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.

The country’s cardiology centers have been producing subspecialists in the field of Invasive and Interventional Cardiology. To date, 11 hospitals and/or medical centers are involved in training these subspecialists in a 1 to 2-year program. And to this date, there have been no uniform standards and guidelines as to what comprises the basic and/or acceptable training outcomes for the interventionalist in training. This paper describes the development of the core curriculum for an interventional cardiovascular training program to prepare its trainees to be competent in performing invasive diagnostic and interventional cardiovascular procedures as part of comprehensive patient care. The task force for the core curriculum of the interventional training program gathered several officers and leaders of the PSCCI, the training heads of the various interventional programs in the country, as well as experts in the field of cardiology education. Through a series of meetings, consultations, and workshops, the task force laid out the template on which all the training programs would be based. Such a framework considered the international standards regarding minimum caseloads for interventional training and the peculiar situation of each training institution. International standards like the Core Cardiovascular Training Statement (COCATS 4) Task Force 10: Training in Cardiac Catheterizations and the 2020 EAPCI Core Curriculum for Percutaneous Cardiovascular Interventions served as the reference framework for key recommendations. A consensus was achieved that upheld the highest standards of competence without disenfranchising certain institutions due to intricacies and uniqueness of hospital set-up and training situation.

INTRODUCTION

Testicular torsion is a true urologic emergency. It occurs when the blood supply to the testis is compromised as the vessels twist along the spermatic cord. Early diagnosis and prompt treatment are critical to prevent prolonged ischemia time which is crucial to its prognosis. This paper aimed to present cases of testicular torsion who underwent testis sparing surgery for torsion.

Cases of testicular torsion admitted at the institution from January 2023 to July 2024 were reviewed. Demographic data, scrotal ultrasound findings, intraoperative findings and ischemia time were documented. Patients who underwent tunica albuginea fasciotomy with tunica vaginalis flap were monitored post-surgery via scrotal ultrasound, documenting testicular size.

Twenty seven (27) cases of testicular torsion were reviewed. Of these cases, 4 improved after detorsion and orchidopexy, 12 cases with > 72 hours ischemia time and failed detorsion underwent orchiectomy, 11 cases with < 72 hours of ischemia time, tunica albuginea fasciotomy were performed. Five (5) of these 11 cases showed no improvement in appearance and no bleeding was observed and subsequent orchiectomy was performed. Six cases demonstrated improvement in appearance and bleeding after tunica albuginea fasciotomy, tunica vaginalis flap used to cover the resulting defect. Of these 6 cases, 2 cases showed intact testicular size, 1 case had testicular atrophy on monitoring and 3 cases were lost to follow-up.

Testicular torsion remains to be a critical urologic emergency. Prompt diagnosis and immediate surgery required to improve salvage rates. Tunica albuginea incision, with subsequent tunica vaginalis flap may be an option for the urologist to improve salvage, although not consistently prevent testicular atrophy.

OBJECTIVE

This study compared the proportion of dry eye disease (DED) diagnosed using the Philippine criteria with that diagnosed using the Asia Dry Eye Society (ADES) criteria among participants, and characterized DED features using clinical tests and the OCULUS Keratograph® 5M (K5M; OCULUS Optikgeräte GmbH, Wetzlar, Germany).

This multicenter, cross-sectional study included participants with and without DED. Participants completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent fluorescein tear breakup time (FTBUT) measurement, fluorescein staining of the cornea, lissamine green staining of the conjunctiva, Schirmer 1 test without anesthesia, and basal tear secretion test (BST). The OCULUS K5M was used to measure noninvasive tear breakup time (NIKBUT) and tear meniscus height (TMH), and to perform meibography.

