OBJECTIVES: Among relatively healthy Filipinos undergoing executive check-ups (periodic health examinations), the study aims 1.) To determine the correlation of hypertension and serum uric acid, 2.) To determine the association between serum uric acid and age, sex, obesity or relative weight, cigarette smoking, alcohol intake, diabetes mellitus, anti-hypertensive drug intake, cholesterol, and serum triglyceride, and 3.) To determine prevalence of hyperuricemia.

METHODS: Retrospective chart review of 2188 adult Filipinos undergoing executive medical check-ups in 6 major hospitals Results: Hyperuricemia was present in 37.9 percent (adjusted prevalence, 95 percentCI 36.0-39.9) (n=845). The mean uric acid was 0.38 mmol/L (95 percent CI 0.37-0.39). It was significantly associated with hypertension at adjusted Odds Ratio 1.27 (95 percent CI 1.05-1.53, p=0.013). The risk factors for hyperuricemia were age, male, weight, smoking, alcohol intake, hypertension, normoglycemia, triglycerides, and cholesterol. After adjustment in a step-wise logistic regression, the independent predictors identified were hypertension, hypercholesterolemia, age, males and non-diabetics.

CONCLUSIONS: Hypertension was significantly associated with hyperuricemia among adult Filipinos undergoing periodic health check-ups. The major predictors of elevated serum uric acid were hypertension, male sex, hypercholesterolemia, age and absence of diabetes mellitus. The prevalence of hyperuricemia at 37.9 percent was much higher compared to a previous local study (21 percent) and prevalence studies from other countries (8.4-27.6 percent).

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Adolescent ; Uric Acid ; Hyperuricemia ; Antihypertensive Agents ; Triglycerides ; Hypercholesterolemia ; Cigarette Smoking ; Obesity ; Body Weight ; Hypertension ; Cholesterol ; Diabetes Mellitus ; Smoking

BACKGROUND: Neonatal mass screening has led to the early diagnosis and management of congenital endocrine and metabolic diseases. The effectiveness and efficiency of neonatal screening had been well established for congenital hypothyroidism (CH) in other settings.

OBJECTIVES: 1) To determine the incidence of CH; and 2) To determine whether a newborn screening program (NSP) for CH is cost-beneficial from a societal perspective.

DESIGN: Screening survey with cost-benefit analysis.

SUBJECTS AND METHODS: Newborns from the original 24 hospitals in Metro Manila that started newborn screening were screened for CH after the 48th hour of life. Confirmatory tests were performed for those who screened positive. Using the incidence from the survey, the costs for the detection and treatment of CH were compared to the projected benefits of preventing the mental retardation and consequent productivity losses. Sensitivity analyses for incidence rates, discount rates and timing of blood collection were included.

RESULTS: A total of 28,088 newborns (40% of 69,391 live births) were screened. Ninety-two were recalled for confirmatory testing after the initial screen; 8 were diagnosed with CH. Assuming that a cohort of 200,000 newborns would be screened in one year, the net costs for the screening program were US$ 2.4M. If the timing of blood collection was after the 24th hour, there was instead a net benefit of US$ 0.6M. The incidence of CH among the hospital admissions in Metro Manila was 0.037% (95% CI 0.009 - 0.064%).

CONCLUSIONS: The net cost of a screening program for CH taken after 48 hours was US$ 2.4M. Newborn screening for CH was cost-beneficial if blood collection occurred after the 24th hour so that expense of an additional hospital day was not incurred. In order to realize the costing benefits illustrated by this study, the timing of sample collection was moved to a day earlier (after 24 hours of age) beginning in 2000.

