Brief Summary
The video is a recording of the second day of the 13th postgraduate course of the Mary Johnston Hospital Department of Internal Medicine. The course, titled "SCOPE: Strengthening Competencies in Outpatient Emergency Care," features lectures and discussions on various medical topics.
- The event includes an opening prayer, national anthem, and PCP hymn.
- There are lectures on tuberculosis, fatty liver disease, and low back pain.
- The event includes raffle draws and sponsor presentations.
Opening and Housekeeping
The second day of the 13th postgraduate course begins with Selena Pisabando welcoming attendees. The course aims to strengthen competencies in outpatient emergency care. The previous day covered stroke, COPD, heart failure, and obesity. The day starts with an opening prayer for knowledge, training, and service to others, followed by singing the national anthem, PCP hymn, and Panatang PCP.
Raffle and Sponsors
The winner of yesterday's Apple iPad raffle is announced as Mam Joan Tapawan. Attendees are reminded to avoid flooding the chat box during raffle draws. The raffle prizes for the day include JBL Wave Buds, JBL Clip 3, and an MSI Modern 14in laptop. Participants must complete the pre-EST to obtain their certificate of completion, CPD units, and qualify for the raffle prizes. The event is sponsored by Just Right, Boringer, Engelheim, Uniarma, Lakeside Pharmaceuticals, Natur, Belle Kens, Labmate, LRI, Theraparma, Macroarma Corporation, Cordbridge, Bioare, Sanovx, ECE Pharmaceutical, Kaufman Pharma, and Westmont. A video presentation from major sponsor Just Right is played, showcasing their gastro care products like Ersomax, Panto press, Dasper, Rebid, Gut biota, and Prograa.
Lecture 1: Towards a TB-Free Philippines
Dr. JC Carlo Viko presents a case study of a 42-year-old male, patient JD, with a chief complaint of cough for 3 weeks. The patient has a history of pulmonary tuberculosis 3 years ago and is now experiencing symptoms like productive cough, intermittent fever, night sweats, and weight loss. Diagnostics reveal pulmonary tuberculosis on the right and refampicin resistance. Dr. Ronald Alan Paumo introduces Dr. Earl Morta, who discusses integrating guidelines in the diagnosis and management of tuberculosis.
TB Epidemiology and Policy
Dr. Morta reviews the latest global and local TB epidemiology and the policy framework for TB elimination. TB is the world's leading infectious killer, and the Philippines is a high-burden country for TB, drug-resistant TB, and TB HIV. The framework aims for zero deaths, zero disease, and zero suffering due to TB. The Philippines has a high TB incidence rate, contributing significantly to the global TB MDRTB burden. The TB elimination act and strategic plans guide efforts, focusing on screening, testing, treatment, and prevention.
TB Screening and Diagnosis
The lecture covers TB screening strategies, including community-based and facility-based screening, with a target of screening 10-30% of the population using X-rays. The manual of procedures outlines symptom screening and chest X-ray pathways. The importance of systematic screening is emphasized, especially for high-risk individuals. The discussion moves to TB testing, aiming to screen 2-3% of the population with presumptive TB and detect 90% of estimated incident cases through universal drug susceptibility testing (DST).
TB Testing Methods and Recommendations
The lecture emphasizes that X-rays are not confirmatory tests for TB, and sputum smear microscopy is not recommended as the initial diagnostic test due to its limitations. The WHO recommends low complexity automated nucleic acid amplification tests (LC NAATs) as initial diagnostic tests for TB and rifampicin resistance. Examples of LC NAATs include Xpert MTB/RIF Ultra and Truenat MTB Plus. Culture is recommended to detect resistance to other anti-TB drugs.
Treatment and Prevention Strategies
The target is to successfully treat 90% of TB cases by adopting cost-effective, patient-centered treatment regimens. The importance of patient support, compliance, and treatment adherence is highlighted. Health education and counseling are crucial interventions. Shorter regimen options for drug-susceptible TB are discussed, including a four-month regimen for children. For drug-resistant TB, the principles include moving towards all-oral regimens, relying on DST, and considering patient-centeredness.
TB Preventive Treatment and Control
The lecture addresses TB prevention, targeting 75% of contacts for preventive treatment. It explains that not all patients exposed to active TB develop the disease, and TB preventive treatment (TPT) works by preventing infected individuals from progressing to active TB. The definition of TB infection is discussed, and the approach to preventive treatment involves ruling out active TB, testing in targeted populations, and offering counseling. Contact investigation is crucial, and TPT is offered to eligible contacts.
Q&A Session
Dr. Morta answers questions about pulmonary clearance, the cost of Xpert Ultra, alternative medications for TB treatment, returning to school or work with drug-resistant TB, drug interactions between anti-TB and anti-retroviral medications, and the availability of NAT in TB DOTS. She emphasizes the importance of negative smears for clearance, the varying costs of Xpert Ultra, referral to TBMAC for allergic reactions, and the availability of Xpert in government health facilities.
Lecture 2: Empagliflozin - Optimal Cardio-Renal Metabolic Protection
Dr. Camilo Oliver Aino discusses the role of Empagliflozin in cardio-renal metabolic protection. He reviews the history of diabetes treatment, highlighting the challenges and controversies before the SGLT2 inhibitor era. The Empa-Reg Outcome trial demonstrated the safety and benefits of Empagliflozin in patients with type 2 diabetes and established cardiovascular disease, including a reduction in cardiovascular death and hospitalization for heart failure.
Empagliflozin in Heart Failure and Kidney Disease
The lecture discusses the use of Empagliflozin in heart failure, referencing the DAPA-HF and Emperor Reduced trials, which showed benefits in patients with reduced ejection fraction (LVEF). The Emperor Preserved trial demonstrated benefits in patients with preserved ejection fraction (HFpEF). The Impulse trial explored the use of Empagliflozin in patients with acute heart failure decompensation, showing positive outcomes. The Empa-Kidney trial demonstrated the benefits of Empagliflozin in patients with chronic kidney disease (CKD), regardless of the cause.
