INTRODUCTION

Acute coronary syndrome (ACS) and end-stage renal disease (ESRD) are both prevalent globally. The diagnosis and management of ACS in ESRD is difficult because the interplay of cardiovascular and renal disease is complicated. The guidelines for ACS may not be applicable to the ESRD population because the trials from which these are drawn mostly excluded ESRD patients.

To determine the clinical profile and outcomes of CKD patients on dialysis admitted for ACS in the Philippine General Hospital (PGH).

We did a retrospective cohort study and employed a retrospective review of electronic medical records among ESRD patients presenting with ACS in PGH from May 2021 to November 2023. The collected data was analyzed using univariate and bivariate statistics using PRISM software.

A total of 48 patients with ESRD were admitted for ACS in this study – 8 with STEMI and 40 with NSTEMI. The mean age was 61 years old and 33 (68.8%) were male. Among those with STEMI, six (75%) presented with Kilip II or more. While among those with NSTEMI, 17 (42.5%) had a GRACE score >140 and 27 (67.5%) had an NSTEMI TIMI risk score >2. On average, the patients were on hemodialysis for 31 months prior to admission. The most common comorbidities were hypertension (91.7%) and heart failure (83.3%). On admission, 18 (37.5%) presented with SBP >160, 7 (14.6%) patients presented with shock, and 4 (8.3%) patients presented with cardiac arrest. 38 (79.2%) patients had anemia on admission. 21 (43.8%) patients had left ventricular hypertrophy on electrocardiogram while 34 (70.8%) patients had cardiomegaly on chest radiography. The average left ventricular ejection fraction on echocardiogram was 46% and 27 (90%) patients had segmental wall motion abnormalities. The most common angiographic finding was 3-vessel coronary artery disease seen in 50% of patients. Almost all patients received dualantiplatelet therapy, high dose statin, and beta-blocker. The mortality rate was high at 43.8% with cardiovascular causes being the most common cause of death.

This study demonstrates the high mortality rate among patients with ESRD presenting with ACS. Our study portrays that patients with ESRD present with higher risk features including abnormalities in vital signs, laboratories, imaging, high prognostications score, and high in-hospital morbidity.

Valacyclovir-associated neurotoxicity (VAN) is a recognized adverse effect in elderly patients with renal impairment but remains underdiagnosed due to its nonspecific presentation and overlap with acute neurologic emergencies. We report a 78-year-old Filipino female with end-stage renal disease on maintenance hemodialysis who developed acute disorientation, agitation, vivid visual hallucinations and generalized weakness shortly after initiation of valacyclovir for herpes zoster. Given the abrupt onset of neuropsychiatric symptoms, viral encephalitis was initially considered. Magnetic resonance imaging of the brain showed no evidence of acute infarction or encephalitis, while electroencephalography demonstrated diffuse generalized slowing consistent with an encephalopathic process. Review of the medication history revealed valacyclovir dosing that exceeded recommendations for patients with end-stage renal disease. Valacyclovir was discontinued and emergent hemodialysis was initiated resulting in marked improvement in sensorium after the second session and complete resolution of symptoms after the third. This case shows VAN as an important diagnostic mimic of acute encephalopathy in elderly patients with renal failure and emphasizes the critical role of early medication review in preventing unnecessary investigations and enabling prompt, reversible management.

BACKGROUND

Self-management is crucial for individuals with chronic illnesses. While mobile applications (mAPPs) have emerged to support diverse health needs, evidence regarding their efficacy for self-management among chronically ill Filipino patients is inconsistent and limited, particularly in provincial settings.

To investigate the effectiveness of the Health Storylines mAPP compared to a traditional pamphlet for enhancing self-management among individuals with chronic illnesses in Baguio City, Philippines.

We conducted a two-arm quasi-experimental study with 33 participants diagnosed with cancer, type 2 diabetes, or heart disease/hypertension. Participants were recruited via convenience sampling and allocated to an intervention group (n=17), which used the Health Storylines mAPP for four weeks, or a comparison group (n=16), which received a traditional pamphlet. Selfmanagement was assessed pre- and post-intervention using the Self-Management Assessment Scale (SMASc).

