Philippine Heart Center

ConclusionThis case illustrates the diagnostic challenge of UAPA in adults with atypical presentations.Comprehensive multimodality imaging is essential for accurate diagnosis and management planning.Early recognition is critical to prevent complications such as pulmonary hypertension and right-sided heart failure.

Background. While many studies compare early intervention versus delayed surgery in fragility hip fractures, there are few studies regarding the postoperative course of these patients. It is worth looking at the other side of the surgery to determine if an early discharge after hip fracture surgery is favorable.Methodology. This was a retrospective cohort study on elderly hip fracture patients. Subjects were classified into those discharged one to two days post-op (early discharge) and three to six days post-op (routine discharge). World Health Organization Quality of Life Brief version (WHOQOL-BREF) in Tagalog scores were taken at two weeks, six weeks, and twelve weeks post-operation. Complications or readmission related to the index surgery, patient satisfaction, and cost difference were also analyzed.Result. Sixty-two subjects were included in this study. WHOQOL-BREF scores of all subjects significantly increased up to 12 weeks of follow-up. Physical domain score in the WHOQOL-BREF was better in the early discharge group in the first six weeks only. Hospitalization costs for the two groups were not significantly different. No participant was readmitted due to complications of their index surgery. Most (73%) said they were Very Satisfied with their course of hospital stay, while 27% were Satisfied.Conclusion. This study shows that even in a low-resource setting, elderly hip fracture patients have good outcomes in terms of quality of life, have a high satisfaction rate, and no increased risk of post-op complications if discharged early.

Abstract Despite advances in heart failure management, treatment for acute decompensated heart failure (ADHF) remains largely unchanged. Loop diuretics are the mainstay for fluid overload due to their rapid onset and efficacy. However, insufficient decongestion, poor diuretic response, and resistance lead to suboptimal symptom relief, prolonged hospital stays, and increased mortality. Evidence suggests that adding acetazolamide to loop diuretics improves decongestion without escalating diuretic doses. However, limited data regarding its efficacy and safety preclude its incorporation in clinical guidelines. Objective: To determine the efficacy and safety of acetazolamide combined with loop diuretics in patients with ADHF. Methods: A systematic review was conducted to assess studies comparing loop diuretics alone versus with acetazolamide in ADHF patients. Eligible studies included prospective and retrospective observational studies, and randomized controlled trials. The primary outcomes evaluated were natriuresis, fluid balance, and weight loss. Secondary outcomes included rate of rehospitalization, all-cause mortality, and presence of adverse events. This review followed PRISMA-P guidelines. Data were analyzed using Review Manager Version 5.4.1. Statistical methods adhered to the Cochrane Handbook for Systematic Reviews of Interventions. Results: Six studies were selected from the initial 681 studies identified through the literature search. Analyses revealed acetazolamide supplementation significantly increased natriuresis by day 3 [SMD 0.68, 95% CI (0.32, 1.04), P=0.0002] and resulted in a more negative fluid balance [SMD -0.77, 95% CI (-1.23, -0.32) P=0.0008]. Weight loss [SMD 0.17, 95% CI, (-0.19, 0.53) P=0.36] was also higher in the acetazolamide group, but the effect was not statistically significant. In terms of safety, the all-cause mortality, rate of rehospitalization, and presence of adverse events were similar between the two groups. Conclusion: This study provides significant evidence regarding the clinical benefit of adding acetazolamide to standard loop diuretic therapy in decongesting patients with ADHF.

Pulmonary embolism (PE) remains a significant cause of cardiovascular mortality. Despite advancements in diagnosis and treatment, gender disparities in high-risk PE management and outcomes remain poorly understood. This study aimed to investigate gender-based differences in the presentation, treatment, and outcomes of patients with high-risk PE. We analyzed data from the National Inpatient Sample for patients with high-risk PE from 2016 to 2021. High-risk PE was defined as PE with cardiogenic shock, mechanical ventilation, mechanical circulatory support, or vasopressors. Multivariable logistic regression was used to examine gender-based differences in management and outcomes. Of 45,140 patients with high-risk PE, 51.4% were female. Female patients were older (mean age 65.2 vs. 63.4 years, p < 0.001) and more likely to present with cardiac arrest (35.4% vs. 30.4%, p < 0.001). After adjustment, females were more likely to receive systemic thrombolysis (aOR 1.17, 95% CI 1.11–1.23, p < 0.001) but less likely to undergo catheter-directed embolectomy (aOR 0.92, 95% CI 0.86–0.99, p = 0.034) or surgical embolectomy/thrombectomy (aOR 0.83, 95% CI 0.73–0.93, p = 0.002). Female patients experienced higher risk of all-cause mortality (aOR 1.22, 95% CI 1.18–1.27, p < 0.001) and major adverse cardiovascular and cerebrovascular events (aOR 1.21, 95% CI 1.16–1.25, p < 0.001). Significant gender disparities exist in the management and outcomes of high-risk PE. Female patients have higher mortality rates despite being more likely to receive systemic thrombolysis. Further research is needed to understand and address these disparities to improve outcomes for all patients with high-risk PE.

