INRODUCTION<p>Stroke is one of the top five leading causes of disability in the Philippines. It has a significant impact on the quality of life (QoL) of patients, particularly in the functional and psycho-emotional aspects. Thus, it is important to understand the health-related quality of life in stroke patients (HRQoLISP), which focuses on the clinical impact of the disease and disability. The assessment of a stroke patient’s QoL is prognostically significant as it can predict a patient’s treatment success and survival.p>OBJECTIVE<p>This study aims to translate the HRQoLISP-26 into Filipino and assess its content validity for Filipino adult stroke patients.p>METHODOLOGY<p>The HRQoLISP-26 was translated into Filipino using a forward translation protocol and an expert analyzed the forward translation. Selected expert committee members reviewed the first version to assess for content validity and the questionnaire was modified accordingly. The content validity index (CVI) was used for content validity.p>RESULTS<p>Majority of the revisions made were done to improve the semantic and grammatical accuracy of items in the Filipino version of the HRQoLISP-26. Only a few items had no revisions implemented. No revisions were done in the final version of the translated questionnaire as each item had a CVI of 1 indicating that it has good content validity.p>CONCLUSION<p>The Filipino translated HRQoLISP-26 questionnaire is a validated questionnaire that allows assessment of a stroke survivor’s QoL.p>
Quality Of Life ; Patients ; Life ; Health ; Adult ; Stroke

OBJECTIVES<p>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.p>METHODS<p>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.p>RESULTS<p>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.p>CONCLUSION<p>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.p>
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: A new diagnostic framework for clinical obesity, proposed by the Lancet Commission, defines obesity as excess adiposity with organ dysfunction, offering a more functional assessment than traditional body mass index (BMI)-based classification. However, it has not been applied to Asian populations, where obesity-related complications arise at lower BMI thresholds. Methods: We analyzed 57,863 Korean adults aged ≥20 years from the 2014 to 2023 Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative, cross-sectional dataset. Clinical obesity was defined as excess adiposity with ≥1 obesity-related complication or functional limitation; preclinical obesity was defined as excess adiposity without complications. Age, sex, and temporal trends were examined and compared with BMI-based classifications using complex sampling weights and age-standardization. Results: The prevalence of clinical obesity and preclinical obesity was 31.2% and 8.1%, respectively. Among those with BMI-defined obesity (≥25.0 kg/m²), 20.1% had no complications, while 19.4% of overweight individuals (BMI 23.0–24.9 kg/m²) met clinical obesity criteria. Clinical obesity increased with age despite stable BMI, driven by metabolic and functional decline. Cancer prevalence was highest among individuals with clinical obesity (1.77%). Applying Western waist circumference cutoffs drastically reduced the estimated prevalence of clinical obesity to 13.1%. Longitudinal analyses showed a rising trend in clinical obesity over ime. Conclusion This is the first large-scale study to apply the clinical obesity framework in an Asian population. The framework identifies high-risk individuals missed by BMI al

Objective: On 18 October 2022, diarrhoeal cases among the Sama Badjao indigenous community in the Philippines were reported from a tertiary hospital in Lucena City, Quezon Province. An investigation was conducted to confirm the outbreak, profile cases, identify the source of infection, and recommend prevention and control measures. Methods: Suspected cases were identified through medical records review, active case finding and key informant interviews. Identified cases were interviewed using a structured questionnaire to collect demographic, clinical and exposure information. Rectal swabs and environmental water samples were collected for bacterial isolation and confirmation. Results: A total of 75 cases were identified, with 40 (53.3%) hospitalized and four fatalities (case fatality rate: 5.3%). Ages ranged from 2 months to 20 years (median: 4 years). Nine of the 15 rectal swabs were positive for Vibrio cholerae Ogawa biotype El Tor. The community practised open defecation, and only 24.7% of households had basic sanitation. Although V. cholerae was not found in water samples, faecal contamination was noted in a community well, and Aeromonas species were isolated, indicating the presence of multiple gastrointestinal pathogens. Discussion: A cholera outbreak was confirmed among the Sama Badjao community in Lucena City. Environmental assessment indicated that poor sanitation, open defecation and unsafe water sources likely contributed to the outbreak. The high case fatality rate (5.3%) was influenced by delayed care and limited health-care access. These findings emphasize the need for interventions to improve water, sanitation and hygiene practices and provide culturally appropriate public health programmes to reduce cholera risk among vulnerable communities.

