bluuebunny/crossref_metadata_2025 huggingface dataset:
FLORES: VERDADEIRO RESERVATÓRIO DE ANTIBIÓTICOS E RESINAS ANTIMICROBIANAS
Authors: Haluch Flavia , Haluch Silvia , Vilas Boas Henrique
Published: July 2024

Microbial resistance is the versatility of microorganisms not to succumb to the harsh environment and to maintain themselves in all environmental compartments, organisms and living cells. This phenomenon is a mechanism of acquired adaptation that directly impacts humans and animals, as these organisms have disharmonious relationships with them, causing several practically intractable pathologies, leading to the death of the host. The World Health Organization points out, every year, the increase of microorganisms resistant to drugs, both for domestic and hospital use, publishing in its reports, the frightening reality of organisms resistant to all commercialized drugs, being called Pan-resistant. Therefore, the objective of the study is to investigate in fresh, freshly picked flowers, a new substance with antimicrobial and/or bactericidal power against Enterobacteria. Of the 66 flowers studied, 29 showed some promising antibiotic/bactericidal effect, with passion fruit and mallow being the ones that stood out the most, followed by dahlia and munguba. The hexane extract of the passion fruit flower showed a halo of formation greater than Gentamicin and Amikacin, of 22 mm with only 0.5 g of the flower. Several studies describe the complexity of substances found in passion fruit flower, making it difficult to indicate a possible organic group or the combination of mixed organic compounds with synergistic effects. The mallow flower, which has the coumarin malvina and the terpenoid malvona exclusively, presented an inhibition halo comparable to antibiotic discs already used in drug therapies, with an effect on all three Enterobacteriaceae studied, Salmonella serotype thyphimurium NCTC® 12023, multiresistant Escherichia coli, and the pan-resistant bacterium kpcKlebsiella planticola2019, being a great antimicrobial potential. For a similar bacteriostatic effect of propolis, 22 flowers expressed a glutinous, expansive and resinous effect, in order to immobilize and prevent an aggressive and pathogenic agent from expressing its metabolism or life cycle, with the highlight being azalea, presenting the largest halo.Thus, it is possible to infer that the production of propolis by bees is the sum of the harvesting of resins from several species of flowers, both exotic and native, in the manufacture of the best resin to protect their hives. Finally, the trend of phytotherapy combined with modern biotechnological science may be the key to success against highly specialized parasites. This study falls under SDG 13 (quality health) and SDG 15 (life on land) of the development goals.
A Novel Chaos-Based Encryption Technique with Parallel Processing Using CUDA for Mobile Powerful GPU Control Center
Authors: Kıran Harun Emre
Published: July 2024

Chaotic systems possess unique properties that can be leveraged for cybersecurity due to their complex and unpredictable nature, making it challenging for systems to interpret them. When combined with CUDA, chaotic systems benefit from high-efficiency parallel processing capabilities, allowing for the rapid and secure handling of large data sets. In this study, a CUDA-supported chaos-based parallel processing encryption mechanism for mobile control centers is developed. The powerful GPU of the control center enables fast encryption and decryption of image data from multiple connected devices. The Logistic Map is used for random number generation, and XOR operations are applied to encrypt the R, G, B, and Gray Scale channels of images. Initially, an analysis of the numbers generated from the Logistic Map is conducted, followed by a detailed explanation of the encryption technique. The technique is then applied to image data, and image analyses are performed. Finally, the performance of the encryption technique is compared with other studies, and encryption speeds are examined. Results indicate that the new encryption technique provides significantly fast encryption and security levels comparable to other studies. The key discovery is that the mechanism is well-suited for parallel processing, allowing for rapid image encryption using the proposed method. For encrypting large IoT files, random number generation is performed first, followed by statistical tests, and then encryption using the developed algorithm. Security analyses are conducted, and the performance of the mechanism is compared with other studies. Results from image analysis and encryption performance demonstrate that the developed mechanism can be effectively used with high security for IoT applications.
Comparative Analysis of State-of-the-Art Q A Models: BERT, RoBERTa, DistilBERT, and ALBERT on SQuAD v2 Dataset
Authors: Özkurt Cem
Published: July 2024

In the rapidly evolving landscape of natural language processing (NLP) and artificial intelligence, recent years have witnessed significant advancements, particularly in text-based question-answering (QA) systems. The Stanford Question Answering Dataset (SQuAD v2) has emerged as a prominent benchmark, offering diverse language understanding challenges. This study conducts a thorough examination of cutting-edge QA models—BERT, DistilBERT, RoBERTa, and ALBERT—each featuring distinct architectures, focusing on their training and performance on SQuAD v2. The analysis aims to uncover the unique strengths of each model, providing insights into their capabilities and exploring the impact of different training techniques on their performance. The primary objective is to enhance our understanding of text-based QA systems' evolution and their effectiveness in real-world scenarios. The results of this comparative study are poised to influence the utilization and development of these models in both industry and research. The investigation meticulously evaluates BERT, ALBERT, RoBERTa, and DistilBERT QA models using the SQuAD v2 dataset, emphasizing instances of accurate responses and identifying areas where completeness may be lacking. This nuanced exploration contributes to the ongoing discourse on the advancement of text-based question-answering systems, shedding light on the strengths and limitations of each QA model. Based on the results obtained, ALBERT achieved an exact match of 86.85% and an F1 score of 89.91% on the SQuAD v2 dataset, demonstrating superior performance in both answerable ('HasAns') and unanswerable ('NoAns') questions. BERT and RoBERTa also showed strong performance, while DistilBERT lagged slightly behind. This study provides a significant contribution to the advancement of text-based question-answering systems, offering insights that can shape the utilization of these models in both industry and research domains.
New Specializations in Accounting Profession
Authors: Ülker Yakup , Koç İlayda
Published: July 2024

