A phenomenological study on the migration trends of Filipino pharmacists who graduated from a university in Manila

Introduction

Migration trends and patterns differ in every country, and the current phenomena are happening at a particular time, whether in retrospect or prospect. In the Philippines, an influx of migration, especially among pharmaceutical healthcare providers, is seen due to the demands in the medical field even before the global COVID-19 pandemic.

Aim

This study determined the factors that influenced Filipino pharmacists' who graduated from a University in Manila; their motivation to work and migrate to other countries, as well as the responsibilities, competencies, and working conditions of pharmacists waiting for them abroad.

Methods

Following institutional ethical approval, snowball sampling was employed as the sampling method wherein the research participants were asked to help determine and recruit potential respondents. The sample size used to collate information for this study was 15 respondents from 3 different countries of origin, specifically Canada, Singapore, and the United States of America. Through a semi-structured interview, the participants elicited different responses with common themes analysed through thematic analysis. The respondents were not required to disclose any information they were not allowed to reveal. Hence, the researchers fully understood and did not force the respondents to get the information without the participant’s permission. In cases where participants shared information with another participant, this was their own doing, and researchers could not be responsible for this. The researchers safeguarded the information and identities of each participant as far as reasonably possible. Furthermore, each piece of data given is protected through the Philippine Data Privacy Act of 2012, and researchers are ensured to comply fully with what was written in the Informed Consent Form.

Results

All fifteen participants took their pharmacy undergraduate degree at a university in Manila before migrating or working abroad. Participants have at least a year of experience working abroad, covering the years 2010-2020, ranging from the completion of four-year pharmacy degrees to participants who graduated with five-year pharmacology degrees. Key themes which influenced the Filipino pharmacists included their chosen pharmacy degrees, including the University's curriculum reliability and relevance, turning point of migration decision, factors of their migration, ways migration was obtained, pharmacy work opportunities abroad, prior pharmacy working experience in the Philippines, work dynamics abroad, and their annual salary with benefits.

Discussion/Conclusion

There are numerous and limitless opportunities abroad, but most of them differ in the work setting in the Philippines, wherein they are more aligned with the clinical side of being a pharmacist. Moreover, the research field of the profession is still an emerging field with a wide array of opportunities. Overall, the study has collected varying and new insights into Filipino Pharmacists' migration, specifically their migration trends, competencies, responsibilities, and working conditions that may contribute to the betterment of the institution's curriculum and pharmacy practice in the Philippines. With the growing demand for pharmacists in the Philippines, the knowledge gained from a similar study would help improve conditions for healthcare workers to avert their desire or need to migrate.

References

1. Loquias, M. and Robles, Y. Issues and Concerns on Utilization of the Pharmacy Workforce in the Philippines. [Internet]. 2012 [cited 2021 Sept 10]; JAASP 2012;1(2):86-96. Available from https://www.aaspjournal.org/uploads/155/5955_pdf.pdf

2. Lorenzo, F., et. al. Migration of Health Workers: Country case study Philippines. ILO. [Internet] 2006. [cited 2021 Oct 15] Available from: https://www.ilo.org/wcmsp5/groups/public/---ed_dialogue/---sector/documents/publication/wcms_161163.pdf

3. Morii, Y., Furuta, S., Ishikawa, T., Fujiwara, K., Yamashina, H., & Ogasawara, K. Projecting supply and demand for pharmacists in pharmacies based on the number of prescriptions and system dynamics modeling. Human Resources for Health, 18(1). [Internet]. 2020 [cited 2021 Sept 27]; Available from: https://doi.org/10.1186/s12960-020-00524-5

Humanized COVID-19 decoy antibody effectively blocks viral entry and prevents SARS-CoV-2 infection

To circumvent the devastating pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a humanized decoy antibody (ACE2-Fc fusion protein) was designed to target the interaction between viral spike protein and its cellular receptor, angiotensin-converting enzyme 2 (ACE2). First, we demonstrated that ACE2-Fc could specifically abrogate virus replication by blocking the entry of SARS-CoV-2 spike-expressing pseudotyped virus into both ACE2-expressing lung cells and lung organoids. The impairment of viral entry was not affected by virus variants, since efficient inhibition was also observed in six SARS-CoV-2 clinical strains, including the D614G variants which have been shown to exhibit increased infectivity. The preservation of peptidase activity also enables ACE2-Fc to reduce the angiotensin II-mediated cytokine cascade. Furthermore, this Fc domain of ACE2-Fc was shown to activate NK cell degranulation after co-incubation with Spike-expressing H1975 cells. These promising characteristics potentiate the therapeutic prospects of ACE2-Fc as an effective treatment for COVID-19.

