OBJECTIVE: To analyze the clinical characteristics, treatment, and prognosis of seven pediatric patients with Acute myeloid leukemia (AML) positive for the t(16;21)(p11;q22) FUS::ERG fusion gene. METHODS: A retrospective analysis was carried out on the clinical data, treatment, and prognosis of seven AML patients with t(16;21)(p11;q22) FUS::ERG fusion gene admitted to Henan Children's Hospital between June 2015 and November 2024. Relevant literature was also reviewed. This study was approved by the Medical Ethics Committee of the Hospital (Ethics No.: 2024-102-001). RESULTS: Among 297 pediatric patients with AML, 7 cases (2.36%) were positive for the t(16;21)(p11;q22) FUS::ERG fusion gene, including 3 males and 4 females, with a median age of 11 years (range: 3 ~ 12 years). According to the FAB classification, these included 1 case of M2, 3 cases of M5, and 3 cases of AML-not otherwise specified (non-M3). All 7 patients were found to harbor the t(16;21)(p11;q22) translocation, with 3 cases showing additional chromosomal abnormalities. Immunophenotyping revealed universal expression of CD13, CD33, CD34, and CD117, with partial expression of CD56, CD4, CD64, CD123, CD15, CD38, CD11b, HLA-DR, cMPO, and CD16. One patient achieved complete remission (CR) after the first course of DAE (cytarabine + daunorubicin + etoposide) induction chemotherapy but relapsed and discontinued the treatment. Six patients received DAH (cytarabine + daunorubicin + homoharringtonine) induction therapy, of whom 2 achieved CR after two courses and underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), resulting in an overall CR rate of 42.86%. Five children did not receive allo-HSCT and had a median overall survival of 9 months (range: 6 ~ 18 months). Two children who underwent transplantation achieved bone marrow morphological and molecular biological relapse at 6 and 9 months post-transplantation, respectively. After receiving combined chemotherapy and donor lymphocyte infusion, one child failed to achieve remission and died at 22 months post-transplantation, while the other has been followed up to date with positive fusion gene status. Their overall survival was 25 months and 30 months, respectively. CONCLUSION The t(16;21)(p11;q22) FUS::ERG fusion gene is rare in pediatric AML and associated with poor prognosis. Allo-HSCT may mitigate the adverse prognostic impact of the FUS::ERG fusion gene and contribute to prolonged survival.
Humans ; Male ; Child ; Female ; Leukemia, Myeloid, Acute/drug therapy* ; Oncogene Proteins, Fusion/genetics* ; Translocation, Genetic ; Retrospective Studies ; RNA-Binding Protein FUS/genetics* ; Chromosomes, Human, Pair 16/genetics* ; Adolescent ; Child, Preschool ; Chromosomes, Human, Pair 21/genetics* ; Prognosis ; Treatment Outcome

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

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 AND OBJECTIVE

The Philippine Package of Essential Noncommunicable Disease Interventions (PhilPEN) was introduced by the Department of Health through AO 2012-0029. This is anchored to WHO PEN, a prioritized set of cost-effective interventions that can be carried out to provide an acceptable standard of care at the primary health care level, even in low-resource settings. The study aims to evaluate the availability and adequacy of primary health care facilities in providing the PhilPEN package of interventions using the WHO assessment tool.

METHODS

A cross-sectional survey was conducted in 25 randomly selected primary health care facilities in Metro Manila. Data were collected through structured interviews with facility staff and direct observation using a standardized questionnaire aligned with PhilPEN and WHO PEN guidelines. The tool assessed PhilPEN inputs (infrastructure, human resources, basic tools and equipment, essential medicines, record-keeping, financing) and services (risk assessment and screening, early diagnosis and monitoring, treatment and follow-up, counseling, referral of patients).

RESULTS

All facilities met the basic standards for infrastructure, human resources, record keeping, and financing. However, only 40% had all essential medicines, and just 16% had complete tools, including urine ketone/protein test strips. Risk assessment and patient counseling were consistently implemented, but early diagnosis and follow-up services were inconsistent due to training and supply gaps.

CONCLUSION

Primary health care centers in Metro Manila demonstrate partial readiness for PhilPEN implementation. Gaps in tools, medicines, and protocol availability should be addressed to optimize NCD service delivery.

Human ; Primary Health Care ; Noncommunicable Diseases ; Delivery Of Health Care ; Standard Of Care ; Cardiovascular Diseases

BACKGROUND

Graduating student nurses are crucial to healthcare delivery, yet concerns about their clinical performance persist. They often face challenges translating theoretical knowledge into practice, leading to a theory-practice gap. Clinical competence is essential for ensuring safe and effective nursing care.

