BACKGROUND AND OBJECTIVE

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the causative agent of COVID-19 has significantly challenged the public health landscape in late 2019. After almost 3 years of the first ever SARS-CoV-2 case, the World Health Organization (WHO) declared the end of this global health emergency in May 2023. Although, despite the subsequent drop of COVID-19 cases, the SARS-CoV-2 infection still exhibited multiple waves of infection, primarily attributed to the appearance of new variants. Five of these variants have been classified as Variants of Concern (VOC): Alpha, Beta, Gamma, Delta, and the most recent, Omicron. Therefore, the development of methods for the timely and accurate detection of viral variants remains fundamental, ensuring an ongoing and effective response to the disease. This study aims to evaluate the feasibility of the application of an in-house approach in genomic surveillance for the detection of SARS-CoV-2 variants using in silico designed primers.

METHODS

The primers used for the study were particularly designed based on conserved regions of certain genes in the virus, targeting distinct mutations found in known variants of SARS-CoV-2. Viral RNA extracts from nasopharyngeal samples (n=14) were subjected to quantitative and qualitative tests (Nanodrop and AGE). Selected samples were then analyzed by RT-PCR and amplicons were submitted for sequencing. Sequence alignment analysis was carried out to identify the prevailing COVID-19 variant present in the sample population.

RESULTS

The study findings demonstrated that the in-house method was able to successfully amplify conserved sequences (spike, envelope, membrane, ORF1ab) and enabled identification of the circulating SARS-CoV-2 variant among the samples. Majority of the samples were identified as Omicron variant. Three out of four designed primers effectively bound into the conserved sequence of target genes present in the sample, revealing the specific SARSCoV-2 variant. The detected mutations characterized for Omicron found in the identified lineages included K417N, S477N, and P681H which were also identified as mutations of interest. Furthermore, identification of the B.1.448 lineage which was not classified in any known variant also provided the potential of the developed in-house method in detecting unknown variants of COVID-19.

CONCLUSION

Among the five VOCs, Omicron is the most prevalent and dominant variant. The in-house direct PCR product sequencing surveillance (DPPSS) method provided an alternative platform for SAR-CoV-2 variant analysis which is accessible and affordable than the conventional diagnostic surveillance methods and the whole genome sequencing. Further evaluation and improvements on the oligonucleotide primers may offer significant contribution to the development of a specific and direct PCRbased detection of new emerging COVID-19 variants.

Sars-cov-2 ; Polymerase Chain Reaction ; Dna Primers ; Oligonucleotide Primers ; Computer Simulation ; Conserved Sequence ; Coronavirus ; Covid-19 ; Disease ; Emergencies ; Evaluation Studies As Topic ; Genes ; Genome ; Global Health ; Health ; Identification (psychology) ; Infection ; Infections ; Membranes ; Methods ; Mutation ; Oligonucleotides ; Organizations ; Population ; Public Health ; Rna ; Rna, Viral ; Sars Virus ; Sequence Alignment ; Severe Acute Respiratory Syndrome ; Syndrome ; Viruses ; Whole Genome Sequencing ; World Health Organization

BACKGROUND AND OBJECTIVE

Community pharmacies are among the most accessible healthcare facilities and play a critical role during medical emergencies. While many countries have implemented structured emergency preparedness systems in pharmacies, such practices remain limited and under-researched in the Philippines. The lack of empirical data on pharmacy-based emergency readiness hampers efforts to strengthen their role in crisis response and inform context-specific policies and training programs. This study aimed to assess the level of medical emergency preparedness and its associated factors among community pharmacies in Metro Manila, Philippines.

METHODS

A community-based, cross-sectional study was conducted among 533 Filipino community pharmacy staff, consisting of 38.8% pharmacy assistants/technicians, 36.8% branch/staff pharmacists, and 24.4% managers/ supervisors. Data was collected using a modified survey questionnaire administered online and face-to-face across various cities in Metro Manila. Self-efficacy and collective efficacy scales were utilized to assess medical emergency preparedness and linear regression models were employed to identify factors associated with preparedness in acute medical emergencies.

RESULTS

Community pharmacies in Metro Manila are moderately prepared (overall mean scores: self-efficacy 3.65, collective efficacy 3.69 on a 1-5 scale) to respond to acute medical emergencies. Regression analysis shows that age, position, and training in first aid, cardiopulmonary resuscitation (CPR), and basic life support (BLS) are positively associated with self-efficacy. Conversely, the number of emergency equipment, pharmacy staff, and training experience are positively associated with collective efficacy.