BACKGROUND<p style="text-align: justify;" data-mce-style="text-align: justify;">The Philippines has been significantly affected by the HIV epidemic in the Asia-Pacific region, with a notable increase in new cases over the past decade. Despite efforts to promote HIV testing, access to treatment, and awareness campaigns, progress has been slow, particularly among youths. Tangere, a market research application, conducted surveys during and after the COVID-19 pandemic to assess HIV knowledge among Filipinos.p>OBJECTIVES<p style="text-align: justify;" data-mce-style="text-align: justify;">This study aimed to evaluate changes in HIV awareness among young Filipinos during and after the COVID-19 pandemic using data collected via Tangere’s surveys. Specifically, it sought to analyze demographic characteristics, sources of HIV information, and knowledge regarding HIV transmission, prevention, and stigma.p>METHODS<p style="text-align: justify;" data-mce-style="text-align: justify;">Tangere collaborated with the investigators to develop a questionnaire assessing HIV knowledge among young Filipinos. Surveys were conducted during and after the COVID-19 pandemic, targeting subscribers aged 18-35 years, primarily from the National Capital Region and Luzon area. Data analysis involved calculating frequencies and percentages to summarize demographic characteristics and HIV knowledge. An Independent-Samples Proportions procedure was used to compare HIV knowledge during and after the pandemic.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">The survey revealed that while respondents generally possessed reasonable knowledge about HIV, there were notable changes in the awareness during and after the pandemic. Social media and television were identified as primary sources of HIV information. Knowledge regarding HIV transmission and prevention increased postpandemic, particularly concerning preventive measures such as pre-exposure prophylaxis (PREP) and motherto-child transmission (MTCT). However, persistent misconceptions and stigma surrounding HIV remained, indicating the need for continued education and advocacy efforts.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">The study underscores the importance of utilizing social media platforms for HIV awareness campaigns, especially among youths who are disproportionately affected by the epidemic. Despite improvements in knowledge, the Philippines has yet to achieve global HIV prevention goals. Continued efforts to enhance awareness, particularly regarding recent advancements in HIV prevention and treatment, are essential for curbing the epidemic and improving public health outcomes nationwide.p>
Human ; Knowledge ; Attitude ; Hiv ; Covid-19 ; Pandemics

