INTRODUCTION

Preeclampsia, a multisystemic, multifactorial disorder, is the second leading cause of maternal deaths in the Philippines. It is diagnosed by the presence of hypertension and proteinuria or significant end-organ damage in a parturient carrying at least 20 weeks age of gestation. Proteinuria, in preeclampsia, is diagnosed by having 300 mg protein in a 24-h urine sample, a 0.3 mg/mg urine protein:creatinine ratio, or 2+ protein on a urine dipstick. All currently available diagnostic tests have their advantages and disadvantages. A novel diagnostic test, the spot ratiometric urine protein:creatinine dipstick test kit, was developed to meet the limitations of the currently available methods. Early diagnosis of preeclampsia will help in the prompt management to decrease maternal and neonatal complications.

The objective of this study was to compare the diagnostic accuracy of the spot ratiometric urine protein:creatinine dipstick test (SUPCR) in comparison to 24-h urine protein (24HUP) in the diagnosis of preeclampsia.

A non-experimental cross-sectional study comparing spot ratiometric urine protein:creatinine dipstick test (SUPCR) to 24HUP and urine dipstick among parturients with elevated blood pressure in a tertiary hospital to diagnose preeclampsia.

A total of 190 parturients were included. SUPCR showed a sensitivity of 88.36%, a specificity of 93.18%, and a likelihood ratio (LR) of 12.96. Urine dipstick (2+) showed a sensitivity of 26.03%, a specificity of 95.45%, and an LR of 5.73.

SUPCR can be an alternative to 24HUP in detecting preeclampsia among pregnant patients due to its high sensitivity, specificity, and LR values. This novel diagnostic can be used in low-resource settings due to its fast results, low cost, and ease of use.

OBJECTIVE

To determine the prevalence of rectal colonization with carbapenem-resistant organisms (CRO) among PGH neonatal intensive care unit (NICU) patients.

A prospective single-center observational study conducted over a 1-month period included all NICU 3 and cohort area patients admitted on April 24, 2024. Rectal swabs were collected for multidrug-resistant organism (MDRO) screening and repeated weekly for 1 month while admitted. Swabs were inoculated on chromogenic media, and isolates were identified and tested for antimicrobial sensitivity by disk diffusion. Clinical characteristics and outcomes were collected for 30 days from initial MDRO screening. Descriptive statistics were used to summarize the data.

The point prevalence of CRO colonization was 37% (14 of 38) at initial screening. There were 14 incident colonizations, hence the 4-week period prevalence of CRO colonization was 72.5% (29 of 40). The patients were mostly very preterm, very low birth weight neonates, majority were tested within the first 2 weeks of life, and half were exposed to meropenem at initial screening. Nosocomial infection developed in 29% and 64%, and 30-day mortality rate was 8% and 21% among initially non-CRO-colonized and CRO-colonized patients respectively. Despite high CRO colonization, no culture-proven CRO infection was observed. Surveillance screening documented persistent CRO colonization in 37%, but no decolonization. Escherichia coli, Klebsiella spp. and Serratia spp. were the most common colonizers.

The high prevalence of rectal CRO colonization in the NICU emphasizes the burden of antimicrobial resistance, but despite the high CRO colonization, no CRO infection was documented from the limited sample and study period.

INTRODUCTION

Hypertension disorders in pregnancy cause significant number of maternal morbidity and mortality. In local statistics for the years 2019–2022, hypertension causes 13.8% of the maternal mortality. Thus, accurate diagnosis of Preeclampsia is crucial to prevent disease progression and to provide timely intervention for improved maternal outcomes. It is widely accepted that 24-h urine protein is the gold standard for detecting proteinuria in patients with preeclampsia, but since the process of collection is too long and complicated, recent studies focus on other less complex yet reliable methods of determining proteinuria for the diagnosis of preeclampsia, including the protein–creatinine ratio (PrCr) dipstick tests.

This study aims to determine the diagnostic accuracy of urine protein detection in patients with preeclampsia, using a urine PrCr dipstick test.

A prospective, cross-sectional study using purposive sampling was used in this study. A total of 153 admitted pregnant patients with gestational hypertension and preeclampsia, without other comorbidities or significant past medical history, were tested for proteinuria using the 24-h urine protein test and urine PrCr dipstick test. Statistical analysis to assess diagnostic accuracy used was the sensitivity, specificity, positive predictive value, and negative predictive value.

The urine PrCr dipstick test has comparable diagnostic accuracy with 24-h urine protein test in detecting proteinuria, with a sensitivity of 88%, a specificity of 64%, and a high positive predictive value of 94%. It is a simpler, faster, yet useful alternative to a more tedious, time and resource consuming process of urine collection in the 24-h urine protein in identifying patients with proteinuria, and therefore, preeclampsia.

BACKGROUND AND OBJECTIVE

Stigma remains a profound barrier to public health, particularly in managing diseases such as Hepatitis B, which is highly prevalent in hyperendemic regions like the Philippines. The social stigma associated with such health conditions can severely limit access to care and hinder adherence to treatment, exacerbating the overall disease burden. Despite the critical impact of stigma on health outcomes, there is a notable gap in the systematic evaluation of the tools used to measure stigma related to health conditions like Hepatitis B. This study aims to fill this gap by reviewing existing instruments for their methodologies, reliability, and validity to inform the development of a refined tool tailored to the Philippine context.