CONCLUSIONS

The study’s findings highlight key factors influencing the preparedness of community pharmacies in Metro Manila. Pharmacies with staff trained in first aid and CPR/BLS, as well as those equipped with adequate emergency supplies, demonstrated significantly higher levels of preparedness for medical emergencies. These results emphasize the critical role of ongoing, comprehensive training for pharmacy personnel. Ensuring that all staff are properly trained to manage acute medical situations can greatly enhance emergency response and improve patient outcomes.

Human ; Collective Efficacy ; Pharmacies ; Community Pharmacies ; Civil Defense ; Emergency Preparedness

BACKGROUND

Convalescent plasma therapy (CPT) has been utilized as an emergency and last-resort treatment for viral infections, particularly in the absence of vaccine. During the COVID-19 pandemic, CPT was implemented worldwide based on its potential to provide passive immunity through SARS-CoV-2 antibodies. While numerous studies explored the effectiveness of CPT to cure COVID-19 patients, there has no research specifically focused on superiority of CPT impact on the length of hospitalization.

OBJECTIVE

This study aimed to evaluate the effect of CPT on the length of hospital stay among patients with moderate COVID-19.

METHODS

This is a single blind randomized controlled trial (RCT) study involved 30 moderate-grade COVID-19 patients age 18-75 years with positive PCR result treated at Unggul Karsa Medika Hospital Bandung from February 2 to May 31, 2022. Moderate-grade COVID-19 defined by clinical pneumonia symptoms based on World Health Organization (WHO) criteria. Eligible patients were randomly assigned (1:1 ratio) and outcome assessors were blinded, while care providers and patients were not due to the intervention nature. The intervention arm (n=15) received 200 ml of high-titer CPT within 24 hours of admission with standard care and the control arm (n=15) received standard care only. The primary outcome measured was the length of stay (LOS) in both the Emergency Room (ER) and COVID-19 High Care Unit (HCU). Data were analyzed using independent T-tests.

RESULTS

Thirty (30) eligible patients (mean age 40 years; 53% female) were analyzed for the primary outcome and all completed follow-ups. The CPT group had significantly shorter LOS than controls (mean difference for ER:-32.7 hours [95% CI:-45.0,-20.4]; HCU:-33.3 hours [95% CI:- 45.8,-20.8]; p

CONCLUSION

The administration of CPT may reduce the LOS in moderate COVID-19 patients. However, the small sample size can limit the generalizability of this result and larger sample studies are needed to strengthen this finding. Early CPT implementation may improve patient management and optimize healthcare resource utilization during the pandemic.

Pandemics ; Polymerase Chain Reaction ; Randomized Controlled Trial ; Emergency Service, Hospital ; Hospitalization ; Emergencies ; Covid-19 ; Length Of Stay ; Antibodies

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

BACKGROUND AND OBJECTIVE

Identifying the factors and reasons behind medical students’ choice of medical specialty will provide an understanding to the health sectors and may serve as data for interventions necessary to address issues such as manpower allocation. This study aimed determine the factors that affect career interest in emergency medicine among postgraduate interns (PGI) of the University of the Philippines-Philippine General Hospital (UP-PGH).

METHODS

A cross-sectional study was conducted among UP-PGH PGI from August 2022 to June 2023. A website link for the validated questionnaire utilized previously by a similar study among medical students in Saudi Arabia was sent to the respondents which instructed them to choose the top 3 medical specialties that they were interested to pursue. Their top choices were evaluated through a 5-point Likert scale that ranged from 1-no influence to 5-major influence which included factors such as medical lifestyle, social orientation, prestige, hospital orientation, role model and varied wide scope of practice that were further divided into 30 variables. Data analysis was done using one-way ANOVA to compare the factors among specialty groups.

RESULTS

A total enumeration was conducted, involving 161 respondents. Respondents chose the following in order of preference as top choice: primary care (PC) (54.7%), controllable lifestyle (CL) (27.3%), surgical specialties (SS) (16.8%), and emergency medicine (EM) (5.6%). In the EM group, medical lifestyle was ranked the highest influential categorized factor and prestige as the least. The most important individualized factors that influence career interest in EM are acceptable hours of practice, able to spend appropriate time with family and focus on urgent care.

