Exploring the knowledge, attitude, and practices of community pharmacists in Eastern Visayas towards readiness to provide information service on Complementary and Alternative Medicine (CAM) products

Background@#Community pharmacists are strategically positioned to dispense Complementary and Alternative Medicine (CAM) products as part of their innate roles in the provision of accurate drug information to patients. This unique position of the pharmacist could be best realized if equipped with good knowledge and skills in regard to CAM products.@*Objectives@#This study aimed to assess the readiness of community pharmacists in the provision of CAM productrelated information to patients by assessing the knowledge and determined the attitudes and practices of community pharmacists regarding CAM products in Eastern Visayas, Philippines.@*Methods@#A descriptive mixed-method (qualitative and quantitative) survey design was utilized in this study. Community pharmacists (n=58) in Eastern Visayas, Philippines were the research participants in the study. The survey questionnaire constituted four sections: socio-demographic profile, attitudes, practices, and knowledge of community pharmacists on CAM products. Descriptive statistical analysis was performed using SPSS Version 20.@*Results@#Results revealed that the majority of respondents are female (87.93%), age range in between 21-30 (62.07%), working full-time (79.31%), and bachelor’s degree holder (98.28%). More than half of the participants (53.45%) did not receive any education or training on CAM products during undergraduate studies. Community pharmacists displayed strong positive attitudes (mean=3.74) and had a moderate frequency of practice on CAM products (mean=3.20). The knowledge test revealed that only a few of the community pharmacists (31.03%) were considered knowledgeable. A significant relationship between years of work experience in community pharmacy and knowledge was found in this study.@*Conclusion@#Despite having strong attitude and moderate level of practice, community pharmacists in Eastern Visayas showed a low level of knowledge on CAM products. Demand for CAM products by patients encouraged community pharmacists to dispense and provide information. Readiness of community pharmacists in terms of knowledge provision of CAM product-related information to patients were found to be insufficient while a moderate level of practice towards CAM products was reported. Community pharmacists displayed a strong positive attitude towards CAM products. Overall, the community pharmacists are not ready to provide CAM information service in the context of the knowledge, attitude, and practices.

Accuracy of Quick Sequential Organ Failure Assessment (qSOFA) scoring as in-hospital mortality predictor in adult patients with sepsis secondary to urinary tract infection admitted in a local tertiary hospital in Davao City: A cross-sectional study

Background@#The quick Sequential Organ Failure Assessment (qSOFA) score was introduced by Sepsis-3 or the Third International Consensus Definitions for Sepsis and Septic Shock to help physicians in identifying patients outside the intensive care unit with suspected infection who are at high risk for in-hospital mortality. However, sepsis is not a homogenous entity and the outcomes vary based on several factors. This study aimed to determine the predictive accuracy of qSOFA in identifying those at high-risk of in-hospital mortality among adult patients with sepsis secondary to urinary tract infection.@*Methodology@#A retrospective cohort study was done involving the use of qSOFA score to predict in-hospital mortality of adult patients with a diagnosis of sepsis secondary to urinary tract infection, admitted in the hospital from January 1, 2013 to December 31, 2020. qSOFA is computed based on the following independent variables: systolic blood pressure (SBP), respiratory rate (RR), and Glasgow Coma Scale (GCS).@*Results@#Of the 128 charts retrieved, 121 patients were included in the study. Fifteen (12.40%) died while 106 (87.60%) survived. Mean age was 60.76 years old, with more females (71.90%) than males (28.10%). Hypertension and Diabetes Mellitus Type 2 were the most frequent comorbidities. Complicated UTI was the most frequent source of infection. Mean length of stay was 8.29 days. Forty (33.06%) patients had qSOFA ≥ 2 wherein 11 (27.5%) died. Diagnostic performance results revealed: sensitivity (73.33%), specificity (72.64%), positive (27.5%) and negative (95.06%) predictive values, and positive (2.68) and negative (0.37) likelihood ratios. qSOFA accuracy was 72.73% with an AUROC of 0.76.@*Conclusion@#Among the admitted adult patients with sepsis secondary to a UTI, qSOFA had a good prognostic accuracy for in-hospital mortality.