Human ; Male ; Female ; Infant Newborn ; Congenital Hypothyroidism ; Neonatal Screening ; Cost-benefit Analysis ; Intellectual Disability ; Live Birth ; Early Diagnosis ; Specimen Handling ; Metabolic Diseases

Objective. The main objective of this study is to determine the level of understanding, accessibility and areas of application of Cochrane reviews (CR) among medical practitioners affiliated with a tertiary care medical center in Metro Manila, Philippines. Study Design. Survey using a self-administered questionnaire was conducted. Target Population and Setting. Consultant doctors of the Philippine General Hospital (PGH) were invited to participate. The PGH is the national university hospital of the Philippines and is a tertiary referral center and teaching hospital of the University of the Philippines Manila. Sampling Scheme. 101 doctors were chosen by stratified random sampling with the clinical department as the stratification variable. Strata samples were targeted according to strata size (proportional to size). Measurement Instrument. Eight domains that are important in the understanding of the CR were included in a 25-item multiple-choice questionnaire. In addition, facilitating factors and barriers to the application of CR or systematic reviews (SR) were asked. Data Analysis. Using a 25-point Multiple Choice Questionnaire, the knowledge of the respondents was measured and the mean score was estimated at a 95% confidence level. The percentage of CR awareness was also estimated at 95% confidence level. Facilitating factors and barriers in the use of SR were described. In addition, the following post-hoc analyses were done: descriptions of the total score according to gender, age, year graduated and year of last training. Results. Of 101 consultants invited, 59 participated (58% response rate) within the 6-month data collection period. The mean age was 47.2 years with a standard deviation (SD) of 7.8 years. Forty-five respondents (76%) had their last formal medical-related training from 1991 onwards. The mean score was 14.7 points (SD 6.7) using the 25-item multiple choice questions on concepts and principles of systematic reviews. Of these 59 respondents, 49 (83.0%: 95% CI: 75.2 - 90.9) indicated that they were aware of the existence of CR. Of those who were aware of CR, 42 (85.7%, 95% CI: 75.9 -95.6) have actually used them. The following factors help the respondents use CR: efficient Internet access, working knowledge of research methodology, working knowledge of how to critically appraise the medical literature, and familiarity with the terms used in the review. On the other hand, the following were considered barriers: inefficient access, poor knowledge of general research methodology, poor understanding of the principles of Evidence-based medicine (EBM) and difficulty in understanding the reviews. Conclusion. Practicing physicians in a tertiary university hospital in the Philippines were only able to get about 60% of the principles and concepts of understanding SR. Eighty three percent of them are aware of CR. Access to internet, familiarity with terms and working knowledge of CR and evidence-based medicine are the facilitating factors for application of the results of SR and CR. Although most claimed to use the SR results in literature reviews, only about 60% are able to use them in teaching, clinical practice or health policy development.
Human ; Male ; Female ; PHYSICIANS ; REVIEW

BACKGROUND: Late Onset Neonatal Sepsis (LONS) or nosocomial sepsis has a significant mortality and morbidity that leads to overtreatment. Overtreatment happens when antibiotics are frequently started and/or shifted, eventually leading to increasing antimicrobial resistamce in NICU.
OBJECTIVE: To validate bedside nosocomial sepsis scoringdeveloped by Okascharoen in 2005.
METHODOLOGY: All neonates admitted in NICU suspected of LONS were enrolled. Using Okascharoe scoring, subjects were scored based hypotension/poor perfusion, abnormal body temperature, respiratory insufficiency, complete blood count, and length of umbilical catheter use. Growth of organisms during blood culture is considered positive outcome and is considered confirmed sepsis.
RESULTS: Of the one-hundred-nineteen (119) subjects included in the analysis, 59 were confirmed sepsis and 60 were LONS negative. Subjects with confirmed sepsis had more events of hypotension/poor perfusion (p < 0.001; -0.141, -0.438), thrombocytopenia (p 0.000; -0.169, -0489), and prolonged umbilical catheter usage (p 0.014; -0.051, -0.311). The ROC curve has an AUC of 0.753 (p < 0.001; 0.664-0.842), which means a randomly chosen neonate with LONS will have a higher predicted score than a neonate without LONS. The sensitivity of this tool was 0.92 (0.82-0.97) and specificity of this tool was 0.32 (0.21-0.46) in this setting. The positive LR =1.35 (1.12-1.64) while the negative LR = 0.26 (0.10-0.65)
CONCLUSION: This scoring is a valid tool that can be used in point-of-care scoring for antibiotic stewardship in a neonate with suspected sepsis.
RECOMMENDATION: it is recommended that a score > 5 be used to be predictive of late onset sepsis, and this would have sensitivity of 83.3%, specificity of 61%, positive predictive value of 68.5% and a negative predictive value of 78.3%

