BACKGROUND

Observational studies have increasingly reported transthyretin amyloid cardiomyopathy (ATTR-CM) as an under-recognized cause of heart failure. We report the first ATTR-CM diagnosed via multi-modality imaging in the Philippines signifying an important milestone in recognition and management of this formerly believed rare disease, locally. Utilization of non-invasive imaging such as echocardiography, cardiac MRI and technetium-99m pyrophosphate scintigraphy (PYP) demonstrates the potential for accurate diagnosis as well as timely and appropriate treatment strategies.

An 81/M Filipino with a history of carpal tunnel surgery, post-percutaneous coronary intervention (PCI), had three months’ history of refractory heart failure symptoms despite optimized medical treatment. His 2D-echo showed an ejection fraction (EF): 45%-50%, increased left ventricular (LV) posterior wall thickness with mild basal inferior wall hypokinesia and ECG: atrial fibrillation with low voltage. Speckle tracking imaging showed average global longitudinal strain: - 6.5% with cherry-on-top pattern on polar strain map. Cardiac MRI demonstrated diffuse late gadolinium enhancement from endocardial to transmural layers of biventricular and biatrial walls, highly suggestive of cardiac amyloidosis (CA). Light-chain amyloidosis was excluded by negative serum/urine protein electrophoresis/immunofixation. Tc-99m PYP scan revealed greater myocardial-than-bone uptake with a Perugini score 3 and calculated heart-to-contralateral ratio of 1.7. Congestion was controlled with intravenous loop diuretics and he was discharged stable with metoprolol succinate, dapagliflozin and apixaban. At the time of paper submission, he is currently being evaluated for tafamidis treatment.

The case highlighted the advantage of multi-modality imaging for noninvasive yet accurate identification of the disease. A tailored approach is required in slowing the disease progression and improving outcomes.

BACKGROUND

Efforts to control Hansen's d isease have progressed through multidrug therapy implementation. However, documented cases of relapse present challenges to its effective management and eradication. Understanding the contributing factors to relapse is crucial for optimizing treatment strategies and achieving better outcomes against Hansen's Disease.

To determine the epidemiological profile and clinical patterns of patients diagnosed with Hansen's Disease Relapse in selected Tertiary Government Hospitals in the Philippines from November 2016 to October 2021.

This was a multi-center, retrospective study involving a five-year chart review method. Charts of all Hansen's Disease Relapse patients were obtained from participating institutions with necessary approvals. Data collection followed approved forms, and patient profiles were analyzed using descriptive statistics. Pre- and post- relapse profiles were compared using T-tests, Wilcoxon tests, and Fisher's Exact Test. Relapse time across subgroups were assessed using Kruskal-Wallis and Mann-Whitney U tests.

A total of 60 relapse cases were included in the study. Majority were single, unemployed males aged 26-35, with low household screening. The Bacillary Index significantly decreased post- relapse. Documented comorbidities included G6PD deficiency before treatment and lepra reactions during MDT. Patients on 12-month MDT regimens had higher relapse time than those on 24-month regimens.

This study underscores the influence of socioeconomic, gender, and age-related factors on relapse. It emphasizes the imperative for enhanced public health measures in accordance with the WHO Global Leprosy Strategy and the importance of considering clinical factors while advocating for continuous improvements in leprosy management protocols.