Participants demonstrated a high level of selfmanagement at baseline (μ=5.20, SD=0.70). After four weeks, the intervention group showed a non-significant decrease in self-management scores (from μ=5.25 to 5.00, p=0.27), while the comparison group exhibited a non-significant increase (from μ=5.19 to 5.37, p=0.61). There was no statistically significant difference in posttest self-management scores between the two groups (U=83.50, p=0.23).

In a population of chronically ill patients already proficient in managing their condition, the Health Storylines mAPP had a marginal impact on selfmanagement, while the use of a traditional pamphlet showed a slight positive effect. The findings suggest that for this population, familiar, low-barrier resources remain valuable, and mHealth interventions must account for baseline self-management capabilities and digital literacy. Chronic Illness; Health Storylines mAPP; Self-management; mHealth; Philippines.

OBJECTIVE

This paper reports a rare presentation of diffuse intraocular inflammation following reversed vaulted multipiece intraocular lens (IOL) implanted in the sulcus of a 7-year-old child.

This is a case report.

A 7-year-old child presented with persistent posterior pole inflammation and optic disc swelling after an improperly placed multipiece intraocular lens in the sulcus. Comprehensive eye and wholebody evaluations were performed with the aid of optical coherence tomography (OCT), magnetic resonance imaging (MRI) and systemic work-up to rule out other causes of uveitis to definitively diagnose the case. The reverse-vaulted lens was eventually explanted. After 1 week post-explantation, the visual acuity improved markedly to 20/100 with the appropriate spectacle prescription. The patient recovered from the ocular inflammation 8 months postoperatively.

This paper reports significant posterior pole inflammation as an uncommon yet potentially visually-disabling consequence of a reverse-vaulted sulcus placement of a multipiece intraocular lens in a child. Careful attention is warranted to ensure proper IOL orientation during implantation, especially in pediatric cataract surgery. Visual rehabilitation is important postoperatively

Introduction: Adolescence is a crucial period for achieving peak bone mass. Risk factors such as chronic inflammation, endocrine issues, corticosteroid use, and extended immobility can lead to severe secondary osteoporosis and fragility fractures. Case: A 15-year-old female with transfusion-dependent thalassemia had been hospitalized for over a year following severe acute gastroenteritis complicated by septic shock, multiorgan failure, and secondary hemophagocytic lymphohistiocytosis (HLH). She received pulse methylprednisolone therapy for HLH, which was tapered over 6 months. Her clinical course was further complicated by critical illness polyneuropathy and post-infectious bronchiectasis, leading to ventilator dependence and a bedbound state. During regular physiotherapy sessions, she developed a sudden onset of severe left shoulder pain. A radiograph of the left shoulder revealed a closed fracture of the humeral neck. Biochemical evaluation showed normal serum calcium and phosphate levels, adequate vitamin D status, and normal alkaline phosphatase levels. However, follicle-stimulating hormone, luteinizing hormone (LH), and estradiol levels were undetectable, consistent with arrested puberty due to chronic illness. A bone mineral density scan showed a lumbar spine Z-score of −6, indicating severe osteoporosis. She was started on intravenous zoledronate for secondary osteoporosis, and physiotherapy was resumed to improve musculoskeletal strength. Conclusion This patient was treated with bisphosphonate therapy for severe secondary osteoporosis caused by multiple risk factors, including chronic illness, prolonged immobility, corticosteroid use, and hypogonadotropic hypogonadism, with limited potential for spontaneous bone recovery. This case highlights the importance of early endocrine monitoring and bone health assessments to identify impaired bone growth and prevent fragility fractures in high-risk adolescents.
Adolescent ; Humans ; Chronic Disease ; Thalassemia

