Philippine Medical Association

Butuan City, Philippines, is prone to seismic events due to its proximity to numerous earthquake generators, resulting in a range of hazards such as liquefaction. This study investigates the liquefaction potential in Caraga State University - Main Campus by analyzing the PF: Surigao and PF: Esperanza segments, an unnamed fault west of Butuan City, and the Philippine Trench. The maximum magnitudes Mw 7.4, Mw 7.1, Mw 6.5, and Mw 8.1, respectively, along with the minimum recorded Mw 5.1, which triggered liquefaction in the Philippines, were considered. A deterministic approach was employed to calculate ground attenuation values. Electrical resistivity tomography (ERT) profiles identified areas prone to liquefaction using resistivity meters, and borehole data were used to calculate the liquefaction potential index (LPI). The calculated LPI varies with the earthquake magnitude and PGA, ranging from high (5-15 LPI) to very high potential (>15 LPI) based on maximum magnitudes and low to no liquefaction based on the smallest magnitude. These findings underscore the need for effective mitigation strategies to reduce the potential damage caused by liquefaction in the study area.

The Kochi Declaration 2024 (resulting from the International Leadership Summit of Medical Associations) marks a significant step in global TB elimination efforts. By emphasising private sector engagement, it addresses critical gaps in TB care delivery, particularly in high-burden countries where 60%–80% of patients initially seek care from private providers. This initiative aligns with the WHO’s public–private mix approach, enhancing case detection, treatment quality, and global health equity. It underscores the potential of collaborative strategies to accelerate progress towards a TB-free world by 2030, aligning with United Nations High-Level Meeting targets and broader global health goals.

Robotic surgery has revolutionized modern surgical practices, expanding across multiple specialties due to its precision, reduced invasiveness, and improved patient outcomes. Initially dominated by the da Vinci system, the field has recently seen an influx of new robotic platforms, presenting challenges in training and adaptation for surgeons and surgical teams. The transition to diverse robotic systems necessitates a structured educational framework to ensure competency across varying platforms. This article explores the evolving landscape of robotic surgery, emphasizing the need for a comprehensive training methodology. A qualitative analysis of expert and novice perspectives identified three key domains for robotic surgery education: (1) Foundational Competence, which includes platform-specific training, ergonomics, teamwork, and emergency protocols; (2) Surgical Competence, focusing on systematic procedural training and stepwise surgical execution; and (3) Task-Based Micro-Competence, addressing fundamental skills like hemostasis, lymph node dissection, vascular control, bowel mobilization, and robotic suturing. The framework highlights the importance of platform-specific technical skills, team dynamics, and cognitive ergonomics to enhance surgical efficiency and patient safety. Additionally, it underscores the necessity for standardized training methodologies adaptable to diverse robotic systems. The study advocates for incorporating simulation-based learning, modular training, and emergency drills into robotic surgery education to bridge the gap between traditional and robotic-assisted techniques. As robotic surgery continues to evolve, the proposed structured training approach ensures surgeons and surgical teams are equipped with the skills required to navigate various platforms, optimize patient outcomes, and advance the field of robotic-assisted surgery.

