BACKGROUND AND OBJECTIVE

Randomized controlled trials (RCTs) are essential for advancing evidence-based healthcare by evaluating the effectiveness and safety of health interventions. Despite the increasing recognition of clinical research, the Philippines has had limited contributions to global RCT output. This bibliometric analysis aims to assess the trends, characteristics, and impact of RCTs conducted in the Philippines and published online.

A systematic search of Medline (PubMed), and EMBASE, along with Acta Medica Philippina, was conducted to identify published RCTs from January 1990 to October 2022. Eligible studies were screened and analyzed based on publication trends, funding sources, study designs, research settings, and institutional contributions. Descriptive statistics were used to summarize key findings.

A total of 391 RCTs were identified, with a notable increase in number of RCTs published over time. Most studies (91.8%) were published in international journals, and funding was primarily sourced from pharmaceutical companies (47.1%). The predominant RCT design was two-arm parallel (64.7%), with hospitals being the most common research setting (54.2%). Research areas were led by infectious diseases, particularly vaccine-preventable illnesses (23.8%). While the University of the Philippines Manila (21.1%) and the Research Institute for Tropical Medicine (13.7%) were the leading institutions in terms of highest number of published RCTs, foreign authors accounted for nearly half (47.3%) of primary authorships. The most cited studies focused on cardiovascular diseases, infectious diseases, and oncology.

The increasing number of published RCTs in the Philippines reflects growth in research capacity and institutional engagement. Strengthening national research dissemination platforms and fostering regional collaborations will be essential in advancing the Philippines’ contribution to global clinical research.

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.

Introduction: There remains little evidence on rehabilitation protocols for proximal humerus fractures (PHFs), although early mobilisation has been associated with positive clinical outcomes. There may be a potential role in allowing patients with more stable fractures to undergo an accelerated rehabilitation process to facilitate quicker return to function, although it must be balanced with safety concerns of premature mobilisation and logistical concerns of implementation with excessive stratification. The study aim was to report the overall safety and outcomes of a simple and implementable 2-tier stratified rehabilitation protocol based on fracture stability adopted by our institution for nonoperatively treated PHFs. Materials and methods: Patients in our institution (level 1 trauma centre) with non-operatively treated PHFs underwent a stratified rehabilitation protocol that classified patients into Accelerated versus Standard arms - with more stable fractures undergoing an accelerated rehabilitation programme. The Oxford Shoulder Score (OSS), Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), EuroQol-5-Dimensions (EQ5D) questionnaires, shoulder range of motion (ROM) and grip strength were measured at six months and one year postinjury. The frequency of adverse events requiring surgical intervention was noted. Results: We included 164 patients and 43% (71/164) went through the accelerated protocol. Overall, patients had favourable OSS (median[range] 47[44-48]), EQ5D (median [range] 1.0[0.82-1.00]), QuickDASH scores (median[range] 2.3[0- 10.7]), and shoulder ROM and grip strength above the requirement for functional activities of daily living at 1 year. There were no adverse events reported 1-year post-injury. Conclusion: This study was the first to report the safety and outcomes of a stratified rehabilitation protocol for PHFs. Our simple 2-tier stratified rehabilitation protocol which allowed a shorter period of rehabilitation and earlier return to function for patients with more stable PHFs is implementable, safe and had overall favourable functional outcome scores.