Humans have innumerable needs, and every economic unit that engages in activities to meet these needs is called a business. As a result of these activities, transactions must be documented and recorded, leading to the emergence of accounting. The accounting profession has developed, training individuals to become Certified Public Accountants (CPAs) and Sworn-in Certified Public Accountants. The rapid advancement of information technologies, globalization, and competitive pressures have significantly impacted accounting, leading to complexities in corporate governance, auditing, and financial reporting. Consequently, new areas of specialization within accounting have emerged. This study begins with an examination of the concept of accounting and the evolution of the accounting profession, followed by a discussion on new specializations and selected topics within these specializations.
AN INSTITUTIONAL ECONOMICS ANALYSIS OF WEARING A MASK:INTERNALISING THE EXTERNALITY
Authors: Bhat N Varada Shyama , Khandelwal Mahek
Published: July 2024

Human behavior is the result of the circumstances and responses to various social factors considering the stakes involved in decision making. When the costs are high, individuals think and rationalize before bearing the cost; when the costs are low, individuals decide to bear the costs. This behavioural pattern can also be traced in the Indian masses reflex to the stimuli of various lockdown and unlock periods in the past six months. Initially, the fear of the unknown and uncertainty played a vital role in enforcing a lockdown and attempted imposition of social distancing to contain the spread of the novel coronavirus. As people became familiar with recovery rates, complacence grew, resulting in choking the already weak public administration and health infrastructure. To contain the surge of the virus, the Government responded by introducing a series of measures such as social distancing with lockdown, which resulted in shutting down the global economy resulting in an economic slump. The country has faced an acute shortage of money in terms of migrant labour crisis and a crumbling economy.
THE `LAW AND ECONOMICS’OF GOVERNMENTS’RESPONSE TO PANDEMICS
Authors: Singh Indervir , Santhakumar V.
Published: July 2024

Governments all over the world may use or institute laws and other measures (like the Epidemic Diseases Act, 1897 in India) during pandemics like the COVID-19. These may provide special powers to governments to restrict social and economic activities and the freedom of individuals with the purpose of containing the spread of epidemics. It may be interesting to use the framework of the `law and economics’ to analyse the need for such restrictions and the conditions with which these may lead to efficient outcomes. This article is an attempt in that direction. It also uses that framework to assess the response of the Government of India towards the COVID-19.
INTERNATIONAL COMMERCIAL ARBITRATION IN THE AFTERMATH OF THE PANDEMIC: A LAW AND ECONOMICS ACCOUNT
Authors: Arlota Carolina
Published: July 2024

This essay researches the main consequences of the pandemic caused by the COVID-19 virus in the field of international commercial arbitration through an economic analysis of law.1 This essay conceptualizes international commercial arbitration as an alternative mechanism for dispute resolution, focusing on how the pandemic may modify the incentives for parties in a different set of circumstances
THE CROSSROAD OF PATENT AND COMPETITION LAW IN THE CONTEXT OF PATENT ASSERTION ENTITIES: A COMPARITIVE ANALYSIS
Authors: Suresh Srishti
Published: July 2024

Determined to supersede one another in the race for technological advancement, patent rights seem to offer a benign opportunity for an inventor, to make exclusive his invention, while offering him the discretion in fixing license fees. This form of exclusivity is purported to behave as an incentive, in allowing an inventor to recoup the cost and energy expended in making the invention, while formally according him the status of being the sole owner of that technology. However, the bailiwick of patent holders is not restricted to first hand innovators and researchers. Intermediate entities and bodies known as Patent Assertion Entities (“PAEs”), have increasingly come to possess patent rights over significant patent technologies and inventions. The leverage offered by patent rights is often abused by PAEs, by adopting various tactful strategies. This abuse of dominance has cascading effects, including but not limited to stymieing innovation and growth; it has detrimental effects on free market competition and antitrust regulation, ultimately affecting the end consumer.
MANDATORY VERSUS VOLUNTARY CORPORATE SOCIAL RESPONSIBILITY: A COMPARATIVE ANALYSIS OF CSR REGIME IN INDIA AND SINGAPORE
Authors: Puri Vidushi
Published: July 2024

Corporate Social Responsibility is a form of business practice wherein a corporate regulates itself by being socially accountable to itself, the stakeholders, as well as the public at large. The concept of social responsibility by its bare meaning points towards a philosophy that seems to be voluntary in nature as the vigour to do social work should come from within and cannot be imposed. On one hand, a corporate needs to be socially responsible and do sustainable business but on the other hand, making expenditure on social causes mandatory poses an extra financial burden which may be undesirable for growing economies and mushrooming corporates. At the same time, it becomes important to ensure that the profit-making zeal of the corporates does not surpass their requirement to be socially responsible and financially sustainable. India has been the forerunner in mandating CSR in the year 2013 and improvising an altogether new legal regime that needs to be complied with by the corporates. Singapore, on the other hand, has been a jurisdiction that motivates the corporates to invest in CSR rather than making it mandatory for them. This paper aims to compare and contrast the existing CSR regimes in both India and Singapore. In the end, certain suggestions will be made as to which model of CSR would be more beneficial for growing economies- Mandatory or Voluntary, given the analysis done in this paper.
SOCIAL INCENTIVES AND THE ENFORCEMENT OF LAW: SOME REFLECTIONS
Authors: Santhakumar V.
Published: July 2024

