1
|
Ditan ID, Turalde CWR. Treatment gaps in the care of amyotrophic lateral sclerosis in the Philippines: A scoping review. Heliyon 2024; 10:e27944. [PMID: 38510000 PMCID: PMC10950718 DOI: 10.1016/j.heliyon.2024.e27944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive disease affecting both the upper and lower motor neurons. Much of the management of ALS is supportive with the goal of maximizing patient quality of life. While the Philippines was participative in the "Ice Bucket Challenge" in 2014, it is up for investigation whether substantial changes occurred to improve healthcare for ALS patients. This study aims to evaluate the treatment gaps in the management of ALS in the Philippines through a scoping review. Data on epidemiology, health systems, and pharmacotherapy available regarding ALS in the local setting were synthesized. Nine articles were included. As of July 2023, there were only four indexed studies on ALS from the Philippines. Five of the included articles investigated ALS in Filipino populations but were not authored by Filipinos nor affiliated with Philippine institutions. The available literature showed a distinct lack of local ALS epidemiologic data, as well as limited availability in diagnostic centers, medications, health financing options, and digestible information for Filipinos. The limitations in managing ALS in the country are multifactorial - from political, medical, and social. It is imperative to establish a national database, financing systems, support groups, and accessible diagnostic centers for ALS patients.
Collapse
Affiliation(s)
- Iris D. Ditan
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Christian Wilson R. Turalde
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
- National Teacher Training Center for the Health Professions, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|
2
|
Lanuza PDT, Garcia JJB, Turalde CWR, Prado MJB. Clinical profile and outcomes of tetanus patients in a tertiary hospital in the Philippines: a ten-year retrospective study. BMC Infect Dis 2024; 24:142. [PMID: 38287272 PMCID: PMC10826059 DOI: 10.1186/s12879-024-09037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Tetanus is a life-threatening but preventable neurologic disorder characterized by trismus and muscle spasms. Despite its decreasing global incidence, it remains to be endemic in resource-limited settings such as the Philippines. This study aimed to determine the incidence, demographic characteristics, risk factors, clinical presentation, management, complications, and outcomes of non-neonatal tetanus cases in a tertiary hospital in the Philippines. It also aimed to compare the clinical profile and outcomes between the adult and pediatric subgroups. METHODS This study used a retrospective cross-sectional design including all adult and pediatric non-neonatal tetanus patients admitted at the University of the Philippines - Philippine General Hospital from January 2012 to June 2023. Data was extracted from department censuses and inpatient charts. RESULTS One hundred thirty-eight cases were included. The incidence rate was 0.03%, while mortality rate was 29%. Majority of patients were males presenting with trismus and spasms after sustaining a puncture wound. Chronic hypertension was associated with an increased hazard of death by 4.5 times (p = 0.004), while treatment with magnesium sulfate was associated with a decreased hazard of death by 35 times (p = 0.005). The mode of infection and the medications administered differed between the adult and pediatric subgroups. CONCLUSIONS Although the total number of cases has decreased over the past decade, tetanus remains to have a high incidence and mortality rate in the Philippines. Increasing vaccination coverage, improving public awareness, and educating health professionals can help reduce morbidity and mortality from this disease.
Collapse
Affiliation(s)
- Pamela Danielle T Lanuza
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Jao Jarro B Garcia
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Christian Wilson R Turalde
- Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
- National Teacher Training Center for the Health Professions, University of the Philippines Manila, Manila, Philippines
| | - Mario Jr B Prado
- Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|
3
|
Turalde-Mapili MWR, Mapili JAL, Turalde CWR, Pagcatipunan MR. The efficacy and safety of nirsevimab for the prevention of RSV infection among infants: A systematic review and meta-analysis. Front Pediatr 2023; 11:1132740. [PMID: 37082704 PMCID: PMC10110918 DOI: 10.3389/fped.2023.1132740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/20/2023] [Indexed: 04/22/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) is a leading cause of morbidity and mortality among infants with a global incidence of 9.5% and a mortality rate of 2.2%. The management of RSV infection is mainly supportive and, aside from emerging monoclonal antibodies, there has been no benefit of most preventive measures. Recent evidence suggests the potential of nirsevimab in preventing RSV infection. Objective This study aims to determine the efficacy and safety of nirsevimab in preventing RSV infection among infants using a review of relevant clinical trials. Methods We performed a random-effects meta-analysis among infants comparing nirsevimab injection vs. placebo. MEDLINE, CENTRAL, Scopus, and ClinicalTrials.gov were searched for relevant trials from inception to June 2022. The selected studies were assessed for risk of bias using the Revised Cochrane Risk-of-Bias (RoB2) tool and for quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results Two studies were included. Data analysis showed that among infants, nirsevimab given before the RSV season significantly reduced the risk of medically attended RSV-related infection (RR: 0.26; 95% CI: 0.18-0.38) and the risk of hospitalization due to RSV infection (RR: 0.24; 95% CI: 0.13-0.47). There was no difference in terms of adverse events leading to death (RR: 0.78, 95% CI: 0.20-2.98) and adverse events of special interest (RR: 0.92, 95% CI: 0.25-3.38). Conclusions The use of nirsevimab to prevent RSV infections and hospitalization shows its promising potential, but studies on its cost-effectiveness are lacking. We recommend that further studies be done to look into the applicability and cost-effectiveness of nirsevimab.
