MORTALITY
The
as defined by the national cancer institute (NCI), is the state or
quality of being mortal or as the state wherein a human body is
destined to die. It is more commonly it is known as death. In
medicine, it can refer to the number of deaths in a certain
group of people in a certain period of time (death rate).
In the Philippines, more than five people die for every one
thousand population this was noted during the 2013 census.
Of these deaths, 57% were males and 43% females from all
causes and all ages. As registered in the national statistics
office, from 2013 there was a constant number of male deaths
showing greater abundance than the number of female deaths.
Among age groups there is a larger number of registered
deaths with the elderly (age 65 and above) and neonates
(aged 1 and below) showing more deaths from diseases rather
than natural causes. According to DOH the top three regions
with the highest mortality are as follows: a) Region IV A
(CALABARZON), b) NCR, and c) Region III (Central Luzon).
These three regions comprise 40% of total deaths in the
Philippines and among these three regions, Pampanga is a
contributing province. Pampanga by statistics contributes to
4% of the total deaths in the Philippines.
Among all the recorded deaths in the Philippines only 57%
were attended to by medical doctors / professionals while the
other 42.6% were not attended to. Although there was a higher
percentage of cases that were handled in a medical setting the
high bracket rates with the deaths outside medical practice
portrays as evidence of unaffordable health cost in the
Philippines despite having accessible public and private health
facilities.
Although this does not prognosticate the future there are
known cases leading to these mortalities. As stated by the
Department of Health Philippines the following are the top ten
leading causes of mortality as of 2019:
1. Heart Disease
2. Disease of Vascular System
3. Pneumonia
4. Malignant neoplastic/ cancers
5. Tuberculosis
6. Accidents
7. COPD and other allied conditions
8. Diabetes Mellitus
9. Nephritic Syndrome
10. Other Respiratory Diseases
Among the indexed diseases above are four of the diseases
that can be transmitted through human to human contact while
the remaining six are known to be non-communicable.
inscribed non-communicable diseases in the DOH registry of
death would include the four major non-communicable
diseases, namely; cardiovascular diseases, cancers, and
diabetes.
HEART DISEASES
The heart acts as the body’s engine room, responsible for
pumping life- supporting blood through a network of blood
vessels. The heart together with the blood and blood vessels
makes up one of the largest systems in the body, the
cardiovascular system which functions by supplying oxygen
and nutrient filled blood to the different organs, tissues and
cells while simultaneously clearing away carbon dioxide and
other waste products produced by the body.
Primarily, the heart is the center of the circulatory system and
is located in between the lungs, in the middle of the chest that
is slightly oriented to the left of the center. Each day, the
average human heart beats 100,000 times a day with around 5
liters of blood constantly being pumped throughout the body.
The heart contracts and relaxes between 70 and 80 times per
minute with each heartbeat filling the four chambers of the
heart with a fresh round of blood. It is made of cardiac muscles
which is a special type of muscle that works ceaselessly and
involuntarily throughout the day. Although it is roughly the size
of a human fist, weighing 250 to 300 grams on average, the
heart does more work than any other muscles over a lifetime.
―Heart diseases‖ is a collective term referring to a variety of
conditions which affects either the heart’s function or structure.
Globally, including the Philippines, ischemic heart disease has
been the principal cause of death for the last 15 years.
Ischemic heart disease, also known as coronary artery disease
is noted to be the leading cause of death in the Philippines. It
is a condition wherein the heart doesn’t get enough supply of
blood and oxygen due to narrowed arteries. Ischemic heart
disease is a condition often caused by atherosclerosis.
Atherosclerosis develops when there is an injury or damage to
the inner layer of a coronary artery causing deposits made of
cholesterol and other waste products to build up at the injured
site. The waxy substance or plaques can partially or
completely block blood flow in the large arteries of the heart
which may lead to heart attacks.
Signs and symptoms of coronary heart disease may develop
slowly as arteries gradually become blocked, or it may occur
quickly if the artery becomes suddenly blocked. In some
circumstances, it presents itself as asymptomatic but may
cause severe chest pain or discomfort known as angina
together with arrythmia or an irregularity in the heart’s rhythm.
The discomfort in the chest area can progress to other areas of
the upper body such as both arms, the back, neck, jaw or
stomach. Other signs and symptoms that may occur with or
without the presence of angina are: shortness of breath,
nausea, lightheadedness and shortness of breath. During an
episode of heart attacks changing position, resting or lying
down is unlikely to bring relief. The pain felt are often constant
lasting from a few minutes to several hours.
A number of factors increases the risk of damage to the inner
lining of the blood vessels. A few of them are lifestyle related
such as High blood pressure or hypertension, High levels of
low-density lipoprotein, Low levels of high-density lipoprotein,
Diabetes, Obesity and Smoking. Although there are cases that
the risk factors are non-lifestyle related such as: High levels of
amino acid homocysteine, high levels of fibrinogen,
menopause for women, and high levels of lipoprotein a
There is no known cure for coronary heart disease. However,
there are ways that a person can manage the condition. The
treatment involves making healthful lifestyle changes such as:
avoiding tobacco, limiting alcohol intake, adopting a healthful
diet (less sugar, salt and unsaturated fats), getting regular
exercise and management of stress.
Some individuals who already underwent an episode of heart
attacks may need to take medications such as:
 Beta Blockers- reduce blood pressure and heart
rate, especially in individuals who already had a heart
attack
 Nitroglycerin- widens the arteries and reduce heart’s
demand for blood
 Angiotensin-converting enzyme inhibitors- brings
down blood pressure and help slow or stop the
progression of coronary heart disease
 Calcium channel blockers- widen the coronary
arteries, improving blood flow to the heart and
reducing hypertension.
In some cases, to prevent the progression of the disease,
individuals undergo surgical procedures that open or replace
blocked arteries if the symptoms of the disease are responding
to medications. A list of procedures available are:
 Laser surgery which involves making several very
small holes in the heart muscles which encourages
formation of new blood vessels.
 Coronary bypass surgery that involves taking a
blood vessel from another part of the body usually
from the leg or an inner chest wall artery to create a
graft that bypasses the blocked artery.
 Angioplasty and stent placement involving an
insertion of a catheter or a soft shallow tube into the
narrowed part of the artery and pass a deflated
balloon through the catheter to the affected area.