This short essay looks at the ineffectiveness of laws to control dowry in India from a law and economics perspective. This starts with an understanding of the economic and social incentives to provide dowry. Ensuring the welfare of daughters through marriage (and not much through employment), and the struggle to get the 'best possible bridegroom’ play an important role in the increase in the dowry. This encouraged even communities that were not following this practice in the past to follow it currently. Hence there are private incentives for both givers and takers to continue with the practice and these work against the enforcement of the dowry prohibition act. Moreover, dowry is a private transaction. At the time of the transaction, both parties expect gains from it. However, these expected gains may not be realised after the transaction or there could be severe losses to one of the parties (mainly to the girl and her family). Parents may have an incentive to bring severe dowry harassment cases to the court, but givers and takers have little incentive to stop the practice or provide adequate information to law enforcement agencies if such a severe harassment is not taking place. This also works against the enforcement of the dowry prohibition act. Though the payment of dowry can be seen as part of an informal contract, there are limitations in using the contract law also against dowry. If the dowry prohibition act is somewhat ineffective in reducing, the paper highlights its possible benefits. These may include creating ideas of a desirable norm in society, and this role of law needs to be understood in detail especially in countries like India.
BUYER POWER, EXCLUSIVE CONTRACTS, AND VERTICAL MERGERS IN COMPETING SUPPLY CHAINS: IMPLICATIONS FOR COMPETITION LAW AND POLICY
Authors: Gupta Srishti
Published: July 2024

This paper studies how the buyer power of downstream firms can affect the market outcomes in both upstream manufacturing and downstream retail markets. In a two-tier oligopoly, where upstream firms are locked in a pair-wise exclusive relationship with their downstream retailers, we study the choice of firms between vertical merger and Nash Bargaining with twopart tariff regimes. On working with three cases of no vertical merger, single chain vertical merger and double chain vertical merger we find that joint profits of upstream and downstream firms are lowest when both channels choose vertical integration as compared to Nash Bargaining regime. We also find that Vertical integration is welfare enhancing because retail price will be minimum as upstream and downstream firms behave as a single entity. Hence for both single and double chain mergers, elimination of double marginalization is procompetitive. These results have implications for the enforcement of competition (antitrust) law.
The Strategy for Mubaligh Cadre Development by LDII at Nurul Hakim Kaliawen Islamic Boarding School in Kediri [Strategi Kaderisasi Mubaligh LDII di Pondok Pesantren Nurul Hakim Kaliawen Kediri]
Authors: Aly Imam , Romadlon Dzulfikar Akbar
Published: July 2024

The Nurul Hakim Kaliawen Islamic Boarding School focuses on training LDII preachers to become professional and religious preachers. This study explores these training strategies, emphasizing how the institution equips students with religious knowledge, noble character, and independence. Using a qualitative approach and descriptive analysis, data was collected through interviews, observations, and document studies, and analyzed using the Miles and Huberman method. The results show that Nurul Hakim Kaliawen implements the manqul-musnad-muttasil method in teaching the Qur'an and Hadith, instills the application of 29 noble characters, and promotes the development of independence. Regular evaluations are conducted to assess students' progress. In conclusion, the implemented training strategies have proven effective in shaping quality preachers and contributing to the development of students' competencies, while also providing additional insights into the effectiveness of training strategies in the context of LDII preaching.
Abstrak
Pondok Pesantren Nurul Hakim Kaliawen memfokuskan diri pada kaderisasi mubaligh LDII untuk membentuk mubaligh yang profesional dan religius. Penelitian ini mengeksplorasi strategi kaderisasi tersebut dengan menekankan cara lembaga ini membekali santri dengan pengetahuan agama, akhlakul karimah, dan kemandirian. Menggunakan pendekatan kualitatif dan analisis deskriptif, data dikumpulkan melalui wawancara, observasi, dan studi dokumentasi, serta dianalisis dengan metode Miles dan Huberman. Hasil penelitian menunjukkan bahwa Ponpes Nurul Hakim Kaliawen menerapkan metode manqul-musnad-muttasil dalam pembelajaran Al-Qur'an dan Hadits, serta membiasakan penerapan 29 karakter luhur dan pengembangan kemandirian. Evaluasi berkala dilakukan untuk menilai kemajuan santri. Kesimpulannya, strategi kaderisasi yang diterapkan terbukti efektif dalam membentuk mubaligh berkualitas dan berkontribusi pada pengembangan kompetensi santri, serta memberikan wawasan tambahan tentang efektivitas strategi kaderisasi dalam konteks dakwah LDII.
Hypertrophic Cardiomyopathy with Absent Major Septal Perforator Coronary Artery Successfully Treated With Dual-Chamber Pacing as an Alternate Strategy to Septal Reduction Therapy: A Case Report
Authors: Albano Bernard Benjamin P , Fadreguilan Erdie C , Gabitoya Ed D , Chua Jeffrey M , Ho James O , Medrano Ana Beatrice D
Published: July 2024

The most important hemodynamic consequence of hypertrophic cardiomyopathy (HCM) is left ventricular outflow tract (LVOT) obstruction. Its primary management is surgical myectomy, but an alternative treatment is alcohol septal ablation (ASA). However, in patients with unfavorable coronary anatomy that precludes ASA (i.e., absent major septal perforator artery), another option is dual-chamber pacemaker implantation to relieve the LVOT obstruction.

