Death in the time of Covid-19: Efforts to restore the death penalty in the Philippines.

The Philippine Congress recently passed a bill amending the Dangerous Drugs Act of 2002 and reimposing the penalty of life imprisonment to death for specific-drug related offenses. House Bill No. 7814 also allows the presumption of guilt in certain drug-related crimes unless otherwise proven, thereby overturning the long-standing constitutional presumption of innocence. The bill has been sent to the Senate for its concurrence and could only be several steps away before being signed into law by President Rodrigo R. Duterte. This paper discusses the ramifications of the new bill and the questioned timeliness of its passage when the country continues to have a large and overcrowded prison population and a significant number of deaths due to SARS-CoV-2 in Southeast Asia. The government's lapses in following the 2021 national vaccination plan became apparent in the 31 March 2021 assessment made by the congressional health panel on the government's response to the pandemic. From the authors' perspective, the urgency of using the country's limited resources to help medical frontliners and local government units prevent further infections and save lives should have outweighed the efforts exerted to pass a law that legalized the death penalty for the third time in the Philippines.

The war on drugs, forensic science and the death penalty in the Philippines.

The effectiveness of the death penalty to deter heinous crimes remains a contentious issue even though it has been abolished in many countries. Three years into President Rodrigo Duterte's administration, the push to re-impose the death penalty is being taken seriously. There is urgency in providing options to the drug problem other than killing drug suspects in the streets or sentencing them to death. The drug problem is a complex issue and exposes the human vulnerability of its users for criminal exploitation. We propose here that addressing these vulnerabilities in a balanced and comprehensive manner through health-focused, rights-based criminal justice responses, conducting forensic science-based drug investigations and determining the social causes of drug abuse is an alternative solution that demands cooperation across different sectors of society as well as underscores the fundamental value of human life.

[Effect of combined beta-blocker and angiotensin-converting enzyme inhibitor treatment on 1-year survival after acute myocardial infarction: findings of the PRIAMHO-II registry]. / Efecto de la asociación de bloqueadores beta e inhibidores de la enzima de conversión en la supervivencia al año tras un infarto agudo de miocardio. Resultados del registro PRIAMHO II.

INTRODUCTION AND OBJECTIVES: Clinical trials have shown that combining beta-blockers and angiotensin-converting enzyme (ACE) inhibitors has an additive effect in reducing mortality in patients with left ventricular dysfunction following acute myocardial infarction. Whether this additive effect also occurs in unselected post-myocardial infarction patients is unknown. METHODS: In total, 5397 patients who were discharged from hospital after suffering an acute myocardial infarction were followed for 1 year. The primary endpoint was all-cause mortality. The effects of the medications on 1-year survival were analyzed using a Cox regression model, which included propensity scores for beta-blocker and ACE inhibitor use to take account of any potential imbalance in drug prescription rates. RESULTS: At hospital discharge, 55.9% of patients were receiving beta-blockers and 45.1%, ACE inhibitors. The 1-year mortality rate was 5.5%. Overall, combination of the two medications significantly reduced the 1-year mortality rate (hazard ratio [HR]=0.51; 95% confidence interval [IC], 0.32-0.82); P<.005) to a greater extent than ACE inhibitors alone (HR=0.78; 95% CI, 0.54-1.12; P=.2) or beta-blockers alone (HR=0.67; 95% CI, 0.43-1.05; P=.08). The same trend was also observed in low-risk patients without acute heart failure who had an ejection fraction > or =40%. CONCLUSIONS: In unselected post-myocardial infarction patients, combined prescription of beta-blockers and ACE inhibitors had an additive effect on the 1-year survival rate.

Efecto de la asociación de bloqueadores beta e inhibidores de la enzima de conversión en la supervivencia al año tras un infarto agudo de miocardio. Resultados del registro PRIAMHO II / Effect of combined beta-blocker and angiotensin-converting enzyme inhibitor treatment on 1-year survival after acute myocardial infarction: findings of the PRIAMHO-II registry