OBJECTIVES

This study assessed the clinical competence of graduating student nurses in HEIs within Baguio City. It specifically evaluated their proficiency in professional behavior, general performance, core nursing competency, and advanced nursing skills. Additionally, it examined whether significant differences in clinical competence existed based on sex, area of duty, and accreditation status.

METHODS

A descriptive-quantitative non-experimental research design was employed. The study surveyed 285 graduating student nurses from six HEIs in Baguio City, selected through fishbowl sampling. Data was collected using the Clinical Competence Questionnaire (CCQ), a 47-item questionnaire with an I-CVI rating of 1.0 and a Cronbach’s Alpha of 0.94. Data analysis included descriptive statistics, Welch's T-test, One-way ANOVA, and Welch's ANOVA.

RESULTS

Students demonstrated high competence with the following means: 4.42 in nursing professional behaviors, 4.32 in general performance, 4.35 in core nursing skills, and 3.92 in advanced nursing skills. While the results were interpreted as high competence, specific advanced nursing skills require further enhancement. No significant differences (p-value < 0.05) in clinical competence were found concerning sex (0.38), duty area (0.92), or accreditation status (0.07).

CONCLUSION

Graduating student nurses show high competency upon entering level IV, emphasizing ongoing skill development for quality patient care. Both genders exhibit proficiency, indicating fair training and effective education regardless of duty area exposure and accreditation status.

Human ; Clinical Competence

Introduction: Primary aldosteronism (PA) is a common yet underdiagnosed cause of secondary hypertension, associated with increased cardiovascular and renal morbidity. Early detection and subtype-directed management significantly improve outcomes. However, adherence to recommended diagnostic pathways in real-world practice remains variable. Case: We conducted a retrospective audit of patients diagnosed with PA in a Malaysian tertiary centre from January 2018 to December 2025. Data collected included demographics, clinical presentation, biochemical parameters, diagnostic workup (aldosterone-renin ratio [ARR], confirmatory testing, adrenal imaging, and adrenal venous sampling [AVS]), treatment modality, and outcomes. Audit standards were based on established international guidelines. A total of 14 patients were included, with equal gender distribution. The cohort comprised 57% Malay and 43% Chinese. Most patients presented with hypertension (mean ~170/100 mmHg), and hypokalemia was present in approximately 70% of the patients. ARR and adrenal imaging were performed in all patients (100%), while confirmatory testing was conducted in 85% of the patients. However, AVS utilization remained limited (50%). Contributing factors included failed cannulation, technical challenges in overweight patients, preference for medical therapy, refusal of surgery, and limited access to AVS services. The majority had unilateral adrenal adenoma (~75%). Treatment was divided between surgical (55%) and medical (45%) approaches. Post-treatment, hypokalemia resolved in 90% of patients, with a significant reduction in antihypertensive burden and complete hypertension resolution in approximately 35% of the patients. Quality of life improved in most patients. Conclusion This audit demonstrates good adherence to initial screening and imaging in PA but highlights suboptimal utilization of AVS. Barriers to AVS utilization are multifactorial, encompassing technical, patient-related, and system level limitations. Addressing these barriers is essential to optimize subtype-directed management and improve longterm cardiovascular outcomes in patients with PA. Despite this, clinical outcomes were favorable. Strengthening adherence to diagnostic pathways, particularly subtype confirmation, may further improve patient outcomes.
Hyperaldosteronism ; Treatment Outcome ; Retrospective Studies

Introduction: Diabetes mellitus (DM) is a significant comorbidity associated with adverse tuberculosis (TB) treatment outcomes and remains an ongoing clinical challenge. Chronic hyperglycemia impairs host immune responses, particularly macrophage function, leading to delayed bacillary clearance. This contributes to poorer outcomes, including delayed sputum conversion, prolonged treatment duration, relapse, and increased mortality. Poor glycemic control is a key modifiable factor influencing these outcomes. This study aimed to evaluate the impact of glycemic control at diagnosis on TB treatment outcomes in a Malaysian cohort. Methodology: A retrospective cross-sectional audit was conducted using the TB clinic registry at Hospital Sungai Buloh from 2022 to 2025. Adult patients (≥18 years) with confirmed TB (any form) and DM (Type 1 or Type 2) with complete records were included. Of 241 patients screened, 131 were included after exclusions due to incomplete records (29.9%), transfer (29.9%), loss to follow-up (19.9%), and drug-resistant TB (2.9%). Data collected included demographics, hemoglobin A1c (HbA1c) at diagnosis, sputum conversion duration, treatment duration, type of DM therapy, and clinical outcomes. Results: The cohort had a mean age of 53 years, with 97% having Type 2 DM. Mean HbA1c at diagnosis was 10.5%. Poorer glycemic control was associated with delayed sputum conversion. Patients who achieved sputum conversion by 8 weeks had an average HbA1c of 9.6%, compared to 11.8% in those with delayed conversion. Longer treatment duration was associated with higher HbA1c (mean 10.5, 8.6, and 11.8% for 6-, 12-, and 18-month regimens, respectively). Relapse analysis demonstrated a trend towards higher HbA1c with increasing relapse episodes (11.2, 13.75, and 14.5% for one, two, and three relapses, respectively). Overall mortality was 17% (22/131), with markedly higher mean HbA1c in deceased patients compared to survivors (16.0% vs 10.5%). Conclusion Poor glycemic control at TB diagnosis is associated with delayed sputum conversion, prolonged treatment duration, and increased mortality. These findings are consistent with regional evidence, including a South Asian systematic review (Gautam et al., 2021), demonstrating higher mortality and treatment failure in patients with TB and DM. Early and aggressive optimization of glycemic control, alongside standard anti-TB therapy, is essential to improve outcomes.
Humans ; Glycemic Control ; Retrospective Studies ; Diabetes Mellitus ; Treatment Outcome ; Tuberculosis

