OBJECTIVES

This study aimed at determining the association of the clinical profile of patients with GDM to maternal and neonatal outcomes

METHODS

This single-center, retrospective, descriptive, cross-sectional chart review was conducted in a tertiary hospital in Cebu City to 229 patients with GDM admitted from January 2021 to December 2022.

RESULTS

The study revealed several significant associations. Hypertension was strongly linked with primary cesarean section (OR: 4.32, P-value 0.004); and severe pre-eclampsia (OR: 16.97, P-value: 0.000). Gravidity showed significant correlations with Ballard’s score (P-value: 0.013), birthweight (P-value: 0.045) and 5-minute APGAR score (P-value: 0.001). Parity was associated with birthweight (P-value: 0.011) and 5-minute APGAR score (P-value: 0.001). Weight gain during pregnancy was linked to birthweight (P-value: 0.004) and occurrence of congenital anomalies (OR: 1.26, P-Value: 0.032). Additionally, prenatal smoking was associated with 5-minute APGAR score (P-value: 0.006). Moreover, having a Small for Gestational Age (SGA) fetal growth status is associated with insulin-requiring mothers, (OR: 4.79, P-Value: 0.049); and a family history of diabetes was significantly associated with insulin therapy (OR: 5.38, P-value: 0.021).

CONCLUSION

Patients' clinical profile affect maternal and neonatal outcomes among patients with GDM. Careful consideration of these factors during the perinatal period may help reduce maternal and fetal risks

Tertiary Care Centers ; Smoking ; Pregnancy ; Diabetes, Gestational ; Hypertension ; Apgar Score

OBJECTIVES

Clinical pathways (CPs) ensure adherence to heart failure (HF) management guidelines. To optimize quality care in a low resource setting, an evidence-based care pathway for the management of acute HF was implemented at the emergency department (ED) of the Philippine General Hospital (PGH), the designated national tertiary hospital and referral center. This study aimed to describe the characteristics of adults with acute HF admitted at the ED and evaluate the quality of care they received, measured using physician adherence to the hospital’s acute heart failure CP.

METHODS

This was a retrospective, descriptive cohort study. We reviewed the inpatient charts of all adult patients with acute HF admitted to the ED of the PGH and referred to the Division of Cardiovascular Medicine between December 1, 2022 and May 31, 2023. Quality of care was assessed based on adherence to quality indicators adapted from routine and conditional order sets detailed in the pathway. Descriptive statistics was utilized to describe patient characteristics, quality of care, and outcomes.

RESULTS

Two hundred thirty-six (236) patients were included, with a mean age of 51.8 years. Majority were male (53.4%); hypertension (61.4%) and ischemic heart disease (53.8%) were the most common comorbidities, and infection the most common precipitant of decompensation (60.6%). There were optimal adherence rates to routine orders, which included referrals to Internal Medicine and Cardiology, baseline vital signs monitoring, fluid intake and output monitoring, chest radiograph, complete blood count, blood urea nitrogen, sodium, potassium, prothrombin time, partial thromboplastin time, arterial blood gas, urinalysis, and N-terminal pro b-type natriuretic peptide. Conditional orders, such as oxygen support, focused echocardiography, thyroid - stimulating hormone, and the use of vasopressors, diuretics, and venous thromboembolism prophylactic agents, were optimally performed when warranted. However, we noted suboptimal adherence to certain resource-intensive conditional orders, such as hourly monitoring of urine output (61.4%), hooking to cardiac monitor (53.8%), and performance of 12-lead ECG within 10 minutes (56.8%). Further, only 43.9% of patients were referred to the intensive care unit. Troponin I, calcium, magnesium, and albumin were ordered in excess.

CONCLUSION

Overall adherence rate of physicians to the hospital’s Acute Heart Failure Pathway was satisfactory. Work is needed to improve adherence to hourly urine output monitoring, consistent hooking to cardiac monitor, and timely performance of 12-lead ECG – an effort that begins with expanding in-hospital diagnostic equipment and human resource supply. We recommend continuous pathway implementation with periodic evaluation and stakeholder feedback to further improve quality of care.

Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult ; Albumins ; Blood ; Blood Urea Nitrogen ; Calcium ; Cardiology ; Chart ; Charts ; Cohort Studies ; Critical Care ; Critical Pathways ; Diagnostic Equipment ; Disease ; Diuretics ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Equipment And Supplies ; Evaluation Studies As Topic ; Feedback ; Heart ; Heart Diseases ; Heart Failure ; Hormones ; Hospitals ; Hospitals, General ; Humans ; Hypertension ; Indicators And Reagents ; Infection ; Infections ; Inpatients ; Intensive Care Units ; Internal Medicine ; Lead ; Magnesium ; Male ; Medicine ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Natriuretic Peptides ; Nitrogen ; Overall ; Oxygen ; Partial Thromboplastin Time ; Patients ; Peptides ; Philippines ; Physicians ; Potassium ; Prothrombin ; Prothrombin Time ; Quality Of Health Care ; Referral And Consultation ; Sodium ; Statistics ; Tertiary Care Centers ; Thorax ; Thromboembolism ; Thromboplastin ; Thyroid Gland ; Time ; Troponin ; Troponin I ; Universities ; Urea ; Urinalysis ; Urine ; Venous Thromboembolism ; Vital Signs ; Work ; Workforce

BACKGROUND AND OBJECTIVES

Technological advancements are reshaping healthcare, particularly through mobile health (mHealth) applications that aid chronic disease management. Medication tracking apps, such as Simpill, have shown potential in improving outcomes for conditions like hypertension. However, disparities in digital literacy and concerns related to technology acceptance and privacy may hinder effective use. Grounded in the principles of the Design Thinking approach, this study sought to evaluate the relationship between health-seeking behavior (HSB), perceived barriers (PB), and the perceived usability (PU) of Simpill among middle-aged hypertensive adults. The research aimed to capture not only measurable associations but also to inform future app development through a user-centered lens that prioritizes empathy and real-world usability.

METHODS

A quantitative, descriptive-correlational research design was employed to assess respondents’ HSB, PB, and PU related to Simpill. The study was guided by core phases of the Design Thinking framework, particularly empathize and define, to ensure a deep understanding of user needs and usability constraints. Data were collected using a four-part, researcher-modified questionnaire administered to 138 purposively selected middle-aged adults (30–59 years old) residing in Barangay Industrial Valley, Zone 6, Marikina City, Philippines. All participants had a confirmed diagnosis of hypertension. Correlational analyses, including Kendall’s Tau B, were conducted to examine relationships among the variables. The integration of Design Thinking informed the development and interpretation of questionnaire items, aligning them with real-world challenges experienced by the target users.

RESULTS

The study investigated the relationship between HSB, PB, and the PU of Simpill among 138 middle-aged hypertensive individuals. Most respondents were female (55.8%), aged 50–59 (47.8%), and employed in non health-related sectors (95.7%). HSB levels were gene rally high (mean = 3.23), particularly in actively seeking health information, while lower engagement was noted in routine vital sign monitoring. PB were moderate (mean = 2.06), with unfamiliarity with the application cited as a common issue. PU was also rated as moderate (mean = 2.80), although ease of use received a low score (mean = 1.99). A weak positive correlation was found between HSB and PU (Kendall’s Tau B = 0.123, p = 0.049), while a moderate negative correlation existed between PB and PU (Tau B = -0.402, p < 0.001). These findings reflect insights derived from the Design Thinking "empathize" phase, suggesting that while proactive health behaviors may modestly support app engagement, unresolved user pain points—such as poor usability and lack of familiarity—remain significant obstacles to adoption. The results underscore the importance of moving to the "ideate" and "prototype" phases, where such user insights can directly shape the redesign and improvement of mHealth tools.

CONCLUSION

The study identified a high level of health- seeking behavior, reflecting the respondents’ engagement with their health and openness to guidance, consistent with the user-empathy foundation of Design Thinking. Moderate perceived barriers highlight existing challenges in technology adaptation, particularly among those who prefer traditional methods. The moderate PU rating of Simpill, especially in terms of ease of use, suggests the app’s current design does not fully align with user capabilities or expectations. In line with Design Thinking principles, particularly user-centered innovation, the findings emphasize the need to involve users in iterative co-design processes to improve mHealth solutions. Addressing perceived barriers through enhanced digital literacy, usability testing, and interface refinement could substantially boost app acceptance and effectiveness in real-world settings.

