OBJECTIVE

Dengue remains a critical public health concern in the Philippines. Late consultation and delayed presentation of dengue patients to hospitals constantly challenge doctors. This study aimed to identify factors contributing to late consultation of dengue patients.

This analytic, cross-sectional study examined patient, parental, socioeconomic, cultural, and health system factors influencing delayed consultation among parents of patients 0 – 18 years at Batangas Medical Center and Lipa Medix Medical Center. A total of 668 parents were enrolled. Descriptive statistics and frequency tables summarized the key characteristics. Test of proportions assessed differences between groups. Univariate logistic regression screened possible predictors, followed by multiple logistic regression to identify significant factors.

Univariate analysis identified significant predictors of late consultation, including older patient age(p=0.002), residence >50 km from the hospital (p 50 km from the hospital were 2.7 times more likely to consult late (p=0.01).

Delayed consultation was influenced by the patient age, hospital type, geographic distance from the hospital, maternal marital status, and cultural beliefs in home remedies and faith healing. Strategies to improve early consultation should consider these factors.

OBJECTIVE

To determine whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) within the first three days of dengue illness are independent predictors of dengue severity among pediatric patients.

A cross-sectional analytical retrospective study was conducted among pediatric dengue patients admitted to The Medical City, Pasig from September 2021 to August 2024. Data collection was done through electronic chart review. Baseline characteristics were analyzed using the Kruskal-Wallis test, Chi-Square test, and Fisher’s exact test. Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analyses, along with diagnostic performance metrics, were used to evaluate daily ratio cut-offs differentiating dengue classifications. Multivariable logistic regression was performed to assess NLR and PLR as independent predictors of warning signs or severe dengue development.

Among the 316 subjects included in the analysis, 40.5% had dengue fever without warning signs, 57.3% had dengue fever with warning signs, and 2.2% had severe dengue. Differentiating patients without warning signs from those with warning signs, the NLR cut-offs were 4.73, 2.07, and 2.5 on days 1-3, respectively, whereas from those with severe dengue, the cut-offs were 1.27, 0.68, and 0.47 on the same days. For this pairwise analysis, PLR cut-offs were 170, 233.92, and 208.79 for the first comparison; and 209.24, 244.12, and 187.5 for the second, respectively. Statistical analysis showed poor discrimination and diagnostic performance for all cut-offs. Likewise, multivariable linear regression revealed no significant correlation between either ratio and dengue severity.

NLR and PLR within the first three days of dengue illness revealed poor performance in predicting the development of warning signs or progression to severe dengue among pediatric patients.

Cough is a very common symptom causing medical consult. Several remedies are readily available in the market however these are currently not recommended among the pediatric population due to a few reasons which include the benign nature of acute cough, limited effectivity and lack of support from the United States Food and Drug Administration (USFDA) due to abuse potential.

We report a case of a 2-year-old male, no known co-morbidities with a 2 week history of upper respiratory tract infection. Initial assessment showed viral infection hence patient was given medications for symptomatic treatment. However, l week after, patient still presented with symptomatic persistent coughing that disrupted his activities of daily living, hence antitussive medication was already prescribed. After another 7 days, there was still persistence of symptoms, hence patient was given a trial medication of Pregabalin 0.7 milligram/kg/dose which noted instant cough relief one hour after the initial intake. Patient also reported to be more playful, improved sleep at night and improved appetite. Patient received total of 2 doses of Pregabalin in the span of 48 hours. On the third day, patient was still coughing but reported to be significantly less frequent and more productive, hence medication was then put on hold. Patient continuously improved after 5 more days and was eventually cough free.

This case report demonstrates the adequacy of Pregabalin as a supportive antitussive medication in a patient with an acute cough secondary to a viral infection.