CONCLUSION

EM specialty was the least chosen top specialty among PGI. Medical lifestyle was considered to be the most influential factor among the EM group and prestige as the least. The low number of respondents who expressed interest in EM necessitates active promotion of the specialty to prevent the shortage of emergency physicians in the future.

Human ; Emergency Medicine

OBJECTIVE

To present a rare case of nine syndrome in a middle-aged patient with stage IV chronic kidney disease presenting with hypertensive emergency at a tertiary government hospital, and to discuss its clinical presentation, diagnostic approach, and management within the realities of limited-resource settings.

METHODS

This is a case report.

RESULTS

A 45-year-old woman with uncontrolled hypertension and stage IV chronic kidney disease came to the emergency department with acute dizziness and vomiting. On neurologic examination, she had left horizontal conjugate gaze palsy and an adduction deficit of the left eye with intact abduction and an abducting nystagmus of the right eye consistent with one-and-a-half syndrome. In addition, she had left-sided facial weakness and right lower limb weakness suggesting nine syndrome. Brain imaging confirmed a left posterior pontine infarct. Treatment for neuroprotection and blood pressure control led to significant improvement in ocular symptoms and muscle strength.

CONCLUSION

This report describes a rare case of nine syndrome. Careful bedside neuro-ophthalmologic examination, supported by MRI, enabled accurate localization to the paramedian pons. Early recognition allowed timely stroke management and initiation of secondary management, even in a resource-limited setting.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Hypertensive Emergency ; Hypertensive Crisis

BACKGROUND

Pediatric Early Warning Scores (PEWS) help identify children at risk of clinical deterioration, but their accuracy across diverse settings, populations, interventions, and outcomes remains unexplored.

OBJECTIVE

To determine the accuracy of PEWS in detecting clinical deterioration events (CDE) among pediatric patients seen at the emergency department (ED).

DESIGN

Retrospective cohort study.

PARTICIPANTS

Pediatric patients aged 1 month to 18 years seen at the ED.

SETTING

Southern Philippines Medical Center Emergency Department, Davao City, Philippines from January 2021 to December 2022.

MAIN OUTCOME MEASURES

Area under the curve (AUC) of PEWS in detecting CDE; Brighton PEWS optimal cut-off and its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR).

MAIN RESULTS

Among the 345 patients, 56 experienced CDE and 289 did not. Patients with CDE had significantly lower median age (1.00 year vs 5.00 years; p < 0.001), oxygen saturation (93.00% vs 98.00%; p < 0.001), and pediatric Glasgow Coma Scale scores (8.00 vs 15.00; p < 0.0001) compared to those without CDE. Heart rate (135.00 vs 111.00 beats per minute; p < 0.001), and respiratory rate (32.50 vs 24.00 breaths per minute; p < 0.001) were significantly higher in patients with CDE. The two groups also differed significantly in terms of comorbidity distribution (p < 0.001) and diagnosis (p < 0.001). The AUC of Brighton PEWS was 0.9064 (95% CI 0.8716 to 0.9357), with an optimal cut-off score of ≥4.00. This threshold yielded 76.79% sensitivity, 88.58% specificity, 56.60% PPV, 95.20% NPV, 6.72 LR+, and 0.26 LR-.

CONCLUSION

The Brighton PEWS demonstrates strong diagnostic accuracy in predicting CDE among pediatric patients. A cut-off score of ≥4.00 offers a balanced combination of sensitivity, specificity, and likelihood ratios for ED application.

Human ; Emergency Departments ; Emergency Service, Hospital ; Resuscitation ; Mortality

INTRODUCTION

The Philippines is considered a disaster-prone country, making basic pre-hospital trauma care essential in the disaster response. The Bureau of Fire Protection (BFP) is mandated by law as the lead agency in providing emergency medical services (EMS) in the country, which plays a critical role in disaster response. This study aimed to investigate the influence of the different factors (knowledge, training, experience, and logistics) on the disaster preparedness of the BFP EMS personnel and to identify the strongest predictor among the factors.

