BACKGROUND AND OBJECTIVE

In 2018, the Philippine Congress passed the Universal Healthcare (UHC) Law and its implementing rules which mandated the enrollment of all Filipinos to PhilHealth, the national social health insurance corporation. The Department of Health (DOH) and PhilHealth will leverage their strategic purchasing power by affiliating Health Care Provider Networks (HCPNs), established within the geopolitical boundaries of a province or a highly urbanized city, through service level agreements. This study aims to shed light on what is expected from providers, payers, and regulators to implement UHC successfully.

The researchers conducted an inductive, content analytic qualitative study guided by the World Health Organization’s (WHO) Building Blocks Framework to determine the understanding and acceptance of the implementing rules of the UHC Law and the perceived barriers and enablers from the provider, payer, and regulator stakeholders in three provinces in the Philippines. Purposive sampling was utilized to provide the best representation across different economic and physical settings. A content analysis was done through an inductive process of coding concepts, which was the basis for categories grouped and matched deductively with the WHO framework. This formed the broader sub-themes and were used for the final data interpretation.

A total of 16 focus group discussions (FGDs) and nine in-depth interviews (IDIs) were performed with 84 participants. Inductive thematic analysis of categories and subcategories showed that the participants support the goals and objectives of the UHC Law. Still, perceived barriers refer to the lack of and improper use of funds, the need to clarify the implementing guidelines, and the role of politics. The participants indicated that solidarity and social connectedness with health system adaptability and resilience are enablers for the success of UHC reforms.

Proposals to mitigate the barriers include expanding the funding source, clarifying rules on the f inancial management system, and providing guidelines on health delivery integration to ensure access to patient care. Decentralization with autonomy will allow the stakeholders to align health programs with local needs. Proper representation in decision-making bodies is desirable to establish strong community involvement and solidarity. Resilience and adaptability based on a feedback loop are imperative.

BACKGROUND

Mental health literacy (MHL) is an important mental health strategy since it contributes to early detection, enhances help-seeking behavior, and reduces stigma and discrimination against people with mental disorders.

The objectives of the present study were to assess the level of mental health literacy and its correlation, and to examine the predictive effect of demographic profiles on mental health literacy among young and adult populations in the five cities of Caraga, using a standardized mental health literacy scale in 2023.

This study applied a cross-sectional survey. It surveyed 729 individuals from five cities in Caraga using the Mental Health Literacy Scale from Dias et al. Descriptive analysis, such as frequency, percentage, mean, and standard deviation, and inferential statistics, such as Pearson correlation, independent t-test, and multi-linear regression, were used for data analysis.

The mental health literacy of the young and adult populations can be classified as adequate or good. Zooming in on details, the respondents have a very good understanding of help-seeking behavior and self-strategies but only a good understanding of knowledge and beliefs/attitudes. Pearson’s correlation analysis revealed a significant positive relationship between knowledge, erroneous beliefs, self-strategies, and help-seeking behavior (p < 0.001). In addition, Independent t-test and ANOVA revealed significant differences in sex, family income, employment, civil status, educational level, and age group (p < 0.01). A multiple linear regression indicated that demographic profile predictors were found to be statistically significant, and positively with mental health literacy, with education and family income as the strongest predictors.

The present study concluded that the young and adult populations in the five cities in Caraga have adequate literacy on mental health, encompassing knowledge, beliefs, self-strategies, and help-seeking behaviors. The increases in knowledge, belief, and self-strategies are associated with their higher level of help-seeking; in addition, the demographic profiles (e.g., sex, age, education, monthly income, and employment) have implications on young and adults’ mental health literacy in the five cities in Caraga. The result may not be generalizable beyond the studied region or demographic. In addition, it recommended that mental health literacy programs prioritize individuals with lower levels of education and family income as these factors Xwere found to have the most significant influence.

