BACKGROUND AND OBJECTIVES

The global pandemic caused by Coronavirus Disease 2019 (COVID-19) has affected millions, with growing evidence of the potential role of ocular tissues in viral transmission. At the time of writing, local data regarding the phenomenon was limited. This study investigated external ocular manifestations in patients with COVID-19 at a referral center in the Philippines, examined correlations between demographics, systemic manifestations, and laboratory results with ocular manifestations, and determined their timing relative to systemic symptoms.

METHODS

This single-center, descriptive cross-sectional study was carried out from December 8 to 18, 2020 at the adult COVID-19 wards of the Philippine General Hospital involving 72 participants. Data collection involved relevant clinical history taking and performing gross eye examination. The prevalence of ocular manifestations was described with 95% confidence intervals. Correlations between ocular manifestations and quantitative variables were analyzed with point-biserial correlation, and associations with qualitative variables were tested using chi-square or Fisher’s exact tests.

RESULTS

Among participants, 31.9% presented with ocular manifestations with foreign body sensation as the most prevalent ocular symptom (11.1%) and conjunctival hyperemia as the most prevalent ocular finding (19.4%). The median age of patients with ocular manifestations was 41 years old with a higher prevalence in the male population (73.9%, CI=95%, p=0.001). No significant correlation was observed between presence of external ocular manifestations and the different systemic and ocular co-morbidities as well as with COVID-19 clinical classification. Among those who experienced symptoms, majority (29.2%) of the patients experienced systemic symptoms prior to the onset of ocular symptoms. Ocular complaints may present as the sole manifestation (13.9%). Several laboratory parameters were measured and only temperature and AST levels showed a low positive correlation with the presence of ocular manifestations. 

CONCLUSION

Ocular manifestations occur in roughly one third of patients with COVID-19 based on this study population. With some individuals presenting with ocular signs or symptoms as the initial and sole manifestation, healthcare practitioners must exercise caution and remain vigilant in managing patients who present as such. At the time of writing, this is the first local study investigating the different external ocular manifestations in patients with COVID-19. There is a need to pursue more robust studies and conduct more local investigations which will guide both ophthalmologists and other practitioners in strengthening existing guidelines regarding precautionary practices, clinical diagnosis, and management of COVID-19 patients.

Human ; Sars-cov-2 ; Covid-19 ; Philippines ; Adult ; Association ; Classification ; Collection ; Confidence Intervals ; Coronavirus ; Cross-sectional Studies ; Data Collection ; Demography ; Diagnosis ; Disease ; Exercise ; Eye ; Foreign Bodies ; History ; Hospitals ; Hospitals, General ; Hyperemia ; Laboratories ; Male ; Morbidity ; Ophthalmologists ; Pandemics ; Patients ; Population ; Prevalence ; Referral And Consultation ; Role ; Sensation ; Temperature ; Time ; Tissues ; Volition ; World Health Organization ; Writing

OBJECTIVES

Herbal plants can be an alternative source of therapy especially against hypertension, which is a prevalent burden in the Philippines. This study investigates the phytochemical composition and angiotensin-converting enzyme 1 (ACE-1) inhibitory activity of Mayana (Coleus scutellarioides Benth.) leaf extract, a plant ethnobotanically reported to be used for its potential antihypertensive properties and yet still lacking in in-vitro investigations.

METHODS

Employing a laboratory experimental research design and standard procedures for phytochemical screening and ACE-1 inhibitory assay, the study compares a crude ethanolic dehydrated leaf extract of Mayana with the positive control, Captopril.

RESULTS

Phytochemical screening revealed the presence of flavonoids and phenolic compounds. ACE-1 inhibitory activity of Mayana at 10 μg/mL, 25 μg/mL, 50μg/mL, 100 μg/mL, 500 μg/mL, 1000 μg/mL were 0.00% ± 0.0000, 12.40% ± 2.7094, 18.76% ± 0.7232, 27.31% ± 2.2159, 30.44% ± 1.6022, 40.12% ± 2.4385, respectively. Mayana exhibited an IC50 value of 55.9154 μg/mL compared to Captopril which was 7.7232 μg/mL, indicating potency disparities.

