Hospital In Manila Research Articles

Cardiovascular Profile of Patients With COVID-19 Infection Admitted in a Tertiary Care Hospital in Manila, Philippines: A 2-Year Single-Center Retrospective Study

INTRODUCTION: Respiratory symptoms are the most commonly observed clinical manifestations in patients with COVID-19 infection; however, some patients may present with cardiovascular complications. Patients with underlying cardiovascular diseases are associated with increased mortality risk. This study aimed to provide local data on the clinical profile and cardiovascular outcomes and to determine predictors of in-hospital mortality among COVID-19 patients admitted to a tertiary care hospital in the Philippines. METHODS: This single-center retrospective study included hospitalized patients diagnosed with COVID-19 between March 2020 and May 2022. Clinical parameters were subjected to univariate and multivariate regression analyses, with in-hospital mortality as the dependent variable. RESULTS: A total of 1341 patients were admitted with a mean age of 50 years, half of whom were males. Hypertension is the most common comorbidity (728 [54.3%]), followed by diabetes mellitus (393 [29.3%]) and heart disease (136 [10.1%]). Patients admitted to the intensive care unit had significantly higher systolic blood pressure than non–intensive care unit patients (127 ± 19 vs 139 ± 26 mm Hg; P < 0.001), as well as higher plasma erythrocyte sedimentation rate, C-reactive protein, D-dimer, troponin, ferritin, and lactate dehydrogenase. The most common cardiac complications observed were heart failure (39%), acute cardiac injury (30%), and arrhythmia (30%). During hospitalization, 100 patients (7.4%) died; almost half were admitted to the critical care unit, and 84 had cardiac complications, with heart failure (21%) being the most common. Sinus tachycardia was the most common electrocardiographic abnormality (436 [32%]). Univariate analysis showed diabetes (odds ratio [OR], 2.7; P = 0.029) and hypertension (OR, 3.4; P = 0.11). Multivariate analysis revealed that age (OR, 1.095; P < 0.05) and admission duration (OR, 0.906; P < 0.05) were significantly associated with mortality. CONCLUSION: This study highlights the clinical characteristics of patients contracted with COVID-19 who may experience several cardiac conditions. Therefore, particular attention should be given to the role of preexisting cardiovascular diseases and cardiac complications that may contribute to long-term outcomes. KEYWORDS: cardiac complications, COVID-19, cardiovascular outcomes

Prevalence and Level of Depression, Anxiety and Stress Among Frontliners Using the Depression, Anxiety and Stress Scale (DASS)-21 in a Tertiary Hospital in Manila, Philippines During the COVID-19 Pandemic: a Cross-Sectional Study

Background: COVID-19 was declared as a pandemic by the World Health Organization (WHO) in March 2020. It has affected millions globally and remains as a public health concern until today. Objectives: The study aims to identify the prevalence of depression, anxiety and stress among UST hospital frontliners during the COVID-19 pandemic using the Depression, Anxiety and Stress Scale (DASS)-21 scale. Methods: A cross-sectional study was conducted among 272 frontliners in a tertiary hospital in Manila, Philippines using the DASS-21 scale. Results: Based on data gathered from the responses of participants using the DASS-21 scale, the prevalence of depression, anxiety and stress among the frontliners were 28.68%, 35.66% and 14.71%, respectively. Being single, living alone, higher degree of educational attainment (postgraduate), trainees (residents and fellows) and those having pulmonary comorbidities were associated with increasing level of depression and stress. Respondents who had less work experience (less than 5 years) had significant depression; being single presented with higher anxiety; and those who had a previous COVID-19 infection had higher degree of stress. Conclusion: Several demographic and occupational characteristics, in accordance to the COVID-19 pandemic, yielded significant results regarding the presence of depression, anxiety and stress. The study recommends closer follow-up of participants which recorded high severity scores in the DASS-21 scale as well as regular psychological briefing and counseling to assess if there are other contributory factors to such responses. Ultimately, this may enlighten us on how to provide holistic care to our own hospital staff. Keywords: COVID-19, Depression, Anxiety, Stress, DASS-21 scale

Physicians’ Knowledge, Attitudes and Practices on the Diagnosis and Management of Osteoporosis in a Tertiary Hospital in Manila

