COVID-19 ; Pneumonia

Objective. This pilot study aimed to determine the epidemiologic burden of hospitalization for bronchial asthma in acute exacerbation. Methods. We used a descriptive cross-sectional study to describe the demographic profile, comorbidities and level of control of patients admitted for bronchial asthma in acute exacerbation admitted to the Philippine General Hospital from May 1 to October 31 2019. The study computed for the admission rate and compared the average cost of hospitalization (diagnostics, therapeutics and room) using direct costing to the total reimbursable cost from PhilHealth. Associations between patient characteristics (age, type of admission) and hospitalization cost were also determined. Results. We enrolled 45 patients in the study. The admission rate was 8/month. The mean cost of admission was significantly higher than the reimbursable amount from PhilHealth (Php 20,074.63 versus Php 9000) (p = 0.004). Cost of hospitalization was significantly higher in pay patients versus charity (p = 0.001 for diagnostics, p = 0.005 for treatment and p = 0.001 for room cost), in patients with poorly controlled asthma (p = 0.020 for diagnostics and p = 0.014 for room cost) and those with frequent short-acting beta-agonist (SABA) use (p = 0.001). Conclusion. Asthma remains an economic burden for the Filipino patient. Persistent SABA use, perceived asthma control of patients and increased expenses associated with an asthma exacerbation admission lead to significant out-of-pocket expenditure.
Asthma ; Costs and Cost Analysis

Objective: This single-subject case study was done to evaluate the presence and evaluate the risk factors for the development of Work-Related Musculoskeletal Disorders (WMSDs) among the staff performing bronchoscopy in the bronchoscopy suite. Methods: A single-subject case study to describe the ergonomic issues in bronchoscopy including identifying multiple factors that can potentially, either singly or in combination, affect physical work capacity. The study focused on the evaluation and control of occupational factors during bronchoscopy to improve awareness of ergonomic issues in bronchoscopy using the following data collection tools: 1) hierarchical task analysis, 2) activity sampling, 3) direct observation of the procedure (walk-around), 5) structured interview of the subject, and 5) utilization of checklists. Results: During the process of bronchoscopy, identified factors that can cause pain in the wrists, fingers, and shoulders include repetitive movement and awkward positions of the hands and wrists coming from the need to move the directional controls and position the bronchoscope. For the back, prolonged standing with awkward postures is a concern. For the neck, the need to look at the monitor which is situated at the side of the patient and frequent shifting of the eyes and head from the monitor to the patient can cause neck pain and stiffness. Aside from the above, other factors would include job stress from the workload, inadequate time for rest and recovery, and the possibility of an uncomfortable environment due to poor air quality. Chronic exposure and repeated injury followed by inflammation and repair lead to structural and biochemical changes in the tissues affected by Cumulative Trauma Disorders (CTDs) leading to the development of WMSDs. Conclusion Although CTDs do not account for work-related deaths, they do account for a significant amount of human suffering, loss of productivity, and economic burden on the compensation system. Thus, ergonomic concerns must be addressed early to prevent WMSDs/CTDs.
Bronchoscopy ; occupational health

Objective: This single-subject case study was done to evaluate the presence and evaluate the risk factors for the development of Work-Related Musculoskeletal Disorders (WMSDs) among the staff performing bronchoscopy in the bronchoscopy suite. Methods: A single-subject case study to describe the ergonomic issues in bronchoscopy including identifying multiple factors that can potentially, either singly or in combination, affect physical work capacity. The study focused on the evaluation and control of occupational factors during bronchoscopy to improve awareness of ergonomic issues in bronchoscopy using the following data collection tools: 1) hierarchical task analysis, 2) activity sampling, 3) direct observation of the procedure (walk-around), 5) structured interview of the subject, and 5) utilization of checklists. Results: During the process of bronchoscopy, identified factors that can cause pain in the wrists, fingers, and shoulders include repetitive movement and awkward positions of the hands and wrists coming from the need to move the directional controls and position the bronchoscope. For the back, prolonged standing with awkward postures is a concern. For the neck, the need to look at the monitor which is situated at the side of the patient and frequent shifting of the eyes and head from the monitor to the patient can cause neck pain and stiffness. Aside from the above, other factors would include job stress from the workload, inadequate time for rest and recovery, and the possibility of an uncomfortable environment due to poor air quality. Chronic exposure and repeated injury followed by inflammation and repair lead to structural and biochemical changes in the tissues affected by Cumulative Trauma Disorders (CTDs) leading to the development of WMSDs. Conclusion Although CTDs do not account for work-related deaths, they do account for a significant amount of human suffering, loss of productivity, and economic burden on the compensation system. Thus, ergonomic concerns must be addressed early to prevent WMSDs/CTDs.
Bronchoscopy ; Occupational Health

