where in parasites that cause infections in the
gastrointestinal tract.
f. Occult blood – Hidden blood in the fecal specimen.
g. Parasites – An organism that lives in or on another organism and benefits by
deriving nutrients at the host’s expense.
h. Parasitic infection – Disease or infection caused by parasites.
i. Parasitism – a non-mutual symbiotic relationship between species, where one
species, the parasite, benefits at the expense of the other, the host.
j. Protozoa – A diverse group of mostly motile unicellular eukaryotic organisms.
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CHAPTER 2
REVIEW OF RELATED LITERATURE AND STUDIES
This chapter presents both foreign and local related literature and studies that
are useful to the present study which contains facts and information on the research
problem at hand. It also provides explanations and logical connections between
previous researcher and the present work on determination of Fecal Occult Blood
among Patients with Intestinal Parasitism.
The researchers were able to review several foreign literatures and studies that
are significant to the present study being conducted.
Foreign Literature
Based on Bustinduy et. al., (2013) the book stated that the severity of intestinal
infection have downstream potential complications of this disease include anemia,
failure to thrive, and chronic multi-organ damage. Point-of-care (POC) tools to
monitor intestinal parasitism in low resource settings are urgently needed to better
quantify the burden of disease in endemic countries. It's important to know the
person's health and condition.
Studies have suggested that the immunochemical fecal occult blood test has
superior specificity for detecting bleeding in the lower gastrointestinal tract even if
bleeding occurs in the upper tract.
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Park et. al.,(2007) Gastrointestinal tract is the primary involvement site of
parasites during their life cycle. Parasitic infection are mostly widespread in
undeveloped or developing countries where sanitation is poor, but now the
diseases are more frequently encountered in developed countries because of
increase immigrations and travelling. Although the incidence of disease include
amebiasis, ascariasis, trichuriasis, hookworm amd tapeworm. Most of these
diseases present with nonspecific radiologic findings making the hygienic
environment and clinical history such as food ingestion important for differential
diagnosis.
Local literature
Cabrera (2004) reported in the book, Philippine Textbook of Medical
Parasitology, about the pathogenesis and clinical manifestations of Hookworm. The
pathology of hookworm infection involves the existence of the adult worms in the
small intestine. The stage of maturation of the worm can be acquired due to
abdominal pain, steatorrhea or sometimes diarrhea with blood and mucus, and
blood eosinophilia of 30 to 60%. The infection is usually chronic, hence, it shows no
acute or terminal manifestation to the patients. Heavy hookworm infection can lead
to a progressive, secondary, microcytic, hypochromic anemia of the iron-deficiency
type, that result to continuous loss of blood. He also stated about Hypoalbuminemia
which is another manifestation of hookworm infection. This infection causes low
level of albumin due to combined loss of blood, lymph, and protein. The diagnosis
of this infection is not pathogonomic to allow differentiation from nutritional
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deficiency anemias and edemas from other helminthic infections. Finding parasite
eggs in the feces is the final diagnosis. The techniques that can be used were
indicated in the book and can be applied to both individual and mass
screening. The first technique was direct fecal smear but this technique is possible
only when the infection is quite heavy. Kato-Katz or Kato technique method may
give a rapid result since more stool is examined while concentration methods like
zinc sulphate (ZnSO4) centrifugal method may increase positive several fold. The
Harada-Mori is an example of a culture method that allows to hatch the larvae from
eggs on strips of filter paper with one end immersed in water.
This literature gives a relevance to the topic for it described one of the parasites
that can be encountered when performing the fecal occult blood test.
Foreign Studies
Majed H. Wakid (2010) stated that Human infections due to intestinal parasites
are most prevalent infections in developing and tropical countries causing a
significant morbidity and mortality. Fecal occult blood (FOB) refers to a nonvisible
blood in the stool. Although the FOB test was developed to specifically screen for
colon cancer there are various causes of positive FOB including infection with some
intestinal parasites. From parasitologic point view, most of the published studies
concerned with determination of FOB in patients infected with Trichuris trichiura,
Hook worm, Schistosoma spp. and Entamoeba histolytica.
Majed H. Wakid (2010) further added that detecting fecal occult blood by a guaiac-
based test is still the most widely used test in medical laboratories in Jeddah. This
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test depends on the peroxidase-like activity of hemoglobin in catalyzing the
oxidation by peroxide of a chromogen.
Dietary and medication restrictions are recommended with this test to decrease
false positive and false negative results guaiac-based test was suitable for our
design during this study to resemble the situations during routine analysis in
medical laboratories in Jeddah,
regardless of dietary and medication restrictions, which is not followed by the
majority of ordinary population in Jeddah and regardless of infection intensity, which
is not performed with routine Fecal Occult Blood testing (Majed H. Wakid 2010).
Sarika, et. al., (2007) stated in their study "Fecal Occult Blood Screening in
Children with Severe Malnutrition" Fecal occult blood test is a rapid test, specific to
human hemoglobin which is based on a one step lateral flow chromatographic
immunoassay. It is a qualitative and sensitive test and highly accurate to detect low
levels of human fecal occult blood. Gastrointestinal tract blood loss in high risk
children is an added source of concern, and under such conditions, FOBT can be
routinely utilized for supportive evidence of the presence of any GIT pathology.
