BACKGROUND

Burn injuries remain a significant global public health problem, causing substantial morbidity, mortality, and economic burden, particularly in low- and middle-income countries where nearly 90% of cases occur. Despite the importance of timely and appropriate first aid in reducing complications, community responses to burn injuries in many settings continue to rely on traditional or non-evidence-based practices.

OBJECTIVES

This qualitative phenomenological study explored community-based knowledge and responses related to the causes and first aid of burn injuries.

METHODS

The study involved ten (10) purposively selected informants residing in South Mangga Dua Urban Village, Central Jakarta, Indonesia. Data collection methods included semi-structured interviews, direct observations, and focus group discussions (FGDs). Thematic analysis was used.

RESULTS

Three (3) core domains were identified: (1) community perceptions of burn causes and classifications, (2) indigenous first aid practices used in domestic settings, and (3) sources of knowledge and information pathways related to burn first aid. Participants commonly attributed burns to incidents involving fire, hot liquids, and electrical faults. Their understanding of burn severity was limited to superficial assessments, with little awareness of clinical classifications. First aid responses were largely based on traditional practices such as the application of toothpaste, honey, or aloe vera, while evidencebased practices like using running water were rarely mentioned. Notably, most participants relied on familial teachings and informal community experiences as their primary sources of knowledge, with limited exposure to health professionals or verified media content.

CONCLUSION

Community knowledge is culturally rooted but misaligned with medical standards, potentially leading to unsafe practices. Culturally sensitive health education integrating traditional beliefs and accurate information is essential to improve outcomes in burn injury management.

Wounds And Injuries ; Residence Characteristics ; Public Health ; Mortality ; Insemination, Artificial, Heterologous ; Income ; Financial Stress ; Burns ; Health Education ; Attitude ; First Aid ; Medicine ; Health Communication ; Urban Population

BACKGROUND

Hospitalization is a major complication of atrial fibrillation (AF) and its burden has been rising across Asia. In Korea alone, AF-related hospitalizations increased by 420% from 2006 to 2015. However, comparable data are lacking in the Philippines. This study aimed to determine the prevalence of AF-related hospitalizations among adult patients aged 19 years or older using database claims of the Philippine Health Insurance Corporation (PhilHealth) in 2017 and 2018.

RESULTS

In both 2017 and 2018, approximately 19–20 per 10,000 total hospital admissions were due to AF. The median patient age was 68 years in 2017 and 69 years in 2018. Most admissions occurred in private tertiary hospitals located in urban areas, with a median length of stay of three days. The in-hospital mortality rate was 1.1% for both years.

CONCLUSION

Among the arrhythmias, AF was the most common cause of hospitalization in the Philippines in 2017 and 2018, which accounted for 19 per 10,000 hospitalizations. Despite this burden, the associated in-hospital mortality rate remained low.

Atrial Fibrillation ; Hospitalization ; Mortality ; Philippines

BACKGROUND

Hospitalization is a major complication of atrial fibrillation (AF) and its burden has been rising across Asia. In Korea alone, AF-related hospitalizations increased by 420% from 2006 to 2015. However, comparable data are lacking in the Philippines. This study aimed to determine the prevalence of AF-related hospitalizations among adult patients aged 19 years or older using database claims of the Philippine Health Insurance Corporation (PhilHealth) in 2017 and 2018.

RESULTS

In both 2017 and 2018, approximately 19–20 per 10,000 total hospital admissions were due to AF. The median patient age was 68 years in 2017 and 69 years in 2018. Most admissions occurred in private tertiary hospitals located in urban areas, with a median length of stay of three days. The in-hospital mortality rate was 1.1% for both years.

CONCLUSION

Among the arrhythmias, AF was the most common cause of hospitalization in the Philippines in 2017 and 2018, which accounted for 19 per 10,000 hospitalizations. Despite this burden, the associated in-hospital mortality rate remained low.

Atrial Fibrillation ; Hospitalization ; Mortality ; Philippines

BACKGROUND

Pediatric Early Warning Scores (PEWS) help identify children at risk of clinical deterioration, but their accuracy across diverse settings, populations, interventions, and outcomes remains unexplored.

OBJECTIVE

To determine the accuracy of PEWS in detecting clinical deterioration events (CDE) among pediatric patients seen at the emergency department (ED).

DESIGN

Retrospective cohort study.

PARTICIPANTS

Pediatric patients aged 1 month to 18 years seen at the ED.

SETTING

Southern Philippines Medical Center Emergency Department, Davao City, Philippines from January 2021 to December 2022.

MAIN OUTCOME MEASURES

Area under the curve (AUC) of PEWS in detecting CDE; Brighton PEWS optimal cut-off and its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR).

