BACKGROUND AND OBJECTIVE

Foreign body (FB) ingestion is a common pediatric concern in the Philippines, but local studies on flexible endoscopic management are lacking. This study aimed to describe the clinical profile and outcomes of children referred for flexible endoscopic management and identify factors associated with poor outcomes.

METHODS

This retrospective cohort study included 145 patients aged

RESULTS

Most FB ingestions (96.55%) were accidental, with coins as the most common FB (56.55%). Patients were admitted an average of 40.42 hours post-ingestion and referred for endoscopy within 9.28 hours. Flexible endoscopy was performed in 44.83% of cases, with a 98.46% success rate and an average procedure time of 32.25 minutes. Spontaneous passage occurred in 50.34% of cases. Poor outcomes were linked to age 48 hours; OR: 15.43, p = 0.0181), and prolonged procedures (>30 minutes; OR: 12, p = 0.0318). Good outcomes were associated with unremarkable physical exams (OR: 0.078; p = 0.0018), early admission (CONCLUSION

Flexible endoscopy is effective and safe for FB extraction in children. Early admission and timely intervention significantly improve outcomes, while delays and prolonged procedures increase the risk of complications.

Human ; Adolescent: 13-18 Yrs Old ; Child: 6-12 Yrs Old ; Foreign Bodies ; Endoscopy ; Child ; Retrospective Studies ; Aged ; Cohort Studies ; Eating ; Methods ; Numismatics ; Patients ; Philippines ; Physical Examination ; Time

OBJECTIVES

Clinical pathways (CPs) ensure adherence to heart failure (HF) management guidelines. To optimize quality care in a low resource setting, an evidence-based care pathway for the management of acute HF was implemented at the emergency department (ED) of the Philippine General Hospital (PGH), the designated national tertiary hospital and referral center. This study aimed to describe the characteristics of adults with acute HF admitted at the ED and evaluate the quality of care they received, measured using physician adherence to the hospital’s acute heart failure CP.

METHODS

This was a retrospective, descriptive cohort study. We reviewed the inpatient charts of all adult patients with acute HF admitted to the ED of the PGH and referred to the Division of Cardiovascular Medicine between December 1, 2022 and May 31, 2023. Quality of care was assessed based on adherence to quality indicators adapted from routine and conditional order sets detailed in the pathway. Descriptive statistics was utilized to describe patient characteristics, quality of care, and outcomes.

RESULTS

Two hundred thirty-six (236) patients were included, with a mean age of 51.8 years. Majority were male (53.4%); hypertension (61.4%) and ischemic heart disease (53.8%) were the most common comorbidities, and infection the most common precipitant of decompensation (60.6%). There were optimal adherence rates to routine orders, which included referrals to Internal Medicine and Cardiology, baseline vital signs monitoring, fluid intake and output monitoring, chest radiograph, complete blood count, blood urea nitrogen, sodium, potassium, prothrombin time, partial thromboplastin time, arterial blood gas, urinalysis, and N-terminal pro b-type natriuretic peptide. Conditional orders, such as oxygen support, focused echocardiography, thyroid - stimulating hormone, and the use of vasopressors, diuretics, and venous thromboembolism prophylactic agents, were optimally performed when warranted. However, we noted suboptimal adherence to certain resource-intensive conditional orders, such as hourly monitoring of urine output (61.4%), hooking to cardiac monitor (53.8%), and performance of 12-lead ECG within 10 minutes (56.8%). Further, only 43.9% of patients were referred to the intensive care unit. Troponin I, calcium, magnesium, and albumin were ordered in excess.

CONCLUSION

Overall adherence rate of physicians to the hospital’s Acute Heart Failure Pathway was satisfactory. Work is needed to improve adherence to hourly urine output monitoring, consistent hooking to cardiac monitor, and timely performance of 12-lead ECG – an effort that begins with expanding in-hospital diagnostic equipment and human resource supply. We recommend continuous pathway implementation with periodic evaluation and stakeholder feedback to further improve quality of care.

Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult ; Albumins ; Blood ; Blood Urea Nitrogen ; Calcium ; Cardiology ; Chart ; Charts ; Cohort Studies ; Critical Care ; Critical Pathways ; Diagnostic Equipment ; Disease ; Diuretics ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Equipment And Supplies ; Evaluation Studies As Topic ; Feedback ; Heart ; Heart Diseases ; Heart Failure ; Hormones ; Hospitals ; Hospitals, General ; Humans ; Hypertension ; Indicators And Reagents ; Infection ; Infections ; Inpatients ; Intensive Care Units ; Internal Medicine ; Lead ; Magnesium ; Male ; Medicine ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Natriuretic Peptides ; Nitrogen ; Overall ; Oxygen ; Partial Thromboplastin Time ; Patients ; Peptides ; Philippines ; Physicians ; Potassium ; Prothrombin ; Prothrombin Time ; Quality Of Health Care ; Referral And Consultation ; Sodium ; Statistics ; Tertiary Care Centers ; Thorax ; Thromboembolism ; Thromboplastin ; Thyroid Gland ; Time ; Troponin ; Troponin I ; Universities ; Urea ; Urinalysis ; Urine ; Venous Thromboembolism ; Vital Signs ; Work ; Workforce

Introduction: Medullary thyroid carcinoma (MTC) comprises sporadic and hereditary forms, the latter commonly associated with multiple endocrine neoplasia type 2 (MEN2) which is identifiable through genetic screening of germline RET protooncogene. We compared the clinicopathological features and outcomes of hereditary and sporadic MTC in our single centre. Methodology: We conducted a retrospective audit of patients with MTC from 2000 to 2026. Patients were classified as either hereditary or sporadic based on genetic testing and/or family history of MTC/MEN2A syndrome. Variables analyzed included age at diagnosis, mode of presentation, pre-operative calcitonin, tumor size, lymph node (LN) involvement, post-operative biochemical cure, repeat surgery and presence of structural residual/recurrent disease. Results: A total of 57 patients were included (18 hereditary [31.6%], 39 presumed sporadic [68.4%]) with a median follow-up of 7.5 years (IQR 1.5–12.4). Hereditary MTC was diagnosed at a significantly younger age than sporadic MTC (33.0 vs. 44.7 years, p = 0.010) where 33% of the cases were diagnosed via screening detection whereas sporadic MTC more commonly presented with symptomatic neck swelling (84.6% vs. 50.0%, p = 0.008). There were no significant differences in median pre-operative calcitonin (513.5 vs. 1148.0 pg/mL, p = 0.101), tumor size (24.5 vs. 22.5 mm, p = 0.301), or LN involvement (41.7% vs. 61.5%, p = 0.307) between hereditary and sporadic MTC. Long-term outcomes were also comparable, with no differences in biochemical status, need for repeat surgery or residual/recurrent structural disease. Conclusion Hereditary MTC presents earlier and is more frequently detected due to screening, whereas sporadic MTC often presents symptomatically. Long-term outcomes are not primarily determined by hereditary status alone. Early access to RET mutation testing with a view to initiating prophylactic treatments rather than post detection surgery may improve disease burden.
Thyroid Neoplasms ; Cohort Studies

Introduction: Bariatric surgery is an established intervention for obesity and its metabolic complications, including diabetes mellitus. However, most studies are from Western populations with limited data in Malaysia. This study evaluated glycemic status improvements and identified predictors of hemoglobin A1c (HbA1c) reduction at 12 months following bariatric surgery to contribute regional data to Southeast Asia. Methodology: This retrospective analysis included 110 patients who underwent bariatric surgery between 2015 and 2025. Pre- and post-operative parameters, including HbA1c, body mass index (BMI), and lipid profiles, were collected at 1, 3, 6, 9, and 12 months and evaluated as potential predictors of glycemic status improvement at 12 months. Univariate analysis followed by stepwise multivariate linear regression was performed to identify predictors of HbA1c improvement at 12 months. Regression coefficients (B), 95% confidence intervals, and p-values were reported. Results: The mean age was 40.5 years with a mean baseline BMI of 43.49 kg/m²; 58% were female. At baseline, 60.9% (n = 67) had diabetes, 30.9% (n = 34) prediabetes, and 8.2% (n = 9) normal HbA1c. In univariate analysis, baseline HbA1c (B = 0.579, p <0.001), age (B = −0.051, p = 0.034), and sex (B = 1.123, p = 0.044) were significantly associated with HbA1c change. In multivariate analysis, the final model identified baseline HbA1c, BMI difference at 12 months, and TG difference at 12 months as independent predictors of HbA1c change. Baseline HbA1c was the strongest predictor (B = 0.857, p <0.001) indicating that higher baseline HbA1c was associated with greater change over time. BMI difference at 12 months was also significantly associated with HbA1c change (B = 0.046, p = 0.016), indicating that greater weight loss contributed to improved glycemic control. Similarly, TG difference at 12 months was a significant predictor (B = 0.337, p = 0.023). The model explained 86.8% of the variation in HbA1c change (adjusted R² = 0.868). Conclusion Bariatric surgery resulted in significant weight loss and improvement in glycemic status at 12 months, with baseline HbA1c, BMI differences, and TG reductions emerging as key predictors of glycemic improvement in a Malaysian cohort.
Cohort Studies ; Bariatric Surgery

