INTRODUCTION: Peripheral arterial disease (PAD) had been shown to have a higher likelihood of developing cardiovascular events as well as cerebrovascular accidents particularly acute ischemic stroke. However, there are limited data on the association between ankle brachial index (ABI) values and the severity of ischemic stroke. This study aimed to determine the correlation of ABI values and the severity of acute ischemic stroke in Southern Philippines Medical Center. METHODS: A prospective cross-sectional study with 112 patients diagnosed with acute ischemic stroke from June to October 2017. The ABI ratio of the subjects were obtained and correlated with the severity of stroke using National Institutes of Health Stroke Scale (NIHSS). Data analyses utilized chi-square test for categorical variables while ANOVA test for continuous variables. Spearman rho was used to determine the association between ABI and NIHSS. RESULTS: Majority of patients with acute ischemic stroke had PAD with ABI ratio of ≤ 0.9 (51.8%). Using t-test, the NIHSS was significantly higher among patients with PAD having a mean score of 12.43 ± 5.29 compared to patients with normal ABI ratio having a mean score of 5.13 ± 4.09 (p= < 0.001). Furthermore, using Spearman’s rho statistics, ABI ratio was negatively correlated with NIHSS score (p < 0.001). CONCLUSION: Our results confirmed that there is a correlation between low ABI value and the severity of acute ischemic stroke. Routine ABI screening may help physicians intensify treatment strategies for those high-risk patients to prevent future events.
Ankle Brachial Index ; Peripheral Arterial Disease ; Stroke

BACKGROUND: Older individuals are more likely to utilize emergency care services than younger individuals due to the complexity of their condition. The increase in the demand for health services may lead to ER congestion, which may affect the quality of care being rendered. To the best of our knowledge, studies investigating the common medical causes of ER visits among older individuals have not been done in the Philippines. OBJECTIVES: The study aimed to determine the characteristics of emergency room visits by older individuals in a tertiary government hospital in Nueva Ecija. METHODS: The study is a single-center, retrospective study conducted in a tertiary government hospital in Nueva Ecija. A total of 270 ER records of Internal Medicine patients aged 60 years old and above seen from June 2019 to September 2019 were included. Patients who absconded or were dead on arrival were excluded. Descriptive statistics were used for the demographic variables and the characteristics of the ER visits. RESULTS AND ANALYSIS: The mean age of older individuals included was 69.72 ± 7.62. The average length of stay in the ER was 3.74 ± 2.34 Hours. Majority of visits occurred during the PM shift and were urgent cases. Majority of the patients seen were self-referral and were discharged. Patients commonly presented with difficulty of breathing. Diseases of the respiratory and circulatory system predominated. Chronic obstructive pulmonary disease and pneumonia were the leading causes of ER visits. CONCLUSION: Diseases of the respiratory and cardiovascular systems remain to be the leading causes of ER visits among older individuals. COPD and pneumonia were the most common diagnoses identified. Factors associated with the increase in frequency of these preventable and treatable diseases should be investigated. Older individuals often seek consultation in the ER rather than a primary health care provider. Some of the cases can be managed on an ambulatory care basis.
Aged ; Emergency Service, Hospital

BACKGROUND AND OBJECTIVES. Several reports have shown that coexistence of diabetes mellitus and COVID-19 is one of the risk factors for poor outcome and increased mortality. Rapid metabolic deterioration with development of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS) may result due to the acute insulin secretory capacity loss, stress condition and the cytokine storm. In this review, we aim to describe the prevalence of hyperglycemic crises(DKA/HHS) in patients with COVID-19 infection as well as their clinical outcomes. METHODS. An intensive search was done using the WebMD, PubMed, Medline and Google Scholar databases for articles published between December 2019 to October 2020 that identified the number of patients who developed DKA and/or HHS among those who were admitted for COVID-19. Their clinical outcomes were likewise described. RESULTS. This review included 4 articles in which individual quality was assessed. A total of 1282 patients were admitted for COVID-19 and the prevalence of DKA was 1.32%. HHS was not reported in any of the studies. Five (29.4%) of the patients with DKA and COVID-19 died and 12 (70.6%) recovered. CONCLUSIONS. A significant number of COVID-19 patients developed DKA and it is associated with a high mortality rate. This reimposes the need for an appropriate algorithm for the optimal management of concomitant COVID 19 and hyperglycemic crises to avoid morbidity and mortality. Additionally, there is paucity of large-scale studies describing the prevalence of DKA/HHS in patients with COVID-19.
Diabetic Ketoacidosis ; COVID-19 ; Water-Electrolyte Imbalance ; Acid-Base Imbalance ; Coma

