INTRODUCTION

It is anticipated that Chronic Obstructive Pulmonary Disease (COPD) has greater risk in acquiring COVID-19 infection and poorer outcome. However, current worldwide data are conflicting.

This study primarily aims to compare the outcomes of COVID-19 patients with COPD and those without COPD in terms of length of hospital stay (LOS), recovery or mortality, treatment received, and predictors of mortality.

This is a retrospective cohort chart review of 1,017 admitted adult COVID-19 patients from July to December 2020. Age, gender, smoking status, current control and medications for COPD, COVID-19 severity, symptoms, treatment, and outcomes of the two study groups were compared.

Prevalence rate of COPD was 3.8%. COVID-19 patients with COPD were older (median age of 69 vs 54, pCONCLUSION

COPD increases the risk for severe COVID-19 and lengthens LOS.

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is prevalent in patients with Type 2 Diabetes Mellitus (T2DM) and is associated with chronic kidney disease (CKD). The aim of this cross-sectional study was to determine the association of Fibrosis-4 (FIB-4) index with CKD among T2DM patients with concomitant NAFLD.

A single center, analytical cross-sectional study was conducted among 216 T2DM patients with concomitant NAFLD. Clinical data were obtained via retrospective review of medical charts. The outcome of interest was CKD which was based on self-report obtained from medical charts or estimated Glomerular Filtration Rate (eGFR)RESULTS

Higher FIB-4 index was found to be significantly associated with CKD. Patients with FIB-4 index of 1.45-3.25 (moderate risk) and >3.25 (high risk) have about 3 times higher odds of CKD. However, after controlling for the significant confounders, only those who belong to high-risk group was found to be associated with CKD.

This study has demonstrated that FIB4 index > 3.25, an index of liver fibrosis, is significantly associated with development of CKD in T2DM patients with concomitant NAFLD.

INTRODUCTION

Chronic Kidney Disease (CKD) is a leading cause of morbidity and mortality in the Philippines. Most Filipino CKD patients prefer hemodialysis due to barriers such as cost and availability of Kidney Transplant. End-stage kidney disease (ESKD) patients face high symptom burden and unmet palliative care needs. Even with advancement in dialysis technology, the annual mortality rate of dialysis patients remains between 20% and 25%. While Advance Care Planning (ACP) can help align care with patient preferences by facilitating discussions about values and future decisions, its utilization in dialysis population remains low due to barriers in implementation. There is limited research specifically addressing the preferences and influencing factors of Advance Care Planning among CKD patients on hemodialysis in the Philippines.

This study aimed to determine the ACP preferences of CKD patients undergoing hemodialysis and to identify the clinicodemographic factors associated with these preferences.

An analytic cross-sectional study was conducted involving 96 chronic kidney disease (CKD) patients undergoing hemodialysis at Baguio General Hospital and Medical Center (BGHMC) from October to November 2024. Data were collected using validated questionnaires administered either through face-to-face interviews or self-administration, depending on patients’ preferences and capabilities. Descriptive and inferential statistical methods were employed for data analysis.

The study revealed limited awareness of ACP among participants (86.5%), underscoring the need for education. Family-centered decision-making was prominent, with most participants preferring family members as surrogate decision-makers and confidants. Quality of life was prioritized over life extension, and preferences for “Do Not Resuscitate” (DNR) orders were notable. Educational attainment and ethnicity significantly influenced preferences, with higher education linked to greater awareness; and Ethnicity shaping preferences for decision-makers, confidants, timing of discussions, and resuscitation choices. Additionally, duration of dialysis was linked to care setting preferences, while social support systems influenced the preferred place for discussions.

The findings highlight critical associations between clinicodemographic factors and ACP preferences among hemodialysis patients. Addressing these associations through targeted education and culturally sensitive approach can promote high-quality end-of-life care, aligned with diverse patient needs, values, and preferences.

BACKGROUND

Chronic Kidney Disease (CKD) patients often face critical treatment decisions that significantly affect their quality of life, making Shared Decision-Making (SDM), a collaborative approach between patients and healthcare providers, an essential component of patient-centered care.

This study aimed to investigate the impact of SDM on decisional readiness and patient satisfaction among CKD patients undergoing hemodialysis (HD) at Southern Isabela Medical Center (SIMC).

An analytical cross-sectional design was utilized. The Tagalog Version of SDM Q-9 questionnaire, Decision survey and CSAT survey tool were given to HD patients of SIMC from September – October 2024. Descriptive statistics, Pearson product-moment correlation and chi square test were used to report and analyze data.

