To establish reference values for lung function test in Filipinos, 283 (130 males and 153 females) normal non-smoking (< 0.5 pack years), adults were studied using a body plethysmograph (Jaeger, West Germany). Spirometric indices were integrated from a pneumotachograph (linear at flows between 0-20 1/sec with ± 2% error). Spirometric performance and measurements followed the ATS Snowbird Workshop recommendations. Lung volumes and airway resistance (Raw) were taken from the average of three plethysmographic determinations.

Multiple linear regressions with backward elimination was done. The data obtained was regressed against independent variables of age height, weight, and body surface area for each sex.

Analysis of variance (ANOVA) of the regression equations for most parameters were significant at = 0.01. In a few parameters were significance was = 0.05. Only in Raw was the regression model not significant. The coefficient of determination (R) of our regression equations were low (<0.50). However, such low R have been observed in other predictions equations which have gained widespread acceptance, attesting to their clinical usefulness. Ninety five percent confidence interval was used to determine the lower limit of normal for FEV1 and FVC. Since the other parameters showed greater individual variability, cumulative percentiles of % of predicted were determine instead (Knudson 1977). For performance test, the 5th percentiles of % of predicted was computed. For lung volumes, the 5th and 95th percentiles were determined. For Raw, the 95th percentiles of the actual values was used. Since there were fewer subjects above the age of 60 years, the use of these equations is subject to this limitation.

Human ; Male ; Female ; Smoking ; Lung ; Analysis Of Variance ; Population

Summary Lung cancer remains a top cause of new cases and deaths from malignancies globally and locally. The development of targeted therapy for advanced non-small cell lung cancer (NSCLC), particularly adenocarcinoma, promises to improve survival significantly among suitable patients as compared to chemotherapy. About 50% of NSCLC patients have some driver mutations that can be treated by targeted therapy. The most common mutation is that involving EGFR which is found in as much as 90% of patients with driver mutations, most especially in those with adenocarcinoma, in women and never-smokers and those of East Asian ancestry. This is followed by patients with ALK or ROS1 rearrangements in another 5% each. Proper molecular profiling is, however necessary at the outset to identify patients who are suitable for targeted treatment. Fortunately, in the Philippines, testing for EGFR, ALK and ROS1 mutations are possible with several of the tyrosine kinase inhibitor drugs (TKIs) that target these mutations also available. A smaller proportion of patients have BRAF mutations (<5%) but the drug needed to treat this is not available commercially in our country. There are other mutations in advanced NSCLC which are considered potential drug targets for treatment. However, developing a clinically acceptable drug for use in lung cancer has been less successful. KRAS mutations, for example, can be as common as EGFR mutations (and sometimes more so) but no suitable drug for lung cancer has been identified yet. This is also true for METex14, HER2, VEGF, and others that are less common. Clinical studies continue to be done involving these target molecules. These biomarkers have sometimes found usefulness as indicators of poor prognosis and/or likelihood of developing drug resistance but for the most part, have remained in the realm of research. Immunotherapy was not included as a topic in this article. The search continues for new molecules to be used in targeted therapy for lung cancer. Development of drug resistance to TKIs, often inevitable and just a matter of time, continue to drive these development efforts. The remaining approximately 50% of NSCLC with no driver mutations also push efforts to search for appropriate drugs that will be good for them – including immunotherapy. Studies are also being done to look at various combinations of targeted therapy with chemotherapy and even immunotherapy. It will not be an overstatement to say that the future of lung cancer, especially NSCLC is rapidly evolving and will be creating data that may be very different from what we know at present. Clinicians who encounter and/or treat lung cancer should keep abreast of this rapidly changing information in properly advise their patients on suitable therapies. This is particularly true in financially constrained settings such as the Philippines where even just the cost of testing for these mutations can already be a significant barrier to whether or not to use targeted therapy.
Carcinoma, Non-Small-Cell Lung ; Mutation

Tuberculosis is a global disease with a high prevalence rate in the Philippines. Frank hemoptysis often occurs later in the disease and is usually not massive since the availability of anti-Koch’s treatment. However, Rasmussen’s aneurysm, a pulmonary vascular complication secondary to tuberculosis from the weakening of the pulmonary arterial wall adjacent or within a tuberculous cavity, can be an uncommon cause of massive and potentially fatal hemoptysis.

A 35-year-old male patient presented with episodes of hemoptysis while being treated for pulmonary tuberculosis for two weeks. An episode of massive hemoptysis of ~400ml prompted his admission. Chest tomography with contrast showed bronchiectatic changes, cavitary formation, and an aneurysmal dilatation of the anterior segmental artery of the left upper lobe. He was diagnosed with Rasmussen’s aneurysm. A multidisciplinary team consisting of pulmonologists, interventional radiologists and thoracic surgeons planned for a surgical intervention as coil embolization was deemed to be difficult due to the wide neck character of the aneurysm. On re-admission after patient optimization, repeat chest tomography showed interval regression of pulmonary cavity with thrombosis of the previously identified Rasmussen’s aneurysm. Patient completed his 6-month antitubercular treatment with no further episodes of hemoptysis.