BACKGROUND: COVID-19 disease has strained our healthcare system. Convalescent plasma is an adjunct treatment used in emerging infectious diseases in past epidemics. OBJECTIVE: This study aims to determine the outcome and clinical course of COVID-19 patients who received convalescent plasma (CP) transfusion at Cardinal Santos Medical Center. METHODS: This is a retrospective cohort analytical study of 75 patients who received convalescent plasma. RESULTS: Median time from admission to CP transfusion was 3 days. Majority of patients received additional therapies including dexamethasone (100%), antibiotics (100%), remdesivir (95%), hemoperfusion (88%), tocilizumab (65%), or combinations of these. Among the survivors, the median length of stay (LOS) was 15 days while non-survivors had a median LOS of 6 days. One patient (1.33%) had a mild transfusion reaction. Four patients (5.33%) developed deep vein thrombosis despite anticoagulation. There was improvement in the inflammatory markers (LDH p value 0.04, CRP p value 0.00, Ferritin p value 0.0001). There was improvement in the pulmonary parameters - increase in mean PaO2, mean SaO2, and mean PFR; and decrease in mean FiO2 and mean RR post-treatment. Median LOS is 14 days for the CP group vs 11 days for the non- CP group. Mortality rate among the CP group was 25.33% while the non-CP group was 26.67%. LOS and mortality rate did not reach statistical significance. CONCLUSIONS: There was no significant difference in mortality and length of hospital stay in patients given CP vs controls. CP when combined with other treatment modalities might have a role in the improvement of inflammatory markers and pulmonary status.
COVID-19 ; Plasma

BACKGROUND: Kidney transplantation (KT) remains to be the preferred mode of renal replacement therapy as it offers the best clinical outcomes, a better quality of life, and lesser complications compared to dialysis. However, KT still carries a number of complications, one of which is graft thrombosis. Despite advancements in treatment, graft thrombosis is still an important cause of early graft loss. Prevention therefore, is of significance. A growing number of evidence suggests that low-dose aspirin has a role in the primary prevention of allograft thrombosis. RESEARCH QUESTION: Among renal transplant recipients, does postoperative aspirin prevent early renal allograft thrombosis? OBJECTIVE: To conduct a meta-analysis to determine the effect of postoperative aspirin on preventing renal allograft thrombosis. METHODS: A systematic search of PubMed, Google Scholar, CENTRAL, and clinicaltrials.gov was done by two independent authors. All randomized and non-randomized studies determining the effect of postoperative aspirin on renal vein/allograft thrombosis were reviewed for eligibility and quality assessment. Studies on both adult and pediatric kidney transplant recipients were included. RESULTS: Five non-randomized cohort studies (3 in adults, 2 in children) with a total of 2,393 patients were included. Using the Newcastle-Ottawa scale, two studies were found to have good quality, while three had poor quality. In a fixed-effects meta-analysis, aspirin was associated with a reduced risk for renal allograft thrombosis in adults (RR 0.13; 95% CI 0.06, 0.28;I2 22%) and children (RR 0.11; 95% CI 0.03, 0.40; I2 0%). CONCLUSION: Post-operative aspirin was associated with reduced risk for renal allograft thrombosis in both adults and children. However, the best available evidence is limited to observational studies. A well-designed randomized controlled trial is needed to confirm this finding.
Aspirin ; Kidney Transplantation ; Renal Veins ; Venous Thrombosis ; Transplantation, Homologous ; Kidney Diseases ; ; Veins ; Allografts