<bold>Background:</bold> Mechanical ventilation liberation is a critical process in the intensive care. Global tissue oxygenation plays a significant role in successful weaning and extubation. Literature suggests that indicators like venous oxygen saturation (VO₂) and hemoglobin (Hb) show a strong association with weaning outcomes. This study aims to assess the utility of changes in mixed venous oxygen saturation(delta-SVO₂) and hemoglobin(delta-Hb)during SBT as predictors of successful weaning and extubation. <bold>Methods:</bold> A prospective, cohort study was done at a cardiac center. Mechanically ventilated patients ≥19 years old with pulmonary artery catheters who were deemed ready for weaning were included in this study. Arterial blood gas, venous blood gas, and complete blood count were obtained before and after SBT. Participants were divided into weaning success and failure, and we observed the outcomes of their admission. <bold>Results:</bold> 85 patients were included,73% successfully passed the SBT, while 27% failed. The demographic and clinical characteristics showed no significant differences in age or gender distribution. Laboratory and clinical parameters were assessed pre and post-SBT. The failure group had longer MV and ICU days, and more likely needed NIV. Their mean Hb and SVO₂ pre and post-SBT were lower. Although SVO₂ (p=0.030) showed significant differences post-SBT, changes in Hb (p=0.461), were not significantly different. The diagnostic performance of delta-Hb and delta-SVO₂ as predictors of SBT success was poor, with ROC area values of 0.4719 and 0.4860,respectively. These results show that neither change in Hb nor SVO₂ is a good predictor for MV weaning and extubation.

Abstract Objective: This study described childhood interstitial lung disease (chILD) profiles at the Philippine Children’s Medical Center (PCMC) between 2013 and 2022. Materials and Methods: A retrospective chart review at PCMC analyzed pediatric interstitial lung disease cases from January 2013 to December 2022. The patients aged 0–18 years with children were included in the study. Those with specific conditions were excluded from the study. Data included clinical course, tests, therapeutic management, and short-term outcomes based on a previous study. Results: Twenty-three patients were included in this study. Most (52.17%) were diagnosed between 2013 and 2017, and were within the ages of 0–2 years. The majority of the patients had normal nutritional status (52.17%). Common clinical presentation on admission included breathing difficulties, with chest retractions, crackles, and hypoxemia. Few had a family history of chronic lung disease. Comorbidities included pulmonary hypertension (30.43%) and pulmonary tuberculosis (21.74%). Chest radiography revealed infiltrates in all cases, and high-resolution computed tomography (HRCT) scans showed ground glass opacities in 82.61%. Prednisone was the primary treatment (86.96%). Lung biopsy results (43.48%) were mostly unclassified or nondiagnostic, with lymphoid interstitial pneumonia as the predominant diagnosis (20%). Improvement of signs and symptoms was seen in 39.13% of cases, whereas death occurred in 21.74%. Furthermore, the outcome remained undetermined in as many as 34.78% of cases due to inadequate follow-up. Conclusion: This retrospective study emphasizes chILD’s prevalence in infants under 2 years, with male predominance. Nutritional variations underscore the need for supplementation. Various common signs include crackles, retractions, and hypoxemia, with breathing difficulty as a frequent symptom. The diagnostic process involves imaging and ancillary tests, advocating a systematic approach with noninvasive methods like chest radiograph and HRCT, reserving lung biopsy for inconclusive cases. Corticosteroids, whether used alone or in combination, prove beneficial in managing chILD by suppressing inflammation.

Stroke prevention in patients with non-valvular atrial fibrillation (NVAF) is a public health priority in the Philippines. This paper aims to assess the existing gaps in stroke prevention and management for patients with NVAF in the Philippines. It focuses on identifying stroke risk, evaluating barriers to care, and ensuring treatment adherence. Barriers such as financial constraints, lack of awareness, and difficulties in accessing healthcare facilities hinder timely diagnosis and proper management. Despite the availability of stroke-ready hospitals, gaps in stroke care infrastructure, including a shortage of specialized healthcare professionals, continue to affect patient outcomes and delay intervention. To improve stroke prevention in patients with NVAF, a comprehensive strategy is needed. This approach should focus on enhancing healthcare infrastructure, expanding public and healthcare provider education, and addressing disparities in care. Furthermore, ensuring access to effective pharmacological options is essential. Non-vitamin K oral anticoagulants, which may be more suitable for resource-limited settings, offer advantages such as reduced risk of bleeding and minimal monitoring requirements. A patient-centric approach that prioritizes adherence and access to pharmacological treatments can help reduce the stroke burden and improve long-term outcomes for patients with NVAF in the Philippines.