OBJECTIVE

To evaluate the effect of mySugr^TM app on diabetes self-management, HbA1c level and its acceptability among app users with type 2 diabetes (T2DM).

A prospective, single-arm interventional study in 70 adult Filipino patients with T2DM and HbA1c ≥ 8.0%. Participants used the basic mySugr^TM mobile app for 12 weeks. The Modified Behavior Score Instrument and the Diabetes Self-Management Questionnaire (DSMQ) pre- and post-intervention measured its impact on diabetes self-management while the Mobile Application rating Scale (MARS) assessed the quality of the app.

There was a significant increased adherence to the diabetes self-care behaviors. DSMQ showed that only 12% of the participants had poor self-care behaviors at week 12 particularly in physical activity and diet. The baseline median HbA1c [9.55% (8.43-11.30)] and estimated HbA1c [8.9% (8.3-10.9)] declined significantly after week 12, [8.0% (8.0-8.43)] and [7.2% (6.5-8.1)] respectively with a very significant p value of (p < 0.00001). About 42% of patients achieved an HbA1c level of ≤7%. MARS confirmed the app’s good quality and acceptability.

Mobile application such as mySugr^TM mobile app can be a viable tool for improved self-care behavior and help in achieving good glycemic control among patients with poorly controlled T2DM even as early as 12 weeks. The app has good quality and acceptability.

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

Objective:To investigate the predictors of intracranial hemorrhage in patients with cerebral venous sinus thrombosis (CVST).Methods:Patients with CVST treated in Drum Tower Hospital Affiliated to Medical School of Nanjing University from January 2008 to March 2021 were retrospectively enrolled. The risk factors, clinical manifestations, imaging examination and 90 d follow-up data were collected. The complicated intracranial hemorrhage group and non-intracranial hemorrhage group were compared. Multivariate logistic regression analysis was used to determine the independent predictors of intracranial hemorrhage in patients with CVST. Results:A total of 104 patients with CVST were enrolled, including 42 males and 62 females. Their age was 35.24 ± 10.92 years old (range 22-68 years). Thirty-eight patients (36.84%) were complicated with intracranial hemorrhage, including 34 hemorrhagic cerebral infarction and 4 complicated subarachnoid hemorrhage. Univariate analysis showed that compared with the non-intracerebral hemorrhage group, the intracranial hemorrhage group was more common in puerperal/pregnant patients (60.52% vs. 48.48%; P=0.012), with more acute onset (57.89% vs. 48.48%; P=0.004), focal neurological signs (47.37% vs. 19.70%; P=0.003) and seizure (39.47% vs. 18.18%; P=0.017), and the site of thrombosis was more common in the superior sagittal sinus (57.89% vs. 36.36%; P=0.033). Multivariate logistic regression analysis showed that puerperium/pregnancy (odds ratio 2.857, 95% confidence interval 1.095-7.453; P=0.031) and superior sagittal sinus thrombosis (odds ratio 2.847, 95% confidence interval 1.110-7.302; P=0.027) were the independent predictors of intracranial hemorrhage in patients with CVST. The analysis at 90 d after onset showed that there was no significant difference in the good outcome rate between the intracranial hemorrhage group and the non-intracranial hemorrhage group (86.84% vs. 89.39%; P=0.695). Conclusions:Puerperium/pregnancy and superior sagittalsinus thrombosis are the independent risk factors for intracranial hemorrhage in patients with CVST. However, complicated with intracranial hemorrhage is not associated with 90-day clinical outcomes.

Background: The clinical course of dengue can be adversely affected by bacterial coinfection. Because of this, clinical manifestations may be severe and may lead to morbidity and mortality. Little is known about this dual infection in the pediatric population. Objectives: This study was conducted to evaluate the clinical characteristics and risk factors of patients with dengue infection and coinfection and subsequently develop a scoring system to diagnose bacterial coinfection in patients with dengue. Methods: A prospective cross-sectional observational study was conducted among hospitalized pediatric patients with confirmed dengue infection between January 2019 to August 2019. Baseline characteristics, risk factors, clinical parameters, laboratory findings, management and outcomes were recorded. Cases with concurrent bacterial infections were further analyzed. A scoring system was created which assigned 1 point each for the following risk factors -age ≤9 years, fever >5 days, dengue severe, and 2 points for CRP >12 mg/l) Results: A total of 154 pediatric dengue patients were enrolled with a mean age of 8.54 ± 4.15 years, and 99 patients (64%) had bacterial coinfection. Patients with coinfection were A total of 154 pediatric dengue patients were enrolled with a mean age of 8.54 ± 4.15 years, and 99 patients (%) had bacterial co-infection. Patients with coinfection were younger, have prolonged fever (>5 days), and were more frequently observed to have hypotension, tachycardia, desaturations and bleeding. Patients with coinfection also had higher white blood cell counts (>8 x109 cells/L), higher neutrophil counts (58.80 ± 18.42 % count), and elevated CRP (>12 mg/l) and procalcitonin (>4.01 ng/L). Utilizing the scoring system developed, a score of ≥3 had a sensitivity of 66.67% and specificity of 76.36%, in diagnosing concurrent bacterial infection in children with dengue. Conclusions Patients with dengue and bacterial coinfections were younger with comorbidities. They presented with significantly abnormal vital signs, physical examination findings, and elevated acute phase reactants. Using age ≤ 9 years, fever >5 days, dengue severe, and CRP >12mg/l, a scoring system was developed to diagnose bacterial coinfection in patients with dengue. A score of ≥3 can help diagnose patients with dengue and bacterial coinfection who will most likely need early empiric antimicrobial therapy.
Dengue ; Risk Factors