Osteoporosis is a major public health concern leading to significant morbidity and mortality, especially in the elderly population. However, this disease is underdiagnosed and, as a result, undertreated. This cross-sectional study aims to determine the knowledge, attitudes and practices (KAP) of physicians in the diagnosis and management of osteoporosis, which would help identify key areas of improvement in the care of patients with this disease. One hundred and nine physicians answered an online questionnaire looking at their KAP on the diagnosis and management of osteoporosis, and their answers were analyzed using descriptive statistics, Pearson’s correlation and the Chi-square test. More than half of the participants obtained satisfactory scores on knowledge, and majority had neutral to positive attitude regarding osteoporosis. A statistically significant correlation was seen between having low knowledge and negative attitudes on osteoporosis screening and management.

7796 The Profile And Associated Risk Factors Of Diabetic Foot Disease Among Patients With Type 2 Diabetes Mellitus Seen At Outpatient Clinics In A Tertiary Private Hospital In Quezon City, Philippines

Abstract Disclosure: D.C. Lopez: None. K.T. Lim: None. B.C. S.: None. O.C. Dampil: None. The Profile and Associated Risk Factors of Diabetic Foot Disease Among Patients with Type 2 Diabetes Mellitus Seen at Outpatient Clinics in a Tertiary Private Hospital in Manila, Philippines. Background: Diabetic foot disease is a debilitating complication of diabetes mellitus and is a major source of morbidity, mortality, and reduced quality of life. Determining the risk factors of diabetic foot ulcer is important to prevent the devastating consequences among patients with diabetes. This study aims to determine the profile and associated risk factors of diabetic foot disease among patients diagnosed with type 2 diabetes mellitus being seen in private specialty clinics. Methodology: A single center, analytical cross-sectional study was conducted among patients with type 2 diabetes mellitus at outpatient clinics in a tertiary private hospital in the Philippines. Clinical information and laboratory results were obtained during the time of consult; and patients were classified as either low risk, moderate risk, high risk for diabetic foot disease or in active foot disease. Interaction between various risk factors was explored by multivariate analysis. Results: A total of 129 adult patients with diabetes mellitus were evaluated using the Diabetes Foot Screening and Risk Stratification Tool from January to May 2021. The demographic and clinical profile of the study showed that proportion of patients with neuropathy (χ2=60.66, p=0.001), long duration of diabetes (F=5.92, p=0.004), and low estimated glomerular filtration rate (eGFR) (F=3.70, p=0.023) was significantly higher in patients with moderate to high risk for diabetic foot disease. Univariate polynomial logistic regression analyses showed that neuropathy greatly increased the odds of having moderate (OR=115.63, p=0.001) and high risk stratification (OR=166.50, p=0.001). Other factors were also noted to affect the risk stratification for diabetic foot disease such as duration of diabetes (OR=1.09, p=0.004) and hypertension (OR=2.45, p=0.027). On the other hand, normal eGFR (OR=–1.02, p=0.011), left normal ankle brachial pressure index (OR=–4.32, p=0.042), and good glycemic control (OR=–5.41, p=0.050) significantly decrease the likelihood of having high risk stratification for diabetic patients. Conclusion: Those most susceptible to developing high risk for diabetic foot disease were patients with neuropathy, hypertension, and long duration of diabetes. High-risk patients with the given profile should be followed closely in order to prevent complications brought by diabetes. Keywords:Diabetes mellitus, Diabetic foot disease, Foot ulcer Presentation: 6/3/2024

Psychosocial Impact of COVID-19 Pandemic on Children of Healthcare Workers at a Private Tertiary Hospital in Manila using the Pediatric Symptoms Checklist-35

Psychosocial Impact of COVID-19 Pandemic on Children of Healthcare Workers at a Private Tertiary Hospital in Manila using the Pediatric Symptoms Checklist-35

#1663 Utilizing the MELD-Na score to predict renal replacement therapy and mortality among adult patients with leptospirosis-associated acute kidney injury