When the balloon is inflated, it compresses the fatty
deposits against the artery wall. In some cases, a
stent or mesh tube is left within the artery to help
keep it open.
Other types of heart disease that affect different parts of the
organ include:
 Congenital heart disease which is a general term for
deformities of the heart that has been present since
birth. Some examples of this are:
o Septal defects: a presence of a hole
between the two chambers of the heart.
o Obstruction defects: a partial or complete
block of blood flow through various
chambers of the heart.
o Cyanotic heart disease: a defect in the
heart causing a shortage of oxygen around
the body.
 Arrythmia that occurs when the electrical impulses in
the heart doesn’t coordinate the heartbeat causing
irregularities in the rhythm of the heart. The irregular
rhythms can be caused by:
o Tachycardia which increase the pulse rate
of the heart beyond the normal.
o Bradycardia which decreases the pulse rate
of the heart beyond the normal.
o Premature ventricular contractions or
additional abnormal beats
Irregular heartbeats are common and can be experienced by
anyone at any age. However, when the irregularities occur
more the span of more than a day or a week the irregularities
must be checked by a professional.
 Cardiomyopathy.It is a condition wherein the heart
chambers become either dilated, hypertrophic, or
restrictive as a result of heart muscle weakness
leading to the inability to pump blood to the other
areas of the body.
 Rheumatic heart disease that is caused by damage
to the heart valves and heart muscles from
inflammation and scarring caused by rheumatic fever.
Rheumatic fever is caused by an abnormal response
of the body to infection with streptococcal bacteria,
 which usually begins as a sore throat in children.
Rheumatic fever mostly affects children in developing
countries, especially where poverty is a widespread.
Globally, about 2% of deaths from cardiovascular
diseases is related to rheumatic heart disease
DISEASE OF VASCULAR SYSTEM
Vascular comes from the Latin word vasculum which refers to
a hollow container or a term pertaining to a tube which allow
passage of a substance. In anatomy the vascular system is the
body’s network of blood vessels which includes: The arteries
that carries oxygen-rich blood from the heart to the organs and
tissues, the veins which carries the blood and waste products
to the heart; and the capillaries, which are tiny blood vessel
that connect the small arteries to the veins. The capillaries, in
structure, are thin and permeable to allow for an exchange of
materials between the tissues and the blood. Together with the
heart, blood vessels are a collective term which makes up the
circulatory system of the body.
The circulatory system is a complex and far reaching system
which allows continuous and controlled movement of blood
through the other systems and organs allowing transport blood
components, such as oxygen, proteins, and removal of waste
products. The vascular system due to its vast domain,
diseases can appear anywhere in the body in many different
forms. Among the diseases, the most common conditions are;
peripheral artery disease, atherosclerosis and carotid
diseases.
Peripheral artery disease (PAD) also known as peripheral
vascular disease results from progressive thickening of artery’s
lining caused by a buildup of plaque, which narrows or blocks
blood flow, reducing the circulation of the blood to a specific
organ or region of the body. If the plaque surface becomes
irregular or ulcerated, it may accumulate small blood clots and
plaque contents. The accumulated particles (emboli) travel in
the circulatory system, ultimately blocking flow through tiny
blood vessels, which can also damage sensitive organs. Often
times people with peripheral artery disease may not
experience symptoms until the disease is advanced. Typically,
people with peripheral artery disease experience symptoms on
the leg muscles due to the lack of blood flow through the
arteries. Some signs and symptoms that are visible in PAD are
painful cramping in the in the hips, thighs, or calves while
exercising that is relieved with rest, a noticeable decrease in
temperature of the lower extremities compared to the rest of
the body, gangrene of the foot and/ or decrease in healing time
of the extremities.
Another type of vascular disease is atherosclerosis. It is a
term which refers to the hardening of the arteries. It is a
chronic disease characterized by the abnormal thickening and
hardening of the inner lining of the arteries, with a resulting
loss of elasticity. The arterial wall is made up of three distinct
layers- an outer layer of tissue (adventitia), a muscular middle
layer (media), and an inner layer of epithelial cells (intima); the
latter is the most commonly affected by atherosclerosis. The
hardening of the arteries is usually caused by a plaque build-
up in the wall of the arteries eventually leading to block the
blood flow.
Once a damage to the inner lining has occurred, platelets,
cholesterol, other cells, and debris such as connective tissues
accumulate over time in the damaged endothelium. These
cells release chemicals that attract more cells to the site of the
injured layer. Fat is then deposited and builds up in and around
these cells. This conglomeration of cells, fat, debris, and
connective tissue is called an atheroma, or fatty plaque. If the
wall of the vessel is overly thickened from a large atheroma or
multiple atheroma, there will be decreased blood flow, which
decreases oxygen supply to the body’s organs.
The exact cause of atherosclerosis is unknown, but
inflammation of the intima is associated with the development
of the disease. It occurs normally as people grow older and it
may begin earlier in individuals with a strong family history of
vascular disease.
Another type of vascular disease is the carotid artery disease
which is a serious condition where the main blood vessel
supplying a part of the brain develop a buildup of plaque
caused by atherosclerosis, which can cause a stroke. A stroke
occurs when a part of the brain is damaged due to the vascular
diseases. There are three known types of stroke; an ischemic
stroke, a hemorrhagic stroke and a transient ischemic
stroke.
The more common type of stroke, comprising of 87% of the
cases of stroke, is ischemic stroke wherein part of the
circulation to the brain is cut off, usually due to the blockage,
resulting in a corresponding loss of neurologic function. It is
also known as brain ischemia or cerebral ischemia. This
type of stroke is caused by a blockage in an artery that
supplies blood to the brain. The blockage reduces the blood
flow and oxygen leading to damage or death of brain cells. If
circulation is not restored quickly, brain damage can be
permanent. The clot causing the stroke usually originates as a
plaque which travels through the circulatory system and gets
lodged in the neck or in the skull
The second type of stroke is hemorrhagic stroke which
makes up 13% of stroke cases. It is caused by a weakened
blood vessel in the brain that ruptures and causes bleeding
within the surrounding of the brain. The bleeding accumulated
and compresses the brain tissue causing damage and
eventually killing the tissue.
The third type of stroke is known as transient ischemic
attack (TIA) also known as mini-strokes. Transient ischemic
attacks are temporary disruptions or stop of blood flow to the
brain. Transient ischemic attack doesn’t cause permanent
damage but may be indicative of an upcoming stroke. Although
transient ischemic attacks present similar symptoms as an
ischemic stroke, stroke lasts longer than TIAs. The effects of
TIAs last a few minutes to a few hours and can be fully
resolved within 24 hours.
