Philippine General Hospital

Diabetic macular oedema (DMO) is a leading cause of visual impairment globally. The COVID-19 pandemic significantly disrupted routine clinical care, including regular intravitreal therapy (IVT) for DMO. This study analysed real-world data from patients whose treatments were deferred due to the pandemic 18 months post-disruption. Patients scheduled for initiation or continuation of aflibercept IVT for DMO at a single centre during the March 2020 lockdown were identified and recruited. Clinical data were collected from January 2019 until September 2021. The primary outcome was best corrected visual acuity (BCVA) at the final visit and its predictive factors. A total of 416 eyes from 416 patients were included (random eye/patient). The mean interval between injections increased significantly during the pandemic, with worsening of mean logMAR BCVA [55 days in 2019 (range 25-302), BCVA 0.36; 86 days in 2020 (range 21-681), BCVA 0.41; and 84 days in 2021 (range 24-885), BCVA 0.45]. However, there was no significant difference when comparing mean BCVA at baseline (0.42 ± 0.3) and final visit (0.41 ± 0.3). Significant predictors of final BCVA included baseline BCVA (0.059 logMAR increase per 0.1 logMAR baseline increase, p < 0.001), follow-up duration (0.038 logMAR increase per additional 6 months, p < 0.001), age at baseline (0.037 logMAR increase per decade, p = 0.001), and ethnicity (White ethnicity had 0.061 logMAR better BCVA compared to non-White groups, p = 0.04). Extended intervals between aflibercept injections during COVID-19 did not independently predict worse visual outcomes. Baseline BCVA, age, and ethnicity were significant predictive factors.

Abstract Background: Schistosomiasis has long been endemic in South Cotabato. Fourteen barangays in Koronadal City and Tantangan, covering over 82,000 people at risk, had received more than a decade of mass drug administration with praziquantel when a focal prevalence survey was conducted in 2016. The survey aimed to update local prevalence estimates, document other helminth infections, and assess the Kato–Katz technique. National data since then have shown declining prevalence in many endemic areas, although persistent animal reservoirs continue to be reported. As the Department of Health pursues transmission interruption by 2025, reporting the 2016 findings remains important for assessing progress and guiding elimination strategies. Methods: Individuals aged 5-65 years from households selected through stratified cluster sampling were invited to submit stool specimens. Local medical technologists were recruited and trained to conduct parasitologic assessment using Kato-katz technique. Each specimen from the 4,387 samples (2,344 from Koronadal and 2,043 from Tantangan) was tested for the presence of Schistosoma japonicum , soil-transmitted helminths, and other intestinal parasite ova. The sensitivity of the field testing was determined through validation of the slides by reference microscopists of the College of Public Health/National Institutes of Health, University of the Philippines Manila. Results: No schistosomiasis cases were detected in Koronadal City. In Tantangan, nine cases were identified in four barangays, corresponding to a prevalence of 3.6 per 1,000 population (95% CI: 1.7–7.8 per 1,000). After adjustment for sampling weights and non-response, the combined prevalence for both municipalities was 0.098%. One barangay, New Lambunao (1.87%), exceeded the &lt;1% near-elimination threshold. Eight infections were of light intensity and one was moderate; no heavy-intensity infections were detected. Soil-transmitted helminths were also identified, with Ascaris lumbricoides (7.29%) being most prevalent. Validation showed high specificity (&gt;98%) and sensitivity of 88.9% for schistosomiasis. Conclusion: The 2016 focal survey demonstrated very low schistosomiasis prevalence in South Cotabato following long-term MDT, with most endemic barangays meeting the &lt;1% near-elimination threshold. However, given the limitations of Kato–Katz in low-intensity settings and the potential influence of post-treatment timing on egg detection, updated focal surveys incorporating more sensitive diagnostic tools are recommended. Strengthened surveillance, integrated helminth control, and a One Health approach will be essential to verify transmission status and guide decisions on sustaining or modifying MDA as the country works toward its 2025 elimination goal.

Background. Continuing Medical Education (CME) serves as a cornerstone for maintaining clinical competence and improving patient care. In the Philippines, CME has become increasingly digital, with the UP Med Webinars emerging as a leading platform for physician education over the past decade. Despite this growth, there has been limited evaluation of how well these webinars align with national health priorities, particularly those reflected in PhilHealth hospital admissions and claims data, which provide insights into the country's disease burden and healthcare utilization patterns. Objectives. This study aimed to determine the extent to which the topics and reach of UP Med Webinars correspond with the Philippine health system’s most pressing clinical demands. Specifically, it aimed to analyze the trend in number of webinars by year; analyze the distribution of webinar topics by medical field; assess physician attendance as a proxy for clinical interest and engagement; evaluate the alignment between UP Med Webinar content and national health priorities based on PhilHealth’s top conditions, procedures, and reimbursed claims. Methods. The study used a qualitative content analysis of all Continuing Professional Development (CPD)-accredited UP Med Webinars from 2015 to 2024, supported by descriptive statistics. Webinar titles were coded thematically and categorized by topic and medical field. Attendance figures were analyzed to identify high-demand topics. These results were compared with PhilHealth Claims Reports (2020–2024), focusing on the top reimbursed medical diagnoses and procedures, to assess alignment with disease burden and health service delivery trends. These findings can help inform strategic planning for CME programs to ensure they remain responsive to the country's evolving public health needs. Results. From 2015 to 2024, a total of 686 CPDaccredited UP Med Webinars were conducted, attended by 685,994 participants. The annual number of webinars and attendees steadily increased, peaking during the COVID-19 pandemic (2020–2022) with heightened demand for virtual CME and pandemic-related topics. Internal Medicine consistently emerged as the most frequently covered field, accounting for 54.1% of webinars and 48.8% of total attendance, followed by Obstetrics and Gynecology (14.4% of webinars; 19.6% of attendance) and Pharmacotherapeutics (6.0% of webinars; 6.9% of attendance). Certain fields, including COVID-19 and Psychiatry, attracted disproportionately high attendance despite fewer sessions, indicating strong interest during periods of public health urgency. The top 10 webinar topics included Diabetes, Pregnancy, Cancer, Hypertension, Reproductive Health, COVID-19, Heart Disease, Antimicrobial Treatment, Vertigo, and Vaccination, reflecting a mix of chronic disease management, maternal health, infectious diseases, and emergent health concerns. Comparison with PhilHealth claims data (2020– 2024) revealed a high disease burden in Internal Medicine, Obstetrics, and Pediatrics, with top medical conditions including Pneumonia, Dengue, Hypertensive emergencies, and Stroke. These findings indicate a strong alignment between the most covered webinar topics and national healthcare utilization trends, particularly in high-burden clinical areas. Conclusion. Findings suggest that the UP Med Webinars have generally aligned with national health priorities, as indicated by PhilHealth claims data, particularly in highburden fields such as Internal Medicine and Obstetrics. However, gaps in coverage for certain high-priority conditions and procedures point to opportunities for more inclusive and data-driven CME planning. Aligning CME content with evolving health system needs can enhance its relevance, support clinical practice improvements, and ultimately contribute to better population health outcomes in the Philippines.

