Background: Infection can be severely complicated by a dysregulated, whole-body inflammatory response known as sepsis. While previous research showed that genetic predisposition is linked to outcome differences, current patient characterization fails to determine which septic patients have greater tendencies to develop into severe sepsis or go into septic shock. As such, the identification of prognostic biomarkers may assist in identifying these high-risk patients and help improve the clinical management of the disease. Objective: In this study, we aimed to identify molecular patterns involved in sepsis. We also aimed to identify essential genes associated with the disease’s survival which could serve as potential prognosticators for the disease. Methods: We used weighted gene co-expression analysis (WGCNA) to analyze GSE63042, an RNA expression dataset from 129 patients with systemic inflammatory response syndrome or sepsis, including 78 sepsis survivors and 28 sepsis nonsurvivors. This analysis included identifying gene modules that differentiate sepsis survivors from nonsurvivors and qualitatively assessing differentially expressed genes. We then used STRING’s protein-protein interaction and gene ontology analysis to determine the functional and pathway relationships of the genes in the top modules. Lastly, we assessed the prognosticator abilities of the hub genes using ROC analysis. Results: We found four diverse co-expression gene modules significantly associated with sepsis survival. Our differential gene expression analysis, combined with protein-protein interaction and gene ontology analysis, revealed that the hub genes of these modules – TAF10, SNAPIN, PSME2, PSMB9, JUNB, and CEBPD – may serve as candidate markers for sepsis prognosis. These markers were significantly downregulated in sepsis nonsurvivors compared with sepsis survivors. Conclusion Weighted gene co-expression analysis, gene ontology enrichment analysis, and proteinprotein network interaction analysis of transcriptomic data from sepsis survivors and nonsurvivors revealed TAF10, SNAPIN, PSME2, PSMB9, JUNB, and CEBPD as potential biomarkers for sepsis prognosis. These genes are associated with functions related to proper immune response, and their downregulation in sepsis nonsurvivors suggests eventual immune exhaustion in late sepsis. Further analyses, however, are necessary to validate their roles in sepsis progression and patient survival.
prognosis

We present a case of a 50-year-old man with chronic kidney disease (CKD) presenting with acute diarrhea and fever. He was admitted a month prior for COVID-19, where he received antibiotics for radiographic findings of pneumonia and elevated procalcitonin. In the emergency department, his stool sample tested positive for Clostridioides difficile antigen and toxin. He was given oral vancomycin and intravenous metronidazole for fulminant C. difficile infection and was discharged with resolution of symptoms. This case documents a potential risk associated with routine antibiotic use during the pandemic and the pitfalls in interpreting procalcitonin, especially in patients with COVID-19 and CKD.
COVID-19 ; Clostridioides difficile ; antibiotic-associated colitis

Introduction: Septic arthritis is an infection of the joint. Considered a medical emergency, it requires prompt diagnosis and treatment. Local data on the clinical profile of septic arthritis patients in the Philippines are still limited. Therefore, this study aims to determine the clinical characteristics and outcomes of patients with septic arthritis in the local setting. Objective: To determine the clinical profile and outcome of adult Filipino patients with septic arthritis admitted at a tertiary hospital. Methodology: This is a retrospective descriptive study of the medical records of patients with septic arthritis admitted at Chong Hua Hospital, Cebu City, from January 2012 to December 2019. Results: Fifty- seven patients were included in this study. Sixty-four percent were males. Forty-three percent were between the ages of 45 to 64 years old. Diabetes mellitus (49.12%) was identified as the most common comorbidity. 94% of patients presented with monoarthritis, with the knee being the most commonly involved joint (73%). 85% of patients presented with joint pain and swelling. Gram-negative bacilli were the most common pathogen isolated at 31.5%. In addition, 87% of patients had synovial fluid white blood cell counts of more than 50,000/uL. Ceftriaxone was the most commonly used empiric antibiotic (31.5%). Based on sensitivity results, empiric antibiotic treatment was adequate in 66.67% of the cases. 64% of patients underwent surgical intervention in addition to antibiotic therapy. Conclusion This study highlights the unique characteristics of septic arthritis in this population, such as its prevalence in middle-aged patients and the isolation of gram-negative bacilli as the most common isolate. This study showed that the majority of patients were male, with monoarthritis as the most common presentation. Half of the studied population had diabetes mellitus. High clinical suspicion and awareness of risk factors should be emphasized so that timely and adequate treatment may be provided.
Septic arthritis

Background: Diabetes self-management is a fundamental aspect of diabetes care and has a significant impact on diabetes- related mortality and morbidity. Assessment of self-care management is thus essential for clinicians and educators seeking better outcomes. However, there are no Filipino-validated tools to objectively measure this. Methodology: A cross-sectional analytic study was done among adult Type 2 diabetic mellitus (T2DM) patients at the Ilocos Training and Regional Medical Center (ITRMC) Department of Internal Medicine outpatient clinic and three private diabetes clinics to determine the reliability and validity of the Filipino-translated Diabetes Self-Management Questionnaire (DSMQ) and its association with glycemic control as measured using glycosylated hemoglobin (HbA1c) values and categorized into good (< 7%), moderate (7-8.9%) and poor (> 9%) control. The English version of the DSMQ was translated to Filipino using forward-backward translation. The pre-tested Filipino translated questionnaire was then distributed to the participants and the responses were analyzed using Cronbach’s alpha, Pearson’s coefficient, and one–way analyses of variance. Results: There were a total of 78 respondents. The test-retest reliability showed a statistically significant correlation (p < 0.05). All the items showed a high difficulty index. Known group validity was computed based on categorized HbA1c values. DSMQ sum scores and subscales showed no significant differences among the three categories of glycemic control. Conclusion The Filipino-translated DSMQ is a reliable tool for measuring the self-care of Filipinos with type 2 diabetes mellitus. Future research using it with a larger sample size and analysis for other factors affecting diabetes control may be better able to demonstrate its association with glycemic control.
self-management

