The daily work life of physicians who function as clinicians, researchers, and academicians is focused on improving public health and patient outcomes in three usually compartmentalized settings: clinics, classrooms, and centers for research. In these settings, physicians are addressing patients’ medical concerns based on evidence, and at the same time, considering if new information could lead to research and discovery for better patient outcomes. The physician then proceeds to mentor, teach, and train medical students in quality evidence-based clinical practice and the conduct of scientific research. The importance of operationally blending these three disciplines with research as a common thread is not only a big challenge for these physicians but also an opportunity to innovate for better public health.
Physicians ; Research Personnel ; Public Health

I see clinicians often and when time is kind, a conversation about research ensues. There is always interest but to actually engage in research, many shake their heads and sigh “no time.” I wonder about lost opportunities to learn and study diseases when clinicians are not inclined to or not supported in research. At every stage of medical education, training, and professional practice whether in academia or in clinic or hospital, physicians inevitably encounter a fork in the road. The paths of clinician and/or academician are large lanes in the highway, yet at a junction, the highway becomes two roads, one to remain as clinician or academicians and the other to pursue research and publication. As well-known, many choose to remain in clinic or in classroom.
Research ; Publications

Background: Allergen sensitization, symptom severity, pulmonary function test, and bronchodilator response are important in the diagnosis and treatment of asthma. However, the relationship between these factors remains unclear. Objective: The objective of this study was to investigate the relationship between aeroallergen sensitization and asthma severity, pulmonary function, and bronchodilator response among pediatric patients with bronchial asthma. Methods: This was a prospective study where 155 pediatric patients aged 7–18 years old with bronchial asthma were recruited from Outpatient Clinics. Patients who met the inclusion criteria proceeded with spirometry and aeroallergen skin prick test. Results: There was a significant degree of sensitization, wherein 100% of the patients had sensitization to one or more aeroallergens. Among these children, 106 (68%) were polysensitized. The polysensitized group had more severe and persistent asthma severity profile (p<0.001) and worse pulmonary function (p<0.001). The frequency of abnormal pre-bronchodilator lung function of the polysensitized group was higher than the monosensitized group (p<0.001). A positive bronchodilator response was higher among polysensitized children as compared to monosensitized children (p<0.001). Sensitization to Dermatophagoides farinae, Dermatophagoides pteronyssinus and dog correlated with impairment of both the large airways and distal small airways while sensitization to cat, cockroach, and horse correlated only with impairment of the large airways (p<0.05). Patients sensitized to D. farinae, D. pteronyssinus, cat and dog had significant bronchodilator response (p<0.05). Conclusion Polysensitized asthmatic children had a more persistent and severe asthma profile, worse pulmonary function, and higher bronchodilator reversibility compared to the monosensitized group.
ASTHMA

Geriatrics is a branch of medicine concerned with diagnosing, treating, and preventing diseases in older people and problems specific to aging. The World Health Organization (WHO) has reported that the number of people aged 65 or older is projected to grow from an estimated 524 million in 2010 to nearly 1.5 billion in 2050. The burden of diseases in the aging population will dramatically impact healthcare expenses in low- and middle-income countries and even developed ones. A preventive approach is essential. The role of medical institutions and inclusion of geriatrics in the medical curriculum have become important. However, incorporating geriatrics into the medical curriculum is associated with various issues and challenges: compact preexisting curriculum, attitudes of teachers and students, and shortage of teaching geriatricians. An individualized institutional approach to curricular integration guided by the American Geriatrics Society’s minimum required competencies for the undergraduate will circumvent these challenges.
CURRICULUM ; EDUCATION