Introduction: Resistant hypertension (RH) is defined as a blood pressure (BP) reading that remains above goal despite concurrent use of three optimally dosed antihypertensives of different classes, including a diuretic. Spironolactone, a mineralocorticoid receptor antagonist, has shown significant benefit in reduction of BP in recent trials and is used empirically as an add-on therapy for RH. The researchers’ objective is to evaluate the BP-lowering efficacy of spironolactone in patients with resistant hypertension. Methods: A meta-analysis was performed on randomized controlled trials (RCTs) comparing office or home BP reduction using spironolactone with placebo or an alternative drug regimen on top of standard-triple drug therapy among patients with RH. The study was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Five RCTs were included comprising a total of 662 patients. Three of these studies were found to have low risk of bias while two had unclear risk of bias. Compared to placebo, the addition of spironolactone significantly decreased office systolic BP (weighted mean difference [WMD]= -16.33, 95% confidence interval [CI]=-24.68 to -7.97, P=0.0001) and office diastolic BP (WMD=-6.12, 95% CI= -9.35 to -2.89, P=0.0002). Compared to an alternative drug regimen, additional spironolactone resulted in a significantly greater reduction in office systolic BP (WMD=-4.58mmHg, 95% CI=-7.19, -1.97, P= 0.0006) and home systolic BP (WMD= -4.33, 95% CI= 5.55, -3.12, P< 0.00001); while the addition of spironolactone had no significant difference compared to an alternative drug regimen in reducing office diastolic BP (WMD=-3.35, 95% CI=-12.08 to +5.38, P=0.45) and home diastolic BP (WMD= 0.00, 95 % CI=-0.73 to 0.73, P=1.0). Conclusion Spironolactone, when added to triple-drug anti-hypertensive therapy, showed significant reduction of systolic office and home BP. It should be considered as the add-on medication of choice for BP reduction in patients with RH.
Antihypertensive Agents ; Spironolactone ; Blood Pressure

Objective: The study aimed to investigate the relationship between cardiac Troponin I (cTnI) level and prognosis among mechanically ventilated patients in terms of mortality, prolonged mechanical ventilation, and tracheostomy rate. Methods: This is a prospective cohort study conducted at Quirino Memorial Medical Center, a tertiary government hospital, over a period of ten (10) months. Seventy-six (76) mechanically ventilated adult patients admitted at the medical intensive care unit, surgical intensive care unit, medical wards, and centers for neurologic sciences were included in the study. Quantitative cardiac Troponin I (cTnI) marker was measured and correlated to prognostic outcomes: a) prolonged ventilation (requiring more than 21 days), b) tracheostomy rate, and c) mortality rate. Data were analyzed using SPSS 16.0 and logistics regression with 95% confidence interval. Results: Results showed that among 76 patients, 15 patients have low cTnI levels, 11 patients have normal levels and 50 patients have elevated levels. Among patients with low cTnI levels (<0.020 ng/mL), 13 (86.7%) were extubated, 1 (6.7%) preceded tracheostomy and 1 (6.7%) expired. Those with normal range cTnI levels (0.020 – 0.060 ng/mL), 10 (90.9%) were extubated, none (0%) preceded tracheostomy and 1 (9.1%) expired. Those with elevated cTnI levels (>0.060 ng/mL), 7 (14.0%) were extubated, 7 (14.0%) preceded tracheostomy and 36 (72.0%) expired. Conclusion Analysis of the results showed a significant correlation of cTnI elevation with prognostic outcome proven by the p-value of < 0.0001. The risk of mortality among subjects with above normal cTnI levels were nine times (9x) higher compared to subjects with normal or low cTnI levels. Duration of intubation among patients with low normal and high cTnI levels did not differ significantly. Tracheostomy rate in the study was inconclusive.
Respiration, Artificial ; Mortality ; Prognosis