Objective: : Posterior endoscopic cervical foraminotomy (PECF) is a minimally invasive surgical technique for treating cervical radiculopathy. Traditionally, PECF is performed under general anesthesia in the prone position, but concerns over anesthesia-related complications have led to the exploration of local anesthesia in the lateral decubitus position as an alternative. This study aims to compare the clinical outcomes, safety, and efficacy of PECF performed under local anesthesia in the lateral decubitus position versus general anesthesia in the prone position. Methods: : We conducted a retrospective analysis of 13 patients who underwent PECF under local anesthesia in the lateral decubitus position. The outcomes were compared with data from 357 patients across eight studies who underwent PECF under general anesthesia in the prone position. Outcomes measures included Visual analog scale (VAS) pain scores, Oswestry disability index (ODI), length of stay (LOS), minimally clinically important difference (MCID), and complications. Results: : Patients in the local anesthesia group demonstrated significant reductions in neck pain (VAS-N : 4.93±1.32 to 1.49±0.52, p<0.001) and arm pain (VAS-A : 8.69±0.75 to 1.85±1.46, p<0.001), achieving a mean pain reduction of 78.8%. These improvements were comparable to the general anesthesia group (VAS-N : 4.80 to 1.28; VAS-A : 6.71 to 1.23). Functional outcomes improved significantly in both groups, with ODI scores improving from 54.76% to 9.82% locally and from 39.92% to 9.62% in the general group. Although LOS was slightly longer for the local anesthesia group (5.85±3.20 vs. 4.81±2.17 days, p=0.18), post-procedure monitoring time was significantly shorter (3.2 vs. 7.4 hours, p<0.001). The local anesthesia group reported zero complications (0%; 95% confidence interval [CI], 0–22.8%) compared to an 8.68% complication rate (95% CI, 5.8–11.6%) in the general anesthesia cohort (p=0.612). Conclusion : PECF under local anesthesia in the lateral decubitus position provides comparably effective pain relief and functional improvement comparable to general anesthesia, though the difference in complication rates was not statistically significant and requires larger studies for confirmation. This technique may be particularly advantageous for patients at higher risk for anesthesia-related complications. Further research is warranted to validate these findings in larger, prospective studies.

In familial chylomicronemia syndrome (FCS), a rare lipid disorder, triglycerides rise to extremely high levels because of the inability to utilize lipoprotein lipase (LPL) for fat metabolism. Traditional triglyceride-lowering medications are ineffective, leaving patients dependent on strict low-fat diets. This review examines emerging non-LPL-based therapies for FCS. This narrative review assessed therapeutic strategies targeting key regulators of triglyceride metabolism, including apolipoprotein C-III (APOC3) and angiopoietin-like protein 3 (ANGPTL3), in both animal and human studies. Investigational approaches included monoclonal antibodies, RNA-based therapies, gene therapy modalities, genome editing platforms, and plasmapheresis. Olezarsen effectively lowers triglycerides with greater safety than older options. Other agents, such as ANGPTL3 inhibitors and RNA interference therapies, also reduce lipids and provide additional treatment options. Gene therapy and clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein 9 approaches are expected to become available in the near future, while plasmapheresis remains an intervention for acute pancreatitis. Innovative therapies targeting APOC3, ANGPTL3, or liver-specific genes are transforming the management of FCS. These advances not only address this rare disorder but also offer insights into treating triglyceride-related cardiovascular risk and lipid abnormalities. Although some uncertainties remain, the outlook for FCS therapy appears highly promising.

Immunoglobulin G4 (IgG4)-related sclerosing cholangitis (IgG4-SC) is a rare condition with symptoms often mimicking malignancy, infection, or other autoimmune diseases. This case report describes the unique case of a 62-year-old male initially diagnosed with IgG4-SC, followed by subsequent diagnosis of cholangiocarcinoma. Biliary tract cancer in the setting of IgG4 related disease has been previously described; however, this patient course is novel as it encompasses the spectrum of challenges in IgG4-SC management, including diagnostic uncertainty, risk of infection with immunosuppressive agents, and development of malignancy diagnosed shortly following IgG4-SC diagnosis. We review the literature of management, outcomes, and malignancy risk and furthermore, highlight a promising recent therapy in treatment of IgG4 related disease, inebilizumab.

Hookworm disease is one of the tropical neglected diseases that significantly impacts human health to varying degrees. Hookworms produce various proteins to facilitate host invasion and immune evasion. Despite available treatments, reinfection is common, underscoring the need for effective vaccines. However, the complexity of the hookworm’s life cycle poses a challenge in understanding the immune response in the vaccine candidates. Reverse vaccinology (RV) offers a powerful approach to understand the immune response by using various bioinformatics tools. This study begins by identifying hookworm antigens capable of inducing host immune responses, followed by docking analysis with different dendritic cell (DC) receptors to investigate the immunological response of antigenic peptides and further correlated to the immunogenicity findings in clinical trial. Necator americanus GlutathioneS-Transferase-1 (Na-GST-1), a known immunogenic protein from Necator americanus, was selected for docking due to its strong antigenic properties. Fifteen DC receptors were evaluated against Na-GST-1, of which seven receptors (TLR2, TLR3, TLR4, TLR7, DEC-205, CD206, and CD36) exhibited stronger predicted interactions, as indicated by stronger binding affinities with Na-GST-1 utilizing various immunoinformatic tools. These receptors are associated with the mediation of Th1/Th2 immune responses, suggesting a potential correlation between docking affinity and the predicted immunogenicity of Na-GST-1. Overall, this study provides valuable insights into DC receptor–antigen interactions and demonstrate a computational approach for assessing the potential of hookworm antigens to engage DC receptors, thereby supporting rational hookworm vaccine design. These findings support the application of early in silico strategies for advancing vaccine candidates against hookworm infection and strengthening control efforts for neglected tropical diseases.