Positive result should be followed up with additional diagnostic procedures to
determine the exact cause and source of the occult blood in the feces. Qualitative
measurement of fecal occult blood can aid in evaluation and timely treatment of
severely malnourished children at highest risk of mortality. However, it
needs a multivariate logistic approach to evaluate the utility of this test as an
additional supplement to age, sex, visible severe wasting, shock, infection, etc.;
responsible for increased morbidity and mortality.
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Betson, et. al., (2012) mentioned that Fecal occult blood (FOB), which refers to
cryptic blood in feces, has been used for a number of years as a marker of
intestinal pathologic changes. They were able to investigate whether FOB could be
used as a marker to assess bowel morbidity associated with intestinal
schistosomiasis over time and after PZQ treatment. The study have found that
there was a tendency for FOB prevalence to increase from baseline to 12 months in
children who become infected with S. mansoni and to decrease in children who
become negative for egg-patent schistosomiasis.
FOB tests would not be appropriate for diagnosis of intestinal schistosomiasis at
an individual or population level, but do have potential for monitoring changes in
intestinal morbidity associated with schistosomiasis at a community level.
Consistent with the specificity of FOB for S. mansoni infection, there was no
association between FOB and hookworm infection. However, it must be
remembered that prevalence level and intensity of this helminth infection were low
in the study cohort. In areas where hookworm prevalence level and intensity are
higher, an association with FOB may be observed and the specificity of FOB for S.
mansoni infection may be lower (Betson, et. al., 2012).
Ugwuoke et. al., (2013) Infections due to intestinal parasites are among the
most prevalent infections in humans in developing countries. These infections
constitute serious health problem among Nigerians especially children. . Symptoms
of infection include abdominal pain, dizziness, fever, nausea, diarrhea, hair loss,
etc. Fecal occult blood refers to blood in the feces that is not visible to the naked
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eye and FOBT, as the name implies, is aimed to detect subtle blood loss in the
gastrointestinal tract from the mouth to the colon.
The prevalence of positive FOBT in some volunteers with parasites of intestinal
tissue invasive capability is of pathological significance. In chronic phase, these
parasites could constitute important risk factor some malignancy in colorectal
region. However, this assertion require further investigation.
Local Studies
Kanzaria, Acosta, Langdon, Manalo, Olveda, McGarvey, Kurtis, Friedman
(2005) conducted a study about the role of occult blood loss in mediating
Schistosoma japonicum which is associated to anemia.
The primary objective of the researchers was to deliberate the function of occult
blood loss in the species after adjusting for age, sex, socioeconomic status and
other helminth infections. The secondary objective was to identify the different
categories of risk for occult blood loss for Trichuris and hookworm.
The purpose of occult blood loss in mediating S. japonicum- associated anemia
was studied cross sectionally in 729 individuals 8-30 years old in Leyte, Philippines.
Stool specimen were examined in duplicate for helminth eggs.
The test was done in order to measure the hemoglobin, fecal occult blood loss
and anemia in determining the presence and intensity of helminths. The
researchers found out that individuals with higher intensities of S. japonicum and T.
trichiura were 3.5 time more likely to be positive in the fecal occult blood test than
the rest of the cohort (P = 0.018) and were more highly anemic. Adjustment was
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done for SESS. japonicum but there was no significant relationship between
hookworm infection and occult blood loss (odds ratio = 1.70, 95% CI= 0.25, 6.58,
P= 0.50) Also, after adjusting for SES, participants with moderate or heavy intensity
of T. trichiura, resulted into fecal occult blood positive by 2.68 times than individuals
who had no Trichuriasis or with low intensity infections. (P = 0.013)
This study was relevant to the present study in that the researchers' limitations
include the lack of performing the fecal occult blood test and that it may help the
present researchers to improve the necessary test.
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CHAPTER 3
METHODS AND PROCEDURE
This chapter presents the method of research used, sample collection and
processing, test procedure and the statistical treatment used in the present study
being undertaken.
Methods of Research Used
This research utilized the correlational method. According to Porter & Carter
(2000) correlational research studies go beyond simply describing what exists and
are concerned with systematically investigating relationships between two or more
variables of interest. Furthermore the correlational method only describes and
attempts to explain the nature of relationships that exist, and do not examine
causality.
Sample Collection and Processing
PATIENT PREAPARATION
Patients should be instructed no avoid eating red meats, horseradish, melons,
raw broccoli, cauliflower, radishes, and turnips for 3 days prior to specimen
collection in such manner presence of dietary pseudo peroxidase activity will be
prevented. Aspirins and nonsteroidal anti-inflammatory drugs other than
acetaminophen should be not taken 7 days prior to specimen collection to prevent
gastrointestinal irritation.
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Vitamin C and Iron should be avoided for 3 days prior to collection because
ascorbic acids is a strong reducing agent that interferes the peroxidase reaction.
