Occupational Injury in the Philippines CASE

CASE REPORT
REPORT
ORIGINAL ARTICLE

AnalysisHeart ofFailure
Trendsand Short Stature Injury
of Occupational in a 43 inyear-old male
the Philippines:
Katerina
Katerina T.
T. Leyritana
Leyritana11,, Ma. CzarlotaImplications
Ma. Czarlota M. for 1Policy
M. Acelajado-Valdenor
Acelajado-Valdenor 1
,, Amado
Amado O.
O. Tandoc
Tandoc III
III22 and
and Agnes
Agnes D.
D. Mejia
Mejia11

Department
Department of
11
of Medicine,
Medicine, College
College of
of Medicine
Medicine and
and Philippine
Philippine General
General Hospital,
Hospital, University
University of
of the
the Philippines
Philippines Manila
Manila
22
Department
Department of
of Pathology, JinkyofofLeilanie
Pathology, College
College Medicine, D. Lu ofof the
Medicine, University
University the Philippines
Philippines Manila
Manila

National Institutes of Health

University of the Philippines Manila

Presentation
Presentation of of the
the case
case require
require regular
regular laxative
laxative use. use. There
There was was also
also aa report
report of of two
two
This
This is is aa case
case ofof aa 43-year-old
43-year-old male male presenting
presenting withwith short
short more
more syncopal
syncopal episodes.
episodes. He He waswas brought
brought to to another
another doctor
doctor
stature
stature and and heart
heart failure.
failure. TheThe patient
patient was was admitted
admitted at at the
the in
in aa private
private hospital
hospital where where the the assessment
assessment was was still
still aa “heart
“heart
medicine
medicine ward ward of of the
the Philippine
Philippine General
General Hospital
Hospital (PGH)
(PGH) problem”.
problem”. The The patient
patient was was againagain prescribed
prescribed unrecalled
unrecalled
for
for dyspnea.
dyspnea. This This paper
paper will will investigate
investigate several
several issues:
issues: medications
medications and and again
again was was lostlost to to follow-up.
follow-up. This This time,
time,
differentiating
differentiating congenital
congenital from from acquired
acquired hypothyroidism,
hypothyroidism, however,
however, symptoms
symptoms were were persistent.
persistent. He He later
later consulted
consulted at at
the
the relationship
relationship between between hypothyroidism
hypothyroidism and and the the another
another local
local hospital,
hospital, where where he he was
was admitted
admitted and and managed
managed
cardiomyopathies,
cardiomyopathies, and and thethe therapeutic
therapeutic optionsoptions in in patients
patients as
as aa case
case ofof anemia
anemia and and bronchial
bronchial asthma.
asthma. He He waswas discharged
discharged
with
with cardiomyopathy
cardiomyopathy secondary secondary to to hypothyroidism.
hypothyroidism. slightly
slightly improved
improved after after fourfour days,
days, onlyonly toto have
have recurrent
recurrent heartheart
The
The patient
patient hadhad beenbeen born
born fullfull term
term to to aa then
then 31-year-
31-year- failure
failure symptoms,
symptoms, prompting prompting admission
admission at
Introduction at PGH.
PGH.
old
old Gravida
Gravida 44 Para Para 33 (G4P3),
(G4P3), the the 44thth of
of 99 siblings,
siblings, with
with an an Upon
Upon admission
admission the
An occupational theinjurypatient
patient is was
was
any in ininjury
mild
mild (e.g.,
respiratory
respiratory
cuts,
apparently
apparently unremarkable
unremarkable delivery delivery at at home
home facilitated
facilitated by by distress,
distress, with
fractures, with stable
stable
sprains, andvital
vital signs
signs and
amputations) and no no note
note
that of
of fever.
results fever.
from Pertinent
Pertinent
a work
aa traditional
traditional birthbirth attendant.
attendant. He He was
was notednoted to to be
be normal
normal physical
physical exam
accident exam
or fromfindings
findings
exposure included
included
involvingshort
shortastature,
stature, thick
thick lips,
single incident lips,innon-
non-
the
at
at birth.
birth. TheThe patient
patient was was allegedly
allegedly at at par
par with
with age
age both
both pitting
pitting periorbital
work periorbital
environment. edema,
edema, Andrydryoccupational
skin,
skin, aa displaced
displaced apical
apical impulse,
accident impulse,
is an
physically
physically and and mentally
mentally untiluntil eight
eight years
years oldold when
when he he was
was crackles
crackles on
unexpected on both
both
and lung
lung
unplannedfields,
fields, and and bilateral
bilateralrelated
occurrence non-pitting
non-pittingto work bipedal
bipedal
that
said
said to
to have
have stopped
stopped growing
growing in in height.
height. He He was
was brought
brought to to edema.
edema. There
There was
was also
also a
a 33 cm
cm xx 33
results to injury, disease or death whether outside the usual cm
cm reducible
reducible umbilical
umbilical
aa private
private doctor,
doctor, whose
whose diagnosis
diagnosis was was undisclosed,
undisclosed, and and he he hernia.
hernia. However,
workplace However,
(e.g., there
there
in anotherwas
was no no establishment,
pallor,
pallor, no no neck
neck veinvein distention,
duringdistention,
travel,
was
was given
given medications
medications to to increase
increase height,
height, whichwhich the
the patient
patient no
transport or in road traffic). This includes all murmurs
no apparent
apparent congenital
congenital malformations,
malformations, no
no cardiac
cardiac murmurs
accidents
took
took for
for only
only one
one month
month with with no no improvement.
improvement. Through Through the the and
and nono clubbing.
occurring clubbing.
out of orThere
There
in thewas was also
alsoofno
course no note
note including
work, of
of anan anterior
anterior neck
accidentsneck
years,
years, thethe patient
patient waswas apparently
apparently well, well, although
although still
still of
of short
short mass.
mass.
“going to and fro” the place of employment. 1