The main symptoms of stroke or TIA can be transcribed as the
word FAST:
 Face Drooping- There is a drop on the one side of
the face together with an inability to control facial
expressions e.g. smiling
 Arms Weakness– Inability to race both arms and
keep them in the air due to weakness or numbness of
the arms.
 Speech Slur– Speech may be slurred or garbled, or
the inability to talk at all
Time to call 911
In regards to the risk factors and treatment of vascular
diseases, the same treatment and medication can be used
from heart diseases.
Other types of vascular diseases that are noted in the
Philippines are:
 Aneurysm which indicates the weakening of the
artery wall allowing it to widen or ―balloon out‖. An
aneurysm can enlarge and burst out causing internal
bleeding and other more serious conditions
 Blood clots – including deep vein thrombosis and
pulmonary embolism
 Raynaud’s disease- a rare disorder that is marked
by a brief episode of vasospasm, which is a
narrowing of the blood vessels due to a brief or mild
change in temperature.
 Vasculitis – inflammation of the blood vessels
PNEUMONIA
The respiratory system of the body aids in the exchange of
gases between the external environment and the body. It is
made of a system composing of the air passages, pulmonary
vessels, the lungs, and the breathing muscles. Most of the
organs or the respiratory system help in the distribution of the
gases within the body but the main functional unit that allows
the gas exchange in the body are the alveoli.
Alveoli are tiny sacs located in the lungs that allows an
exchange of carbon dioxide and oxygen between the lungs
and the bloodstream. Air entering the lungs during inhalation,
passes through the numerous passageways called bronchi
and flows into the alveoli, the alveoli then collects the oxygen
and allows it to pass through the blood vessels from the lungs
through diffusion. Simultaneously carbon dioxide from the
different tissues of the body is forced out of the alveoli from the
blood vessels and into the respiratory passageway. Air
containing carbon dioxide is then forced out of the body
through exhalation.
There are multiple diseases affecting the respiratory system,
according to the world health organization, four of the leading
causes of death in the Philippines is caused by respiratory
diseases. Pneumonia being known as one of the leading
causes of death.
Pneumonia is an infection of the lungs wherein there is an
inflammation of the tissues in either one or both of the lungs.
The presence of the bacteria causing pneumonia causes
inflammation of the lungs together with fluid accumulation
within the alveoli affecting the breathing including the
exchange of gases within the body. Although it can cause mild
infections, if not treated, it can become a serious and life-
threatening disease. Ranking as third in the Philippine mortality
statistics, pneumonia is also known to be the leading cause of
death in children younger than 5 years old worldwide most
especially in countries in South Asia and sub-Saharan Africa.
There are different types of pneumonia depending on their
causes, some of the known types are; bacterial pneumonia,
viral pneumonia and fungal pneumonia.
Bacterial Pneumonia is the most common form of
pneumonia. it is a result of a pneumococcal infection caused
by a bacterium called Streptococcus pneumoniae which is the
primary cause of bacterial pneumonia. Other types of bacteria
that can invoke bacterial pneumonia includes Haemophilus
influenzae and Staphylococcus aureus, although it occurs
rarely compared to Staphylococcus pneumoniae.
Viral pneumonia is most commonly caused by RSV
(respiratory syncytial virus) and sometimes influenza type A
and B also known as the flu. Viral pneumonia is common in
cases of infection among children. The presenting features of
viral and bacterial pneumonia are similar however, viral
pneumonia presents more symptoms than bacterial
pneumonia such as wheezing which is more common in
bacterial pneumonia.
The last type of pneumonia is Fungal Pneumonia which can
result from a condition such as valley fever, caused by the
Coccidioides fungus. It is more likely to affect individuals with
weakened immune system and is known to be the least
common type of pneumonia.
Pneumonia occurs in all ages and in healthy individuals but is
more likely to infect certain groups of people such as the
elderly, infants and immunocompromised individuals.
The common symptoms of pneumonia usually resemble signs
and symptoms of a cold or flu and may develop suddenly (over
24-48 hours) or may progress slowly over several days. Some
of the known signs and symptoms include: coughing with dry
thick mucus, difficulty in breathing, rapid heartbeat, increase in
temperature, loss of appetite and chest pains.
Treatment of pneumonia depends on the type and severity of
pneumonia. Bacterial pneumonia is treated with antibiotics,
viral pneumonia is usually treated with rest and plenty of
fluids, and fungal pneumonia are treated with antifungal
medications.
Most cases of pneumonia can be contagious and can be
passed on through coughing and sneezing or spread through
shared objects. To be able to prevent the spread of the
disease the following are known to be precautions:
 Good Hygiene; regular washing of the hands and
covering the mouth when coughing
 A healthy lifestyle; excessive and prolonged alcohol
intake including smoking weakens the lungs natural
defenses against infection and increases vulnerability
to pneumonia.
 Vaccinations; there are two known vaccines to
prevent a wide variety of bacterial pneumonia which
is recommended for both children and adults:
o Prevnar (PCV 13) – this is also known as the
pneumococcal conjugate vaccine which is
included in an infant’s routine immunization. It is
recommended for children under 2 years of age
and adults over 65 years of age
o Pneumovax (PPSV23) – also known as the
pneumococcal polysaccharide vaccine which is
recommended for children and adults who are at
increased risk of developing pneumococcal
infections such as; adults aged 65 or older,
diabetic patients, patients with chronic diseases,
and patients without a spleen.
The WHO and UNICEF integrated Global action plan for
pneumonia and diarrhea (GAPPD) aims to accelerate
pneumonia control with a combination of interventions to
protect, prevent, and treat pneumonia in children with actions
to:
 protect children from pneumonia including promoting
exclusive breastfeeding and adequate
complementary feeding
 prevent pneumonia with vaccinations, hand washing
with soap, reducing household air pollution, HIV
prevention and cotrimoxazole prophylaxis for HIV-
infected and exposed children
 treat pneumonia focusing on making sure that every
sick child has access to the right kind of care.
MALIGNANT NEOPLASMS
Cells are the basic units that make up the human body. Cells
grow and divide to make new cells as the body needs them. In
a normal cell cycle, cells die when they get too old or
damaged. Then, new cells are produced to replace the
damaged cells.