BACKGROUND AND OBJECTIVE

Proper documentation of patient safety events is important to be able to provide changes that can prevent events from occurring again. The Philippine General Hospital launched an online platform for reporting patient safety events in 2017. This paper aimed to describe the patient safety events, initial response to the event, and preventive actions done in the institution.

METHODS

This is a retrospective descriptive study of patient safety event records from August 2017 to April 2022. General data of the patients, details surrounding the events, response to the event, and preventive measures done after the event were documented. Descriptive analysis was performed.

RESULTS

There was a total of 625 events reported with 525 total unique reports. There was an increased rate of patient safety event reports from 2021 to 2022. The average rate was 23.8 and 25.7 reports per month, respectively. Most reports were for in-patient cases and were type 3 preventable adverse events. The general initial response of healthcare personnel to the adverse events is to provide the appropriate clinical care. Preventive measures include re-orientation and event specific actions.

CONCLUSION

Documentation is crucial for patient safety events to provide solutions and prevent reoccurrence of these events that can cause harm to patients.

Human ; Healthcare Quality ; Quality Of Health Care ; Medical Errors ; Patient Safety ; Patient Harm

OBJECTIVE: To evaluate the mid-term efficacy of talonavicular joint fusion alone combined with navicular stress adjustment in Müller-Weiss disease with significant paradoxical flatfoot deformity. METHODS: Between January 2016 and March 2021, a total of 13 patients diagnosed with Müller-Weiss disease underwent simple talonavicular joint fusion combined with navicular stress adjustmentadjustment.Among them, 5 patients were male and 8 patients were female;age ranged from 42 to 67 years old. The duration of the disease ranged from 8 to 20 years. According to Maceira staging system, 5 patients were in stage III and 8 patients were in stage IV. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, visual analogue scale (VAS), and foot length were evaluated preoperatively and 10 months postoperatively. Additionally, the talonavicular coverage angle, the talus-first metatarsal angle, and the calcaneal inclination angle were assessed preoperatively and 6 months postoperatively. RESULTS: All 13 patients were followed up a period ranging from 24 to 40 months. All patients achieved clinical healing within a period of 3 to 6 months. However, one patient experienced a screw fracture. The VAS decreased from a range of 3 to 7 points preoperatively to a range of 0 to 2 points at the 10 months postoperative. The AOFAS midfoot score improved from a preoperative range of 12 to 66 points to a range of 72 to 100 points at the 10 months postoperative. Based on the AOFAS midfoot score evaluated at 10 months postoperatively, the outcomes were rated as excellent in 3 feet, good in 6 feet, and fair in 4 feet. The talo-navicular coverage angle, the preoperative talus-first metatarsal angle, calcaneal inclination angle were 14.3° to 33.4°, -4.6° to -19.6°, and 3.0°to 16.4° respectively. Six months postoperatively, these angles improved to 2.7°to 9.6°, -8.4°to 1.1°, and 18.8°to 24.9°respectively. Additionally, the foot length increased by 0 to 6 mm at 10 months post-surgery. CONCLUSION Simple talonavicular arthrodesis combined with scaphoid stress adjustment has satisfactory clinical efficacy in Müller-Weiss disease in terms of deformity, foot length, foot function and pain.
Humans ; Male ; Female ; Adult ; Middle Aged ; Arthrodesis/methods* ; Aged ; Flatfoot/physiopathology* ; Tarsal Bones/physiopathology* ; Tarsal Joints/surgery* ; Treatment Outcome

