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.

BACKGROUND AND OBJECTIVES

Heart Failure (HF) remains a major health concern worldwide. In the Philippine General Hospital (PGH), HF is consistently a top cause of mortality and readmissions among adults. The American College of Cardiology (ACC) and European Society of Cardiology (ESC) published guidelines for interventions that improve quality of life and survival, but they are underused and untested for local acceptability. Hospitals overseas used order sets created from these guidelines, which resulted in a considerable decrease in in-hospital mortality and healthcare costs. We aimed to develop an order set for adult patients with acute heart failure (AHF) admitted to the PGH Emergency Department (ED) to improve care outcomes.

This study utilized a mixed methods approach to create the AHF order set. ESC and ACC HF guidelines were appraised using the AGREE II tool. Class I interventions for AHF were included in the initial order set. Through focused group discussions (FGD), clinicians and other care team members involved in the management of AHF patients at PGH ED modified and validated the order set. Stakeholders were asked to use online Delphi and FGD to get a consensus on how to amend, approve, and carry out the order given.

Upon review of HF guidelines, 29 recommendations on patient monitoring, initial diagnostic, and therapeutic interventions were adopted in the order set. Orders on subspecialty referrals and ED disposition were introduced. The AHF patient was operationally defined in the setting of PGH ED. The clinical orders fit the PGH context, ensuring evidence-based, cost-effective, and accessible care responsiveness to patients’ needs and suitable for local practice. Workflow changes due to COVID-19 were considered. Potential barriers to implementation were identified and addressed. The final order set was adopted for implementation through stakeholder consensus.

The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.

BACKGROUND AND OBJECTIVE

Nurses comprise the majority of the health workforce in the Philippines. Previous studies revealed that nurses manifest negative mental health outcomes exacerbated by COVID-19 pandemic. This study aims to determine the Professional Quality of Life (ProQOL) of nurses in the Philippines and their workplace psychosocial support interventions during the pandemic. The ProQOL measures compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS).

A self-administered online questionnaire was disseminated by the Philippine Nurses Association, Inc. to affiliated nurses via email and Facebook posts. Out of 713 responses, 239 were eligible with their data analyzed using t-test, one-way ANOVA, and post hoc pairwise multiple comparisons.

Respondents were found to have high CS (41.95 [SD 5.97]), moderate BO (23.56 [SD 6.07]), and moderate STS (26.62 [SD 8.18]). The most reported intervention was policies on confidentiality of workers’ mental health (84.94%) while the least reported was community engagements under the hospital’s mental health program (61.51%). ProQOL scores significantly differed in CS by age (p=0.011), position (p=0.044) and monthly income (p=0.016), BO by age (p=0.001) and years with current employer (p=0.009), and STS by region (p=0.017) and area of assignment (p=0.015). The existence of interventions yielded significant increase in CS and decrease in BO scores.

Nurses in the Philippines exhibit high and favorable ProQOL during the pandemic. The majority of respondents reported the presence of workplace interventions which yield significant differences in CS and BO. The findings highlight the importance of workplace psychosocial support interventions and the need to strengthen implementation.

OBJECTIVE

Given that rabies remains endemic in the Philippines despite government interventions and the pandemicrelated restrictions have hampered its surveillance, this study aimed to estimate the effect of human population, anti-rabies vaccination efforts, and COVID-19 situation on the spread of rabies cases in the districts of Davao City, Philippines.

A retrospective study of the canine records at Davao City Veterinarians’ Office was done from January 2018 to June 2021. Monthly rabies cases were ascertained, and the effect of the human population, COVID-19 season, and vaccination ratio on rabies cases was estimated using panel regression models adjusting for confounding factors.

The reporting of rabies cases was lower during COVID-19 than during the non-COVID-19 season, with an IRR of 0.52 [95% confidence interval (CI): 0.33–0.82]. Furthermore, rabies cases increased by 2.23% (95% CI: 0.60–3.89) per 1% increase in vaccination ratio. Additionally, high-population districts recorded more rabies cases than low-population districts.