The analysis included 344 eyes from 172 patients with DED and 44 eyes from 22 normal participants. Patients with DED were mostly female (66.3%). Compared to normal participants, patients with DED were older (42.7 ± 14.6 years) and had higher OSDI scores (28.6 ± 21.0). Among those diagnosed with DED using the Philippine criteria, 53.2% met the ADES criteria. Evaporative DED was the predominant type (53.2%). DED eyes had lower FTBUT (5.0 ± 3.3 seconds) and NIKBUT (12.3 ± 5.9 seconds) than controls (p CONCLUSION

There were disparities between the Philippine and ADES criteria for DED diagnosis and differences in tear measurements using clinical tests and the OCULUS Keratograph, indicating the need to harmonize diagnostic standards.

OBJECTIVE

Despite being a preventable and treatable condition, central microbial keratitis (CMK) and its complications remain to be a significant cause of vision loss in our country. This study presents the demographic profile, risk factors, etiologies, treatments, and outcomes of CMK in the Philippines.

The study was a two-center, prospective, non-randomized clinical study involving the patients of the External Disease and Cornea Clinics of two tertiary eye referral centers in the Philippines. It was conducted as the Philippine leg of the Asia Cornea Society Infectious Keratitis Study (ASCIKS).1 Patients with a clinical diagnosis of CMK rendered by a cornea specialist, and who signed the consent form, were recruited into the study. They underwent uniform sample collection and culture techniques as described in the ACSIKS. All patients were followed-up for 6 months. Data collected included demographics, risk factors, culture results, management, and treatment outcomes. Descriptive statistics and frequency were used to analyze the data.

A total of 348 patients diagnosed with CMK were included. Trauma (65.5%) among the middle-aged (42.9 ± 17.9 years) male population was the most significant risk factor for development of CMK, followed by contact lens wear (12.9%), prior ocular surgery (6.0%), and ocular surface diseases (3.4%). Bacterial keratitis (53.2%) was still the most common etiology of CMK, followed by fungal keratitis (27.0%), Acanthamoeba keratitis (5.7%), and viral keratitis (2.0%). Aspergillus species (18.3%) were the most common microbial isolates. Pseudomonas species (13.9%) were the most common bacterial isolates. The median time from onset of symptoms to consultation with the study centers was 2 weeks. Medical treatment was enough to treat the infection in 34.8% of cases. Surgical intervention was necessitated in 22.6% with evisceration/enucleation done in 1 out of 3 patients who had surgery.

Bacterial infection remains the most common cause of CMK in the Philippines, followed by fungal infection. Significant risk factors include trauma and contact lens wear. Aspergillus species and Pseudomonas species were the most common fungal and bacterial isolates, respectively. Despite medical treatment, almost a quarter of the cases still required surgical intervention.

Human ; Research Personnel ; Nurses ; Students

Background: The skin barrier serves as the primary defense against environmental factors. Mongolia’s extreme climate conditions may contribute to skin barrier impairment, increased trans-epidermal water loss (TEWL), and decreased skin moisture. Objective: To determine and compare skin moisture, TEWL, and skin pH levels in children. Methods: A cross-sectional study was conducted in June 2023 with 104 relatively healthy children selected through random sampling. Skin physiological parameters, including skin moisture, skin pH and TEWL were measured following the EEMCO (European Group on Efficacy Measurement of Cosmetics and Other Topical Products) guidelines using the Multi Skin Test MC750 device (Courage+Khazaka Electronics, Germany) at nine different sites. Data analysis was performed using Microsoft Excel and Stata-14 software. Results: Among the participants, 51.9% (n=54) reported having dry skin (p<0.0001). Additionally, 64.5% (n=67) used moisturizers, but their usage did not show a statistically significant difference in skin moisture (p=0.929), skin pH (p=0.378), or TEWL (p=0.332). 14.42% (n=15) had extremely dry skin, while 85.58% (n=89) had dry skin, with no participants falling within the normal skin moisture range. TEWL showed a moderate inverse correlation with age (r=-0.331, p=0.0006). When analyzed by age groups, skin moisture (p=0.023) and TEWL (p=0.038) differed significantly between groups. Conclusion Skin moisture and TEWL significantly differ across age groups. Given that all participants had dry skin, moisturization is crucial. Mongolia’s extreme climate is likely a key contributing factor to childhood skin dryness.