Human ; Male ; Adult ; Anti-bacterial Agents ; Neonatal Sepsis ; Anti-infective Agents ; Blood Culture ; Sepsis ; Morbidity ; Hypotension ; Thrombocytopenia ; Blood Cell Count

BACKGROUND: Newborn Screening (NBS) is a public health activity aimed at the early identification of infants who are affected by certain genetic/metabolic/infectious conditions. A cost analysis is critical for national implementation for integration as a public health program.

OBJECTIVES: 1) To determine the incidence rates of congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH), galactosemia (GAL), phenylketonuria (PKU) and glucose-6-phosphate dehydrogenase (G6PD) deficiency; and 2) To determine whether NBS is cost-beneficial for each disorder individually or in combination, from a societal perspective.

STUDY DESIGN: Cross sectional survey and cost-benefit analysis.

SUBJECTS AND METHODS: The study was conducted through a screening survey of the original 24 Metro Manila hospitals. Newborns were screened for CH, CAH, GAL, PKU and G6PD deficiency after the 24th hour of life. Those who screened positive underwent serum confirmatory testing. Using incidence rates from the screening survey, a population of 1.5 million, and different screening combinations, the costs for the detection and treatment of the five disorders were compared to the benefits projected from preventing the corresponding complications and consequent productivity losses. For economic evaluation, we compared sequential analysis of doing tandem/multiple testing for the different disorders vs a "do-nothing" alternative. Sensitivity analyses for different incidence and discount rates were conducted to test the strength of the conclusions.

RESULTS: The incidences of the disorders with 95% confidence intervals are: CH is 1:3 235 (1:2 219 - 1:5 946); CAH is 1:7 455 (1:4 046 - 1: 14245); GAL is 1: 106 006 (1: 44 218-1:266 796); and G6PD deficiency is 1:167 (1:151 - 1: 186). Screened individually, CH and G6PD deficiency had net benefits of US$ 5.29 M and US$ 15.44 M, respectively. The other conditions yielded net costs when screened individually - CAH (US$ 2.61 M), GAL (US$ 0.90 M) and PKU (US$ 6.74 M). Pairing the disorders with CH showed the following benefit:cost ratios - CH + CAH, 1.3; CH + GAL, 2.0; CH + G6PD deficiency, 3.4; and CH + PKU, 0.9. Combining disorders resulted in the following benefit:cost ratios - CH + CAH + GAL, 1.2; CH + CAH + GAL + PKU, 0.8; and CH + CAH + GAL + G6PD deficiency, 2.1. Screening for the 5 disorders in tandem resulted in a benefit:cost ratio of 1.4 and a net benefit of US$ 11.42 M.

Human ; Galactosemias ; Glucosephosphate Dehydrogenase Deficiency ; Adrenal Hyperplasia, Congenital ; Glucosephosphate Dehydrogenase ; Phenylketonurias ; Lgals7 Protein, Human ; Galectins