A systematic search was conducted across six databases, including PubMed, Cochrane Database of Systematic Reviews, Open Grey, DissOnline, Philippine Health Research Registry (PHRR), and Health Research and Development Information Network (HERDIN), following PRISMA guidelines. The search strategy focused on identifying quantitative and mixed-methods studies using questionnaires to measure HBV-related stigma and discrimination. Studies published between January 1, 1992, and December 31, 2023, were considered. The selection process involved screening for duplicates, reviewing titles and abstracts, and performing a full-text review based on predetermined eligibility criteria.

The initial search yielded 1,198 articles, with 24 duplicates removed. After title and abstract screening, 28 articles were considered for full-text review, resulting in 17 relevant articles in the final analysis with 15 unique instrumentations. The majority of studies employed cross-sectional designs (n=8), with a significant concentration in Asian countries (n=11), indicating a regional focus in HBV stigma research. The review identified a range of questionnaire methodologies, but most studies lacked specificity regarding the type of stigma measured. The Likert Scale was the most commonly used measurement tool, yet few studies provided cut-off values for stigma levels. Validity and reliability testing was reported in 12 articles, including pilot studies, Cronbach’s alpha, and factor analysis.

The lack of a universal methodology and specificity in existing instruments underscores the importance of developing a refined tool that can accurately capture the nuances of stigma and discrimination associated with HBV. The urgent need for standardized, reliable, and culturally sensitive questionnaires is evident, underscoring their importance in developing effective public health strategies and improving treatment outcomes for individuals living with HBV, especially in the Philippines.

Background and Objective: Pediatric COVID-19 epidemiology and factors associated with adverse outcomes-mortality, need for invasive mechanical ventilation, and ICU admission, are largely unstudied. We described the clinicodemographic characteristics of Filipino pediatric COVID-19 patients and determined the factors associated with adverse outcomes. Methods: This is a retrospective cohort study of 180 hospitalized SARS-CoV-2-confirmed cases 0-18 years old from April 2020 to August 2021 in a tertiary COVID-19 referral hospital in Manila, National Capital Region. Crude associations were determined using chi-squared or Fisher’s exact tests; and medians were compared using the Mann-Whitney test. Factors predictive of mortality were determined using Cox proportional hazards regression analysis. The survivor functions were depicted in graphs. Results: About 41.67% had mild disease, 58.33% were males, 39.4% aged 0-4 years, and 69.44% had at least one comorbidity. About 9.44% died (adjusted 9.2 persons per 1000 patient-days, 95% CI 5.5%-15.2%), 17.78% needed invasive mechanical ventilation, and 20% needed ICU admission. Independently, severe-critical COVID-19 (HRc 11.51, 95% CI 3.23, 41.06), retractions (HRc 10.30, 95% CI 3.27, 32.47), alar flaring (HRc 4.39, 95% CI 1.53, 12.58), cyanosis (HRc 4.39, 95% CI 1.72, 14.11), difficulty of breathing (HRc 7.99, 95% CI 2.25, 28.71), poor suck/appetite (HRc 4.46, 95% CI 1.59, 12.40), ferritin (HRc 1.01, 95% CI 1.00, 1.01), IL-6 (HRc 1.01, 95% CI 1.00, 1.01), aPTT (HRc 1.05, 95% CI 1.01, 1.10), IVIg (HRc 4.00, 95% CI 1.07, 14.92) and corticosteroid (HRc 6.01, 95% CI 2.04, 17.67) were significant hazards for mortality. In adjusted Cox analysis, only retractions (HRa 34.96, 95% CI 3.36, 363.79), seizure (HRa 9.98, 95% CI 1.76, 56.55), and corticosteroids (HRa 8.21, 95% CI 1.12, 60.38) were significantly associated with mortality while alar flaring appeared to be protective (HRa 0.10, 95% CI 0.01, 0.95). Several clinical characteristics were consistently associated with adverse outcomes. Conclusions Majority of hospitalized pediatric COVID-19 patients were very young, males, had mild disease, and had at least one comorbidity. Mortality, invasive mechanical ventilation, and ICU admission were relatively low. Except for alar flaring which appeared to be protective, retractions, seizure, and use of corticosteroids were associated with adverse outcomes.
COVID-19 ; Epidemiology ; Philippines ; Child ; Pediatrics