Therefore these precautions must be followed in order not to obtain false positive
and false negative results.
This study will be carried out on pediatric and pregnant patients of Pateros
Public Health Hospital. Stool samples were collected from the patients, after
informed and written consent were obtained from them, following the explanation on
the purpose of the investigation and the need for their participation. Three specimen
containers will be collected from each subject for giving stool samples for three
consecutive days and the procedure for introduction of stool specimens into the
containers was carefully explained to them.
Parasitologic Examination
DETECTION OF DIAGNOSTIC STAGES
The direct fecal smears and formal ether concentration techniques will be used
for the detection of diagnostic stages of enteric parasites.
Direct stool smears will be performed by emulsifying 2 mg of stool uniformly in a
drop of saline or iodine on a microscope slide, then covered with cover glasses and
scanned microscopically.
Formal ether concentration technique shall be performed by emulsifying 2 g of
stool in 15 mL of 10% (v/v) formal-saline. In unpreserved specimens, the
suspension is allowed to stand for 30 min, then strained through two layers of gauze
into a 15 mL conical centrifuge tube and centrifuged at 2000 rpm for 5 min. When
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needed, washing step will be repeated until supernatant becomes clear. The
sediment is then resuspended with 10 mL of 10% (v/v) formal-saline, then 3 mL of
diethyl ether is added. The tube will be shaken vigorously for 30 sec and followed
by centrifugation at 2000 rpm for 5 min. The fecal debris layer will be loosened by
wooden applicator stick and the tube rapidly inverted to discard the top three layers
while the sediment remained at the bottom. A drop of iodine is to be mixed with the
sediment, then transferred to a microscope slide, covered with a cover glass, and
scanned microscopically. Wakid (2010)
OCCULT BLOOD TESTING
Each stool sample will be processed to detect occult blood using a guaiac-
based test (Hema-Screen, Stanbio, Texas, USA) by spreading thin smear of stool
according to the manufacturer instructions. Hema-Screen can detect 10 mg of
hemoglobin per gram of feces. A positive reaction is indicated by the appearance of
a blue-green color between 30 seconds to two minutes after addition of two drops
of developer reagent. The occult blood tests is to be achieved by a technologist
blinded to parasitologic results.
QUALITY CONTROL
A. External Quality Control is not available for fecal occult blood testing.
B. Internal Quality Control (positive and negative Performance Monitors) must be
performed and documented for all individual patient tests performed.
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C. Patient results may be reported only when both the Positive and Negative
Performance Standards give the expected results.
D. Corrective action must be performed and documented whenever the Positive or
Negative Performance Standards fail to give expected results.
Statistical Analysis
The Chi square test will be used for determining the significance of association
between intestinal parasitic infection and FOB test finding. A P-value level of
significance was 0.05.
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Fig. 2 Diagram of Research Methodology
PATIENT PEPARATION
Explanation of research purpose
Obtain patient/parent’s consent
SAMPLE COLLECTION
Three fecal samples for 3
consecutive days
PARASITOLOGIC EXAM
+ - Reject
Direct Fecal Smear (DFS) Formal Ether Technique
+ +
- Reject
- Defer -
Fecal Occult Blood Testing
+ -
+ -
Quality Control
STATISTICAL ANALYSIS
Direct Fecal Smear (DFS)
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BIBLIOGRAPHY
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Articles:
Majed H. Wakid., (2010) “Fecal Occult Blood Test and Gastrointestinal Parasitic
Infection,” Journal of Parasitology Research, vol. 2010, Article ID 434801, 4
pages. Retrieved from http://www.hindawi.com/journals/jpr/2010/434801
Kanzaria HK1 et. Al. (2005) International Health Institute. Schistosoma japonicum
and occult blood loss in endemic villages in Leyte, the Philippines. Retrieved
from http://www.ncbi.nlm.nih.gov/pubmed/15741543
Porter, S., Carter, DE (2000) Common terms and concepts in research & In
Cormack, D. (Ed.) The Research Process in Nursing (4th Ed.). Oxford,
Blackwell Science (pp. 17-28) Retrieved from
http://www.researchproposalsforhealthprofessionals.com/correlational_research
Books:
Cabrera, Benjamin. (2004). Philippine Textbook of Medical Parasitology. Taft
Avenue, Manila: The Publications Program.
Strasinger, S. K. & Di Lorenzo, M. S. (2008). Urinalysis and Body Fluids 5th ed.