Human ; Hypertension ; Mobile Applications ; Health Behavior ; User-centered Design

INTRODUCTION

Secondary hypertension should be suspected among young individuals and patients with recent onset of hypertension or drug-resistant hypertension. Among the causes of secondary hypertension, renovascular hypertension is well-established and correctible if diagnosed appropriately. We report the case of a young female with an unusual cause of renovascular hypertension.

CLINICAL PRESENTATION:

A 29-year-old female was admitted for elevated blood pressure and headache, unresponsive to multiple antihypertensives. The workup for secondary hypertension was mostly unremarkable. However, renal Doppler ultrasound showed elevated peak systolic velocity in the left renal artery. CT angiogram revealed an outpouching between the left gonadal and renal veins. No renal artery stenosis was found on renal angiography, but venography revealed an aneurysm between the left gonadal and renal veins. An aberrant vein draining into the inferior vena cava (IVC) and severe reflux into a dilated left gonadal vein were also noted.

MANAGEMENTCONCLUSION

This case highlights a rare cause of renovascular hypertension due to renal vein congestion from severe left gonadal vein reflux and a renal/gonadal vein aneurysm. Additional mechanisms may include external compression of the renal artery or a suction effect caused by multiple venous outflows. Regardless of the exact pathophysiology, coiling of the aneurysm and gonadal vein successfully restored normal venous return and resolved hypertension.

Human ; Female ; Adult: 25-44 Yrs Old ; Veins ; Research Report ; Renal Veins ; Pharmaceutical Preparations ; Patients ; Hypertension, Renovascular ; Hypertension ; Female ; Aneurysm

Ischemic heart disease (IHD) remains the most common cause of death while cerebrovascular disease (CVD) is the third most common in the Philippines. IHD and CVD represent complications resulting from prevalent non-communicable diseases (NCDs) and risk factors which present important opportunities for primary and secondary prevention.

This study aimed to pilot a sustainable multisectoral approach for community-based screening and management of cardiovascular (CV) risk factors and determine the effects of a multisectoral collaboration approach on the rate of screening, prevalence and control rates for selected risk factors.

This is a quality improvement project that determines the baseline prevalence and control rates of CV risk factors followed by intense screening efforts with support from private partnerships. The project's core components are: (a) capacity building (b) information dissemination; (c) service provision; and (d) health monitoring. Rates of screening, prevalence and control were monitored over a two-year period.

A total of 94,125 patients were screened through the ONE Cavite Project over two years (January 2021 to December 2022). A total of 61,271 were newly identified as having hypertension (65.1%), 24,069 diagnosed with diabetes mellitus type 2 (25.6%), 29,257 diagnosed to have dyslipidemia (31.1%) and 13,204 smokers (14.0%) were identified.

Intensification of screening was successful in improving identification of individuals with NCDs. The impact of continued educational support for both providers and patients in this study reaffirmed its role as a central component of NCD diagnosis, management and prevention.

Hypertension ; Diabetes Mellitus ; Dyslipidemias ; Myocardial Ischemia ; Primary Prevention

Ischemic heart disease (IHD) remains the most common cause of death while cerebrovascular disease (CVD) is the third most common in the Philippines. IHD and CVD represent complications resulting from prevalent non-communicable diseases (NCDs) and risk factors which present important opportunities for primary and secondary prevention.

This study aimed to pilot a sustainable multisectoral approach for community-based screening and management of cardiovascular (CV) risk factors and determine the effects of a multisectoral collaboration approach on the rate of screening, prevalence and control rates for selected risk factors.

This is a quality improvement project that determines the baseline prevalence and control rates of CV risk factors followed by intense screening efforts with support from private partnerships. The project's core components are: (a) capacity building (b) information dissemination; (c) service provision; and (d) health monitoring. Rates of screening, prevalence and control were monitored over a two-year period.