BACKGROUND : The Indonesian chronic disease management program (PROLANIS) was introduced to provide structured chronic disease management for hypertension and type 2 diabetes (T2D) at the primary healthcare level. This study aimed to evaluate the health-related outcomes of PROLANIS among T2D patients in the eastern border region. METHODS : This retrospective cohort study used secondary data from PROLANIS reports of all primary healthcare facilities in Atambua Regency, East Nusa Tenggara Province, Indonesia. Inclusion criteria were all T2D patients who participated in routine 6-month evaluations conducted between June 2023 and December 2023. The assessed parameters and their defined targets were body mass index (BMI) (18.5–23 kg/m²), systolic blood pressure (SBP) (<140 mmHg), diastolic blood pressure (DBP) (<90 mmHg), hemoglobin A1c (HbA1c) (<7%), total cholesterol (TC) (<200 mg/dl), high-density lipoprotein (HDL) (>40 mg/dl for males and >50 mg/dl for females), low-density lipoprotein (LDL) (<100 mg/dl), and triglycerides (TGs) (<150 mg/dl). Wilcoxon signed-rank and paired t-tests were used for statistical analyses. RESULTS : There were 51 T2D patients included in the analyses. Of these, 84% achieved SBP and 96% achieved DBP targets. However, only 45% achieved HbA1c, and 33% achieved BMI targets. For lipid profiles, 55%, 51%, 47%, and 41% achieved TC, LDL, HDL, and TG targets, respectively. No significant differences were found between baseline and follow-up across these parameters (all p>0.05). CONCLUSIONS In the border region, while PROLANIS maintains blood pressure levels, it does not significantly improve other health-related outcomes in T2D patients. This underscores the need to strengthen program intensity, support adherence, and address contextual barriers to achieve meaningful metabolic improvements.
chronic disease ; government programs health services ; Indonesia ; primary healthcare ; type 2 diabetes mellitus

INTRODUCTION

Chronic Kidney Disease (CKD) is a leading cause of morbidity and mortality in the Philippines. Most Filipino CKD patients prefer hemodialysis due to barriers such as cost and availability of Kidney Transplant. End-stage kidney disease (ESKD) patients face high symptom burden and unmet palliative care needs. Even with advancement in dialysis technology, the annual mortality rate of dialysis patients remains between 20% and 25%. While Advance Care Planning (ACP) can help align care with patient preferences by facilitating discussions about values and future decisions, its utilization in dialysis population remains low due to barriers in implementation. There is limited research specifically addressing the preferences and influencing factors of Advance Care Planning among CKD patients on hemodialysis in the Philippines.

This study aimed to determine the ACP preferences of CKD patients undergoing hemodialysis and to identify the clinicodemographic factors associated with these preferences.

An analytic cross-sectional study was conducted involving 96 chronic kidney disease (CKD) patients undergoing hemodialysis at Baguio General Hospital and Medical Center (BGHMC) from October to November 2024. Data were collected using validated questionnaires administered either through face-to-face interviews or self-administration, depending on patients’ preferences and capabilities. Descriptive and inferential statistical methods were employed for data analysis.

The study revealed limited awareness of ACP among participants (86.5%), underscoring the need for education. Family-centered decision-making was prominent, with most participants preferring family members as surrogate decision-makers and confidants. Quality of life was prioritized over life extension, and preferences for “Do Not Resuscitate” (DNR) orders were notable. Educational attainment and ethnicity significantly influenced preferences, with higher education linked to greater awareness; and Ethnicity shaping preferences for decision-makers, confidants, timing of discussions, and resuscitation choices. Additionally, duration of dialysis was linked to care setting preferences, while social support systems influenced the preferred place for discussions.

The findings highlight critical associations between clinicodemographic factors and ACP preferences among hemodialysis patients. Addressing these associations through targeted education and culturally sensitive approach can promote high-quality end-of-life care, aligned with diverse patient needs, values, and preferences.

BACKGROUND

Chronic Kidney Disease (CKD) patients often face critical treatment decisions that significantly affect their quality of life, making Shared Decision-Making (SDM), a collaborative approach between patients and healthcare providers, an essential component of patient-centered care.

This study aimed to investigate the impact of SDM on decisional readiness and patient satisfaction among CKD patients undergoing hemodialysis (HD) at Southern Isabela Medical Center (SIMC).

An analytical cross-sectional design was utilized. The Tagalog Version of SDM Q-9 questionnaire, Decision survey and CSAT survey tool were given to HD patients of SIMC from September – October 2024. Descriptive statistics, Pearson product-moment correlation and chi square test were used to report and analyze data.

One hundred eight (108) CKD patients on HD were included in the study. Shared decision-making score was high and overall satisfaction on health services was outstanding. Higher decisional readiness was associated with greater odds of reporting outstanding satisfaction (OR = 3.47, 95% CI: 2.563–4.688, p = 0.009). There was no significant association between patient satisfaction and SDM (r= 0.111, p =0.253.). Shared decision-making had a significant but weak positive correlation with decisional readiness (r =0.2043, p 0.035).