Consistency in monitoring rabies cases during the pandemic is suggested as a roadmap for future program initiatives. Vaccination efforts should be reinforced to increase rabies awareness and ensure early response to emerging diseases. Moreover, highpopulated districts should be prioritized in implementing rabies control interventions to gain optimal development.

BACKGROUND AND OBJECTIVE

Rabies continues to be a challenge in Davao City despite the efforts of the city’s local government to vaccinate primarily the non-stray dog population. Meanwhile, studies have shown that time-dependent vaccination strategy is considered a prime factor for a cost-effective rabies control strategy. Hence, this study aims to provide information that will determine the optimal vaccination strategy targeted to the stray dog population that minimizes the rabies-infected dog population and vaccination costs using optimal control theory (OCT).

OCT is used to identify the optimal level of key rabies control, i.e., vaccination. Here, OCT was applied to a modified Susceptible-Exposed-Infectious-Vaccinated (SEIV) compartmental model. The study's key parameters were derived from published articles on rabies in Davao City and similar regions, along with the city's rabies reports.

The findings revealed that while rabies remains endemic in the city, it is possible to reduce the number of cases through consistent implementation of vaccination programs to the exposed and susceptible dog populations. Nevertheless, the feasibility of these findings relies to the effective targeting of vaccine coverage for the dog population. From the simulations performed, the exposed dog population (i.e., pre-rabid dogs) was able to reach zero observation when the transmission rate (?) is 0.001 for all values of anti-rabies vaccine coverages for exposed (?) and susceptible (b) dog populations and ? = 0.01 only when ? = 0.7 and b = 0.7, ? = 0.7 and b = 0.5, and ? = 0.5 and b = 0.7. Consequently, the number of infectious dogs will thereby decrease. Moreover, a nonlinear correspondence was also observed in all scenarios between the vaccination rate and the number of rabies-exposed dogs such that the reduction in the incidence of rabies cases becomes apparent only when the vaccination rate is at least 0.9995.

In high rabies transmissibility scenarios, a time-dependent vaccination strategy demonstrated a reduction in the number of rabies-infected dogs. However, this approach involves a trade-off, limiting the period during which monthly vaccinations can be relaxed. Consequently, a robust and timely vaccination program for dogs is crucial to manage high rabies transmission rates. Lastly, the model simulation underscores the importance of initiating monthly vaccinations.

BACKGROUND

Pneumococcal vaccination has been widely used for the prevention of pneumococcal disease, with two types of vaccines available since 2009. With the World Health Organization (WHO) recommendation of incorporating pneumococcal conjugate vaccines (PCVs) in National Immunization Programs (NIPs) worldwide, a ten-valent PCV (PHiD-CV) was initially introduced in the Philippines in 2012. This, however, transitioned to the use of the 13-valent PCV (Prevnar) subsequent to the recommendation of the Formulary Executive Council in 2014.

This review aimed to present evidence on pneumococcal disease and vaccine inclusion in the Philippine NIP from 2005 - 2021.

This narrative review compiled articles on Pneumococcus from January 2005 to October 2021, sourcing literature from databases such as BIOSIS Preview, CAB Direct, Embase, Google Scholar, and others.

In the Philippines, there was a shift in prevalent serotypes of Streptococcus pneumoniae among children under five following the introduction of PCV13 in the National Immunization Program in 2014, with serotype 14 becoming the most common by 2018, and a significant reduction in isolates reported in 2020, where only serotypes 5, 19A, and 23F were identified among invasive strains. The immunogenicity results of a potential vaccine candidate should be factored into the overall evidence when conducting a reassessment of PCV.

As part of the decision making about the inclusion of the PCVs in the NIP of the Philippines, various factors such as local epidemiology, vaccine supply, cost, and programmatic characteristics must be careful weighed. Enhancing laboratory and surveillance capacity are essential to provide evidencebased decision-making in terms of existing serotype distribution and antimicrobial resistance (AMR) profile in the country. With the introduction of a new affordable formulation of a 10-valent PCV offering a comparable serotype coverage, the reassessment of choice of PCV with the consideration of all three formulations, namely PCV13, PHiD-CV, and SIIPL-PCV, may be warranted.