A total of 94,125 patients were screened through the ONE Cavite Project over two years (January 2021 to December 2022). A total of 61,271 were newly identified as having hypertension (65.1%), 24,069 diagnosed with diabetes mellitus type 2 (25.6%), 29,257 diagnosed to have dyslipidemia (31.1%) and 13,204 smokers (14.0%) were identified.

Intensification of screening was successful in improving identification of individuals with NCDs. The impact of continued educational support for both providers and patients in this study reaffirmed its role as a central component of NCD diagnosis, management and prevention.

Hypertension ; Diabetes Mellitus ; Dyslipidemias ; Myocardial Ischemia ; Primary Prevention

Food-derived bioactive peptides (FBPs), particularly those with ten or fewer amino acid residues and a molecular weight below 1300 Da, have gained increasing attention for their safe, diverse structures and specific biological activities. The development of FBP-based functional foods and potential medications depends on understanding their structure‒activity relationships (SARs), stability, and bioavailability properties. In this review, we provide an in-depth overview of the roles of FBPs in treating various diseases, including Alzheimer's disease, hypertension, type 2 diabetes mellitus, liver diseases, and inflammatory bowel diseases, based on the literature from July 2017 to Mar. 2023. Subsequently, attention is directed toward elucidating the associations between the bioactivities and structural characteristics (e.g., molecular weight and the presence of specific amino acids within sequences and compositions) of FBPs. We also discuss in silico approaches for FBP screening and their limitations. Finally, we summarize recent advancements in formulation techniques to improve the bioavailability of FBPs in the food industry, thereby contributing to healthcare applications.
Humans ; Peptides/therapeutic use* ; Structure-Activity Relationship ; Functional Food ; Diabetes Mellitus, Type 2/drug therapy* ; Biological Availability ; Alzheimer Disease/drug therapy* ; Inflammatory Bowel Diseases/drug therapy* ; Hypertension/drug therapy* ; Liver Diseases/drug therapy* ; Bioactive Peptides, Dietary

COMPERA 2.0 risk stratification has been demonstrated to be useful in patients with precapillary pulmonary hypertension (PH). However, its suitability for patients at risk for post-capillary PH or PH associated with left heart disease (PH-LHD) is unclear. To investigate the use of COMPERA 2.0 in patients with severe aortic stenosis (SAS) undergoing transcatheter aortic valve replacement (TAVR), who are at risk for post-capillary PH, a total of 327 eligible SAS patients undergoing TAVR at our institution between September 2015 and November 2020 were included in the study. Patients were classified into four strata before and after TAVR using the COMPERA 2.0 risk score. The primary endpoint was all-cause mortality. Survival analysis was performed using Kaplan-Meier curves, log-rank test, and Cox proportional hazards regression model. The study cohort had a median (interquartile range) age of 76 (70‒80) years and a pulmonary arterial systolic pressure of 33 (27‒43) mmHg (1 mmHg=0.133 kPa) before TAVR. The overall mortality was 11.9% during 26 (15‒47) months of follow-up. Before TAVR, cumulative mortality was higher with an increase in the risk stratum level (log-rank, both P<0.001); each increase in the risk stratum level resulted in an increased risk of death (hazard ratio (HR) 2.53, 95% confidential interval (CI) 1.54‒4.18, P<0.001), which was independent of age, sex, estimated glomerular filtration rate (eGFR), hemoglobin, albumin, and valve type (HR 1.76, 95% CI 1.01‒3.07, P=0.047). Similar results were observed at 30 d after TAVR. COMPERA 2.0 can serve as a useful tool for risk stratification in patients with SAS undergoing TAVR, indicating its potential application in the management of PH-LHD. Further validation is needed in patients with confirmed post-capillary PH by right heart catheterization.
Humans ; Aortic Valve Stenosis/complications* ; Aged ; Hypertension, Pulmonary/mortality* ; Male ; Female ; Transcatheter Aortic Valve Replacement ; Aged, 80 and over ; Risk Assessment/methods* ; Proportional Hazards Models ; Kaplan-Meier Estimate ; Retrospective Studies