CONCLUSION

Mayana has been shown to contain flavonoids and phenolic compounds that exhibit preliminary anti- hypertensive potential through the inhibition of ACE-1. However, the bioactivity of Mayana is lower when compared with a positive control. As such, more research is needed. Despite that, this research contributes to our under- standing of Mayana as a medicinal plant and its potential contribution to complementary and alternative healthcare, with implications for patient care, community awareness, farmer livelihood, education, and future research.

Plants ; Antihypertensive Agents ; Antihypertensive ; Coleus ; Phytochemicals ; Philippines

OBJECTIVE

To compare the sedation practices of adult intubated patients with COVID-19-related Acute Respiratory Distress Syndrome (C-ARDS) and ARDS from other causes, and their impact on clinical outcomes in a tertiary hospital.

METHODS

We performed a retrospective cohort on the sedation practices of adult intubated patients with C-ARDS and non-C-ARDS admitted to the intensive care unit of a tertiary hospital from January 2021 to December 2021. Electronic medical records were reviewed to obtain sedative use, sedative dosages, clinical outcomes, and complications.

RESULTS

Among the 150 included patients, 112 had C-ARDS, and 38 had non-C-ARDS. The C-ARDS group showed a significant difference with the non-C-ARDS group in terms of BMI (24.11 vs. 21.09 kg/m2, p < 0.001), use of higher PEEP (16 vs. 10, p < 0.001), and prone positioning (40.18% vs 2.63%, p < 0.01). In terms of sedation practice, C-ARDS patients targeted deeper RASS scores (p=0.038), with a significantly higher proportion receiving more than one sedative (82.14% vs. 18.42, p < 0.001) than non-C-ARDS patients. Sedation doses for midazolam (78 mg/d vs. 36 mg/d; p=0.01) and propofol (mean 2626±1312.97 mg/d vs. 1742±380.99 mg/d; p=0.007), were significantly higher among C-ARDS versus non-C-ARDS group. Duration of hospitalization (9 vs. 20 days; p < 0.001) and ventilator use (7 vs. 14.50 days; p < 0.001) were significantly shorter in the C-ARDS group, albeit with a high mortality (100% vs. 89.47%; p=0.004). Shock-requiring pressor was significantly associated with multiple sedation use [OR=15.11 (1.52-2032.89); p=0.017] and combination use of benzodiazepine and non-benzodiazepines [OR=11.51 (1.17-1541.91); p=0.034] in the C-ARDS but not the C-ARDS group.

CONCLUSION

Patients with C-ARDS had higher sedation requirements in terms of dosage and number of sedatives. The use of multiple sedatives was significantly associated with shock-requiring pressor. We recommend the development of a sedation protocol to guide sedation practices and monitoring of complications in the critically ill.

Human ; Covid-19 ; Intensive Care Units

Objective: This study aimed to demonstrate the benefits of using SaTScan (Boston, MA, USA), a cluster-detection software programme, and whole genome sequencing to investigate a suspected outbreak of Serratia marcescens infections in a tertiary government hospital in the southern Philippines. The hospital is part of the national Antimicrobial Resistance Surveillance Program’s network of sentinel sites. Methods: The investigation followed national outbreak investigation protocols. In May 2022, when evaluation of daily hospital laboratory census data revealed an increase in the number of Serratia species in the hospital, an alert was triggered. A concurrent, routine SaTScan analysis of the hospital’s surveillance data by the Antimicrobial Resistance Surveillance Reference Laboratory confirmed a cluster of cases. The Reference Laboratory requested isolates from clinical specimens from the hospital for confirmation of bacterial identification, antimicrobial susceptibility testing and whole genome sequencing. Results: Six isolates were submitted for genomic analysis, two of which were from the identified cluster. Although originally identified as S. marcescens, five of the isolates were subsequently confirmed as S. sarumanii. Phylogenetic analysis showed that the two isolates from the cluster were closely related and belonged to the same clade, which may suggest a common source. Three antimicrobial resistance genes were identified, but their phenotypic expression was limited, with one isolate exhibiting resistance mechanisms. Discussion: This study highlighted the utility of SaTScan for the early detection of potential disease outbreaks. The use of whole genome sequencing enhanced the investigation by enabling the analysis of potential transmission pathways at the genetic level, identification of the outbreak source and the detection of novel species.