Rabies remains a persistent public health issue in the Philippines, despite the existence of national and local policies and programs aimed at addressing its eradication. The viral disease, which elicits fatality yet is preventable, disproportionately affects rural areas, especially geographically isolated and disadvantaged area due to the junction of socio-cultural and technical challenges. This commentary article explores the myriad of barriers to rabies prevention and control, including poverty, cultural beliefs, limited health literacy, health delivery, and access inequity. However, the implementation of Rabies Act of 2007, which mandates mass vaccination, education, and the establishment of Animal Bite Treatment Centers (ABTCs), has gaps in the implementation that compromises the program’s sustainability and effectiveness. Deep-rooted cultural practices and beliefs delay or, more so replace evidence-informed medical practices, while geographic isolation and underfunded healthcare facilities hinder optimal provision of care. Moreover, interagency coordination and fragmented reporting surveillance systems further complicate effective rabies control. To address the gaps, this paper advocates for a culturally tailored and community-centered One Health approach that addresses both social and technical aspects of rabies prevention. Important recommendations include decentralizing ABTCs, sustaining vaccination programs with local government support and funding, integrating rabies education into schools and community outreach, and intensifying through multisectoral collaboration both government and nongovernment institutions. Achieving a rabies-free country requires not only biomedical interventions but also a holistic approach – equitable access to healthcare, trust building in communities, and long-term political commitment. In this manner, regardless of location and socioeconomic status, it ensures that this viral disease will be controlled and prevented.

BACKGROUND

Mpox, a zoonotic disease identified in central Africa in 1958, is mainly endemic to the Congo basin and West Africa. Collecting demographic and clinical data is crucial for early recognition and differentiation of skin lesions as the Philippines addresses this public health challenge.

We describe the demographics, clinical profile, and outcomes of suspected and confirmed mpox cases in the Philippines from July to November 2022.

This case series reviewed suspected and confirmed mpox cases at the Research Institute for Tropical Medicine from July to November 2022. Clinical data, demographics, and outcomes were collected through retrospective chart reviews and summarized using descriptive statistics.

Fifteen cases were reviewed, including 2 confirmed mpox cases, with an average age of 37.8 years and 80% male. The other symptoms associated with rash at presentation included fever (20%) followed by lymphadenopathy, malaise and chills reported in 1 case each. All patients had pustules and erythematous papules, with 67% showing vesicles. Lesions mainly appeared on the extremities (93%), trunk (60%), and head/neck (47%), evolving into crusts within 1–2 days. Non-confirmed cases were often misdiagnosed as varicella (60%), arthropod bites (20%), or folliculitis (7%).

Young to middle-aged males with travel histories were common in suspected and confirmed mpox cases. Lesions typically included papules and pustules on the extremities, evolving into crusts and erosions within 1–2 days. Confirmed cases had umbilicated papules and fever, while PCR-negative cases were diagnosed with local skin conditions. Testing is vital for timely detection and management, especially since mpox resembles other conditions.

Dengue hemorrhagic fever is a severe form of dengue presenting commonly with bleeding diathesis, but rarely with peripheral nervous system manifestations. Proximal median neuropathy comprises 1% of upper limb compression syndromes, and this case is the first to report injury to the proximal median nerve due to compression from hematoma formation. This case report presents the rehabilitation process of a 25-year-old Filipino female median nerve entrapment from venipuncture-associated hematoma presenting as burning sensation on the medial elbow, forearm and hand, weak flexion movement of her left thumb, index, and middle fingers. The patient was managed conservatively with pain medications, range of motion, gross and fine motor, and sensory re-education exercises. At 12 months, there was partial but functional recovery of median motor distribution and full recovery of median sensory distribution, as evidenced by improved sensory nerve action potential conduction velocity and amplitude, and compound motor action potential conduction velocity, with persistent decreased amplitude at 50%, and decrease in cross-sectional area of the left median nerve.

This paper highlights the functional outcomes of a conservatively managed median nerve entrapment from venipuncture hematoma from dengue hemorrhagic fever. This case report also emphasizes that in the presence of severe bleeding risk of surgery in the background of severe thrombocytopenia, timely rehabilitation medicine referral with monitoring through clinical evaluation, musculoskeletal ultrasound, and electrodiagnostic study presents a viable alternative in the management of compression neuropathy.