Safety and Guidelines for Empagliflozin
The safety profile of Empagliflozin is reviewed, noting similar rates of hypoglycemia and urinary tract infections compared to placebo. The American College of Cardiology now recommends SGLT2 inhibitors early in the treatment of acute heart failure. Guidelines have been updated to reflect the benefits of Empagliflozin in patients with diabetes, heart failure, and CKD, emphasizing a risk-oriented approach.
Q&A and Appreciation
Dr. Aino receives a certificate of appreciation for his lecture.
Lecture 3: Confronting the Silent Epidemic - Advances in Liver Disease Management
Dr. Diana Alcantara Pawal discusses metabolic-associated fatty liver disease (MAFLD), highlighting its global prevalence and the increasing shift from hepatitis B to MAFLD as a cause of liver cancer in the Philippines. She emphasizes that there is no safe limit for alcohol consumption and that diabetes and alcohol are significant prognostic indicators for liver cancer.
MAFLD: Clinical Consequences and Risk Factors
The lecture covers the clinical consequences of MAFLD, including its systemic effects on cardiovascular disease, stroke, kidney disease, and diabetic nephropathy, as well as its hepatic consequences such as cirrhosis and liver cancer. The importance of identifying risk factors, including obesity, type 2 diabetes, and metabolic factors, is emphasized. Uncommon risk factors such as gut microbiota alterations, hyperuricemia, and hypothyroidism are also discussed.
Diagnosis and Risk Stratification of MAFLD
The lecture emphasizes the role of primary care physicians in diagnosing and stratifying patients with MAFLD into low, intermediate, and high risk categories. The use of Fib4 score and transient elastography (FibroScan) for assessing liver fibrosis is recommended. The importance of monitoring liver fibrosis is highlighted, as it is a direct marker of mortality and liver-related events.
Treatment Goals and Lifestyle Interventions for MAFLD
The goals of treatment for MAFLD include resolution, improvement, reversibility, control of obesity, reduction of cardiovascular risk, prevention of cirrhosis, and improvement of quality of life. Lifestyle interventions, including weight loss, diet, and exercise, are emphasized. The lecture also discusses the role of GLP-1 receptor agonists and SGLT2 inhibitors in promoting weight loss and reducing liver inflammation.
Pharmacological Agents and Management Strategies for MAFLD
The lecture discusses various pharmacological agents for MAFLD, including PPAR agonists, bile acid modulators, and Resmetirom, the first drug approved by the FDA for MAFLD. The importance of a multidisciplinary approach, including lifestyle evaluation and structured programs, is emphasized. The 2024 APASL guidelines for MAFLD are presented, highlighting the importance of risk stratification and monitoring.
Q&A and Appreciation
Dr. Pawal answers questions about screening for MAFLD, the dynamic nature of the disease, and the role of various medications. She emphasizes the importance of weight loss and the use of metrics to track improvement. Dr. Pawal and Dr. Guzman receive certificates of appreciation for their contributions.
Lecture 4: Innovations in Low Back Pain Diagnosis and Management
Dr. Mark Joseph Lopez presents a case of a 47-year-old male with low back pain radiating to the left leg. The patient has persistent low back pain worsened by prolonged standing or bending, associated with numbness and tingling. Physical examination reveals weakness in plantar flexion and decreased sensation along the left leg. MRI confirms an L5 to S1 disc herniation. Dr. Consuelo B. Gonzalez Suarez discusses innovations in low back pain diagnosis and management.
Low Back Pain: Prevalence, Anatomy, and Causes
Dr. Suarez discusses the prevalence of low back pain, its classification, and its impact on global health. The anatomy of the lumbar spine is explained, highlighting the pain-sensitive structures and the role of muscles in supporting the spine. The causes of low back pain are reviewed, including nonspecific low back pain, degenerative disc disease, nerve root impingement, and spinal stenosis.
Risk Factors and Physical Examination for Low Back Pain
The lecture covers risk factors for low back pain, including heavy physical work and psychosocial factors. The physical examination of the spine is described, including palpation, range of motion testing, manual muscle testing, sensory testing, and reflex testing. Special tests such as straight leg raising, cross straight leg raising, and femoral nerve test are explained.
Clinical Diagnostic Rules and Red/Yellow Flags for Low Back Pain
The lecture presents clinical diagnostic rules for intervertebral disc derangement, disc herniation with nerve root involvement, spinal canal stenosis, spondylolisthesis, and myofascial pain syndrome. Red flags indicating more grave causes of low back pain, such as violent trauma, suspected cancer, and loss of bowel control, are discussed. Yellow flags indicating psychosocial factors that increase the risk of persistent low back pain are also highlighted.
Management and Prevention of Low Back Pain
The recent clinical practice guidelines for the management of low back pain are reviewed, emphasizing self-management, education, psychosocial interventions, over-the-counter medication, and therapeutic exercises. The role of injections and surgical intervention is discussed. The importance of proper posture and workstation ergonomics is emphasized.
Q&A and Closing Remarks
Dr. Suarez answers questions about the biopsychosocial model, the role of ultrasonography, the use of antidepressants, and the reversibility of lumbar disc herniation. She emphasizes the importance of clinical history and physical examination, the role of exercise, and the need for a multidisciplinary approach. Dr. Suarez and Dr. Solimmano receive certificates of appreciation. Dr. Maria Asunano shares closing remarks, thanking the speakers, moderators, sponsors, and participants. The final raffle draw is conducted, and the post-test is announced.