Introduction: Arginine vasopressin deficiency (AVP‑D), previously termed central diabetes insipidus, is a rare paediatric endocrine disorder that may present as an early manifestation of diverse hypothalamic–pituitary conditions. Identifying the underlying etiology is crucial for guiding management and surveillance; however, in some children, the cause remains unresolved, leading to primarily symptomatic treatment. In Malaysia, published literature on paediatric AVP‑D has been limited to isolated case reports, with no cohort‑level data available. This study aims to describe the clinical features, etiological spectrum, and treatment patterns of paediatric AVP-D in a single-centre Malaysian cohort, emphasizing diagnostic yield, unresolved causes, and the central role of neuroimaging. Methodology: A retrospective review was conducted of children diagnosed with AVP-D. Data collected included age at symptom onset, age at presentation, clinical features, etiological classification, neuroimaging findings, comorbidities, treatment modalities, and follow-up outcomes. Descriptive statistics were used for analysis. Results: Twelve children were included, with a median age of 9.8 years; two-thirds were male. Children were referred at a median age of 3.4 years, with presentation ranging from the neonatal period to 10.4 years. Diagnostic delay was minimal overall, although 25% experienced delays exceeding 1 year. The water deprivation test was performed in 33.3% of patients. Magnetic resonance imaging (MRI) was completed in all children and served as the principal determinant of etiology. Structural abnormalities were identified in 50% of the cohort, including semilobar holoprosencephaly (33.3%), Arnold– Chiari I malformation (8.3%), and pituitary stalk interruption syndrome (8.3%). The posterior pituitary bright spot was absent in most patients, and 50% required repeat MRI to clarify evolving neurohypophyseal features. Tumor-related AVP-D accounted for 8.3%, while one-third had no definitive etiology despite imaging. Initial therapy included desmopressin (58.3%), hydrochlorothiazide (25%), and diluted sublingual desmopressin (8.3%), with most requiring dose escalation. Growth impairment occurred in 66.7% of patients, and delayed puberty in 16.7%. Conclusion MRI played a central role in defining etiology, with half of the cohort demonstrating congenital structural abnormalities. Persistent unresolved cases highlight the diagnostic challenges of AVP-D and underscore the importance of early MRI and longitudinal endocrine follow-up.
Child ; Cohort Studies ; Diabetes Insipidus, Neurogenic ; Arginine

OBJECTIVES

While many healthcare workers (HCWs) contracted COVID-19 during the pandemic, more information is needed to fully understand the potential for adverse health effects in this population segment. The aim of the present study is to examine the association between healthcare worker status and neurologic and clinical outcomes in COVID-19 infected inpatients.

METHODS

Using the nationwide database provided by the retrospective cohort Philippine CORONA study, we extracted relevant data and performed a secondary analysis primarily focusing on the presentation and outcomes of healthcare workers. Propensity score matching in a 3:1 ratio was performed to match HCWs and non-HCWs. We performed multiple logistic and Cox regression analyses to determine the relationship between HCWs and COVID-19 clinical outcomes.

RESULTS

We included 3,362 patients infected with COVID-19; of which, 854 were HCWs. Among the HCWs, a total of 31 (3.63%) and 45 (5.27%) had the primary outcomes of in-hospital mortality and respiratory failure, respectively. For both overall and 3:1 propensity-matched cohorts, being an HCW significantly decreased the odds of the following outcomes: severe/critical COVID-19 at nadir; in-hospital mortality; respiratory failure; intensive care unit admission; and hospital stay >14 days.

CONCLUSION

We found that being an HCW is not associated with worse neurologic and clinical outcomes among patients hospitalized for COVID-19.

