Current epidemiology of periampullary malignancies in a tertiary referral center in the Philippines: A five-year review

Background@#Periampullary malignancies traditionally occur during the later decades of life, but casual observations at the Philippine General Hospital (PGH) have shown more patients presenting at younger ages. Updates on the epidemiology and clinical features of these uncommon cancers may improve detection and result in better outcomes. @*Objective@#The study aimed to describe the current epidemiology of adult patients diagnosed with periampullary malignancies seen in the past five years at the PGH Department of Surgery. @*Methods@#Demographic and clinical data were obtained on patients with either pancreatic head, ampullary, distal bile duct, or duodenal cancer diagnosed from 2015 to 2019. Age and sex distributions, rates of symptom presentation, utilization of diagnostic modalities, and prevalence of comorbid conditions were analyzed per individual primary site and for the entire study population. @*Results@#Two hundred seventy-seven patients were included in the study, comprised mostly of pancreatic head cancers (56.32%) followed by ampullary (19.86%), duodenal (9.75%), and distal CBD cancers (7.58%). The mean age of presentation was 59.30 years. 33.94% of cases occurred in the 6th decade of life, while 24.91% of patients were aged 50 years and below. There was a nearly equal distribution by sex (50.90% female, 49.10% male). Majority of patients presented with jaundice (89.65%) and abdominal pain (71.64%). CT scan was used to diagnose 71.48% of patients. We observed a higher prevalence of diabetes mellitus (21.32%), biliary stone disease (19.12%), and smoking history (36.88%) in the study group compared to the general Philippine population. @*Conclusion@#The epidemiology of periampullary malignancies at UP-PGH showed a younger age at presentation and an equal sex ratio compared to published data. Distributions of the primary sites, symptom frequency, and rate of associated comorbidities were consistent with previous findings from the literature.

Message of the Philippine General Hospital Director

@#The proverbial "walking while chewing gum" statement has been once again proven by our colleagues in PGH. Being able to publish quality research articles amidst the challenges brought about by the turn of events, is testament to not only the grit that we have developed in its wards but also to the commitment in pursuing new knowledge. Prior to the pandemic, PGH has shown a continuous trend of increasing annual publication. From 8% in 2015, it has steadily risen to 42%. The investment in focused attention guided by a clear agenda, extensive funding and protected time for research obviously is paying off handsomely. It is my fervent hope that we will be able to bring our research output to the next level which is health policy formulation based on the knowledge that we have generated.

Hospitalization expenditure of COVID-19 patients at the University of the Philippines-Philippine General Hospital (UP-PGH) with PhilHealth coverage

@#Objective. This research aimed to determine the in-patient expenditure of COVID-19 adult patient s and their out-of-pocket (OOP) payments at the University of the Philippines-Philippine General Hospital (UP-PGH) after the new PhilHealth case rate coverage was instituted last 15 April 2020. It also intended to present the preliminary data on the expenses incurred by COVID patients during the initial phase of the pandemic in the country. Methods. This study was a retrospective chart review of admitted COVID-19 patients aged 19 years old and above from 15 April to 14 August 2020 at UP-PGH that availed of PhilHealth COVID-19 case rate benefits package (C19C1-C4). Data were analyzed to extract overall expenses, out-of-pocket (OOP) charges, cost centers utilization, and other hospitalization expenditure sources. Results. Of the 691 COVID-19 patients included during the study period, 55.72% were male, mostly belonging to the 61-70 age range with a median age of 58. The average in-hospital stay was 14.20 days, and 76.99% were under charity services, with the moderate (42.84%) and mild (25.33%) pneumonia cases accounting for 68.17% of the admissions. Total hospital expenses clustered around Php51,000 to 200,000 (~USD 1,041 to 4,156), most spending between Php101,000 to 150,000 (~USD 2,078 to 3,118). The top three cost centers and expenditure sources were pharmacies, personal protective equipment (PPE) usage, and laboratory. The average OOP payment for patients less than 60 years old was higher, ranging from Php 25,899 to Php 44,428.63 (USD 538 to USD 924.44) compared to patients older than 60 (Php4,005.60 to Php 32,920.20 ~ USD 83.35 to 684.98). The most OOP charges were for the age group 19-30, amounting to Php 44,428.63 (USD 924.44). Conclusion. Preliminary findings of this study gave an actual representation of the expenses of COVID-19 patients, which can guide future utilization of the national health insurance during unexpected pandemics. Early price regulation of new therapeutic interventions, diagnostic tests, and medical supplies, e.g., PPEs, disinfectants, air filters, are measures that can be implemented.