In neoplasms the cycle begins when genetic changes that
interfere with this orderly process. Cells start to grow
uncontrollably and may form a mass called a tumor. A tumor
can be categorized as cancerous or benign. A cancerous
tumor is malignant, indicating that it can grow and spread to
other parts of the body while benign tumor indicated that there
is a presence of a tumor but has no capability to spread.
Malignant neoplasms are collectively known as cancers.
Malignant neoplasms display aggressive characteristics that
can invade and destroy adjacent tissues, and spread to distant
sites. Most commonly, the cause of death associated with
malignant neoplasms can be attributed to the metastatic
spread of the cancer. Common sites of metastasis for
malignant epithelial neoplasms include the lungs, liver, bone,
and brain.
The mechanism as how the cancer metastasizes starts with a
tumor formation. As a cancerous tumor grows, the
bloodstream or lymphatic system may carry cancer cells to
other parts of the body. During this process, the cancer cells
grow and may develop into new tumors. This is known as
metastasis.
One of the first places a cancer often spreads is to the lymph
nodes. Lymph nodes are tiny, bean-shaped organs that help
fight infection. They are located in clusters in different parts of
the body, such as the neck, groin area, and under the arms.
Cancer may also spread through the bloodstream to distant
parts of the body. These parts may include the bones, liver,
lungs, or brain. In the nomenclature or naming of the cancer
type the origin of neoplasm is followed, thus a cancer
originating in the breast is still considered as breast cancer
even if there was a spread of the disease to the different areas
of the body such as the liver.
There are more than 100 types of cancer. Cancer is one of the
four epidemic non-communicable diseases or lifestyle-related
diseases which include cardiovascular diseases, diabetes
mellitus, and chronic respiratory diseases. According to Dr.
Antonio Miguel Dans in his paper ―Introduction to Non-
Communicable Diseases‖ in August 2014, the non-
communicable diseases are now considered a ―silent disaster‖
of massive proportion that is ravaging the Filipino population,
killing 300,000 victims a year, 800 every day, and 33 every
hour.
In the Philippines as of 2018 the top two cancer related deaths
reported are; Breast cancer, and Lung cancer respectively.
These statistics was recorded from both sexes and all ages of
diagnosis in the Philippines.
Breast cancer is the most common type of cancer in women
globally. About 1 in 8 women are diagnosed with breast cancer
in a lifetime but this can be reprimanded if it is detected at an
early stage. Which is why it is recommended by the world
health organization to have at least one or two visits annually
to a gynecologist to check if there are any changes in the
breast area. Although breast cancer occurs almost entirely in
women, men are also prone in developing breast cancers.
Breast cancer have several symptoms, but the first noticeable
symptom is usually a lump or an area of thickening of the
breast tissue. It’s important to understand that most breast
lumps are benign and non-malignant. Non-cancerous breast
tumors are abnormal growths, but they do not spread outside
of the breast. They are not life threatening, but some types of
benign breast lumps can increase a woman's risk of getting
breast cancer.
There are different types of breast cancers and they can
originate from different parts of the breast. It is often divided
into either:
 Non- invasive breast cancer is those which do not
spread into the breast tissues, in most often cases
breast cancers starts in the ducts that carry milk to
the nipples. This type of breast cancer is known as
ductal cancer. Included as a non-invasive breast
cancer is lobular cancer wherein the malignant cells
originate from the glands that produce the milk.
 Invasive breast cancer is a type of breast cancer
where the cancer cells have spread through the lining
of the ducts into the surrounding breast tissue. This is
the most common type of breast cancer.
The exact cause of breast cancer is not fully understood.
However, there are certain factors known to increase the risk
of breast cancer. Including
 Age
 Family history of breast cancer
 Previous diagnosis of breast cancer
 Previous non-cancerous breast lump
 Being tall, overweight and obese
The second type of cancer visible in the Philippines is lung
cancer. The lung is the most common site for cancer
metastasis
Metastatic cancer found in the lungs is characterized by the
presence of multiple cancer nodules that can replace large
percentages of the normal tissue. There are two main forms of
primary lung cancer, the non-small-cell lung cancer and the
small-cell lung cancer. These two groups are classified by the
type of cell in that is seen during biopsy.
Non small cell lung cancer (NSCLC) is the most common
form of lung cancer accounting for more that 87% of the cases.
The main subtypes of non-small cell lung cancer are
adenocarcinoma, squamous cell carcinoma, and large cell
carcinoma. These subtypes, which start from different types of
lung cells are grouped together as NSCLC because their
treatment and prognoses are often similar.
 Adenocarcinoma is usually found in the outer parts
of the lung. Individuals with a adenocarcinoma tend to
have a better prognosis of the disease than those
with other types of lung cancer.
 Squamous cell carcinoma originates in squamous
cells, which are flat cells that line the inside of the
airways in the lungs. They are often linked to a history
 of smoking and tend to be found in the central part of
the lungs, near a bronchus.
 Large cell also known as undifferentiated
carcinoma can appear in any part of the lung. It
tends to grow and spread quickly, which can make it
harder to treat.
Small cell lung cancer (SCLC) accounts for about 10% to
15% of all lung cancers and it is sometimes called oat cell
cancer. This type of lung cancer is known to be the most
aggressive and rapidly growing of all lung cancers. About 70%
of individuals with SCLC will have cancer that has already
spread at the time they are diagnosed. Since this cancer grows
quickly, it tends to respond well to chemotherapy and radiation
therapy. Unfortunately, for most individuals people with SCLC
has a high chance of recurrence of the disease.
There are usually no signs or symptoms in the early stages of
lung cancer, but eventually develops through the course of the
disease. Some of the known signs and symptoms are:
 Persistent cough with or without the presence of
blood
 Persistent breathlessness
 Unexplained weakness and weight loss
 Pain during breathing or coughing
There are multiple risk factors surrounding the development of
lung cancer. Included in the list are: smoking, second hand
smoke, radon, and other substances (asbestos, arsenic, diesel
exhaust, some forms of silica and chromium)
Cigarette smoking is the number one risk factor for lung
cancer. Tobacco products such as cigar or pipes contains a
mix of more than 7,000 chemicals where at least 70 are known
to cause cancer in people including animals. Individuals who
smoke cigarettes are 15 to 30 times more likely to get lung
cancer or die from lung cancer than people who do not smoke.
