Tertiary Hospital In Philippines Research Articles

Ophthalmologic Findings of Parachiasmal Lesions in a Tertiary Philippine Hospital

Ophthalmologic Findings of Parachiasmal Lesions in a Tertiary Philippine Hospital

Safety and Outcomes of Same-Day Discharge Versus Overnight Observation After Transradial Percutaneous Coronary Intervention: A Retrospective Cohort Study in a Tertiary Hospital in Philippines

INTRODUCTION: Since earlier days of percutaneous coronary intervention (PCI), there has been improvement in several aspects of PCI including use of transradial approach and third-generation drug-eluting stents. Despite data showing its safety, same-day discharge (SDD) PCI has not been widely practiced in our institution and country. At present, there are no published studies from the Philippines showing the safety and outcome of SDD PCI. OBJECTIVES: The primary objective of this study is to determine and compare the safety and outcomes of SDD versus overnight observation after PCI in The Medical City from 2018 to 2021. METHODS: This was a retrospective cohort study. The primary endpoint was to describe and compare the clinical profile of patients who underwent same-day versus overnight observation after PCI such as age, sex, comorbidities, indication for coronary angiogram, procedure time, total dye used, stent, and drug-eluting stent used. Incidence of major adverse cardiovascular event, mortality, readmission, and access site complications were also determined at 48 hours and 30 days after PCI. RESULTS: Ninety-three patients were included in the analysis. Reasons for undergoing PCI were a positive noninvasive stress test (45%), stable angina (40%), coronary artery disease (26%), and heart failure (20%). More single-vessel (60%) than multivessel (40%) PCIs were performed. The most frequently affected coronary artery was the LAD (82%), followed by right coronary artery (32%) and left circumflex artery (30%). Compared with patients who stayed longer after PCI, the SDD group had lower mean (±SD) body mass index (25.10 ± 3.12 vs 28.55 ± 4.95 kg/m2), less due to a positive noninvasive test (26% vs 51%), more who underwent a single-vessel PCI (78% vs 54%), lower median amount of injected dye (130 vs 188 mL), shorter median procedural time (74 vs 101.5 minutes), and greater use of sirolimus-eluting stent (22% vs 3%). No adverse outcome of interest was noted in any patient up to 30 days after hospital discharge. CONCLUSION: No adverse outcome was noted with SDD PCI. Larger, prospective, randomized comparative studies are needed to ascertain its safety before recommending SDD PCI routinely. KEYWORDS: left anterior descending artery, left circumflex artery, percutaneous coronary intervention, right coronary artery, same-day discharge

Varied clinical presentations of genitourinary tuberculosis: A case series at a tertiary Philippine hospital

Genitourinary tuberculosis (GUTB) represents a critical aspect of extra-pulmonary tuberculosis (TB). While it is the second most common form of this disease, its diverse clinical presentations pose a substantial challenge. This report, titled “Varied Clinical Presentations of Genitourinary Tuberculosis: A Case Series from a Tertiary Philippine Hospital,” aims to shed light on the intricacies of GUTB diagnosis, treatment, and its broader implications. In this case series, we present five unique clinical scenarios. Cases 1, 2, and 3, having completed TB treatment, developed spontaneous genitourinary fistulae. Case 4 was initially managed as interstitial cystitis, while Case 5 underwent diverticulectomy for a urethral diverticulum. The diagnosis of GUTB as the underlying cause in these cases, despite conventional treatment, highlights the diagnostic challenges posed by this disease. All five patients, experienced irritative voiding symptoms and recurrent urinary tract infections with limited improvement following antibiotic therapy. Imaging studies consistently revealed upper urinary tract involvement. Importantly, only one case exhibited histologic evidence of granuloma suggestive of GUTB, and microbiologic confirmation of Mycobacterium tuberculosis infection was obtained in only two cases. This underscores the need for a multidimensional diagnostic approach. The findings in this case series emphasize that GUTB diagnosis, often reliant on clinical findings supported by imaging studies and suggestive cystoscopy findings, remains critical for prognosis, even in the absence of microbiologic confirmation. Beyond the individual cases, this series offers insights into the complexity of GUTB, raising questions about the overall management and implications for TB control.

