Background: Worldwide, diabetes mellitus (DM) is a serious health issue with a global prevalence of 9.8% in 2021. According to the latest 2018 Expanded National Health and Nutrition survey done by the DOST-FNRI, the prevalence of diabetes in the Philippines have more than doubled from 3.4% in 2003 to 7.9% in 2018. The latest research conducted regarding diabetes care in the Philippines was in 2008 which showed that 85% of patients with diabetes failed to achieve the HbA1c general target of <7%. Objectives: A population-based cross-sectional study to update the current status of diabetes care in the Philippines, specifically to determine glycemic control, trends in DM management, prevalence of complications and lastly their clinico-socio demographic profile. Methods: 340 patients with diabetes were included from the clinics of the Institute for Studies on Diabetes Foundation, Inc. physicians. The following data were collected: clinico-socio demographic profile, HbA1C-based glycemic control, trend in the use of glucose lowering agents, and prevalence of diabetes complications. Results: The mean age of the 340 patients with diabetes in this study was 62 years old. Almost sixty-seven percent (66.8%) were females. The mean body mass index was 26 kg/m2. The mean duration of diabetes was 12.63 years. Close to sixty- eight percent (67.6%) had tertiary education, 58.8% were unemployed and 65% had above minimum income. The most commonly used single oral agent was biguanide (72.9%), followed by dipeptidyl peptidase-4 inhibitors (64.3%). The most common dual therapy combinations were biguanide plus dipeptidyl peptidase-4 inhibitors (43.2%), biguanide plus sulfonylureas (27.2%), and biguanide plus sodium-glucose co-transporter-2 inhibitors (11.1%). Basal insulin was the most commonly used injectable agent. The present study showed that 47.4% of patients achieved an HbA1c of <7%. For the microvascular complication group alone, most had neuropathy (30.4%) followed by nephropathy (17.3%) and by retinopathy (5.4%). For the macrovascular complication group, the most common was coronary artery disease (82%) followed by peripheral artery disease and DM foot (27%). Overall, the most frequent DM complication identified was neuropathy (30.4%) , nephropathy (17.3%) and coronary heart disease (16.1%). Discussion Compared to the 2008 study, oral glucose lowering agents’ usage shifted from sulfonylureas to more use of dipeptidyl peptidase-4 inhibitors. There was a decline in the use of thiazolidinediones, α-glucosidase inhibitors and non-use of meglitinides. For insulin use, there was a shift from the use of premixed insulin to more basal insulin usage. There was marked improvement in the diabetes care situation in the Philippines from the 2008 study to the 2020 study. Glycemic control defined as HbA1c level of <7.0 increased from 15% to 47.4%. Coronary artery disease was the most common macrovascular complication while neuropathy was the most common overall and microvascular complication.
Diabetes Complications ; Glycemic Control

Introduction: Coronavirus disease (COVID-19) is currently a global health crisis and is caused by a new strain of coronavirus. However, emerging literature of case reports noted possible extrapulmonary manifestations of the disease. Because COVID 19 is a relatively new disease, at present, little existing literature tackles the diagnosis and therapeutic management of COVID‐19‐related conditions outside the pulmonary system. Case: A 24-year-old male presented with sudden stiffening of all extremities but non-contrast computed tomography (CT) scan was unremarkable. Chest X-ray revealed interstitial pneumonia and SARS-CoV-2 RT-PCR (OPS/NPS) was positive. Electrocardiogram (ECG) findings showed supraventricular tachycardia and had elevated Troponin I levels. Pertinent physical findings noted were slurring of speech, dysmetria, and vertical nystagmus. The patient was initially treated as a case of Bacterial Abscess versus Viral encephalitis. Pericardial ultrasound revealed small pericardial effusion and was started on Colchicine. Repeat cranial CT scan noted unremarkable results but due to persistence of symptoms, the patient was started with Dexamethasone. On Day 16 of illness, the patient was noted to have full resolution of symptoms. Rapid antibody testing was done which revealed positive for both IgG and IgM hence the patient was discharged with the final diagnosis of Viral Myopericarditis resolved, Viral encephalitis resolved, COVID-19 pneumonia recovered. Conclusion Extrapulmonary manifestations have been reported increasingly as an atypical presentation of COVID 19 infection. Early recognition of viral myopericarditis and viral encephalitis as a manifestation of COVID 19 can lead to the initiation of proper treatment and management. More reports on these cases can aid future studies on diagnostics and therapeutic approaches during the COVID-19 pandemic.
COVID-19 ; Encephalitis, Viral ; SARS-CoV-2 ; Coronavirus Infections