Background: A 2018 study on the global burden of disease, accidents, and risk factors reported that 1.6 million peo ple died in 2017 due to household air pollution. Poor indoor air quality has been highlighted as a contributing factor to respiratory diseases, cardiovascular conditions, and exacerbation of asthma and allergies. A 2019 study estimated that long-term exposure to fine particulate matter (PM2.5) with a diameter of 2.5 micrometers or less reduces average life expectancy by 1.8 years, with more severe effects in highly polluted regions. Additionally, a study by Miller et al. (2007) found that prolonged exposure to PM2.5 increases the risk of cardiovascular diseases, particularly among women. Direct measurement devices are highly effective in determining indoor PM2.5 concentrations, identifying sources of pollution, tracking pollutant dispersion, and monitoring temporal variations. Studies suggest that direct measurement is an accurate, cost-effective method that provides detailed data suitable for local conditions. Aim: To investigate the indoor air quality of houses and apartments in Darkhan city during the winter season using the Purple Air monitoring device. Materials and Methods: A cross-sectional study was conducted with a targeted sample of 128 households in Darkhan city. The study examined factors such as stove type, type of coal used, annual and daily coal consumption, frequency of heating, and chimney sealing conditions. To collect data, the Purple Air monitoring device was installed in each house hold for a month, after which it was retrieved. During retrieval, participants completed a questionnaire. The questionnaire consisted of 55 questions across 7 pages at the time of device installation and 25 questions across 3 pages at the time of device retrieval. The collected data was analyzed using SPSS 25.0. Results: A total of 128 households in Darkhan city participated in the study. The average duration of residence in the current home was 9.5 years, with no statistically significant variation. The distribution of housing types was as follows: traditional Mongolian gers (40.6%), houses (39.1%), and apartments (20.3%). The 24-hour average PM2.5 concentration was highest in gers (70.9 μg/m³), followed by houses (46.8 μg/m³) and apartments (22.8 μg/m³), with a statistically significant difference (p=0.0001). PM2.5 levels were most variable in gers, followed by houses and then apartments. House holds using central heating (apartments) had an average 24-hour PM2.5 concentration of 22.8 μg/m³, whereas households using stoves (gers and houses) had a significantly higher concentration of 59.4 μg/m³ (p=0.0001). However, there was no statistically significant difference between traditional and improved stoves. Among study participants, 21.4% reported that someone in their household smoked indoors. Additionally, 86.5% regularly burned incense, candles, or herbs, while 99.2% did not use an air purifier. Conclusion The indoor particulate matter concentration in houses and gers in Darkhan was 59.4μг/m3. Variations in stove types, poor chimney sealing limited space, and frequent gaps and cracks contribute to increased spread of indoor air pollutants.

The International Severe Asthma Registry (ISAR) was established in 2017 to advance the understanding of severe asthma and its management, thereby improving patient care worldwide. As the first global registry for adults with severe asthma, ISAR enabled individual registries to standardize and pool their data, creating a comprehensive, harmonized dataset with sufficient statistical power to address key research questions and knowledge gaps. Today, ISAR is the largest repository of real-world data on severe asthma, curating data on nearly 35,000 patients from 28 countries worldwide, and has become a leading contributor to severe asthma research. Research using ISAR data has provided valuable insights on the characteristics of severe asthma, its burdens and risk factors, real-world treatment effectiveness, and barriers to specialist care, which are collectively informing improved asthma management. Besides changing clinical thinking via research, ISAR aims to advance real-world practice through initiatives that improve registry data quality and severe asthma care. In 2024, ISAR refined essential research variables to enhance data quality and launched a web-based data acquisition and reporting system (QISAR), which integrates data collection with clinical consultations and enables longitudinal data tracking at patient, center, and population levels. Quality improvement priorities include collecting standardized data during consultations and tracking and optimizing patient journeys via QISAR and integrating primary/secondary care pathways to expedite specialist severe asthma management and facilitate clinical trial recruitment. ISAR envisions a future in which timely specialist referral and initiation of biologic therapy can obviate long-term systemic corticosteroid use and enable more patients to achieve remission.