MAIN RESULTS

Among the 345 patients, 56 experienced CDE and 289 did not. Patients with CDE had significantly lower median age (1.00 year vs 5.00 years; p < 0.001), oxygen saturation (93.00% vs 98.00%; p < 0.001), and pediatric Glasgow Coma Scale scores (8.00 vs 15.00; p < 0.0001) compared to those without CDE. Heart rate (135.00 vs 111.00 beats per minute; p < 0.001), and respiratory rate (32.50 vs 24.00 breaths per minute; p < 0.001) were significantly higher in patients with CDE. The two groups also differed significantly in terms of comorbidity distribution (p < 0.001) and diagnosis (p < 0.001). The AUC of Brighton PEWS was 0.9064 (95% CI 0.8716 to 0.9357), with an optimal cut-off score of ≥4.00. This threshold yielded 76.79% sensitivity, 88.58% specificity, 56.60% PPV, 95.20% NPV, 6.72 LR+, and 0.26 LR-.

CONCLUSION

The Brighton PEWS demonstrates strong diagnostic accuracy in predicting CDE among pediatric patients. A cut-off score of ≥4.00 offers a balanced combination of sensitivity, specificity, and likelihood ratios for ED application.

Human ; Emergency Departments ; Emergency Service, Hospital ; Resuscitation ; Mortality

OBJECTIVES

To describe the treatment outcomes of patients who underwent open repair of infrarenal abdominal aortic aneurysm (AAA) and to determine the risk factors affecting morbidity and mortality.

METHODS

Data were obtained from patients with infrarenal AAAs who underwent open surgical repair at the University of the Philippines-Philippine General Hospital (UP-PGH) from January 2013 to October 31, 2023. These patients’ demographic and clinical profile, and treatment outcomes were evaluated using frequencies and percentages. Student’s t-test and chi-square test were used for the inferential analysis. Multivariable logistic regression analysis was used to identify factors associated with in-hospital mortality and morbidity.

RESULTS

In this study, 131 patients underwent open surgical repair of AAA. 82.4% of the patients were males, and 45.8% were between 61-70 years old. The majority of them had hypertension (81.4%) and were smokers (75%). The mortality rate was 17.6%, while the morbidity rate was 35.9%. For elective operations, the mortality was 8.9%, and for ruptured aneurysms, it was 56.5%. Eleven factors associated with mortality included ruptured aneurysm (OR=11.5, 95%CI=4.1 to 32.2), decreased hemoglobin (OR=1.1, 95%CI=1.05 to 1.2), decreased hematocrit (OR=1.1, 95%CI=1.06 to 1.4), emergency surgery (OR=10.3, 95%CI=2.9 to 36.3), higher volume of blood loss (OR=1.5, 95%CI=1.5 to 1.9), higher red cell transfusion (OR=1.3, 95%CI=1.1-1.5), intraoperative cardiopulmonary (CP) arrest (OR=15.9, 95%CI=1.6 to 159.2), need for multiple inotropes (OR=2.7, 95%CI=1.5-4.8), intraoperative hypotension (OR=3.6, 95%CI=1.4-9.7), juxta-renal location (OR=5.0, 95%CI=1.2 to 10.0), and presence of any complication (OR=5.7, 95%CI=2.1-15.1). Seven factors associated with morbidity included ruptured aneurysm (OR=3.9, 95%CI=1.5 to 9.8), decreased preoperative hemoglobin (OR=1.2, 95%CI=1.1 to 1.4), decreased preoperative hematocrit (OR=1.5, 95%CI=1.1 to 1.7), elevated preoperative creatinine (OR=1.1, 95%CI=1.06 to 1.9), higher intra-operative blood loss (OR=1.4, 95%CI=1.1 to 1.6), higher red cell transfusion (OR=1.6, 95%CI=1.3-2.1), and preexisting chronic renal disease (OR=3.3, 95%CI=1.4 to 7.5). Other preoperative and intraoperative factors did not show a significant association with mortality or morbidity.

CONCLUSION

The open repair of an infrarenal AAA is linked to high overall mortality (17.6%) and morbidity (35.9%). The mortality rate for elective repair was 8.9%, but it significantly increased to 56.5% in cases of ruptured aneurysms. Factors with very high Odds Ratio such as emergency surgery, ruptured aneurysm, cardiac arrests during surgery, complex juxtarenal anatomy, and postoperative complications can lead to a high chance of mortality. Healthcare professionals should be vigilant and focus on early detection and repair of abdominal aneurysms to prevent emergency surgery, rupture, and mortality. It is crucial to prevent acute kidney injury, acute respiratory failure, and pneumonia, as these are common complications of open repair.

