PERPETUAL HELP MEDICAL CENTER-BIÑAN

DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE

Manimtim, Kim Adarem Joy Laroza July 6, 2021

Post Graduate Medical Intern

REFLECTION PAPER

Topic: Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study
including 8.3 million people
Reporter: PGI Baes, Jeco Angelo

After hearing the critical appraisal on harm presentation of PGI Baes, I learned that prescriptions for
ACE inhibitors and ARBs were associated with a lower risk of hospitalization for COVID-19 RT-PCR positive
disease. The interaction of SARS viruses with ACE2 may be a determinant of their infectivity, and there are
concerns that RAAS inhibitors may alter ACE2 expression and thus COVID-19 virulence.
In the presentation, I realized that I have little knowledge on the mechanisms of drug and through this
presentation, I learned that angiotensin renin blockers was not just anti-hypertensive medication but can also
decrease the virulence of COVID-19.
As a post graduate medical intern, I will advocate to my hypertensive patients the use of angiotensin
renin blockers to prevent or reduced the risk of COVID-19 hospital admission.

Topic: Preoperative Analgesia, Complications, and Resource Utilization After Total Hip Arthroplasty: Tramadol
Is Associated with Less Risk Than Other Preoperative Opioid Medications
Reporter: PGI Baylon, Patrick

Preoperative opioid use has been shown to have a negative impact on outcomes following total hip
arthroplasty (THA). This is concerning because tramadol is recommended by several societies for the
treatment of arthritis.
After hearing the presentation, I learned preoperative tramadol only is associated with less
postoperative risk than non-tramadol use and is similar to opioid naivety. The number of patients receiving
preoperative non tramadol appears to be decreasing and the researchers concluded that tramadol as an
appropriate pre total hip arthroplasty analgesic.
I realized that thromboembolic event is one of the major complications of total hip replacement
surgery, with this we should chose a safer pain medication to our patients.
As a post graduate medical intern, I will be able to give tramadol to my patients as a pain medication
since it has a decrease risk for thromboembolic event.
 PERPETUAL HELP MEDICAL CENTER-BIÑAN
DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE

Topic: Association of tramadol with risk of myocardial infarction among patients with osteoarthritis
Reporter: PGI Pacheco, Marissa

Osteoarthritis (OA) is a leading cause of pain, disability, and socioeconomic cost throughout the world.
To date, no effective treatment exists to halt OA progression, and the primary goal of clinical management
remains pain control with treatments such as oral nonsteroidal anti-inflammatory drugs (NSAIDs). However,
the safety of NSAIDs, particularly in terms of cardiovascular risk, has sparked widespread concern. Diclofenac
had the highest risk of cardiovascular risk among commonly used NSAIDs, while naproxen had the lowest.
After hearing this presentation, I learned that patients with osteoarthritis the six month risk of
myocardial infarction among tramadol user was higher than naproxen.
I realized that the side effects of pain medications should be evaluated in order to prescribed to our
patient the medications that has a lesser side effect.

Topic: Association of metformin with mortality or acute respiratory distress syndrome in patients with COVID-
19 and type 2 diabetes: a retrospective cohort study
Reporter: PGI Malicsi, Cris

Diabetes is also associated with a poorer outcome in COVID19 patients. According to a meta-analysis,
COVID-19 patients with diabetes were 1.9 times more likely to die than those without diabetes. According to a
Chinese Center for Disease Control and Prevention study of 72,314 COVID-19 patients, the mortality rate of
patients with COVID-19 and diabetes was more than three times that of the general population. As a result,
determining the most effective therapeutic regimen to improve the prognosis of patients with COVID-19 and
diabetes is critical.
After hearing this presentation, I learned that patients with COVID-19 and type 2 diabetes who took
metformin had a lower incidence of ARDS than those who did not, especially in females. However, the link
between metformin use and lower mortality was not statistically significant. Given that metformin therapy can
benefit patients, it is recommended that patients with COVID-19 and type 2 diabetes continue to use
metformin unless there are obvious contraindications.
I realized that the risk of severe cases of COVID-19 on patients with co-morbidities who’s complaint
with their maintenance medication has a lower chance of having COVID-19 complication and even death.
As a post graduate medical intern with this information, I will be able to strongly advise diabetic
patient to comply with their medication since this lowers their chance of having severe cases of COVID-19.