Work-related quality of life and performance appraisal among nurses at a tertiary hospital in Philippines

Work-related quality of life and performance appraisal among nurses at a tertiary hospital in Philippines

Cardiac biomarkers as prognosticators among SARS-CoV-19 patients in a tertiary hospital in Philippines

BackgroundThere is overwhelming volume of confirmed cases of COVID-19, despite this numerous knowledge gaps remain in the diagnosis, management, and prognostication of this novel coronavirus infection, making prevention and control a challenge.MethodsThis retrospective cohort study included patients with real-time reverse transcriptase polymerase chain reaction (rRT-PCR)-confirmed COVID-19. Binary logistic regression was used to determine the association between the cardiac biomarkers and in-hospital mortality. ROC, AUC, and cutoff analyses were used to determine optimal cutoff values for the cardiac biomarkers.ResultsA total of 90 subjects with a complete panel of cardiac biomarkers out of the 224 rRT-PCR confirmed cases were included. The median age was 57 years (IQR, 47–67 years), majority were males. Sixty-six (77.6%) subjects survived while 19 (22.4%) expired. The most common presenting symptom was fever (75.6%), and the most common comorbidity was hypertension (67.8%). Spearman rho correlation analysis showed moderate positive association of high sensitivity troponin I (hsTnI) with in-hospital mortality (R, 0.434, p = <0.001). Multivariate binary logistic regression analysis showed that creatine kinase and hsTnI were independently associated with in-hospital mortality (OR, 4.103 [95% CI, 1.241–13.563], p=0.021; and OR, 7.899 [95% CI, 2.430–25.675], p=0.001, respectively). ROC curve analysis showed that hsTnI was a good predictor for in-hospital mortality (AUC, 0.829 [95% CI, 0.735–0.923], p = <0.001) and that creatine kinase was a poor predictor (AUC, 0.677 [95% CI, 0.531–0.823], p=0.018). Optimal cutoff point derived from the ROC curve for hsTnI was 0.010 ng/ml (J, 0.574) with a sensitivity of 84% (TPR, 0.842 [95% CI, 0.604–0.966]), specificity of 73% (TNR, 0.732 [95% CI, 0.614–0.386]), and an adjusted negative predictive value of 99% (Known prevalence*adjusted NPV, 0.989), a positive likelihood ratio of 20% (LR+, 3.147 [95% CI, 2.044–4.844]) and a negative likelihood ratio of 30% (LR−, 0.216 [95% CI, 0.076–0.615]).ConclusionHigh sensitivity troponin I level was a good tool with a very high negative predictive value in significantly predicting in-hospital mortality among rRT-PCR positive COVID-19 patients.Funding AcknowledgementType of funding sources: None. ROC Curve

PFM-006 - A case report on the first documented case of Candida auris fungemia in a tertiary hospital in Philippines

PFM-006 - A case report on the first documented case of Candida auris fungemia in a tertiary hospital in Philippines

Evaluation of Macular Ganglion Cell Layer Thickness vs Peripapillary Retinal Nerve Fiber Layer Thickness for Glaucoma Detection Using Spectral-domain Optical Coherence Tomography in a Tertiary Philippine Hospital.

Aim and objectiveTo appraise the validity of measuring macular ganglion cell layer (mGCL) thickness as an indicator of early glaucoma, as compared to measurement of peripapillary retinal nerve fiber layer (pRNFL) thickness.Materials and methodsThis was a single-center, single-observer, cross-sectional, retrospective study. Records included Filipino adult patients seen from January 2017 onward. Patients underwent testing of both automated visual field (VF) testing with either Humphrey Visual Field Analyzer (24-2 SITA program) or Octopus 311 (G1 program), and standard Spectral-Domain Optical Coherence Tomography (Cirrus HD-OCT 5000). Modified Hodapp–Anderson–Parrish criteria were used to classify subjects as either healthy, suspect, or early glaucomatous eyes. Thickness changes were directly observed through optical coherence tomography. Area under receiver operating curve (AUC) analysis was used to determine ability of mGCL and pRNFL to discriminate between healthy and early glaucomatous states.ResultsA total of 96 eyes were included. Progressive thinning for all parameters was noted for both pRNFL and mGCL from healthy to suspect to early glaucomatous eyes. The highest AUC of 0.744 was seen in average pRNFL of healthy vs early glaucomatous eyes. However, AUC values for both pRNFL and mGCL were all above 0.500.ConclusionMeasurements of mGCL thickness in Filipino patients exhibit comparable performance to pRNFL measurements in detecting early anatomic glaucomatous change. It is a tool that can be utilized for early glaucoma detection in addition to current standard diagnostic tests.Clinical significanceThis study, the first to be performed on Filipino patients, validates using mGCL thickness as a good parameter in discriminating between normal and early glaucoma patients for this particular population and Ethnic group.How to cite this articleAquino LG, Aquino NM. Evaluation of Macular Ganglion Cell Layer Thickness vs Peripapillary Retinal Nerve Fiber Layer Thickness for Glaucoma Detection Using Spectral-domain Optical Coherence Tomography in a Tertiary Philippine Hospital. J Curr Glaucoma Pract 2020;14(2):50–56.