In patients with tuberculosis, hemoptysis results from involvement of the parenchyma, bronchiectasis, or erosion of residual cavities. Hemoptysis from the rupture of a dilated vessel such as Rasmussen’s aneurysm is a rare cause. Chest tomography with contrast is the imaging modality of choice as it demonstrates the focal pulmonary artery dilatation. Embolization or surgical lobectomy are typically utilized to control the bleeding. However, treatment with anti-tuberculous regimen may result already in regression and eventual thrombosis of the aneurysm. Watchful monitoring is imperative as massive hemoptysis may recur; radiologists and surgeons must be available at any time in case intervention is required.

Human ; Male ; Adult: 25-44 Yrs Old ; Hemoptysis ; Tuberculosis

Background and Objectives: Mechanical ventilators are essential albeit expensive equipment to support critically ill patients who have gone into respiratory failure. Adequate numbers should always be available to ensure that a hospital provides the optimal care to patients but the number of patients requiring them at any one time is unpredictable. Finding therefore the best balance in providing adequate ventilator numbers while ensuring the financial sustainability of a hospital is important. Methods: A quantitative method using Monte Carlo Simulation was used to identify the optimal strategy for acquiring ventilators in a large private tertiary medical center in Metro Manila. The number of ventilators needed to provide ventilator needs 90% of the days per month (27/30) was determined using historical data on ventilator use over a period of four years. Four acquisition strategies were investigated: three ownership strategies (outright purchase, installment, and staggered purchase) and a rental strategy. Return on Investment (ROI), Internal Rate of Return (IRR), Modified Internal Rate of Return (MIRR), Net Present Value (NPV), and Payback period (or Breakeven Point) for each strategy were determined to help recommend the best strategy. A qualitative survey was also conducted among doctors, nurses, and respiratory therapists who were taking care of patients hooked to ventilators to find out their experiences comparing hospital-owned and rental ventilators. Results: It was found that a total of 11 respirators were needed by the hospital to ensure that enough respirators were available for its patients at least 90% of the days in any month based on the previous four-year period. This meant acquiring three more ventilators as the hospital already owned eight. Among the strategies studied, projected over a 10-year period, the installment strategy (50% down payment with 0% interest over a 5-year period) proved to be the most financially advantageous with ROI = 9.36 times, IRR = 97% per year, MIRR = 26% per year, NPV = ₱39,324,297.60 and Payback period = 1.03 years). A more realistic installment strategy with 15% (paid quarterly or annually) and 25% annual interest rates were also explored with their financial parameters quite like but not as good as the 0% interest. The outright purchase of three ventilators came in lower (ROI = 4.53 times, IRR = 55% per year, MIRR = 19% per year, NPV = ₱38,064,297.60 and Payback period = 1.81 years) followed last by staggered purchase with ROI = 3.56 times, IRR = 64% per year, MIRR = 28% per year, NPV = ₱29,905,438.08, and payback period of 2.06 years. As there was no investment needed for the rental strategy, the only financial parameter available for it is the NPV which came out as ₱21,234,057.60. The qualitative part of the study showed that most of the healthcare workers involved in the care of patients attached to the ventilator were aware of the rental ventilators. The rental ventilators were generally described as of lower functionality and can more easily break down. The respondents almost uniformly expressed a preference for the hospital-owned ventilators. Conclusion This analysis showed that the best ventilator ownership strategy from a purely financial perspective for this hospital is by installment with a 50% down payment and 0% interest. Moderate rates of 15% and 25% interest per year were also good. These were followed by outright purchase and lastly by staggered purchase. The rental strategy gave the lowest cumulative 10-year income compared to any of the ownership strategies, but may still be considered good income because the hospital did not make any investment. However, it seems that most of the healthcare workers involved in taking care of patients on ventilators thought the rental ventilators were of lower quality and preferred the hospital-owned ventilators.
Ventilators, Mechanical

Myeloid sarcoma, characterized by the presence of immature myeloid cells occurring at an extramedullary site, is a rare manifestation of acute myelogenous leukemia (AML). Spinal cord compression as an initial presentation of AML is very rare with only a few reported cases. We discuss a case of a 22-year-old male who presented with bicytopenia and paraplegia. Workups were consistent with AML with monocytic differentiation. Chromosomal analysis revealed loss of Y and t (8;21). Spinal cord MRI showed intradural extramedullary-enhancing soft tissue lesions at levels T2 to T7 and L5 to S1, suspected to be myeloid sarcoma. Patient, however, succumbed to severe nosocomial infection prior to initiation of chemotherapy and radiotherapy.
Human ; Leukemia, Monocytic, Acute ; Sarcoma, Myeloid ; Spinal Cord Neoplasms