Background: The COVID-19 pandemic posed challenges in making time-bound hospital management decisions. The University of the Philippines -Philippine General Hospital (UP-PGH) is a tertiary COVID-19 referral center located in Manila, Philippines. The mismatch of increasing suspected or confirmed COVID-19 infected mothers with few documented cases of infected infants has caused significant patient overflow and manpower shortage in its NICU. Objective: We present an evaluated scheme for NICU bed reallocation to maximize capacity performance, staff rostering, and resource conservation, while preserving COVID-19 infection prevention and control measures. Methods: Existing process workflows translated into operational models helped create a solution that modified cohorting and testing schemes. Staffing models were transitioned to meet patient flow. Outcome measurements were obtained, and feedback was monitored during the implementation phase. Results: The scheme evaluation demonstrated benefits in (a) achieving shorter COVID-19 subunit length of stay; (b) better occupancy rates with minimal overflows; (c) workforce shortage mitigation with increased non-COVID workforce pool; (d) reduced personal protective equipment requirements; and (e) zero true SARS-CoV-2 infections. Conclusion Designed for hospital operations leaders and stakeholders, this operations process can aid in hospital policy formulation in modifying cohorting schemes to maintain quality NICU care and service during the COVID-19 pandemic.
COVID-19 ; Operations Research ; Intensive Care Units, Neonatal

Introduction: The coronavirus pandemic has affected millions worldwide. Better understanding of COVID-19 in pediatric hematology-oncology patients in a resource-limited setting is crucial to improve care as the pandemic ensues. Objectives: This study describes the clinical profile and outcomes of pediatric hematology oncology patients with COVID-19 seen at the Philippine General Hospital (PGH). Methods: A retrospective, descriptive review of pediatric hematology oncology patients with COVID-19 seen between March 2020 to March 2021 in PGH was done. Results: Forty patients were identified. Seventeen percent had non-malignant hematologic conditions, 40% had leukemias, and 42.5% had solid tumors. Fever and cough were the most common manifestations. Seventy-six percent were on treatment, 9% were newly diagnosed, and 7% were in relapse or disease progression. Fifty-five percent had mild COVID-19; 5% and 2.5% had severe and critical COVID-19, respectively. Thirty-seven percent were asymptomatic. Cancer-related therapy was placed on hold for most patients. There were two mortalities, none was due to COVID-19. Conclusion Results suggest that patients with hematologic and oncologic conditions have a mild course, with majority showing recovery from COVID-19. Delays in cancer-related therapy however, may contribute to disease progression and mortality.
COVID-19

BACKGROUND

Type 2 Diabetes Mellitus (T2DM) patients are predisposed to cognitive decline and dementia. The cooccurrence of the two diseases translate to a higher medical cost. Identification of factors contributing to cognitive impairment is warranted.

To determine the predictors of cognitive impairment among Filipino patients with Type 2 Diabetes Mellitus.

This is a cross-sectional analytical study involving Filipino patients diagnosed with T2DM in the outpatient clinic. A total of 171 patients were included and were screened using AD8-P tool.

A total of 171 adult patients were included and screened for cognitive impairment.19.3% were cognitively impaired, with mean age of 59.6 years old (vs. 55.5 years old, p < 0.029), and two-thirds were female. The mean duration of the patient’s diabetes was 11.2 years. After adjusting for confounders and multi-collinearity, the duration of diabetes was significantly associated with cognitive impairment with odds of developing cognitive impairment increasing as the duration reach 10 years above. Those with T2DM for at least ten years were 2.5 times more likely to develop cognitive impairment, holding the age constant. (OR = 2.5, 95% CI – 1.0 to 5.8, p < 0.043).

19.3% of Filipino patients with Type 2 Diabetes Mellitus in a tertiary government hospital are cognitively impaired and this can occur even in less than 65 years old. The ten years or longer duration of T2DM increases the risk of developing cognitive impairment by 2.5%.

BACKGROUND

As smartwatches with atrial fibrillation detection features gain popularity, it is important to assess the accuracy of these devices to guide decision-making.

Our study aimed to assess the sensitivity and specificity of the irregular rhythm notification and the electrocardiogram (ECG)–based detection features of a commonly used smart wearable device (Apple Watch) in detecting atrial fibrillation.

This was a prospective, pragmatic study conducted in Perpetual Succour Hospital–Cebu Heart Institute from August 2023 to January 2024. To assess the irregular rhythm notification feature, participants were asked to wear an Apple Watch alongside a 24-hour Holter monitor to verify notifications. For the ECG-based detection feature, participants had to tap the crown of the Apple Watch for 30 seconds to get a single-lead ECG similar to a lead I ECG tracing. They were instructed to get manual ECGs hourly, or more often while awake. Irregular rhythm notifications and ECG readings were then compared with that of the 24-hour Holter monitor. Sensitivity and specificity were then computed.

A total of 140 participants consented to join after full study disclosure. The irregular rhythm notification feature of the Apple Watch exhibited a low sensitivity of 21.4% but achieved a high specificity of 100% in detecting atrial fibrillation. Meanwhile, the ECG-based detection feature, analyzed from 1295 manually taken ECGs with interpretable sinus rhythm or atrial fibrillation, demonstrated a high level of agreement with the Holter monitor, with a sensitivity of 100% and a specificity of 99.1%.

The low sensitivity of the irregular rhythm notification feature of the Apple Watch in detecting atrial fibrillation cautions against relying on it as a primary screening tool. However, the high concordance of manually taken Apple Watch ECGs positions the device as a robust tool for detecting atrial fibrillation through manual ECG detection.

Objectives: This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients. Methods: This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking. Results: The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT. Conclusions FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.