Objective: To investigate COVID-19 mortality in Philippine provinces from 2020 to 2023. Methods: Crude mortality rate (CMR), age-standardized mortality rate (ASMR) and age-specific mortality rate were computed for 84 areas (82 provinces and 2 cities) using COVID-19 surveillance data from the Philippine Department of Health, which captured data about confirmed deaths occurring between 20 January 2020 and 9 May 2023. Provinces were ranked by their ASMR. A correlation analysis was conducted to identify possible predictors of COVID-19 mortality. Among the factors investigated were the incidence of poverty, population density, proportion of the population considered elderly (aged >=65 years), hospital bed density and COVID-19 testing rates. Results: Eight of the 10 provinces that had the highest COVID-19 ASMRs were located in the Luzon island group. The province with the highest ASMR was Benguet in Northern Luzon (207.83 deaths/100 000 population), and the lowest rate was in Tawi-Tawi in Southwestern Mindanao (2.22 deaths/100 000 population). The incidence of poverty was negatively correlated with COVID-19 mortality, while hospital bed density and COVID-19 testing rates were positively correlated with CMRs and ASMRs. Discussion: This analysis provides a starting point for investigating COVID-19 mortality in Philippine provinces. The ranking of provinces by their ASMR is useful for directing future epidemiological investigations and, coupled with the results of the correlation analysis, provides insight into the factors that may have impacted COVID-19 mortality in the Philippines. Our analysis suggests that COVID-19 mortality patterns can partly be explained by the streetlight effect and factors linked to the availability of and access to health care.

BACKGROUND

Community pharmacists are strategically positioned to dispense Complementary and Alternative Medicine (CAM) products as part of their innate roles in the provision of accurate drug information to patients. This unique position of the pharmacist could be best realized if equipped with good knowledge and skills in regard to CAM products.

OBJECTIVES

This study aimed to assess the readiness of community pharmacists in the provision of CAM productrelated information to patients by assessing the knowledge and determined the attitudes and practices of community pharmacists regarding CAM products in Eastern Visayas, Philippines.

METHODS

A descriptive mixed-method (qualitative and quantitative) survey design was utilized in this study. Community pharmacists (n=58) in Eastern Visayas, Philippines were the research participants in the study. The survey questionnaire constituted four sections: socio-demographic profile, attitudes, practices, and knowledge of community pharmacists on CAM products. Descriptive statistical analysis was performed using SPSS Version 20.

RESULTS

Results revealed that the majority of respondents are female (87.93%), age range in between 21-30 (62.07%), working full-time (79.31%), and bachelor’s degree holder (98.28%). More than half of the participants (53.45%) did not receive any education or training on CAM products during undergraduate studies. Community pharmacists displayed strong positive attitudes (mean=3.74) and had a moderate frequency of practice on CAM products (mean=3.20). The knowledge test revealed that only a few of the community pharmacists (31.03%) were considered knowledgeable. A significant relationship between years of work experience in community pharmacy and knowledge was found in this study.

CONCLUSION

Despite having strong attitude and moderate level of practice, community pharmacists in Eastern Visayas showed a low level of knowledge on CAM products. Demand for CAM products by patients encouraged community pharmacists to dispense and provide information. Readiness of community pharmacists in terms of knowledge provision of CAM product-related information to patients were found to be insufficient while a moderate level of practice towards CAM products was reported. Community pharmacists displayed a strong positive attitude towards CAM products. Overall, the community pharmacists are not ready to provide CAM information service in the context of the knowledge, attitude, and practices.