Collapse
Affiliation(s)
- Maria Wilma R. Turalde-Mapili
- Department of Pediatrics, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jerahmeel Aleson L. Mapili
- Department of Medicine, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Christian Wilson R. Turalde
- Department of Physiology, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- National Teacher Training Center for the Health Professions, University of the Philippines Manila, Manila, Philippines
- Correspondence: Christian Wilson R. Turalde
| | - Marimel R. Pagcatipunan
- Department of Pediatrics, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|
4
|
Pagaling GT, Turalde CWR, Jamora RDG. Autoimmune Encephalitis in the Philippines: A Scoping Review on the Treatment Gaps, Challenges, and Current State of Care. Front Neurol 2022; 13:788309. [PMID: 35197921 PMCID: PMC8858951 DOI: 10.3389/fneur.2022.788309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/10/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives We reviewed the current health service delivery for individuals with Autoimmune Encephalitis (AE) in the Philippines and to identify the gaps and challenges in its management. Methodology We conducted a scoping review of pertinent literature AE in the Philippines using the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines. We extracted data on epidemiology, legislation, health financing, information systems, pharmacotherapy, and healthcare services related to the management of AE in the local setting. Discussion The epidemiology of AE is still unknown. Out-of-pocket expenses contribute to most of the healthcare expenditure despite government-led programs to reduce the financial burden. The access to diagnostic examinations such as magnetic resonance imaging, electroencephalogram, and antibody testing is limited by the geographic distribution of the facilities and costs. The acute and long-term management of AE are cost-prohibitive and are not readily available. There are significant treatment gaps in the care of individuals with AE in the Philippines in terms of disease recognition, resource allocation, access to satisfactory diagnostic evaluation, and provision of prognosis-changing therapeutics. We proposed core strategies that can address these treatment gaps such as increasing awareness, improving access to health resources, adequate healthcare financing, and availability of support systems.
Collapse
Affiliation(s)
- Gerald T. Pagaling
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Christian Wilson R. Turalde
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Roland Dominic G. Jamora
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
- *Correspondence: Roland Dominic G. Jamora ; orcid.org/0000-0001-5317-7369
| |
Collapse
|
5
|
Turalde CWR, Espiritu AI, Macinas IDN, Jamora RDG. Burnout among neurology residents during the COVID-19 pandemic: a national cross-sectional study. Neurol Sci 2021; 43:1503-1511. [PMID: 34846584 PMCID: PMC8630990 DOI: 10.1007/s10072-021-05675-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/15/2021] [Indexed: 11/06/2022]
Abstract
Background Neurology residents are particularly vulnerable to burnout because of the novel logistical and clinical challenges brought about by the coronavirus disease 2019 (COVID-19) pandemic. Despite its implications, knowledge on burnout and its predictors among neurology residents is lacking. This study aimed to determine the prevalence of burnout among neurology residents during the pandemic, to compare burnout subscale scores and sociodemographic and work characteristics, and to explore residents’ perceptions on how to address burnout. Methods We conducted a cross-sectional survey among all 120 residents from the nine institutions in the Philippines offering neurology residency programs from March to August 2020. We obtained sociodemographic and work characteristics using questionnaire. We measured burnout using the Maslach Burnout Inventory. We performed an inductive thematic analysis to analyze perceptions on how to reduce burnout. Results The response rate was 71.67% (86/120). The mean age was 30.1 ± 3.1 years. Using predefined subscale critical boundaries, the prevalence of burnout was 94% (95% CI 89, 99). The lack of compensation and number of on-duty days influenced emotional exhaustion scores. The number of on-duty days influenced depersonalization scores. Thematic analysis revealed five themes: increasing manpower; self-care; reducing clerical tasks; improving work environment; and adequate compensation. Conclusions The prevalence of burnout among neurology residents during the COVID-19 pandemic was alarmingly high. Reforms in hiring policies, work-hour management, manpower organization, work environment, and logistics may be considered. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05675-4.
Collapse
Affiliation(s)
- Christian Wilson R Turalde
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Adrian I Espiritu
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | | | - Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines. .,Institute for Neurosciences, St. Luke's Medical Center, Quezon City & Global City, Philippines.
| |
Collapse
|
6
|
Turalde CWR, Espiritu AI, Anlacan VMM. Memantine for Multiple Sclerosis: A Systematic Review and Meta-Analysis of Randomized Trials. Front Neurol 2021; 11:574748. [PMID: 33658967 PMCID: PMC7917060 DOI: 10.3389/fneur.2020.574748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/22/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Multiple sclerosis (MS), a disabling demyelinating disease of the central nervous system, is associated with cognitive impairment, spasticity, and fatigue. There are still no established guidelines on the management of MS-related sequela. Memantine has the potential to reduce glutamate toxicity, thereby reducing consequent cognitive impairment, spasticity, and fatigue. Objectives: This study aims to determine the efficacy and safety of memantine in preventing cognitive impairment, reducing spasticity and fatigue, and controlling disability in MS patients through a review of relevant randomized trials. Methods: MEDLINE, CENTRAL, Scopus, Embase, LILACS, ClinicalTrials.gov, and HERDIN were searched from inception to May 2020 for relevant trials. Results: The search yielded 203 articles; four studies were included in the analysis. Pooled evidence shows that memantine compared with placebo does not significantly improve PASAT, ASS, MFIS, and EDSS scores of patients with MS. Memantine is associated with mild adverse drug events such as dizziness, fatigue, and anxiety. Conclusion: There is not enough evidence to support the efficacy of memantine in preventing cognitive decline, controlling spasticity, reducing fatigue, and preventing disability. Future researches should consider the different MS subtypes, effect of co-administration of disease-modifying therapies, longer duration of administration, and more sensitive outcome measures to evaluate the potential benefit of memantine in MS.
Collapse
Affiliation(s)
- Christian Wilson R Turalde
- Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Adrian I Espiritu
- Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Veeda Michelle M Anlacan
- Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Neurosciences, Center for Memory and Cognition, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|