Philidephia, Pennsylvania: F.A. Davis Company
Online Sources:
http://www.wpro.who.int/philippines/areas/communicable_diseases/mvp/story_ntd/en/i
ndex2.html
http://en.wikipedia.org/wiki/Pateros,_Metro_Manila
http://en.wikipedia.org/wiki/Pateros,_Metro_Manila#Geography
https://www.google.com.ph/maps/place/Pateros,+Metro+Manila/
http://www.webmd.com/colorectal-cancer/guide/fecal-occult-blood-test
http://labtestsonline.org/understanding/analytes/fecal-occult-blood/tab/test/
http://en.wikipedia.org/wiki/Parasitism
http://en.wikipedia.org/wiki/Protozoa
http://www.medicinenet.com/script/main/art.asp?articlekey=4769
http://www.mayoclinic.org/tests-procedures/fecal-occult-blood-
test/basics/definition/prc-20014429
http://en.wikipedia.org/wiki/Human_gastrointestinal_tract
http://www.healthline.com/health/parasitic-infections#Overview1
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APPENDICES
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APPENDIX 1
INFORMED CONSENT
Research Title: Determination of Fecal Occult Blood among Patients with Helminthic
Infection in Pateros Public Health Department.
Purpose/s: To determine if the cause of positive fecal occult blood in stool in patients
from Pateros Public Health Department is indeed due to parasitic infection of
helminthes.
Procedure/s:
Name Discomfort/Risks Recovery Time
Direct Fecal Smear none 10 minutes _
Formal Ether Concentration none 20-30 minutes
Fecal Occult Blood Testing none 30 minutes__
Benefits/Compensation: This study will help the participants know if they have
intestinal parasites or gastrointestinal bleeding by the presence of occult blood in
stool. Confirming the positive result can also alleviate the awareness of participants,
establishments, authorities, and children to be conscious of their day-to-day
exploring activity.
Subject-participant shall: (1) receive adequate and immediate medical treatment
should complication arise; (2) receive full and adequate compensation and
indemnification in case harm or injury arise out of participation; and (3) be free to
withdraw his/her consent to discontinue participation in the research anytime without
prejudice to him/her and no explanation is required.
The researchers shall: (1) answer at anytime, any inquiry of subject-participant
concerning the procedure; (2) preserve anonymity and respect full confidentiality;
and (3) be fully responsible and accountable for all complications, injury,
compensation, and the like to subject-participant as a result of any or all of the
procedures.
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SUBJECT-PARTICIPANT
Name: __________________________________ Date: _________________
Address: __________________________________________________________
Birthday: ___________________________Signature: _______________________
Parents/Guardian’s Name and Signature:_________________________________
RESEARCHERS
Name Participation Signature Date Pacunayen, Kate Mylene __ Leader ____ __________________ ____________________
Abuel, Jasmine Karla __ Member ____ __________________ ____________________
Constantino, Danika Mae __ Member ____ __________________ ____________________
Dris, Nicole Jellie __ Member ____ __________________ ____________________
Dela Paz, Katherine __ Member ____ __________________ ____________________
Garcellano, Auwie Gleah __ Member ____ __________________ ____________________
Gruta, Margerette Victoria __ Member ____ __________________ ____________________
Lorzano, Josephina __ Member ____ __________________ ____________________
Magtalas, Anna Rose __ Member ____ __________________ ____________________
Medes, Danica Mae __ Member ____ __________________ ____________________
Noveno, Sachiko Aivee Mari __ Member ____ __________________ ____________________
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APPENDIX 2
APPROVAL SHEET
CENTRO ESCOLAR UNIVERSITY
Manila * Makati * Malolos Research and Evaluation Office
Approval Sheet For the Conduct of Scientific Procedures Using Human Subjects
Undergraduate Graduate Research Faculty Research
School/College/Department/Program: College of Medical Technology
Research Title: Determination of Fecal Occult blood among Patients with Helminthic
Infections in Pateros Public Health Department
Researchers: Lead Researcher: Kate Mylene Pacunayen Co-researchers: Abuel, Jasmine Gruta, Margarette Constantino, Danica Lorzano, Josephina Dris, Nicole Magtalas, Anna Rose Dela Paz, Katherine Medes, Danica Mae Garcellano, Auwie Gleah Noveno, Sachiko Purposes of the conduct of Scientific Procedures (encircle one or more):
a. Biomedical research, experiment, studies, investigation (including pre-clinical research) b. Teaching and instruction c. Product testing d. Production of antisera or other biologicals I certify that the statements made herein are correct and true.
________________________________ _________________________
Signature of adviser/ Lead Researcher Signature of Dean
Date:__________________________ Date:_____________________
Approved by IERC members: Subject Specialist/s: ______________________ IERC Member ______________________ _____________________ IERC Member Subject Specialist ______________________ IERC Member
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______________________ _____________________ IERC Member Subject Specialist ______________________ IERC Member Recommending approval: ______________________ IERC Chair
Instrument for the Approval of Research Proposal Requiring Human Subjects
(Protocol Review Form)
I. Procedure(s) or Title of Research/ Study:
Determination of fecal occult blood among patients with helminthic infection in Pateros Health Department.
II. Purpose/ Objectives:
The study aims to determine if the cause of positive for fecal occult blood in
patients from Pateros Public Health Department is indeed due to parasitic
infection of helminths.