Abstract Background and Aims Leptospirosis is a zoonotic disease with manifestations ranging from mild to severe. Acute kidney injury (AKI) in leptospirosis is usually a marker of poor prognosis and there remains a paucity of scoring systems utilized to predict renal replacement therapy (RRT) and mortality. The Model for End-Stage Liver Disease-Sodium (MELD-Na) was originally developed to predict survival in patients with liver cirrhosis. The components of the MELD-Na score evaluate renal and hepatic dysfunction, which are frequent complications in leptospirosis. This study aims to evaluate the prognostic significance of the admission MELD-Na score in predicting renal replacement therapy and mortality among patients with leptospirosis-associated AKI. Method A retrospective, single-center, cross-sectional study was conducted at a tertiary hospital in Manila, Philippines. The study enrolled patients from January 2018 to September 2023 and collected demographic and clinical data, along with laboratory values taken on admission. The MELD-Na score was developed using these values and its distribution was visualized by histogram. Receiver operating characteristic curve analysis was used to determine the score's predictive ability and the optimum cut-off was determined by the cut-point with the highest Youden index. Results The study included a total of 298 patients. The median age of the participants was 39, with 88.59% being males, and 77.52% having no known comorbidities. Of the study population, 74.16% underwent RRT, while the in-hospital mortality rate was 12.08%. Univariate analysis revealed that oliguria, serum creatinine, arterial pH, serum bicarbonate, and administration of methylprednisolone pulse therapy were among the predictive factors for RRT, in line with clinical practice guidelines. Other parameters found to be predictive of RRT were serum sodium and bilirubin. An admitting MELD-Na score of >26 predicted RRT with 91.0% sensitivity [86.4, 94.4] and 87.7% specificity [76.3, 94.9], yielding an area under the curve (AUC) of 0.953 (95% CI). Conversely, an admitting MELD-Na score >31 was found to be 77.8% sensitive [60.8, 89.9] and 64.9% specific [58.8, 70.7] for predicting mortality, with an AUC of 0.748 (95% CI). Conclusion The MELD-Na is a good predictor of renal replacement therapy and in-hospital mortality among patients with leptospirosis-associated AKI. This scoring system holds the potential to serve as a tool for risk stratification and prognostication in moderate to severe cases of the disease. A validation cohort study is recommended for formulating a prediction scoring system based on the individual components of the MELD-Na score, such as bilirubin and sodium.

Factors Associated with Adverse Outcomes among SARS-CoV-2 Positive Children in a Tertiary Government COVID-19 Referral Hospital in the Philippines.

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 clinico-demographic characteristics of Filipino pediatric COVID-19 patients and determined the factors associated with adverse outcomes. 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. 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. 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.

A Comparative Study on the Efficacy of Wound Infiltration of Tramadol versus Bupivacaine for Postcesarean Section Pain Control in a Tertiary Hospital in Manila, Philippines: A Double-blind Randomized Controlled Trial

ABSTRACT Background: In developing countries, postcesarean pain control remains a challenge due to the limited supply of medication and medical equipment. Wound infiltration provides a cost-effective, easy-to-administer postoperative analgesia with a high safety of margin. Several studies suggest that tramadol and local anesthetics have similarities in terms of its action. The study aims to compare the efficacy of tramadol and bupivacaine administered through wound infiltration in postcesarean patients aged 18-40 years old at a tertiary hospital in Manila, Philippines. Methods: Using a double-blind randomized controlled trial, study participants for low transverse cesarean section (CS) were allocated to either Group A or Group B. Group A (n = 20) received a local infiltration of 2 mg/kg tramadol diluted to 20 ml of 0.9% saline solution. Group B (n = 20) received a local infiltration of 0.5 ml/kg of 0.25% bupivacaine isobaric diluted to 20 ml of 0.9% saline solution. All wound infiltrations were performed once at the postoperative site to establish cost-effectivity. Pain severity was assessed using the Visual Analogue Scale (VAS) scoring at rest and at movement done by the anesthesiologist at 4, 8, 16 and 24 h post-CS. A significance level of 0.05 was set and P<0.05 was considered statistically significant. Before inclusion in the study, informed consent was secured from the study participants. The research protocol and informed consent were submitted for ethical review and were subsequently approved. Results: There is no significant difference between the VAS scores of patients treated with tramadol and those treated with bupivacaine across all times of recording except for VAS scores at movement during the 16th and 24th hours. Results of the study revealed that the VAS scores in the tramadol group are lower at all times than those of the bupivacaine group. In general, it is also observable that the VAS scores are higher when the patient is moving than when at rest. There were no observed effects in breastfeeding and no allergic, cardiovascular or central nervous system side effects were observed among all study participants. Conclusion: Because of its mechanism similar to that of local anesthetics, tramadol wound infiltration is a suitable, safe and cost-effective alternative to bupivacaine for pain control after CS.

