Internship and Residency

Background: The standard treatment of patients with advanced nasopharyngeal carcinoma is concurrent chemoradiotherapy followed by chemotherapy. The voluminous number of patients with this disease and the constraints of limited facilities to accommodate such number of patients in our institution have brought about treatment modifications. This pilot study compared the 3-year progression-free survival (PFS) and overall survival (OS) of patients with advanced nasopharyngeal cancer who received concurrent chemoradiotherapy as induct ion fol lowed by chemotherapy ver sus chemotherapy fol lowed by concurrent chemoradiotherapy. Patients and Methods: From 2005 to 2007, 30 patients with biopsy-proven stage III to IV-B nasopharyngeal cancer seen at the Medical Oncology Outpatient/Inpatient unit of the Philippine General Hospital were randomized to receive cisplatin (25 mg/m2 D1-4) on weeks 1, 4 and 7 of radiotherapy (70 Gy for 7 weeks) followed by cisplatin (20 mg/m2 D1-4) and 5-fluorouracil (1000 mg/m2 D1-4) on weeks 11, 15 and 19 (standard arm) or to receive cisplatin (20 mg/m2) on D1-4 and 5-fluorouracil (1000 mg/ m2 on D1-4) on weeks 1, 5 and 9 followed by concurrent chemoradiotherapy. started after 4 weeks of the 3rd cycle of chemotherapy (week 13) with cisplatin (25 mg/ m2 on D1-4) given on weeks 13, 16 and 19 of treatment every 3 weeks dur ing radiotherapy (investigative arm).Treatment modifications were done based on creatinine clearance and toxicities. Carboplatin (AUC 5) was substituted for cisplatin for creatinine clearance < 30 ml/min or grade 3 hearing impairment. Results: Baseline characteristics were comparable except for age and histology. Median PFS was 19.6 months (standard arm) versus 25.7 months (investigative arm). 3-year PFS rates were 25% and 63%, respectively with hazard ratio 2.64 (p= 0.176). Median OS were 17.5 months and 21.5 months, respectively. 3-year survival rates were 36% and 25.4%, respectively with hazard ratio 0.92 (p= 0.889). The complete response rate was 18.7% (standard arm) versus 28.5% (investigative arm), partial response rate was 31.2% vs 21.4% and progressive disease was 31.2% and 28.5% respectively. Anemia, anorexia, nausea, vomiting and xerostomia were the most frequent grade 3 adverse events. Conclusion: Induct ion chemotherapy fol lowed by concur rent chemoradiotherapy appears to be comparable to the standard of concurrent chemoradiotherapy followed by chemotherapy in terms of PFS and OS. However, no final conclusion can be drawn due to the small sample size and poor follow-up.

Electrocardiography

The electrocardiographic analysis of heart blocks provides great opportunities for the discussion of mechanisms of electrical cardiac conduction, serving as “teachable moments” in medicine. Recognition of heart blocks can sometimes be a challenge as they can present in many forms, different severities and levels of blocks that present as varied patterns on electrocardiographic tracing. The ultimate key to correct diagnosis rests on adequate understanding of normal electrophysiology of the electrical system of the heart. While it is vital to recognize the pattern, we should always know and understand the physiology behind the pattern. This article presents a detailed analysis of a case of heart block which can easily be misinterpreted on first look. The case is featured not for its rarity but for the interesting concepts in cardiac electrophysiology that are highlighted. Navigation of the different elements of tracing can be an adventure and a great learning experience enjoyed by both students and experts.
Heart Block ; Electrocardiography

Introduction: The evolution of cardiac pacing is expected to decrease the cardiovascular morbidity and mortality but this type of intervention might affect the health-related quality of life (HRQOL) and eventually the overall prognosis of the patient. This study assessed the HRQOL in patients with permanent pacemaker using Philippines (Tagalog) Short Form (SF)-36v2 health survey.Introduction:The evolution of cardiac pacing is expected to decrease the cardiovascular morbidity and mortality but this type of intervention might affect the health-related quality of life (HRQOL) and eventually the overall prognosis of the patient. This study assessed the HRQOL in patients with permanent pacemaker using Philippines (Tagalog) Short Form (SF)-36v2 health survey. Methods: A cross-sectional correlation study was conducted. Philippines (Tagalog) SF-36v2 health survey was administered among patients with permanent pacemaker who had their pacemaker analysis at the University of Santo Tomas Hospital from October to December 2015. The higher the score the better HRQOL and many studies used a cut-off point of 50. Pearson Correlation and Non-Parametric Mann-Whitney Tests were used in this study. Results: Forty-two patients were enrolled in this study. There were 24 male and 18 females with mean interval of age 71.48+12.3. Most of the HRQOL scores were lower than 50. The highest HRQOL scores were vitality and mental health aspect while the worst were role emotional and physical functional aspect. Age, educational attainment, type of permanent pacemaker, pacemaker dependency, NYHA (New York Heart Association) functional capacity and presence of co-morbidities particularly diabetes mellitus type 2 were significant factors for poor HRQOL. Conclusion This study showed that overall the HRQOL in patients with permanent pacemaker was below average. A comprehensive management in order to improve the HRQOL should be considered among patients with permanent pacemaker.
Quality of Life

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

Introduction: Anxiety and depression are the two most common mental disorders among medically ill patients with prevalence of 10%-50%. Anxiety and depression are prevalent in patient with heart disease and are associated with high morbidity and mortality. This study aims to determine the prevalence of anxiety and depression and its correlation with clinical profile in heart failure patients using the Hospital Anxiety and Depression Scale Filipino Version (HADS-P). Methods: A prospective cross-sectional study was conducted. HADS-P questionnaire was administered to heart failure patients admitted at the University of Santo Tomas Hospital from December 2013 to November 2014. After securing consent from the attending physicians and patients, the HADS-P questionnaires were then administered to the patients at the end of hospitalization by the investigator/s. The recommended cut-off score for HADS-P is score of 11. Chi-square and Independent T-tests were used in this study. Results: 144 heart failure patients were enrolled in this study. The prevalence of depression and anxiety among heart failure patients is 13.2% and 25.7%, respectively. Having prior coronary angiography, coronary angioplasty, EF < 40%, and multiple co-morbidity diseases/s are significant factors for depression. While among patients with anxiety, the significant factor is the length of hospital stay. Conclusion This study shows that depression and anxiety are common among heart failure patients. Heart failure patients should be screened for depression and anxiety especially among those having above mentioned clinical profile. The HADS-P questionnaire is an easily applied screening method. A formal psychiatric referral can be taken and should be a part of the comprehensive management among heart failure patients with depression and anxiety.
Anxiety ; Depression ; Heart Failure ; Heart Diseases