Clinical profile and outcome of adult COVID-19- related consults at the University of the Philippines - Philippine General Hospital Emergency Department

@#Background. Scarcity of early local clinical data of COVID-19 proved to be a major challenge as its course rapidly evolved over time. The information gathered from this study can be used in improving awareness and understanding a novel disease particularly in detecting demographic trends, vulnerable clinical profiles and potential clusters in order to be abreast on how the virus behaves in the local setting. Objectives. 1) To describe the clinical profile of COVID-19 adult consults at the University of the Philippines- Philippine General Hospital (UP-PGH) during the early months of the outbreak 2) To determine their association with the COVID-19 results and final outcome Methods. A retrospective medical record review was done on COVID-19-related consults of patients aged 19 years and above from 01 January to 30 June 2020 at the emergency department (ED). Statistical analyses were done using Chi-squared and Fisher’s exact test using STATA V15.1 with 95% level of significance (p<0.05). Results. The median age of the 901 COVID-19-related consults at the ED was 46 years; 55.49% were males mostly belonging to the age group below 60 years. Almost all were Filipinos (99.44%), majority residing in the city of Manila (64.93%) and only 2.22% had a history of travel outside the country. The most common chief complaint was fever (32.47%) followed by cough (27.58%) and shortness of breath (25.75%). Most had their onset of symptoms from 1-7 days (79.80%) before ED arrival and 86.07% (n=210) were COVID-positive after performing the confirmatory test. Patients with confirmed COVID-19 mostly resided in cities of the National Capital Region (p=0.046), either presented with fever or asymptomatic but with exposure to COVID patients (Fisher’s Exact test; p<0.001) and onset of symptoms was 4-5 days (p=0.007). Those identified with poor prognosis were those aged 60 years and older (p<0.001), with complaint of shortness of breath (Fisher’s exact test; p<0.001) and with delayed symptom presentation of 6 days or more (p=0.037). Conclusion. The COVID-19-related consults at UP-PGH during the first 6 months of the pandemic were mostly males, Filipinos, belonging to the less than 60 years age group (median age=46 years), residing in the city of Manila and no history of travel outside the country. The most common presenting complaint was fever and onset of symptoms was typically 1-7 days before ED arrival. The positive RT-PCR result was significantly associated to patients residing in Metro Manila, either presenting with fever or no symptoms but with exposure to COVID patients, and with onset of symptoms of 4-5 days. Older age (60 years old and above), shortness of breath and delayed symptom presentation of 6 days of more were also found to have significant association with poor prognosis. As not much is known of the behavior and course of COVID-19 particularly at the local setting, it is therefore crucial to be aware of emerging trends to respond adequately and achieve optimal outcomes.

Filipino normative data for thyroid ultrasonography: Correlates with weight, height and gender but not urinary iodine levels

OBJECTIVE: To establish a normal range of values for thyroid volume among adult Filipinos and to correlate thyroid dimensions with age, sex, weight, height, and urinary iodine.METHODS: This is a cross-sectional study conducted at the University of the Philippines-Philippine General Hospital. Out of 212 health personnel screened, 169 were included based on the following exclusion criteria: goiter stage Ib to III as defined by WHO, hyperthyroid or hypothyroid, hospitalization within the past month, chronic renal disease, chronic alcohol intake, more than 4 pack years of smoking, and abnormal laboratory profile. Laboratory parameters included FT3, FT4, TSH, creatinine, anti-thyroglobulin, anti-thyroid peroxidase, 24-hr urinary iodine , and thyroid ultrasonography. There were 55 males and 114 females with a mean age of 38.98 +/- 11.21 years old, mean weight of 59.84 +/- 11.91 kg.RESULTS: The size of the right lobe ranged from 3.58-5.09 x 1.15-1.89 x 1.01-1.90 cm (LxWxD) while the left lobe ranged from 3.62-5.01 x 1.15-1.93 x 1.03-1.84, comparable with established values in literature. Using Hotelling's T-squared, male sex was associated with a larger thyroid dimension, (p-value CONCLUSIONS: The normative thyroid dimensions established among Filipino adults were comparable with the accepted reference values. Thyroid dimensions were significantly correlated with weight, height, and sex but not with urinary iodide levels.