One hundred eight (108) CKD patients on HD were included in the study. Shared decision-making score was high and overall satisfaction on health services was outstanding. Higher decisional readiness was associated with greater odds of reporting outstanding satisfaction (OR = 3.47, 95% CI: 2.563–4.688, p = 0.009). There was no significant association between patient satisfaction and SDM (r= 0.111, p =0.253.). Shared decision-making had a significant but weak positive correlation with decisional readiness (r =0.2043, p 0.035).

This study showed that fostering SDM positively enhances patients’ preparedness to make healthcare decisions. Decisional readiness is strongly associated with patient satisfaction, as confident patients are more likely to be satisfied with their care. The findings underscore the need for improved patient education to boost decisional readiness and support ongoing SDM practices. Integrating SDM into clinical workflows is essential to advancing patient-centered care and improving health outcomes for CKD patients undergoing hemodialysis.

Peripheral nerve block (PNB) has been successfully used as the sole anesthetic for Peritoneal dialysis (PD) catheter insertion, and has been shown to provide satisfactory anesthesia and analgesia perioperatively, especially among critically – ill patients.

This report describes the anesthetic management of an 18 – year old underweight patient with End-stage renal disease (ESRD) and decompensated heart failure who was scheduled for PD catheter insertion. He was given a left lateral Transversus abdominis plane (TAP) block and a right Rectus sheath (RS) block as the main anesthetic. Fifteen mL of Isobaric Bupivacaine 0.375% with Epinephrine 1:400,000 dilution was injected for the TAP block, and 10mL for the RS block, for a total volume of 25mL (93.7mg). Sedation was given via a Remifentanil infusion at 0.1mcg/kg/min. Intraoperatively, the patient was awake, conversant, and comfortable, no pressors were used, and no conversion to general anesthesia was done. Post-operatively, he had good pain control, with a pain score of 1/10, and successfully underwent dialysis via the PD catheter on the 2ndhospital day.

This pediatric patient who is critically ill is not a good candidate for general or neuraxial anesthesia due to the risk of hemodynamic instability and perioperative decompensation. PNB was done to provide anesthesia, and ensure good pain control post-operatively, and a right TAP and left RS were done instead of a bilateral TAP to lower the LA volume and decrease the risk of LA toxicity.

Unilateral TAP with contralateral RS is a safe anesthetic technique among critically-ill pediatric patients who will undergo PD catheter insertion without the risk of hemodynamic instability with general or neuraxial anesthesia.

: Peripheral nerve block (PNB) has been successfully used as the sole anesthetic for Peritoneal dialysis (PD) catheter insertion, and has been shown to provide satisfactory anesthesia and analgesia perioperatively, especially among critically – ill patients. : This report describes the anesthetic management of an 18 – year old underweight patient with End-stage renal disease (ESRD) and decompensated heart failure who was scheduled for PD catheter insertion. He was given a left lateral Transversus abdominis plane (TAP) block and a right Rectus sheath (RS) block as the main anesthetic. Fifteen mL of Isobaric Bupivacaine 0.375% with Epinephrine 1:400,000 dilution was injected for the TAP block, and 10mL for the RS block, for a total volume of 25mL (93.7mg). Sedation was given via a Remifentanil infusion at 0.1mcg/kg/min. Intraoperatively, the patient was awake, conversant, and comfortable, no pressors were used, and no conversion to general anesthesia was done. Post-operatively, he had good pain control, with a pain score of 1/10, and successfully underwent dialysis via the PD catheter on the 2nd hospital day. : This pediatric patient who is critically ill is not a good candidate for general or neuraxial anesthesia due to the risk of hemodynamic instability and perioperative decompensation. PNB was done to provide anesthesia, and ensure good pain control post-operatively, and a right TAP and left RS were done instead of a bilateral TAP to lower the LA volume and decrease the risk of LA toxicity. Unilateral TAP with contralateral RS is a safe anesthetic technique among critically-ill pediatric patients who will undergo PD catheter insertion without the risk of hemodynamic instability with general or neuraxial anesthesia.
Human ; Male ; Adolescent: 13-18 yrs old ; End-stage Renal Disease (ESRD) ; kidney failure, chronic ; heart failure

OBJECTIVE

To describe the treatment outcomes of patients who underwent Percutaneous Transluminal Angioplasty (PTA) for Central Vein Occlusive Disease (CVOD) in end-stage kidney disease and determine the association between patient profile and treatment outcomes.