III. Duration or Time Frame:
Summer Term (March-April 2015) IV. Responsible Person or Principal Investigator:
A. Name:
Kate Mylene Pacunayen
B. Qualification (degree(s) or training experience)
B.S. Medical Technology (Undergraduate) – CEU
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V. Background and Significance of the Procedure or Research:
Intestinal parasitism is a widespread condition here in the Philippines. It may
be caused by a poor hygiene, environment, and a lot more instances like food,
and water contaminations. It must be diagnosed as soon as possible to prevent
further complications. Presence of fecal occult blood in the sample may serve
as a step in detecting intestinal parasitism. Detection of blood in stool will show
a positive result.
VI. Description of Methodologies/ Experimental Design:
This section should establish that the proposed procedures/research is well
designed scientifically and ethically. The following should be indicated or
described:
A. Written informed consent – Attached herewith
B. Human subject participation
The study is comprised by only pediatric (ages 1-18) and pregnant
women (with no particular age) from Pateros Public Health Department who will
be enrolled in the collection of stool samples to be used in the study.
C. Rationale of Selecting Human Subject
Pediatric and pregnant patients are the subjects of the study to their
vulnerability to intestinal parasitism because of many factors. The inclusion
criteria include the pediatric patients with ages 1-18 and pregnant women with
no particular age who are willing to participate and will sign the informed
consent. Study is limited to those who are positive in intestinal parasitism. As
per the exclusion criteria, patients who are found to have carcinoma,
inflammatory, ulcerative and erosive conditions and vascular disorders
involving gastrointestinal tract are excluded from the study. Parents who did not
allow their children to join in the study may also be a cause for exclusion.
Contaminated specimens will also be excluded.
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D. Number of Human Subjects
The researchers’ collaborators will administer questionnaires and will
evaluate approximately 200 to 300 patients from which positive for parasitism
are will be identified and undergo fecal occult blood testing.
E. Pre-treatment Procedure
The study will be conducted after obtaining the ethical approval from the
Centro Escolar University Research and Evaluation Office. Informed consent
will be given to the parents or guardians of participating pediatric patients, and
pregnant women from the Pateros Public Health Department. Participants will
be informed that all personal information is treated strictly confidential. The
researchers will explain to the patients that the procedures that will be used will
pose no risk and that their participation is voluntarily and they could withdraw
from the study at any time without giving any reason. The collaborators will
evaluate the patient’s profile and medical history. Collection procedures will be
instructed by the researchers to the patients for prevention of poorly collected
stool specimens. All participating subjects will be given sterile stool containers
with no preservatives and includes the label for name, age, and sex. The stool
samples, collected by the patients under the supervision of the collaborators,
will be verified and will be processed by the researchers. A data sheet will be
used to record each stool sample’s macroscopic and microscopic
examinations.
F. Safety Information
The researchers will be guided by the staff of Pateros Public Health
Department in doing the collection of data and specimens and in performing the
experiment. The researchers will assure that the following procedures are of no
risks and will not harm the subject-participants who will undergo the
experiment. The methods will follow the WHO protocol that ensure the safety of
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both the researchers and the participants and will produce accurate results for
the participant’s benefit of knowing their health status.
G. General Description
The study will be conducted at Pateros with the cooperation of the local
community which posses the records of the patients that are willing to
participate. This study will identify the prevalence of parasitism among the
pediatric, adolescents, and pregnant women of Pateros public health
department. This study will give the patients considerable awareness on
preventing helminthic infections.
H. Medication and Treatment – Not applicable
I. Monitoring procedure after the experiment – Not applicable
J. Rights and Privileges
The rights of the subject-participants: (1) The researchers has the full
responsibility to the subject participants especially when complication arise
within the study should receive adequate and intermediate treatment (2) The
participants are free to withdraw his/her consent and to discontinue
participation in the research anytime with no explanation required.
Examinations of stool samples are free with no financial obligation.
K. Obligation and Risk
The researchers are obliged to reach out to their patients especially for
the concerns and performing proper examination is essential to obtained
accurate results. Risk may be concerned with the patient’s discomfort in
collection of their specimen and errors may occur if specimens are improperly
collected.
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L. Benefits of the Human Participants
The patients who are in need of medical attention as for the result
obtained from the study will be referred to the physician of the municipality for
consultation and treatment. This study will give patients awareness in parasitic
infection and the need for prevention.
VII. Gantt Chart
(Attached herewith)
VIII. Declaration by the Responsible Person:
I accept responsibility for assuring that the procedures/ study will be conducted in accordance with the approved protocol. I assure that all personnel (adviser, researcher, students, consultant, and project leader have appropriate training and expertise in conducting scientific research that requires human subjects. I also ensure that safety, protect the right and promote the welfare and well-being of the human participants for the benefit of mankind as a whole. I take the full responsibility of the human subjects including the pre-treatment and post-treatment procedure and medication in specified duration. I agree to obtain written approval form from the institutional ethics review committee. And if in cases revisions will be made in the approved protocol, I also agree that IERC have the right to know the update if the study and may suggest termination of the experimentation if it inflict harm/danger to human. Signature of the Responsible Person Researchers Adviser Consultant Date: _____________________ Date:_______________________
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APPENDIX 3
LETTER OF CONSENT
(English)
Informed Consent
Research Title: DETERMINATION OF FECAL OCCULT BLOOD AMONG
PATIENTS WITH HELMINTHIC INFECTION IN PATEROS PUBLIC HEALTH
DEPARTMENT
Researchers: Kate Mylene S. Pacunayen
Jasmine Karla Abuel, Danica Constantino, Katherine Dela Paz, Nicole Jellie Dris,
Auwie Gleah S. Garcellano, Margerette Victoria J. Gruta, Josephina P. Lorzano,
Anna Rose D. Magtalas, Danica Mae P. Medes, Sachiko Aivee Mari S. Noveno,
Before agreeing to participate and comply in this research, we strongly
encourage you to read the following explanation of this study for you to have a
knowledge about the study to be conducted. This statement describes the purpose
and procedures that will be done in the study.
