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 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

The Remote Home Environment Assessment (RHEA) Framework is a guide designed to help therapists conduct structured home environment assessments remotely using tools and technology. It offers an efficient and practical approach to overcoming the limitations of facility-based home assessments. The framework offers step-by-step procedures for remote home environment assessment for adult clients with physical dysfunction. It involves four major steps that focus on assessing the client’s physical environment: a) screening for selecting the most appropriate remote home environment assessment modality/ies; b) a preparatory phase that includes signing consent forms, explaining the assessment process, and previewing preliminary information; c) administration of the remote assessment; and d) consolidation of the home information. Furthermore, supplementary materials such as screening form, client and health facility consent forms, home evaluation questionnaire and checklist, and client instructions were developed to facilitate and guide the implementing therapist through the aforementioned steps. Pilot testing is recommended to gain accurate and practical insights into the RHEA Framework’s usability and effectiveness.

Human ; Home Environment ; Occupational Therapy

INTRODUCTION

Exercise intolerance in patients with heart failure (HF) leads to a lower quality of life. An increasing number of studies suggest that early initiation of guided-directed medical therapy (GDMT) leads to better outcomes. Sodium-glucose cotransporter-2 (SGLT-2) inhibitor is one of the cornerstones in HF treatment, but its effectiveness in improving quality of life remains uncertain.

METHODS

A comprehensive search of randomized controlled trials (RCT) was conducted. Outcome measures for cardiovascular death and HF symptoms using the Kansas City Cardiomyopathy Questionnaire - Total Symptom Score (KCCQ-TSS) in the early phase of treatment and at 8 months were analyzed using the Review Manager V5.4. The KCCQ-TSS ranges from 0 to 100, with higher scores indicating fewer symptoms and physical limitations associated with HF. The treatment effect was shown as a win ratio, in which a value greater than 1 indicates superiority.

RESULTS

Five RCTs were included in the meta-analysis. There was improvement in HF symptoms based on the KCCQ-TSS (HR 3.39 [95%CI: 2.95-3.89]I2 = 68%, pCONCLUSION

The meta-analysis showed that initiation of SGLT-2 inhibitors resulted in improvement of HF symptoms which may lead to improvement of patients’ quality of life. Therefore, SGLT-2 inhibitors in all types of HF are effective in promoting better quality of life.

Heart Failure ; Quality Of Life

OBJECTIVE

This study aims to determine the clinical profile and incidence of in-hospital outcomes of patients who underwent coronary artery bypass graft surgery (CABG) under the Philippine Health Insurance Corporation (Philhealth) Z Benefit Package (PZBP).

METHODS

A retrospective descriptive cohort study. A review of medical records was done from July 2017 to October 2023 to collect data and in-hospital outcomes of patients who underwent CABG surgery under Z benefit package.

RESULTS

One hundred twenty-six patients were included in the study. The mean age of patients was 60 years and majority of them were male and came from NCR. Hypertension was the leading cause of comorbidity. The top two most common in-hospital outcomes were hospital-acquired pneumonia and postoperative atrial fibrillation. Most commonly observed caused of increased length in hospitalization was pneumonia. The mean Society of Thoracic Surgeons (STS) (operative mortality) and Euro scores were 1.04 ± 0.82 and 0.88 ± 0.56, respectively. All patients had successful surgical outcome with no mortality and an average length of stay in the hospital of six days.

CONCLUSIONS

This study will serve as a future reference to enhance screening criteria and improved in-hospital outcomes for those who will undergo CABG under Z benefit package. The study also showed insights on clinical profile and in-hospital outcomes of patients who underwent CABG in our own institution and this may give way to a larger scale of study involving multiple centers who also offer the said program.

Human ; Coronary Artery Bypass ; Atrial Fibrillation ; Insurance, Health

RATIONALE/OBJECTIVE

Aneurysmal subarachnoid hemorrhage (aSAH) may be associated with meteorologic factors in temperate countries. The authors aimed to investigate the relationship between meteorologic factors and aSAH admissions in the Philippines, a tropical country with two seasons: rainy and dry.

METHODS

A census review of aSAH admissions from 2015 to 2019 at a tertiary hospital was performed. Meteorologic data were collected for the same time period, and statistical analysis was performed.

RESULTS

A total of 660 patients were admitted for aSAH, 275 and 385 during the rainy and dry seasons, respectively. August and October had the greatest number of mean admissions (13.2) while February had the least (6.2). There was a moderate positive correlation between aSAH admissions and mean temperature. Negligible to weak negative correlations were seen between aSAH admissions and humidity, barometric pressure and precipitation. However, there was no correlation on regression analysis.

CONCLUSION

There were no significant differences in aSAH admissions between rainy and dry seasons. The authors found an increase in aSAH admissions during months with higher temperatures and HI, and weak to negligible negative correlations between aSAH admissions and humidity, barometric pressure, and precipitation. These findings may inform health care facilities in terms of readiness for aSAH admissions.

Subarachnoid Hemorrhage ; Aneurysm ; Meteorology ; Weather

Occult Breast Carcinomas (OBCs) are rare. History and physical examination alone may lead to misdiagnosis hence inappropriate investigative and treatment modalities. Diagnosis is difficult without tissue biopsy and extensive immunohistochemical staining. Presented here is a 74-year-old Filipino male with a 2-month history of axillary mass with erythematous skin, initially assessed as hidradenitis suppurativa failing to resolve with antibiotics. An excision biopsy revealed adenocarcinoma within the lymph nodes. Immunohistochemical stains confirmed a breast primary. Radiologic imaging showed no breast lesions and no distant metastasis. Axillary node dissection done showed metastasis to 5 in 14 nodes harvested, classifying him as OBC Stage IIIA (cT0pN2M0). He completed whole breast radiotherapy and chemotherapy. No tumor recurrence was documented thereafter. Although misdiagnosis is common, OBC is a condition to consider in male patients presenting with axillary lymphadenopathy.

Human ; Male ; Aged: 65-79 Yrs Old ; Lymphadenopathy