Background: Antimicrobials are drugs that are often misused and inappropriate antimicrobial prescribing often results in poor clinical outcome and drug resistance. Monitoring and regulation of antimicrobial use is currently being done by the Department of Health through the Antimicrobial Stewardship (AMS) Program. There is a need to determine the factors that affect successful implementation of an AMS program in private hospitals in the Philippines. This study was conducted to identify the enablers and potential barriers in implementing an AMS program in nine (9) private hospitals. Methodology: A concurrent mixed methods design was used to assess various stakeholders’ (physicians, administrators, other AMS members) perceptions of existing or proposed AMS programs, and to identify barriers and enablers in their implementation. Quantitative data were collected using self-administered survey questionnaire to assess clinician’s acceptance of AMS programs. Qualitative data were collected through semi-structured one-on-one interviews of clinicians and other AMS personnel and focus group discussions (FGD) of selected clinician groups. Data were gathered from October 2018 to October 2019. Results: 409 clinicians were surveyed, 52 were interviewed and 46 sat for 13 sessions of FGDs. Overall, the survey established that physicians were well aware of antimicrobial resistance problem. Majority of the clinicians indicated general agreement with the currently practiced antimicrobial protocols in their hospitals and with the AMS program. However, there were disagreements in perceptions with how antimicrobial restrictions impair prescribing practices and overuse of the same. These responses were strong points of discussion during the Key Informant Interviews (KII) and FGDs. All respondents were amenable with the institutionalization of an AMS program in their hospitals. The hospital leadership’s commitment was determined to be the key enabler of a successful AMS program’s implementation. Barriers identified for hospitals with existing AMS programs were: lack of dedicated staff, resistance and/or non-cooperation of physicians, lack of support from non-medical departments, and inadequate cooperation between hospital personnel. Barriers identified, regardless of the status of the AMS programs were: deficiency in knowledge with developing and implementing an AMS program, inadequate information dissemination, unavailability of an IT-based monitoring for antibiotic use, and the influence of pharmaceutical companies on stakeholders with regards to antimicrobial use. Conclusion Similar enablers and barriers to a successful implementation of an AMS program were seen in the different hospitals. A hospital leadership’s commitment was determined to be the key enabler. The success or failure of any AMS program appears to depend on physician understanding, commitment and support for such a program. By involving the main players in an AMS program- the hospital administrators, clinicians and other key members, perceived barriers will be better identified and overcome, and enablers will help allow a successful implementation of an AMS program. This multi-center study was funded by Philippine Council on Health Research and Development ( PCHRD) and Pediatric Infectious Disease Society of the Philippines ( PIDSP) and was conducted by the PIDSP Research Committee.
Physicians ; Multicenter Studies as Topic

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.
Education, Medical

Primary peritoneal carcinoma is rare, presents with non-specific abdominal symptoms, is usually diagnosed late and is associated with a poor prognosis. A 51-year-old female with Primary Peritoneal Carcinoma Stage III-C, was initially treated with cytoreductive surgery and intravenous paclitaxel and carboplatin. After 28 months in remission, she developed tumor recurrence. She underwent tumor excision followed by combined intravenous paclitaxel and intraperitoneal carboplatin. The patient is alive and disease-free 5 years after the initial operation. This case was reported to inform our clinicians that the peritoneum can be the primary site of a rare malignancy. Prognosis may be poor but long-term survival can be achieved in younger patients with good performance status. Having a tumor that is sensitive to platinum-based chemotherapy can contribute to a longer survival even if the tumor was sub-optimally reduced.
Drug Therapy ; Cytoreduction Surgical Procedures