A Comparison of Psychological Distress and Coping Styles among Physicians and Nurses in a COVID-19 Referral Hospital in Manila: A Cross-sectional Study.

This study aimed to compare the levels of depression, anxiety, and stress, and the coping styles among physicians and nurses in a COVID-19 referral hospital in Manila from June to July 2020. A cross-sectional study among medical residents and nurses selected via convenience sampling was employed. Data were obtained through COVID Stressors and Stress Reduction Questionnaire, Depression, Anxiety, and Stress Scale-21, and Filipino Coping Strategies Scale. Descriptive and inferential analysis of data was done. Five hundred seventy-one (571) healthcare workers (total population: 1,650 nurses and physicians) participated in the study, representing 81.6% of the computed sample size of 700 respondents. Among the participants, 60.6 %, 69.0%, 48.9% reported symptoms of depression, anxiety, and stress, respectively. Nineteen percent (19%) of nurses reported severe to extremely severe depression, and 42.0% reported severe to extremely severe anxiety. In contrast, 30.8% of residents reported severe to extremely severe depression, and 28.4% conveyed severe to extremely severe anxiety. There was no association observed between perceived levels of stress between the two healthcare professions.There were more mildly to extremely severe anxious healthcare workers in the COVID areas (74.6%) compared to the non-COVID areas (61.2%). Differences in coping styles were observed among the participants' clinico-demographic characteristics. Top healthcare worker stressors include being negligent and endangering co-workers (88.6%), frequent modification of infection control procedures (87.0%), and discomfort from protective equipment (81.4%). Top stress-reducing factors include provision of food and vitamins (86.7%), sufficient rest (84.2%), and support from higher-ranking colleagues (73.7%). This study has shown that more than half of the healthcare workers reported mild to extreme levels of depression and anxiety, while a little less than half reported mild to extreme levels of stress. The development and implementation of hospital interventions and programs based on the sources of distress and stress-reducing factors is recommended to mitigate the impact of sustained psychological distress on mental health and physical wellbeing of hospital healthcare workers.

Clinical Profile, Treatment Strategies, and Outcomes of Filipino Adults with Brugada Pattern Electrocardiogram and Syndrome in a Tertiary Care Hospital in Manila, Philippines

BACKGROUND: Brugada syndrome is an inheritable syndrome that carries an increased risk of sudden cardiac death. This study aims to delineate the natural history, clinical and electrophysiologic profile, treatment strategies, and outcomes of patients with Brugada pattern electrocardiogram (ECG) and Brugada syndrome in a tertiary care hospital in the Philippines. METHODOLOGY: This is a retrospective observational study of patients diagnosed with Brugada pattern ECG and Brugada syndrome admitted in a single center from 2004 to 2019. RESULTS: Twenty-three patients were included in the study. All patients were male. In both groups, the majority were nonsmokers (n = 13) and nonalcoholic beverage drinker (n = 14). In patients with Brugada pattern ECG, all presented as an incidental finding (n = 10; P < 0.001), whereas in Brugada syndrome, six patients presented with out-of-hospital resuscitated cardiac arrest (46.15%, P = 0.019). There were only three patients with a family history of sudden cardiac death. All patients had normal ejection fraction and sinus rhythm. Twenty-one patients had ST elevation (91.30%). Fourteen patients had spontaneous type 1 Brugada pattern ECG, whereas the rest were inducible to type 1 after flecainide test. Seven patients underwent implantable cardioverter-defibrillator implantation before discharge; one patient died at the time of diagnosis, and one had recurrent admission for arrhythmia. No single patient received medical management. CONCLUSION: Clinical profile, ECG findings, and outcomes were not significantly different between the two groups of patients except for the clinical presentation upon diagnosis. Treatment strategies were guideline-directed. KEYWORDS: Brugada pattern ECG, Brugada syndrome

Indications and Outcomes of Tracheostomy: A Descriptive Study Using the Outcome-Based Evaluation Forms of Otorhinolaryngology - Head and Neck Surgery Department in a Tertiary Hospital (2016-2020)