Association of body mass index and outcomes of patients admitted for decompensated heart failure among adult Filipino patients in a tertiary hospital in Cebu City

Introduction@#Obesity remains to be a public health concern across the globe. Studies have established that obesity plays an important role in the pathogenesis and progression of cardiovascular diseases such as hypertension and coronary artery disease. Evidence suggesting the link between obesity and decompensation of heart failure is only just emerging.@*General Objective@#Determine the associations between body mass index (BMI) outcomes of severity and mortality among adult Filipino patients admitted with decompensated heart failure.@*Study Design@#Retrospective Cohort study design.@*Study Setting@#Chong Hua Hospital, a tertiary hospital in Cebu City, Philippines@*Study Population@#All adult patients with a diagnosis of Decompensated heart failure who were admitted in the hospital from 2015 to 2019. @*Main Outcome Measure@#Determine association of BMI using Asian cut-offs and Outcomes of patients admitted for decompensated heart failure.@*Results@#A total of 356 patients were admitted for acute decompensated heart failure from year 2015-2019. Majority of the patients were in the obese category 1 (28.93%) and predominantly were classified as NYHA Class III heart failure. There was no significant association between BMI and outcomes among patients with decompensated heart failure. Furthermore, it was noted that the pro-BNP values were higher in patients with lower BMI categories than in the overweight and obese categories.@*Conclusion@#Obesity, while increasing the chance of developing heart failure (HF), appears to protect people who have already been diagnosed with HF (the "obesity paradox"). This study, although not reaching statistical significance, showed that patients with lower BMI admitted for heart failure decompensation had increased use of positive pressure ventilation and higher mortality rates compared to obese patients. A larger sample size may be needed to show such association. Furthermore, patients in lower BMI category had higher pro-BNP values than their counterparts consistent with previous literature.

The role of first trimester HbA1c as a rredictor of Gestational Diabetes Mellitus and adverse maternal and perinatal outcomes among non-diabetic pregnant Filipino women

Objectives@#This study aims to determine the role of HbA1c level during first trimester in predicting gestational diabetes mellitus in Filipino non-diabetic women. Hence, to identify those will be at increased risk of its adverse maternal and perinatal outcomes, and who will benefit from early intervention. This will aid in preventing maternal and perinatal morbidity and mortality and reducing health care cost by avoiding strategies which can result in false positive cases.@*Methodology@#A cross-sectional study conducted in a tertiary hospital in the Philippines. Seventy-one Filipino pregnant women were included in the final analysis. HbA1c levels were taken during the first trimester and routine screening of gestational diabetes mellitus (GDM) utilizing 75 grams OGTT during 24th-28th weeks age of gestation. Binary logistic regression modeling was performed to determine if HbA1c was a predictor of gestational diabetes mellitus. The calculated median for Hba1c was then utilized as a threshold value to predict GDM. Odds ratio, relative risk and corresponding 95% confidence intervals from binary logistic regression were computed to determine the association of variables.@*Results@#In this study the prevalence rate of GDM is 38%. It showed that first-trimester HbA1c level is not a predictor of GDM and adverse maternal and perinatal outcomes. However, in utilizing an HbA1c threshold of ≥ 5.2%, there is a two-fold increase risk of developing hypertensive disorders, requiring insulin during pregnancy, and macrosomic newborns and a four-fold increase risk of having large for gestational age newborns. It has a positive predictive value (PPV) of only 16%. However, it has a high negative predictive value (NPV) of 88% therefore it can be used to rule out risk of GDM as early as in the first trimester.@*Conclusion@# The association of HbA1c level and the occurrence of GDM was not observed in this study. However, by using an HbA1c threshold of ≥ 5.2%, as opposed to the standard reference range for diagnosing type 2 diabetes mellitus and gestational diabetes mellitus in Caucasians, the relative risk of developing GDM in 24th-28th weeks AOG is 1.26 (0.6865, 2.3242).