INTRODUCTION: COVID 19 has become the most important public health issue today. It has the potential to significantly affect the mental health of frontline healthcare workers (HCW) putting them at a higher risk of developing psychological problems especially to those who acquired COVID19 infection. OBJECTIVES: To determine the level of depression, stress, anxiety and coping strategies among Filipino HCWs with confirmed COVID-19 infection and its association with demographic and clinical profiles. STUDY DESIGN: Single center Descriptive study materials and methods consisted of 114 Filipino HCW with COVID 19 infection. Data were collected utilizing the Filipino translation of DASS 21 and Filipino Coping Strategy scale. RESULTS: There was a significant increase of HCWs with moderate depression, anxiety, and stress. A large proportion of the HCWs were also severely depressed, severely anxious and severely stress. Majority of the COVID19 positive HCWs were nurses accounting to 35%. More likely, the occupation was significantly associated with their degree of depression and stress. Hypertension associated significantly with elevated stress while having diabetes was instrumental for the depression, anxiety and stress. Moreover, appreciation was more felt at the workplace, then at home. While discrimination was prevalent in the community, workplace and social media. Religiosity ranked the most sought coping strategy. CONCLUSION: The study has found that a large percentage of HCWs had moderate level and a notable portion of respondents had severe to extremely severe level in each of the psychological domains in which factors such as gender, occupation, comorbidities, area of assignment and disease severity have brought significant impact. Discrimination is prevalent in the community and surprisingly in the workplace. In contrast, appreciation was felt more at home and in the workplace. Religiosity was shown to be the top coping strategy among HCWs who tested positive.
COVID-19 ; Adaptation, Psychological

BACKGROUND: Falls are common in older people and a leading cause of injury. Exercise programmes are available for falls prevention, including the Otago Exercise Programme (OEP). The Southeast Asia region has a rapidly ageing population with unique aspects to consider in falls prevention. This systematic review aims to explore the effectiveness of OEP in Southeast Asia for falls prevention. METHODS: A literature search conducted in April 2020 of PubMed and Google Scholar databases was performed to identify randomised controlled trials on OEP in Southeast Asia. RESULTS: Three studies met inclusion criteria for the systematic review. The studies in Malaysia and Thailand did not identify any differences in the rate of falls with the modified OEP intervention compared to conventional treatment. The study from Indonesia inferred a reduced fall risk with improved Timed Up and Go with the intervention, but did not quantify fall rates. CONCLUSION: The three studies identified used a modified OEP, with limited evidence of efficacy or reduction in fall rates. Further research is required, particularly randomized controlled trials to evaluate OEP for falls prevention in Southeast Asia.
Accidental Falls ; Secondary Prevention ; Asia, Southeastern

