The surface electrocardiogram (ECG) can provide many clues to a patient’s underlying medical condition or tendency for arrhythmogenesis. An 80-year-old man with severe aortic stenosis and an implantable cardioverter-defibrillator (ICD) for advanced heart block presented with burping, chest discomfort and intermittent pounding sensations. His ECG showed atrial fibrillation with intermittent ventricular pacing at 60 bpm characterized by irregularly irregular rhythm, absent P waves, narrow intrinsic QRS complexes alternating with wide-paced beats (left bundle branch block [LBBB] morphology, superior axis) and visible pacing spikes. Device interrogation revealed ventricular tachycardia (VT) storm with multiple appropriate ICD shocks explaining his pounding sensations. This report highlights two key teaching points: recognizing atrial fibrillation during ventricular pacing—a frequently missed diagnosis affecting nearly half of patients with pacemakers—and managing VT storm to reduce shock burden. After device reprogramming and antiarrhythmic adjustment, the patient became asymptomatic.

Human ; Male ; Aged: 65-79 Yrs Old ; Thorax ; Teaching ; Tachycardia, Ventricular ; Electrocardiography ; Atrial Fibrillation ; Bundle-branch Block ; Constriction, Pathologic

Abstract Ectopic hepatocellular carcinoma (EHCC) is an extremely rare neoplasm, especially in the mediastinum, which shares morphologic characteristics with intrahepatic hepatocellular carcinoma (HCC). Its clinical features remain unclear, posing significant diagnostic and therapeutic challenges. The prognosis is also unclear due to its rarity and potential variability. This study reports the first case of EHCC in the mediastinum with subsequent brain metastasis. A 50-year-old man presented with shoulder and chest discomfort persisting for 5 months, accompanied by progressive weight loss and fatigue over the preceding 2 years. Imaging showed a mediastinal mass initially suspected to be lymphoma due to its malignant characteristics. However, histopathological examination identified the lesion as HCC, supported by characteristic immunohistochemical markers, despite normal abdominal imaging. Two months later, the tumor progressed despite intensive radiotherapy, and the patient experienced recurrent seizures. Subsequent brain imaging confirmed multiple intracranial metastases. Unfortunately, the patient died 6 months after diagnosis. The ectopic liver is more susceptible to hepatocarcinogenesis than the main liver; this is attributed to its incomplete functional structure. EHCC can be considered as differential diagnosis of mediastinal masses, even when no intrahepatic HCC is found. The rarity of EHCC in the mediastinum poses difficulties in developing treatment protocols. This case emphasizes the diagnostic challenges and aggressive nature of ectopic HCC and the need for comprehensive management strategies. There are currently no definite guidelines regarding the diagnosis, treatment, and prognosis of EHCC.
ectopic hepatocellular carcinoma ; mediastinum ; metastasis

INTRODUCTION

Early, high-quality cardiopulmonary resuscitation (CPR) improves survival in cardiac arrest. In the Philippines, guidelines specify chest compression depth, but challenges like fatigue and limited staff affect outcomes. This has led to interest in devices like the LUCAS, a portable, battery-powered machine that provides consistent compressions. This study evaluates the clinical profile, outcomes and risks of patients treated with LUCAS at a private tertiary hospital in the Philippines.A

METHODS

This retrospective cohort study was conducted at a private tertiary hospital, reviewing records of patients who received LUCAS-assisted compressions (March 2023–September 2024) and manual compressions (March 2023–January 2024) based on inclusion criteria.

RESULTS

Out of the 188 cases, 63 patients received mechanical cardiopulmonary resuscitation (mCPR) and 122 received manual compressions. Demographics were similar between the groups with notable differences in hypertension and coronary artery disease prevalence. The causes of arrest varied: arrhythmias and cardiogenic shock were more common in the mCPR group, while septic shock and COVID-19 were predominant in the manual compression group. The mCPR group showed higher survival rates, improved rhythm recovery and lower asystole rates. However, no significant differences in long-term survival or other vital signs were observed between the groups.

DISCUSSION AND CONCLUSION

The study suggests mCPR may improve immediate outcomes, particularly in cases of arrhythmias and cardiogenic shock, though long-term effects remain unclear. Chest fractures were commonly observed in LUCAS recipients. As the first Philippine study on mechanical CPR, it highlights potential benefits and underscores the need for further research on its risks and broader applications.

Human ; Male ; Female ; Asian ; Heart Arrest ; Cardiopulmonary Resuscitation ; Thorax

INTRODUCTION

Early, high-quality cardiopulmonary resuscitation (CPR) improves survival in cardiac arrest. In the Philippines, guidelines specify chest compression depth, but challenges like fatigue and limited staff affect outcomes. This has led to interest in devices like the LUCAS, a portable, battery-powered machine that provides consistent compressions. This study evaluates the clinical profile, outcomes and risks of patients treated with LUCAS at a private tertiary hospital in the Philippines.A

METHODS

This retrospective cohort study was conducted at a private tertiary hospital, reviewing records of patients who received LUCAS-assisted compressions (March 2023–September 2024) and manual compressions (March 2023–January 2024) based on inclusion criteria.

