1.Effects of clinical pathways on stroke outcomes at a tertiary rural hospital.
Philippine Journal of Neurology 2023;26(1):33-60
Stroke is the most common neurologic admission in our Center. Healthcare needs to be
sustainable, while maintaining the standard of care. Will codifying acute stroke care into a pre-
written clinical pathway reduce mortality, lengths of hospital stay, and costs? We pilot-tested an
Acute Stroke Clinical Pathway based on the Stroke Society of the Philippines, Department of
Health, and other international guidelines. Mortality rate, lengths of hospital stay, excess
hospital costs and complication rates were compared. Those enrolled into the Ischemic Stroke
pathway stayed one day less compared to those who were not. The hospital share for mild
hemorrhagic stroke, mortality rate for moderate hemorrhagic stroke, and length of stay and
hospital share in severe hemorrhagic stroke patients enrolled into a Hemorrhagic Stroke
pathway were statistically significantly less. The savings in some patient groups (e.g., in Mild
Hemorrhagic strokes) were offset by losses in others (e.g., in Moderate to Severe Ischemic
Strokes). Patients enrolled into a stroke pathway were recorded to have more nosocomial
infections. The findings show that using a pre-written clinical pathway reduces stroke patient
mortality, length of stay, and hospital cost, but only in specific patient groups. The increase in
reported nosocomial infections in stroke-pathway-enrolled patients is hypothesized to be due to
better reporting.
2.Therapeutic plasma exchange as a treatment for Central Pontine Myelinolysis in a 41-year-Old male with Chronic Renal Insufficiency: A case report
Guillermo III Lacuesta Manalo ; Aurelio Pantaleon S Reyes ; Jane Wendolyn Wong Lu-Reyes ; Catherine Matnao Carabbacan ; Joice Bumanglag Dela Cruz ; Marie Joyce Urnos Santos ; Donaryn Villa Pasamonte ; Sheryll Juan Pascual ; Deanna Dauz Quilala
Philippine Journal of Internal Medicine 2022;60(3):215-218
Therapeutic plasma exchange (TPE) has been reported as a possible treatment for osmotic demyelination syndrome – central pontine myelinolysis (ODS-CPM), a degeneration of myelin within the central nervous system related to rapid hyponatremia correction, which though uncommon, has significant morbidity, and has no established specific treatment. We present our experience with a 41-year-old male with chronic kidney disease, maintained on steroids, who presented with lethargy and behavioral changes. Initial metabolic panel showed severe hyponatremia (Na 109 mEq/L). Despite cautious sodium correction, the patient’s sensorium decreased further and was intubated. Involuntary movements of the left face and arm were later seen. T2/FLAIR hyperintensities in the brainstem and thalami affirmed the diagnosis of ODS. A total of nine cycles (one cycle every two to three days) of TPE were completed. The patient was discharged with improved sensorium, from E2VxM4 to E4VxM6, and with no indication for hemodialysis due to improved creatinine. One year later, the patient has no remaining neurologic deficits. Our experience supports other case reports that TPE is a viable therapy for ODS-CPM.
Myelinolysis, Central Pontine
;
Renal Insufficiency, Chronic