Background. Systemic Lupus Erythematosus (SLE) in children has been estimated to account for 15 to 20% of all SLE cases worldwide. It was described to have more severe disease at presentation including renal, neuropsychiatric, and hematologic involvements; more disease activity over time, and a significantly higher risk of organ damage. Thus, considered a significant risk factor for mortality among adult SLE patients. Objective. This is a retrospective cohort study aimed to determine the clinical profile, outcome, and survival of SLE among Filipino children. Methods. All SLE patients, less than 19 years old, diagnosed in the pediatric department of a tertiary hospital from January 2008 to December 2017 were included in the study. Their medical charts were retrieved for data gathering. Demographics, and clinical disease characteristics were collected from admission and on subsequent follow ups. Lost to follow up patients were contacted for updates of their current clinical status. Results. A total of 261 pediatric SLE patients were gathered. Average age at diagnosis is 14.5 years old (±2.7), with female to male ratio of 16:1. Symptoms starts at 3 months prior to consult (±2.1). Upon diagnosis, most of the patients have fever, malar rash, alopecia, oral ulcers, and proteinuria. Most common systemic organ involvement through time were mucocutaneous, hematologic, and renal. Steroids were the mainstay management for all patients, in which 95% started on oral Prednisone, while 71% needed IV Methylprednisolone in at least once during the disease course. Two patients received biologic treatment. Overall mortality rate was 14.9%, identified to be secondary to sepsis and/or SLE activity. Myocarditis, pleural effusion, and seizures were identified as significant risk factors for mortality. Survival rate at 1 year and 10 years were 92% and 79%, respectively. Conclusion. SLE in Filipino children mostly presents with mucocutaneous symptoms. Presence of seizures, myocarditis, and pleural effusion at any time of the disease entails risk for mortality. SLE nephritis is a substantial cause of morbidity due to its chronicity. The survival rate of Filipino children with SLE is comparable with the data from other developing countries.
Lupus Erythematosus, Systemic ; Survival Analysis

One of the consequences of the COVID-19 pandemic is an avalanche of information that is unprecedented in magnitude. In the past 2 months, healthcare providers, policy-makers and the general public have been overwhelmed by this phenomenon. Aside from usual news from TV, radio, newspapers and medical journals, people from all walks of life have had to process kilometric threads on viber, facebook and twitter, as well as hundreds of issuances from all government agencies - from the Office of the President down to the barangays. The information from these various sources are often inconsistent or conflicting, and are always rapidly evolving. New information emerges as outdated information is just beginning to circulate. To aggravate the situation, the chaos is taken advantage of by perpetrators of false information. Clearly, this “informageddon” has led to “information overload” – the inability to process facts because of volume or pace. The manifestation is the widespread panic we are witnessing from all sectors of society. The consequence is impaired decision making – by individuals, families, communities and policy makers. Ultimately, this may lead to a prolonged, uncontrolled pandemic characterized by avoidable deaths, disability, and huge social and economic costs. Even healthcare providers are affected. Because of fear, many feel pressured to do tests and give treatments for COVID-19, that are poorly tested for effectiveness and safety. To help manage the information for policy-makers, healthcare workers and the general public, a group of 70 clinical epidemiologists and health professionals gathered together from the Institute of Clinical Epidemiology, National Institutes of Health-UP Manila and the Asia-Pacific Center for Evidence Based Healthcare Inc. The group conducted voluntary rapid evidence reviews and referred to themselves as “The Rappers”. The reviews were graciously shared by Philippine Society of Microbiology and Infectious Diseases through their website (PSMID.org). The online version allowed regular and rapid updates as evidence accrued.
Covid-19 ; coronavirus

Executive Summary The Coronavirus disease 2019 (COVID-19) pandemic has triggered a global crisis and has affected millions of people worldwide. With the evolution of the different variants of concern, the incidence of COVID- 19 in the pediatric population has risen. The Surveillance and Analysis of COVID-19 in Children Nationwide (SALVACION) Registry, developed by the Pediatric Infectious Disease Society of the Philippines (PIDSP) and the Philippine Pediatric Society (PPS), has reported 3,221 cases as of March 31, 2022, with 90.4% requiring hospitalization and 36.2% with moderate to critical disease severity. Given the magnitude of the impact of COVID-19, with most of the clinical recommendations available designed towards adult patients, there was an urgent need for clinicians, public health officials and the government to also prioritize evidence-based clinical practice guidelines for the pediatric population. Hence, the development of the Philippine Pediatric COVID-19 Living Clinical Practice Guidelines was conceptualized. This independent project, funded and supported by the PPS and PIDSP, aimed to formulate up-to-date, evidence-based recommendations on the treatment, diagnosis, infection prevention and control of COVID-19 in children. Following the standard CPG development process outlined in the DOH Manual for CPG Development and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, 15 evidence summaries and 24 recommendations were generated by 12 consensus panelists representing their specific health organizations and institutions.

