1.Effectiveness of Tocilizumab in COVID-19 patients with pneumonia: A systematic review
Johanah Laisah M. Salo ; Lyka Jam N. Marcelo ; Ariana Claire A. Sanchez ; Chonamae P. Marcelino ; Hazel Anne Lamadrid-Catublas ; Kevin Jace A. Miranda ; Rogie Royce Z. Carandang
Acta Medica Philippina 2024;58(Early Access 2024):1-9
Background and Objective:
COVID-19 contributes significantly to global morbidity and mortality. Age-related
comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older.
Methods:
We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence.
Results:
Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P < 0.001). Despite this, TCZ-treated patients had shorter hospital stays.
Conclusions
The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.
COVID-19
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Pneumonia
2.Is satisfaction with the medication provisions of the Senior Citizens Act and frequency of senior identification card use associated with medication compliance among hypertensive patients in the Philippines?
Nativity R. Labbao ; Mary Kriznah S. Hidalgo ; Ram Joseph D. Doroliat ; Daisy-Mae Alegado-Bagaoisan ; Kevin Jace A. Miranda ; Royce Z. Carandang
Acta Medica Philippina 2024;58(Early Access 2024):1-8
Background:
Long-term treatment and medication compliance are critical for managing conditions like hypertension, yet only 20% of cases are well-controlled, mainly due to socioeconomic factors. The Expanded Senior Citizens Act of 2010 offers a 20% discount on medications to improve compliance, but many seniors need to be made aware of these benefits. Evaluating satisfaction with the Act, specifically regarding its medication-related provisions, is essential for enhancing compliance and health outcomes among senior citizens.
Objective:
This study examined the association between satisfaction with the medication provisions of the Senior Citizens Act, the frequency of senior identification card usage, and medication compliance among hypertensive patients.
Methods:
We conducted a community-based cross-sectional study with 458 hypertensive senior citizens in Dasmariñas City, Cavite, Philippines. Senior citizens were randomly selected and completed a survey using a validated, self-developed questionnaire and the Hill-Bone High Blood Pressure (HB-HBP) compliance scale. We performed linear regression analysis to examine the association between their satisfaction and the use of senior citizens’ benefits on their medication compliance.
Results:
Senior citizens were 60-88 years old (mean 69; standard deviation [SD] 5.9). Thirty-eight percent were satisfied with the Senior Citizens Act and 49% regularly used their senior citizen card. Senior citizens scored an average of 46.82 (SD 4.96) on the HB-HBP compliance scale (possible range = 14-56), indicating high compliance. Those dissatisfied with the Senior Citizens Act were less compliant with their antihypertensive medications [B (unstandardized beta) = -1.65, 95% CI (Confidence Interval) = -2.70, -0.61]. Similarly, those who rarely or never used their senior identification cards (B = -1.54, 95% CI = -2.61, -0.48) and those who used them occasionally (B = -1.43, 95% CI = -2.57, -0.29) showed lower medication compliance compared to those who used them regularly.
Conclusion
Senior citizens who are satisfied with the medication provisions of the Act and regularly use their senior identification cards exhibit higher compliance with their antihypertensive medications than those with lower satisfaction and infrequent card usage. Interventions should prioritize educational sessions to inform senior citizens about the benefits of the Senior Citizens Act, including how to use their identification cards to access medication discounts effectively.
Human
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hypertension
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medication adherence
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Philippines
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satisfaction
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personal satisfaction
3.“They say it may cause cancer:” A qualitative exploration of Filipinos' contraceptive misconceptions and primary healthcare interventions
Pamela Mae Q. Aseremo ; Jayne Patricia C. Herco ; Charlene A. Paraleon ; Azel Ruth E. Pumaras ; Nikki M. Matibag ; Kevin Jace A. Miranda ; Rogie Royce Z. Carandang
Acta Medica Philippina 2024;58(Early Access 2024):1-10
Background and Objective:
Contraceptives are widely acknowledged for preventing unwanted pregnancies. However, there is a prevalent lack of awareness regarding contraceptives, leading to unaddressed misconceptions. This study aimed to identify common contraceptive misconceptions among men and women of reproductive age and explore how primary health workers address them.
Methods:
A qualitative study was conducted in two phases within District 5, Manila City. Phase 1 comprised focused group discussions with men and women of reproductive age (n=60), while Phase 2 involved conducting in-depth interviews with primary healthcare providers (n=16). MAXQDA, a qualitative software, to organize and code the data, was utilized.
Results:
Women of reproductive age reported several misconceptions about contraceptives, including concerns about adverse health effects, emotional and behavioral changes, perceived ineffectiveness, and cosmetic or bodily changes. For instance, they believed that contraceptives could lead to serious health complications, such as cancer, genital injury, and even death. Primary healthcare providers addressed these misconceptions through open dialogue during service delivery, particularly during prenatal and postpartum check-ups and infant immunizations. They utilized patient education strategies, including the teach-back method, and conducted community outreach and workshops on contraceptives and family planning, especially during Women’s Month.
Conclusion
Several misconceptions were identified among women of reproductive age regarding the proper use and safety of contraceptive methods, as well as misguided beliefs. In contrast, men did not exhibit any misconceptions about contraceptives, which warrants further investigation. Primary healthcare providers have taken a proactive approach to address this issue by offering comprehensive explanations and ensuring clear understanding between healthcare providers and women. Promoting contraceptive health literacy could help bridge the knowledge gap between men and women of reproductive age.
contraceptives
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contraceptive agents
;
health literacy
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Philippines