The International Severe Asthma Registry (ISAR) was established in 2017 to advance the understanding of severe asthma and its management, thereby improving patient care worldwide. As the first global registry for adults with severe asthma, ISAR enabled individual registries to standardize and pool their data, creating a comprehensive, harmonized dataset with sufficient statistical power to address key research questions and knowledge gaps. Today, ISAR is the largest repository of real-world data on severe asthma, curating data on nearly 35,000 patients from 28 countries worldwide, and has become a leading contributor to severe asthma research. Research using ISAR data has provided valuable insights on the characteristics of severe asthma, its burdens and risk factors, real-world treatment effectiveness, and barriers to specialist care, which are collectively informing improved asthma management. Besides changing clinical thinking via research, ISAR aims to advance real-world practice through initiatives that improve registry data quality and severe asthma care. In 2024, ISAR refined essential research variables to enhance data quality and launched a web-based data acquisition and reporting system (QISAR), which integrates data collection with clinical consultations and enables longitudinal data tracking at patient, center, and population levels. Quality improvement priorities include collecting standardized data during consultations and tracking and optimizing patient journeys via QISAR and integrating primary/secondary care pathways to expedite specialist severe asthma management and facilitate clinical trial recruitment. ISAR envisions a future in which timely specialist referral and initiation of biologic therapy can obviate long-term systemic corticosteroid use and enable more patients to achieve remission.

The International Severe Asthma Registry (ISAR) was established in 2017 to advance the understanding of severe asthma and its management, thereby improving patient care worldwide. As the first global registry for adults with severe asthma, ISAR enabled individual registries to standardize and pool their data, creating a comprehensive, harmonized dataset with sufficient statistical power to address key research questions and knowledge gaps. Today, ISAR is the largest repository of real-world data on severe asthma, curating data on nearly 35,000 patients from 28 countries worldwide, and has become a leading contributor to severe asthma research. Research using ISAR data has provided valuable insights on the characteristics of severe asthma, its burdens and risk factors, real-world treatment effectiveness, and barriers to specialist care, which are collectively informing improved asthma management. Besides changing clinical thinking via research, ISAR aims to advance real-world practice through initiatives that improve registry data quality and severe asthma care. In 2024, ISAR refined essential research variables to enhance data quality and launched a web-based data acquisition and reporting system (QISAR), which integrates data collection with clinical consultations and enables longitudinal data tracking at patient, center, and population levels. Quality improvement priorities include collecting standardized data during consultations and tracking and optimizing patient journeys via QISAR and integrating primary/secondary care pathways to expedite specialist severe asthma management and facilitate clinical trial recruitment. ISAR envisions a future in which timely specialist referral and initiation of biologic therapy can obviate long-term systemic corticosteroid use and enable more patients to achieve remission.

The International Severe Asthma Registry (ISAR) was established in 2017 to advance the understanding of severe asthma and its management, thereby improving patient care worldwide. As the first global registry for adults with severe asthma, ISAR enabled individual registries to standardize and pool their data, creating a comprehensive, harmonized dataset with sufficient statistical power to address key research questions and knowledge gaps. Today, ISAR is the largest repository of real-world data on severe asthma, curating data on nearly 35,000 patients from 28 countries worldwide, and has become a leading contributor to severe asthma research. Research using ISAR data has provided valuable insights on the characteristics of severe asthma, its burdens and risk factors, real-world treatment effectiveness, and barriers to specialist care, which are collectively informing improved asthma management. Besides changing clinical thinking via research, ISAR aims to advance real-world practice through initiatives that improve registry data quality and severe asthma care. In 2024, ISAR refined essential research variables to enhance data quality and launched a web-based data acquisition and reporting system (QISAR), which integrates data collection with clinical consultations and enables longitudinal data tracking at patient, center, and population levels. Quality improvement priorities include collecting standardized data during consultations and tracking and optimizing patient journeys via QISAR and integrating primary/secondary care pathways to expedite specialist severe asthma management and facilitate clinical trial recruitment. ISAR envisions a future in which timely specialist referral and initiation of biologic therapy can obviate long-term systemic corticosteroid use and enable more patients to achieve remission.

BACKGROUND

With childhood overweight and obesity becoming widespread in the Philippines, there is an increased risk of developing non-communicable diseases at a younger age. The school environment, found to be associated with body mass index, offers an avenue to address and prevent school-aged obesity. However, the lack of data on the current school environment poses a barrier to improving these conditions.