Objective: Mortality data is a critical input to public health decision-making and planning. Yet, about 36% of underlying causes of death reported by physicians in 2018 are considered garbage codes, not useful in analyzing public health and mortality (PSA, 2018). We used the PRECEDE-PROCEED approach to develop, implement, and report an advocacy and education Project to improve training on medical certification of cause of death (MCCOD) among senior medical students and interns. Methods: An MCCOD Instructional Design and eLearning course was introduced and validated in 33 medical education institutions. Lessons enhanced these education materials and are proposed for nationwide adoption. In the middle of the COVID-19 pandemic, the Project fast-tracked the training of physician-learners on the correct cause of death reporting and certification. Results: Awareness of correct MCCOD and its personal and public health value reached at least 4000 learners, over a hundred medical faculty, and all deans of medical colleges in the Philippines. Conclusion The PRECEDE-PROCEED Model provided a clear and practicable framework for the advocacy and education efforts to train senior medical students and interns on MCCOD. It can similarly guide other medical education innovations by defining predisposing, enabling, and reinforcing factors then considering these factors for intervention strategies, implementation, process evaluation, outcome evaluations, and impact evaluations.
advocacy ; medical education

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Since ancient times, various herbal medicines have been used in folk medicine to treat a variety of diseases. While the majority of drugs belong to the Kingdom of Plantae, some drugs from the Kingdom of Animalia are listed in various Materia medica of alternative medicines. Animal-derived drugs are mentioned in the Unani system of Medicine (USM) and have been used successfully to treat a variety of diseases. Marjan (Corallium rubrum) is a vital marine drug of animal origin that has been used in USM since ancient times and continues to be used today. It possesses a variety of beneficial pharmacological properties, including tonic effects on the heart, brain, stomach, and eyes, pregnancy protection, expectorant, and hemostyptic properties. It is used to treat hemoptysis, palpitation, bleeding piles, hemiplegia, heart failure, and general weakness. It is also an ingredient in a variety of Unani formulations with pharmacological significance. Unani physicians expanded the uses of Marjan and successfully used it to treat a variety of new diseases. There is a dearth of scientific research on its pharmacological and medicinal properties. The urgent need is to validate the Unani claims about its beneficial cardiac and nervine actions, as well as other significant actions mentioned in the Unani literature.

Since ancient times, various herbal medicines have been used in folk medicine to treat a variety of diseases. While the majority of drugs belong to the Kingdom of Plantae, some drugs from the Kingdom of Animalia are listed in various Materia medica of alternative medicines. Animal-derived drugs are mentioned in the Unani system of Medicine (USM) and have been used successfully to treat a variety of diseases. Marjan (Corallium rubrum) is a vital marine drug of animal origin that has been used in USM since ancient times and continues to be used today. It possesses a variety of beneficial pharmacological properties, including tonic effects on the heart, brain, stomach, and eyes, pregnancy protection, expectorant, and hemostyptic properties. It is used to treat hemoptysis, palpitation, bleeding piles, hemiplegia, heart failure, and general weakness. It is also an ingredient in a variety of Unani formulations with pharmacological significance. Unani physicians expanded the uses of Marjan and successfully used it to treat a variety of new diseases. There is a dearth of scientific research on its pharmacological and medicinal properties. The urgent need is to validate the Unani claims about its beneficial cardiac and nervine actions, as well as other significant actions mentioned in the Unani literature.

Aims: To determine abundance of potential pathogenic microorganisms in pangasius and tilapia farms in five major fish-producing areas in Bangladesh by PCR approaches. Methodology and results: Important microbial water quality indicators were studied in water of 38 fish farms producing pangasius (Pangasianodon hypophthalmus) and tilapia (Oreochromis niloticus) in five major fish-producing areas of Bangladesh. The parameters included physicochemical data and PCR detection of total coliforms and E. coli, species of potentially pathogenic Vibrio, and cyanobacterial genes encoding the toxins microcystin and saxitoxin. Quantitative PCR showed that coliform bacteria occurred in all fish farms with densities from one to 2.2 × 105 per mL, while E. coli ranged from none to 5.0 × 104 per mL. Numbers of total coliforms and E. coli were higher in pangasius farms than in tilapia farms, and when high abundances occurred, coliform bacteria and E. coli bacteria co-varied. Detection of Vibrio-specific genes indicated presence of Vibrio species in 76% of the farms and included V. vulnificus and V. cholerae. The human pathogen type of V. cholerae (carrying the ctxA gene) and the fish pathogen V. parahaemolyticus were not detected. The microcystin-encoding mcyE gene ranged from undetectable to 2.6 × 105 copies per mL and tended to be highest in pangasius farms. The saxitoxin-encoding gene sxtA was not found in any of the farms. Conclusion, significance and impact of study Based on the high abundance of especially coliform bacteria and E. coli, we recommend more efficient water quality monitoring systems to improve detection and control of fecal coliforms and to reduce presence of microcystin-producing cyanobacteria in aquaculture farms in Bangladesh
Water Quality ; Tilapia ; Catfishes