METHODS

A correlational study was done among 125 EMS personnel in the Bureau of Fire ProtectionNational Capital Region (BFP-NCR) using stratified random sampling. A four-part questionnaire, which included a demographic form, a 20-item knowledge test, a logistics compliance checklist from the Department of Health licensing tool, and the Emergency Preparedness Information Questionnaire (EPIQ) was used. Statistical analysis done were Pearson correlation and logistic regression.

RESULTS

The findings showed that knowledge (OR = 0.299, 95% CI: 0.128–0.689), training (OR = 3.2, 95% CI: 1.8–5.6), and experience (OR = 1.9, 95% CI: 1.1–3.4) affected the level of disaster preparedness. Furthermore, logistics did not show a significant effect (p > 0.05).

CONCLUSION

The strongest predictor of disaster preparedness among the factors is knowledge. Even though logistics is an essential factor, its effectiveness still depends on the proper utilization by trained personnel. Recommendations include continuous training and retention of experienced personnel, which are essential to enhance BFP EMS readiness during disasters.

Emergency Medical Services

Objective:To determine the association of demographic profiles and clinical characteristics of patients with aural foreign bodies seen at the Emergency Room (ER) of the East Avenue Medical Center with clinical outcomes

Methods:
Design:Cross-Sectional Study
Setting:Tertiary Government Training Hospital
Participants:A total of 143 aural foreign body cases seen at the ER from January to December 2022 under the Department of Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) of East Avenue Medical Center were included in the study.

Results: Of the 143 patients, majority (84; 58.74%) were males. Mean age was 21.92 years old with two peak incidences noted at ages 1-12 years old and 18-65 years old. Most of the patients were right-handed (134; 93.71%). Majority of the foreign bodies were animate (76; 53.15%) and were frequently found to be lodged on the right ear (86; 60.14%) with duration from lodgment to
extraction commonly within less than 24 hours (119; 83.22%). One hundred forty two (99.30%) patients had successful foreign body extraction, 60 (41.96%) had complications, specifically involving the external auditory canal (51; 35.66%) and tympanic membrane (6; 4.20%). Significant associations were found between age and type of foreign body [χ2 (3, N =143) = 31.24, p < .01] with a higher proportion of animate foreign bodies in adults and inanimate foreign bodies in children; sex and presence of complications [χ²(1, N = 143) = 5.41, p < .05] with males experiencing more complications than females; type and duration of foreign body [, χ²(2, N = 143) = 16.33, p < .01] with animate foreign bodies generally having a shorter duration of less than 24 hours compared to inanimate foreign bodies; and the duration of foreign body and presence of TM complications [χ²(4, N = 143) = 14.21, p < .01] with shorter durations (less than 24 hours) showing fewer TM complications. Males had higher odds of developing complications compared to females (OR = 2.315, 95% CI [1.105, 4.851])

Human ; Male ; Female ; Child: 6-12 Yrs Old ; Young Adult: 19-24 Yrs Old ; External Ear Canal ; Emergency Room ; Association

BACKGROUND AND OBJECTIVE

First responders must be physically and mentally healthy to ensure effective emergency response. However, literature showed that Filipino first responders continue to have elevated levels of stress and increased risk for post-traumatic stress and other mental health problems months after their deployment. The “Mi Salud” app was created to help Filipino first responders, their team leaders, and their agencies monitor and manage the responders’ real-time stress levels before, during, and after their deployment more effectively.

METHODS

The “Mi Salud” app was pretested with Filipino first responders (n=30) to establish convergent validity using existing validated scales measuring the same construct. Participants also completed a Likert scale and questionnaire to assess user experience and app recommendations. During the rollout, first responders (n=32) tested the app and completed a survey on user experience and app recommendations. A focus group discussion (n=11; FGD) was conducted to further explore their experiences with the app. Survey data were analyzed using descriptive statistical methods, while FGD data were examined through thematic analysis.

RESULTS

Results from the online survey showed that the app was generally found to be helpful and that the recommendations within the app were useful. The emerging themes from the FGD corroborated many of the themes from the survey, particularly the benefits of using the app and the app’s ease of use. Positive effects were observed both on the responders and on the responders’ team leader and teammates, which further established the value of the “Mi Salud” app.

CONCLUSION

The findings show that the “Mi Salud” stress check-app may serve as a useful tool for monitoring and managing the stress levels, a critical aspect for Filipino first responders to maintain optimal functioning during deployments and daily activities.

Human ; Emergency Responders ; Mental Health ; Mobile Applications ; Philippines