Introduction: Tracheostomy is a surgical procedure that creates a neck opening directly into the trachea, typically performed to establish an alternative airway for individuals who experience difficulty breathing as a result of certain medical conditions. Tracheostomy can be temporary or permanent, and it plays a crucial role in the management of both acute and chronic respiratory issues and can significantly improve the quality of life for those who require it. Objective: This study aims to investigate the incidence, common indications and outcomes of tracheostomy in the Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) department of a tertiary hospital in Manila, Philippines. Methodology: This is a retrospective descriptive study including all admissions and in-patient referrals to the clinical division of the Department of Otorhinolaryngology-Head and Neck Surgery who underwent tracheostomy from January 2016 to December 2020. Data were retrieved by review of medical records and Outcome Based Evaluation (OBE) form of all patients who underwent tracheostomy during the study period. Results: Our study involved 74 patients with a male-to-female ratio of 22:15. The patients' ages ranged from 5 to 89 years. Prolonged intubation was the main reason for tracheostomy, followed by upper airway obstruction due to supraglottic mass for males and vocal cord paralysis for females. Only three patients who had tracheostomy experienced complications and were managed accordingly. Conclusion: Tracheostomy is one of the most valuable and reliable surgical procedures for managing airway obstructions. Proper patient and caregiver education as well as constant follow-up are crucial to prevent complications. Keywords: Airway, Tracheostomy, ORL-HNS, Outcome Based Evaluation form, Head and Neck Surgery

Presence of blaCTXM-1, blaCTXM-9, and blaTEM-1 Genes in Extended-spectrum β-lactamase-producing Escherichia coli Isolates from Hospital Wastewater

BACKGROUND: Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) are selectively proliferated in the human gut, excreted through feces, and deposited through wastewater lines, with hospital wastewater acting as a major reservoir of antibiotic resistance genes and resistant bacteria, thus pose adverse effects to human health. This study aimed to determine the presence of blaCTXM-1, blaCTXM-9, blaTEM-1, and blaSHV-1 genes in ESBL-EC in wastewater from selected hospitals in Manila and Quezon City, the Philippines.METHODS: Influent and effluent in twelve hospital wastewater treatment plants were collected, screened for cefotaxime-resistant E. coli, and examined for the ESBL production through phenotypic characterization using conventional bacterial identification, disk diffusion method, and VITEK® 2 Compact system and genotypic identification of ESBL-EC blaCTXM-1, blaCTXM-9, blaTEM-1, blaSHV-1 genes using multiplex polymerase chain reaction (PCR).RESULTS: Conventional bacterial identification methods and the VITEK® 2 Compact system results showed that both influent and effluent samples were positive for ESBL-EC at 33.3% and 16.7%, respectively. Multiplex PCR results revealed that various E. coli isolates were of ESBL-EC blaCTXM-1, blaCTXM-9, and blaTEM-1 genes. Multi-drug resistance was observed among all ESBL-EC isolates with resistance being highest against ampicillin, cefuroxime, ceftazidime, ceftriaxone, cefepime, piperacillin, and aztreonam.CONCLUSION: As the study revealed the presence of ESBL-producing bacteria, efforts must be made to ensure the prudent antimicrobial use with possible emphasis on antibiotic rotation accompanied by intensified infection prevention and control in hospital settings.KEYWORDS: antimicrobial resistance, beta-lactams, blaCTXM, blaTEM, extended-spectrum beta-lactamase, E. coli, hospital wastewater

Predictors of readmission in a medical department of a tertiary university hospital in the Philippines

BackgroundIdentifying factors that increase the risk for hospital readmission helps in determining potential targets for quality improvement efforts. The main objective of this study was to examine factors that predict increased risk of hospital readmission within 30 days of hospital discharge of patients under the General Medicine service of a tertiary government hospital in Manila, Philippines.MethodsWe performed a retrospective cohort study which included service patients 19 years old and above readmitted within 30 days following discharge. A total of 324 hospital readmissions within 30 days of discharge from January 1 to December 31, 2019 were reviewed. We estimated the rate of 30-day readmission and identified factors associated with preventable readmissions using multivariable logistic regression.ResultsOf the 4,010 hospitalizations under General Medicine service in 2019, 602 (18%) were readmissions within 30 days of discharge, majority of which were related to the index admission (90%) and unplanned (68%). Predictors of preventable readmission were emergency readmission (OR 3.37, 95% CI 1.72 to 6.60), having five to ten medications at discharge (OR 1.78, 95% CI 1.10 to 2.87), and presence of nosocomial infection (OR 1.86, 95% CI 1.09 to 3.17). The most frequent reason for readmission among preventable ones is health-care related infection (42.9%).ConclusionsWe identified factors which increased the likelihood of preventable readmissions such as type of readmission, number of medications per day, and presence of nosocomial infections. We propose that these issues be addressed to improve healthcare delivery and reduce readmission-related expenditures. Further studies should be pursued to identify impactful evidence-based practices.