Purpose: There is ongoing debate on the haemoglobin level at which red cell transfusion should be administered following surgery. This study aimed to evaluate the benefits of a restrictive blood transfusion strategy and assess potential adverse effects of anaemia in the immediate postoperative phase, determining whether a liberal transfusion approach still remains necessary. Materials and Methods: A randomized control trial compared two groups: Group 1, with a liberal blood transfusion strategy, and Group 2, with a restrictive blood transfusion protocol. Haemoglobin levels were measured on the 3rd and 12th postoperative days, and at 1-month follow-up. Clinical and functional evaluations were conducted at the 1-month follow-up. Results: There was no significant difference between the liberal and restrictive groups in 10 feet walking with support at 12 days and at 1 month. The restrictive group had a shorter hospital stay (17.57±4.66 days) compared to the liberal group (19.56±5.34 days). Incidence of surgical site infections were similar (4.0% in liberal, 2.0% in restrictive), and no mortalities were observed in either group at the 1-month follow-up. Conclusion Both liberal and restrictive transfusion strategies were similarly effective in terms of early postoperative mortality and functional mobility. However, patients in the liberal transfusion group had a significantly longer length of stay compared to the restrictive group. Leading us to conclude that a restrictive strategy is effective and beneficial for patients and hospitals provided there are no signs of anaemia or a haemoglobin drop below 8 g/dL.

Background: The role of pulsed-field ablation (PFA) in convergent procedure for atrial fibrillation (AF)/atrial tachycardia remains unclear.Case presentation: We describe a case of a patient who developed pulmonary vein (PV)-left atrium macroreentrant tachycardia following the epicardial portion of convergent procedure for AF and subsequently underwent successful endocardial ablation using a pentaspline PFA system. Conclusions The application of PFA successfully terminated the tachycardia and eliminated the PV potentials, thereby completing the convergent ablation procedure.

Heart failure with preserved ejection fraction (HFpEF) represents approximately half of all heart failure cases and poses a growing global health challenge driven by an ageing population and an increasing comorbidity burden. Once regarded as a condition without effective, evidence-based therapy, HFpEF has undergone a paradigm shift in recent years. Advances in the understanding of its complex pathophysiology have highlighted the multifactorial interplay between systemic inflammation, endothelial dysfunction, and metabolic derangements. The introduction of sodium-glucose cotransporter 2 inhibitors has transformed the HFpEF therapeutic landscape, following large-scale trials such as EMPEROR-Preserved and DELIVER demonstrating consistent reductions in mortality/morbidity in this patient population. More recently, the non-steroidal mineralocorticoid receptor antagonist finerenone, tested in the FINEARTS-HF trial, was also shown to improve mortality/morbidity in HFpEF, marking a further milestone in disease-modifying therapy. Further, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and a dual gastric inhibitory polypeptide analogue/GLP-1 RA (tirzepatide) have shown to reduce body weight and improve quality of life and mortality/morbidity in the obese-HFpEF phenotype, suggesting the need of additional tailoring of HFpEF therapy based on specific patient profiles. Despite these advances, HFpEF remains a frequently underdiagnosed syndrome, with diagnostic uncertainty often delaying therapy. Comprehensive management of comorbidities and systematic implementation of guideline-directed medical therapy remain crucial to improve patient outcomes.This narrative review provides an updated overview of the pathophysiological mechanisms, diagnostic approaches, and evolving pharmacological strategies shaping the modern management of HFpEF.

Agarwood (Aquilaria spp.) is a resinous wood traditionally used in various medicinal systems across Asia for treating inflammation-related ailments. Despite its longstanding ethnopharmacological use, scientific validation of its anti-inflammatory effects remains fragmented. This scoping review aims to systematically evaluate and synthesize current evidence from animal studies investigating the anti-inflammatory potential of agarwood. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science. Inclusion criteria focused on original animal studies assessing the anti-inflammatory effects of agarwood extracts, essential oils, or derivatives. Data on study design, animal models, agarwood species, treatment dosage, duration, biomarkers, and outcomes were extracted and summarized narratively due to methodological heterogeneity. Eight studies met inclusion criteria, involving models of inflammation-related conditions such as pain, neuroinflammation, gastrointestinal injury, cancer, and toxicity. Agarwood treatment consistently reduced pro-inflammatory cytokines (e.g., IL-1β, IL-6, TNF-α), modulated oxidative stress markers (e.g., NO, SOD, GSH), and regulated signalling pathways including NF-κB, p38 MAPK, and Nrf2–ARE. Notably, improvements were observed in behavioural and histological outcomes across models, with evidence of dose-dependent effects in several studies. In conclusion, preclinical evidence supports agarwood’s broadspectrum anti-inflammatory and antioxidant properties across multiple organ systems. These findings provide mechanistic insights and a scientific basis for its traditional use. However, variability in species, extraction methods, and study designs highlights the need for standardised protocols and clinical validation to advance agarwood as a potential therapeutic agent.