BACKGROUND AND OBJECTIVE

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of hospital and community-acquired infections, showing antimicrobial resistance (AMR), which is an increasing public health concern. One of the commonly-used methods to evaluate resistance include the Kirby-Bauer disk diffusion method. However, this test is found to be time-consuming, lacking in terms of mechanization and automation, alongside its non-applicability to certain antibiotics such as vancomycin. Thus, the Clinical Laboratory Standards Institute (CLSI) recommends using the broth microdilution method in the evaluation of antibacterial activities against S. aureus. A rapid laboratory identification of MRSA is important in the treatment of patients. Therefore, this study aims to optimize and evaluate the effectiveness of a rapid microplate assay using resazurin dye as a colorimetric indicator in determining antibacterial activity against clinical isolates of MRSA and methicillin-susceptible S. aureus (MSSA).

Clinical isolates of MRSA and MSSA were obtained from the Philippine General Hospital (PGH) Microbiology Section, and American Type Culture Collection (ATCC) controls of both strains (ATCC 25923 and ATCC 43300) were acquired. These were then subjected to identification and confirmation procedures. A standardization of bacterial inoculum was performed by comparing its 24-hr growth in Mueller Hinton Broth to 0.5 McFarland Standard. The resazurin microplate assay (REMA) was set-up using two-fold serial dilution of control antibiotics such as oxacillin, vancomycin, and cefoxitin. Each plate was inoculated with standardized bacterial growth of controls and clinical isolates. To determine the time needed for the reduction of the resazurin dye, a qualitative assessment was conducted by comparing the reaction time between a 6.75 mg/mL dye with a 0.01 mg/mL dye. The plates were also subjected to different incubation times and dye concentrations, and the optical densities of the plates were compared using a microplate reader.

Results showed that there were no significant differences between the optical densities of the wells of those incubated for 5 hours and for 24 hours (p >0.05). Furthermore, there was a significant reduction in the reaction time of the dye (from 18 hours to 1 hour) when the dye concentration was reduced from 6.75 mg/mL to 0.01 mg/mL. The optimized REMA showed a significant difference between the minimum inhibitory concentrations (MICs) of the different antibiotics against the control and isolate strains of MRSA and MSSA, showing a W of -2.98 (pCONCLUSION

Based on the results presented, the researchers determined the optimal condition for the resazurin microtiter assay, which was 0.01 g/mL concentration of resazurin dye, at a 5-hour incubation period. This study has shown that an optimized REMA is an efficient and fast method to determine the antimicrobial activities of oxacillin, cefoxitin, and vancomycin against MRSA and MSSA.

OBJECTIVES

Workers are continuously exposed to occupational hazards and risks. By analyzing recent data on the status of occupational safety and health (OSH) in the Philippines, this study aimed to determine the common occupational injuries and diseases among Filipino workers, and preventive and control measures/activities and occupational safety and health policies and programs implemented across the country.

A review of data on Philippine OSH from the Integrated Survey of Labor and Employment (ISLE) by the Philippine Statistics Authority (PSA) covering data from 2015/2016, 2017/2018, and 2019/2020 was done. The number of occupational injury cases, types of injuries, and types of diseases were assessed as well as the implementation of OSH policies and programs. Descriptive statistics, simple T-test, and Pareto analysis were used to analyze the collated data sets.

The number of occupational injury and diseases in the Philippines across industries are decreasing. Superficial injuries and open wounds (56.47%), and Work-related Musculoskeletal Diseases (WMSDs) (61.82%) top the list as the most common injury and disease across industries, respectively. In 2018, OSH programs and preventive and control measures underwent reforms due to the implementation of the Republic Act (RA) 11058. For OSH programs, there is an increase in implementation between 2015 and 2019.

Occupational injury and occupational diseases in the Philippines across industries are declining. In terms of OSH measures and programs, there has been a significant change over the years, especially after the introduction of RA 11058 in 2018. A rise in the implementation of measures and policies was noted. However, there are still gaps that need to be addressed.