Introducción y objetivos. La combinación de bloqueadores beta e inhibidores de la enzima de conversión de la angiotensina (IECA) ha demostrado reducir la mortalidad en pacientes con infarto de miocardio y disfunción sistólica. Sin embargo, no sabemos si esta asociación presenta efectos aditivos sobre la supervivencia al año en una población no seleccionada de pacientes con infarto agudo de miocardio con y sin elevación del segmento ST. Métodos. Se realizó un seguimiento durante un año a 5.397 pacientes dados de alta tras un infarto agudo de miocardio. El criterio de valoración fue la mortalidad por cualquier causa. Para analizar el efecto de la medicación se utilizó el modelo de regresión logística de Cox, en el que se incluyó el propensity score para compensar las posibles desviaciones en la prescripción de los 2 grupos de fármacos. Resultados. En el momento del alta, el 55,9% de los pacientes recibió bloqueadores beta y el 45,1%, IECA. La mortalidad al año fue del 5,5%. En el grupo total, la combinación se asoció con una reducción significativa de la mortalidad (hazard ratio [HR] = 0,51; intervalo de confianza [IC] del 95%, 0,32-0,82); p < 0,005) superior a la de los IECA solos (HR = 0,78; IC del 95%, 0,54-1,12; p = 0,2) y los bloqueadores beta solos (HR = 0,67; IC del 95%, 0,43-1,05; p = 0,08). Esta misma tendencia se observó en los pacientes de bajo riesgo, sin insuficiencia cardiaca en fase aguda y con fracción de eyección ≥ 40%. Conclusiones. En una población no seleccionada de pacientes con infarto agudo de miocardio, la prescripción conjunta de bloquedores beta e IECA en el momento del alta hospitalaria muestra efectos aditivos sobre la supervivencia al año

Introduction and objectives. Clinical trials have shown that combining beta-blockers and angiotensin-converting enzyme (ACE) inhibitors has an additive effect in reducing mortality in patients with left ventricular dysfunction following acute myocardial infarction. Whether this additive effect also occurs in unselected post-myocardial infarction patients is unknown. Methods. In total, 5397 patients who were discharged from hospital after suffering an acute myocardial infarction were followed for 1 year. The primary endpoint was all-cause mortality. The effects of the medications on 1-year survival were analyzed using a Cox regression model, which included propensity scores for beta-blocker and ACE inhibitor use to take account of any potential imbalance in drug prescription rates. Results. At hospital discharge, 55.9% of patients were receiving beta-blockers and 45.1%, ACE inhibitors. The 1-year mortality rate was 5.5%. Overall, combination of the two medications significantly reduced the 1-year mortality rate (hazard ratio [HR]=0.51; 95% confidence interval [IC], 0.32-0.82); P<.005) to a greater extent than ACE inhibitors alone (HR=0.78; 95% CI, 0.54-1.12; P=.2) or beta-blockers alone (HR=0.67; 95% CI, 0.43-1.05; P=.08). The same trend was also observed in low-risk patients without acute heart failure who had an ejection fraction ≥40%. Conclusions. In unselected post-myocardial infarction patients, combined prescription of beta-blockers and ACE inhibitors had an additive effect on the 1-year survival rate

Tricuspid valve repair: an old disease, a modern experience.

BACKGROUND: We review our experience in patients who required surgical correction of tricuspid valve disease with concomitant disease of the mitral or aortic valve, or both, operated on between 1987 and 1999. METHODS: We studied 232 consecutive patients (mean age, 59.8 years) followed for a mean of 6.8 years (range, 2 to 12 years). All patients were investigated by means of Doppler echocardiography, with hemodynamic studies in 135. Median tricuspid insufficiency was 3+. The cause was rheumatic heart disease in 186 patients and degenerative in 46. All patients underwent suture annuloplasty (De Vega or segmental) at the time of mitral or aortic valve surgery. Tricuspid lesions were functional in 128 patients and organic in 104. RESULTS: The hospital and late mortality rates were 8.1% and 23.3%, respectively. These figures were independent of the type of annuloplasty performed. Predictors of hospital mortality were biologic prosthesis, renal insufficiency, time of cardiopulmonary bypass, and use of inotropic drugs. Predictors of late mortality were age older than 60 years, left ventricular ejection fraction less than 0.50, and New York Heart Association functional class IV. At 12 years, the actuarial survival rate was 50.5% +/- 6.1%, and the actuarial curve free from reoperation 75.7% +/- 7.3%. The actuarial curve for freedom from valve-related complication was 39.0% +/- 6.3% at 11 years. CONCLUSIONS: Despite the use of modern technologic advances in the diagnosis and treatment of valvular hear disease, tricuspid insufficiency continues to be a poor prognostic factor in patients with concomitant disease of the mitral or aortic valve, or both.