This research is conducted to examine the stools given with positive results of
intestinal parasitism. The researchers are conducting this study to determine if the
presence of fecal occult blood may be due to intestinal ulcerations caused by
intestinal parasites. The research will be undtertaken by Kate Mylene S. Pacunayen
and the group under the supervission of Mr. Mark Mendros, Mrs. Corazon Tan and
Mrs. Nenita Alcantara, Professors of College of Medical Technology in Centro
Escolar University.
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Participation in the study involves complying on basic questions that my be
asked by the researchers and with the instructions that must be undergone prior to
sampling. The researchers will highly appreciate your willingness and cooperation to
obtain information that may give a great contribution to fulfill the needs of this study.
The researchers will conduct a house-to-house visit for those patients that are
positive for intestinal parasitism. They will be asking some questions that can give
additional information in the study. You will also be requested to collect a sample of
your stool with proper guidelines to avoid contamination. Plastic containers and
sticks for collecting samples are provided. The stool samples shall be collected by
the researcher on the same day of collection and will be examined. This procedure
will be done in three consecutive days.
There are no risks or discomforts that are anticipated from your participation in
the study.
The anticipated benefit of participation is to know and have knowledge in your
own condition or the condition of your son/daughter. For you to be aware on the
things that is needed to be done and to know the causes and effect of the infection.
The researchers will provide information and safety measures to prevent further
complications.
The information gathered during this study will remain confidential. The results
and findings will only be relayed to you. Only the researchers, research panelist and
the physician will have access to the study data and information. There will not be
any identification of names on the results and samples,. Codes will be used and
assigned in each patients that will serve as a form of identification. Your names or
your son/daughter’s name and any other identifying details will never be revealed in
any publication of the results of this study.
Results that need medical attention will be referred to the physicians in the
health centers of this municipality for consultation advice and treatment to prevent
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further complications.
Participation in this study is voluntary; if you feel uncomfortable with the study,
refusal to participate will involve no penalty.
You are welcome to ask questions to the researchers for verification and some
concerns. If you have other concerns, you can contact this number 09********.
Thankyou.
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Consent Form
I, _________________________________, resident of Pateros have read and
fully understood all the information and procedures conducted during the research.
All guidelines are clear and reviewed. I have received a copy of this informed
consent form.
_______I voluntarily agree to participate in the study
_______I agree and allow my child to participate in the study
Statement by the researcher/person taking consent
I reviewed the information sheet to the potential respondent and made sure that
the patient understands the research objectives and methodology.
I confirm that the respondent is not forced to comply, they are voluntarily
participating in the study.
Signature of Researcher/person taking the consent: ________________________
Date: ______________________________
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APPENDIX 4
LETTER OF CONSENT
(Tagalog)
Pagpapahayag ng Pahintulot
Research Title: DETERMINATION OF FECAL OCCULT BLOOD AMONG
PATIENTS WITH HELMINTHIC INFECTION IN PATEROS PUBLIC HEALTH
DEPARTMENT
Pangalan ng Researcher: Kate Mylene S. Pacunayen
Jasmine Karla Abuel, Danica Constantino, Katherine Dela Paz, Nicole Jellie Dris,
Auwie Gleah S. Garcellano, Margerette Victoria J. Gruta, Josephina P. Lorzano,
Anna Rose D. Magtalas, Danica Mae P. Medes, Sachiko Aivee Mari S. Noveno,
Bago pumirma sa pahayag na ito ay maaaring basahin lamang mabuti ang mga
nakapaloob sa pagaaral na ito upang magkaroon kayo ng kaalaman sa mga
mungkahi at proseso sa gagawing pagsusuri.
Ang pagaaral na ito nais isagawa upang pagaralan at examinahin ang mga
dumi na makakalap na mayrong positibong resulta mula sa naunang grupo kung ito
ay mayroong parasitic infection. Isinakatuparan ito ng mga mananaliksik upang
makita kung ang fecal occult blood na makikita mula sa duming makakalap ay may
kinalaman sa pagkabutas ng bituka na sanhi ng intestinal parasitism. Ang pagaaral
na ito ay isasagawa ni Kate Mylene S. Pacunayen at ng kanyang mga kagrupo sa
ilalim ng pamumuno ni Mr. Mark Mendros, Mrs. Corazon at Mrs. Nenita Alcantara,
mga Propesor ng College of Medical Technology mula sa Cento Escolar University.