In most cancers, a biopsy is the most diagnostic procedure to
make a definite diagnosis. A biopsy is the removal of a small
amount of tissue from a suspected area of metastasis and a
series of routine processes are done to be able to view the
tissue under a microscope. A pathologist then creates a
diagnosis report containing any abnormalities found in the
tissues including the presence or absence of a metastatic
neoplasm.
Due to the invasiveness of a biopsy procedure, multiple
screening tests are available before a biopsy is done. Some of
the available screening test in the Philippines are:
 Endoscopy – a procedure where a thin light tube
(endoscope) is inserted in the patients natural
opening such as the mouth or the anus, allowing the
examination of the internal organs without undergoing
surgery
 Imaging tests – a procedure wherein there is a
production of images of the internal organs to
determine if a tumor is present. Some examples of
imaging tests are; MRI, CT scans and Nuclear Scans
 Laboratory Tests - involve testing of blood or tissue
samples for tumor markers. Tumor markers are
substances that are produced by cancer cells or by
other cells of the body in response to cancer. Most
tumor markers are made by normal cells but are
produced at much higher levels by cancer cells.
Once a diagnosis has been made the following treatment
depend on the stage of the cancer and may include surgery,
chemotherapy, or radiation.
Surgery involves removing a small tumor or removing a tumor
and a portion of the surrounding tissue with the goal of
removing as much cancer cells as possible.
Chemotherapy also known as drug therapy is used to stop the
growth of cancer cells, either by killing the cancer cells or by
stopping its division.
Radiation therapy is a procedure using high energy radiation
from x-rays and gamma rays to kill cancer cells and shrink
tumors.
ACCIDENTS
An accident is an unforeseen, unplanned and unexpected
event or circumstance that has a negative influence on an
individual either through an injury, damage of the environment,
death or a combination of thereof.
In the Philippines, the top ten accidents are: Road accidents,
drowning accidents, work related accidents, fire accidents,
maritime accidents, electrocution accidents, accidental food
poisoning, aviation accidents, stray bullet and firework
accidents and selfie related accidents respectively’.
According to the department of health, as of 2017 road
crashes are the fourth leading cause of deaths in the country.
In the Philippines, there are 7.6 million registered motorcycles
and 3.2 million other vehicles according to the land and
transport office and by statistics one Filipino perishes in vehicle
collisions every 17 hours, or 43 per month and 509 per year.
According to the metro manila development authority, the
capital region alone in 2018 counted an average of 49 injuries
and one death per day. Among these deaths it has been noted
that road crashes are the top killer of youths aged five to 29 in
the Philippines. Worldwide, more than half of all the road traffic
accidents are among the vulnerable road users such as
pedestrians, cyclists and motorcyclists.
The worsening statistics have prompted promotion of and
public education on road safety. Of particular concern is
enforcement of laws and regulations on motor vehicles.
In 2017, WHO released Save LIVES a road safety technical
package which synthesizes evidence-based measures that
can significantly reduce road traffic fatalities and injuries. Save
LIVES: a road safety technical package focuses on
Leadership, Infrastructure design and improvement, Vehicle
safety standards, Enforcement of traffic laws and post-crash
Survival and Speed management.
The package prioritizes 6 strategies and 22 interventions
addressing the risk factors highlighted above, and provides
guidance to Member States on their implementation to save
lives and meet the road safety target of halving the global
number of deaths and injuries from road traffic crashes by
2020.
Road traffic injuries can be prevented but the efforts require
the involvement from multiple sectors such as transport, police,
health, education, and actions that address the safety of roads,
vehicles, and road users.
 The common risk factors in road accidents are listed
below:
 In the Philippines and most countries, the allowable
speed rate in national roads is 60kmph. By statistics
there is a direct relationship between the average
speed and the likelihood of a road crash occurring
 Driving under influence of alcohol or other
psychoactive substance. The genal rule when it
comes to driving is that the driver should be fully
capable in rational thinking and control of the vehicle
Driving under the influence of alcohol and any
psychoactive substance or drug increases the risk of
a crash that results in death or serious injuries. The
allowable blood alcohol concentration in the
Philippines including most of the countries is 0.08
g/dl.
 Non use of motorcycle helmets, seatbelts and child
restraint. Correct helmet use can lead to a 42%
reduction in the risk of fatal injuries and a 69%
reduction in the risk of head injuries and wearing a
seat-belt reduces the risk of death among drivers and
front seat occupants by 45 - 50%, and the risk of
death and serious injuries among rear seat occupants
by 25%.
 Distracted driving. There are many types of
distractions that can lead to impaired driving. The
distraction caused by mobile phones is a growing
concern for road safety. Drivers using mobile phones
are approximately 4 times more likely to be involved
in a crash than drivers not using a mobile phone.
Using a phone while driving slows reaction times
(notably braking reaction time, but also reaction to
traffic signals), and makes it difficult to keep in the
correct lane, and to keep the correct following
distances.
 Unsafe road infrastructures. The design of roads can
have a considerable impact on their safety. Ideally,
roads should be designed keeping in mind the safety
of all road users. This would mean making sure that
there are adequate facilities for pedestrians, cyclists,
and motorcyclists. Measures such as footpaths,
cycling lanes, safe crossing points, and other traffic
calming measures can be critical to reducing the risk
of injury among these road users.
 Inadequate law enforcement of traffic laws. Effective
enforcement includes establishing, regularly updating,
and enforcing laws at the national, municipal, and
local levels that address the risk factors. It includes
also the definition of appropriate penalties.
TUBERCULOSIS
Tuberculosis is a major communicable disease caused by
Mycobacterium tuberculosis. It primarily attacks the lungs but
may also be associated with the kidney, spine and the brain. It
is a communicable disease that is acquired through inhalation
of the droplets of the tubercle bacilli.
There are two known types of individuals who acquire the
disease; latent tuberculosis and active tuberculosis. About
one-quarter of the world’s population has latent tb wherein
individuals have been infected by tuberculosis but doesn’t
have the signs and symptoms of the disease together with the
inability to transmit the disease. While an individual who
contracts or develops an active tuberculosis disease presents
symptoms on the onset of the disease which is characterized
by cough, fever, night sweats or a sudden weight loss. A
person with active TB can infect 5–15 other people through
close contact over the course of a year. Without proper
treatment, 45% of HIV-negative people with TB on average
and nearly all HIV-positive people with TB will die.