Topic: Gabapentin dose and the 30-day risk of altered mental status in older adults: A retrospective
population-based study
Reporter: PGI Evardone, Mimosa
 PERPETUAL HELP MEDICAL CENTER-BIÑAN
DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE

Gabapentin is an effective treatment for chronic neuropathic pain; however, it can cause dizziness,
drowsiness, and confusion in some elderly people. In this presentation the researchers assessed the
relationship between gabapentin dosing and adverse outcomes in older adults in Ontario, Canada who were
started on high dose versus low dose oral gabapentin in routine outpatient care.
After hearing the presentation, I learned that the resulting relative risk was calculated to be 1.29,
indicating that receiving high dose gabapentin increases the risk of hospitalization with altered mental status
by 29 percent. I was able to confirm the negative effects of gabapentin and what it may bring to the patient
based on this presentation. This has taught me that patients receiving high doses of gabapentin may actually
increase their chances of being hospitalized with altered mental status.

Topic: Angiotensin receptor blocker in patients with ST segment elevation myocardial with preserved left
ventricular systolic function: prospective cohort study
Reporter: PGI Dimaisip, Bernadette Dianne

In patients with ST segment elevation myocardial infarction (STEMI) and heart failure or left ventricular
systolic dysfunction, angiotensin converting enzyme (ACE) inhibitors are beneficial and strongly
recommended. In STEMI patients with preserved left ventricular systolic function, ACE inhibitors may also be
beneficial. However, up to 20% of patients are unable to tolerate ACE inhibitors due to adverse reactions such
as coughing and angioedema. Angiotensin-converting enzyme (ACE) inhibitors may be an alternative to ACE
inhibitors in STEMI patients with heart failure or left ventricular systolic dysfunction, particularly those who
are ACE inhibitor intolerant.
After hearing the presentation, I learned that when the risk of those receiving ARB was divided by the
risk of those not receiving ARB, the relative risk was 0.55. According to the relative risk, there is a 45 percent
lower risk of cardiac death or myocardial infarction in patients taking ARB. After hearing this, I was able to
confirm that even if a patient has already undergone PCI, maintenance medication such as ARB must be
continued.

Topic: Top 10 Morbidity: Influenza

Reporter: PGI Abiera, Nikki Mari and PGI Dimaisip, Bernadette Dianne

After hearing the presentation on influenza as one of the top ten causes of morbidity in the Philippines
It provided me with basic understanding of the disease. In terms of disease burden, the Centers for Disease
Control (CDC) estimates that influenza has caused between 9 million and 45 million illnesses, 140,000 –
810,000 hospitalizations, and 12,000 – 61,000 deaths per year since 2010.
The CDC also estimates that the 2019–2020 flu season had a moderate illness burden, with an
estimated 38 million people sick with flu, 18 million visits to a health care provider for flu, 400,000
hospitalizations for flu, and 22,000 flu deaths. In terms of the top ten leading causes of morbidity, influenza is
ranked sixth.
 PERPETUAL HELP MEDICAL CENTER-BIÑAN
DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE

In this presentation, I learned that increasing the knowledge of the general public on influenza,
promotion of the use of risk reduction interventions and strategies and healthy living habits and behavioral
changes, routine annual influenza vaccination, practice of proper and good personal hygiene, appropriate use
of personal protective equipment and staying indoors will help us to minimize the incidence of influenza in our
country.

Topic: Top 10 Morbidity: Infectious Gastroenteritis

Reporter: PGI Evardone, Mimosa and PGI Malicsi, Cris

Gastrointestinal illness or gastroenteritis is an inflammation of the stomach, small and large intestines,
and colon. The most common symptoms are vomiting and watery diarrhea. Fever, abdominal cramps, nausea,
muscle aches, and headache are all possible symptoms.
After hearing this presentation, I learned In the spectrum of disease that in most cases of
gastroenteritis, the incubation period for E histolytica infection is 2-4 weeks, but it can range from a few days
to years. The clinical spectrum of amebiasis ranges from asymptomatic infection to fulminant colitis and
peritonitis to extraintestinal amebiasis, with amebic liver abscess being the most common form. Amebiasis is
more severe in very young patients, the elderly, and patients on corticosteroids. The clinical manifestations of
amebiasis may be geographically related. This is the most frequently identified organism in stool samples
collected from acute bloody diarrhea cases in the 2019 FWBD Monthly Surveillance Report. I also learned the
treatment for this disease. Prompt fluid resuscitation based on the degree of volume depletion is the mainstay
of treatment. Always stay hydrated. Oral rehydration solution should be used if an estimated 5% to 10% of
body weight has been lost. In an emergency, a homemade solution of one liter of water, six teaspoons of
sugar, and a half teaspoon of salt can be made. Antibiotic therapy can begin once an appropriate volume
status has been achieved. Death rates of more than 50% have been reported in the absence of hydration.
Children, pregnant women, and the elderly have higher mortality rates.