A qualitative study of barriers and facilitators to pediatric early warning score (PEWS) implementation in a resource-limited setting.

Globally, pediatric hospitals have implemented Pediatric Early Warning Scores (PEWS) to standardize escalation of care and improve detection of clinical deterioration in pediatric patients. This study aims to utilize qualitative methodology to understand barriers and facilitators of PEWS implementation at Philippine Children's Medical Center (PCMC), a tertiary care hospital in Manila, Philippines. Semi-structured interviews querying current processes for clinical monitoring, Pediatric Intensive Care Unit (PICU) transfer, and clinician attitudes towards PEWS implementation were audio recorded. In-person hospital observations served to triangulate interview findings. The Systems Engineering Initiative for Patient Safety (SEIPS) framework guided content coding of interviews to characterize work systems, processes, and outcomes related to patient monitoring and care escalation. Thematic coding was performed using Dedoose software. This model allowed identification of barriers and facilitators to PEWS implementation. Barriers within PCMC workflow included: limited bed capacity, delay in referral, patient overflow, limited monitoring equipment, and high patient to staff ratio. Facilitators of PEWS implementation included support for PEWS adaptation and existence of systems for vital sign monitoring. Observations by study personnel confirmed validity of themes. Utilizing qualitative methodology to understand barriers and facilitators to PEWS in specific contexts can guide implementation at resource-limited hospitals.

Evaluating cognitive function in patients with differentiated thyroid cancer who experienced short- term hypothyroidism by levothyroxine withdrawal using Montreal Cognitive Assessment-Philippines (MoCA-P) tool

Background & Objective: Although there are numerous data studying cognitive dysfunction on hypothyroidism in general, there are limited researches that venture on short-term hypothyroidism. This study aimed to determine the cognitive function of patients with differentiated thyroid cancer (DTC) who experienced short-term hypothyroidism. Methods: This was a prospective study done in a tertiary hospital in Manila that enrolled 16 DTC patients either for radioactive iodine (RAI) therapy or thyroid cancer monitoring, who were followed at baseline before levothyroxine (LT4) withdrawal, during hypothyroid state and post-LT4 treatment. MoCA-P tool was used to objectively assess cognition while HADS-P tool was used to detect anxiety and depression. Mean scores were calculated for each time point and analyzed using paired T-test. Results: There was a decrease in the mean MoCA-P score from baseline to hypothyroid state (25.22 to 22.97, p= 0.032) with improvement post-LT4 treatment (22.97 to 24.93, p= 0.004). Older age was associated with decrease in MoCA-P scores (p= 0.04). Total HADS-P scores were nonsignificant. Visuospatial (3.86 to 3.43, p 0.014) and attention (4.86 to 4.36, p value 0.021) domains declined with hypothyroidism, with reversal of visuospatial function post-LT4 treatment. Conclusion: There is a significant alteration in cognition during short-term hypothyroidism that generally improves with LT4 treatment. It is important to educate patients on specific cognitive domains that can be affected to ensure occupational safety.