A single-institution, retrospective review of patients aged 18 and above with end-stage kidney disease who underwent PTA for CVOD in the University of the Philippines - Philippine General Hospital (UP-PGH) from January 1, 2013, to December 31, 2022, was performed. These patients’ demographic and clinical profiles were evaluated using means, frequencies, and percentages. The relationship between patient profile and success of PTA was assessed using Chi-square and Mann-Whitney U tests.

One hundred one patients were included in the study. Eighty-two had a first intervention, and 19 had a recurrent first intervention. The mean age was 49.8 years, with forty-six (45.5%) males and fifty-five (54.5%) females. The most common comorbidity was hypertension (59.4%). This was followed by diabetes (35.6%), chronic glomerulonephritis (18.8%), and NSAID nephropathy (4.9%). Other comorbidities include lupus nephritis, urate nephropathy, and polycystic kidney disease. The interval between symptoms and intervention ranged from two weeks to ninety-six weeks. Eleven patients (10.9%) had an arterio-venous fistula (AVF) before initiating dialysis and did not have a history of dialysis catheter use. Temporary catheters comprise most of the central vein catheters (CVC) (84.2%), while tunneled catheters were a minority (8.9%). The overall central line insertions of one hundred one patients were one hundred fifty-five, most via the right internal jugular vein (86%). There was a total of one hundred twenty-seven lesions seen during venography. Most of these lesions were in the left Innominate vein (38.6%, 39/101) and the right innominate vein (32.7%, 33/101). The most common type of lesion was stenosis (47.5%), followed by abrupt occlusions (31.7%) and tapered occlusions (20.8%). The overall success rate of PTA was 74.2%. In the second intervention for recurrence (n=19), the success rate was 78.9% (15/19). Third-time intervention in three patients was all successful. The success rate in stenotic, tapered, and abrupt lesions were 100%, 85.7%, and 28.1%, respectively. Symptomfree intervals ranged from twelve to one hundred ninetytwo weeks. After a failed intervention, a new fistula or graft was the most common access option (50%). This was followed by central catheter (38.5%), venous bypass (7.7%), and peritoneal dialysis catheter (3.8%). Morbidity was 0.99%. The in-hospital mortality was zero.

Overall PTA success rate for non-recurrent and first operation of recurrent patients with CVOD was high (74%). Stenotic type of lesions were the best vessels to dilate. Failure of PTA was directly related to previous right subclavian catheter insertion, multiple central vein catheter insertions, lesions in the right innominate vein, and an abrupt type of central vein occlusion. The current strategy of PTA for CVOD is both safe and effective. Early AVF creation can prevent patients from requiring multiple catheter insertions and developing CVOD. The right internal jugular vein is the optimal choice for access, while subclavian vein access should be avoided.

Background: The global impact of the COVID-19 pandemic has been significant, affecting individuals across all health spectrums. Many have adapted their lifestyles to navigate the challenges posed by the pandemic. Despite this, there remains a lack of understanding regarding the specific lifestyle changes made by Filipinos with comorbidities during this time. Objectives: We aimed to ascertain the lifestyle changes among Filipinos with comorbidities and examine how their condition and various sociodemographic factors influenced these changes during the pandemic. Methodology: We conducted a community-based cross-sectional study involving 402 Filipino adults with comorbidities residing in Metro Manila. Using descriptive statistics, we summarized sociodemographic profiles and considerations for lifestyle changes. We assessed lifestyle changes using principal component analysis. Multiple linear regression was used to identify factors associated with these changes. Results: Lifestyle modifications include positive changes in a healthy diet, nutrition, and social support, as well as negative changes in restorative sleep, mental and physical states, and unhealthy eating habits. Monthly household income was positively associated with lifestyle changes. Specifically, individuals belonging to the middle to upper-income categories tend to adopt these modifications compared to those in the lower-income brackets (B [unstandardized beta]=3.99; 95% CI [Confidence Interval)= 0.98, 6.99). The primary reason for embracing these changes was to delay or prevent the progression of diseases, followed by the desire to minimize health complications. Conclusions High-income Filipinos are more inclined to adopt lifestyle modifications compared to lower-income individuals. Prioritizing disease prevention and minimizing health complications are common considerations for these changes.
Chronic Disease ; Comorbidity ; COVID-19 ; Health

Child ; Humans ; Granulomatous Disease, Chronic/complications* ; Pneumonia

Humans ; Aged ; Lung Diseases ; Pneumonia/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Administration, Inhalation ; Community-Acquired Infections/drug therapy*