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Ang mga tagapanliksik ay bibisita sa mga bahay bahay ng mga patienteng
nagkaroon ng positibong resulta ng intestinal parasitism. Maaari silang tanungin ng
mga kaunting impormasyon na maaaring makatulong sa kanilang pagaaral. Kayo rin
o ang inyong mga anak ay hihilinging magbigay sa mga tagapanaliksik ng inyong
dumi upang examinahin. Kayo ay tuturuan kung paano ang tamang pagkolekta sa
mga ito at ang tamang lagayan at stick na gagamitin ay manggagaling sa mga
mannaliksik. Ang sample ay kailangaang makalap sa mismong araw na nasabi. Ang
pagkuha ng sample na ito ay gagawin ng tatlong beses.
Ang inyong pagpapartisipa ay hindi magdudulot ng kahit ano mang negtibo sa
inyong parte.
Makakatulong ang pagaral na ito upang kayo ay magkaroon ng kaalaman
tungkol sa kondisyon na maaring mayroon kayo. Importante rin ito upang alam ng
bawat isa ang mga dapat at hindi dapat gawin upang maiwasan pa ang pagkumplika
ng kondisyon. Ang mga tagapanaliksik ay magbibigay impormasyon din upang
maibahagi ang kanilang kaalaman kung paano maaagapan o maiiwasan pa ang
paglala ng kundisyon.
Ang mga impormasyong makakalap ay konpindensyal. Ang mga resulta ay
ilalathala sa iyo lamang. Tanging ang mga taga-panaliksik, Research Panel, at
Physician lamang ang may karapatang makaalam ng nakapaloob sa pagaaral na ito.
Hindi gagamitin ang mg pangalan ng mga responde sa bawat sample at resulta
upang mapantili ng pagiging pribado. Gagamit lamang ng mga palantandaan upang
hindi mapagpalitpalit ang mga ito.
Ang mge resulta na nangangilangan ng lubusang pagaaral ay ilalathala sa
tagasuri ng munisipalidad na ito para sa mga konsultasyon upang maiwaasaan ang
paglubha nito.
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Ang pagsangayon sa pagpartisipa sa pagaral na ito ay hindi sapilitan, maaaari
ang sinuman g tumaanggi kung kayo ay hindi kumportable sa gagawing
pageexamina.
Kayo ay maaaring magtanong kung mayroon kayong hindi nauunawaan sa
nasabing pagaaral. Maari kaayong sumangguni saa numerong ito para sa mga
katanungan, 09********. Salamat.
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Consent Form
Ako si, ________________________________________, residente ng Pateros
nagsasaad na nabasa at naintindihan kong mabuti ang mga nakapaaloob sa
pahayag na ito. Lahat ng impormasyon ay malinaw at napagaaralan. Ito ay
nagpapatunay na nakatanggap ako ng kopya ng pahayag na ito.
______ Ako ay sumasangayon sa pagiging parte ng pagaaral na ito.
______ Ako ay sumasangayon at pumapayag na maging parte ang anak ko ng
pagaaral na ito.
Pirma ng Patiente
______________________ ________________________ ________________
Pangalan Pirma Petsa
Pirma ng Magulang
_____________________ ________________________ ________________
Pangalan Pirma Petsa
Pahayag ng tagapanaliksik/kukuha ng impormasyon
Binasa at inaral ko ang mga impormasyon na nakasulat na inilathala ng
responde at nakakasisigurong naintindihan at napagaralan niya ang mga nakasaad
dito. Ito ay patunay na hindi pinilit at ito’y kusang loob na inaprubahan ng responde.