BACKGROUND

Dengue is a global health concern, particularly in tropical regions such as the Philippines. In 2019,Cebu City reported the highest number of dengue cases in Central Visayas with 3,290 cases and 20 deaths, an 11.8% increase compared to 20181 . To help predict disease outcomes and provide timely management, a scoring system, the Daily Dengue Severity Score (DDSS)² was utilized.

To determine the clinicodemographic profile of dengue patients, determine the accuracy of the DDSS in assessing disease severity, and determine a cut off score that suggests severe dengue.

Patients 1 month to 18 years admitted for dengue at Perpetual Succour Hospital from January 2018 to December 2020 were included. Cases were classified as Dengue without Warning Signs, Dengue with Warning Signs, and Severe Dengue, and scored using the DDSS. Statistical analysis used were Geometric mean and Area Under the Receiver Operating Characteristic (AUROC) curves to analyze the discriminative performance of the DDSS among the different disease severity states.

Out of 327 cases, 34 were classified as Dengue without Warning Signs, 271 Dengue with Warning Signs, and 22 Severe Dengue. The highest mean DDSS was 17.7 ±14.0 at Day -4 among those with Severe Dengue, and the lowest mean DDSS was 1.1 ± 2.0 at Day +3 among those with Dengue without Warning Signs. A cut off point of 10 on Day -1 predicted subsequent Severe Dengue among patients with Dengue with Warning Signs. In 91.39% of cases, there was a significant relationship between the DDSS and dengue classification, and the higher the DDSS, the more severe the disease.

Majority of dengue patients were males, aged 8.1 to 9.2 years. DDSS showed 66.67% sensitivity, 92.86% specificity, a positive likelihood ratio of 9.3, and a cutoff of 10 is predictive of severe dengue among patients with dengue with warning signs.

OBJECTIVE: This paper aimed to describe the clinical profile and short-term clinical outcomes of children with Acute Kidney Injury (AKI) requiring hemodialysis in a tertiary pediatric hospital. MATERIALS AND METHODS: A retrospective cohort on in-patients who received hemodialysis treatments at our institution was performed. Medical charts of patients admitted between July 2018 and July 2023 were retrieved. Demographic data, clinical profiles and subsequent outcomes in terms of mortality and recovery or non-recovery from AKI were recorded. RESULTS: After meeting the inclusion and exclusion criteria, 129 patients were included in the study‘s statistical analysis. There was an even distribution between males and females. The average age of treated patients was 10 years old (SD ± 4.3). The average weight of patients was 35kg (SD ± 16.9). The most common diagnosis of patients was severe dengue (21.7%), followed by severe sepsis (14.7%). More than half of patients (51.9%) had an existing co-morbidity, of which Systemic Lupus Erythematosus (22.4%) and solid tumors (22.4%) were most common. The most common indication for hemodialysis was uremia (52.7%). In terms of short-term outcome, majority of patients died during the same admission (56.5%), while 31 patients (24.0%) recovered. CONCLUSION The clinical profile of patients who underwent hemodialysis treatments for AKI were comparable to international data. The study did not differentiate deaths from AKI or underlying illness, but demonstrated a higher mortality rate compared to other existing studies. This study is the first known local paper to describe the profile and outcomes of children who received hemodialysis for AKI.
Hemodialysis ; Renal Dialysis ; Severe Sepsis ; Sepsis ; Severe Dengue