OBJECTIVES: To explore the mechanism of Qingda Granules (QDG) for alleviating brain damage in spontaneously hypertensive rats (SHRs). METHODS: Twelve 5-week-old SHRs were randomized into SHR control group and SHR+QDG group treated with QDG by gavage at the daily dose of 0.9 g/kg for 12 weeks. The control rats, along with 6 age-matched WKY rats, were treated with saline only. Blood pressure changes of the rats were monitored, and pathologies and neuronal apoptosis in the cerebral cortex were examined with HE staining and TUNEL staining. Cerebral cortical expressions of miR-124 and STAT3 mRNA were detected using RT-qPCR, and the protein expressions of NeuN, STAT3, Bcl-2, Bax, and cleaved caspase-3 were detected with immunohistochemistry and Western blotting. In a HT22 cell model of oxygen and glucose deprivation/reoxygenation (OGD/R), the effects of QDG on cell viability and apoptosis, expressions of miR-124 and STAT3 mRNA, and protein expressions of STAT3, Bcl-2, Bax, and cleaved caspase-3 were evaluated using CCK8 assay, Hoechst 33342 staining, RT-qPCR, and Western blotting. RESULTS: Compared with WKY rats, SHRs had significantly elevated systolic blood pressure, diastolic blood pressure and mean arterial pressure with significantly increased neuronal apoptosis in the cerebral cortex, reduced expressions of NeuN, miR-124 and Bcl-2, and enhanced expressions of STAT3, Bax and cleaved caspase-3 (P<0.05). All these changes in the SHRs were significantly ameliorated by treatment with QDG (P<0.05). In the HT22 cell model, QDG treatment obviously reduced OGD/R-induced cell apoptosis, increased the expressions of miR-124 and Bcl-2, and suppressed the elevation of protein expressions of STAT3, Bax and cleaved caspase-3. CONCLUSIONS QDG inhibits cerebral cortical neuronal apoptosis and thereby attenuates brain damage in SHR rats by modulating the miR-124/STAT3 signaling axis.
Animals ; Rats, Inbred SHR ; MicroRNAs/metabolism* ; STAT3 Transcription Factor/metabolism* ; Signal Transduction/drug effects* ; Drugs, Chinese Herbal/pharmacology* ; Rats ; Apoptosis/drug effects* ; Rats, Inbred WKY ; Male ; Hypertension

OBJECTIVES: To explore the correlation of hypertension with postoperative cognitive dysfunction and its possible mechanism. METHODS: Twelve-week-old spontaneously hypertensive rats (SHRs) and Wistar-Kyoto (WKY) rats were both randomized into control group and surgical group (n=8). In the latter group, the rats received carotid artery exposure surgery under sevoflurane anesthesia to establish models of postoperative learning and memory impairment. Postoperative cognitive function changes of the rats were evaluated using behavioral tests. The hippocampus of the rats were collected for determining ATP level and mitochondrial membrane potential (MMP) and for detecting expressions of UCP2 and astrocyte markers (GFAP and NOX4) using Western blotting and immunofluorescence staining. Serum levels of ROS, IL-6, IL-1β and TNF‑α were detected using ELISA. Nissl staining was used to examine hippocampal neuronal loss in the CA1 region. RESULTS: The SHRs exhibited exacerbated learning and memory deficits following the surgery as shown by significantly reduced performance in novel object recognition tests and context-related and tone-related fear conditioning experiments. Compared with WKY rats, the SHRs had significantly decreased mitochondrial UCP2 expression and MMP in the hippocampus, increased hippocampal ATP level, and markedly increased serum levels of ROS and inflammatory factors, showing also increased activation of hippocampal astrocytes and microglia and reduced number of neurons positive for Nissl staining. CONCLUSIONS Hypertension can exacerbate major postoperative learning and memory impairment in rats possibly as a result of UCP2-mediated mitochondrial dysfunction and oxidative stress damage, which further leads to astrocyte overactivation and neuronal damage.
Animals ; Rats, Inbred SHR ; Rats ; Uncoupling Protein 2 ; Rats, Inbred WKY ; Hypertension/physiopathology* ; Hippocampus/metabolism* ; Mitochondria/metabolism* ; Down-Regulation ; Male ; Memory Disorders/etiology* ; Mitochondrial Proteins/metabolism*