INTRODUCTION

Cardiac arrest occurs when abrupt cessation of cardiac function results in loss of effective circulation and complete cardiovascular collapse. For every minute of cardiac arrest without early intervention (cardiopulmonary resuscitation [CPR], defibrillation), chances of survival drop by 7 – 10%. It is crucial that CPR be initiated within 4 – 6 minutes to avoid brain death. Most out-of-hospital cardiac arrests (OHCA) occur in a residential setting where access to trained personnel and equipment is not readily available, resulting in poor victim outcomes.

This descriptive study was done from August to November 2021 using a prospective cohort design. Participants of the study include adult patients aged 18 years and above brought to the emergency room who suffered from out-ofhospital cardiac arrest. Out of the total 102 cases of OHCA, 63 participants were included in the study. Descriptive statistics was used to summarize the demographic and clinical characteristics of the patients.

Forty-three subjects were male patients, comprising the majority at 73.02%. Hypertension was identified as the top comorbidity, followed by diabetes mellitus, heart failure, and chronic kidney disease (CKD). Medical causes of arrest were identified in 96.83% of the cases. 90.48% of cardiac arrests occurred at home. Only 26 patients (41.27%) received prehospital intervention before ER arrival, comprising only hands-on CPR. Twenty-three of these were performed by individuals with background knowledge of CPR. 60.32% were brought via self-conduction, the remainder by ambulances, which were noted to have no available equipment necessary to provide proper resuscitation. The average travel time from dispatch to
ER arrival is 20 minutes.

Overall survival of OHCA in our local setting remains dismal, as the return of spontaneous circulation was not achieved in any of the patients. The small number of patients having pre-hospital CPR indicates the need for emphasis on training and community education.

Anti–N-methyl-D-aspartate (NMDA) receptor encephalitis is a neurologic disease first identified by Dr Josep Dalmau and colleagues at the University of Pennsylvania in 2007. The first confirmed case of anti-NMDA receptor encephalitis reported in the Philippines was published in the Philippine Journal of Neurology last August 2012; it was entitled “A rare disease with a unique feature: Anti-NMDA receptor encephalitis and mesenteric teratoma”. Anti-NMDA receptor encephalitis is an autoimmune disease where the body creates antibodies against the NMDA receptors in the brain, in which antibodies disrupt normal brain signaling, causing brain swelling, or encephalitis; many reports claim that it is often misdiagnosed due to atypical presentation that overlaps neurologic and psychiatric symptoms, in which it is difficult to recognize, and that may delay management.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; N-Methylaspartate ; D-Aspartic Acid ; Receptors, N-Methyl-D-Aspartate

Introduction: The increasing incidence of stroke in young adults has been a growing concern, which is why research studies were generated to find out the risk factors contributing to the development of this disease. This study investigated the dose-dependent effect of smoking in the development of stroke in the young ages (19-45 years). Methods: A case-control retrospective study was conducted using electronic and printed records of the patients admitted to Amang Rodriguez Memorial Medical Center last 2017-2018. There were 275 patients included in the study. The smoking status and pack-years cigarette smoking of the subjects were recorded and were correlated with the duration of hospitalization and the Modified Rankin Scale (MRS). Results were analyzed using student’s t-test, ANOVA, and Pearson’s Correlation. Result: The prevalence of stroke was higher in men than in women. The ORs (95% CI) of stroke were significant in current cigarette smoking at 2.71 (CI: 1.6398 to 4.4943). Compared with non-smokers and those who smoked 1 to 9 pack years, the OR of stroke was significantly increased for those who smoked 10 to 19, and ≥ 20 cigarettes per day with OR of 14.0765 (4.10 to 48.35), and 31.5854 (1.82 to 548.97), respectively (p= 0.032 for linear trends). There was a weak positive linear correlation between pack years of cigarette smoking (1-9, 10-19, >20 pack years) and days of hospitalization (r= 0.28; p for trend = 0.0168). There was also a strong positive linear correlation between stroke outcome using the Modified Rankin Scale and pack years of cigarette smoking (r = 0.72; P for trend = 0.001). This study shows an increase in the odds of stroke in current cigarette smokers with a dose-dependent relationship in its outcome. Conclusion Smoking is a significant risk factor for stroke with a dose-dependent effect on its outcome. Furthermore, quitting smoking significantly decreases the risk of developing stroke.
Stroke ; Case-Control ; Retrospective