Identification of cyclin B1 as a shared human epithelial tumor-associated antigen recognized by T cells

We eluted peptides from class I molecules of HLA-A2.1(+) breast adenocarcinoma and loaded reverse phase high-performance liquid chromatography (HPLC) fractions onto dendritic cells to prime naive CD8(+) T cells. Fractions that supported growth of tumor-specific cytotoxic T lymphocytes were analyzed by nano-HPLC micro-ESI tandem mass spectrometry. Six HLA-A2.1-binding peptides, four 9-mers (P1-P4) differing in the COOH-terminal residue, and two 10-mers (P5 and P6) with an additional COOH-terminal alanine, were identified in one fraction. Peptide sequences were homologous to cyclin B1. We primed CD8(+) T cells from another HLA-A2.1(+) healthy donor with synthetic peptides and generated P4-specific responses. We also detected memory T cells specific for one or more of these peptides in patients with breast cancer and squamous cell carcinomas of the head and neck (SCCHN). T cells from one patient, restimulated once in vitro, could kill the tumor cell line from which the peptides were derived. Immunohistochemical analysis of tumor lines and tissue sections showed cyclin B1 overexpression and aberrant localization in the cytoplasm instead of the nucleus. Sequencing genomic DNA and cDNA corresponding to P1-P6 region showed that differences in COOH-terminal residues were not due to either DNA mutations or errors in transcription, suggesting a high error rate in translation of cyclin B1 protein in tumors.

A new strategy for tumor antigen discovery based on in vitro priming of naive T cells with dendritic cells

We describe a method for discovery of new tumor antigens that uses dendritic cells (DCs) as antigen-presenting cells to prime autologous naive CD4+ and CD8+ T cells from healthy donors against tumor proteins and peptides. For the identification of HLA class I-restricted tumor antigens, peptides were extracted from tumor HLA class I molecules, fractionated by reverse phase-high performance liquid chromatography, and loaded onto in vitro-generated DCs to prime naïve CD8+ T cells. Our results show that we were able to prime naive CD8+ T cells in vitro to several peptide fractions and generate specificity for the tumor. Electrospray ionization mass spectrometry was used to confirm that these fractions contained peptides derived from MHC class I molecules, and the primed CD8+ T cells were used to further analyze the immunostimulatory peptide fractions. For the identification of HLA class II-restricted tumor antigens, we fractionated tumor protein extracts using reverse phase-high performance liquid chromatography and loaded individual fractions onto DCs to prime naive CD4+ T cells. Our results show that we were also able to prime naive CD4+ T cells to several protein fractions and generate specificity for the tumor. These results illustrate the potential of this method to identify new immunostimulatory MHC class I- and class II-restricted tumor antigens.

Clinical care issues for women living with HIV and AIDS in the United States

As the number of women infected with HIV in the United States continues to increase, the medical community is faced with the challenge of providing adequate and appropriate care to them. This paper reviews key questions concerning the state of knowledge on the epidemiology, biology, and clinical care of women living with HIV and AIDS in the United States. Because heterosexual transmission accounts for a growing number of cases among women, biological factors and cofactors that may enhance women's susceptibility to HIV infection are also reviewed. HIV-related gynecological issues are presented separately to evaluate whether gynecological complications are distinct in HIV-uninfected and HIV-infected women. Questions of whether there are sex-specific differences in the efficacy and adverse effects of new antiviral agents are discussed. In addition, significant gaps are highlighted that still exist in our understanding of both the effects of HIV and HIV-related drugs upon pregnancy. Finally, the psychiatric stresses and complications that affect women living with HIV and AIDS are also discussed. In each section of this review, gaps in our knowledge of these issues are identified. To properly address these disparities in knowledge, not only do efforts to gather sex-specific biomedical data need to be more exacting, but there is a distinct need to conduct more sex-specific research concerning HIV.

The chi-Chi earthquake sequence: active, out-of-sequence thrust faulting in taiwan

We combined precise focal depths and fault plane solutions of more than 40 events from the 20 September 1999 Chi-Chi earthquake sequence with a synthesis of subsurface geology to show that the dominant structure for generating earthquakes in central Taiwan is a moderately dipping (20 degrees to 30 degrees ) thrust fault away from the deformation front. A second, subparallel seismic zone lies about 15 kilometers below the main thrust. These seismic zones differ from previous models, indicating that both the basal decollement and relic normal faults are aseismic.