Thyroid storm and thionamide-induced agranulocytosis are both rare and serious medical emergencies. We report a case of a patient in which these two rare events simultaneously occurred. A 33-year-old male, maintained on Methimazole for Graves’ Disease, presented with fever, throat pain, and uncontrolled thyrotoxic symptoms. Methimazole was promptly discontinued. Thyroid storm was alternatively treated with lithium, hydrocortisone, and propranolol. Agranulocytosis was managed supportively with GCSF and empiric antibiotics. Lithium was maintained until after radioablation. When thionamides are contraindicated, lithium is a viable option for the acute management of thyroid storm and a bridge to definitive therapy.
Methimazole ; Lithium

Introduction: Spontaneous acute subdural hematoma (ASDH) is rare and comprises 2.6% of all ASDH. In one recent study, only 178 spontaneous ASDH were documented. However, only 1 case was attributed to dural arteriovenous fistula (dAVF). Vascular malformations cause less than 10% of subarachnoid hemorrhage (SAH). Spontaneous ASDH and SAH occurring together are extremely rare. Literature is scarce on cases with dAVF of the occipital lobe as a cause of simultaneous spontaneous ASDH and SAH. Objective: This paper aims to present a case of a spontaneous acute subdural hematoma and subarachnoid hemorrhage caused by a dural arteriovenous fistula of the occipital lobe, along with its clinical presentation, diagnosis, and treatment. Case Summary: A 44-year-old Filipino male with no history of trauma presented with severe headache, vomiting, and decreasing sensorium – CT scan revealed acute parenchymal bleed in the left occipital lobe with subarachnoid extension and subdural hematoma in the left fronto-parieto-temporal convexity along the tentorium cerebelli and posterior interhemispheric falx. Due to the location of the lesion seen on the CT scan and the gender distribution, Arteriovenous malformation (AVM) was initially considered, thus proceeded to computed tomography angiogram (CTA) to establish the diagnosis of vascular anomaly, however, revealed dAVF instead. Four-vessel angiogram was done to assess the tributaries of the dAVF and confirmed the diagnosis. Complete obliteration of dAVF of the occipital lobe was done with Onyx Embolization in one session. Conclusion This is the first case of Borden type II, Cognard type IIa+IIb dAVF, as reported in this institution. Although extremely rare as a cause of SAH and ASDH, dAVF should be considered a differential diagnosis in patients with no identifiable common cause of the new onset of severe headache and poor neurologic status.
Subarachnoid Hemorrhage

Introduction: Human immunodeficiency virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS) prevalence has been increasing for the past years in the Philippines since the early 1980s. The health care team which is comprised of doctors, nurses, pharmacists, medical technologists, and other allied health practitioners is the front liner in the care and management of such patients afflicted with the disease. Methods: This descriptive cross-sectional study assessed the knowledge, attitudes, beliefs, and practices among the health workers in Makati Medical Center. A questionnaire based on the 1988 WHO Knowledge, Attitudes, Beliefs, and Practices (KABP) of AIDS survey was used. It was sent to 307 health workers selected by cluster sampling. Results: Based on the survey, sources of information among participants regarding HIV/AIDS were quite diverse; books and journals being the most common. The majority of the participants demonstrated satisfactory levels of awareness regarding HIV/AIDS and its mode of transmission; however, a small percentage of the respondents were found to have a misconception that there is a vaccine available for HIV/AIDS and that insect bites and sharing of utensils can transmit the virus. Some of the respondents also do not know much about transmission routes and there are a few who are not willing to care for and live with patients with HIV. The majority however have a positive attitude towards people living with HIV/AIDS. Conclusion Most of the respondents of this research have good knowledge regarding the disease process and its mode of transmission. At the same time, the majority of the respondents also have a positive attitude and acceptance towards people living with HIV/AIDS. The data from the study can be used to develop interventions to decrease if not eliminate HIV stigma and discrimination. Interventions can include educating health care workers by utilizing all possible modalities to have a broader reach.
HIV ; Acquired Immunodeficiency Syndrome ; Knowledge ; Attitude ; Health Personnel