BACKGROUND AND OBJECTIVE

Physician adherence to the recommended management of patients with heart failure with reduced ejection fraction (HFrEF) at the outpatient setting is crucial to reduce the burden of subsequent rehospitalization, morbidity, and mortality. Recently updated guidelines recommend early and rapid titration to optimal doses of medications in the first 2 to 6 weeks of discharge. In the absence of local data, our study evaluates physician adherence to guideline-recommended treatment in this setting.

This is a retrospective cross-sectional study among post-discharge HFrEF patients at the outpatient department from December 2022 to May 2023 with a follow-up within three months. Clinical profile and treatment were extracted from medical records. Adherence to the 2021 ESC Guidelines Class I recommendations, among eligible patients, is measured as quality indicators. Data are presented using descriptive statistics.

A total of 99 patients were included in the study. Overall, adherence to prescription of beta-blockers (94.8%), ACEI/ARNI/ARBs (88.5%), and diuretics (100%) were high. Prescription of mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) were 67% and 57.3%, respectively. Over three months of follow-up, improvement in the quality of care was demonstrated with ACEI/ARNI/ARBs (81.8% to 90.9%), MRA (68.7 to 81.2%), and SGLT2i (58% to 67.7%). Beta-blocker use is consistently high at 97%. In the 3rd month post-discharge, titration to optimal doses was achieved in only 26.4%, 15%, and 6.25% for those on beta-blockers, ACEI/ARNI/ARB, and MRA, respectively. For non-pharmacologic management, referral to HF specialty was made in 30% and cardiac rehabilitation in 22.2%.

Among patients with HFrEF seen at the outpatient, there is good physician adherence to betablockers, ACEI/ARNI/ARBs, and diuretics. MRA and SGLT2i prescription, referral to HF specialty and cardiac rehabilitation, and up-titration to optimal doses of oral medications for HF need improvement. Hospital pathway development and regular performance evaluation will improve initiation, maintenance, and up-titration of appropriate treatment.

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic has disrupted the sports industry, resulting in the postponement of events worldwide. This posed a significant burden in the mental and emotional well-being of athletes due to uncertainties and diminished training levels. As an adaptation, bubble camps emerged as a new approach to resuming training and tournaments under stringent regulations of the COVID-19 protocols. In the national context, the University Athletic Association of the Philippines (UAAP) has adapted the bubble set-up by implementing antigen testing, RTPCR, and other health protocols as a prerequisite to bubble training. However, uncertainties in the future of sports continue to present as a psychological toll to the well-being of student-athletes despite the sense of normalcy instilled by bubble training. Existing literature on bubble training is grounded heavily on the quantitative assessments of an athlete's well-being in a bubble set-up and its effectiveness in mitigating COVID-19 transmission, thereby lacking insights that may be obtained from qualitative data. This study explored the experiences of UAAP Season 84 studentathletes in a bubble set-up by examining personal and contextual factors that impacted their well-being.

The study employed a qualitative descriptive phenomenological approach based on Seligman's WellBeing Theory. A purposeful sampling technique was used to recruit UAAP student-athletes through online dissemination of Google Forms for recruitment. Only three student-athletes from UAAP fit the eligibility criteria. Data were collected through on-site and online interviews using a semi-structured interview guide to reveal a narrative of the student-athletes' bubble training experiences, common themes, and patterns. The NVivo software program was used for data analysis, utilizing a deductive thematic approach.

The lived experiences of three UAAP studentathletes were classified into six major themes: (1) Availability and Accessibility of Services; (2) Restrictions; (3) Mental Health; (4) Fostering Relationships; (5) Support Systems; and (6) Individual Growth. Accounts of both positive and negative training perceptions and outcomes regarding the bubble set-up were noted from all student-athletes. The set-up provided studentathletes with easy access to training facilities and services, eventual development of mental fortitude and  perseverance, improved interpersonal relationships, and opportunities for individual growth. However, the restrictions, isolation, internal and external pressures, and routinary nature of the set-up contributed to the elevated levels of stress and anxiety, eventually leading to fatigue and burnout.

The study elucidates on the multi-faceted experiences of UAAP student-athletes in bubble training, underpinning the essence of the adequacy of training services and facilities, enhanced support systems, and prompt policy development that caters to improving the holistic well-being of student-athletes amidst adverse changes in the trajectory of sports.