Case: A 77-year-old Filipino female presented with one week’s history of chest pain and dyspnea. On work-up, 2D-echocardiography revealed HCM with systolic anterior motion (SAM) of the mitral valve, with a peak instantaneous gradient of 194 mmHg across the basal left ventricular cavity. The patient refused myectomy; ASA was the preferred treatment option. However, coronary angiography revealed incidental absence of major septal perforator artery, which made the patient unsuitable for ASA. As an alternate strategy, a dual-chamber pacemaker was inserted. This resulted in a significant decrease in peak instantaneous gradient (from 194 mmHg to 37 mmHg), the obliteration of systolic anterior motion and improvement in overall wall motion. She was asymptomatic and stable after pacemaker insertion and remained asymptomatic on follow-up after five months.

Conclusion: We present a case of HCM with congenitally absent major septal perforator coronary artery, treated with dual-chamber pacemaker. To our knowledge, this is the first reported local experience of an angiographically absent major septal perforator coronary anatomy in the setting of HCM and also the first description of dual-chamber pacemaker implantation done to successfully relieve LVOT obstruction. Although the role of dual-chamber pacing has become limited in HCM because septal reduction therapy has resulted in improved symptoms and decrease in LVOT gradient, this cardiac pacing remains essential and may be considered the treatment of choice in patients who are unsuitable for surgical myectomy and ASA.

KEYWORDS: hypertrophic cardiomyopathy, hypertrophic obstructive cardiomyopathy, HCM, HOCM, surgical myectomy, alcohol septal ablation, dual chamber pacemaker implantation
When STEMI is not STEMI: HIV Myocarditis Mimicking ST elevation Myocardial Infarction on Electrocardiogram: A Case Report
Authors: Aherrera Jaime Alfonso M , Gauiran Deonne Thaddeus , Mejia Agnes D
Published: July 2024

BACKGROUND: Myocarditis is a common occurrence among human immunodeficiency virus (HIV) infected patients, which either resolves spontaneously or results in death. Anecdotal reports have shown that myocarditis can mimic acute myocardial infarction (MI) with chest pain and electrocardiographic (ECG) abnormalities. We present a case of HIV myocarditis unusually presenting with transient ST-segment elevations and cardiogenic shock.

CASE: We present a 42 year old male who sought consult due to chronic dyspnea. He has had recurrent pneumonias for the previous 4 months, associated with weight loss and undocumented febrile episodes. HIV testing on admission was positive and he was managed as a case of pneumocystis pneumonia. Chest x-ray showed interstitial infiltrates and cardiomegaly. Electrocardiogram (ECG) suggested left ventricular hypertrophy (LVH) with Q-waves in lead V1-V3. Troponin-I at this time was within normal.

Co-trimoxazole was started with note of slight improvement in symptoms. On the fourth hospital day, he was referred for worsening dyspnea and desaturations. He had a blood pressure of 170/100 mmHg, and had supraclavicular retractions and crackles, distended neck veins, distinct heart sounds, and an S3 gallop. Electrocardiogram showed ST segment elevations on the anteroseptal wall. Assessment at this time was an ST elevation MI (STEMI).

A few hours after, the blood pressure suddenly dropped to 60 mmHg (palpatory) associated with worsening dyspnea. Inotropic support was started and he was subsequently hooked to mechanical ventilator.

A repeat ECG done 6 hours after revealed similar findings to that of the first ECG (Q-waves on septal wall with LVH). Troponin-I was taken at baseline, at 12 hours, and at 24 hours after the onset of ST elevation, and none were significantly elevated (0.34, 0.32, and 0.50 mcg/L respectively; with a normal reference range of 0-0.3 mcg/L). Echocardiogram done while on inotropic support showed a depressed ejection fraction with global hypokinesia.

The patient was diagnosed with HIV myocarditis. He was managed supportively for the fulminant heart failure. Three days after, he went into sudden cardiac arrest leading to his demise.

KEYWORDS: Myocarditis, myocardial infarction, human immunodeficiency virus.
Association of Chromosomal 22q11 Deletion with Conotruncal Heart Defects in 0 to 18 Year Old Filipino Children
Authors: Callanta Maria Llaine J , Silao Catherine Lynn T , Sison Maria Concepcion C , Salonga Edsel Allan G
Published: July 2024

BACKGROUND: Chromosome.22q11 deletion is associated with DiGeorge syndrome in which conotruncal heart defect is an important feature. Studies showed that non-syndromic patients with conotruncal anomalies may have 22q11 deletion.

OBJECTIVES: This study aimed to determine the frequency of chromosome.22q11 deletion, and to describe the clinical manifestations of Filipino patients aged 0 to 18 years with non-syndromic conotruncal heart defects (CTHD).

METHODS: This was a case-control study with 17 cases and 9 controls, age and sex matched. Four mL of blood was extracted for karyotyping and fluorescence in situ hybridization test using N25 (D22S75) and TUPLE1 probes. Degree of cyanosis and the number of medicine intake were also determined.

RESULTS: None of the 17 cases had chromosome.22q11 deletion. Two patients had severe cyanosis (60-69% O2). The mean number of medication was two, with seven patients not receiving any medication.

CONCLUSION: Our findings suggest the low prevalence of chromosome 22q11 deletion among isolated CTHD patients. The absence of this among non-syndromic cases may suggest other etiologies for conotruncal malformations.