BACKGROUND<p style="text-align: justify;" data-mce-style="text-align: justify;">Down syndrome or trisomy 21, the most common chromosomal disorder, results from the presence of a third copy of chromosome 21 and manifests as mild to moderate intellectual disability, growth retardation, congenital heart defects, gastrointestinal abnormalities, and characteristic facial features. Several methods have been used to screen for Down syndrome in the prenatal period, such as ultrasound, biomarkers, cell-free DNA testing, and combinations of these tests. A positive result from one or more of these screening tests signals the need for confirmatory karyotyping to clinch the diagnosis. Ultrasound between 11 to 14 weeks of gestation can evaluate nuchal translucency (NT) to screen for Down syndrome. During the second trimester, a triple or quadruple test can also be performed alone or in addition to NT to quantify Down syndrome risk. In limited resource settings however, only the measurement of NT via ultrasound can be performed since biomarker tests are either unavailable or inaccessible. While the diagnostic performance of NT measurement alone has been investigated in several observational studies, there is no consensus on its performance as a sole test to screen for Down syndrome.p>OBJECTIVE<p style="text-align: justify;" data-mce-style="text-align: justify;">To determine the diagnostic performance of NT during prenatal first-trimester ultrasound as a screening test for Down syndrome.p>METHODS<p style="text-align: justify;" data-mce-style="text-align: justify;">We performed a systematic search on the PubMed, ProQuest, and Cochrane Library databases for recent systematic reviews and meta-analyses that addressed the objective. The existing reviews found were then independently appraised by the two reviewers with the AMSTAR-2 checklist. To update the existing reviews, a systematic search was done in the same databases to identify additional primary diagnostic studies, which were appraised using the QUADAS-2 tool. Random-effects univariate meta-analysis and summary receiving operator curve (HSROC) analysis for the outcomes were performed using Review Manager version 5.4 and R version 4.2.2, respectively. Subgroup analysis was performed by stratifying the baseline risk of mothers for fetal anomaly as low- or high-risk. Highrisk mothers were defined as women with risk factors such as advanced age, positive serum screen, presence of other ultrasound anomalies, and history of previous fetus with anomaly.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">We found 22 cohort studies (n=225,846) of women at low-risk for fetal anomaly. The pooled sensitivity was 67.8% (95% CI: 61.4%-73.6%, I2=70.4%) and specificity was 96.3% (95% CI: 95.5%-96.9%, I2=96.7%). For low-risk women, the overall certainty of evidence was low, due to different modes of verification and heterogeneity not completely explained by variability in baseline risk or cut-points. Seven studies (n=9,197) were on high-risk women. The pooled sensitivity was 62.2% (95% CI: 54.1%-69.7%, I2=38.8%) and specificity was 96.5% (95% CI: 93.6%-98.1%, I2=95.5%). For women at high-risk, the evidence was rated as moderate due to differential verification.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">Our analysis showed that NT measured through first-trimester ultrasound is specific for Down syndrome but has low sensitivity. Despite this, it is a useful screening test for Down syndrome in low-resource settings where other strategies may not be available or accessible. Furthermore, interpretation of NT results must take into consideration its limited sensitivity as this may lead to missed cases.p>
Human ; Nuchal Translucency Measurement ; Down Syndrome ; Sensitivity And Specificity

BACKGROUND AND OBJECTIVES<p style="text-align: justify;" data-mce-style="text-align: justify;">COVID-19 has quickly spread over the world and became an unprecedented burden on health care systems. COVID-19 diagnosis necessitates the use of precise testing methods such as RT-PCR. This method is generally reported as positive or negative, however, studies have shown its semi-quantitative capability through Ct values. This study determined an association that exists between the Ct values, clinical features, and laboratory findings among COVID-19 patients admitted in a tertiary infectious disease hospital in Manila, Philippines. This attempts to further explore the utility of RT-PCR in disease severity classification and diagnosis.p>METHODS<p style="text-align: justify;" data-mce-style="text-align: justify;">This was an observational retrospective study that utilized a purposive sampling method, wherein patients were selected based on the DOH case definition of confirmed COVID-19, and were stratified according to disease severity. Baseline laboratory data of the patients were gathered from medical records covering the period of June 2021 to January 2022 using a Data Collection Form. Chi-square test was used to measure the degree of association between the groups and categorical variables. Regression Analysis was used to identify predictors for certain variables. SPSS Statistics for Windows, Version 25.0 was utilized for the statistical analysis.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">The total WBC, neutrophil, lymphocyte and monocyte counts, serum urea, LDH, CRP and PTT were found to be predictors of COVID-19 severity. There was no significant difference observed between the disease severity and the patient’s clinical outcome. All routine laboratory tests that were taken at baseline (ORF Gene, N-Gene, Hematocrit, White Blood Cells, Neutrophil, Lymphocyte, Monocyte, Platelet Count, Urea, Creatinine, SGPT, SGOT, Na, K, LDH, Ferritin, C Reactive Protein, Procalcitonin, D-Dimer, PT, PTT) were not significant predictors of the clinical outcome. Although WBC, neutrophil, lymphocyte, and monocyte count, urea, LDH, CRP, and PTT were predictors  of disease severity. The study also reported that the odds of having severe to critical disease increases by 20.6% for every one unit increase in neutrophil count, and 17.4% for every one unit increase in lymphocyte count. Among the laboratory parameters, neutrophil count (p=0.010654063) and urea (p= 0.04149874 have direct relationship with the N gene Ct values while Orf gene Ct Values have direct relationship with lymphocyte count (p=0.01269027). Similarly, regression showed that as monocyte count, creatinine levels, and serum ferritin decrease, Ct values increase. Sex was found to not be a significant predictor of disease severity and clinical outcome. There was also no significant difference observed between the disease severity and the patient’s clinical outcome.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">The study showed that the Ct values for both ORF and N genes were not significant predictors of both disease severity and clinical outcome. However, ORF gene Ct values have direct relationship with lymphocyte counts while N gene Ct values have direct correlation with neutrophil count and urea levels. Similarly, monocyte, creatinine, and ferritin are negatively correlated with Ct values. It is important to monitor the patient’s laboratory biomarkers in order to determine the proper course of treatment and management for each case.p>
Human ; Sars-cov-2 ; Covid-19