Abstract Background and Aims Diabetes insipidus (DI) typically causes hypernatremia, but in rare cases like Paragonimiasis, which can lead to eosinophilic granulomatosis and result in syndrome of inappropriate antidiuretic hormone secretion, hyponatremia can occur even in the presence of DI. Method We present a case of a 37-year-old cachectic Filipino female with a history of possible resistant tuberculosis (TB). Despite extensive treatment, her condition did not improve, leading to admission due to severe pulmonary distress. During her hospital course, she experienced chronic polyuria, and her serum sodium levels remained low-normal, with episodes of hyponatremia. Due to inadequate clinical response to treatment, further investigation ultimately confirmed Paragonimiasis as the underlying etiology. Results Upon admission, a complete blood count revealed leukocytosis with a predominance of neutrophils and a significantly elevated eosinophil count. A high-resolution chest CT scan was subsequently performed, revealing multiple small non-calcified and calcified nodules scattered throughout both lungs. Additionally, ground-glass opacities were noted in the right lower lobe and left lung, suggesting pulmonary granulomas and fibrosis secondary to a prior inflammatory process, along with associated bilateral cicatricial atelectasis, bullous changes, air trapping, and a possible lung abscess. To address the underlying pneumonia, infected bullae, and possible lung abscess, the patient was started on a regimen of vancomycin and amikacin for 7 days, followed by ertapenem, which she completed over several months. Endobronchial aspiration was recommended for further evaluation at a specialized facility; however, due to unavailability of intensive care unit beds for potential resistant TB, transfer to another institution was not feasible. Despite aggressive antibiotic therapy, the patient continued to experience a productive cough, hemoptysis, and intermittent dyspnea. Given the CT scan findings, the possibility of pulmonary TB remained a differential diagnosis. The patient presented with significant polyuria, with urine output measured between 4.8 to 5.6 cc/kg/day. This polyuria contributed to her hypotension secondary to dehydration, necessitating continuous fluid resuscitation. Notably, despite episodes of polyuria, serum sodium levels remained low, ranging from 130 to 135 mmol/L. Urine biochemical analysis revealed a urine osmolality of only 171 mOsm/kg H2O and a urine specific gravity of 1.005, leading to a diagnosis of DI. Random serum osmolality was recorded at 287 mOsm/kg H2O. The presence of polyuria and elevated serum osmolality, despite relatively high basal level of vasopressin, suggests a diagnosis of nephrogenic DI. Given the persistence of symptoms and lack of response to treatment, further diagnostic workup was done, including testing for paragonimiasis, a parasitic infection caused by lung flukes. This parasitic infection can manifest with pulmonary symptoms that may be easily misdiagnosed as other respiratory illnesses, such as tuberculosis. Paragonimiasis is a globally prevalent but underrecognized disease, predominantly affecting regions in East Asia, particularly the Philippines, as well as endemic areas in Africa and South America. The diagnostic test confirmed the presence of the infection. Therefore, the patient was promptly treated with praziquantel at a dosage of 600 mg every 8 hours, specifically 2 tablets in the morning and 1 tablet at lunchtime and in the evening for 2 days. Following this treatment, the patient exhibited significant clinical improvement, including a marked reduction in polyuria, and was subsequently discharged. Conclusion This case highlights the importance of considering atypical infectious etiologies, such as Paragonimiasis, in patients with respiratory distress and eosinophilia, especially when standard tuberculosis treatments fail. The resolution of her symptoms following targeted therapy for Paragonimiasis emphasizes the importance of thorough diagnostic evaluations in challenging medical cases.

Background:Information on pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and adverse outcomes in the Philippines is limited particularly in primary care settings.Objectives:This study aims to assess the nutritional status of Filipino women in early pregnancy, their GWG, and associated outcomes.Design:This prospective study included 176 Filipino pregnant women aged 15–49 years, recruited from 35 locations between October 2021 and December 2022.Methods:Measured weight was recorded in the mother–infant booklet by midwives as reported by pregnant women through phone interviews. Weight during the first prenatal visit (<15 completed weeks) was considered the pre-pregnancy weight (PPW). Pre-pregnancy BMI was calculated using the World Health Organization and Centers for Disease Control and Prevention classifications. Total GWG (tGWG) was determined by subtracting PPW from the weight measured at the last prenatal visit, assessed according to the 2009 Institute of Medicine (IOM) recommendations, and analyzed using logistic regression. Dietary intake was assessed using the standardized 24-h food recall method.Results:Of the study participants, 15.3% were underweight, 56.8% normal, and 27.8% overweight/obese. The mean tGWG was 9.0 ± 4.9 kg, with most women having a tGWG below the 2009 IOM recommendations. Overweight and obese women had nearly three times the odds of having a cesarean section (odds ratio [OR] 2.85 (95% confidence interval [CI] 1.14–7.13), p = 0.025), while those whose gestational weight gain was below the IOM recommendations had significantly lower odds of having such a procedure (OR 0.24 (95% CI 0.09–0.67), p = 0.007).Conclusion:Total GWG varies by pre-pregnancy BMI, with many Filipino women not meeting the 2009 IOM recommendations for GWG, yet without negative outcomes. These findings indicate that lower GWG may be typical among Filipino women. From the outcomes studied, only the rate of cesarean sections and having a GWG below the 2009 IOM recommendations reached statistical significance. This highlights the need for further evaluation of the 2009 IOM recommendations for Filipino women through well-designed prospective studies.

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.