Predictors of 30-day unplanned hospital readmissions among maintenance dialysis patients

Background and Objectives@#Patients on dialysis are twice as likely to have early readmissions. This study aimed to identify risk factors for 30-day unplanned readmission among patients on maintenance dialysis in a tertiary hospital.@*Methods@#We conducted a retrospective, unmatched, case-control study. Data were taken from patients on maintenance hemodialysis admitted in the University of the Philippines–Philippine General Hospital (UP-PGH) between January 2018 and December 2020. Patients with 30-day readmission were included as cases and patients with >30-day readmissions were taken as controls. Multivariable regression with 30-day readmission as the outcome was used to identify significant predictors of early readmission. @*Results@#The prevalence of 30-day unplanned readmission among patients on dialysis is 36.96%, 95%CI [31.67, 42.48]. In total, 119 cases and 203 controls were analyzed. Two factors were significantly associated with early readmission: the presence of chronic glomerulonephritis [OR 2.35, 95% CI 1.36 to 4.07, p-value=0.002] and number of comorbidities [OR 1.34, 95% CI 1.12 to 1.61, p-value=0.002]. The most common reasons for early readmission are infection, anemia, and uremia/underdialysis. @*Conclusion@#Patients with chronic glomerulonephritis and multiple comorbidities have significantly increased odds of early readmission. Careful discharge planning and close follow up of these patients may reduce early readmissions.

Peritoneal dialysis for refractory heart failure from a congenitally corrected transposition of the great arteries who has not undergone definitive surgery: A case report

@#Heart failure (HF) is a major cause of significant morbidity, mortality, and hospitalization worldwide including the Philippines. Congenitally corrected transposition of the great arteries (C-TGA) occurs when the right atrium enters the morphological left ventricle which gives rise to the pulmonary artery and the left atrium communicates with the right ventricle which gives rise to the aorta. Heart failure can occur in C-TGA especially if associated with other heart defects. Ideal management is anatomic correction via surgery to prevent or address heart failure. Peritoneal dialysis has been used as a therapeutic intervention for patients with refractory heart failure and kidney injury with or without kidney failure due to its gentler fluid removal compared to conventional ultrafiltration resulting in less myocardial stunning and neurohormonal activation. We present the case of a patient with heart failure who started on peritoneal dialysis (PD) as an adjunct therapy for fluid management after failing to satisfactorily achieve volume control with diuretics. The patient is a 56-year-old man with C-TGA admitted for decompensated heart failure. He was initially treated with intravenous diuretics on the first admission but was readmitted after 3 months for decompensation this time with borderline low blood pressure making diuresis difficult. The patient was given loop diuretics, tolvaptan, and angiotensin receptor neprilysin inhibitor (ARNI) but still with decreasing trends in urine output and inadequate symptom control. PD was initiated before discharge with subsequent improvement in heart failure symptoms. The patient was on regular follow-up for PD maintenance and titration of heart failure medication. In this case report, we have shown how PD can be an effective adjunct to guideline-directed medical therapy in patients with severely symptomatic heart failure who have an unstable hemodynamic status and for which volume management cannot be satisfactorily achieved with diuretics.

Clinical profile and outcomes of Coronavirus Disease 19 (COVID-19) patients who underwent Hemoperfusion (HP) in a tertiary COVID-19 referral hospital: A descriptive study

Introduction@#As of February 4, 2021, a total of 530,118 COVID-19 cases were recorded in the Philippines with a fatality rate of 2.1%. Significant morbidity from COVID-19 is caused by hyperinflammation. Hemoperfusion (HP), which adsorbs inflammatory cytokines, has been performed in the Philippine General Hospital (PGH) as an adjunct to management given to COVID-19 patients. @*Objectives@#This study aimed to describe the clinical and laboratory profile, ventilatory support, therapeutic regimens, and outcomes of COVID-19 patients who underwent hemoperfusion in PGH. @*Methods@#The COVID-19 patient electronic database (April to September 2020) of the Division of Nephrology was reviewed and we included patients with COVID-19 who underwent hemoperfusion. Demographic, clinical, and laboratory data as well as therapeutics and outcomes were described. @*Results@#Sixty-six patients with COVID-19 underwent hemoperfusion. The majority were male (59.1%) with an average age of 61.3 years (SD 15). Hypertension was the most common comorbidity (62.1%). Acute kidney injury (AKI) requiring dialysis comprised 28.8% while 33.3% had diagnosed chronic kidney disease (CKD). The majority were critical COVID-19 cases who had acute respiratory distress syndrome (ARDS) (56.1%). The mean baseline inflammatory marker levels (Il-6, CRP, LDH, ferritin) were elevated. Post-HP inflammatory markers decreased except for IL-6 among patients who died. Most patients were mechanically ventilated (54.5%). Steroids were the most common medications administered (71.2%). Mortality occurred in 62.1% of the patients. The average length of hospital stay was 20.8 days (SD 19.5), duration from admission to first HP 5.9 days (SD 5.8), and 15.3 days (SD 17.4) from first HP to death or discharge. @*Conclusion@#Our study showed the characteristics of patients with COVID-19 who underwent HP. Majority were hypertensive men in their early 60s with critical COVID-19 disease. The mean inflammatory markers were elevated with a decrease in most markers post-hemoperfusion (except for IL-6 among those who died). Despite this, mortality was still high and the average length of hospital stay was long.