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.

BACKGROUND AND OBJECTIVE

Primary care providers are key players in providing quality care to patients and advancing Universal Health Care (UHC). However, effective and quality healthcare delivery may be affected by inadequate knowledge and failure to adhere to evidence-based guidelines among providers. The Philippine Primary Care Studies (PPCS) is a five-year program that pilot tested interventions aimed at strengthening the primary care system in the country. Evidence-based training modules for healthcare providers were administered in Sorsogon and Bataan from the years 2018 to 2021. Module topics were selected based on common health conditions encountered by providers in rural and remote settings. This program aimed to evaluate the effectiveness of training in increasing provider knowledge.

A series of training workshops were conducted among 184 remote- and 210 rural-based primary care providers [nurses, midwives, barangay or village health workers (BHWs)]. They covered four modules: essential intrapartum and newborn care (EINC), integrated management of childhood illness (IMCI), non-communicable diseases (NCD), and geriatrics. A decision support system (UpToDate) was provided as a supplementary resource for all participants. We administered pre-tests and post-tests consisting of multiple-choice questions on common health conditions. Data was analyzed using paired one-tailed t-test, with an alpha of 0.05.

The knowledge of nurses, midwives, and BHWs improved after the training workshops were conducted. The largest increase from pre-test to post-test scores were observed among the midwives, with a mean difference (MD) of 32.9% (95% CI 23.9 to 41.9) on the EINC module, MD of 25.0% (95% CI 16.6 to 33.4) in the geriatrics module, and MD of 13.5% (95% CI 6.9 to 20.1) in the NCDs module. The nurses had the greatest improvement in the IMCI module (MD 10.8%, 95% CI 2.5 to 19.1). The knowledge of BHWs improved in all participated modules, with greatest improvement in the NCD module (MD 9.0%, 95% CI 5.77 to 12.14).

Primary care workshops, even if conducted as single-sessions and on a short-term basis, are effective in improving short-term knowledge of providers. However, this may not translate to long-term knowledge and application in practice. Furthermore, comparisons across provider categories cannot be made as participant composition for each training workshop varied. Ultimately, this study shows enhancing provider knowledge and competence in primary care will therefore require regular and diverse learning interventions and access to clinical decision support tools.

BACKGROUND AND OBJECTIVES

One of the effects of the COVID-19 pandemic on medical education is an increased awareness and use of social media (SocMed) to facilitate learning. However, literature on the use of SocMed in medical education has focused primarily on educator-led teaching activities. Our study aimed to describe SocMed initiatives that were student-led, particularly for information dissemination and peer collaborative learning, and to elicit perceptions of medical students towards such activities.

An online survey on SocMed usage in medical education was sent to all first- and second-year medical students at the University of the Philippines Manila College of Medicine from October to December 2021. The questionnaire collected data on demographics, SocMed habits and preferences, and perceived advantages and disadvantages of SocMed. Descriptive statistics were calculated while the free-text responses were grouped into prominent themes and summarized.

We received a total of 258 responses (71%) out of 361 eligible participants. Overall, 74% found SocMed platforms to be very and extremely helpful; 88% recommended its continued use. The most popular SocMed platforms for different tasks were as follows: Discord for independent study groups and for conducting peer tutoring sessions; Facebook Messenger for reading reminders; Telegram for reading announcements related to academics and administrative requirements, and for accessing material provided by classmates and professors.

The high uptake of SocMed among medical students may be attributed to its accessibility and costefficiency. The use of a particular SocMed platform was dependent on the students’ needs and the platform's features. Students tended to use multiple SocMed platforms that complemented one another. SocMed also had disadvantages, such as the potential to distract from academic work and to become a source of fatigue. Educators must engage with students to understand how SocMed platforms can be integrated into medical education, whether in the physical or virtual learning environment.