For the diagnosis of tuberculosis, the gold standard of the
laboratory is called a Direct Sputum Smear Microscopy
(DSSM) wherein a medical laboratory technologist takes 2
sputum samples that undergoes a series of processes and is
viewed under a microscope. Detection of the bacteria also
known as the acid-fast bacilli is a confirmation of the presence
of the disease in an individual. Although it is known to be the
gold standard of the diagnosis microscopy detects only half the
number of TB cases and cannot detect drug-resistance.
Upon advancement of technology the use of the rapid test
Xpert MTB/RIF® has been recommended by the WHO. The
test simultaneously detects TB and resistance to rifampicin, a
drug widely used in the treatment of tuberculosis. With the
rapid test gene Xpert diagnosis can be made within 2 hours
and the test is now recommended by WHO as the initial
diagnostic test in all persons with signs and symptoms of TB.
TB occurs in every part of the world. In 2018, the largest
number of new TB cases occurred in the South-East Asian
region, with 44% of new cases, followed by the African region,
with 24% of new cases and the Western Pacific with 18%.
According to the world health organization an estimated 10
million people fell ill with tuberculosis (TB) worldwide by 2018
with a total of 1.5 million deaths due to the disease including
those infected with HIV. Claiming up to 75 to 90 lives daily in
the Philippines. According to statistics, eight countries; India,
China, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh
and South Africa respectively; account for the two thirds of the
total TB burden globally.
Since tuberculosis is a disease that is treatable and curable,
one of the health targets of sustainable development goals of
WHO is ending the tuberculosis epidemic by 2030. Currently
tuberculosis incidence is falling at about 2% per year. This
needs to accelerate to a 4-5% decline to be able to reach the
2020 milestone. As a participation of the Philippines in the the
world health organization efforts to decrease tuberculosis
burden globally, the implementation of TB-DOTs in the country
started.
TB DOTS also known as the directly observed treatment
short course is the world health organization recommendation
for tuberculosis control strategy. It is when a person with TB
disease meets with a health care worker every day or several
times per week usually for the span of 6 months. The person
with TB disease and the health care worker meet at a place
that both agree on where medicines are given and taken with
the supervision of a health care worker. TB DOTs ensures that
an individual with the disease undertake the complete
treatment and ensures complete supervision of the disease.
In treating an active tuberculosis individual, a regimen of four
antimicrobial drugs, usually including rifampin is given in a
standard 6 months course
COPD
According to the latest WHO estimates, currently 64 million
people have Chronic obstructive pulmonary disease and 3
million people died of chronic pulmonary disease as of 2014.
Most of the information available on COPD prevalence,
morbidity and mortality comes from high-income countries.
Even in those countries, accurate epidemiologic data on
COPD are difficult and expensive to collect. It is known that
almost 90% of COPD deaths occur in low- and middle-income
countries.
Chronic pulmonary disease is a widespread disorder that
describes chronic lung disorders that cause limitations to lung
airflow such as blockage and breathing related problems. The
most common progressive lung disorders included in chronic
obstructive pulmonary diseases are: emphysema and chronic
bronchitis.
Emphysema is the damage to the air sacs of the lungs called
the alveoli. The inner lining of the alveoli becomes damages
causing the small sacs to become enlarged. These enlarged
alveoli would lose its capability to stretch and function causing
decrease in the exchange of gases in the lungs. The airways
cause air to be trapped within the alveoli leading to a shortness
of breathing.
Chronic bronchitis is the damage and inflammation to the
bronchial tubes. This causes coughing and shortness of
breath. If the inflammation together with increased production
of mucus is progressive up to 3 months for two years in a row
the bronchitis is considered as chronic. The production of
mucus may decrease overtime due to the damage and
degradation of the cilia which functions to propel the mucus out
of the bronchial tree.
The signs and symptoms of COPD can vary from one person
to another but can be characterized by a group of symptoms
including Increased shortness of breath, Frequent coughing,
wheezing and tightness of the chest.
The causes for COPD have opposite patterns according to the
geographic areas. In high- and middle-income countries
tobacco smoke is the biggest risk factor, meanwhile in low-
income countries exposure to indoor air pollution, such as the
use of biomass fuels for cooking and heating, causes the
COPD burden.
Almost 3 billion people worldwide use biomass and coal as
their main source of energy for cooking, heating, and other
household needs. In these communities, indoor air pollution is
responsible for a greater fraction of COPD risk than smoking or
outdoor air pollution. Biomass fuels used by women for
cooking account for the high prevalence of COPD among
nonsmoking women in parts of the Middle East, Africa and
Asia. Indoor air pollution resulting from the burning of wood
and other biomass fuels is estimated to kill two million women
and children each year.
Other risk factors for COPD include occupational dusts and
chemicals (such as vapours, irritants, and fumes) and frequent
lower respiratory infections during childhood.
Diagnosis of COPD should be considered in any patient who
has symptoms of a chronic cough, sputum production,
dyspnoea (difficult or labored breathing) and a history of
exposure to risk factors for the disease. A chronic obstructive
pulmonary disease (COPD) diagnosis is confirmed by a simple
test called spirometry, which measures how deeply a person
can breathe and how fast air can move into and out of the
lungs.
Where spirometry is unavailable, clinical symptoms and signs,
such as abnormal shortness of breath and increased forced
expiratory time, can be used to help with the diagnosis. A low
peak flow is consistent with COPD, but may not be specific to
COPD because it can be caused by other lung diseases and
by poor performance during testing.
Chronic cough and sputum production often precede the
development of airflow limitation by many years, although not
all individuals with cough and sputum production go on to
develop COPD. Because COPD develops slowly, it is most
frequently diagnosed in people aged 40 years or over.
There is no known cure for COPD but an effective COPD
management plan includes four components: (1) assess and
monitor disease; (2) reduce risk factors; (3) manage stable
COPD; (4) manage exacerbations.
The goals of effective COPD management are to:
 Prevent disease progression
 Relieve symptoms
 Improve exercise tolerance
 Improve health status
 Prevent and treat complications
 Prevent and treat exacerbations
 Reduce mortality
DIABETES MELLITUS
The body is made up of multiple metabolic processes one of
them involves how the body converts food specifically glucose
into energy. When there is an intake of food, during digestion,
carbohydrate intake is converted into a sugar form called
glucose, which is one of the primary sources of energy of the
cells in the body. Glucose is then released into the blood
stream where it remains as an inactive form that is not being
used for energy consumption. To be able to use glucose it
should be converted into its active form in the tissues. The
inactive form of glucose must bind to a hormone that is
secreted by the pancreas namely insulin and bind to the
receptors on the cell for absorption where the energy
consumption begins.