Background: : Disruption of neurocognitive functioning is one of the most frequent complications in patients infected with Human immunodeficiency virus. It manifests as a form of subcortical dementia characterized by psychomotor slowing, changes in mood and anxiety levels and deficits in memory, abstraction, information processing, verbal fluency, decision-making, and attention. The primary objective of this study is to determine the prevalence of neurocognitive impairment among HIV-positive individuals in the Philippines. Methods: : This is a cross-sectional study done at the outpatient department of a tertiary infectious disease hospital located in Manila, Philippines conducted from May to July 2015. The Montreal Cognitive Assessment – Filipino (MoCA-P) was used to differentiate non-cognitively impaired and cognitively impaired participants. Demographic data was obtained using structured interviews including the CD4 count. Results: : One hundred and twelve HIV positive patients were examined and 56.7% of them were noted to have cognitive impairment while none of them met the criteria for dementia. After logistics regression analysis, only the CD4 count (x=224) was shown to have significant association with cognitive impairment (p=0.0001, OR 0.96). Conclusion: Cognitive impairment was significantly associated with low CD4 count, with a sensitivity of 100% for a count of <224. More than half or 58.7% of subjects with cognitive impairment did not show any neuropsychiatric symptoms. Neurocognitive impairment is still an important component of HIV infection and this study highlights the need to further increase awareness regarding this HIV complication.
Cognitive Dysfunction ; Cognitive Dysfunction ; Dementia

Rationale: Leukoencephalopathy, a complication associated with chemotherapy has been reported after giving high doses of methotrexate and cytarabine with no specific risk factors to date.

Objectives:
1. To review the prevalence of chemotherapy-induced leukoencephalopathy in children with acute lymphoblastic leukemia (ALL).
2. To present the clinical course, pathogenesis and neuro-imaging findings of chemotherapy-induced leukoencephalopathy in children with ALL.

Case: We reported three cases of adolescent ALL precursor B-cell patients who received high doses of methotrexate and presented with neurologic and MRI findings consistent with leukoencephalopathy. Our patients were only placed on supportive measures with adequate hydration, without providing any special intervention. Yet, all of them had complete neurological recovery.

Discussion and Summary: Methotrexate is a cell cycle-specific agent that inhibits the enzyme dihydrofolate reductase, preventing the conversion of folic acid to tetrahydrofolic acid and inhibiting cell replication. It is one of the most commonly implicated drug causing leukoencephalopathy. [3] On MRI T2-weighted images, all of them had hyperintensities on the posterior frontal/parietal corona radiata and centrum semiovale consistent with leukoencephalopathy. Complete recovery happened spontaneously in all of the cases. There is no standard treatment for acute and subacute toxicities from methotrexate.

Background: Apart from its role in bone health, recent developments have shown that vitamin D also has anti-inflammatory properties, and therefore may have a role in inflammatory bowel disease (IBD) in children. Objectives: To determine the effect of vitamin D supplementation on the disease activity of pediatric patients with IBD. Design: Random-effects meta-analysis Data Sources: : Studies were searched at Cochrane Library, PubMed, EBSCO Host, ScienceDirect, Google Scholar, and Wiley Online. Review Methods: Experimental studies measuring the effect of vitamin D on the disease activity of pediatric patients with IBD were included. The proportion of disease activity, measured as remission rate or inactivity using Pediatric Crohn’s Disease Activity Index (PCDAI) or Pediatric Ulcerative Colitis Activity Index (PUCAI), and the mean and standard deviation of mean serum vitamin D [25(OH)D] level, change in 25(OH)D, and different inflammatory markers [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] were extracted or estimated and recorded in an abstraction form. Standardized mean difference and odds ratio were used as summary effect measures and estimated using Stata/Multiprocessor. Results: The serum 25(OH)D (SMD = 1.75, z = 2.33, p = 0.001) and change in 25(OH)D (SMD = 3.37, z = 2.34, p = 0.019) was significantly higher among those who received a high dose of vitamin D. However, a significantly high heterogeneity was estimated (I2 >50%). For the disease activity of IBD, the standard mean difference of mean ESR (SMD = –1.10, z = 5.35, p = 0.001) was significantly lower with high-dose vitamin D. The likelihood of remission rate using the Pediatric Crohn’s Disease Activity Index (PCDAI) or Pediatric Ulcerative Colitis Activity Index (PUCAI), and standardized mean difference of CRP were not significantly different among those who received high-dose and low-dose vitamin D. Conclusion Cognizant of the functions of vitamin D in enhancing intestinal flora balance, regulating immunologic response, and improving intestinal mucosal barrier, vitamin D can be recommended as a supplementary treatment for IBD among the pediatric population. Nevertheless, there is still insufficient evidence for the cut-off level of adequate levels of serum 25(OH)D among pediatric patients with IBD, thus necessitating further studies.
Vitamin D Deficiency