RESULTS

Out of the 188 cases, 63 patients received mechanical cardiopulmonary resuscitation (mCPR) and 122 received manual compressions. Demographics were similar between the groups with notable differences in hypertension and coronary artery disease prevalence. The causes of arrest varied: arrhythmias and cardiogenic shock were more common in the mCPR group, while septic shock and COVID-19 were predominant in the manual compression group. The mCPR group showed higher survival rates, improved rhythm recovery and lower asystole rates. However, no significant differences in long-term survival or other vital signs were observed between the groups.

DISCUSSION AND CONCLUSION

The study suggests mCPR may improve immediate outcomes, particularly in cases of arrhythmias and cardiogenic shock, though long-term effects remain unclear. Chest fractures were commonly observed in LUCAS recipients. As the first Philippine study on mechanical CPR, it highlights potential benefits and underscores the need for further research on its risks and broader applications.

Human ; Male ; Female ; Asian ; Heart Arrest ; Cardiopulmonary Resuscitation ; Thorax

BACKGROUND AND OBJECTIVE

Access to healthcare remains a challenge in most areas in the Philippines. Fifty-three percent (53%) of the Philippine population do not have access to a rural health unit (RHU) within a 30-minute travel t ime. As a response, the Department of Health (DOH) needs to construct an additional 2400 RHUs by 2025. This paper uses the Philippine Health Facility Development Plan 2020-2040 (PHFDP) as a reference to present a solution for locating sites for RHU placement in under-served areas using neural networks to meet the 30-minute travel time by maximizing population accessibility.

METHODS

RHU accessibility was measured using geographic attributes as inputs to a back propagation neural network (BPNN) and a recurrent neural network (RNN): (1) land coverage and hazard data, representing geographical limitations; (2) population density and distribution, indicating demand for healthcare services; and (3) infrastructure-related features, such as road networks, points of interest, and the locations of existing RHUs, which influence healthcare accessibility. The models were trained to identify underserved areas and were implemented on a nationwide scale, excluding NCR, to locate candidate areas to increase population access to the new RHUs. The models were validated using a healthcare facility accessibility index (HCFAI) to assess RHU coverage improvement.

RESULTS

The BPNN showed stronger generalization across regions, achieving 79.1% average accuracy in distinguishing low from high accessible areas on Region 1 and identifying 1668 out of 3305 locations in the region as candidate sites. The RNN, better capturing unique regional characteristics, required separate training: 77.2% average accuracy on Region 1, identifying 1593 candidate sites. Our findings suggest expanding the use of land improves population access to healthcare facilities. Both models found more than the needed number of RHUs by 2040. The BPNN was more consistent than RNN to improve a region’s overall accessibility by increasing the HCFAI. The BPNN can increase population access to an RHU from 2.5-98.5% from its original population with access to an RHU.

CONCLUSION

The study demonstrates the usage of geographic attributes and neural networks to improve healthcare accessibility. The BPNN and RNN are adequate algorithms to find under-served areas and candidate sites for RHU construction to maximize population accessibility. The HCFAI metric validates the locations to highlight which neural network maximizes more of the region’s populat ion. The study contributes to ongoing efforts to improve healthcare infrastructure and accessibility, offering datadriven recommendations for RHU locations.

Human ; Universal Health Care ; Rural Health ; Delivery Of Health Care ; Health Services Needs And Demand ; Health Facilities ; Algorithms ; Back

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: There is a gap in understanding the effects of different acupoints and treatment methods (acupuncture and moxibustion) on microcirculatory changes in the lumbar region. OBJECTIVE: This study aimed to assess the thermal effects of acupuncture at Weizhong (BL40), with acupuncture at Chize (LU5) and moxibustion at both acupoints as control interventions. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: In this randomized controlled trial, 140 healthy participants were equally divided into four groups: acupuncture at BL40 (Acu-BL40), acupuncture at LU5 (Acu-LU5), moxibustion at BL40 (Mox-BL40) and moxibustion at LU5 (Mox-LU5). Participants underwent a 30-minute session of their assigned treatment. Infrared thermal imaging was used to collect temperature data on the areas of interest for analysis. MAIN OUTCOME MEASURES: The primary measure was the change in average temperature of the observed area after the intervention. The secondary measures included periodic temperature changes every 5 min and the temperature changes of the Governor Vessel and Bladder Meridian in the observed area after the intervention. RESULTS: Significant interactions were observed between treatments and acupoints affecting temperature (P < 0.001). The Acu-BL40 group showed a notably higher increase in mean temperature after 30 min compared to the Acu-LU5 and Mox-BL40 groups, with increases of 0.29 (95% confidence interval [CI] = 0.17 to 0.41) and 0.24 (95% CI = 0.08 to 0.41) °C, respectively. CONCLUSION: Acupuncture at BL40 acupoint can significantly increase the mean temperature in the observed area, highlighting the specific thermal effect of acupuncture compared to moxibustion in the lumbar area. This suggests a potential therapeutic benefit of acupuncture at BL40 for managing lumbar conditions. TRIAL REGISTRATION ClinicalTrials.gov (NCT05665426). Please cite this article as: Zheng SY, Wang XY, Lin LN, Liu S, Huang XX, Liu YY, Yu XS, Pan W, Fang JQ, Liang Y. Lumbar temperature change after acupuncture or moxibustion at Weizhong (BL40) or Chize (LU5) in healthy adults: A randomized controlled trial. J Integr Med. 2025; 23(2): 145-151.
Adult ; Female ; Humans ; Male ; Young Adult ; Acupuncture Points ; Acupuncture Therapy ; Body Temperature ; Healthy Volunteers ; Lumbosacral Region/physiology* ; Moxibustion ; Adolescent

