OBJECTIVES

Epidemiology data on prolonged mechanical ventilation (PMV) and PMV patient features in the Philippines is lacking. This retrospective cross-sectional study aimed to determine the prevalence of PMV among intubated patients, describe patient characteristics and outcomes, and identify risk factors associated with PMV.

METHODS

A retrospective review of records was done on adult intubated patients admitted under the Medical Intensive Care Unit Service from July 2022 to June 2023. Various clinical characteristics and outcomes of PMV and non-PMV patients were collected, compared, and analyzed. PMV was defined as having MV for ≥6 hours per day
for >21 days.

RESULTS

Among 261 intubated ICU patients admitted, 75 (28.7%) required PMV. PMV patients were older (62 vs.
53.5), had higher Charlson Comorbidity Index scores (4 vs. 3), and required vasopressors (81.33% vs. 54.84%)
and blood products (93.33% vs. 51.08%) more often. Nosocomial infections (86.67% vs. 45.70%), ventila- tor-related (30.67% vs. 12.37%) and in-hospital (66.22% vs. 32.97%) complications developed more frequently.
Outcomes such as ICU length of stay (29.5 vs. 7 days) and hospital mortality (61.33% vs. 41.94%) were longer. Vasopressor use (OR 2.25, 95% CI 1.06-4.76), develop- ment of nosocomial infections (OR 6.20, 95% CI 2.64-
14.56), and development of in-hospital-related compli- cations (OR 2.20, 95% CI 1.13-4.30) were independent predictors of PMV.

CONCLUSION

In this single-center investigation, 28.7% of ICU patients required PMV. Knowledge of patient characteristics and risk factors aid in the development of interventions that improve outcomes and reduce PMV prevalence. Larger studies are recommended to assess nationwide PMV epidemiology and provide data on the need for step-down units for weaning.

Human ; Male ; Female ; Weaning ; Ventilation ; Tertiary Care Centers ; Length Of Stay ; Comorbidity

This study aims to determine the prevalence of erectile dysfunction (ED) and identify its associated risk factors among young and middle-aged Filipino male patients diagnosed with diabetes mellitus. This study utilized a cross-sectional design to investigate the prevalence and associated factors of ED among male patients with diabetes. A total of 423 participants were recruited from clinical settings using purposive sampling. Data were collected using structured interviews and medical records, including demographics, comorbidities and laboratory results. Among 423 male diabetic patients, 78% were found to have ED. Patients with ED were significantly older (median: 49.5 versus 42 years, p<0.001), had higher body mass index (BMI), longer diabetes duration and more comorbidities. Univariable logistic regression showed that age (OR: 1.06, p<0.001), diabetes duration (OR: 1.11, p<0.001), hypertension (OR: 1.62, p = 0.042), dyslipidemia (OR: 1.75, p = 0.022), elevated HbA1c (>9.0%; OR: 3.43, p = 0.034) and serum creatinine (OR: 1.01, p = 0.008) were significantly associated with ED. However, none remained significant in the multivariable model. Male Filipino patients with diabetes have a significant burden of ED. Results of the univariable models show that age, duration of diabetes, hypertension, dyslipidemia, HbA1c and serum creatinine are significant individual predictors of ED.

Human ; Male ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Tertiary Care Centers ; Risk Factors ; Risk ; Medical Records ; Erectile Dysfunction ; Diabetes Mellitus ; Philippines

BACKGROUND

Diabetic retinopathy (DR) remains to be the leading cause of blindness worldwide. Traditionally, risk factors such as diabetes duration, HbA1c levels, hypertension and dyslipidemia have been closely linked to the development of this condition. However, recent research suggests that these factors account for only a portion of DR cases. Emerging studies highlight additional potential risk factors including diabetic nephropathy, insulin use, and body mass index -though data on these factors remain limited and at times contradictory. While there have been a few local studies exploring some of these variables, none have comprehensively examined how these factors collectively influence the occurrence and severity of diabetic retinopathy. This study aims to asses both the factors associated with presence and occurrence of diabetic retinopathy.

