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.

WAGR syndrome is a rare congenital disorder, occurring in approximately 1 in 500,000 to 1,000,000 individuals, often presenting with ocular malformations such as aniridia. Glaucoma frequently develops when the iris and angle structures are affected, posing a significant risk of vision loss. We report a one-year and seven-month-old patient who presented with corneal opacity of the left eye. Examination revealed corneal opacity, aniridia, and markedly elevated intraocular pressure of 65 mmHg, while the fellow eye, also with aniridia, was normotensive. The patient underwent immediate combined trabeculectomy-trabeculotomy. Postoperative follow-up and timely management of complications allowed acceptable pressure control over one year, though visual prognosis remained guarded. This case highlights the challenges of managing glaucoma in WAGR syndrome, particularly in resource-limited settings. Medical therapy alone is often insufficient, making surgical intervention essential. Combined trabeculectomytrabeculotomy proved effective in maintaining pressure control when glaucoma drainage devices were not feasible. Multiple interventions and close monitoring are frequently required due to the risk of scarring and postoperative complications. Our experience emphasizes the need for a multidisciplinary ophthalmology approach to optimize outcomes. Despite pressure control, visual outcomes often remain poor due to structural anomalies and the challenges inherent to pediatric patients with this rare syndrome.

Intestinal Tuberculosis (ITB) presents a significant diagnostic challenge due to its nonspecific clinical presentation and the lack of comprehensive local data to guide diagnostic strategies. This study aims to fill the gap by conducting a twelve-year retrospective cross-sectional analysis at a tertiary hospital in Cebu, Philippines. Electronic records of 209 patients aged 18 years old and above were first reviewed, focusing on clinical features, laboratory results, endoscopic findings, and CT scan of the abdomen. Initial screening identified 54 patients meeting the predefined criteria for gastrointestinal tuberculosis (GITB). In addition, statistical analyses, including logistic regression models, were employed to identify significant predictors of ITB which can further enhance the ITB diagnosis and management in the region.

Clinical manifestations observed include: symptoms and signs resembling those observed in malignancies and inflammatory bowel diseases, such as abdominal pain (92.6%), ascites (57.4%), fever (51.9%), hematochezia (25.9%), abdominal mass (24.1%) and intestinal obstruction (5.6%). The findings from CT scans of the abdomen were consistent with other studies, including the presence of matted mesenteric lymph nodes (79.6%), concentric mural thickening (57.4%), ileocecal involvement (44.4%). However, dilated bowel loops (20.4%), intestinal perforation (5.4%) and strictures (3.7%) were observed in only a few cases. Ileocecal involvement was found to be a dependable predictor among all the variables when logistic regression analysis was employed, emphasizing its diagnostic utility.

Our findings highlight the importance of local epidemiological insights in improving diagnostic strategies and patient outcomes. Consolidating the clinical profiles and diagnostic markers contributes to evidence-based strategies tailored to the Philippine context. This localized approach can further help medical professionals in making more informed decisions. Future studies could validate these findings to develop region-specific predictive tools, for a more time sensitive management of ITB.

BACKGROUND

Infections of the central nervous system may develop in patients with traumatic brain injury after the implant of external ventricular drainage catheters or after neurological surgeries.

We report the case of a woman in her 50s who was admitted with a subarachnoid hemorrhage secondary to a ruptured aneurysm, for which she underwent a tube ventriculostomy with an external ventricular drain attached and developed neurosurgical meningitis. The cerebrospinal fluid culture showed the presence of multidrug-resistant Acinetobacter baumannii. Intrathecal delivery of 65,000 units of colistin methyl sodium twice daily with a clamp drain for 15 to 60 min after administration was used as treatment. After 72 hours of treatment, the patient's infection improved, and repeat cerebrospinal fluid culture showed no microbial growth.

Intrathecal colistin can be used as a treatment for multidrug-resistant A. baumannii meningitis.

Ocular cicatricial pemphigoid (OCP) is a chronic bilateral, blinding, cicatrizing form of conjunctivitis with relapsing and remitting periods. It has strong evidence for an immune type II hypersensitivity that leads to subconjunctival fibrosis and extensive systemic bullae formation. To the best knowledge of the authors, this is the first reported case of direct immunofluorescence (DIF) assay-proven OCP in an elderly Filipino man.

A 68-year-old male presented with bilateral corneal conjunctivalization, symblepharon, ectropion, conjunctival hyperemia testing positive with conjunctival biopsy for basement membrane antibodies with DIF for the left eye, while turning out negative for the right eye. He was managed as a case of OCP, both eyes, and was given topical steroids and antibiotics. Oral Dapsone was started by Dermatology and Rheumatology Services.

OCP is a rare autoimmune and blinding disease. Early diagnosis and prompt treatment are vital as ocular complications permanently affect the quality of life of patients as seen in our patient. DIF assay remains the gold-standard for diagnosis. Systemic immunosuppression is the mainstay of treatment. Adjunctive supportive topical medication may be given to alleviate ocular discomfort. A multidisciplinary approach is essential to provide holistic care to each patient.

In this article, we present a comprehensive overview of the regulatory landscape governing Chinese medicinal practices in Australia, in which we describe the regulations for Chinese medicine practitioners in Australia, as of 2024, focusing in particular on the Title Protection model under the Health Practitioner Regulation National Law. Central to this discussion are the core roles of the Chinese Medicine Board of Australia (the Board) and the Australian Health Practitioner Regulation Agency (Ahpra) in ensuring public safety by guaranteeing that practitioners are appropriately qualified and suitable for registration. We also examine the structure and demographics of the Chinese medicine workforce in Australia and present details of the required registration process for practitioners. In addition, the article outlines specific requirements for registration, including the standards set by the Board for initial and ongoing registration, which are administered with the support of Ahpra under the National Registration and Accreditation Scheme. Furthermore, we present details regarding the approved qualifications, the rigorous assessment process for overseas qualifications, and the important role of regulatory examinations designed to uphold the high standards expected of practitioners, thereby ensuring they have acquired the professional competencies required by the Australian healthcare system. This overview offers valuable insights for both current and prospective practitioners of Chinese medicine in Australia.