Pirmaa ng tagapanaliksik/kukuha ng impormasyon: _______________________
Petsa: ______________________________
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APPENDIX 5
RESEARCH TIMETABLE
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APPENDIX 6
THE RESEARCHERS: Curriculum Vitae
CONTACT INFORMATION Name: Kate Mylene S. Pacunayen Address: Blk 7 Lt 11 Amethyst St. Golden City Subdivision, Taytay Rizal Telephone: 368 43 11 Cell Phone: 09058243898 Email: [email protected] PERSONAL INFORMATION
Date of Birth: September 6, 1994 Place of Birth: Davao City Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION Tertiary: Centro Escolar University Mendiola, Manila 2011-present Secondary: Harris Memorial College Taytay, Rizal 2007-2011 Primary: Harris Memorial College Taytay, Rizal 2001-2007 ACCOMPLISHMENTS
PHISMETS Vice President S.Y 2015-2016 President's Lister Second Semester S.Y. 2012 – 2013 President's Lister First Semester
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Curriculum Vitae
CONTACT INFORMATION Name: Auwie Gleah S. Garcellano Address: 25 Chiefmate Lane Regatta Classic Subdivision, Anabu 2B Imus, Cavite Telephone: (046) 515 72 95 Cellphone: 0927328722 Email: [email protected] PERSONAL INFORMATION
Date of Birth: October 29, 1994 Place of Birth: UERM Hospital, Quezon City Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION Tertiary: Centro Escolar University Mendiola, Manila 2011-present Secondary:Vel Maris School Inc. Dasmariñas, Cavite 2007-2011 Primary: Hansel and Gretel School of Cavite Imus, Cavite 2001-2007
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Curriculum Vitae CONTACT INFORMATION
Name: Margerette Victoria J. Gruta Address: 61-A San Perfecto St. San Juan City Cell Phone: 09173780040 Email: [email protected] PERSONAL INFORMATION Date of Birth: August 21, 1995 Place of Birth: San Juan City, Manila Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION Tertiary:Centro Escolar University Mendiola, Manila 2012-present Secondary: University of The East-Secondary Laboratory High School 2009-2012
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Curriculum Vitae
CONTACT INFORMATION Name: Josephina P. Lorzano Address: 1248 Abreu St. San Miguel, Manila Telephone: 4104929 Cell Phone: 09153857524 Email: [email protected] PERSONAL INFORMATION Date of Birth: August 7, 1994 Place of Birth: Sta. Mesa, Manila Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION Tertiary: Centro Escolar University Mendiola, Manila 2011-present Secondary: Canossa Academy Lipa City, Batangas 2005-2011 Primary: De La Salle Lipa Lipa City, Batangas 2001-2005 Pinagtung-ulan Elementary School Pulo Lipa City, Batangas ACCOMPLISHMENTS Medical Technology Student Council Year Level Secretary S.Y. 2011 - 2012 Dean's Lister First Semester S.Y. 2012 – 2013 Dean's Lister First Semester
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Curriculum Vitae
CONTACT INFORMATION Name: Anna Rose D. Magtalas Address: 8 Mendiola St. San Miguel, Manila Cell Phone: 09278786266 Email: [email protected] PERSONAL INFORMATION
Date of Birth: October 30, 1995 Place of Birth: Cebu City Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION
Tertiary: Centro Escolar University Mendiola, Manila 2012-present Secondary: Our Lady of Caysasay Academy Taal, Batangas 2009-2012 Primary: Our Lady of Caysasay Academy Taal, Batangas 2004-2009 ACCOMPLISHMENTS Dean's Lister First-Second Semester S.Y. 2012 – 2013 Dean's Lister First Semester S.Y. 2013 – 2014 President’s Lister Second Semester S.Y. 2013 – 2014
Curriculum Vitae
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CONTACT INFORMATION
Name: Danica Mae P. Medes Address: P-7 Batang, Ligao City, Albay Cellphone: 09174734918 Email: [email protected] PERSONAL INFORMATION Date of Birth: May 23, 1996 Place of Birth: Batang, Ligao City, Albay Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION
Tertiary: Centro Escolar University Mendiola, Manila 2012-present Secondary:Bicol Regional Science High School Tuburan, Ligao City, Albay 2008-2012 Primary: Ligao East Central School Tuburan, Ligao City, Albay 2002-2008 ACCOMPLISHMENTS
Dean's Lister Second Semester S.Y. 2012 – 2013 Dean's Lister First Semester S.Y. 2013 – 2014
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Curriculum Vitae
CONTACT INFORMATION
Name: Sachiko Aivee Mari S. Noveno Address: 821 Nueve de Pebrero St. Mandaluyong City Cell Phone: 09051804296 Email:[email protected] PERSONAL INFORMATION Date of Birth: October 26, 1996 Place of Birth: San Juan City Citizenship: Filipino Gender: Female Marital Status: Single EDUCATION Tertiary: Centro Escolar University Mendiola, Manila 2011-present Secondary: Mataas na Paaralang Neptali A. Gonzales 2007-2011 Primary: Highway Hills Elementary School 2001-2007 ACCOMPLISHMENTS Dean's Lister First Semester S.Y. 2012 – 2013
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APPENDIX 7
BUDGET PROPOSAL
The researchers proposed a budget worth for their research entitled
“Determination of Fecal Occult Blood Among Patients with Helminthic
Infection in Pateros Public Health Department”. The said budget will be used
for the following:
Name of Item Unit Price
(Php)
Quantity Total Price (Php)
A. Materials
Fecal Occult Blood Kit 3,500 300 10,500
Box of slides (frosted) 250 4 1,000
Box of Gloves 150 1 150
Box of Mask 80 1 80
Big Alcohol 160 1 160
Stool Container 17 300 5,100
Tissue Roll 12.50 12 150
Cotton (Big) 150 1 150
Yellow bag 50 1 pack 50
Applicator Sticks 15 2 box 30 B. Others
Transportation 200/person 8 1,600
Patient’s Snack 100 15 1,500
Paper Form 150 1 150
Short Envelopes 5 3 15
Book Bind 350 1 350
English Editor 1,000 1 1,000
Statistician 1,000 1 1,000
Panelist refreshment and souvenir
120 15 1,800
C. Miscellaneous 1000
TOTAL AMOUNT PHP 25,785
BUDGET PHP 26,000