The pH-dependent biphasic release of azidothymidine from a layered composite of PVA disks and P(MMA/MAA) spheres

A composite device was developed to provide a biphasic drug release using poly(vinyl alcohol) (PVA) and poly(methylmethacrylate-co-methacrylic acid) (P(MMA/MAA)) spheres. Azidothymidine (AZT), an anti-HIV agent with a short biological half-life, was used as the model drug. Dynamic and equilibrium swelling of the polymers, and kinetics of AZT release from these polymers were determined in pH 1.2 and 6.8 buffer solutions. The swelling of PVA and release of AZT from PVA disks were fast and nearly pH-independent, whereas the swelling behavior and drug release kinetics of P(MMA/MAA) spheres were strongly pH-dependent. A swelling interface number for the spheres at pH 6.8 was determined to be Sw&z.Lt;1 and time dependent. Nevertheless, Fickian diffusion might also contribute to the drug release in this system. The composite disks consisting of PVA matrix and P(MMA/MAA) spheres provided prolonged (over 20 h) and more steady release profiles, differing profoundly from individual components. Such release profiles resulted from the second phase release at pH 6.8 and the presence of PVA layer. The relative drug loading in the matrix could be tailored to produce release profiles varying from a distinct bimodal release to a pseudo zero-order release with an initial burst.

Chimpanzee dendritic cells derived in vitro from blood monocytes and pulsed with antigen elicit specific immune responses in vivo

Dendritic cells differentiated in vitro from blood and other sources using cytokines hold particular promise as immunotherapeutic agents in cancer. However, there are currently no data to show that human in vitro-derived dendritic cells are immunogenic in vivo. We have developed a primate model of immunotherapy using dendritic cells differentiated in vitro from blood monocytes by culturing with human granulocyte/ macrophage colony-stimulating factor and interleukin-4. We measured the immune response to antigen elicited by in vitro-derived and antigen-treated dendritic cells following a single intravenous inoculation an boost in chimpanzees. The antigens tested were ovalbumin, a complex foreign protein, and a peptide derived from the MUC-1 mucin tumor antigen, a relatively uncomplex self antigen. Four chimpanzees were immunized either with antigen-pulsed dendritic cells (two animals) or mock-treated dendritic cells (one animal) given intravenously or both antigens given in adjuvant subcutaneously (one animal). Each animal received a boost of both antigens in adjuvant 10 days later. All animals responded with an IgG-mediated humoral response to ovalbumin measured in the serum at day 24. This was associated with a proliferative cellular response to ovalbumin in the inguinal lymph node draining the boost injection. In contrast, antibody responses to mucin peptide were detected in one animal in response to the boost injection, and no T cell proliferative responses to mucin peptide were detected in the draining lymph node of any animal. To determine if the single inoculation of antigen-pulsed dendritic cells elicited any immunity, we measured the T cell response to ovalbumin in blood mononuclear cells harvested prior to the boost. Ovalbumin-specific proliferative responses that were antigen dose dependent were detected in one of two treated animals. In contrast, ovalbumin given with adjuvant and mock-treated dendritic cells induced no response. The three animals inoculated with dendritic cells, either antigen or mock treated, had moderate T cell responses to bovine serum albumin, a constituent of the medium used to culture cells prior to injection. We conclude from these data that in vitro-derived dendritic cells can elicit T cell responses to a complex foreign antigen following a single intravenous injection in a large primate. It is likely that immunity to a simple self antigen, MUC-1 mucin peptide, may require multiple inoculations. The results support the use of dendritic cells differentiated in vitro as vehicles for immunotherapy in humans.

Functional consequences of the binding of MHC class II-derived peptides to MHC class II

Three MHC class II-derived synthetic peptides (I-A beta (g7)1-16, I-A beta (g7)52-77 and I-A alpha (g7)63-82YC) were analyzed for their ability to bind to syngeneic and allogeneic MHC class II molecules using a whole cell, competitive peptide binding assay. These studies demonstrated that the A beta (g7)1-16 peptide was able to specifically bind to syngeneic as well as to four allogeneic MHC class II molecules. The A alpha (g7)63-82YC peptide bound to self MHC class II molecules with a lower relative affinity and was able to bind to three out of the four allogeneic cells tested. The binding of the three I-A(g7)-derived peptides to the self MHC class II was functionally significant. The A beta (g7)1-16 and A beta (g7)52-77 peptides inhibited the proliferation of a heat shock protein 60 peptide-specific Th1 clone by MHC blockade. Interestingly, the A alpha (g7)63-82YC peptide appeared to interact directly with T cells as pretreatment of the Th1 clone with this peptide resulted in inhibition of antigen-induced proliferation. This phenomenon was analyzed in more detail and it was found that this peptide could behave as a partial agonist. Incubation of T cells with the A alpha (g7)63-82YC peptide resulted in up-regulation of IL-2R alpha chain expression and induction of IFN-gamma secretion. In addition T cells pretreated with this peptide were rendered hyporesponsive to further antigenic stimulation. Thus, a peptide derived from MHC class II may be used in an immunoregulatory capacity.