KEYWORDS: Conotruncal heart defect, 22q11 deletion, DiGeorge syndrome, Velocardiofacial syndrome, Conotruncal anomaly face syndrome.
Anticoagulation with Vitamin K Antagonists Versus Antiplatelet Therapy After Surgical Bioprosthetic Valve Implantation in the Prevention of Thromboembolism: A Meta-Analysis of Randomized Controlled Trials
Authors: Gerodias Ferdinand , Locnen Sue Ann , Gerodias Anthony , Datukan Jay , Mariano Patricia
Published: July 2024

BACKGROUND: The optimum medical therapy in the first three months after surgical bioprosthetic valve implantation (BVI) remains controversial. Current guidelines of the American College of Cardiology recommend either anticoagulation with vitamin K antagonists (VKA) (level IIa) or antiplatelet (AP) using aspirin (level IIa) after surgery, which is based on non-randomized studies. Hence, we performed a meta-analysis of randomized controlled trials (RCT) comparing the efficacy and safety of VKA vs AP therapy early after surgical BVI.

METHODS: An extensive search of PubMed, Medline, Cochrane and Ovid was performed for RCTs comparing VKA vs AP therapy among adult patients who underwent surgical BVI. Outcome measures for thromboembolism, all-cause mortality and major bleeding were extracted and analyzed using a random effect model via Review Manager V5.3.

RESULTS: Three RCTs with 590 patients were included. There were no differences in the rates of thromboembolic events (5% vs 6.8%; p=0.37) or all-cause mortality (4.7% vs 5.8% p=0.64) between the VKA vs AP groups There was a higher incidence of major bleeding in the VKA group (6% vs 2.4%), which was statistically significant (OR 2.63 (95% CI 1.08–6.43; p=0.03)).

CONCLUSION: Vitamin K antagonist and AP therapies have similar rates of thromboembolic events and all-cause mortality in the first three months among patients post-surgical BVI. However, VKAs have a significantly higher incidence of major bleeding, which suggests that AP therapy may be the preferable strategy for anticoagulation in BVI post-surgery.

KEYWORDS: Prosthetic heart valve, Anticoagulation, Antiplatelet therapy, Bioprosthetic Valve Implantation
Clinical Profile and Outcome of Post-revascularization Patients Presenting with Acute Coronary Syndrome: A Retrospective Study
Authors: Valdez Thessie Minelli O
Published: July 2024

BACKGROUND: Studies on previously revascularized patients presenting with acute coronary syndrome (ACS) are lacking, especially among Asian patients. This study aimed to provide data regarding the risk factors and clinical profile of post-revascularization patients who present with ACS in a local medical institution.

METHODOLOGY: This was a retrospective cohort study conducted at the Philippine Heart Center from January 2009 to December 2011. The study included all adult patients with a previous history of revascularization and admitted for ACS. Data collection was achieved through chart review. Data collected included demographic variables, coronary risk factors, medication history, and invasive revascularization procedure. Measured outcomes included mortality; hospitalization due to cardiovascular causes; occurrence of symptomatic heart failure; stroke; and arrhythmias.

RESULTS: Seventy nine patients were included. The mean age was 66 years ± 13.87. The most common CV risk factors aside from gender and a previous history of ACS were hypertension (78.5%) and smoking (60.8%) as predominant risk factors. The most common clinical presentation of ACS was non-ST elevation MI (NSTEMI) (53.0%), followed by ST elevation MI (STEMI) (18.7%) and unstable angina (29.1%). Majority did not receive revascularization for the current admission (79.8%); 15.2% received PCI; 2.5% underwent CABG; and 2.5% underwent thrombolysis. Twenty four patients (30.4%) experienced a major adverse cerebrocardiovascular event (MACCE), which included death, hospitalization for HF, arrhythmia, and stroke. CV mortality was 15%. The only statistically significant independent variable predictive of MACCE was age (p=0.032). All patients who underwent dialysis or intra-aortic balloon pump (IABP) insertion developed a negative outcome.
The Association of Triglyceride/HDL Ratio with In-hospital Mortality in Adult Patients Admitted for Acute Coronary Syndrome in Manila Doctors Hospital
Authors: Diansuy Nina Noreen P , Uy-Reyes Michelle Andrea , Seguban Joseph Marc , Amoloza Karen , Pestano Noemi , Punzalan Felix Eduardo , Mendoza Bernadette Tumanan
Published: July 2024

Background: Studies showed that the triglyceride/HDL ratio is a predictor of long-term mortality and (CV) events. However, the association of the triglyceride/HDL ratio to in-hospital mortality in acute coronary syndrome (ACS) patients is less studied. This study aimed to determine the association of triglyceride/ HDL ratio taken within four days of admission on in-hospital mortality in adult patients admitted for ACS.

Methodology: This was a retrospective cohort study involving adult patients admitted for ACS in Manila Doctors Hospital from January to December 2015. Only patients with lipid profile determination within four days of admission were included. The triglyceride/HDL ratio was computed and compared between survivors and non-survivors until discharge or death.