Rotavirus acute gastroenteritis among Filipino children

This is a prospective study aimed to determine the clinical profile of pediatric patients less than 5 years old with rotavirus diarrhea seen at the Philippine General Hospital from August 1-September 15, 2001. Ninety-one patients with acute diarrhea were included in the study. Of these 39 patients (42.9 percent) had rotavirus antigen in the stool as detected by the ELISA method. The mean age of the patients was 11.5 months with 61.5 percent of the patients belonging to the 7-12 months of age, mostly well-nourished. The stools were described as watery (74.4 percent), yellow in color (84.7 percent), with no pus, red blood cells or parasite. Average duration of diarrhea prior to consultation was 2.5 +/- 1.8 days with 7 episodes per day. Vomiting, fever and concomitant upper respiratory tract infection were noted in 76.9 percent, 64 percent and 23.7 percent of the patients respectively. A comparison of the rotavirus versus bacterial etiology of diarrhea showed fever and vomiting to be more predominant in rotavirus while dehydration was noted in bacterial isolates. Antibiotic was noted to be given to 38.5 percent rotavirus cases. Increased awareness of rotavirus diarrhea, regarding its high incidence and clinical profile, will help guide physicians in their rational use of antibiotics for patients with acute diarrhea

A university-based forensic pathology practice: The UPM-PGH experience (1996-2000)

Forensic Pathology is not a widely recognized field of medicine in the Philippines. Doctors involved in death investigation are often unskilled due to lack of formal training and their work is further hampered by insufficient support and material resources. Upon the authors return in 1995 from post-residency training in forensic pathology at a medical examiners office in the United States, she sought to establish a practice as a specialist based at the University of the Philippines Manila-Philippine General Hospital. This case review is the authors initial experience over the period 1996-2000. The procedures done and problems encountered are described, and recommendations on how the specialty can be professionalized are offered, Included are templates of actual worksheets for the guidance of local doctors doing forensic autopsies. (Author)

Sheehan's Syndrome: UP-PGH experience from 1974-1984

Nineteen patients with a diagnosis of Sheehan's syndrome or postpartum hypopituitarism admitted to the UP-PGH Medical Center from 1974-1984 were reviewed. The history, signs and symptoms, and results of various laboratory examinations were assessed. Two patients had available postmortem reports Panhypopituitarism (89%) was more common than selective hypopituitarism. LSH producing cells seemed to be spared more often than the others. Hypothyroidism was seen in only 89% of the cases as compared to gonadal failure (100%), and cortisol insufficiency (100%). The pituitary involvement was not limited to the anterior pituitary but may involve the posterior pituitary and or the hypothalamus as suggested by the coexistence of manifestations of diabetes insipidus in 2 of our patients Most common cause of postpartum pituitary necrosis was obstetric hemorrhage but it could also be produced by any condition resulting in severe shock. The syndrome was usually heralded by failure of lactation and amenorrhea associated later with loss of axillary and public hair; genital, uterine, and breast atrophy; symptoms and signs of hypothyroidism and various degrees of adrenocortical insufficiency The different tests designed to show target organ failure did not show positivity in all patients. Among the tests which showed consistent results and thus were most helpful for diagnosis were determinations of: FSH, cortisol and T4 There is excellent prognosis for a productive life of patients with replacement of all target gland hormonal deficiencies. However, failure to diagnose it is disastrous for the patients. Continuation of treatment especially in the presence of stress, i.e. infection should be emphasized by the physicians. Regular follow-up at intervals of all patients with Sheehan's syndrome is necessarily recommended, (Summary)