Epidemiological and clinical characteristics of children with confirmed COVID-19 infection in a tertiary referral hospital in Manila, Philippines

BackgroundCOVID-19 has challenged the under-resourced health systems of low- and middle-income countries, significantly affecting child health. Available published data on Filipino children with COVID-19 infection are limited. This study aims to describe the epidemiological and clinical characteristics of pediatric patients with confirmed COVID-19 in an infectious disease hospital in Manila, Philippines.Main textThis cross-sectional study reviewed data on patients ages 0 to 18 years with confirmed COVID-19 infection, admitted to San Lazaro Hospital from January 25, 2020 to January 25, 2022. Demographic data and clinical characteristics obtained from COVID-19 case investigation forms were summarized and compared between severe and non-severe cases. Risk factors for disease severity and mortality were analyzed. Of 115 patients, 64% were males. There were 87 patients (75.7%) with asymptomatic, mild, or moderate disease, and 28 cases (24.3%) with severe or critical illness. The median age of all patients was 10 years (interquartile range: 4–15 years). The majority of patients (40.9%) were adolescents ages 13 to 18 years. Predominant symptoms were fever (73.9%) and cough (55.7%). Patients with severe or critical illness were more likely to experience difficulty of breathing (55.2% vs 44.8%, p < 0.001), and have a longer hospital stay (11 days vs 8 days, p = 0.043). Among all patients, 48.7% had at least one underlying disease; and common infectious co-morbidities were tuberculosis (17.4%), dengue (12.2%), and HIV (4.3%). Having tuberculosis (p = 0.008) or at least one co-morbidity (p < 0.001) was associated with disease severity. Ten patients (8.7%) died; and mortality was higher among those with severe or critical illness (80% vs 20%, p < 0.001). Sepsis (p = 0.020) or having at least one co-morbidity (p = 0.007) was associated with death.ConclusionChildren of all ages remain susceptible to COVID-19 infection, and usually present with mild or moderate symptoms. In this study, many adolescents are affected, highlighting the value of COVID-19 vaccination in this age group. Understanding the clinical features of COVID-19 in Filipino children is essential to identifying and optimally managing those at highest risk of severe disease.

Prevalence and predictors of prolonged length of stay among patients admitted under general internal medicine in a tertiary government hospital in Manila, Philippines: a retrospective cross-sectional study

BackgroundProlonged hospitalization leads to poorer health outcomes and consumes limited hospital resources. This study identified factors associated with prolonged length of stay (PLOS) among internal medicine patients admitted in a tertiary government hospital.MethodsWe reviewed the medical records of 386 adult patients admitted under the primary service of General Internal Medicine at the Philippine General Hospital from January 1 to December 31, 2019. PLOS was defined as at least 14 days for emergency admissions or 3 days for elective admissions. Sociodemographics, clinical characteristics, admission- and hospital system-related factors, disease-specific factors, outcome on the last day of hospitalization, and hospitalization costs were obtained. We determined the proportion with PLOS and reviewed reasons for discharge delays. We conducted multiple logistic regression analyses to assess associations between various factors and PLOS.ResultsThe prevalence of PLOS is 19.17% (95% CI 15.54, 23.42). Positive predictors include being partially dependent on admission (aOR 2.61, 95% CI 0.99, 6.86), more co-managing services (aOR 1.26, 95% CI 1.06, 1.50), and longer duration of intravenous antibiotics (aOR 1.36, 95% CI 1.22, 1.51). The only negative predictor is the need for intravenous antibiotics (aOR 0.14, 95% CI 0.04, 0.54). The most common reason for discharge delays was prolonged treatment. The median hospitalization cost of patients with PLOS was PHP 77,427.20 (IQR 102,596).ConclusionsAlmost a fifth of emergency admissions and a quarter of elective admissions had PLOS. Addressing factors related to predictors such as functional status on admission, number of co-managing services, and use of intravenous antibiotics can guide clinical and administrative decisions, including careful attention to vulnerable patients and judicious use of resources.

Determination of the Enablers and Challenges in the Implementation of Pharmacy-based Antimicrobial Stewardship (AMS) Program in a Level 3 Hospital in Manila.