Abstract Propofol is a widely used intravenous anesthetic agent known for its anticonvulsant properties and off-label use in refractory status epilepticus. However, paradoxical excitatory manifestations, collectively termed seizure-like phenomena (SLP), have been documented despite their central nervous system-depressant profile. These reactions are rare and often under-recognized. We report a case of a 28-year-old male with a remote history of spinal cord compression but no prior seizures, who developed seizure-like activity immediately after propofol administration during induction of general anesthesia for cystolithotomy. The episode was characterized by upward rolling of eyeballs, stiffening of extremities, generalized tonic–clonic seizures, and decorticate posturing, which resolved spontaneously. A second episode occurred during patient positioning, prompting the postponement of surgery. Laboratory tests, blood gases, and imaging revealed no metabolic or intracranial pathology. The patient was referred to the neurology service, which suggested a propofol-induced etiology in the absence of other causes. One week later, the procedure was completed under general anesthesia without propofol, and no recurrence of seizure-like activity was observed. Proposed mechanisms include modulation of GABAergic and glycinergic neurotransmission and suppression of cortical excitatory signals. The absence of seizure recurrence when propofol was avoided supports a likely causal relationship. This case underscores that although propofol is predominantly anticonvulsant, it may paradoxically induce SLP even in neurologically intact patients.

Following the implementation of the Sin Tax Reform Law of 2012 and the Graphic Health Warning Law of 2014 in the Philippines, this study assessed the knowledge on smoking and its related laws, described attitudes towards smoking, graphic warnings, excise tax, and government intervention, and explored self-reported smoking behaviors and factors influencing these. Convergent mixed-methods study. A total of 393 survey respondents and 30 in-depth interviewees were recruited, both from outpatient clinics of a tertiary-level university hospital and a primary-level urban health center. Descriptive statistics were obtained from quantitative data, and a Chi-square test was done to compare types of smoking behaviors. Thematic analysis by extracting codes and grouping into themes was done for qualitative data. Respondents included 249 (63%) never smokers, 60 (15%) former smokers, 59 (15%) quit attempters, and 25 (6%) persistent smokers. Never smokers, former smokers, and quit attempters had better knowledge and more positive attitudes compared to current smokers. Having a family or community member suffering from a smoking-related illness might have significantly shaped the decision to avoid or quit smoking. While both excise taxes and graphic warnings helped in smoking cessation and deterrence, addiction was a major barrier, causing respondents to ignore health and cost-related information about smoking, as well as the graphic warnings. The laws were effective in preventing smoking initiation among never-smokers and in supporting cessation among former smokers and quit attempters. For current smokers, the laws still served as important deterrents, but multi-level strategies may be needed to promote smoking cessation.

Abstract Background The diagnostic accuracy of HbA 1C for prediabetes has been questioned due to its discordance with fasting plasma glucose (FPG) and 2 h oral glucose tolerance test (OGTT) glucose in non-white populations. This study aims to estimate concordance in the diagnosis of prediabetes using HbA 1C FPG, and OGTT in a Filipino-American cohort. Methods Cross-sectional data from 149 Filipino-Americans without known diabetes living in the San Francisco Bay Area were used to compare prevalence of prediabetes as diagnosed by HbA 1C, versus diagnosis by FPG and OGTT. Results Thirty nine percent of subjects met the diagnosis of prediabetes using any one of the measures. Overall agreement between HbA 1C , FPG and OGTT was low. Prevalence was 8.1% by FPG, 8.7% by OGTT and 35% by HbA 1C . BMI, waist-hip ratio, insulin, HOMA-IR, blood pressure, and triglycerides were significantly higher in those with prediabetes by HbA 1C versus normal HbA 1C . Conclusions There is significant discordance between HbA 1C , FPG, and OGTT in diagnosing prediabetes in a Filipino-American cohort. HbA 1C detected four times as many individuals with prediabetes than FPG or OGTT. Individuals classified with prediabetes by HbA 1C had indicators of more insulin resistance compared to individuals with normal HbA 1C suggesting that HbA 1C appears to detect true metabolic abnormalities on the path to diabetes as opposed to detecting false positives. These results have important implications for diabetes and prediabetes screening in Filipinos.