Clinical profile and prognostic factors of mortality among adult tetanus patients in Cagayan Valley Medical Center: A crosssectional study

Introduction@#Tetanus remains a public health threat in developing countries and is associated with a high morbidity and mortality rate. There is paucity of published data regarding the management of tetanus in the Philippines, hence, the study was conducted to determine the demographic, clinical profile, and prognostic factors that are associated with mortality among adult tetanus patients admitted in Cagayan Valley Medical Center (CVMC).@*Methods@#This is a retrospective study of patients who presented with a clinical diagnosis of tetanus, above 19 years old at CVMC between September 1, 2012 to October 31, 2018.@*Results@#A total of 194 patients were studied. The male to female ratio was 11:1.Majority of patients were aged > 40 years (68.56%), rural dwellers (88.66%), farmers (84.02%) and males (91.75%). Only 3.09% of patients had prior tetanus immunization. Most common antecedent injury is trauma (84.53%), most commonly due to punctured wounds (63.40%). All patients had generalized tetanus, and majority were admitted in moderate grade (68.56%). Most common manifestations were trismus (92.78%), spasms (84.02%), dysphagia (80.93%) and rigidity (68.04%). Complication rate is 64.43%. Mortality rate is 38.66%. Most common cause of death is acute respiratory failure. Poor prognostic factors determined by univariate analysis were age more than 40 years (OR=2.24, p-value=0.0160), incubation period less than seven days (OR=2.65, p-value= 0.0027), period of onset less than three days (OR=2.52, p-value=0.0150) , severity of disease (OR=17.35, p-value=<0.0001), need for ventilatory support (OR=22.20, p-value=<0.0001) and presence of complications (OR=2.96, p-value= 0.0013). In multivariate analysis, only need for ventilatory support is associated with mortality (OR=31.57, p-value=0.000).@*Conclusion@#Mortality rate of adult tetanus in Cagayan Valley Medical Center is high. Therefore, health education is highly encouraged to promote awareness, specifically in immunization and basic wound management.

Clinical presentation and outcomes of Intentional Paraquat Ingestion in a hospital at Northern Philippines from 2011 to 2013

Introduction@#Acute paraquat (PQ) poisoning is associated with high case fatality rate. Following a report of 108 cases of poisoning from 2011 to 2013, the distribution, sale, and use of PQ was recently prohibited in the Philippines. However, there still is a need to gather additional information on the manifestations of PQ poisoning in the Philippines. Hence, this study aimed to identify the clinical presentation and outcomes of cases of PQ poisoning seen in a hospital at northern Philippines.@*Case presentation@#Nine cases of oral PQ poisoning from 2011 to 2013 were included in this series. All cases were intentional. Majority (88%) of the patients were females. Seven of the nine (77%) cases were from Baggao, Cagayan, a nearby agricultural town. Mean age was 30 (range 21-47). Initial presenting symptoms were vomiting, difficulty in swallowing, abdominal pain and gastrointestinal bleeding. Of the nine cases, four died (44%) in the hospital. Three (33%) survived without complications. Long-term outcomes of the remaining two cases (22%) were unknown. All patients who eventually died developed dyspnea during their hospital stay, and subsequently went into acute respiratory failure. Azotemia and leukocytosis were also recorded among those who died.@*Discussion@#High mortality rate among PQ poisoning patients can be attributed to the absence of antidote and the unsatisfactory outcomes of post-exposure management.@*Conclusion@#Mortality rate for this series was 44%, and all died of progressive respiratory failure. Gastrointestinal toxicity was universal in the nine reported cases. Azotemia and leukocytosis were the other significant findings observed among the cases of fatal poisoning