Berardinelli-Seip Congenital Lipodystrophy in a Filipino child

Berardinelli-Seip Congenital Lipodystrophy (BSCL) is an autosomal recessive inborn error of the common pathway of acylglycerol and phospholipid synthesis. Patients with this condition present with generalized lipoatrophy, hepatomegaly, acromegalic features, hypertrichosis, and developmental delay. But on workup, they may also be discovered to have hypertriglyceridemia with or without hypercholesterolemia and insulin resistance. A high index of suspicion is required for diagnosis which may have implications in management. Here we present a 5-year old male with clinical features of BSCL. BSCL2 gene sequencing done showed a homozygous c.782dupG, p.(Ile262Hisfs*12) sequence alteration, classified as pathogenic, hence, confirming the diagnosis of BSCL. This is the first reported case in the Philippines.Key Words: Berardinelli-Seip Congenital Lipodsytrophy, insulin resistance

Association and interaction of pre-pregnant body mass index and gestational weight gain of women on neonatal birthweight / 中华流行病学杂志

Objective: To investigate the association between maternal pre-pregnant body mass index and gestational weight gain, as well as their interaction on neonatal birthweight. Methods: We built a cohort in Anqing Municipal Hospital from January 2014 to March 2015, enrolling pregnant women who decided to give birth in this hospital. All women were asked to fill a questionnaire for basic information collection. Medical information of both pregnant women and their newborns were obtained through electronic medical record. Chi-square analysis, multinomial logistic regression, multiplicative and additive interaction methods were used to analyze the association between pre-pregnant body mass index and gestational weight gain as well as their interactions on birth weight of the neonates. Results: A total of 2 881 pregnant women were included in this study. Of the 2 881 newborns, 359 (12.46%) were small for gestational age (SGA) and 273 (9.48%) were large for gestational age (LGA). After adjusting the possible confounding factors, results from the multinomial logistic regression showed that pre-pregnancy underweight women were more possible to deliver SGA (aRR=1.33, 95%CI: 1.02-1.73). If the gestational weight gain was below the recommended criteria, the risk of SGA (aRR=1.64, 95%CI: 1.23-2.19) might increase. Pre-pregnancy overweight/obese could increase the risk of being LGA (aRR=1.86, 95%CI: 1.33-2.60). Maternal gestational weight gain above the recommendation level was associated with higher rates of LGA (aRR=2.03, 95%CI: 1.49-2.78). Results from the interaction analysis showed that there appeared no significant interaction between pre-pregnancy BMI and gestational weight on birthweight. Conclusion: Pre-pregnancy body mass index and gestational weight gain were independently associated with neonatal birthweight while pre-pregnancy BMI and gestational weight gain did not present interaction on birthweight.

History of influenza pandemics in China during the past century / 中华流行病学杂志

Five influenza pandemics had occurred during the past century (1918 "Spanish flu" , 1957 "Asian flu" , 1968 "Hong Kong flu" , 1977 "Russian flu" and 2009 H1N1 Pandemic), accounting for hundreds of millions of people infected and tens of millions dead. China was influenced by all the five pandemics, and three of them (1957 "Asian flu" , 1968 "Hong Kong flu" and 1977 "Russian flu" ) were originated from China. The pandemics triggered the establishment of public health agencies and influenza surveillance capacities. In addition, more resources were allocated to influenza-related research, prevention and control. As a leader in the field of influenza, China should further strengthen its pandemic preparedness and response to contribute to global health.