Abstract: This current study aims to report the clinical profiles and characteristics of diabetic patients who had been admitted for hyperglycemic crises from 2007 to 2017 at our institution. Methodology: We conducted a retrospective study in a tertiary care university hospital outside Metro Manila. The data gathered were divided into three categories: clinical data, biochemical data and precipitating factors. Results: A total of 3,120 adult patients with diabetes mellitus were admitted for various reasons, and 71 cases presented with DKA or HHS over the 10-year period of review which is equivalent to 2% of all diabetes mellitus cases admitted. Forty-six (64.79%) of the patients with hyperglycemic crises were known diabetics with a duration of 7-13 years. Majority of patients were not taking anti diabetic medications upon admission. Most patients with hyperglycemic crises were tachycardic and hypertensive upon admission. Majority were discharged and improved. Majority of the cases 53 (81.69%) had DKA. The most common precipitating factor in DKA and HHS was infection. Conclusion In conclusion, the biochemical profiles in our series did not significantly differ from the past study by Gatbonton et.al (1998). Despite the advent of new therapies for diabetes mellitus control, mortality among the patients with hyperglycemic crises was slightly higher in our study at 11% compared to the global reported data of 2-10%. One of the reasons could be the minimal improvements in our health care delivery system that is still unable to cater to the needs of diabetic Filipinos. Early screening programs should be done for patients beginning age 40 years and even earlier for those with risk factors for prompt detection and treatment of diabetes mellitus. Education and awareness should be strengthened for patients with diabetes mellitus to avoid the crises by emphasizing the importance of regular follow-up, monitoring and compliance with a diabetic regimen, especially with insulin and multiple OADs (oral anti- diabetic drugs) since the disease is progressive, and timely intensification of therapy is needed.
Diabetes Mellitus, Type 2

Objectives: This study aimed to determine the mental health of Filipino healthcare workers (HCWs) in terms of their feelings and ability to cope during the COVID-19 pandemic and the factors that motivated them to continue their work. Methods and Results: This was a cross-sectional, descriptive survey, single-center study, conducted in Perpetual Succour Hospital, Cebu City, Philippines, within 3 months from the declaration of the COVID-19 pandemic. Of the 215 respondents, almost 50% thought of quitting their job due to fear of getting infected with COVID-19 and transmitting the disease to their families. Ninety-four percent (94%) of HCWs were nervous and scared and 85% were experiencing physical fatigue and emotional exhaustion. Despite all these, 97% of HCWs felt that their service during the pandemic was part of their professional obligation and ethical duty. HCWs coped with the present pandemic by strictly following safety protocols and the assurance of the safety of their families helped reduce their stress. Family support is their most important source of motivation. Conclusion Filipino HCWs experience physical and emotional stress during the COVID-19 pandemic but were motivated to work because of their professional obligation with an assurance of safety and support from their family.
Mental Health ; Adaptation, Psychological ; Health Personnel ; COVID-19

Background: On top of adjusting to the societal shifts and emotional stressors faced by everyone, health care workers are also confronted by stressors such as an increased risk of exposure, extreme workloads, moral dilemmas, and a dynamic practice environment that differs greatly from what was familiar. These can lead to burnout, a state of physical, emotional, and mental exhaustion that results from long-term involvement in work situations that are emotionally demanding. General Objective: This is a descriptive cross-sectional study that intends to measure the degree of burnout and determine its association with depression, anxiety, and stress among health care workers in Chong Hua Hospital Mandaue during the COVID-19 pandemic. Methodology: The data collection process entailed the researchers’ physical and online administration of a questionnaire which included the health care workers’ socio-demographic data and questions lifted from both the Copenhagen Burnout Inventory (CBI) and Depression, Anxiety, Stress Scales (DASS) 42-item. Also included was an open-ended questionnaire to enumerate outbreak-specific contributors to burnout. Results: 222 health care workers were surveyed. Almost half (98, 44.2%) of the health care workers registered moderate to high overall burnout scores on the CBI but none of them had severe burnout. The degree of burnout was determined to be moderately associated with all three negative emotional states using the Cramer’s V coefficient: depression (V = .448), anxiety (V = .378), and stress (V = .415). The foremost factor identified to be a contributor to burnout was the high workload which was exacerbated by the onset of the pandemic. Conclusion The study showed that burnout and the negative psychological states of depression, anxiety, and stress, are prevalent in health care providers with results comparable to other global studies. The contributors to burnout identified by the respondents were either present pre-pandemic but were aggravated by it and those which were outbreak-specific.
Burnout, Psychological ; COVID-19 ; Depression ; Anxiety