METHODOLOGY

This analytical cross-sectional study included patients with diabetes (n=201, aged 18 years and older) who underwent fundus photography at The Medical City Ortigas between January 1, 2022, and December 31, 2022. Data collection involved a thorough review of patient records, which provided demographic information and details on potential risk factors. The presence and severity of diabetic retinopathy (DR) were assessed based on fundus photography results, as interpreted by ophthalmologists. To evaluate the statistical significance of the association between risk factors and DR status, logistic regression analysis was done

RESULTS

Duration of diabetes (odds ratio [OR] 1.07; 95% CI, 1.01-1.13 per year increase), HBA1c (OR 1.4; 95% CI, 1.1-1.86),
fasting blood sugar (OR 1.4; 95% CI, 0.977-0.998), hypercholesterolemia (OR 5.02; 95% CI 1.67-16.44) and presence of
nephropathy (OR 3.39; 95% CI 1.49-8) were correlated with diabetic retinopathy.

CONCLUSION

The presence of diabetic retinopathy was significantly associated with several clinical factors. Each additional year of diabetes mellitus duration was associated with a 1.07-fold increase in the likelihood of DR. Additionally, each 1% increase in HbA1c was linked to a 1.40-fold increase in DR risk. The presence of diabetic nephropathy and hypercholesterolemia were also strong predictors, associated with a 3.39-fold and 5-fold increase in the likelihood of DR, respectively. Glycemic control, dyslipidemia and nephropathy appear to be associated with more severe forms of diabetic retinopathy. Clinicians handling diabetes patients with this patient profile should be wary of this diabetes complication.

Human ; Male ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Diabetic Retinopathy ; Hospitals ; Risk ; Risk Factors ; Tertiary Care Centers

BACKGROUND

Early-stage endometrial cancer often presents with favorable survival rates, but high-risk factors, including TP53 mutations and high-grade serous pathology, can lead to recurrence and poor prognosis. The standard primary treatment for endometrial cancer is surgical staging, and lymph node metastases significantly impact adjuvant therapy decisions. The subgroup of p53-abnormal (p53abn) indicates the worst prognosis and potential benefits from adjuvant chemotherapy. Molecular classification, while recommended, faces practical challenges due to resource constraints.

OBJECTIVES

The study aimed to assess the incidence of p53 abnormal expression in clinical stage 1 endometrial cancer cases that underwent surgery at a government tertiary hospital, and assess its relationship with clinicopathologic factors and pelvic and paraaortic lymph node metastasis (LNM).

METHODS

A cross-sectional retrospective analysis was conducted on clinical early-stage endometrial cancer cases that underwent surgical primary treatment between January 2018 and December 2022. Patient records were reviewed to gather demographics, surgical information, and pathological evaluations. Preoperative clinical staging was determined through imaging, and surgical staging involved comprehensive lymphadenectomy. Immunohistochemistry studies for p53 were carried out on formalin-fixed paraffin-embedded tissue samples.

RESULTS

A total of 233 endometrial cancer cases were included. The mean age at diagnosis was 53.7 years. Common comorbidities included hypertension (47.2%) and dyslipidemia (20.6%). Most cases were endometrioid histology (82.8%) and low-grade tumors (85.8%). Tumor grade (p=0.010), myometrial invasion (p<0.001) and lymphovascular space invasion (p<0.001) significantly correlated with lymph node metastasis. However, tumor size and p53abn were not significantly associated with lymph node metastasis. p53abn overexpression was significantly associated with non-endometrioid histology at 33% and Grade 3 tumors at 23%. Preoperative grading demonstrated moderate reliability (0.51) with postoperative grading, with an agreement of 65.4%.

CONCLUSION

Tumor grade, myometrial invasion, and LVSI were all significantly associated with lymph node involvement. While p53 immunohistochemical stains show promise in predicting metastasis and has been associated with tumor aggressiveness, this should still be correlated with clinicopathological parameters to carry out a more accurate risk stratification of early-stage patients.