Results: There were 132 ACS patients included in the study, with 11 in-hospital mortality. The median total cholesterol level was 170.15mg/dL (IQR 139.21– 201.08); median LDL was 117.94mg/dL (IQR 85.07- 150.81); median HDL was 40.80mg/dL (IQR 34.80- 53.56) and median triglycerides was 127.88mg/dL (IQR 91.60- 185.85). The triglyceride/HDL ratio of ACS patients was elevated at 3.31 (IQR 2.25- 5.13). In patients with elevated triglyceride/HDL ratio (³2.067), the odds ratio (OR) for total mortality was 0.48 (95% CI 0.13-1.76) and the OR for CV mortality was 0.66 (95% CI 0.16-2.74), both of which were not statistically significant.

Conclusion: Patients with ACS have deranged lipid parameters and elevated triglyceride/HDL ratio. However, there was no evidence of association of elevated triglyceride/HDL ratio with in-hospital mortality.
Fatal Eosinophilic Myocarditis from Intestinal Parasitism and Bronchial Asthma Mimicking Acute Coronary Syndrome in a 39-Year-Old Filipino Female
Authors: Duya Jose Eduardo DL , Alad Paul Anthony O , Cruz Mariel B , Tiongco Richard Henry  P , Tindoc John Anthony D
Published: July 2024

Eosinophilic myocarditis (EM) is a rare and often underrecognized disease (0.5% of unselected autopsy series) leading to progressive myocardial damage, heart failure and death. Although parasitism is a common cause of eosinophilia in developing countries, marked eosinophilia causing myocardial infiltration and progressive heart failure is rare. The incidence of bronchial asthma (BA) leading to EM is not known either. In this paper, we report a case of EM in a 39-year-old female with a history of BA and ascariasis.

KEYWORDS: eosinophilic myocarditis, hypereosinophilia, acute coronary syndrome.
In-Hospital Outcomes of Patients with Thoracic and Abdominal Aortic Aneurysm Who Underwent Surgical, Endovascular and Conservative Medical Management
Authors: Gabitoya Ed D , Arellano Rosella S
Published: July 2024

Background: Aortic aneurysm is a life-threatening condition related to its catastrophic complications of rupture and dissection that warrants consideration of early surgical repair. The decision to intervene for aortic disease remains a challenging decision because of the concomitant high-risk factors and comorbid illnesses as well as increased morbidity and mortality related to it.

Methods: We performed a retrospective cohort study that included 275 patients with thoracic and abdominal aortic aneurysms with indication/s for intervention seen at January 2012 to December 2015. The population was divided into three groups, namely, surgical, endovascular or hybrid and medical management groups, respectively. Outcome measured included in-hospital mortality, cardiovascular, cerebrovascular, pulmonary and renal complications, embolic events and infection.

Results: Seventy-six percent of the patients underwent surgical repair, 16% underwent endovascular or hybrid strategy and 8% received conservative medical management. The overall mortality rate was 16.36%, with a significant higher in-hospital mortality in the medical group (p=0.001). Infection rate was highest in the surgical group (54.07%, p=0.001). The rates of cardiovascular events (p=0.069), neurologic complications (p=0.094), renal failure (p=0.082), respiratory failure (p=0.908), and embolic events (p=0.381) were similar between the groups. Multivariate logistic regression analysis for in-hospital mortality showed that strategies of endovascular repair were not associated with significant survival benefit (adjusted OR 0.987; 95% CI 0.22 – 4.44; p=0.986).

Conclusion: Prompt evaluation for early aortic aneurysm intervention either by open surgery or endovascular procedure is needed because of high mortality related to medical management of large aortic aneurysms. A strategy of endovascular and/or hybrid repair was not associated with significant reduction in in-hospital mortality when compared to open surgery, but evaluation of intermediate and long-term outcomes is warranted. The use of endovascular or hybrid technique can be considered a feasible alternative to surgical repair especially in high-risk patients.

Keywords: open surgical repair, endovascular, medical management, thoracic aortic aneurysm, abdominal aortic aneurysm, 30-day mortality.
The Management of Atrial Fibrillation in the Philippines: A State-of-the-Art Review
Authors: Fadreguilan Erdie
Published: July 2024

Although atrial fibrillation is the most common sustained arrhythmia, data in the Philippines are scarce. Limited data exist as to its prevalence, complications and management patterns. Notwithstanding the lack of data, state-of-the-art management and local experts are available however accessibility remains to pose a significant challenge.
Economic Burden of Fatal and Non-fatal Acute Coronary Syndrome to Filipinos Admitted at a Tertiary Care Center
Authors: Salalima Augusto Niccolo S , Miranda Ariel , Ramos Joselito , Esteban Charlies
Published: July 2024

INTRODUCTION: Acute coronary syndrome (ACS) contributes to approximately 30% of deaths in the Philippines based on the latest available data from the Department of Health. This study aimed to determine the economic burden of ACS to patients and their families and to determine the incidence of catastrophic healthcare expenditure among patients with ACS.

Methods: This was a retrospective study that reviewed the computerized medical records of patients admitted due to fatal or non-fatal ACS from January to December 2016. We extracted and analyzed patient demographic information, length of hospital stay, disposition, type of management, cost of hospitalization and coverage of the Philippine Health Insurance Corporation (PhilHealth). We also calculated the percentage of patients with catastrophic expenditure, defined as >30% of the patient’s annual household income lost to healthcare services.

Results: Of the 310 patients diagnosed and managed for ACS during the study period, 90.97% had PhilHealth coverage. However, across the ACS spectrum, the actual PhilHealth case rate only covered an average of 10.21% of the total hospitalization costs. Over half (57.42%) of ACS patients incurred catastrophic expenditure.

