Lithium as pre-radioablative treatment of Graves’ Disease Complicated by Thyroid Storm and Methimazole-induced Agranulocytosis: A case report

@#Thyroid storm and thionamide-induced agranulocytosis are both rare and serious medical emergencies. We report a case of a patient in which these two rare events simultaneously occurred. A 33-year-old male, maintained on Methimazole for Graves’ Disease, presented with fever, throat pain, and uncontrolled thyrotoxic symptoms. Methimazole was promptly discontinued. Thyroid storm was alternatively treated with lithium, hydrocortisone, and propranolol. Agranulocytosis was managed supportively with GCSF and empiric antibiotics. Lithium was maintained until after radioablation. When thionamides are contraindicated, lithium is a viable option for the acute management of thyroid storm and a bridge to definitive therapy.

Appropriate use of coronary angiogram among service patients at the UP-Philippine General Hospital in the Year 2019

Rationale@#Coronary artery disease (CAD) is the leading cause of death worldwide and coronary angiography (CA) remains the gold standard for its diagnosis. However, proper patient selection for CA is important to avoid unnecessary risks and expense. The American College of Cardiology (ACC), with other major organizations, developed Appropriate Use Criteria (AUC) for CA. AUC assist clinicians in decision making on whether to use the tests according to indications and objectively assess if these tests are appropriately utilized. This is the first study to determine the appropriateness of CA performed and the clinical and angiographic profile among adult service patients in UP-PGH. @*Objectives@#To determine (1) the indications for CA and its appropriateness based on 2012 AUC for Diagnostic Catheterization by the ACC, (2) the clinical profile of patients who underwent CA among adult service patients at UP-PGH and (3) the angiographic profile of these patients. @*Methods@#This cross-sectional study included all CA studies performed on adult service patients from January to December 2019. Demographic and clinical profiles, non-invasive tests, and angiographic findings were collected. The primary outcome determined was the appropriateness of the indications for each CA performed based on AUC scores. Descriptive analysis using frequencies and mean values with standard deviations were used. @*Results@#Among the 515 patients included, majority were males, above 50 years of age, with normal eGFR, presented initially with chest pain, and with a presenting diagnosis of chronic coronary syndrome. Majority of these patients had obstructive CAD (75%), with left anterior descending artery as the most frequently involved vessel. Non-obstructive CAD was found in 11% while normal coronaries were noted in 14% of these patients. Our findings showed that 99.8% of the CA performed were appropriate, of which majority (54%) had an AUC score of A9. STEMI or a suspicion of STEMI, with an A9 score, was the most frequently encountered indication at 33% of the time. @*Conclusion@#Majority (99%) of the CA studies performed in the PGH cardiac catheterization laboratory for the year 2019 were executed based on highly appropriate indications (AUC scores A7 to A9) and followed Class I and II recommendations from guidelines. The allocation of resources is deemed to be well-utilized based on the data generated from this study.

Quality of care of adult patients with ST-Elevation Myocardial Infarction (STEMI) at the emergency room of a tertiary hospital in the Philippines

@#<p style="text-align: justify;"><strong>Introduction.</strong> Coronary artery disease (CAD) remains a significant public health problem worldwide and in the Philippines. Adherence to guideline-directed therapy improves the quality of care (QOC).</p><p style="text-align: justify;"><strong>Objective.</strong> We aimed to evaluate the QOC initially received by ST-Elevation Myocardial Infarction (STEMI) patients at our Emergency Room (ER), based on compliance to 2014 PHA CAD guidelines recommendations.</p><p style="text-align: justify;"><strong>Methods.</strong> We reviewed the charts of adult patients with STEMI admitted at the ER who were not previously managed in a different hospital. The primary outcome was QOC assessed through quality indicators (QI) based on class I and IIa recommendations in the PHA CAD guidelines.</p><p style="text-align: justify;"><strong>Results.</strong> Of the 29 patients included, all had ECG done upon admission, but only four were done within 10 minutes (QI: 13.79%). All eligible patients received antiplatelets (QI: 100%). Six eligible patients (QI: 100%) received nitrates, and four eligible patients (QI: 100%) received morphine. Of 16 eligible patients, only six were reperfused within the recommended 12 hours of ischemia (QI: 37.5%), two by thrombolysis and four by the primary percutaneous coronary intervention (PCI).</p><p style="text-align: justify;"><strong>Conclusion.</strong> The timely performance of initial ECG and reperfusion need improvement. Suitable performance measures for the provision of nitrates and morphine to eligible patients were met. Investigating intrinsic and extrinsic factors that lead to the time delays observed are also recommended.</p>

Measuring stigma and discrimination towards people living with HIV among health care workers in a tertiary, government teaching hospital in the Philippines

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong>The incidence of human immunodeficiency virus (HIV) infection in the Philippines is increasing. HIV-related stigma in the health care setting is a known barrier to healthcare access for people living with HIV (PLHIV).</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to identify stigmatizing attitudes and practices towards PLHIV among healthcare workers in Philippine General Hospital.</p><p style="text-align: justify;"><strong>METHODS:</strong> In this cross-sectional descriptive study, 375 healthcare workers were recruited via convenience sampling. A standardized questionnaire developed by the Health Policy Project was used.</p><p style="text-align: justify;"><strong>RESULTS: </strong>The study demonstrated concerns regarding transmission, particularly during drawing blood (87.1%),assisting in labor and delivery (82%), and dressing wounds (80.4%). Use of special infection-control measures (76.1%),wearing double gloves (72.8%), additional infection-control procedures during labor and delivery (72.2%), and wearing gloves during all aspects of patient care (70.2%) were reported as well. Perceptions such as the belief that pregnant women who are HIV positive must inform their families of their HIV status (82.1%), and that PLHIV engage in irresponsible behaviors (69.1%) and are promiscuous (66.4%) were also detected.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The study confirmed the presence of HIV-related stigma among healthcare workers in Philippine General Hospital.This finding could potentially catalyze the development of stigma-reducing measures which could hopefully translate to improved healthcare for PLHIV.</p>