Human ; Health Personnel ; Covid-19 ; Sars-cov-2 ; Cohort Studies

OBJECTIVES: Rheumatoid arthritis (RA) imposes a heavy burden on individuals, families, and society. This study analyzed the incidence and mortality trends of RA in China from 1990 to 2023 to provide epidemiological evidence for precise prevention and control. METHODS: Data on RA incidence, age-standardized incidence rate (ASIR), deaths, and age-standardized mortality rate (ASMR) in China by sex and age group from 1900 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression was used to analyze trends in ASIR and ASMR. An age-period-cohort model was constructed using R4.3.1 to evaluate longitudinal age trends and estimate relative risk (RR) values for period and cohort effects. RESULTS: In 2021, the number of RA cases, ASIR, deaths, and ASMR in China were 247 300, 13.70 per 100 000, 10 300, and 0.54 per 100 000, respectively. From 1990 to 2021, the ASIR of RA increased annually among both females and males, with average annual percentage changes (AAPCs) of 0.44% and 0.72%, respectively. Over the same period, ASMR declined in the total population and among females, with AAPCs of -0.78% and -1.19%, while the change in males was not statistically significant. Age-period-cohort analysis showed that the peak incidence occurred in women aged 60-64 years and men aged 75-79 years, and mortality increased with age. The period effect for incidence rose in both sexes, reaching 1.10 [95% confidence interval (CI) 0.94 to 1.27] for females and 1.14 (95% CI 1.02 to 1.27) for males during 2017 to 2021, compared with 2002 to 2006. The mortality period effect RR exhibited a downward-upward-downward pattern, decreasing to 0.56 (95% CI 0.52 to 0.61) in females and 0.75 (95% CI 0.68 to 0.82) in males in 2017 to 2021. Cohort analysis indicated that the highest incidence risk occurred in individuals born during 2012 to 2016, while the cohort effect RR for female RA mortality showed a continuous decline beginning with the 1922 to 1926 birth cohort. CONCLUSIONS The incidence and mortality risks of RA in China have continued to decline. However, with the aging of the population, the incidence and mortality risks among the elderly have increased. Middle-aged women and elderly men should receive focused attention. Health authorities should strengthen education, prevention, and screening among middle-aged women and enhance disease monitoring in elderly populations to reduce the national burden of RA.
Humans ; China/epidemiology* ; Arthritis, Rheumatoid/epidemiology* ; Incidence ; Male ; Female ; Middle Aged ; Adult ; Aged ; Cohort Studies ; Mortality/trends* ; Age Distribution ; Age Factors ; Aged, 80 and over ; Adolescent

OBJECTIVES

To create a pilot urologic malignancy registry using demographic and clinical data of a cohort of patients newly diagnosed to have urologic malignancies in the year 2021.

METHODS

This was a prospective cohort study conducted in four study sites: National Kidney and Transplant Institute, East Avenue Medical Center, UP-Philippine General Hospital and Batangas Medical Center

RESULTS

A total of 243 patients with newly diagnosed urologic cancers were enrolled. The median age was 61 years, with a wide range of 1 to 87 years. Most of the patients (81.47%) were male, while there were 45 females (18.52%) who had either urinary bladder, kidney or upper urothelial cancer. The most common type of malignancy was prostate cancer (34.57%), followed by kidney cancer (30.04%) and urinary bladder cancer (24.69%), consistent with the currently observed worldwide incidence. There were also 3 patients (1.23%) noted with multiple primaries. More than half of the patients (63.37%) received surgery as active treatment. After the two-year follow-up period, thirteen patients (5.35%) developed progressive disease, and 14 patients (5.76%) died.

CONCLUSION

This urologic cancer registry represents the first multi-center, investigator-initiated epidemiologic study of its kind in the Philippines. As a proof-of-concept (POC) project, it demonstrates the feasibility of establishing a national database capturing baseline data on the country’s most common urologic malignancies.

Cohort Studies ; Multiple Chronic Conditions ; Prostatic Neoplasms ; General Surgery ; Epidemiology