Conclusion: This study showed that despite the high number of patients with PhilHealth, almost six out of ten Filipino patients still had to shoulder a majority of the hospitalization costs due to ACS. These costs do not even include productivity losses and costs due to consumption of other resources. As the ACS becomes severe and requires revascularization, the average cost of hospitalization and the average expense incurred by the patient and his or her family also increases. However, the percentage of the expenses shouldered by PhilHealth does not increase commensurately. Thus, the main goal of PhilHealth to provide universal health coverage remains unfulfilled.
Recurrent Tachyarrhythmia in a 50-Year Old Male: A Case Report
Authors: Bermudez April Ann A , Pestaño Noemi S , Leachon Anthony C
Published: July 2024

BACKGROUND: Ebstein’s anomaly is characterized by displacement of the posterior and septal leaflets of the tricuspid valve. The most common presentation of this anomaly in adulthood is arrhythmia.

CASE: This is a case of a 50-year-old male who presented with recurrent arrhythmias in a three-year span. He was eventually diagnosed with Ebstein’s anomaly, and was initially managed medically. However, due to increasing frequency of admissions due to recurrent supraventricular tachycardia, patient eventually underwent radiofrequency catheter ablation, with successful control of the arrhythmia.

KEYWORDS: Ebstein’s anomaly, tricuspid valve, recurrent arrhythmias, radiofrequency catheter ablation, congenital heart disease.
Triple Chamber Myxoma (Biatrial and Right Ventricle) in a 17-year- old Male: A Case Report
Authors: Evangelista Lauren Kay M , Salvador David Raymund K , See Jason A , Javelosa Ana  Marie
Published: July 2024

We present the case of a 17-year-old male with gelatinous masses in the right atrium, left atrium and right ventricle. The patient consulted a neurologist due to recurrent episodes of syncope with a prodrome of blurring, palpitations and light headedness which usually occurred after exertion. Magnetic resonance imaging (MRI) of the brain revealed contrast enhancing lesions in the right thalamus and hypothalamus and non-enhancing fairly defined lesions in the left thalamus and left centrum semiovale. Two-dimensional transthoracic echocardiography revealed ectopic densities in the left atrium, right atrium and right ventricle probably a triple chamber myxoma. A preoperative transesophageal echocardiogram (TEE) confirmed the presence of three masses located in the right atrium, left atrium and right ventricle. Excision of the bilateral atrial tumors and the right ventricular tumor with mitral valve repair were performed.
Cardiac Tamponade Complicating Disseminated Non-tuberculous Mycobacterial Infection Involving the Pericardium: A Case Report
Authors: Manguba Alexander S , Aherrera Jaime Alfonso M , Faltado Antonio L , Llanto Melissa A , Jara Raul D
Published: July 2024

BACKGROUND: The most common mycobacterial species causing infection in the Philippines is Mycobacterium tuberculosis. Non-tuberculous mycobacteria (NTM) have not been reported in Philippine literature to disseminate to the pericardium.

CASE: We present a case of disseminated mycobacterial (tuberculous and non-tuberculous co-infection) involving the pericardium, pleura, spleen and abdominal wall. This is the case of a 37-year old female who presented with dyspnea and multiple nodules within the abdominal wall. Computed tomography scan showed a thickened pericardium with minimal pericardial effusion, pleural effusion, and multiple abscesses within the spleen, and abdominal wall muscles. Pleural fluid and abdominal wall abscesses were positive for acid-fast bacilli. Mycobacterial cultures also later yielded growth of rapidly growing mycobacteria (Mycobacterium spp. growth within 24 hours). Pericardiostomy was performed to relieve tamponade. The patient was treated with quadruple anti-mycobacterials and a coarse of cefoxitin, amikacin, and clarithromycin. After six months of therapy, there was no recurrence of pericardial effusion.

This case highlights the importance of a high index of suspicion in considering nontuberculous mycobacterial species in patients who do not show improvement with the standard quadruple anti mycobacterial regimen for M. tuberculosis.

KEYWORDS: Cardiac tamponade, mycobacterium, pericardial effusion.
Validation of the HEART Score System in Emergency Department Patients with Chest Pain and Possible Acute Coronary Syndrome
Authors: De Leon Jericho C , Permejo Chito C
Published: July 2024

Chest pain is one of the most common complaints of patients seeking consult in the emergency room (ER). The HEART score is a novel scoring system that utilizes the patient’s history, electrocardiogram, age, risk factors, and troponin level (HEART) to aid clinicians in the stratification of patients with chest pain in the ER. This study aims to determine the validity of the HEART score in predicting outcome in patients with chest pain seen in our ER.

Methods: Patients who presented with chest pain in the ER of the Philippine Heart Center were included in the study, and their HEART scores were determined prospectively. Patients were followed up for 30 days, and the occurrence of acute myocardial infarction, revascularization and/or death were noted. The sensitivity, specificity, and positive and negative predictive values were then calculated in each HEART score.

Results: Three hundred twenty-eight patients were included. One hundred seventy-six patients (53.7%) reached at least one endpoint. HEART scores 0–3 yielded excellent sensitivity and negative predictive values. A score ≥7 showed high specificity and positive predictive values. The measured C-statistic for the HEART score was 0.951.

Conclusion: The HEART score is an easy, reliable, and convenient scoring system for stratifying patients with chest pain in the ER. It can be applied in our local setting, and it has an excellent ability to predict the occurrence of adverse cardiac events.

