A 42-year-old male was admitted at the University of the Philippines-Philippine General Hospital (UP-PGH) for a 3-month history of non-healing wound in the medial side of his right leg in spite of multiple antibiotics. The wound worsened with multiple ulcerations and draining sinuses. The wound was shown to have suppurative and granulomatous infiltrates that yielded Mycrobacterium tuberculosis. An algorithm in the approach to a chronic or non-healing wound is discussed.

Human ; Male ; Adult ; Hospitals, General ; Anti-bacterial Agents ; Suppuration ; Tuberculosis ; Communicable Diseases ; Lower Extremity

Background: The implementation of the "Sin Tax Law" (RA 10351) in 2013 has increased revenues for healthcare in the Philippines. What changes have taken place in government hospitals since the passage of the law? This qualitative study sought to answer this question by presenting perspectives from patients, doctors, and nurses.

Methods: Four focus group discussions (FGDs) and eight semi-structured interviews (SSIs) were conducted among patients, doctors, and nurses in two tertiary government hospitals in Metro Manila, Philippines.

Results: Significant changes noted by study participants over the past several years included increased financial assistance for patients as well as improvements in health services and continuity of care. However, their narratives underscored shortcomings in human resources and facilities, raising questions of 'absorptive capacity'.

Conclusion: Given that the Sin Tax Law was the main policy intervention to which the changes reported by study participants can be attributed, the study provides a strong case for a continuation - if not expansion - of the Law, with the recommendation that increased health revenue should also translate to greater support for healthcare workers and enhanced health facilities. As these insights may be overlooked by traditional metrics, the study also recommends that policymakers consider qualitative studies in evaluating the efficacy of health care reforms.

Human ; Healthcare Financing ; Philippines

INTRODUCTION: Ventricular tachycardias (VT) are commonly associated with structural heart disease. However, 10% of VTs have no identifiable cause. Right ventricular outflow tract ventricular tachycardia (RVOT VT), a small subgroup of idiopathic VTs localized in the right ventricular outflow tract is highly sensitive to adenosine (ADO). Only 11% of RVOT VT is ADO-insensitive, posing a diagnostic challenge. We present a peculiar case of an ADO-insensitive RVOT-VT storm and the challenges of recognizing and managing it in a resource-limited setting.

CASE SUMMARY: A 15-year-old female, asthmatic, complained of palpitations, lightheadedness, chest pain and dyspnea a few hours prior to admission. She had a similar episode a month ago, which necessitated ER admission, electrical cardioversion and amiodarone.

On admission, she was tachycardic but normotensive. She had diffuse wheezes. Cardiac exam was normal. ECG revealed a wide complex tachycardia (WCT). Work-up revealed a normal chest x-ray, thyroid function tests and electrolytes. Echocardiogram showed a structurally normal heart. She was managed as a case of viral myocarditis and SVT with aberrancy. Vagal maneuvers and adenosine was given which slowed down the tachycardia. She was then started on IV anti-arrhythmics however, sustained symptomatic VT recurred on the same day. ECG analysis showed a WCT, LBBB, AV dissociation with positive QRS complexes in inferior leads suggestive of VT originating from the RVOT. RVOT VT storm was considered and adenosine (maximum dose) was given. The patient did not revert to sinus, hence, ADO-insensitive RVOT VT was considered. Cardioversion terminated the VT storm.

On electrophysiology study, the VT was induced/ localized at the RVOT via 3D mapping. Ablation of the RVOT focus was performed, immediately terminating the VT. Post ablation, the patient was asymptomatic and was discharged improved with excellent prognosis.

DISCUSSION: This case report highlights two things. The ECG remains a reliable tool in recognizing and localizing VTs clinically. Secondly, it highlights the importance of prompt recognition of ADO-insensitive RVOT VT because its management and prognosis is very different from the common causes of VT.

Human ; Female ; Adolescent ; Anti-arrhythmia Agents ; Amiodarone ; Electric Countershock ; Adenosine ; Dizziness ; Myocarditis ; Beta-apocarotenoid-14' ; ,13' ; -dioxygenase ; X-rays ; Tachycardia, Ventricular ; Echocardiography ; Heart Ventricles ; Dyspnea ; Chest Pain ; Electrocardiography ; Prognosis ; Electrolytes ; Thyroid Function Tests ; Electrophysiology