Kajian ini bertujuan untuk mengkaji strategi yang digunakan untuk mencegah gangguan muskuloskeletal akibat kerja (WMSDs) dalam kalangan ahli fisioterapi dari segi kesedaran, keberkesanan, galakan, dan halangan. Kajian kualitatif telah dilakukan dalam kalangan ahli fisioterapi di Malaysia menggunakan metodologi keratan rentas, dengan platform dalam talian digunakan untuk menjalankan temu bual semi-struktur secara individu. Analisis tematik menunjukkan bahawa 13 peserta menyedari kaedah berbeza yang digunakan oleh ahli fisioterapi untuk mencegah WMSD. Peserta menyedari kepentingan menggunakan strategi yang berkesan untuk mencegah WMSD, seperti mengekalkan mekanik badan yang betul (61.5%), melakukan senaman fizikal (23.1%), memastikan ergonomik tempat kerja yang sesuai (15.4%), mempunyai kakitangan yang mencukupi (15.4%), menggunakan peralatan (15.4%), dan mempraktikkan teknik memanaskan badan yang betul (7.7%). Peserta kerap mempromosikan penggunaan alatan dan peralatan (53.8%), mengekalkan mekanik dan postur badan yang betul (46.2%), dan menerima pendidikan (30.8%) sebagai strategi pencegahan utama. Namun begitu, terdapat halangan untuk mengambil bahagian dalam langkah pencegahan, seperti kekurangan peralatan, beban kerja yang tinggi, dan kakitangan yang tidak mencukupi. Penemuan menunjukkan bahawa ahli fisioterapi sedar dan menyokong idea bahawa melaksanakan strategi khusus boleh membantu mencegah WMSD. Namun begitu, keputusannya menggariskan kepentingan untuk mempertimbangkan halangan ini untuk meningkatkan keberkesanan strategi pencegahan dalam intervensi amalan klinikal.

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.

The Remote Home Environment Assessment (RHEA) Framework is a guide designed to help therapists conduct structured home environment assessments remotely using tools and technology. It offers an efficient and practical approach to overcoming the limitations of facility-based home assessments. The framework offers step-by-step procedures for remote home environment assessment for adult clients with physical dysfunction. It involves four major steps that focus on assessing the client’s physical environment: a) screening for selecting the most appropriate remote home environment assessment modality/ies; b) a preparatory phase that includes signing consent forms, explaining the assessment process, and previewing preliminary information; c) administration of the remote assessment; and d) consolidation of the home information. Furthermore, supplementary materials such as screening form, client and health facility consent forms, home evaluation questionnaire and checklist, and client instructions were developed to facilitate and guide the implementing therapist through the aforementioned steps. Pilot testing is recommended to gain accurate and practical insights into the RHEA Framework’s usability and effectiveness.

BACKGROUND

Low back pain is a major global cause of disability, typically treated through traditional onsite rehabilitation. However, the advancement of telerehabilitation during the COVID-19 pandemic presents an opportunity to examine its effectiveness as a treatment option for low back pain. This study aims to seek and explore the experiences and perspectives of healthcare professionals about onsite or online management of LBP.

The study will employ a phenomenological qualitative study design that will use quota sampling to recruit a total of 16 participants, equally distributed among rehabilitation doctors, physical therapists, barangay healthworkers, and patients with low back pain, coming from hospitals and centers affiliated with the University of Santo Tomas in Metro Manila. Key informant interviews that follow a semi-structured interview format will be conducted either on-site or online, depending on the preference of the invited informant. The NVivo data analysis software will be utilized to produce codes and outline themes from the gathered data.

The research is expected to highlight the nuanced interplay between individual viewpoints and contextual factors that influence decision-making in rehabilitation settings, besides identifying these themes. Findings will be instrumental in informing best practices for managing low back pain, thereby helping physical therapists determine the most effective treatment approach—whether through telerehabilitation or traditional on-site care. The study can provide actionable recommendations through grounding the implications of the analysis to the anticipated findings that might affect the rehabilitation practices and patient outcomes in the Philippines.

OBJECTIVE

To determine the prevalence of rectal colonization with carbapenem-resistant organisms (CRO) among PGH neonatal intensive care unit (NICU) patients.

A prospective single-center observational study conducted over a 1-month period included all NICU 3 and cohort area patients admitted on April 24, 2024. Rectal swabs were collected for multidrug-resistant organism (MDRO) screening and repeated weekly for 1 month while admitted. Swabs were inoculated on chromogenic media, and isolates were identified and tested for antimicrobial sensitivity by disk diffusion. Clinical characteristics and outcomes were collected for 30 days from initial MDRO screening. Descriptive statistics were used to summarize the data.

The point prevalence of CRO colonization was 37% (14 of 38) at initial screening. There were 14 incident colonizations, hence the 4-week period prevalence of CRO colonization was 72.5% (29 of 40). The patients were mostly very preterm, very low birth weight neonates, majority were tested within the first 2 weeks of life, and half were exposed to meropenem at initial screening. Nosocomial infection developed in 29% and 64%, and 30-day mortality rate was 8% and 21% among initially non-CRO-colonized and CRO-colonized patients respectively. Despite high CRO colonization, no culture-proven CRO infection was observed. Surveillance screening documented persistent CRO colonization in 37%, but no decolonization. Escherichia coli, Klebsiella spp. and Serratia spp. were the most common colonizers.