Therapeutics ; Survival Rate ; Risk Factors ; Recurrence ; Prognosis ; Pathology ; Endometrial Neoplasms ; Immunohistochemistry ; Tumor Suppressor Protein P53 ; Lymph Node Excision ; Risk Assessment

OBJECTIVE: To explore the clinical and genetic characteristics of two children diagnosed with two rare genetic diseases simultaneously. METHODS: Two children with comorbidity of two genetic diseases due to dual genetic mutations diagnosed at the Third Affiliated Hospital of Zhengzhou University respectively in May 2022 and March 2023 were selected as the study subjects. Clinical and genetic data of the two children were retrospectively analyzed. This study has been approved by the Ethics Committee of the Third Affiliated Hospital of Zhengzhou University (Ethic No. 2021-062-01). RESULTS: Child 1 was a 2-year-and-4-month-old boy whose clinical manifestations included facial dysmorphism, developmental delay, short stature, microcephaly, cleft palate, cryptorchidism, hypospadias, recurrent infections and immunological abnormalities. Whole exome sequencing revealed that he had harbored a heterozygous c.6595delT (p.Y2199Ifs*65) variant of the KMT2D gene and a heterozygous c.1892G>A (p.R631Q) variant of the PIK3R1 gene. This has led to a dual genetic diagnosis of Kabuki syndrome and PI3Kδ-related immunodeficiency type 36. Child 2 was a 15-year-old girl whose clinical manifestations included epilepsy, Albright's hereditary osteodystrophy, long body trunk, short limbs, hypocalcemia, hyperphosphatemia and hyperparathyroidism. The child also had a family history of short stature. Whole exome sequencing revealed that she had harbored a heterozygous c.2T>C (p.Met1?) variant of the GNAS gene and deletion of exons 2 to 6 of the SHOX gene. The two variants have led to dual diagnose of pseudohypoparathyroidism and X-linked idiopathic short stature. CONCLUSION When the clinical phenotype of a genetic disease is complex and cannot be fully explained with a single genetic variant, multiple pathogenic variants should be considered, and this may lead to the diagnosis of co-morbid genetic diseases. To adopt or supplement corresponding genetic testing in time and re-analyze the genetic data may facilitate accurate diagnosis of co-morbid genetic diseases.
Child, Preschool ; Female ; Humans ; Male ; Class Ia Phosphatidylinositol 3-Kinase/genetics* ; Comorbidity ; Exome Sequencing ; Mutation ; Rare Diseases/genetics* ; Retrospective Studies ; Adolescent

OBJECTIVE: To assess the association of single nucleotide polymorphisms of rs700519 and rs4646 loci of cytochrome P450 19A1 (CYP19A1) gene with risk of Breast cancer. METHODS: Two hundred patients with breast cancer treated at Xinxiang Central Hospital between January 2019 and January 2024 and 100 healthy individuals were enrolled as the study group and control group, respectively. The genotypes of the CYP19A1 gene at the rs700519 and rs4646 loci were determined by direct sequencing. The general data, distribution of CYP19A1 genotypes and alleles were compared between the two groups. This study has been approved by the Medical Ethics Committee of Xinxiang Central Hospital (Ethics No. 2021-182). RESULTS: No significant difference was found in age, body mass index, times of conception and proportion of menopause between the two groups (P > 0.05). The frequencies of AA genotype and A allele at the rs700519 locus, and the CC genotype and C allele at the rs4646 locus in the study group were significantly higher than those of the control group (P < 0.05). The frequencies of AA genotype at the rs700519 locus and CC genotype at the rs4646 locus in patients with breast cancer at stages III-IV were significantly higher than those at stage I-II (P < 0.05). CONCLUSION Polymorphisms of CYP19A1 gene at the rs700519 and rs4646 loci are associated with susceptibility of breast cancer. The AA and CC genotypes at the two loci may increase the risk for breast cancer.
Humans ; Female ; Breast Neoplasms/genetics* ; Aromatase/genetics* ; Polymorphism, Single Nucleotide/genetics* ; Middle Aged ; Genetic Predisposition to Disease ; Adult ; Genotype ; Case-Control Studies ; Alleles ; Gene Frequency ; Risk Factors ; Aged

INTRODUCTION

Multisystem Inflammatory Syndrome in Children (MIS-C) is a delayed hyperinflammatory condition affecting multiple organ systems. Prominent symptoms include fever, skin rashes, and gastrointestinal symptoms, manifesting prior to critical signs such as cardiac involvement, hypotension, and shock.