OBJECTIVE: To compare the effect of acupuncture-moxibustion on idiopathic facial palsy (IFP) at acute phase and recovery phase. METHODS: According to whether received acupuncture-moxibustion at acute phase or not, 198 IFP patients were divided into an early-phase intervention group (118 cases) and a non-early-phase intervention group (80 cases). With the propensity score matching employed, 70 cases were included in each group. On the basis of the conventional treatment of western medicine, acupuncture-moxibustion was supplemented in the two groups. In the early-phase intervention group, acupuncture-moxibustion was delivered at the acute phase (duration of illness≤7 days); in the non-early-phase intervention group, acupuncture-moxibustion was operated at the recovery phase (duration of illness>7 days). At the acute phase, warm needling was performed at Yifeng (TE17), Xiaguan (ST7), Hegu (LI4) and Zusanli (ST36) on the affected side; and at the recovery phase, electroacupuncture was delivered at Cuanzhu (BL2), Sizhukong (TE23) and Yangbai (GB14), etc. on the affected side, with the disperse-dense wave and 2 Hz/100 Hz of frequency. The intervention was operated for 30 min each time, once every two days, three treatments weekly and for 4 weeks. Before treatment, 1 week and 4 weeks of treatment, the House-Brackmann (H-B) facial nerve function grade, the score of Sunnybrook facial nerve function, and the score of facial disability index (FDI) were compared between the two groups. The clinical effect in 1 and 4 weeks of treatment and safety were evaluated. RESULTS: In 1 and 4 weeks of treatment, the H-B grade was improved when compared with that before treatment in each group (P<0.05), and in 4 weeks of treatment, H-B grade in the early-phase intervention group was superior to that of the non-early-phase intervention group (P<0.05). In 1 and 4 weeks of treatment, Sunnybrook scores and the scores of physical function of FDI were elevated in comparison with those before treatment in the two groups (P<0.05); and in 4 weeks of treatment, the elevation of these two indexes in the early-phase intervention group was greater than that of the non-early-phase intervention group (P<0.05). In 4 weeks of treatment, the scores of social function in FDI were reduced when compared with those before treatment in the two groups (P<0.05). In 4 weeks of treatment, the total effective rate (97.1%, 68/70) in the early-phase intervention group was higher than that (87.1%, 61/70) of the non-early-phase intervention group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05). CONCLUSION Acupuncture-moxibustion therapy starting at the acute phase is more beneficial to the functional recovery of the impaired facial nerve than at the recovery phase in the IFP patients.
Humans ; Female ; Male ; Acupuncture Therapy ; Moxibustion ; Adult ; Middle Aged ; Young Adult ; Acupuncture Points ; Treatment Outcome ; Facial Paralysis/therapy* ; Cohort Studies ; Aged ; Bell Palsy/therapy* ; Adolescent

INTRODUCTION: Interpretation and analysis of magnetic resonance imaging (MRI) scans in clinical settings comprise time-consuming visual ratings and complex neuroimage processing that require trained professionals. To combat these challenges, artificial intelligence (AI) techniques can aid clinicians in interpreting brain MRI for accurate diagnosis of neurodegenerative diseases but they require extensive validation. Thus, the aim of this study was to validate the use of AI-based AQUA (Neurophet Inc., Seoul, Republic of Korea) segmentation software in a Southeast Asian community-based cohort with normal cognition, mild cognitive impairment (MCI) and dementia. METHOD: Study participants belonged to the community-based Biomarker and Cognition Study in Singapore. Participants aged between 30 and 95 years, having cognitive concerns, with no diagnosis of major psychiatric, neurological or systemic disorders who were recruited consecutively between April 2022 and July 2023 were included. Participants underwent neuropsychological assessments and structural MRI, and were classified as cognitively normal, with MCI or with dementia. MRI pre-processing using automated pipelines, along with human-based visual ratings, were compared against AI-based automated AQUA output. Default mode network grey matter (GM) volumes were compared between cognitively normal, MCI and dementia groups. RESULTS: A total of 90 participants (mean age at visit was 63.32±10.96 years) were included in the study (30 cognitively normal, 40 MCI and 20 dementia). Non-parametric Spearman correlation analysis indicated that AQUA-based and human-based visual ratings were correlated with total (ρ=0.66; P<0.0001), periventricular (ρ=0.50; P<0.0001) and deep (ρ=0.57; P<0.0001) white matter hyperintensities (WMH). Additionally, volumetric WMH obtained from AQUA and automated pipelines was also strongly correlated (ρ=0.84; P<0.0001) and these correlations remained after controlling for age at visit, sex and diagnosis. Linear regression analyses illustrated significantly different AQUA-derived default mode network GM volumes between cognitively normal, MCI and dementia groups. Dementia participants had significant atrophy in the posterior cingulate cortex compared to cognitively normal participants (P=0.021; 95% confidence interval [CI] -1.25 to -0.08) and in the hippocampus compared to cognitively normal (P=0.0049; 95% CI -1.05 to -0.16) and MCI participants (P=0.0036; 95% CI -1.02 to -0.17). CONCLUSION Our findings demonstrate high concordance between human-based visual ratings and AQUA-based ratings of WMH. Additionally, the AQUA GM segmentation pipeline showed good differentiation in key regions between cognitively normal, MCI and dementia participants. Based on these findings, the automated AQUA software could aid clinicians in examining MRI scans of patients with cognitive impairment.
Humans ; Cognitive Dysfunction/pathology* ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Female ; Aged ; Artificial Intelligence ; Software ; Dementia/diagnostic imaging* ; Aged, 80 and over ; Adult ; Singapore ; Neuropsychological Tests ; Brain/pathology* ; Cohort Studies ; Gray Matter/pathology* ; Southeast Asian People