Keyword: HEART score
Publications, Mindsets, and Public Health Policies
Authors: Ramirez Marcellus Francis L
Published: July 2024

Scientific journals have evolved into one of the most vital means for disseminating  research findings and communicating new knowledge which is critical for  the progress of science. But more than this, journals are also important in the  development of public health. And when we talk about public health in the  Philippines, the role and relevance of the Philippine Journal of Cardiology (PJC) as  the scientific publication arm of the Philippine Heart Association is truly crucial  with cardiovascular diseases continuing to be the top cause of mortality.
Eosinophil-to-Leukocyte Ratio as an Inflammatory Marker in Patients With Coronary Artery Disease—A Retrospective Cohort Study
Authors: Dychiching Arlene Melissa T , Chan Henry L
Published: July 2024

BACKGROUND: Cardiovascular disease remains one of the leading causes of death and major causes of disability and loss of productivity in adults worldwide. Inflammation is a key feature of atherosclerosis and its clinical manifestations. Because inflammation plays a key role in atherosclerosis and its end results, discovering new biomarkers of inflammation becomes important to help diagnostic accuracy and provide prognostic information about coronary artery disease (CAD). The eosinophil count and eosinophil-to-leukocyte ratio (ELR), in particular, have become novel biomarkers for risk assessment in patients with CAD. The current study aimed to evaluate the association of ELR with presence of CAD.

OBJECTIVES: The aim of this study was to investigate the prognostic value and predictive performance of ELR in patients with suspected CAD. Furthermore, if proven of value, this study aims to use ELR as a biomarker for screening patients at risk for CAD for early prevention and intervention.

METHODS: This is a retrospective cohort study involving a chart review of CAD suspects 40 years or older who underwent elective coronary angiogram from January 2019 to December 2019. Eosinophil-to-leukocyte ratio was calculated by dividing the number of eosinophils by the number of leukocytes

RESULTS: A total of 436 patients were included in this study. With an optimal cutoff value of 0.5 (area under the curve, 0.9911; sensitivity, 96.63%; specificity, 95.27%), ELR demonstrated efficiency in detecting CAD.

CONCLUSION: Patients with CAD has a higher ELR than those without CAD in the control group. Furthermore, this study supports the positive association of ELR in predicting CAD.

 

KEYWORDS: eosinophil-to-leukocyte ratio, coronary artery disease
COVID and the Heart–Arrhythmia in COVID-19: A Case Report
Authors: Narvas Nicy F , Gaspar-Trinidad Emma Y
Published: July 2024

BACKGROUND: A 65-year-old man, Filipino, with comorbidities consulted because of  shortness of breath. Chest computed tomography scan showed ground-glass opacities and  crazy paving patterns (computed tomography severity score = 29). He required oxygen at  4 L/min, with bradycardia. Cardiac enzymes and transthoracic echocardiogram did not show  abnormalities. Serial electrocardiogram and electrolytes showed arrhythmia and electrolyte  imbalance.  

Accumulated evidence showed that cardiac involvement is common in patients with  COVID-19. Atrial and ventricular arrhythmia is common even if there is no history of arrhythmia,  normal cardiac biomarkers, and transthoracic echocardiogram. Different mechanisms have been  proposed for the cause of electrolyte imbalance (see Discussion) that may lead to arrhythmia.  Both potassium and calcium were used as a marker of clinical severity and worse prognosis in  patients with COVID-19. 

CONCLUSION: Arrhythmia in COVID-19 patients are more frequent in elderly with comorbidities.  Close monitoring and correction of electrolyte imbalance are important to prevent arrhythmia, which can sometimes be fatal.
Transcatheter Aortic Valve Implantation with Corevalve®: A New Mode of Therapy for Surgically High-Risk Patients with Severe or Critical Aortic Stenosis
Authors: Isidro-Foronda Ma. Richelle , Menor Theresa , Lee Nelson C , Co-Sia Melissa , Panlilio Aristides G , Morales Dante , Dy Timothy C
Published: July 2024

INTRODUCTION: Aortic Stenosis (AS) is a common and life-threatening disease that presents with angina, heart failure, or syncope. Internationally, transcatheter aortic valve implantation (TAVI) has become accepted as a less invasive percutaneous alternative to surgical replacement for high-risk patients with severe or critical AS.

OBJECTIVE: This paper presents the first TAVI case performed at The Heart Institute of the Chinese General Hospital and Medical Center, and reports the first valve-in-valve TAVI case in the Philippines.

CASE: An 87-year old diabetic male patient presented with congestive heart failure and a history of coronary artery bypass grafting, chronic obstructive pulmonary disease, and chronic renal insufficiency. A 2-D echocardiogram (2DE) revealed severe AS with normal left ventricular function. Left heart catheterization confirmed severe AS and showed severe triple vessel coronary artery disease with continued patency of all bypass grafts. Surgical aortic valve replacement was recommended but deemed too high-risk. Ancillary studies revealed that the patient was a viable candidate for TAVI. A 29-mm Corevalve® was implanted, with subsequent moderate to severe paravalvular aortic regurgitation (AR). A second 29-mm Corevalve® was implanted within the first Corevalve®. The patient tolerated the procedure well with marked improvement in symptoms. A repeat 2DE showed normal functioning bioprosthetic valve with minimal AR.

CONCLUSION: TAVI is an alternative mode of therapy in carefully selected surgically high-risk patients with severe or critical AS. Careful and thorough pre-procedural measurements are key for proper valve sizing. Post TAVI calculation of the aortic regurgitation index is important in determining the short- and long term success of the procedure.