The high prevalence of rectal CRO colonization in the NICU emphasizes the burden of antimicrobial resistance, but despite the high CRO colonization, no CRO infection was documented from the limited sample and study period.

INTRODUCTION

Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) poses a therapeutic dilemma for the attending physician. Standard anticoagulation with a vitamin K antagonist (VKA) plus dual antiplatelet therapy with a P2Y12 inhibitor and aspirin reduces the risk of stroke and thrombosis, but increases risk of bleeding. The effectiveness and safety of several novel oral anticoagulants are still unclear in these patients.

PubMed, Cochrane and Embase databases were systematically searched for studies from 2016 until 30 November 2023. The search key terms were ‘DOACs,’ ‘atrial fibrillation,’ ‘percutaneous coronary intervention’ and ‘bleeding.’ Two independent reviewers appraised eligible studies using well-defined criteria. The main outcomes of interest were International Society on Thrombosis and Haemostasis (ISTH) major bleeding, stent thrombosis and major adverse cardiovascular events (MACE). The random-effects model was used to derive pooled estimates.

The search yielded four studies which were all randomized controlled trials (RCTs). There were a total of 10,963 participants. Pooled estimates showed a statistically significant difference between direct oral anticoagulants (DOAC) + P2Y12 and VKA + DAPT for ISTH major bleeding (OR 0.62, 95% CI 0.57 – 0.69, p =DISCUSSION

In patients with AF who had undergone PCI, the risk of bleeding was lower among those who received dual therapy with DOAC + P2Y12 than among those who received triple therapy with warfarin, a P2Y12 inhibitor and aspirin. However, dual therapy was noninferior to triple therapy with respect to the risk of stent thrombosis and MACE.

Vulvar Rhabdomyosarcoma (VR) is a rare gynecological cancer primarily found in children. This case report discusses the diagnosis, treatment, and management complexities of a 19-year-old patient with a slow-growing vulvar lesion.

A 19-year-old female with obesity and non-alcoholic fatty liver disease presented with a left vulvar lesion measuring 11 x 7 x 7 cm that was noticed five months ago. Core needle biopsy of the lesion revealed findings consistent with rhabdomyosarcoma. A Positron Emission Tomography-Computed Tomography (PET-CT) scan showed a hypermetabolic 8.3 x 6.7 x 6.7 cm mass in the left vulvar area, extending to the vagina, rectal wall, and anal region along with enlarged left inguinal lymph nodes.

The patient was treated with the Intergroup Rhabdomyosarcoma Study-IV (IRS-IV) protocol for 16 weeks with vincristine, dactinomycin, and cyclophosphamide. Concurrent chemoradiotherapy was administered between weeks 9-14, followed by continuation chemotherapy until week 28. Interim PET-CT scan prior to concurrent chemoradiotherapy revealed a reduced mass size to 3.8 x 2.8 cm and resolved left inguinal lymphadenopathy.

Despite completing treatment, the patient reported persistent back pain and mobility issues three weeks later. A subsequent PET-CT scan showed hypermetabolic lesions at vertebral locations C6, T9, T12, and L1-L3, along with the left ischium and bilateral femoral shafts. Thoracic vertebrae biopsy confirmed rhabdomyoblasts. Patient underwent palliative radiotherapy and spinal stabilization then proceeded with second line therapy with 1 cycle of GemcitabineDocetaxel but showed progression of symptoms described as persistent bleeding (hematuria) and neutropenia. Further diagnostics done to the patient showed possible bone marrow involvement. Unfortunately, the patient expired owing to symptoms of cancer progression.

The management of adult-onset VR presents a significant therapeutic challenge, largely attributable to the scarcity of clinical trials and tailored treatment regimens for this specific age group. Outcomes documented in existing literature for adult VR cases present with recurrence, disease progression, and mortality. The treatment landscape in adults is complicated by comorbidities which may influence both the therapeutic choices and outcomes. Given these intricate challenges, this case echoes the need for research efforts aimed at developing management protocols specifically designed for adults with VR.