Acta Medica Philippina最新文献

Objective: This study aimed to determine the incidence of encephalopathy among hospitalized patients with COVID-19.

Methods: This was a retrospective observational study conducted in a tertiary hospital in Cebu City, Philippines. This study is a complete enumeration of all records of adult patients admitted for COVID-19 detected through polymerase chain reaction from March 1, 2020 to September 30, 2021. The cases were then classified as to the presence or absence of encephalopathy.

Results: The study determined that 6 in every 1000 admitted COVID-19 patients developed encephalopathy. The clinico-demographic profile of patients with encephalopathy were mostly elderly with a mean age of 67, males (55.7%), and obese stage I (61.1%). Encephalopathy was more likely to develop in patients with type 2 diabetes mellitus (80.1%) and coronary artery disease (40.0%). Most patients who did not have encephalopathy however had a history of CVD. Most patients (66.7%) who developed encephalopathy were dyspneic on presentation. Laboratory examination results showed an increase in fasting blood sugar and elevated levels of LDH, CRP, serum ferritin, procalcitonin, and D-dimer. Majority of patients (66.7%) with encephalopathy were intubated. Taking into consideration the stage of infection and the incidence of encephalopathy, most patients (66.6%) were in the hyperinflammatory stage. The number of hospitalization days and severity of illness did not have any association with developing encephalopathy. Dichotomous categorization of outcomes into deceased and discharged showed that clinical outcomes and the development of encephalopathy were significantly associated, with 66.7% of patients with encephalopathy expiring during their course of hospitalization.

Conclusion: The incidence of encephalopathy among admitted COVID-19 patients was 6 in every 1000 patients. Encephalopathy was more common in elderly males who were obese with type 2 diabetes mellitus and coronary artery disease. The most common presentation of patients who developed encephalopathy was dyspnea. Collated laboratory results showed an increase in fasting blood sugar and elevated levels of LDH, CRP, serum ferritin, procalcitonin, and D-dimer. Majority of patients with encephalopathy were intubated and were in the hyperinflammatory stage of COVID-19 infection. Dichotomous categorization of outcomes into deceased and discharged showed that clinical outcomes and the development of encephalopathy were significantly associated, with most patients with encephalopathy expiring during their course of hospitalization.

Objectives: The aim of this study is to establish a Reversed Phase - High Performance Liquid Chromatographic (RP-HPLC) method for the quantification of Rhein from Cassia fistula L. leaves.

Methods: A Shimadzu system equipped with a C18 Column (150 x 4.6 mm, 5 μm) with an isocratic elution of Acetonitrile (solvent A) and 0.1% trifluoroacetic acid aqueous solution (solvent B) (Merck, 1.08178.0050) with a 55:45 ratio, respectively and a flow rate of 1.0 mL/min and sample injection of 10 μL detection was done at 230 nm. Standard solution of Rhein (Chengdu Biopurify) was prepared for method development. This study was validated using the guidelines set under "ICH Topic Q2 R2 or the Validation of Analytical Procedures". Procedures for linearity, precision, accuracy, limit of detection, and limit of quantitation were performed.

Results: The retention time of Rhein standard was determined at 5.10 minutes. LOD and LOQ were determined to be 1.278 mcg/mL and 3.872 mcg/mL, respectively with good linearity (R2 ≥0.996) with a linear range of 2.5-20 ug/mL of the Rhein standard. The accuracy of the method was determined based on % recovery method and ranged from 94.75%-100.32% (intraday, n=3) with %RSD of 0.71. The intraday precision %RSD was 2.92 (n=6) while interday precision %RSD was 3.75 (n=3). The method was able to check the Rhein quantity among 10 samples of Cassia fistula L. leaves from different locations in the Philippines.

Conclusion: The method was found to be sensitive and accurate for the quantification of Rhein. The method was found to be useful for the quantification of the amount of Rhein and can be used as a Quality Control tool for the assessment of Cassia fistula.

Background and objectives: Intraperitoneal injection (i.p.) of D-galactose (D-gal) accelerates aging and develops aging models. A low dose of long-term use and a high dose of short-term use of D-gal can induce natural aging in mice, like brain, cardiac, liver, renal, and skin aging, and erectile dysfunction. Our research aims to determine whether a high dose of short-term use of D-gal. i.p. in rats can induce natural aging and affect the following parameters: body weight (BW), Superoxide Dismutase (SOD), Vascular endothelial growth factor (VEGF), C-reactive protein (CRP), and myostatin.