BACKGROUND AND OBJECTIVE<p style="text-align: justify;" data-mce-style="text-align: justify;">COVID-19 has been associated with cardiac injury, often detectable through electrocardiographic (ECG) changes. This study seeks to characterize the cardiovascular and electrocardiographic profiles of adult patients diagnosed with COVID-19.p>METHODS<p style="text-align: justify;" data-mce-style="text-align: justify;">This study included adult patients with confirmed COVID-19 from June 2021 to June 2022. Clinical profiles and 12-lead ECG tracings were obtained from electronic medical records and reviewed independently by three cardiologists. Descriptive analysis was performed to summarize the cardiovascular and electrocardiographic findings in this population.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">The study included 998 COVID-19 patients (mean age: 50 years; 53.7% male). The most common comorbidities were hypertension, diabetes, and dyslipidemia. A majority (31.36%) presented with severe COVID-19 infection. The most frequent significant ECG abnormalities observed at admission were sinus tachycardia (22.8%), and atrial fibrillation (11.02%). Additional ischemic findings included ST segment depression (2.91%), T-wave inversion (1.70%), and ST segment elevation (2.71%).p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">The baseline ECG findings among COVID-19 patients were predominantly normal; however, significant abnormalities were also identified. The most frequent abnormalities included sinus tachycardia, atrial fibrillation, and ischemic changes, all of which may have clinical implications.p>
Human ; Coronavirus Disease 19 ; Covid-19 ; Electrocardiography ; Atrial Fibrillation

Objective: Using semiquantitative risk scoring, this study estimated the probability of ASF transmission in 23 selected provinces. Methods: The factors influencing ASF spread were identified; 10 through a literature review and the positivity for ASF virus (ASFv) of meat samples from an ongoing surveillance study.Secondary data from each sampled province were collected, and the provinces were scored across these factors and classified into one of three risk categories. Results: Six out of 23 provinces were categorized as high-risk due to the high number of ASFv-positive meat samples, backyard pigs, and ASF occurrences. Conversely, four provinces were classified as low-risk due to consistently low scores across all indicators. The difference in the meat contamination level between low- and high-risk provinces emphasizes the importance of including this factor in the ASF spread assessment. Conclusions and Relevance: Risk estimation of ASF transmission must consider meat sample contamination. Active surveillance at local borders can monitor contamination and prevent ASFv sources from entering areas. This approach allows the government to allocate resources and prioritize higher-risk areas.

Objective: Using semiquantitative risk scoring, this study estimated the probability of ASF transmission in 23 selected provinces. Methods: The factors influencing ASF spread were identified; 10 through a literature review and the positivity for ASF virus (ASFv) of meat samples from an ongoing surveillance study.Secondary data from each sampled province were collected, and the provinces were scored across these factors and classified into one of three risk categories. Results: Six out of 23 provinces were categorized as high-risk due to the high number of ASFv-positive meat samples, backyard pigs, and ASF occurrences. Conversely, four provinces were classified as low-risk due to consistently low scores across all indicators. The difference in the meat contamination level between low- and high-risk provinces emphasizes the importance of including this factor in the ASF spread assessment. Conclusions and Relevance: Risk estimation of ASF transmission must consider meat sample contamination. Active surveillance at local borders can monitor contamination and prevent ASFv sources from entering areas. This approach allows the government to allocate resources and prioritize higher-risk areas.