Technical guidelines for seasonal influenza vaccination in China, 2018-2019 / 中华流行病学杂志

Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and its complications. Currently, China has licensed trivalent (IIV3) and quadrivalent inactivated influenza vaccine (IIV4), including split-virus influenza vaccine and subunit vaccine. In most parts of China, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients need to pay for it. To strengthen the technical guidance for prevention and control of influenza and the operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC), Influenza Vaccine Technical Working Group (TWG), updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)" , based on most recent existing scientific evidences. The main updates include: epidemiology and disease burden of influenza, types of influenza vaccines, northern hemisphere influenza vaccination composition for the 2018-2019 season, and, IIV3 and IIV4 vaccines'major immune responses, durability of immunity, immunogenicity, vaccine efficacy, effectiveness, safety, cost-effectiveness and cost-benefit. The recommendations include: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for any influenza vaccine product for persons who can accept ≥1 licensed, recommended, and appropriate products. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-60 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to pregnant during the influenza season. Children aged 6 months to 8 years old require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in previous influenza season, 1 dose is recommended. People ≥ 9 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. Influenza vaccination should continue to be available for those unable to be vaccinated before the end of October during the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for CDC members who are working on influenza control and prevention, PoVs members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and members of maternity and child care institutions at all levels.

The role of n-acetylcysteine supplementation on the oxidative stress levels, genotoxicity and lineage commitment potential of ex vivo murine haematopoietic stem/progenitor cells

Objectives: The ex vivo maintenance of haematopoietic stem/progenitor cells [HSPCs] is crucial to ensure a sufficient supply of functional cells for research or therapeutic applications. However, when exposed to reactive oxygen species [ROS] in a normoxic microenvironment, HSPCs exhibit genomic instability which may diminish their quantity and quality. This study aimed to investigate the role of N-acetylcysteine [NAC] supplementation on the oxidative stress levels, genotoxicity and lineage commitment potential of murine haematopoietic stem/progenitor cells [HSPCs]

Methods: This study was carried out at the Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, between June 2016 and July 2017. Bone marrow cells were isolated from nine mice and cultured in a growth medium. Various concentrations of NAC between 0.125-2 MuM were added to the culture for 48 hours; these cells were then compared to non-supplemented cells harvested from the remaining three mice as the control group. A trypan blue exclusion test was performed to determine cell viability, while intracellular ROS levels and genotoxicity were determined by hydroethidine staining and comet assay, respectively. The lineage commitment potential of erythroid, myeloid and pre-B-lymphoid progenitor cells was evaluated via colony-forming cell assay

Results: NAC supplementation at 0.25, 0.5 and 2 MuM significantly increased cell viability [P <0.050], while intracellular ROS levels significantly decreased at 0.25 and 0.5 MuM [P <0.050]. Moreover, DNA damage was significantly reduced at all NAC concentrations [P <0.050]. Finally, the potential lineage commitment of the cells was not significantly affected by NAC supplementation [P >0.050]

Conclusion: The findings of this study indicate that NAC supplementation may potentially overcome the therapeutic limitations of ex vivo-maintained HSPCs

Clinical, surgical, and histopathologic outcomes of Filipino patients who underwent adrenalectomy in a tertiary hospital in Cebu, Philippines