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.

METHODS

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.

EXPECTED RESULTS

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.

Human ; Low Back Pain

BACKGROUND AND OBJECTIVE

The Oswestry Disability Index (ODI)–English is a valid and reliable instrument for disability measurement in low back pain (LBP) patients. There is no existing ODI–Ilokano that evaluates LBP patients. This study aimed to cross-culturally adapt the ODI–English into Ilokano.

METHODS

The ODI–English was cross-culturally adapted into Ilokano through a process that included forward translation, synthesis of the translations, back translation, expert committee review, and testing of the pre-final version.

RESULTS

Forward translation focused on capturing the essence of terms related to pain intensity, personal care, and daily activities, achieving consensus on phrases that accurately mirrored the original English meanings. Subsequent synthesis refined these translations, emphasizing idiomatic and conceptual equivalence over literal interpretations, particularly in nuanced areas like sleep disturbance and social life activities. Backward translation processes aligned Ilokano and English terms, especially for pain intensity and personal care, ensuring consistency across languages. The expert committee review addressed spelling, word choice, and sentence structure, making strategic adjustments for cultural relevance. Pilot testing with participants from Ilocos Norte and Ilocos Sur, Philippines highlighted comprehension challenges with specific terms, leading to adaptations like replacing 'milya' and 'yarda' with metric units and retaining culturally sensitive terms with supplementary English explanations.

CONCLUSION

This study refined the ODI–English into a culturally adapted Ilokano version, focusing on semantic, idiomatic, and cultural equivalence. Incorporating pilot testing feedback, such as modifying measurement units and addressing sensitive terms, highlighted the thorough adaptation process. The collaborative translation efforts and diverse patient input ensured a culturally resonant ODI version for Ilokano speakers. This adaptation enhances physical therapy practices by improving patient assessments and advocates for adapting patient-reported outcomes to diverse cultures, advancing patient-centered care.

Human ; Low Back Pain ; Cross-cultural Comparison ; Translations ; Surveys And Questionnaires

OBJECTIVE: To observe the clinical efficacy of acupuncture combined with thunder-fire moxibustion in treating low back pain with cold-damp. METHODS: Seventy-two patients of low back pain with cold-damp were randomly divided into an observation group (36 cases, 1 case was eliminated) and a control group (36 cases, 1 case dropped out). The control group received acupuncture at Jizhong (GV6), Yaoyangguan (GV3), ashi points, bilateral Shenshu (BL23), Dachangshu (BL25), and Weizhong (BL40) for 30 min daily. The observation group was treated with thunder-fire moxibustion in addition to the same acupuncture regimen as the control group, once daily. Both groups were treated for 6 consecutive days followed by one rest day, for a total duration of 4 weeks. The visual analog scale (VAS) score, Oswestry disability index (ODI) score, Japanese Orthopedic Association (JOA) score, present pain intensity (PPI) score, and serum levels of β-endorphin (β-EP), 5-hydroxytryp tamin (5-HT), and substance P (SP) were compared before and after treatment, and the clinical efficacy was also compared between the two groups. RESULTS: Compared before treatment, the VAS scores, ODI scores, PPI scores, and serum levels of 5-HT and SP were decreased (P<0.01), while JOA scores and serum levels of β-EP were increased (P<0.01) in both groups after treatment. The observation group showed lower VAS, ODI, and PPI scores and serum levels of 5-HT and SP than those in the control group (P<0.05), as well as higher JOA score and serum level of β-EP (P<0.05). The total effective rate in the observation group was 94.3% (33/35), higher than 82.9% (29/35) in the control group (P<0.05). CONCLUSION Acupuncture combined with thunder-fire moxibustion could effectively alleviate pain and improve lumbar function in patients of low back pain with cold-damp, possibly by regulating β-EP, 5-HT, and SP levels.
Humans ; Moxibustion ; Low Back Pain/blood* ; Male ; Female ; Adult ; Middle Aged ; Acupuncture Therapy ; Acupuncture Points ; Treatment Outcome ; Combined Modality Therapy ; beta-Endorphin/blood* ; Young Adult ; Aged