OBJECTIVE: To compare the clinical efficacy of oblique lateral interbody fusion(OLIF) combined with lateral fixation and transforaminal lumbar interbody fusion(TLIF) in patients with lumbar spinal stenosis. METHODS: Totally 47 patients with lumbar stenosis from November 2018 to December 2021 were analyzed retrospectively and were divided into two groups according to the surgical methods. Among them, 21 cases underwent oblique lumbar interbody fusion supplemental anterolateral screw and rod instrumentation, including 5 males and 16 females, with a mean age of (68.19±6.13) years old ranging 55 to 74 years; the other 26 cases underwent posterior pedicle screw fixation and reduction were recorded, including 8 males and 18 females with a mean age of (65.35±7.64) years old ranging 54 to 78 years. Visual analogue scale(VAS) of pain was recorded to evaluate the degree of low back pain and lower extremity pain. The radiographic parameters were collected to evaluate the efficacy of two approaches including disc height, foraminal height, canal sagittal diameter and cross-sectional area. RESULTS: All operations were completed successfully. The wound healed normally and bone fusion was obtained in the last final follow up. No serious complication was occurred in both groups. One case of dural tear occurred in direct compression group. Four cases of left thigh weakness and pain were recorded in indirect decompression group. The average postoperative follow-up was(21.69±4.37)months in direct compression group, while(20.43±4.80)months in another group. There were no significant difference in bone density, body mass index(BMI), hospital stay, Cobb angel(P>0.05). The differences in intra-operative blood loss, operation time, disc height, foraminal height between two groups were statistically significant(P<0.05). The area and sagittal diameter of the spinal canal in the two groups were significantly improved after surgery(P<0.05). CONCLUSION Both two fusion methods have achieved good clinical results in the treatment of lumbar spinal stenosis, with the advantages of good stability, fast recovery and high fusion rate. Compared with TLIF, the advantage of OLIF has greater advantages in less bleeding and less trauma.
Humans ; Male ; Female ; Spinal Stenosis/surgery* ; Spinal Fusion/methods* ; Aged ; Middle Aged ; Lumbar Vertebrae/surgery* ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To compare clinical efficacy of intermetatarsal incision and lateral soft tissue release of medial incision combined with Scarf osteotomy in treating moderate to severe hallux valgus (HV). METHODS: A retrospective analysis was conducted on clinical data of 42 patients with moderate to severe HV admitted from January 2022 to December 2022. According to different incisions, the patients were divided into medial incision group with 22 patients (22 feet) and intermetatarsal incision group with 20 patients (20 feet). In medial incision group, there were 3 males and 19 females, aged from 40 to 69 years old with an average of (55.0±11.4) years old;body mass index (BMI) ranged from 21 to 29 kg·m-2 with an average of (25.2±2.1) kg·m-2;the courses of disease ranged from 8 to 16 years with average of (12.0±2.2) years;11 patients with moderate deformity and 11 patients with severe deformity. In transplantar incision group, there were 3 males and 17 females, aged from 39 to 68 years old with an average of (53.0±7.5) years old;BMI ranged from 20 to 28 kg·m^-2 with an average of (24.8±1.9) kg·m^-2;the courses of disease ranged from 9 to 17 years with an average of (14.0±3.1) years;9 patients with moderate deformity and 11 patients with severe deformity. Hallux valgus angle (HVA) and the first-second intermetatarsal angle (IMA), American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores and complications between two groups before operation and 12 months after operation were observed and compared. RESULTS: All patients were successfully completed the surgery and were followed up for 12 to 15 months with an average of (13.52±1.65) months. There were no statistically significant difference in HVA and IMA between two groups before operation and 12 months after operation (P>0.05). AOFAS forefoot scores of medial incision group before operation and 12 months after operation were (45.0±6.8) and (86.0±6.7) respectively, and those of transmetatarsal incision group were (46.0±7.4) and (83.0±7.5) respectively. Postoperative AOFAS forefoot scores between two groups at 12 months were statistically significant compared with those of before operation (P<0.01). According to AOFAS forefoot scores, 8 patients got excellent result, 14 good in medial incision group;while 6 excellent and 14 good in transplantar incision group. At 12 months, postoperative AOFAS forefoot score of functional score of in medial incision group(38.0±2.5), was better than that in transplantar incision group (34.0±2.2), and the difference was statistically significant (P<0.05). One patient in medial incision group occurred HV deformity, mild numbness occurred in 3 toes in transplantar incision group, and 3 patients were dissatisfied with scar. No complications such as infection, nonunion of bones or ischemic necrosis of metatarsal heads occurred in either group. CONCLUSION Both intermetatarsal incision and lateral soft tissue release of medial incision combined with Scarf osteotomy can effectively treat moderate to severe HV. The functional recovery after medial incision is better than that after intermetatarsal incision.
Humans ; Male ; Female ; Hallux Valgus/physiopathology* ; Middle Aged ; Osteotomy/methods* ; Adult ; Aged ; Retrospective Studies ; Treatment Outcome ; Metatarsal Bones/surgery*