Human ; Morbidity ; Mortality

BACKGROUND AND OBJECTIVE

Patients with liver cirrhosis have an increased risk for poor postoperative outcomes after non-hepatic surgery, with liver dysfunction being the most important predictor of poor outcomes. This study aims to determine the association of the albumin-bilirubin (ALBI) grade, aspartate aminotransferase-platelet ratio index (APRI) score, and ALBI-APRI score with postoperative outcomes among cirrhotic patients who have undergone non-hepatic surgery.

METHODS

This was a retrospective cohort study involving 34 patients. Age, ASA class, urgency of surgery, etiology of liver cirrhosis, preoperative Child-Turcotte-Pugh (CTP) score, Model for End-Stage Liver Disease (MELD) score, ALBI grade, APRI score, and ALBI-APRI score were documented. The outcomes analyzed were postoperative hepatic decompensation (POHD) and in-hospital mortality. Bivariate analysis using the Mann-Whitney U test and Fisher’s exact test was performed. Receiver operating characteristic (ROC) curve analysis was performed to compare the ability of the liver scoring systems to predict the occurrence of study outcomes. Binary logistic regression was performed to measure the odds ratio.

RESULTS

The ALBI grade and ALBI-APRI score were significantly associated with both POHD and in-hospital mortality. Both scores were non-inferior to the CTP and MELD scores in predicting study outcomes. Compared to CTP and MELD scores, the ALBI grade was more sensitive but less specific in predicting POHD and as sensitive but more specific in predicting in-hospital mortality. The ALBI-APRI score was less sensitive but more specific than the ALBI grade in predicting both POHD and in-hospital mortality.

CONCLUSION

The ALBI grade and ALBI-APRI score were both associated with postoperative hepatic decompensation and in-hospital mortality and were noninferior to the CTP score and MELD score in predicting short-term in-hospital outcomes among cirrhotic patients after non-hepatic surgery.

Liver Cirrhosis ; In-hospital Mortality ; Hospital Mortality

INTRODUCTION: Out-of-hospital-cardiac-arrest (OHCA) is a major public health challenge and post-return-of-spontaneous-circulation (ROSC) goals have shifted from just survival to survival with intact neurology. Although post-ROSC care is crucial for survival with intact neurology, there are insufficient well-established protocols for post-resuscitation care. We aimed to evaluate post-resuscitation care in the emergency department (ED) of adult (aged ≥16 years) OHCA patients with sustained ROSC and its associated neurologically intact survival. METHODS: A retrospective review of electronic medical records was conducted for OHCA patients with sustained ROSC at the ED. Data including demographics, pre-hospital resuscitation, ED resuscitation, post-resuscitation care and eventual outcomes were analysed. RESULTS: Among 921 OHCA patients, 85 (9.2%) had sustained ROSC at the ED. Nineteen patients (19/85, 22.4%) survived, with 13 (13/85, 15.3%) having intact neurology at discharge. Electrocardiogram and chest X-ray were performed in all OHCA patients, whereas computed tomography (CT) was performed inconsistently, with CT brain being most common (74/85, 87.1%), while CT pulmonary angiogram (6/85, 7.1%), abdomen and pelvis (4/85, 4.7%) and aortogram (2/85, 2.4%) were done infrequently. Only four patients (4.7%) had all five neuroprotective goals of normoxia, normocarbia, normotension, normothermia and normoglycaemia achieved in the ED. The proportion of all five neuroprotective goals being met was significantly higher ( P = 0.01) among those with neurologically intact survival (3/13, 23.1%) than those without (1/72, 1.4%). CONCLUSION Post-resuscitation care at the ED showed great variability, indicating gaps between recommended guidelines and clinical practice. Good quality post-resuscitation care, centred around neuroprotection goals, must be initiated promptly to achieve meaningful survival with intact neurology.
Humans ; Out-of-Hospital Cardiac Arrest/mortality* ; Retrospective Studies ; Male ; Female ; Middle Aged ; Emergency Service, Hospital ; Cardiopulmonary Resuscitation/methods* ; Return of Spontaneous Circulation ; Aged ; Adult ; Treatment Outcome ; Electrocardiography ; Tomography, X-Ray Computed ; Aged, 80 and over

