Prioritizing the vulnerable over the susceptible for COVID-19 vaccination.

The COVID-19 pandemic led to a health crisis with widespread social and economic adverse effects. To address the fallout, vaccine development has been pursued in record time. Several vaccines have already been deployed in countries worldwide, but as the supply is limited, these have been provided selectively. Various allocation schemes, premised on ensuring an equitable distribution, have prioritized the elderly, given their apparent susceptibility. For the Philippines and possibly other countries with extremely limited supplies, the elderly need not always be given primary preference. The level of available supplies can be so low that the immediate focus of allocation should be on mitigating both infection and transmission. The proposed alternative vaccine allocation framework gives priority to groups rendered more vulnerable, such as those who are unable to avoid prolonged exposure to possibly infected people because of medical necessity or occupational conditions. Vulnerable groups include healthcare and other essential workers as well as patients requiring continued healthcare services. The proposed allocation scheme is meant to be complementary to concurrent public health measures, which have to be maintained though made less restrictive as the pandemic is brought under control.

Hydrops fetalis and neonatal abdominal compartment syndrome continuum from immature gastric teratoma: a case report.

BACKGROUND: Hydrops fetalis as well as abdominal compartment syndrome (ACS) are conditions that are associated with high mortality rates. A rare case of immature gastric teratoma causing fetal hydrops and subsequent ACS is presented. The related pathophysiologic mechanisms are discussed, and the importance of timely recognition and appropriate interventions are highlighted. CASE PRESENTATION: The male patient was born preterm, weighing 3.9 kg., by Cesarean section. Prior prenatal ultrasounds were normal, but a scan done just before delivery had findings indicating polyhydramnios, fetal ascites, and meconium peritonitis. Upon delivery, the patient had respiratory distress, anasarca and a massively distended abdomen. Resuscitation measures, including ventilatory support, were instituted. Imaging studies showed ascites as well as a large, complex intra-abdominal lesion with calcifications. In the succeeding hours, anuria persisted, anasarca worsened, the abdomen became more distended, and inotrope requirements increased. The occurrence of ACS, from what was presumed to be a retroperitoneal teratoma, was therefore considered. Laparotomy was done on the 28th hour of life, with en bloc excision of a massive tumor and attached section of the greater curvature of the stomach. Passage of urine occurred intra-operatively, and the patient was soon after weaned off inotropes and ventilator support. The histopathologic result was immature gastric teratoma. No chemotherapy was given, and the patient's serum AFP is at normal levels 15 months following surgery. CONCLUSION: The presence of a massive intra-abdominal lesion can result in the pathophysiologic continuum of hydrops fetalis and neonatal ACS. The early recognition of such an association can enable appropriate expectant management of similarly affected neonates, including emergent decompression laparotomy.

Pediatric Anastomosing Hemangioma: Case Report and Review of Renal Vascular Tumors in Children.

The case involves a 10-year-old child who underwent a left radical nephrectomy for what was believed to be a Wilms' tumor. Histopath examination indicated a benign vascular lesion, subsequently determined to be an anastomosing hemangioma of the kidney. A comparison with the previously cited pediatric patients with renal vascular tumors is provided, and the inconsistent diagnostic terminologies for these conditions are highlighted. The therapeutic implications of these predominantly benign renal tumors, in the context of the much more frequently encountered malignant neoplasms in children, are additionally discussed.

Financial protection mechanisms for inpatients at selected Philippine hospitals.

The study was undertaken to determine, from the patient's perspective, the comparative effectiveness of locally established financial protection mechanisms particularly for indigent and severely-ill hospitalized patients. Data was obtained from a survey conducted in 2010 in Philippine provinces which were part of the Health Systems Development Project and involved 449 patients from selected private and public hospitals. Direct medical expenses incurred during the confinement period, whether already paid for prior to or only billed upon discharge, were initially considered. Expenses were found to be generally larger for the more severely ill and lower for the poor. Hospital-provided discounts and social health insurance (PhilHealth) reimbursements were the financial protection mechanisms evaluated in this study. In average terms, only up to 46% of inpatient expenses were potentially covered by the combined financial support. Depending on the hospital type, 28-42% of submitted PhilHealth claims were invalidated. Multiple linear regression analysis was utilized to determine the relationship of the same set of patients' demographic characteristics, socioeconomic status, severity of illness, and hospital assignments with selected expense categories and financial protection measures. Pre-discharge expenditures were significantly higher in public hospitals. The very ill also faced significantly larger expenses, including those for final hospital charges. Hospital-derived discounts provided significantly more support for indigent as well as very sick patients. The amounts for verified PhilHealth claims were significantly greater for the moderately-ill and, incongruously, the financially better-off patients. Sponsored Program members, supposed indigents enjoying fully-subsidized PhilHealth enrollment, qualified for higher mean reimbursements. However, there was a weak correlation between such patients and those identified as poor by the hospital social service staff. Thus, while hospital discounts, subsidies for practical purposes, and PhilHealth reimbursements progressively supported sicker patients, discounts were more responsive in assisting the poor. PhilHealth processes therefore need to be improved so as to more effectively support indigent patients.

Human resources for health and Philippine policy options

The migration "carousel" for health workers - or human resources for health (HRH) - is a phenomenon ripe with opportunities and difficulties for its many stakeholders. With an in-depth literature review, the situation is put into context, in terms of the underlying factors that prompt workers to relocate, as well as the facilitating effects of globalization and worldwide HRH shortages. The possible outcomes are discussed, particularly the externalities that relate to source and recipient countries. The actual impact of worker shortages on the delivery of health care is further clarified. Policy options for modulating HRH flows and enhancing HRH stocks are thereafter drawn. Individual as well as country interests are taken into consideration in deriving a range of applicable policy instruments. Managed migration schemes for HRH flows appear to provide the greatest flexibility for most concerned parties. The application of the derived policy framework in a leading HRH "donor" country, the Philippines, is presented. 

Comparison of a locally prepared polyethylene glycol electrolyte lavage solution with the standard three day procedure for pediatric preoperative bowel preparation

The use of a locally prepared polyethylene glycol electrolyte lavage solution (PEG-ELS) for preoperative bowel preparation of pediatric patients undergoing colostomy/ileostomy closure was compared with a standard three day regimen.Twenty-three patients were randomly assigned to either PEG-ELS or a standard three day bowel preparation, For both groups,? there were no significant differences in the changes in the pre and post-prep body weights, hematocrit, and serum electrolytes.Patients did not exhibit? abdominal cramps nor vomiting with either preparation. Intra-operative assessment showed adequate cleansing of bowels in both procedures. Postoperative complications were?not related to the preparations.? This study shows that using a locally prepared polyethylene glycol?electrolye lavage solution may be an excellent alternative to the standard?three day bowel preparation in pediatric patients.