This study showed that fostering SDM positively enhances patients’ preparedness to make healthcare decisions. Decisional readiness is strongly associated with patient satisfaction, as confident patients are more likely to be satisfied with their care. The findings underscore the need for improved patient education to boost decisional readiness and support ongoing SDM practices. Integrating SDM into clinical workflows is essential to advancing patient-centered care and improving health outcomes for CKD patients undergoing hemodialysis.

BACKGROUND

Diabetes mellitus (DM) is a significant and growing global health concern. Worldwide, 537 million adults have diabetes and 206 million of them are from the Western Pacific Region1. Local prevalence continues to remain high at 7.5%, with 4,303,899 adult Filipinos suffering from diabetes in 2021. DM significantly contributes to the growing burden of chronic kidney disease (CKD) worldwide with about 50% of end-stage renal disease (ESRD) being due to diabetic nephropathy alone. Likewise, 60% of Filipinos on maintenance dialysis have ESRD due to DM and hypertension. The primary care setting is the initial point of contact between healthcare providers and patients with type 2 diabetes, hence, the development of clinical practice guidelines that will provide guidance in caring for patients with stable complications of diabetes. The guideline is the first of 3 that are being developed by the Philippine Academy of Family Physicians for the diagnosis and management of adult patients with type 2 diabetes and stable microvascular complications – nephropathy, retinopathy and neuropathy.

This guideline aims to provide evidence-based recommendations on the diagnosis and management of adults with type 2 diabetes mellitus (T2DM) and early stage CKD and is divided into 5 main sections – Clinical Assessment, Diagnostic Tests, Pharmacologic Treatment, Non-pharmacologic Treatment and Patient Outcomes.

The method of guideline development followed the ADAPTE process. The Technical Working Group identified 19 key questions after consultation with colleagues and patients. Recommendations were adopted from high-quality clinical practice guidelines whenever applicable for most of the key clinical questions. On the other hand, the De Novo method of evidence review was used to answer key clinical questions for which recommendations from reviewed guidelines were not available. A modified GRADEPro was used in assessing the quality of evidence – high, moderate, low or very low. Following external review by a nephrologist, the draft recommendations were sent to the members of the consensus panel. Voting on whether to include or not by the consensus panel was facilitated to determine the strength of each recommendation – strong, moderate or weak.

After reviewing 3 high-quality clinical practice guidelines and the current evidence, the technical working group was able to develop 40 recommendations for the 19 key clinical questions.

Peripheral nerve block (PNB) has been successfully used as the sole anesthetic for Peritoneal dialysis (PD) catheter insertion, and has been shown to provide satisfactory anesthesia and analgesia perioperatively, especially among critically – ill patients.

This report describes the anesthetic management of an 18 – year old underweight patient with End-stage renal disease (ESRD) and decompensated heart failure who was scheduled for PD catheter insertion. He was given a left lateral Transversus abdominis plane (TAP) block and a right Rectus sheath (RS) block as the main anesthetic. Fifteen mL of Isobaric Bupivacaine 0.375% with Epinephrine 1:400,000 dilution was injected for the TAP block, and 10mL for the RS block, for a total volume of 25mL (93.7mg). Sedation was given via a Remifentanil infusion at 0.1mcg/kg/min. Intraoperatively, the patient was awake, conversant, and comfortable, no pressors were used, and no conversion to general anesthesia was done. Post-operatively, he had good pain control, with a pain score of 1/10, and successfully underwent dialysis via the PD catheter on the 2ndhospital day.

This pediatric patient who is critically ill is not a good candidate for general or neuraxial anesthesia due to the risk of hemodynamic instability and perioperative decompensation. PNB was done to provide anesthesia, and ensure good pain control post-operatively, and a right TAP and left RS were done instead of a bilateral TAP to lower the LA volume and decrease the risk of LA toxicity.

Unilateral TAP with contralateral RS is a safe anesthetic technique among critically-ill pediatric patients who will undergo PD catheter insertion without the risk of hemodynamic instability with general or neuraxial anesthesia.