INTRODUCTION: Oral cancer is a major public health concern in India. Both conventional and altered fractionation radiotherapy schedules have been used in curative treatment of oral cancer. This study aimed to retrospectively evaluate the clinical profile and treatment outcomes of patients with carcinoma buccal mucosa who underwent treatment with definitive hypofractionated accelerated radiotherapy. METHODS: A total of 517 patients treated from January 2011 to December 2016 were eligible for the analysis. All patients were treated with definitive hypofractionated accelerated radiotherapy schedule of 5,250 cGy in 15 fractions over 3 weeks. Survival estimates were generated using the Kaplan-Meier method. RESULTS: At a median follow-up of 77.4 months, 473 (91.5%) patients attained complete remission with radiation therapy. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 69% and 80.5%, respectively. The 5-year OS for stage I, II, III and IVa tumours was 80.3%, 84.4%, 81.4% and 73.7%, respectively, and the DFS was 75.7%, 73.2%, 69.6% and 60.2%, respectively. Age >50 years was found to be a significant factor affecting DFS ( P = 0.026) and OS ( P = 0.048) in multivariate analysis. Fifty-three (10.3%) patients developed osteoradionecrosis of the mandible. CONCLUSION Excellent outcome could be achieved in less-aggressive, low-volume carcinoma of the buccal mucosa with radical accelerated hypofractionated radiotherapy. A radiotherapy schedule over a 3-week period is useful in high-volume centres.
Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Mouth Neoplasms/mortality* ; Mouth Mucosa/radiation effects* ; Treatment Outcome ; Aged ; Adult ; Radiation Dose Hypofractionation ; Disease-Free Survival ; India ; Kaplan-Meier Estimate ; Dose Fractionation, Radiation ; Aged, 80 and over

INTRODUCTION: Testicular tumours in childhood have diverse characteristics for different age ranges. This study aimed to describe the pattern, presentation and outcomes of primary testicular tumours in a paediatric population. METHODS: A retrospective study was conducted from January 2010 to December 2020 on children (≤18 years) with a diagnosis of primary testicular tumour. Baseline demographics, clinical characteristics, pathology, treatment and outcomes of these patients were analysed. The data were entered into IBM SPSS Statistics version 20.0. Chi-square test and Fisher's exact test were applied to find the statistical significance, which was set at P value ≤ 0.05. RESULTS: The study included 115 males, with 85 (73.9%) patients in the prepubertal age range with a mean age of 2.53 ± 2.06 years and 30 (26.1%) patients in the postpubertal group with a mean age of 15.73 ± 1.25 years. Yolk sac tumour was the most common (62.6%) histological subtype. Majority (46.1%) of patients had stage I disease on presentation, while 29.6% had stage IV disease. All patients underwent upfront high inguinal radical orchiectomy, which was followed by platinum-based adjuvant chemotherapy in 67% of the patients. The five-year event-free survival and overall survival for all patients were 75% and 91%, respectively. CONCLUSION Primary testicular tumours follow a bimodal age distribution pattern. Majority of patients can be cured with platinum-based chemotherapy despite having advanced disease at presentation.
Humans ; Male ; Testicular Neoplasms/mortality* ; Retrospective Studies ; Adolescent ; Child ; Child, Preschool ; Orchiectomy/methods* ; Chemotherapy, Adjuvant ; Treatment Outcome ; Neoplasm Staging ; Infant ; Endodermal Sinus Tumor/therapy* ; Neoplasms, Germ Cell and Embryonal

INTRODUCTION: Degenerative mitral stenosis (DMS) is frequently cited as increasing in prevalence in the developed world, although comparatively little is known about DMS in comparison to rheumatic mitral stenosis (RMS). METHOD: A retrospective observational study was conducted on 745 cases of native-valve mitral stenosis (MS) with median follow-up time of 7.25 years. Clinical and echocardiographic parameters were compared. Univariate and multivariate Cox regression analyses were performed for a composite of all-cause mortality and heart failure hospitalisation. RESULTS: Patients with DMS compared to RMS were older (age, mean ± standard deviation: 69.6 ± 12.3 versus [vs] 51.6 ± 14.3 years, respectively; P<0.001) and a greater proportion had medical comorbidities such as diabetes mellitus (78 [41.9%] vs 112 [20.0%], P<0.001). The proportion of cases of degenerative aetiology increased from 1.1% in 1991-1995 to 41.0% in 2016-2017. In multivariate analysis for the composite outcome, age (hazard ratio [HR] 95% confidence interval [CI] of 1.032 [1.020-1.044]; P<0.001), diabetes mellitus (HR 1.443, 95% CI 1.068-1.948; P=0.017), chronic kidney disease (HR 2.043, 95% CI 1.470-2.841; P<0.001) and pulmonary artery systolic pressure (HR 1.019, 95% CI 1.010- 1.027; P<0.001) demonstrated significant indepen-dent associations. The aetiology of MS was not independently associated with the composite outcome. CONCLUSION DMS is becoming an increasingly common cause of native-valve MS. Despite numerous clinical differences between RMS and DMS, the aetiology of MS did not independently influence a composite of mortality or heart failure hospitalisation.
Humans ; Mitral Valve Stenosis/etiology* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Rheumatic Heart Disease/mortality* ; Echocardiography ; Hospitalization/statistics & numerical data* ; Heart Failure/epidemiology* ; Singapore/epidemiology* ; Proportional Hazards Models ; Diabetes Mellitus/epidemiology*