RESEARCH QUESTION: What are the profiles and the degree of burnout among resident physicians in private tertiary hospitals in Bacolod City? BACKGROUND: Exhaustion from work may result into negative effects not only to the medical staff and patients. Systematic reviews revealed an association in physician burnout and suboptimal quality of care, patient safety and patient satisfaction. However, the prevalence of burnout among resident physicians in Bacolod City has not been established. OBJECTIVES: The study aimed to determine the profiles and the degree of burnout among resident physicians in private tertiary hospitals in Bacolod City. STUDY DESIGN: Cross-sectional survey PARTICIPANTS: We invited all resident physicians in private hospitals in Bacolod City. OUTCOME MEASURE: This study used the 22-item Maslach Burnout Inventory-Human Services Survey. ANALYSIS: IBM SPSS version 22 was used in the data analysis. Mean and frequency distribution were utilized. Analysis of percentage of distribution was used to determine their difference. RESULTS: From December 2019 to January 2020, ninety-three resident physicians consented to participate in the study. The majority of the participants were young adults, females and single. Only a minority of the residents exercised regularly. The majority were practicing their religion. Most of the residents are in their early years of training. Residents in Internal Medicine comprised the majority of the respondents. Among the respondents, in the Emotional Exhaustion (EE) domain: 24.7% were low, 37.6% were moderate, and 37.6% were high. While in the Depersonalization (DP) domain: 43% were low, 34.4% were moderate, and 22.6% were high. Lastly, in the Personal Achievement (PA) domain: 33.3% were low, 35.5% were moderate, and 31.2% were high. High burnout was present in 22.6% among the respondents. CONCLUSIONS: High burn out was seen among young adults, male, single, and more senior resident physicians. Furthermore, residents who exercise regularly and practice their religion have lower burnout. And Internal Medicine residents were seen to have high burnout compared to other training specialization. Organizational- and physician-directed interventions have an essential role in preventing and reducing burnout in training institutions.
Burnout, Professional ; Burnout, Psychological ; Hospitals, Private ; Physicians

INTRODUCTION: Primary peritoneal carcinoma (PPC) is an uncommon malignancy and is often misdiagnosed as peritoneal carcinomatosis from metastatic gastrointestinal carcinoma and more frequently from ovarian carcinomas due to a common embryonic origin of the ovary and the peritoneum. Its diagnosis is a challenge for clinicians. Herein, we report a rare case of PPC in a 72-year-old woman who was initially suspected with metastatic ovarian malignancy, and emphasizes points that help differentiate PPC from primary ovarian cancer. CASE: This a case of a 72-year-old female with abdominal discomfort and distension, initially diagnosed with ovarian carcinoma, with abdominal CT scan revealing thickening of the omentum multiple enhancing nodules in the left adnexa, within the pouch of Douglas and subdiaphragmatic region compatible with malignancy such as metastases from carcinoma. Cancer antigen (CA) 125 (3476 u/mL) and CA 15-3 (45.94 u/mL) were elevated. The patient underwent dilation and curettage and diagnostic laparoscopy and biopsy with frozen section, which revealed metastatic clear cell adenocarcinoma, favoring primary ovarian carcinoma. The patient then underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy with bilateral lymph node dissection, and omentectomy. Further histopathological findings later confirmed that the patient had carcinoma primarily from the peritoneum instead of from the ovary. The patient was discharged, improved and underwent chemotherapy post-operation. CONCLUSION: This report emphasizes how to distinguish primary malignancy from the peritoneum from that in the ovary, preventing misdiagnosis. The emphasis in considering primary peritoneal cancer as a differential diagnosis in patients with abdominal symptoms suspected due to malignancy should be noted.
Peritoneal Neoplasms Carcinoma, Ovarian Epithelial ; Ovarian Neoplasms ; Carcinoma

The objective of the study was to evaluate the effect of cardiovascular health education on change in blood pressure at 3, 6, 12, and 18 months follow-up. This was a prospective cohort study. Participants were from an urban poor community in Metro Manila. Included were the 98 adults at least 40 years of age with hypertension, without cardiovascular disease. Among those previously diagnosed with hypertension, 20.3% had controlled blood pressures at the time of screening. There were 29.6% newly diagnosed cases of hypertension in the study. During the 18-month intervention phase, cardiovascular disease health education and counseling on risk factor control were given along with medical check-ups. Systolic and diastolic blood pressures were measured at 3, 6, 12, and 18 months. The decreases in mean systolic blood pressures from the baseline at 3, 6, 12 and 18 months were 11.9, 15.2, 9.1, and 14.1-mm Hg, respectively. The diastolic blood pressures decreased by 6.9, 9.3,.4.6, and 4.4 mm Hg. These differences were statistically significant. For the urban poor, health education on risk factor modification and cardiovascular diseases can be an important tool in improving blood pressure.
Blood Pressure ; Life Style ; Urban Health ; Health Education