Objective: The study aimed to investigate the relationship between cardiac Troponin I (cTnI) level and prognosis among mechanically ventilated patients in terms of mortality, prolonged mechanical ventilation, and tracheostomy rate. Methods: This is a prospective cohort study conducted at Quirino Memorial Medical Center, a tertiary government hospital, over a period of ten (10) months. Seventy-six (76) mechanically ventilated adult patients admitted at the medical intensive care unit, surgical intensive care unit, medical wards, and centers for neurologic sciences were included in the study. Quantitative cardiac Troponin I (cTnI) marker was measured and correlated to prognostic outcomes: a) prolonged ventilation (requiring more than 21 days), b) tracheostomy rate, and c) mortality rate. Data were analyzed using SPSS 16.0 and logistics regression with 95% confidence interval. Results: Results showed that among 76 patients, 15 patients have low cTnI levels, 11 patients have normal levels and 50 patients have elevated levels. Among patients with low cTnI levels (<0.020 ng/mL), 13 (86.7%) were extubated, 1 (6.7%) preceded tracheostomy and 1 (6.7%) expired. Those with normal range cTnI levels (0.020 – 0.060 ng/ mL), 10 (90.9%) were extubated, none (0%) preceded tracheostomy and 1 (9.1%) expired. Those with elevated cTnI levels (>0.060 ng/mL), 7 (14.0%) were extubated, 7 (14.0%) preceded tracheostomy and 36 (72.0%) expired. Conclusion Analysis of the results showed a significant correlation of cTnI elevation with prognostic outcome proven by the p-value of < 0.0001. The risk of mortality among subjects with above normal cTnI levels were nine times (9x) higher compared to subjects with normal or low cTnI levels. Duration of intubation among patients with low normal and high cTnI levels did not differ significantly. Tracheostomy rate in the study was inconclusive.
Respiration, Artificial ; Mortality ; Prognosis

BACKGROUND: Septic shock causes life threatening organ dysfunction needing vasopressor despite adequate fluid resuscitation. Numerous studies and meta-analysis have proven norepinephrine as the initial vasopressor of choice in septic shock with vasopressin as add-on. Although guidelines have established the goal monitoring response in septic shock, optimal approach in discontinuation of the vasopressors in the recovery phase of septic shock remains limited. METHODS: A systematic review and meta-analysis was performed on randomized controlled trials (RCTs) and nonrandomized studies comparing incidence of hypotension within 24 hours of discontinuing norepinephrine first versus vasopressin. Three reviewers independently selected studies, assessed their quality, and extracted the following data: the number and characteristics of patients enrolled, inclusion and exclusion criteria for each study, the description of interventions (discontinuing norepinephrine first versus discontinuing vasopressin first) and outcomes (incidence of hypotension within 24 hours). RESULTS: Seven retrospective cohort studies and one prospective randomized control trial were included. Compared with norepinephrine, risk of hypotension is higher when vasopressin is discontinued first among patients in the recovery phase of septic shock (RR 2.06; 95% CI [1.11,3.82]; I 2 91%). Results were consistent in the subgroup analysis after excluding abstract-only and poor-quality studies (RR 1.73; 95% CI [0.74, 4.03]; I 2 93%). There is no difference in ICU (RR 0.97; 95% CI [0.71, 1.32]; I 2 38%) and in-hospital mortality (RR 0.88; 95% CI [0.66, 1.16]; I 2 41%) between the two vasopressor weaning strategies. Finally ICU length of stay was reported on 5 studies with no significant difference between the two strategies. CONCLUSION: Based on the results, there is increased risk of hypotension when vasopressin is discontinued first versus norepinephrine.
Norepinephrine ; Shock, Septic ; AVP protein, human ; Vasopressins ; Vasoconstrictor Agents ; Neurophysins

Objective: This study aims to validate a Filipino version of the questionnaire by Delclos et al on occupational risk factors and asthma among the health care workers of the Philippine General Hospital. Methodology: Forward and backward translation method for bilinguals was used in this study. The Filipino translation was administered to 110 health care workers selected by stratified random sampling. After 24 hours, the retranslated English version was given to the same respondents. Testing for internal consistency reliability was done by computing for Cronbach's alpha. Construct validity was subsequently determined using the Cramer's V Coefficient. Results: The Filipino questionnaire showed good internal consistency reliability, as shown by the overall Cronbach’s alpha of 0.9016, which is comparable to that of the original version by Delclos. Likewise, our Filipino questionnaire showed good construct validity, supported by the Cramer’s V coefficients ranging from 0.2204 (strong relationship) to 0.7843 (very strong relationship). Conclusion Overall, the Filipino version of the questionnaire for work-related asthma tested among the health care workers of Philippine General Hospital showed good reliability and validity. This may now be used as screening tool for occupational asthma among health care workers who are at risk of developing the disease. In addition, this research tool may be utilized to establish the prevalence of occupational asthma in hospitals and later on, aid in the development of a better working environment for the whole health care team.
Health Personnel ; Surveys and Questionnaires