Background: The COVID-19 pandemic has caused a global public health emergency. High levels of fear and limited access to cancer treatment may jeopardize the delivery of optimal oncologic care, potentially influencing treatment outcomes. This study aimed to identify patients’ and their caregivers’ perception of safety and accessibility of cancer care during the COVID-19 pandemic. Methods: A cross-sectional survey of patients and caregivers at the Benavides Cancer Institute, University of Santo Tomas Hospital was performed from August to October 2020 using a 20-item investigator-developed questionnaire. Results: A total of 207 participants answered the survey. Frequency of hospital visits varied from none to more than ten times in the previous month; but having multiple postponements were uncommon. Eighty-two percent, 77%, 62%, and 55% of participants reported being afraid of contracting COVID-19 from other patients, hospital surroundings, hospital staff, and doctors, respectively. Twenty-six percent and 12% had difficulty finding transportation and passing through checkpoints, respectively. Twenty-eight percent strongly expressed financial limitations in prioritizing cancer care. Participants were amenable to the use of telemedicine and stringent protocols to reduce in-hospital transmission risk, but had some reluctance to spend out of their pockets for screening tests. Conclusion The perceived safety of cancer care was influenced by fears of contracting COVID-19; and accessibility was influenced by limited transportation and financial constraints. Despite these, multiple postponements and cancelled hospital visits were uncommon. Institutional approaches targeting these concerns will be crucial to ensure safe and timely delivery of cancer care during the COVID-19 pandemic and further mitigate its impact on oncologic outcomes.
COVID-19 ; Pandemics ; Safety

Rationale Probiotics are live microorganisms that exert beneficial effects on the host, including a reduction of allergic disease symptoms. Lactobacillus reuteri in particular was shown to attenuate the allergic airway, and when used as an adjunct in the treatment of asthma in children, resulted in decreased fractional exhaled nitric oxide and interleukin levels when compared to placebo. However, insufficient information is available regarding the significance of L. reuteri as an adjunct in the treatment of allergic disorders, particularly in allergic airway disease.
Limosilactobacillus reuteri ; Probiotics ; Asthma ; Child

Introduction: The coronavirus (CoVid-19) pandemic brought about a massive impact to the healthcare system, including disruption of patient follow-ups and consultations. Subsequently, an increase in physicians’ use of telemedicine was seen. While this technology has been documented to improve delivery of care, it has encountered varied acceptance among physicians. Gaps in specific national legislation, lack of established rules and accreditation standards, and ethical/legal implications add to the concerns. Anchored on the Unified Theory of Acceptance and Use of Technology model, this study aimed to segment physicians according to their perspectives regarding telemedicine during the pandemic. Methods A mixed methods sequential explanatory design using Q-methodology was applied to identify distinct patterns and perceptions of physicians on the use of telemedicine during the pandemic. A Q-sample of 25 statements on perceptions of telemedicine was developed through literature review, and 24 physicians were purposively selected. Participants were instructed to sort statements into a distribution grid according to their degree of agreement/disagreement. Post-sorting interview was conducted to expound on their response. Data were analyzed using by-person factor analysis through the PQMethod software version 2.35.
Telemedicine ; Physicians ; Pandemic ; COVID-19