Antimicrobial resistance (AMR) is a global public health threat that results from misuse and overuse of antimicrobials. The Department of Health (DOH) institutionalized the Antimicrobial Stewardship (AMS) Program in hospitals, based on the core elements (1) Leadership, (2) Policies, Guidelines, and Pathways, (3) Surveillance Antimicrobial Use (AMU) & AMR, (4) Action, (5) Education, and (6) Performance Evaluation to ensure rational use of antimicrobials and improve patient outcomes. The program implementation will require the involvement of the AMS clinical pharmacist to positively influence the success of the program's implementation. This study aims to identify the enablers and challenges as perceived by AMS clinical pharmacists in the implementation of an AMS program in a level 3 hospital in Manila. A quantitative descriptive study design was employed by administering an online 50-item survey questionnaire to AMS pharmacists, who have at least six (6) months of experience as an AMS pharmacist in the hospital. The survey questionnaire was validated by an expert consultant and underwent pre-testing (Cronbach α = 0.983) for acceptable internal consistency. Responses were collated, coded, and analyzed using median values and frequency distributions for each questionnaire item per Department of Health (DOH) Core Element. Items garnering a median of >3.50 up to 5 were considered as perceived enablers, while those ≤3.50 were identified as perceived challenges. Some perceived enablers by the AMS pharmacists include presence of a leader and/or clinician in the AMS team, Information Technology (IT) resource availability, clear roles of AMS pharmacists, readily available hospital AMS guidelines, engagement in AMR and AMU surveillance activities, regular performance of AMS interventions (e.g., IV-to-PO conversion, dose optimization, de-escalation of broad spectrum), regular monitoring and evaluating of prescriptions and prescribing behavior, and continuous education on infection, prevention, and control (IPC) and hygiene. On the other hand, some perceived challenges include insufficient funding, inadequate knowledge in interpreting antibiograms, lack of adequate and specialized training sessions, lack of coordination with medical and nursing staff to ensure timely drug administration and automatic stop order, prescribing of non-Philippine National Formulary (PNF) antimicrobials, lack of time to perform AMS activities, lack of qualified personnel, and lack of hospital management and information technology (IT) support. Empowering AMS clinical pharmacists is vital to addressing the perceived challenges and maximizing the perceived enablers to ensure the successful implementation of the AMS program in the hospital.

Surgical Outcomes for Sensory Exotropia in a Tertiary Hospital in Manila, Philippines

Surgical Outcomes for Sensory Exotropia in a Tertiary Hospital in Manila, Philippines

Outcomes of Patients Newly-diagnosed with Systemic Lupus Erythematosus Managed in a Tertiary Training and Referral Hospital in the Philippines.

To determine the one-year outcomes of newly-diagnosed patients with systemic lupus erythematosus (SLE) in a tertiary government hospital in Manila, Philippines. After ethics approval, we reviewed the medical records of a cohort of 44 newly-diagnosed SLE patients at 6- and 12-months post-diagnosis in 2018-2019. The outcomes of interest were: modified lupus low disease activity state as defined (mLLDAS), remission, hospitalization, 30-day readmission, organ damage, and mortality. The patients were predominantly young females (mean age of 29 ± 9.9 years). There was an average interval period of six months between onset of symptoms and diagnosis (6.4 ± 10.8 months). The most common manifestations were mucocutaneous (86.4%), hematologic (63.6%), musculoskeletal (61.4%), and renal disorder (47.7%). There was at least one positive serologic test in 88.7%. Five patients (11.4%) had comorbidity, usually hypertension (9.1%). The initial lupus treatment consisted of moderate to high doses of glucocorticoids and hydroxychloroquine. Patients with life-threatening or organ-threatening disease, usually nephritis, received cyclophosphamide, azathioprine, or mycophenolate mofetil. One patient received rituximab. Fewer patients with nephritis received cyclophosphamide infusions during the first six months compared to the later six months.Most of the hospitalizations (34/36) occurred during the first six months and 22 of these were for diagnosis. Seven patients had more than one hospitalization and five (20%) had 30-day readmissions. mLLDAS was achieved by 15 (34.1%) and 30 (68.2%) patients at 6- and 12-months, respectively. Only one patient was in remission a year after diagnosis. Seven patients (15.9%) were assessed with organ damage, six (13.64%) of them at 6-months post-diagnosis. Organ damage was most commonly renal. Four (9.1%) patients died, all during their initial hospitalization. In our population observed over a period of one year (2018-2019), there was a very low rate of remission (1/44, 2.3%), mLLDAS in 68.2%, and organ damage in 15.9%. Most of the hospitalizations (65%) were for the diagnosis of lupus and all deaths (9.1%) occurred during this first hospital confinement. We must intensify our efforts to (1) achieve earlier diagnosis, (2) deliver optimal lupus treatment and supportive care during the first lupus hospitalization, and (3) initiate early and persistent immunosuppressive treatment for nephritis to improve outcomes for our patents with SLE.