Methods: A daily D-gal i.p. dose of 300 mg/ml/kg for seven days was carried out to induce aging parameters in the rats. After seven days, the body and gastrocnemius circumference of the rats were weighed, and biochemical analysis for SOD, VEGF, CRP, and myostatin in the blood plasma was done.

Results: The data obtained were analyzed using nonparametric statistics Friedman test and Mann-Whitney test. After the seven day-intervention, both the control (NaCl 0.9% i.p.) and the high dose of short-term use of D-gal i.p. groups showed no significant difference in the body weight and gastrocnemius circumference. However, D-gal administration could increase the blood plasma level of SOD, VEGF, CRP, and myostatin.

Conclusion: We conclude that a high dose of short-term intraperitoneal D-galactose can be administrated to induce aging in rat models. The SOD, VEGF, CRP and myostatin can be used as aging parameters.

Background: Medicinal plants are widely used for healthcare needs, including oral health. In the Philippines, garlic, guava, tsaang-gubat, and hierba buena, although primarily recognized as plants used for the treatment of systemic diseases, are indicated as analgesics for dental pain, treatment of gingival inflammation, and oral health maintenance. Despite studies focusing on the effectiveness of these plants for oral health, there is little to no research on the populace's knowledge, attitude, and practices on these medicinal plants.

Objectives: The study aimed to determine the knowledge, attitude, and practices of Oral Medicine patients from a dental college in Manila on four medicinal plants (garlic, guava, tsaang-gubat, and hierba buena) for oral health.

Methods: A descriptive study design was used. Oral Medicine patients (694) were invited to participate in the study through daily text messages containing brief research details. The link to the three-part online questionnaire (Google Forms) was sent via text and Facebook messages, and was answerable within 15-20 minutes.

Results: Two hundred fourteen (214) Oral Medicine patients participated, with 147 (68.69%) having knowledge on using medicinal plants for oral health which they mostly knew through friends and acquaintances. Most participants had a generally positive attitude toward medicinal plants for oral health and believed they were beneficial (177, 82.71%), safe, effective, and cheaper than conventional medicine (175, 81.78%), and accessible (171, 79.91%). Only 64 (29.91%) personally used medicinal plants to address their oral health conditions. Garlic (144, 97.96%) was the most widely known and used, followed by guava (52, 35.37%), hierba buena (12, 8.16%), and tsaang-gubat (4, 2.72%).

Conclusion: Most participants were knowledgeable with a generally positive attitude toward the four medicinal plants for oral health but did not use these to address their oral health problems.

Objectives: This study sought to investigate citizens' awareness, availment, satisfaction, and perceived need for action with health services offered by a rural municipality in Samar, Philippines.

Methods: This study utilized an explanatory-sequential research design, involving 150 participants selected through the Kish Grid Method via a multi-stage sampling approach within the community. The Citizen Satisfaction Index System was employed to assess the levels of awareness, utilization, and satisfaction with health services in the municipality.

Results: Among the assessed health services, the cohort had low awareness and low availment on services for communicable diseases, basic dental/oral hygiene, and reproductive health. While high awareness was observed for childbirth services, there was low availment on these. The participants showed high awareness and availment for only two services namely, free general consultation and the free medicine program. While high satisfaction was seen among all services that were assessed, the participants also expressed a high perceived need for action to improve their delivery.

Conclusion: This study presents a comprehensive view of rural healthcare in Samar, Philippines. Despite high satisfaction rates, gaps persist in the citizen's awareness and availment due to accessibility, costs, fear, misinformation, and cultural differences. The findings of this study can guide policymakers in identifying gaps in healthcare in rural areas.

Objectives: The present study explored the experiences of caregivers raising a child with perinatal HIV infection through a narrative inquiry approach. It uncovered how caregivers learned about their children's diagnosis, the challenges that they experience in raising their children, and how they cope with the ordeal caused by HIV infection.