Human ; Complementary Therapies ; Medicine, Traditional ; Philippines

Education ; Health Education ; Global Health

Higher Education Institutions (HEIs) are acknowledged as key drivers in realizing health-related Sustainable Development Goals (SDGs). The University of the Philippines Manila, College of Public Health (UP CPH) together with the Asia-Pacific Academic Consortium for Public Health (APACPH), hosted the 53rd APACPH International Conference last 21-23 September 2022. The conference discussed current issues relating to the attainment of SDGs and promoted collaboration of leading academic institutions and other stakeholders in addressing various public health challenges. The conference revolved around the challenges and opportunities in attaining health-related SDGs, and the good practices and roles of HEIs in addressing health disparities. The lack of certificati on framework of public health tertiary programs, pedagogy and infrastructure, and ambiguous roles and network of public health professionals were discussed. The conference served as a platform for discussing potential resolutions and ways forward in addressing these challenges. Opportunities for improvement such as updating of policies and curricula, strengthening of internship and community engagement programs, establishment of capacity-building partnerships and programs, and developing multidisciplinary-competent faculty and students were identified. This paper providesthe highlights of the conference focusing on the good practices and roles of HEIs in addressing health disparities, the impact of COVID-19 pandemic, and other issues and challenges in attaining SDGs.

Human ; Sustainable Development ; Sustainable Development Goals ; Public Health

BACKGROUND

State universities in the Philippines should comply with the 2020 Occupational Safety and Health (OSH) standards for government workers and must be guided by the 2017 ASEAN University Network’s Healthy University Framework (HUF) for them to become healthy universities. Both policy documents identify OSH policy and programs as key components.

OBJECTIVE

This study aimed to explore the challenges and opportunities in the implementation of health and safety policies and programs in a state university in the Philippines.

METHODS

A case study design was used with a state university as its study site. Investigators conducted 14 key informant interviews and nine focus group discussions which were participated by system officials, campus officials, academic teaching staff, academic non-teaching Staff, support staff, and students. Thematic analysis was used to identify and understand emerging patterns and themes.

RESULTS

The results generated seven themes consisting of Policy and Committee, Dedicated Personnel and Unit,Budget and Technology, Collaboration, Programs and Services, Working and Learning Environment, and Role Models. The identified challenges in the implementation of health and safety programs in the university were: (1) limited budget to implement initiatives, (2) lack of collaboration among its offices, and (3) absence of a dedicated unit and staff. There were also opportunities to improve implementation: (1) strong implementation of certain policies and programs, (2) presence of a good working and learning environment, and (3) existence of role models.

CONCLUSION

The identified challenges and opportunities correspond to the elements of the system and infrastructure considered as principal determinants of a healthy university. There is a need to recognize the interrelatedness of such elements to ensure effective implementation of health and safety programs in the university. It also underscores the relevance of the HUF in promoting OSH within a university context.

Human ; Health ; Safety ; Universities

BACKGROUND AND OBJECTIVE

The World Health Organization (WHO) reported that most of the tuberculosis (TB) cases are aged between 15 to 54 years old, the working population. This study described workplace policies on TB in selected low- and middle-income countries (LMIC) in Asia-Pacific.

METHODS

Among the LMICs, countries wherein TB is a public health concern were included. Six policies written in English were included in this study and were reviewed based on the components of the TB workplace programs that were extracted from the WHO Guidelines for Workplace TB Control Activities.

RESULTS

The Philippine policy had the most number of components while those of Cambodia and Papua New Guinea had the least. Only the component on implementing environmental controls was common among the policies. Components on respecting patient rights and confidentiality, tailoring of workload to TB patient’s state of health, registration of all patients with TB diagnosis, reporting of cases to central NTP office, recording of standard treatment outcome, and inclusion of multidrug-resistant TB (MDR-TB) provisions were missing for the majority of the policy documents.

CONCLUSION

The workplace TB program policies included in this study can be reviewed and updated accordingly, with the coverage expanding to all workplaces. The policies can also integrate measures on COVID-19 as the pandemic has slowed the progress in TB control. With the similarities in the preventive measures against TB and COVID-19, this can be an avenue to develop integrated policies especially for workplaces.

Human ; Tuberculosis