OBJECTIVE

To determine if certain demographic, clinical, and laboratory markers are predictive of poor outcomes in patients diagnosed with MIS-C.

METHOD

This is a retrospective, cross-sectional study (2020-2023) of children who met the 2020 CDC MIS-C criteria. Data on demographics, comorbidities, clinical course, outcomes, laboratory results and 2D Echocardiogram findings were obtained and analyzed.

RESULTS

There were 28 patients with MIS-C, with a median age of 4.5 years. The majority of patients were male (64%). The percentage of neutrophils showed a significant association with hypotension/shock (OR 1.16). White blood cell count (WBC) and ferritin were significantly associated with ICU admission (OR 3.5 and 2.9, respectively). Pericardial effusion was observed in 71.4% while myocarditis was present in 67.9% of patients. The most notable risk factor was HIV infection, which was significantly associated with a more than 50-fold increase in the odds of developing ARDS and 165-fold increase in the odds of mortality; there was only one mortality, and only one patient with documented HIV infection.

CONCLUSIONS

The outcome was good in non-immunocompromised patients and the only recorded mortality was a patient not previously known to have HIV. We identified statistically significant factors that were associated with adverse outcome measures, with the limitation of a small sample, such as HIV infection and risk for ARDS and mortality; elevated neutrophil percentage and risk for hypotension/shock; elevated WBC and ferritin and risk for ICU admission; and saw a high prevalence of pericardial effusion and myocarditis in these patients, highlighting the critical role of hyperinflammation and cardiac involvement in disease progression and outcome.

Human ; Covid-19 ; Risk Factors

OBJECTIVES: The risk factors and role of mother‒child gut microbiota in pediatric inflammatory bowel disease (PIBD) remain unclear. We aimed to explore the clinical risk factors associated with PIBD, analyze the characteristics of gut microbiota of children and their mothers, and examine the correlation of the microbial composition in mother‒child pairs. METHODS: We conducted a case-control study including children with PIBD and their mothers as the case group, as well as healthy children and their mothers as the control group. Questionnaires were used to collect information such as family illness history and maternal and early-life events. Fecal samples were collected from the children and mothers for microbiota 16S ribosomal RNA (rRNA) sequencing to analyze the composition and its potential association with PIBD. RESULTS: A total of 54 pairs of cases and 122 pairs of controls were recruited. A family history of autoimmune disease and antibiotic use during pregnancy were associated with an increased risk of PIBD, and a higher education level of the father was associated with a decreased risk of PIBD. Children with PIBD and mothers exhibited different gut microbiota compared to healthy children and mothers. Similarities were observed in the gut microbiota of mothers and children in the same groups. Some bacterial biomarkers of mothers discovered in this study had the power to predict PIBD in their offspring. CONCLUSIONS PIBD is influenced by maternal risk factors and has unique gut microbiota characteristics. The mother‒child gut microbiota is closely related, suggesting the transmission and influence of the gut microbiota between mothers and children. This study highlights the potential pathogenesis of PIBD and provides a basis for developing targeted interventions.
Humans ; Gastrointestinal Microbiome ; Female ; Risk Factors ; Case-Control Studies ; Male ; Child ; Inflammatory Bowel Diseases/etiology* ; Adult ; RNA, Ribosomal, 16S/genetics* ; Feces/microbiology* ; Mothers ; Pregnancy ; Child, Preschool