Methods: A total of ten participants joined the study - five caregivers participated in the key informant interviews (KIIs), with their respective child diagnosed to have perinatal HIV infection joining the focus group discussion (FGD) (n=5). Semi-structured individual interviews were carried out to examine in-depth narratives from the caregivers. We thoroughly analyzed the verbatim interview transcripts using reflexive thematic analysis (RTA) by the six-phase process outlined by Braun and Clarke (2019). NVivo 12 was utilized in the process of data analysis. The transcribed data were uploaded, coded, and analyzed individually. The software helped the organization and expression of the codes and themes.

Result: In this study, three major themes and four sub-themes in each theme were generated: a) becoming known: the journey towards testing and treatment, which includes reasons for testing, cause of acquiring HIV, reactions, and treatment, b) passing through challenging times, which cover preparing the child to understand illness, child's awareness and understanding of illness, physical health, and discrimination, and c) receiving essential support which includes an understanding of illness, building hope, needs received, and sources of support.

Conclusions: Caregivers with children living with HIV face challenges such as preparing the illness to be known and understood by their child, managing the child's physical health, and discriminating against others. However, they can live healthy and meaningful lives if they are given comprehensive support from the government, access to quality healthcare and education, and psychosocial interventions. The government and private sectors must make efforts to promote physical, emotional, and mental health care underpinning the well-being of caregivers and children with HIV. The retention of the programs offered by certain organizations (e.g., testing and treatment needs, nutritional and basic needs support, educational supply, and livelihood program for caregivers) and the increase in the number of psychoeducational and support group activities were suggested to significantly help in addressing the concerns of both caregivers and their child with perinatal HIV infection.

Objectives: This study aimed to describe the roles and responsibilities of doctors and nurses in managing conditions like hypertension and diabetes in rural areas.

Methods: This study employed a cross-sectional study design using the task analysis methodology. A self-administered questionnaire derived from a national health practice guideline was used. A combination of frequency, criticality, and performance was assessed to identify tasks that needed attention by educators and policymakers.

Results: Of the 142 health workers who participated in the study, 81% were nurses and 19% were doctors. The tasks most frequently performed by these professionals were taking vital signs (88.7%), recording patient history (87.3%), and advising patients on regular follow-ups (86.6%). In terms of criticality, the top three tasks were performing diagnostic tests for acute chest pain (50.8%), diagnosing neurological disorders (49.2%), and referring patients for specialized tests at other facilities (43.6%). However, the tasks perceived as most challenging or outside their capability were the Fagerstorm test for assessing nicotine dependence (57.5%), the AUDIT tool for identifying binge drinkers (55.5%), and fundoscopy for diagnosing diabetic retinopathy (54%).

Conclusion: The primary care practice of the participants typically involved tasks that are centered on health promotion or disease prevention. Many of the tasks are shared by doctors and nurses, with some highly critical tasks performed less frequently due to a lack of training. Pre-service courses may need to be revised to ensure that health professionals have the required skills to carry out shared tasks.

Objectives: PhilHealth's present health benefit scheme is largely centered on in-patient services. This inadvertently incentivizes hospital admissions for increased access to benefit coverage. To address this problem, this study proposes a costing method to comprehensively finance outpatient care. The objective of this paper is to estimate an annual primary care benefit package (PCBP) cost based on experience analysis (actual benefit usage) on the first year of implementation at an urban pilot site.

Methods: A cost analysis was conducted to assess a disease-agnostic primary care benefit package for an urban outpatient government facility over the first year of implementation. Costing information was gathered through staff interviews, accounting documents, and usage data from the electronic health records system available on-site.

Results: The annual primary care cost was defined as the estimated financial coverage for eligible employees and their eligible dependents (n=15,051). The annual utilization rate for consultations was reported at 51%. Of patients who consulted, approximately 38% accessed free available diagnostic procedures and 48% availed of free available medicines. Based on these usage rates, the annual primary care cost for the first year was computed at PhP 403.22 per capita.

Conclusion: Our study shows that on the first year of coverage in a government run urban outpatient facility, an allocation of PhP 403.22 per capita can allow coverage for a disease-agnostic package (comprehensive); this amount excludes out-of-pocket expenses incurred by the target population of this study. This amount is feasible only when co-opted with opportunistic registration, reduction of untargeted check-ups, prior contextual community engagement, and streamlining of patient-transactions through an electronic health record (EHR).