Objective To study the effect of carotid artery stenting (CAS) on rCBF and rCVR.Methods Seventeen patients with unilateral internal carotid artery symptomatic severe stenosis who underwent CAS in our hospital were included in this study.Their rCBF volume and rCVR were measured by single photon emission CT scanning combined with CO2 loading test 1 week be fore and 3 months after CAS.Their data were analyzed according to the ROI in ipsilateral middle cerebral artery blood supply territory.Results Sixty eight ROIs were detected in the 17 patients with impaired rCBF in 16 ROIs (23.5％) before CAS.The mean improved rate of rCBF was significantly higher in impaired rCBF and rCVR ROI before CAS than that of rCBF in normal and impaired rCVR ROI after CAS (P=0.001).The mean improved rate of rCVR was significantly higher in normal rCBF and impaired rCVR ROI after CAS than before CAS (P=0.014).The improved rate of rCBF was significantly higher in impaired rCBF and rCVR ROI after CAS than that of normal and impaired rCVR ROI before CAS (81.3％ vs 50.0％,P=0.027).The improved rate of rCVR was significantly higher in normal rCBF ROI and impaired rCVR ROI before CAS than in impaired rCBF and rCVR ROI after CAS (59.6％ vs 31.3％,P=0.047).Conclusion CAS can improve the ROI rCBF and rCVR in patients with unilateral ICA symptomatic severe stenosis.Its modified model is closely related with rCBF before CAS.

Objective To analyze the effect of carotid artery stenting (CAS) on cerebralblood flow and cerebrovascular reactivity in patients with severe carotid stenosis.Methods Twenty patients with unilateral severe internal carotid artery stenosis,conformed by carotid color ultrasonography or MR angiography in our hospital from August 2014 to December 2015,were chosen in our study.CAS was performed;relative cerebral blood flow (rCBF) detection and relative cerebrovascular reactivity (rCVR) assessment were performed by single photon emission computed tomography (SPECT) combined with carbon dioxide (CO2) inhalation within one week before surgery and 3 months after surgery.Four regions of interest (ROIs) in the bilateral middle cerebral artery (MCA) territory of internal carotid stenosis were selected for data analysis.The changes of rCBF and rCVR before and after CAS between the ipsilateral and contralateral ROIs of these patients were compared.Results In these 20 patients,80 ROIs from each patient were obtained.Preoperative ipsilateral rCBF averaged 0.883±0.075,and contralateral rCBF averaged 0.929±0.033;preoperative ipsilateral rCVR averaged 0.010±0.055,and contralateral rCBF averaged 0.124±0.053;postoperative ipsilateral rCBF and rCVR averaged 0.927±0.040 and 0.092±0.058,and contralateral rCBF averaged 0.938±0.038 and 0.127±0.054.Postoperative ipsilateral rCBF and rCVR were significantly improved as compared with preoperative ones (P＜0.05).Postoperative contralateral rCBF and rCVR were improved as compared with preoperative ones,without significant differences (P＞.05).Conclusions CAS can not only improve rCBF and rCVR of the MCA in the carotid artery stenosis,but also improve the contralateral side.

ObjectiveToinvestigatetheriskfactorsofepilepticseizuresanditseffectonclinical outcome in patients w ith cerebral venous sinus thrombosis (CVST). Methods The patients w ith CVST w ere enrol ed retrospectively. The risk factors, clinical manifestations, and imaging data w ere col ected. The data of an epileptic seizure group and a non-epileptic seizure group w ere compared. Results A total of 69 patients with CVST were enroled, including 32 (46.38%) secondary epileptic seizures. In the aspect of clinical manifestations, more patients show ed hemiplegia in the epileptic seizure group (37.50%vs.15.63%; χ2 =5.240, P=0.020). Imaging examination show ed that more patients in the epileptic seizure group presented w ith bleeding ( 29.41%vs. 10.81%; χ2 = 3.818, P= 0.047 ), more lesion involving frontal lobe (31.25%vs.10.81%; χ2 =5.008, P=0.023), and temporal lobe (43.75%vs.8.11%; χ2 =7.318, P=0.005), and the thrombosis sites w ere more common in the superior sagittal sinuses (65.63%vs.40.54%;χ2 =4.264, P=0.036). Multivariate logistic regression analysis show ed that focal neurological deficits (odds ratio 5.167, 95% confidence interval 1.993-15.764; P=0.004) and superior sagittal sinus thrombosis (odds ratio 0.126, 95% confidence interval 0.042-0.370; P=0.039) w ere the independent risk factors for patients w ith secondary epileptic seizures. There w ere no significant differences in hospital mortality (6.25%vs.2.7%; χ2 =0.512, P=0.469 ) and 90 day 90-day ful recovery rate ( defined as Barthel Index >60) (81.25%vs.86.47%; χ2 =0.346, P=0.793) betw een the epileptic seizure group and the non-epileptic seizure group. Conclusions Focal neurologic deficits and superior sagittal sinus thrombosis are the independent risk factors for secondary epileptic seizures, how ever, secondary epileptic seizures is not associ-ated w ith in-hospital mortality risk and 90-day clinical outcomes in patients w ith CVST.