Regan Syrup has the effect of clearing heat, releasing exterior, benefiting pharynx and relieving cough, and previous phase Ⅱ clinical trial showed that the efficacy of Regan Syrup high-dose and low-dose groups was better than that of the placebo group, and there was no statistically significant difference in the safety between the three groups. The present study was conducted to further investigate the efficacy and safety of the recommended dose(20 mL) of Regan Syrup in the treatment of common cold(wind-heat syndrome). Patients who met the inclusion and exclusion criteria were selected and divided into the test group(Regan Syrup+Shufeng Jiedu Capsules placebo), positive drug group(Regan Syrup placebo+Shufeng Jiedu Capsules) and placebo group(Regan Syrup placebo+Shufeng Jiedu Capsules placebo) at a 1∶1∶1 using a block randomization method. The course of treatment was 3 days. A total of 119 subjects were included from six study centers, 39 in the test group, 40 in the positive drug group and 40 in the placebo group. The onset time of antipyretic effect was shorter in the test group than in the placebo group(P≤0.01) and the positive drug group, but the difference between the test group and the positive drug group was not significant. The test group was superior to the positive drug group in terms of fever resolution(P<0.05), and had a shorter onset time of fever resolution than the placebo group, but without obvious difference between the two groups. Compared to the positive drug group, the test group had shortened disappearance time of all symptoms(P≤0.000 1). In addition, the test group was better than the positive drug group and the placebo group in relieving symptoms of sore throat and fever(P<0.05), and in terms of clinical efficacy, the recovery rate of common cold(wind-heat syndrome) was improved in the test group compared to that in the placebo group(P<0.05). On the fourth day after treatment, the total TCM syndrome score in both test group and positive drug group was lower than that in the placebo group(P<0.05). There was no significant difference in the incidence of adverse events between three groups and none of them experienced any serious adverse events related to the study drug. The results indicated that Regan Syrup could shorten the onset time of antipyretic effect, reduce the time of fever resolution, alleviate the symptoms such as sore throat and fever caused by wind-heat cold, reduce the total score of Chinese medicine symptoms, and improve the clinical recovery rate with good safety.
Humans ; Antipyretics/therapeutic use* ; Capsules ; Common Cold/diagnosis* ; Double-Blind Method ; Fever/drug therapy* ; Hot Temperature ; Pharyngitis ; Treatment Outcome

Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic herbal formula. All of them are derived from Treatise on Cold Damage(Shang Han Lun) by ZHANG Zhong-jing. This combination has the effects of harmonizing lesser yang, relieving exterior syndrome, clearing lung heat, and relieving panting. It is mainly used for treating the disease involving the triple-Yang combination of diseases and accumulation of pathogenic heat in the lung. Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic combination for the treatment of exogenous diseases involving the triple-Yang combination. They are commonly used in exogenous diseases, especially in the north of China. This combination is also the main treatment strategy for coronavirus disease 2019(COVID-19) accompanied by fever and cough. Maxing Shigan Decoction is a classical herbal formula for treating the syndrome of phlegm-heat obstructing the lung. "Dyspnea after sweating" suggests the accumulation of pathogenic heat in the lung. Patients with mild symptoms may develop cough and asthma along with forehead sweating, and those in critical severe may develop whole-body sweating, especially the front chest. Modern medicine believes that the above situation is related to lung infection. "Mild fever" refers to syndromes rather than pathogenesis. It does not mean that the heat syndrome is not heavy, instead, it suggests that severe heat and inflammation have occurred. The indications of Xiao Chaihu Decoction combined with Maxing Shigan Decoction are as follows.(1) In terms of diseases, it is suitable for the treatment of viral pneumonia, bronchopneumonia, lobar pneumonia, mycoplasma pneumonia, COVID-19 infection, measles with pneumonia, severe acute respiratory syndrome(SARS), avian influenza, H1N1 influenza, chronic obstructive pulmonary disease with acute exacerbation, pertussis, and other influenza and pneumonia.(2) In terms of syndromes, it can be used for the syndromes of bitter mouth, dry pharynx, vertigo, loss of appetite, vexation, vomiting, and fullness and discomfort in the chest and hypochondrium. It can also be used to treat alternate attacks of chill and fever and different degrees of fever, as well as chest tightness, cough, asthma, expectoration, dry mouth, wanting cold drinks, feeling agitated, sweating, yellow urine, dry stool, red tongue, yellow or white fur, and floating, smooth, and powerful pulse, especially the right wrist pulse.
Animals ; Humans ; Cough ; Syndrome ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; COVID-19 ; Drugs, Chinese Herbal/pharmacology* ; Lung ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Asthma ; Critical Care ; Medicine, Chinese Traditional