BACKGROUND AND OBJECTIVES

Mechanical ventilators are essential albeit expensive equipment to support critically ill patients who have gone into respiratory failure. Adequate numbers should always be available to ensure that a hospital provides the optimal care to patients but the number of patients requiring them at any one time is unpredictable. Finding therefore the best balance in providing adequate ventilator numbers while ensuring the financial sustainability of a hospital is important.

METHODS

A quantitative method using Monte Carlo Simulation was used to identify the optimal strategy for acquiring ventilators in a large private tertiary medical center in Metro Manila. The number of ventilators needed to provide ventilator needs 90% of the days per month (27/30) was determined using historical data on ventilator use over a period of four years. Four acquisition strategies were investigated: three ownership strategies (outright purchase, installment, and staggered purchase) and a rental strategy. Return on Investment (ROI), Internal Rate of Return (IRR), Modified Internal Rate of Return (MIRR), Net Present Value (NPV), and Payback period (or Breakeven Point) for each strategy were determined to help recommend the best strategy. A qualitative survey was also conducted among doctors, nurses, and respiratory therapists who were taking care of patients hooked to ventilators to find out their experiences comparing hospital-owned and rental ventilators.

RESULTS

It was found that a total of 11 respirators were needed by the hospital to ensure that enough respirators were available for its patients at least 90% of the days in any month based on the previous four-year period. This meant acquiring three more ventilators as the hospital already owned eight. Among the strategies studied, projected over a 10-year period, the installment strategy (50% down payment with 0% interest over a 5-year period) proved to be the most financially advantageous with ROI = 9.36 times, IRR = 97% per year, MIRR = 26% per year, NPV = ₱39,324,297.60 and Payback period = 1.03 years). A more realistic installment strategy with 15% (paid quarterly or annually) and 25% annual interest rates were also explored with their financial parameters quite like but not as good as the 0% interest. The outright purchase of three ventilators came in lower (ROI = 4.53 times, IRR = 55% per year, MIRR = 19% per year, NPV = ₱38,064,297.60 and Payback period = 1.81 years) followed last by staggered purchase with ROI = 3.56 times, IRR = 64% per year, MIRR = 28% per year, NPV = ₱29,905,438.08, and payback period of 2.06 years. As there was no investment needed for the rental strategy, the only financial parameter available for it is the NPV which came out as ₱21,234,057.60.

The qualitative part of the study showed that most of the healthcare workers involved in the care of patients attached to the ventilator were aware of the rental ventilators. The rental ventilators were generally described as of lower functionality and can more easily break down. The respondents almost uniformly expressed a preference for the hospital-owned ventilators.

CONCLUSION

This analysis showed that the best ventilator ownership strategy from a purely financial perspective for this hospital is by installment with a 50% down payment and 0% interest. Moderate rates of 15% and 25% interest per year were also good. These were followed by outright purchase and lastly by staggered purchase. The rental strategy gave the lowest cumulative 10-year income compared to any of the ownership strategies, but may still be considered good income because the hospital did not make any investment. However, it seems that most of the healthcare workers involved in taking care of patients on ventilators thought the rental ventilators were of lower quality and preferred the hospital-owned ventilators.

Ventilators, Mechanical

BACKGROUND

The University of the Philippines College of Medicine has been lauded for its research output, especially among faculty members. Research is also integrated in its curriculum for medical students in pursuit of “six-star physicians.” However, there has been no consolidated analysis on the outcomes of feedback collected from students.

OBJECTIVES

The study aims to describe the perception of research education among medical students in Learning Units III to VII (LU III-VII) from academic year 2017-2018 to 2019-2020 in the University of the Philippines College of Medicine (UPCM).

METHODS

Through a mixed-method descriptive design, students enrolled in the MD and MD-PHD program from LU III-VII of the UPCM were invited to participate in a survey. Furthermore, a review of the student research database and course evaluations were conducted.

RESULTS

A total of 197 student-initiated studies were conducted according to the college database, varying in types and approaches. However, only 4% of the registered research was published. Research-oriented courses were also rated highly among the medical students. This was consistent with positive attitudes towards research among the majority of participants. However, only 32.2% of the target sample size participated in the survey.

CONCLUSION

Participants of the survey had positive perceptions regarding their research education. However, there are several areas for improvement such as provision of grants, publication assistance, compliance with research registration, and mentorship in data analysis.

Human ; Education, Medical