Introduction: Smoking is prevalent among Filipinos, but little is known about whether this is associated with the rapid decline of the renal function among patients with existing chronic kidney disease (CKD). The purpose of this study is to investigate whether or not there is a direct relationship of smoking to the progression of CKD requiring patient to be on dialysis/renal replacement therapy.

Methods: A cross-sectional, retrospective study design was used. All CKD 5D patients of the Amang Rodriguez Memorial Medical Center (ARMMC) Hemodialysis (HD) Unit in the month of July to August, 2019 were included, if they are > 18yo, regardless of their co-morbidities. Excluded are those with acute kidney injury (AKI), and iatrogenic, surgical or trauma complications that cause renal dysfunction. Charts were reviewed and 55 patients qualified. Smoking status were grouped according to the US Centers for Disease Control (CDC) smoking definitions, either never, former and current smoker. Estimated glomerular filtration rate (eGFR) Creatinine were computed using the CKD-Epi formula 3-yr, 2-yr, 1-yr and 0-yr prior to HD. The main outcome measure was whether and what among the smoking status hastens the progression of CKD. Descriptive statistical analyses were done along with one-way variance, two-way variance, and chi-square.

Results: Most of the smokers were males (p < 0.001). Most of the participants had diabetes as the primary illness. All of the participants had same endpoint of having eGFR < 15 at the time of dialysis initiation. There was a significant progressive decrease from eGFR3 to eGFR0 in all smoking status. Current smokers have the highest significant reduction in eGFR (p <0.001).

Conclusion: Smoking hastens the progression of CKD among Filipinos. With that, we support the smoking cessation campaign of the ARMMC and the DOH. In addition, further work up is suggested to determine the primary mechanistic pathway of smoking that affects the renal cells.

Introduction: Pneumonia continues to be a leading cause of morbidity and mortality worldwide. Locally, pneumonia is the 3rd cause of death (2016). Currently, one of the concerns is the rise of resistant microorganisms particularly MRSA. Knowledge regarding MRSA pneumonia is mostly from international data. This study aims to determine the factors that may affect the outcome of MRSA and non-MRSA pneumonia as well as describe the susceptibility patterns of its etiologic agents.

Methods: This is a retrospective, cross-sectional cohort study. The setting is a tertiary government hospital. The target subjects are patients 18 y/o and above, with bacteriologically-confirmed pneumonia, and were admitted in 2017.

Results: The results revealed a high rate of MRSA pneumonia (88.2%), most are community-acquired (90%), and factors associated with mortality were: male, Type 2 DM, smoking history, radiographic findings of congestion, and significant difference was noted. For Non-MRSA pneumonia factors associated with mortality were: erythrocytosis, kidney and liver disease, cancer, previous cerebrovascular disease, previous admission (ARMMC), number of comorbidities, findings of altered sensorium, chest retractions, DBP ? 60 mmHg, radiographic findings of pulmonary congestion, and classification of CAP-MR. Morbidity factors included: anemia, trauma, multiple comorbidities, radiographic findings of bilateral infiltrates, unilateral/bilateral consolidation, unilateral/bilateral minimal pleural effusion, subcutaneous emphysema, congestion, and infection with multiple bacteria. The first antibiogram for the institution revealed a poor susceptibility pattern for the usually used empiric treatment.

Conclusion: This study reveals a high rate of MRSA pneumonia, with several factors associated with its mortality. In terms of morbidity, no significant difference was noted from the variables measured. For Non-MRSA pneumonia which is seen in the majority of the subjects, several factors associated with mortality were noted and unlike MRSA pneumonia the morbidity is affected by the presence of anemia, trauma, multiple comorbidities, etc.
The antibiogram showed a poor susceptibility to the usually used empiric treatment.