Introduction: The delicate balance of risk versus benefit of oral anticoagulation in the general population is well established but the decision to use these agents in end-stage renal disease (ESRD) remains complex and difficult owing to the paucity of clinical trials and lack of substantial evidence in literature for its safe and effective use in the hemodialysis population. This study aims to determine the difference in clinical outcomes between oral anticoagulation and no anticoagulation therapy among ESRD patients on maintenance hemodialysis with atrial fibrillation. Methods: This is a prospective, single-center, observational study conducted in Perpetual Succour Hospital that included all ESRD patients on maintenance hemodialysis for at least 3 months with atrial fibrillation. Out of the 188 identified patients, only 69 patients were included in the study and were grouped according to how the cardiac dysrhythmia was approached either with oral anticoagulation or no use of oral anticoagulation. Basic demographic information were obtained as well as the etiology of ESRD, CHA2DS2-VASc Score and the HAS-BLED Score. Lastly, patients were prospectively followed for a period of 12 months and were then assessed for new onset of thromboembolic events, hemorrhagic events, calciphylaxis and all-cause mortality. Results: At enrollment, 59 (85.5%) patients were identified to have no oral anticoagulation therapy and 10 (14.5%) were already receiving oral anticoagulation. Ischemic strokes were more prevalent among patients who were on oral anticoagulant (80%, p <0.0001). Patient outcomes differ significantly in terms of intracranial hemorrhage (30%, p= 0.0004) and gastrointestinal bleeding (50%, p <0.00001) which were noted among patients on oral anticoagulation. In relation to over-all mortality, acute myocardial infarction, peripheral arterial occlusive disease and calciphylaxis, there was no significant difference between the two groups. Conclusion This study suggests that the use of oral anticoagulation did not prevent ischemic strokes in ESRD patients on maintenance hemodialysis with atrial fibrillation and its use was associated with increased risk for intracranial hemorrhage and gastrointestinal bleeding. There was no significant difference in relation to all-cause mortality, acute myocardial infarction, peripheral arterial occlusive disease and calciphylaxis between the two study groups.
Kidney Failure, Chronic ; Atrial Fibrillation

Background: Cardiovascular disease is the leading cause of death in both genders worldwide. Gender differences in clinical presentation and treatment have been reported. Objective: This study aims to describe and compare the cardiovascular risk factors and management strategies for primary prevention among Filipinos. Methods: An analytical cross-sectional study was done on 2,082 patients at the Preventive Cardiology Clinic of a tertiary referral center in Quezon City, Philippines from January 1, 2002 to December 31, 2017. Results: Seventy-two percent of the patients were females with a higher mean age compared to males (57.67 + 10.50 vs 55.66 + 11.82, p 0.002). There were more women who were unemployed (75.2 vs 45.9, p<0.001). There was no significant difference in the prevalence of hypertension (68.6% vs 67.9%, p=0.542) and type 2 diabetes mellitus (19.8% vs 21.5%, p=0.437) in both genders. Beta blockers (24.1%), calcium channel blockers (22.9%) and angiotensin receptor blockers (22.1%) were the most commonly prescribed anti-hypertensive drugs. Biguanides were the most commonly prescribed glucose-lowering drug (11.3%). Compared to men, more women had dyslipidemia (51.8% vs 38.6%, p<0.001). Statins were more commonly prescribed in women (22.4 vs 18.1%, p=0.033). Conclusion There were significantly more women seen in our Preventive Cardiology clinic. Smoking and alcoholic drinking were higher in males. BMI, total cholesterol and HDL were significantly higher in females than in males.
Sex Characteristics ; Heart Disease Risk Factors ; Primary Prevention ; Preventive Medicine