Factors Associated with Survival from In-Hospital Cardiac Arrest in the Service Wards and Intensive Care Units of a Tertiary Hospital

@#Background. Despite the recent advances in advanced cardiac life support (ACLS), there has been no significant improvement in survival among patients who undergo cardiac arrest. To date, there are no local guidelines on the requirements or standards of in-hospital cardiac arrest teams in the Philippines. In addition, there are still no studies on the outcomes of cardiac arrests among adult patients in a tertiary hospital in the Philippines. Objectives. The objective of this study is to investigate patient-, event-, and hospital-related factors associated with survival among adult patients who underwent in-hospital cardiac arrest in the service wards and intensive care units of a tertiary hospital. Methods. This is a prospective cross-sectional study conducted over three months in 2018. Patient-, event- and hospital-related data were collected from each patient with a cardiac arrest event who was referred to the cardiac arrest teams based on the modified Utstein form of reporting cardiac arrests. Survival to discharge from cardiac arrest was the main outcome. Results. The study included 119 patients, 47.9% male, with a mean age of 50.1 years (SD 16.7). Survival rate was 6.7%. The mean response time did not differ between survival group (1.46 minutes) and mortality group (1.82 minutes) (p value = 0.26). The presence of a shockable initial rhythm (3.6% vs 3/8; p value = 0.01), shorter lag time to initiation of electrical therapy (6.0 vs 9.3 ± 5.6 min; p value = 0.02), shorter time to establishment of an airway (2.75 ± 1.6 vs. 6.98 ± 5.2 min; p value = 0.01), and shorter duration of resuscitation (7 ± 4.6 vs. 13.0 ± 7.9 min; p value = 0.01) were significantly associated with survival. The presence of underlying illnesses is associated with higher mortality. The most common hospital-related problems identified were the need to cover long distances, delay in the call, and the lack of elevators. Conclusion. The survival rate of patients who underwent cardiac arrest and resuscitation by a cardiac arrest team is low. The initial presenting rhythm, lag time to initiation of electrical therapy, time to establishment of airway, duration of resuscitation, as well as the underlying disease can significantly affect survival. Streamlining the resources of the hospital to address these matters can have an impact on survival.

Determination of the antimicrobial property of oregano (Plectranthus amboinicus (Lour.) Spreng.) crude aqueous leaf extract against throat pathogens using broth and checkerboard dilution methods

@#<p style="text-align: justify;"><strong>Objective:</strong> This study aimed to determine the antimicrobial property of oregano (Plectranthus amboinicus) crude leaf extract against pathogens that infect the throat, specifically Streptococcus pyogenes and Candida albicans using the broth and checkerboard dilution methods.</p><p style="text-align: justify;"><strong>Methods:</strong> This study employed an experimental study design using broth dilution method for the determination of the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) against Streptococcus pyogenes ATCC 19615, and minimum fungicidal concentration (MFC) against Candida albicans ATCC 14053 of P. amboinicus crude extract (PA extract). Checkerboard dilution method was then used for determination of the synergy between PA extract and the standard antimicrobials.</p><p style="text-align: justify;"><strong>Results:</strong> In vitro growth inhibition of S. pyogenes (MIC 0.13 g/mL) and C. albicans (MIC 0.03 g/mL) was exhibited by the PA extract. The highest concentration of PA extract used in this study was not sufficient to demonstrate bactericidal and fungicidal activity (MBC >0.25 g/mL, MFC >0.25 g/mL). Results of checkerboard dilution method revealed that PA extract when combined with either penicillin (for S. pyogenes) or nystatin (for C. albicans) demonstrated indifference.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The crude extract of Plectranthus amboinicus has the capability to inhibit the growth of both S. pyogenes and C. albicans. This demonstrates its potential use in the treatment of throat infections caused by these organisms.</p><p style="text-align: justify;"><strong>Key Words:</strong> Plectranthus amboinicus, oregano, antimicrobial, throat infections, herbal medicine</p>