Introduction@#Hormone-producing adrenal tumors, adrenal carcinomas and other adrenal diseases can be potentially cured with adrenalectomy. In the local setting, studies are often limited by a small sample size and inadequate patient data. This study aimed to determine the clinical and histopathologic characteristics and perioperative outcomes of patients who underwent adrenalectomy.@*Methods@#This is a retrospective chart review study from January 2007 to June 2017 in a tertiary hospital in Cebu City, Philippines. Clinical profiles, type of surgery, and operative outcomes were determined. Comparative analysis of clinical profile, histopathologic features, and surgical outcome was done. Descriptive as well as appropriate inferential statistical methods were used to analyze the data.@*Results@#A total of 31 patients who underwent adrenalectomy were included with the mean age of 45.7 [SD=17.1] years old and a 1:3 male to female distribution. The distribution of tumors was as follows: hormone-producing adrenal tumor (74.2%), malignant adrenal tumors (12.9%), and other benign lesions (12.9%). Among patients with hormoneproducing tumors, 39.1% had catecholamine excess, 34.8% had aldosterone excess, and 26.1% had cortisol excess. Hormone-producing adrenal tumors were common at age 20 to 40 years old while malignant tumors were more common among those above 40 years old (p-value=0.023). Stage 3 hypertension (p-value=0.010) and improvement of hypertension postoperatively (p-value=0.046) were more common among hormone-producing tumors. On the other hand, large tumor size (>4cm) (p-value=0.011), blood loss needing blood transfusion (p-value=0.001), prolonged operation (p-value=0.046), and longer hospital stay (p-value=0.002) were common among those with malignant tumors. Open adrenalectomy was associated with significant blood loss needing transfusion (p-value=0.001) and prolonged hospital stay (p-value=0.024).@*Conclusion@#Hormone-producing adrenal tumors with secondary hypertension are the most common pathology among patients who underwent adrenalectomy. They are usually seen among patients less than 40 years old, with smaller tumor size, and frequently present with higher blood pressures that improve following adrenalectomy. In contrast, adrenal carcinomas are more common among patients above 40 years old and have larger tumor size. More often they have prolonged operation time, greater blood loss, and longer hospital stay. Patients who underwent open adrenalectomy had more blood loss and had a longer hospital stay than those who underwent laparoscopic surgery.

Predictive values of TNF-alpha, IL-6, IL-10 for radiation Pneumonitis

Background: To investigate the expression of TNF-alpha, IL-6, IL-10 in the plasma of patients with lung cancer who received radiation therapy [RT], and to analyze the correlation between these cytokines and radiation pneumonitis [RP]. Materials and Methods: Patients with lung cancer who received 3D-CRT in our hospital were prospectively evaluated. Circulating cytokine levels were measured with ELISA before RT and at the end of RT. Regular follow-up was undertaken 3 months after RT. Statistical analysis was applied to determine the relevance of cytokines to radiation-induced lung injury. Results: Of 104 patients, 29 [27.9%] developed RP. The levels of TNF-alpha and IL-6 levels in the plasma after RT were significantly higher than before RT [p<0.05], whereas IL -10 levels were significantly lower after RT than before RT [p<0.05]. Before RT, TNF-alpha levels were higher in RP group [p<0.05],but there were no differences in TNF-alpha levels after RT. No association was observed between IL-6 and IL-10 levels and the risk of RP. Univariate analysis showed that baseline pulmonary function, smoking history, histopathology, lung volume receiving >/=20 Gy [V20], Mean lung dose [MLD] and total radiation dose were related to RP, but only MLD was an independent risk factor for RP in lung cancer patients [OR>1]. Conclusion: TNF-alpha levels in plasma were closely related to RP but still cannot be used as predictors for RP

Clinics in diagnostic imaging. 145

A 63-year-old man presented with painless jaundice, loss of appetite and significant weight loss. Cross-sectional imaging showed a diffusely enlarged pancreas, with no significant fat stranding and a hypodense rim on computed tomography, which appeared hypointense on T2-weighted magnetic resonance imaging. There was a narrowed pancreatic duct and features of common bile duct narrowing in the region of the pancreatic head. However, there was no obvious mass seen in the pancreatic head region. These features were classical of autoimmune pancreatitis with diffuse involvement of the gland. Laboratory investigation showed abnormal liver function and the classical sign of raised immunoglobulin G class 4 antibodies. The patient showed dramatic response to high-dose steroids, with resolution of both the laboratory and imaging abnormalities within one month. We discuss the classical imaging features of Type 1 autoimmune pancreatitis, an uncommon condition that needs to be differentiated from pancreatic malignancy.

Medical professionalism: our badge and our pledge

Medical professionalism: our badge and our pledge by S.Y Tan Is reproduced In the Bulletin of the Kuwait Institute for Medical Specialization with permission from the Singapore Medical Association. It was originally published on the website of the Singapore Medical Association at http:/www.sma.org.sg/cmep/whatsnew/prof'sytan.html