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.

Objective: There is increased use of 3-dimensional (3D)-printing for manufacturing of interbody cages to create microscale surface features that promote bone formation. Those features may be vulnerable to abrasion and/or delamination during cage impaction. Our objective was to quantify loss of mass and changes in surface topography of 3D-printed titanium interbody cages due to surgical impaction. Methods: Eight surfaces of four 3D-printed titanium modular interbody fusion cages were tested. The cages were impacted into the Sawbones model with compression preload of either 200N or 400N using a guided 1-lb (0.45 kg) drop weight. Mass and surface roughness parameters of each endplate were recorded and compared for differences. Results: Significant weight loss was observed for the superior endplate group and for both 200N and 400N preloads. For pooled data comparison, significant postimpaction decreases were observed for mean roughness, root-mean-squared roughness, mean roughness depth, and total height of roughness profile. No significant differences were observed for profile skewness and kurtosis. There were significant changes in almost all roughness parameters in the anterior region of the cage postimpaction with significant changes in 2 out of 6 parameters in the middle, posterior, and central regions postimpaction. Conclusion Three-dimensional-printed titanium interbody fusion cages underwent loss of mass and alteration in surface topography during benchtop testing replicating physiologic conditions. There was an endplate- and region-specific postimpaction change in roughness parameters. The anterior surface experienced the largest change in surface parameters postimpaction. Our results have implications for future cage design and pre-approval testing of 3D-printed implants.

BACKGROUND

Social Innovation in Health Initiative Philippines introduced the community engagement self-monitoring strategy in two community-managed social innovations in 2021. Phase 1 demonstrated the strategy's viability by identifying community “local monitors,” selecting indicators, monitoring, and conducting feedback sessions. In 2022, a second phase was implemented to improve the process by integrating capacity-building activities and praxis sessions, and gathering insights on the strategy’s sustainability.

In this paper, we sought to describe the stages of the CE-SM strategy applied within a Philippine local health system in geographically isolated and disadvantaged contexts. Specifically, we: 1) Identified the key competencies of the local CE-SM monitors; 2) facilitated capacity building to strengthen their skills and abilities; 3) explored sustainability mechanisms; and 4) identified integration points of the CE-SM in strengthening local health systems.

Two communities in a rural municipality implementing a social innovation called the “Seal of Health Governance'' were chosen for the expanded community engagement self-monitoring (CE-SM) pilot. Profiling of local monitors and self-assessment of competencies were facilitated. Capacity-building activities were conducted for community engagement, data processing, and data analysis, complemented by praxis sessions guided by people-centered principles.

Local monitors from both communities showed determination in performing their responsibilities but differed in their levels of participation. Their appreciation of their role increased as it broadened from merely collecting data to understanding and using it to advocate for their community’s needs. The minimum resources for communities to implement the strategy include financial mechanisms to ensure the availability of resources. Local monitors have improved their ability to analyze their communities' realities, particularly regarding health leadership and governance.

Community engagement self-monitoring is a feasible and sustainable strategy for monitoring and evaluating health interventions if adequate support is provided and complemented by capacity-building and praxis sessions. It promotes listening to the community and empowering them to participate in decision-making, which are vital in fostering ownership and sustainability of social innovations in health.

Hyalinizing clear cell carcinoma of the salivary gland is a rare neoplasm, accounting for only less than 1% of malignancies arising from the salivary gland. It is molecularly defined by the expression of the EWSR-ATF1 fusion oncogene. To date, there has been no previous studies published yet in the Philippines regarding the existence of this tumor. In this paper, we present a case of a 70-year-old elderly female who had a 10-year history of a gradually enlarging left lateral neck mass. Histopathologic examination showed a tumor arranged of cords, nests, and trabeculae of monomorphic round cells with abundant clear to lightly eosinophilic cytoplasm surrounded by thick hyalinized collagen bundles. Immunohistochemistry and molecular studies were done which revealed a positive p63 staining, negative SMA and S100, and an EWSR1 rearrangement in Fluorescence in situ hybridization (FISH), thus, confirming the diagnosis.

OBJECTIVE

Manihot esculenta (Crantz) leaves have been used for the management of diabetes based on cited ethnopharmacological studies. However, scientific evidence to support its efficacy is lacking. The aim of the study was to assess the cytotoxicity of the aqueous leaf extract and fractions of Manihot esculenta and its potential hypoglycemic effect on male Swiss albino mice.

The cytotoxicity assay was necessary to screen which extract and fractions will be used for the in vivo hypoglycemic study.

Phytochemical screening identified the composition of the aqueous crude extract and its fractions. The phytochemical results showed the presence of alkaloids, anthraquinone glycosides, carbohydrates, phenolic glycosides, saponins, and flavonoids.

Cytotoxicity was screened using CytoTox 96® (Promega), a NonRadioactive Cytotoxicity Assay on liver cancer (HepG2) and normal kidney (HK-2) cell lines. Five samples were tagged as highly cytotoxic and were flagged for further assays. These samples were DCM fraction (100 ppm), n-Hexane fraction (1 and 10 ppm), Ethyl acetate fraction (1 ppm), and Aqueous fraction (100 ppm).

The hypoglycemic activity was examined in alloxan-induced diabetic mice using in vivo hypoglycemic study. The aqueous crude extract at dose levels of 200 mg/kg and 300 mg/kg body weight showed significant reduction in blood glucose levels compared to the diabetic control but not exceeding the results in the metformin treatment group. A p-value of 0.05 set a priori was used to consider whether the intervention had a statistically significant difference compared to the diabetic control.

The effectiveness of aqueous crude extract in reduction of blood glucose in mice may be attributed to the synergistic effects of phytochemicals present, especially the alkaloids which were retained in the extract but were undetectable in the fractionated samples. The results of this study also support the findings of existing ethnopharmacological studies on M. esculenta leaf extract as a hypoglycemic agent.

BACKGROUND AND OBJECTIVES

One of the effects of the COVID-19 pandemic on medical education is an increased awareness and use of social media (SocMed) to facilitate learning. However, literature on the use of SocMed in medical education has focused primarily on educator-led teaching activities. Our study aimed to describe SocMed initiatives that were student-led, particularly for information dissemination and peer collaborative learning, and to elicit perceptions of medical students towards such activities.

An online survey on SocMed usage in medical education was sent to all first- and second-year medical students at the University of the Philippines Manila College of Medicine from October to December 2021. The questionnaire collected data on demographics, SocMed habits and preferences, and perceived advantages and disadvantages of SocMed. Descriptive statistics were calculated while the free-text responses were grouped into prominent themes and summarized.

We received a total of 258 responses (71%) out of 361 eligible participants. Overall, 74% found SocMed platforms to be very and extremely helpful; 88% recommended its continued use. The most popular SocMed platforms for different tasks were as follows: Discord for independent study groups and for conducting peer tutoring sessions; Facebook Messenger for reading reminders; Telegram for reading announcements related to academics and administrative requirements, and for accessing material provided by classmates and professors.

The high uptake of SocMed among medical students may be attributed to its accessibility and costefficiency. The use of a particular SocMed platform was dependent on the students’ needs and the platform's features. Students tended to use multiple SocMed platforms that complemented one another. SocMed also had disadvantages, such as the potential to distract from academic work and to become a source of fatigue. Educators must engage with students to understand how SocMed platforms can be integrated into medical education, whether in the physical or virtual learning environment.