Recombination sites in the HLA class II region are haplotype dependent

We have analyzed DNA sequence polymorphisms of DQ alpha and DQ beta chains from three haplotypes from the DRw52 family: DR5 DQw1 (FPA, GM3106), DRw6 DQw1 (CB6B, 10w9060), and DRw6 DQw3 (AMALA, 10w9064). The results indicate that the DR5 DQw1 and DRw6 DQw1 haplotypes have arisen by recombination between the DR beta 1 and DQ alpha loci. This contrasts with our previous analysis of DR4 DQ"Wa", DR3 DQ"Wa", and DR7 DQw3 haplotypes, all of which appear to have arisen by virtue of recombination between DQ alpha and DQ beta. Thus, there appear to be at least two different sites where recombination has occurred within the DR and DQ subregions. These differing patterns of recombination were interpreted in the context of the three major family groups of class II haplotypes, the DRw53, DRw52, and DR1/2 haplotype families. The data indicate that haplotypes from these family groups tend to undergo recombination at different locations. We propose that these differences in site of recombination are a reflection of differences in the molecular organization of the haplotypes belonging to each family group.

Recombination sites in the HLA class II region are haplotype dependent

We have analyzed DNA sequence polymorphisms of DQ alpha and DQ beta chains from three haplotypes from the DRw52 family: DR5 DQw1 (FPA, GM3106), DRw6 DQw1 (CB6B, 10w9060), and DRw6 DQw3 (AMALA, 10w9064). The results indicate that the DR5 DQw1 and DRw6 DQw1 haplotypes have arisen by recombination between the DR beta 1 and DQ alpha loci. This contrasts with our previous analysis of DR4 DQ"Wa", DR3 DQ"Wa", and DR7 DQw3 haplotypes, all of which appear to have arisen by virtue of recombination between DQ alpha and DQ beta. Thus, there appear to be at least two different sites where recombination has occurred within the DR and DQ subregions. These differing patterns of recombination were interpreted in the context of the three major family groups of class II haplotypes, the DRw53, DRw52, and DR1/2 haplotype families. The data indicate that haplotypes from these family groups tend to undergo recombination at different locations. We propose that these differences in site of recombination are a reflection of differences in the molecular organization of the haplotypes belonging to each family group.

Acute type A hepatitis in three patients with chronic HBV infection

We have studied three patients with chronic HBV infection who had a superimposed bout of type A hepatitis. The patients recovered uneventfully without observing a change in their clinical course afterwards. In one patient we observed transient disappearance of DNA polymerase during type A hepatitis; we have postulated that this is probably related to hepatic necrosis.

Alcoholic foamy degeneration--a pattern of acute alcoholic injury of the liver

A newly recognized clinical and morphologic pattern of acute alcoholic liver disease is described. Twenty-one patients, having the hepatic morphologic features of alcoholic foamy degeneration, were retrospectively analyzed. All patients had a significant history of chronic alcoholism. Jaundice and hepatomegaly were usually present. Hepatic encephalopathy, ascites, bleeding esophageal varices, or functional renal failure occurred in less than 10%. Usually this was the first episode of decompensation. Laboratory studies revealed a pattern of very transiently marked elevation of serum aminotransferase and more prolonged elevation of alkaline phosphatase activity and bilirubin levels. In the majority of cases, leukocytosis was absent, and serum cholesterol was elevated. The laboratory profile differed significantly from that of acute sclerosing hyaline necrosis. Serologic markers of acute viral hepatitis A and B were absent. Needle biopsy specimens of the liver revealed intact lobular architecture except for 1 case of cirrhosis. The perivenular hepatocytes revealed foamy fatty change characterized by striking cell swelling with massive accumulation of microvesicular fat, bile pigment deposition in the cytoplasm, and no displacement of the nucleus to the periphery of the cell. Megamitochondria were frequently identified. Multiple foci of hepatocyte dropout without significant parenchymal neutrophilic exudation and delicate intrasinusoidal collagen fibers were present in the perivenular area. Macrovesicular fatty change coexisted to a variable degree. The affected hepatocytes had extensive disorganization of the organelles by electron microscopy and decreased or absent functional activity by enzyme histochemical staining. These changes appear to be a purely degenerative process without inflammatory reaction. All patients in the present series showed a rapid recovery upon abstaining from alcohol.

Rheumatic fever in native children in Manitoba

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