There is conflicting evidence on the efficacy of intravenous immunoglobin G in the treatment of COVID-19 patients with severe disease. Intravenous immunoglobulin G (IVIg) is a mixture of polyclonal immunoglobulin G (IgG3, IgG4) antibodies as well as variable amounts of proteins; IgA, IgE and IgM antibodies isolated and pooled from healthy donors. IgG is involved in viral neutralization, modulates anti-inflammatory cytokines and cytokine antagonists. Immediate adverse effects of IVIg include flu-like syndrome, dermatologic side effects, arrhythmia, hypotension, and transfusion-related acute lung injury (TRALI). Delayed adverse effects can involve any organ which could be severe or even lethal There was a retrospective study (Yun Xie 2020) and several case reports that described recovery of COVID positive patients with severe disease. However, a retrospective study showed that immunoglobulin G with steroids and antivirals did not improve COVID patients with acute respiratory distress syndrome (Liu Y 2020). Similarly, another study showed no significant difference in the 28- and 60-day mortality between the IVIg and non-IVIg groups but subgroup analyses reported that in those with critical COVID illness, 28 day mortality is decreased with IVIg (Shao Z). There are eight registered clinical trials on the use of intravenous immunoglobulin G in COVID-19 patients.
Covid-19

Objective: This rapid review aimed to summarize data on the accuracy, benefits, harms, and cost-effectiveness of preoperative COVID-19 clinical risk assessment for asymptomatic individuals. Methods: A comprehensive search in MEDLINE, Cochrane CENTRAL, ChinaXiv, medRxiv, and bioRxiv was done until March 10, 2021, using the keywords “COVID-19”, “surgery”, “RT-PCR”, “clinical risk assessment” and “cost-effectiveness”. We searched for studies that assessed the diagnostic accuracy of preoperative clinical risk assessment in COVID-19 screening among asymptomatic individuals, its cost-effectiveness, and its impact on surgical outcomes and management decisions. Risk of bias was assessed using Evaluation of Articles on Diagnosis (Painless Evidence Based Medicine)10 for accuracy studies, Newcastle-Ottawa Scale11 for cohort studies, and Drummond’s checklist12 for economic evaluations. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the overall evidence. Data from included studies were collated qualitatively using summary tables and analyzed in Review Manager 5.4. Pooling of sensitivity and specificity, odds ratio or adjusted odds ratio, and cost-effectiveness measures using a random-effects model was planned. Heterogeneity was determined using I2. Subgroup and sensitivity analyses were preplanned in case significant heterogeneity was found. Results: Three observational studies were included. Preoperative clinical risk assessment for COVID-19 demonstrated a sensitivity of 0.42 (95% CI 0.15-0.72) and a specificity of 0.85 (95% CI 0.76-0.92), using RT-PCR as a reference standard. Indirect evidence showed that any positive clinical risk assessment, COVID-19 antigen or RT-PCR test is done within 0–7 weeks from surgery was associated with a higher 30-day postoperative mortality (RR 3.96, 95% CI 3.41, 4.59) and pulmonary complications (RR 3.41, 95% CI 3.04, 3.83). Delaying surgery at least seven weeks from COVID-19 diagnosis was associated with lower post-surgical complications. Universal pre-endoscopy virus testing using the antigen rapid diagnostic test (Ag-RDT) (ICER = -26,286 €), standard RT-PCR (ICER = -11,128€), or rapid PCR (ICER = -13,703 €) combined with high-risk personal protective equipment (PPE) use in all patients irrespective of test results were found to be more cost-effective compared to no pre-endoscopy testing and no high-risk PPE use, at an, assumed COVID-19 prevalence of 1% or higher among asymptomatic individuals. Overall certainty of evidence was very low. Conclusion Preoperative clinical risk assessment has poor sensitivity but high specificity for detecting COVID-19 among asymptomatic individuals undergoing elective surgery. Objective diagnostic tests such as RT-PCR or Ag-RDT may still be needed to inform surgery schedules.
COVID-19 ; Mass Screening