BackgroundPulmonary hypertension is a usual complication of long-standing mitral valve disease. Perioperative pulmonary hypertension is a risk factor for right ventricular failure and is an important cause of morbidity and mortality in patients with pulmonary hypertension undergoing mitral valve surgery. Phosphodiesterase-5 inhibitors particularly sildenafil citrate have proven clinical benefit for pulmonary arterial hypertension but have shown discordant results in group 2 pulmonary hypertension patients. We sought to determine the effect of pre-operative sildenafil on the intra-operative hemodynamic parameters of these patients.MethodsStudies were included if they satisfied the following criteria: 1) Randomized controlled trials; 2) Adult patients with pulmonary hypertension scheduled for elective mitral valve surgery; and 3) Reported data on changes in pre-, intra-, and post-operative hemodynamic parameters. Using PUBMED, Clinical Key, Science Direct, and Cochrane databases, a search for eligible studies was conducted from September 1 to December 31, 2018. The quality of each study was evaluated using the Cochrane Risk of Bias Tool. The primary outcome of interest is on the effect of pre-operative sildenafil on the improvement of intra-operative hemodynamic parameters such as systolic pulmonary artery pressure (sPAP), mean pulmonary arterial pressure, mean arterial pressure, pulmonary and systemic vascular resistances. We also investigated its effect on the post-operative mortality, length of cardiopulmonary bypass time, ventilation time, and inotrope support requirement. Review Manager 5.3 was utilized to perform analysis of random effects for continuous outcomes.ResultsWe identified three studies involving 153 patients with pulmonary hypertension undergoing mitral valve surgery, showing that among those who received pre-operative sildenafil there is a significant decrease in intra-operative systolic pulmonary arterial pressure (mean difference -11.19 (95% confidence interval (CI), -20.23 to -2.15), P < 0.05) and post-operative sPAP (mean difference -13.67 (95% CI, - 19.56 to - 7.78), P < 0.05) without significantly affecting the mean arterial pressure (mean difference 1.94 (95% CI, -5.49 to 9.37), P < 0.05). The systemic and pulmonary vascular resistances were not affected as well.ConclusionsAdministration of pre-operative sildenafil to patients with pulmonary hypertension undergoing mitral valve surgery decreases intra-operative and post-operative systolic pulmonary arterial pressure without significantly affecting other systemic hemodynamic parameters.

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Background. Nosocomial TB transmission adversely affects inpatients and healthcare workers (HCWs). HCWs have a higher risk of tuberculosis and MDR-TB compared to the general population. Nosocomial TB outbreaks have occurred among patients with HIV/AIDS. Hospitals need to examine TB infection control measures in order to address this growing concern. Objective. This study aimed to evaluate the TB infection control strategies in the adult service wards of the Philippine General Hospital (PGH). Methods. This descriptive study was conducted on adult inpatients with bacteriologically-confirmed PTB admitted in April-August 2016. A data collection tool based on Center for Disease Control (CDC) guidelines was utilized for chart review. Baseline characteristics, diagnosis, treatment, and isolation intervals were obtained and compared between areas. In-hospital TB infection control practices were reviewed using the CDC TB Risk Assessment Worksheet with data from the TB-DOTS, UP Health Service, PGH Hospital Infection Control Unit, and PGH Department of Laboratories. Results. Of the 95 patients with bacteriologically-confirmed PTB, data from 72 medical records were available and included in the analysis. Majority were Medicine patients (55.6%) with a diagnosis of pneumonia (52.8%). Only 61.1% were PTB suspects on admission. The mean diagnosis interval was 5.82 days±5.473, the mean treatment interval was 0.77 days±2.941, and the mean isolation interval was 8.23 days±6.372. Only 41.7% were successfully isolated. The most common reasons for isolation failure/delay were lack of vacancy (ER, Medicine wards) and lack of isolation room (Surgical wards). Treatment initiation rate was 66.7% while TB-DOTS inpatient referral rate was 55.6%. The hospital is classified as having potential ongoing transmission of PTB. Conclusion. In this study, TB treatment was promptly started but there were delays in diagnosis and isolation. Gaps included 1) lack of recognition of a PTB case, 2) limited isolation rooms, and 3) inadequate utilization of TB-DOTS. TB infection control measures need to be strengthened in order to prevent nosocomial transmission of PTB.

The previous year, 2020, was one challenging year for everyone, most especially to the healthcare workers. We experienced a pandemic no one ever imagined that would happen in our lifetime. Medical frontliners, the People Giving Hope, were called and were given the responsibility of taking care and defending the patients from the unfamiliar enemy, the COVID 19 virus. With the changes brought about the pandemic, transformation of the cardiology fellowship training also happened. Three Cardiology fellows in training gives us a sneak peek of how the pandemic affected their lives after a year of battling the virus. KEYWORDS Covid 19, Cardiology, Training

Funding Acknowledgements Type of funding sources: None. Introduction International guidelines recommend effective cardiac rehabilitation programs to decrease mortality and morbidity and improve health-related quality of life. However, cardiac rehabilitation remains underutilized with low referral rates. Data on referral rates and factors affecting referral are lacking in our setting. Purpose We evaluated the utilization of inpatient cardiac rehabilitation in our general hospital in terms of referral rates of patients with Class I indications for cardiac rehabilitation, time to referral, treadmill exercise test (TET) participation rate, and characteristics of patients referred and not referred. Methods We conducted this retrospective descriptive cross-sectional study by reviewing the medical records of eligible patients admitted between January 1 to December 31,2018. Patient characteristics, indications for cardiac rehabilitation, referral rates, time to referral, and TET participation rates were determined. Results We included 759 patients with a mean age of 57.5 years; majority were male (59.9%), married (66.8%), hypertensive (58.4%) and diabetic (32%). The overall referral rate is 17.7%. The highest indication-specific referral rates were for CABG(70%), STEMI(32%), PCI(32%), and PAD(32%). The lowest referral rates were seen in patients with NSTEMI(18%) and HF (16%). The mean time to referral was 6 days. The TET participation rate was 1.3%. Conclusion Cardiac rehabilitation remains underutilized despite evidence-based recommendations. Intensified efforts are needed to enroll all patients with Class I indications for inpatient cardiac rehabilitation, increase referral rates, improve the existing program, and optimize the management of our cardiovascular patients.