In diabetes mellitus there is an impairment of the ability of
glucose to be absorbed by the cells. It is a group of metabolic
diseases characterized by hyperglycemia resulting from
defects in insulin secretion, insulin action, or both. The chronic
hyperglycemia of diabetes is associated with long-term
damage, dysfunction, and failure of various organs, especially
the eyes, kidneys, pancreas, heart, and blood vessels.
In Asian countries including the Philippines, diabetes is
increasing at an alarming rate. Both the prevalence and
incidence of type 2 diabetes mellitus continue to increase with
a proportionate upward trend in the prevalence of prediabetes.
Prediabetes is a condition wherein the blood sugar is higher
than the normal level but not high enough to be classified as a
type of diabetes. Those showing symptoms of pre diabetes are
most likely to develop into a type 2 diabetic stage.
Several pathogenic processes are involved in the development
of diabetes. These range from autoimmune destruction of the
β-cells of the pancreas with consequent insulin deficiency to
abnormalities that result in resistance to insulin action. Both of
these processes lead to an increase glucose level in the blood
and urine. Symptoms of marked hyperglycemia include
polyuria, polydipsia, weight loss, sometimes with polyphagia,
and blurred vision.
In classifying diabetes mellitus, there are three categories
namely; Type 1 diabetes mellitus, Type 2 diabetes mellitus and
Gestational diabetes.
Type 1 diabetes mellitus is a form of diabetes, which
accounts for only 5–10% of those with diabetes, previously
encompassed by the terms insulin-dependent diabetes, type I
diabetes, or juvenile-onset diabetes. This type of diabetes
often occurs in childhood. It is an autoimmune condition
wherein the pancreas is attacked by the antibodies of the
individual. Once there is a damage to the organ there is no
longer a production of insulin in the body.
Multiple health problems arises with type 1 including damage
to tiny blood vessels in your eyes (diabetic retinopathy), nerves
(diabetic neuropathy), and kidneys (diabetic nephropathy).
People with type 1 also have a higher risk of heart disease and
stroke
Treatment for type 1 diabetes involves injecting insulin into the
fatty tissue just under your skin with the use of:
 Syringes
 Insulin pens that use prefilled cartridges and a thin
needle
 Jet injectors that use high-pressure air to send a
spray of insulin through your skin
 Pumps that send insulin through a tube to a catheter
under the skin of your belly
 A test called the HbA1c blood test , a laboratory test
used to evaluate the prognosis of the disease,
estimates your blood sugar levels over the previous
three to four months.
There is no known cure for diabetes but some management
treatments have been recommended by WHO. In an individual
with type 1 diabetes, the following changes including:
Frequent testing of your blood sugar levels
 Careful meal planning
 Daily exercise
 Taking insulin and other medications as needed
Type 2 diabetes mellitus is a form of diabetes, which
accounts for 90–95% of those with diabetes, previously
referred to as non-insulin-dependent diabetes, type II diabetes,
or adult-onset diabetes. It encompasses individuals who have
insulin resistance and usually have relative insulin deficiency.
Type 2 diabetes mellitus often occurs in adults but it’s become
more common in children and teens over the past 20 years,
largely because more young people are overweight or obese.
In type 2 diabetes mellitus pancreas has the ability to produce
insulin but either the amount of insulin of insufficient or the
receptors of the cells are damaged thus causing a decrease or
no glucose uptake leading to insulin resistance. Insulin
resistance, when your cells don’t respond to insulin, usually
happens in fat, liver, and muscle cells.
Type 2 diabetes is often milder than type 1. But it can still
cause major health complications, especially in the tiny blood
vessels in your kidneys, nerves, and eyes. Type 2 also raises
your risk of heart disease and stroke.
People who are obese (more than 20% over their target body
weight for their height) have an especially high risk of type 2
diabetes and the health problems that can follow. Obesity often
causes Insulin resistance
Treatment for type 2 diabetes involves keeping a healthy
weight, eating right, and exercising including a regimen of
medications.
The last type of diabetes is known as Gestational diabetes. It
is a form of diabetes that would affect pregnant women.
Pregnancy usually causes some form of insulin resistance that
is usually diagnosed in middle or late pregnancy. Because a
woman’s bloody sugars travel through her placenta to the
baby, it’s important to control Gestational diabetese to protect
the baby's growth and development.
Doctors report gestational diabetes in 2% to 10% of
pregnancies. It usually goes away after birth. But up to 10% of
women who have gestational diabetes get type 2, weeks or
even years later.
Gestational diabetes is more of a risk for the baby than the
mother. A baby might have unusual weight gain before birth,
trouble breathing at birth, or a higher risk of obesity and
diabetes later in life.
Gestational diabetes treatment involves:
 Careful meal planning to make sure you get enough
nutrients without too much fat and calories
 Daily exercise
 Keeping weight gain under control
 Taking insulin to control your blood sugar levels, if
needed
NEPHROTIC SYNDROME
Nephrotic syndrome is a collection of symptoms that indicate
kidney damage. Nephrotic syndrome includes the following:
 Albuminuria—large amounts of protein in the urine
 hyperlipidemia—higher than normal fat and
cholesterol levels in the blood
 edema, or swelling, usually in the legs, feet, or ankles
and less often in the hands or face
 hypoalbuminia—low levels of albumin in the blood
Albumin is a protein that acts like a sponge, drawing extra fluid
from the body into the bloodstream where it remains until
removed by the kidneys. When albumin leaks into the urine,
the blood loses its capacity to absorb extra fluid from the body,
causing edema.
Nephrotic syndrome results from a problem with the kidneys’
filters, called glomeruli. Glomeruli are tiny blood vessels in the
kidneys that remove wastes and excess fluids from the blood
and send them to the bladder as urine.
As blood passes through healthy kidneys, the glomeruli filter
out the waste products and allow the blood to retain cells and
proteins the body needs. However, proteins from the blood,
such as albumin, can leak into the urine when the glomeruli
are damaged. In nephrotic syndrome, damaged glomeruli
allow 3 grams or more of protein to leak into the urine when
measured over a 24-hour period, which is more than 20 times
the amount that healthy glomeruli allow.