OBJECTIVES: To develop an early atrial fibrillation (AF) risk prediction model based on large-scale electrocardiogram (ECG) data from the Chinese population. METHODS: The data of multiple ECG records of 30 383 patients admitted in the Chinese PLA General Hospital between 2009 and 2023 were randomly divided into the training set and the internal testing set in a 7:3 ratio. The predictive factors were selected based on the training set using univariate analysis, LASSO regression, and the Boruta algorithm. Cox proportional hazards regression was used to establish the ECG model and the composite model incorporating age, gender, and ECG model score. The discrimination power, calibration, and clinical net benefits of the models were evaluated using the area under the receiver operating characteristic curve (AUROC), calibration curves, and decision curves. RESULTS: The cohort included 51.1% male patients with a median age of the patients of 51 (36, 62) years and an AF incidence of 4.5% (1370/30 383). In the ECG model, the parameters related to the P wave and QRS complex were identified as significant predictors. In the testing set, the AUROC of the ECG model for predicting 5-year AF risk was 0.77 (95% CI: 0.74-0.80), which was increased to 0.81 (95% CI: 0.78-0.83) after incorporating age and gender, with a net reclassification improvement of 0.123 and an integrated discrimination improvement of 0.04 (P<0.05). The calibration curve of the model was close to the diagonal line. Decision curve analysis showed that the clinical net benefit of the composite model was higher than that of the ECG model across the majority of threshold probability. CONCLUSIONS The composite model incorporating quantitative ECG features during sinus rhythm, along with age and gender, can effectively predict AF risk in the Chinese population, thus providing a low-cost screening tool for early AF risk assessment and management.
Humans ; Atrial Fibrillation/epidemiology* ; Electrocardiography ; Middle Aged ; Male ; Female ; China/epidemiology* ; Proportional Hazards Models ; Adult ; Risk Factors ; Risk Assessment ; East Asian People

OBJECTIVES: To compare perioperative and mid-term results of multiple versus single arterial off-pump coronary artery bypass grafting (OPCABG) in patients with impaired left ventricular function. METHODS: This study was conducted among 86 patients with a left ventricular ejection fraction (LVEF) <50%, who underwent OPCABG at our hospital between January, 2018 and December, 2021. Of these patients, 22 underwent OPCABG with multiple arterial grafts (multiple graft group) and 64 received a single arterial graft in OPCABG (single graft group). The preoperative, intraoperative, and perioperative data were collected, and the patients were followed up for a mean of 29.28±14.84 months. The perioperative outcomes and follow-up results of the patients were compared, and the factors influencing major adverse cardiovascular events (MACE) were identified using logistic regression. Kaplan-Meier analysis was used to compare the postoperative survival rate without MACE. RESULTS: The patients in multiple graft group had a significantly younger age than those in single graft group (P<0.05), but the other baseline data were similar between the two groups (P>0.05). Perioperative mortality, 24-h postoperative drainage volume, length of ICU stay, intubation time, and the incidence of new-onset atrial fibrillation were all similar between the two groups (P>0.05), but the rate of postoperative hypotension was significantly higher in multiple graft group (34.78% vs 11.54%, P=0.009). No significant differences were found in the incidence of MACE or echocardiographic data during the follow-up. Logistic regression identified the female sex (OR: 0.191, 95% CI: 0.049-0.075) and creatinine level (OR: 1.016, 95% CI: 1.000-1.033) as factors affecting postoperative MACE occurrence. Kaplan-Meier analysis showed no significant difference in MACE-free survival rate between the two groups. CONCLUSIONS OPCABG with multiple arterial grafts does not increase severe perioperative complications or the risk of mid-term MACE in patients with impaired left ventricular function.
Humans ; Follow-Up Studies ; Postoperative Complications/epidemiology* ; Ventricular Dysfunction, Left/physiopathology* ; Coronary Artery Bypass, Off-Pump/adverse effects* ; Male ; Female ; Ventricular Function, Left ; Middle Aged ; Risk Factors ; Aged ; Perioperative Period ; Stroke Volume