This study aimed to describe the physical, political, and sociocultural environment characteristics of primary schools in the Municipality of Pateros (Philippines) that affect nutrition and physical activity of school-aged children. 

Self-administered questionnaires for key school personnel and observational checklists were used to examine available resources, policies, and current practices for obesity prevention in five public schools in a municipality. The role perceptions of all school personnel on childhood obesity prevention were also gathered. Descriptive statistics was used to describe the number and categories of food items, functional spaces and equipment for physical activity, policies and scores of attitude toward obesity prevention. Data were collected in May to June 2019 and were analyzed descriptively.

Majority of the schools serve food items that contain high amounts of saturated fat, sugar, or salt, provide excess calories, and are not recommended to be sold at school canteens based on guidelines by the Department of Education. While all schools have areas and functional equipment for physical activity, students have limited access to these. Policies and guidelines for nutrition were present but sparse for physical activity and obesity prevention. Positive attitude towards childhood obesity prevention was seen across all school personnel respondents.

Participant primary schools are eager to address childhood obesity, however, the physical, political, and sociocultural environments do not seem to enable this. This situation may promote, rather than prevent, overweight and obesity among school children. This points to the need of reorientation and implementation of policies on obesity prevention to the schools as well as developing the skills of both teaching and non-teaching personnel in healthy eating and physical activity to students. School-based healthcare workers like school nurses and doctors would have critical roles in supporting schools in this regard.

BACKGROUND

Medication compliance contributes to preventing significant morbidities, such as stroke, among hypertensive patients.

This study aimed to examine the factors affecting hypertensive patients' medication compliance in Sambag II, Cebu City.

This study is an observational cross-sectional study. The study was conducted in Barangay Sambag II of Cebu City and involved 170 random, voluntary, self-reporting hypertensive patients. The Tao Yamane formula was used to determine the sample size. An interviewer-guided survey questionnaire was utilized to collect the data for the pilot study. The data were analyzed using Cronbach’s Alpha Test for internal consistency and reliability.

Three factors were shown to influence compliance with antihypertensive medications. These are the source of medication, access to medication, and symptoms experienced before intake of anti-hypertensive medications. A factor that significantly affects compliance is the source of medication, wherein hypertensive patients prefer medications from retail pharmacies compared to the free medications supplied by the local health center.

Residents of Sambag II, Cebu City preferred medications from retail pharmacies over the free medications provided by the local health center. Local health units may use this information to implement information drugs regarding the efficacy of medications provided by government agencies. Further studies are recommended to use subgroup analysis on factors influencing compliance and non-compliance to anti-hypertensive medicines.

Ocular cicatricial pemphigoid (OCP) is a chronic bilateral, blinding, cicatrizing form of conjunctivitis with relapsing and remitting periods. It has strong evidence for an immune type II hypersensitivity that leads to subconjunctival fibrosis and extensive systemic bullae formation. To the best knowledge of the authors, this is the first reported case of direct immunofluorescence (DIF) assay-proven OCP in an elderly Filipino man.

A 68-year-old male presented with bilateral corneal conjunctivalization, symblepharon, ectropion, conjunctival hyperemia testing positive with conjunctival biopsy for basement membrane antibodies with DIF for the left eye, while turning out negative for the right eye. He was managed as a case of OCP, both eyes, and was given topical steroids and antibiotics. Oral Dapsone was started by Dermatology and Rheumatology Services.

OCP is a rare autoimmune and blinding disease. Early diagnosis and prompt treatment are vital as ocular complications permanently affect the quality of life of patients as seen in our patient. DIF assay remains the gold-standard for diagnosis. Systemic immunosuppression is the mainstay of treatment. Adjunctive supportive topical medication may be given to alleviate ocular discomfort. A multidisciplinary approach is essential to provide holistic care to each patient.