A pilot study on the effectiveness of Basic Emergency Obstetric and Newborn Care (BEmONC) training done at a tertiary hospital in Philippines from January 2015 to December 2016

A pilot study on the effectiveness of Basic Emergency Obstetric and Newborn Care (BEmONC) training done at a tertiary hospital in Philippines from January 2015 to December 2016

Diabetes Mellitus and Prediabetes in Patients with Hepatocellular Carcinoma in a Tertiary Philippine Hospital

BackgroundDiabetes mellitus (DM) has been shown to be associated with an increased risk for hepatocellular carcinoma (HCC). DM and obesity are coexisting conditions that can increase the risk and severity of nonalcoholic fatty liver disease (NAFLD), leading to HCC even in the absence of cirrhosis. With the rising incidence of HCC and DM worldwide, it is important to identify the clinical characteristics of individuals with DM among those with HCC in our local setting.ObjectivesTo determine the prevalence of DM among Filipino patients with HCC at our institution, determine their demographic and clinical profile, and compare the characteristics of HCC patients with and without DM.MethodologyThis is a retrospective, analytical, cross-sectional study involving patients with HCC seen at The Medical City’s Center for Liver Disease Management and Transplantation from January 2010 to December 2014. A chart review was conducted and patients were grouped according to the presence or absence of DM. Data on demographics, body mass index (BMI), comorbidities, social and family history, risk factors for liver disease, and laboratory test results were gathered. STATA 12.0 was used for data analysis.ResultsWe included 180 patients with HCC in the analysis. The prevalence of type 2 DM and prediabetes was 52.78%. The median age of patients with DM and prediabetes was 65 years, and 58 years for patients without DM (p=0.002). The average BMI was 27.35 + 4.68 for patients with DM, and 25.04 + 5.11 for those without DM (p=0.002). Among the patients without DM, 50.59% had hepatitis B virus (HBV) infection compared to 24.21% of patients with DM (p=0.000). Twenty one percent of patients with DM had cryptogenic cirrhosis compared to 8.24% of patients without DM (p=0.016). Patients with DM had a higher proportion of hypertension (66.32% vs. 42.35%, p=0.001) and dyslipidemia (48.42% vs. 10.59%, p=0.000).ConclusionThe prevalence of DM and prediabetes among HCC patients is higher in our institution compared to findings from previous studies. HCC patients with DM were older, and had increased BMI, higher proportion of hypertension and dyslipidemia, lower incidence of HBV infection, and higher incidence of cryptogenic cirrhosis.

Etiology and outcome of infants and children in a tertiary hospital in the Philippines with convulsive status epilepticus

Introduction: Among the paediatric neurological disorder, seizure ranks first. Status Epilepticus (SE) is a neurological emergency. It is associated with significant morbidity and mortality. The objectives of the presented study were to determine the clinical profile and outcome of status epilepticus in infant and children at a tertiary care hospital in Philippines. Methodology: It was a retrospective study conducted in Department of Pediatrics, National Children's Hospital, Quezon City, Philippines. All the patients in the age range 1 month to 18 years, admitted and diagnosed as cases of SE between January 2008 to December 2014 formed the sample size. Results: The seven-year average hospital based incidence of SE was 138.5 per 100,000 admissions. The most common underlying cause of SE was seizure disorder (29.89%), followed by bacterial meningitis (13.8%), and cerebral palsy (10.3%). Conclusion: Febrile SE is the common form of convulsive SE. There is high morbidity and mortality associated with SE.