Nephrotic syndrome can be caused by diseases that affect
only the kidneys, such as focal segmental glomerulosclerosis
(FSGS) or membranous nephropathy. Diseases that affect
only the kidneys are called primary causes of nephrotic
syndrome. The glomeruli are usually the targets of these
diseases for reasons that are not fully understood. In FSGS—
the most common primary cause of nephrotic syndrome—scar
tissue forms in parts of the glomeruli. In membranous
nephropathy, immune molecules form harmful deposits on the
glomeruli.
Nephrotic syndrome can also be caused by systemic diseases,
which are diseases that affect many parts of the body, such as
diabetes or lupus. Systemic diseases that affect the kidneys
are called secondary causes of nephrotic syndrome. More than
50 percent of nephrotic syndrome cases in adults have
secondary causes, with diabetes being the most common
In addition to albuminuria, hyperlipidemia, edema, and
hypoalbumina, people with nephrotic syndrome may
experience
 weight gain
 fatigue
 foamy urine
 loss of appetite
Urine samples are taken to diagnose people suspected of
having nephrotic syndrome.
Nephrotic syndrome is diagnosed when large amounts of
protein are found in the urine. The blood protein albumin
makes up much of the protein that is lost, though many other
important proteins are also lost in nephrotic syndrome.
The presence of albumin in the urine can be detected with a
dipstick test performed on a urine sample. The urine sample is
collected in a special container in a health care provider’s
office or commercial facility and can be tested in the same
location or sent to a lab for analysis. For the test, a nurse or
technician places a strip of chemically treated paper, called a
dipstick, into the urine. Patches on the dipstick change color
when protein is present in urine.
A more precise measurement is usually needed to confirm the
diagnosis. Either a single urine sample or a 24-hour collection
of urine can be sent to a lab for analysis. With the single urine
sample, the lab measures both albumin and creatinine , a
waste product of normal muscle breakdown. The comparison
of the measurements is called a urine albumin-to-creatinine
ratio. A urine sample containing more than 30 milligrams of
albumin for each gram of creatinine may signal a problem.
With a 24-hour collection of urine, the lab measures only the
amount of albumin present. The single urine sample is easier
to collect than the 24-hour sample and is usually sufficient to
confirm diagnosis, though the 24-hour collection may be used
in some cases.
OTHER RESPIRATORY CONDITIONS
In the Philippines the most prevalent and common form of
respiratory condition is asthma. Asthma is a chronic, or long-
term, condition that intermittently inflames and narrows the
airways in the lungs. The inflammation makes the airways
swell. Asthma causes periods of wheezing, chest tightness,
shortness of breath, and coughing. People who have asthma
may experience symptoms that range from mild to severe and
that may happen rarely or every day. When symptoms get
worse, it is called an asthma attack. Asthma affects people of
all ages and often starts during childhood.
The exact cause of asthma is unknown, and the causes may
vary from person to person. However, asthma is often the
result of a strong response of the immune system to an
allergen in the environment. For example, exposure to an
allergen in the environment, such as ragweed, may make your
airways react strongly. Other people exposed to the same
allergen may not react at all, or their response may be
different. The reason one person reacts to an exposure while
others do not is not completely understood, though it may be
partially explained by genes.
Common asthma triggers include:
 Allergies (household dust mites, animal fur, pollen.
Etc.)
 Smoke, pollution, and cold air
 Infections like cold or flu
Asthma is a long-term condition for many people, particularly if
it develops during adulthood. Individual who contracted the
disease during childhood tends to improve during their teenage
years, but may reappear later in life.
The symptoms can usually be controlled with treatment. Most
people have normal and active lives, although some with
severe asthma may contract other health problems.
Several tests may be done to help determine if asthma is likely
to be the cause of symptoms. These tests include:
 Pulmonary function test such as spirometry, which
involves breathing in and out through a tube
connected to a computer. This measures how much
and how fast the air moves when you breathe in and
out with maximum effort.
 Spirometry with bronchodilator (BD) test tomeasure
how much and how fast air moves in and out both
before and after you take an inhaled medicine to relax
the muscles in your airway.
 Bronchoprovocation tests to measure how your
airways react to specific exposures. During this test,
you inhale different concentrations of allergens or
medicines that may tighten the muscles in your
airways. Spirometry can also be done before and
after the test.
 Peak expiratory flow (PEF) to measure how fast you
can blow air out using maximum effort. This test can
be done during spirometry or by breathing into a
separate device, such as a tube.
There is no known cure for asthma but control medicines are
usually administered to prevent the signs and symptoms by
reducing airway inflammation and preventing narrowing of
airways. Some of the available control medicines include:
 Corticosteroids to reduce the body’s inflammatory
response. Your doctor may prescribe inhaled
corticosteroids that you will need to take each day. If
your symptoms get worse, your doctor may increase
the dose of the inhaled corticosteroids to prevent
severe asthma attacks or even give corticosteroids by
mouth for short periods. Common side effects from
inhaled corticosteroids include a hoarse voice or a
mouth infection called thrush. A spacer or holding
chamber on your inhaler can help avoid these side
effects. Using high-dose inhaled corticosteroids more
often or for longer periods may affect growth in young
children. Oral corticosteroids also have more side
effects than inhaled corticosteroids because more of
the medicine goes outside the lungs.
 Biologic medicines, such as omalizumab,
mepolizumab, resulizumab, and benralizumab, to
target specific parts of the body’s response to
allergens. Biologic medicines are antibodies used in
people who have severe asthma. These medicines
are given by injection, either below the skin or in a
vein, every few weeks.
 Leukotriene modifiers to reduce the effects of
leukotrienes, which are released in the body as part
of the response to allergens. Leukotrienes cause the
airway muscles to tighten. These medicines block this
response, allowing the airways to open, and reduce
inflammation. You take these pills by mouth, alone or
with corticosteroids, depending on what your doctor
prescribes.
 Mast cell stabilizers such as cromolyn,to help
prevent airway inflammation caused by exposure to
allergens or other triggers. These medicines stop
certain immune cells from releasing the signals that
cause inflammation.
 Inhaled long-acting beta2-agonists (LABAs) keep
the airways open by preventing narrowing of the
airways. LABAs may be added to your inhaled
corticosteroids to reduce narrowing and inflammation.