stature,
stature, withwith thick
thick lips,
lips, coarse
coarse facial
facial features
features andand dry
dry skin.
skin. Laboratory
Laboratory
Occupational workup
workup injuriesshowed
showed arecardiomegaly
cardiomegaly
a major health with
withproblem
pulmonary
pulmonary in
He
He was
was notably
notably slowslow in in ambulation.
ambulation. He He waswas said
said toto have
have congestion,
developing countries, estimated by the World aorta
congestion, thoracic
thoracic dextroscoliosis,
dextroscoliosis,
2 and
and atheromatous
atheromatous aorta
Health by
by
bronchial
bronchial asthma
asthma at at age
age 1515 years,
years, and
and since
since then
then he
he had
had been
been chest
chest radiograph,
radiograph,
Organization and
and left
(WHO) left ventricular
ventricular
and the hypertrophy
hypertrophy
International by
by 12-lead
12-lead
Labor
taking
taking salbutamol
salbutamol tablets
tablets occasionally
occasionally for for bouts
bouts ofof dyspnea
dyspnea electrocardiogram
electrocardiogram (12-L
(12-L ECG)
ECG) (Figures
(Figures
Organization (ILO) to cause the deaths of about 1.1 million 1
1 and
and 2),
2), normocytic
normocytic
occurring
occurring one one toto two
two times
times annually.
annually. normochromic
normochromic
people yearly anemiaanemia
because(Hgb (Hgb
of 90 90 mg/dL),
unsafemg/dL),and dyslipidemia,
dyslipidemia,
unhealthy work and
and
The
The patient’s
patient’s symptoms
symptoms started started in in 2001
2001 when
when he he was
was pre-renal
pre-renal azotemia
azotemia (serum
(serum creatinine
creatinine
environments. In 2002, the Bureau of Working Conditions
3 123
123 mmoL).
mmoL). Electrolytes
Electrolytes
reported
reported to to have
have sudden
sudden loss loss of of consciousness.
consciousness. During During this this on
on admission
(BWC)admission
stated that showed
showedthere slightslight
were only hyponatremia,
hyponatremia,
59 accredited hypokalemia,
hypokalemia,
workplace
time,
time, the
the patient
patient did
did notnot have
have any any symptoms
symptoms of of heart
heart failure;
failure; and
inspectors assigned to monitor more than 700,000Blood
and hypochloremia
hypochloremia (serum
(serum Na
Na 136,
136, K
K 3.35,
3.35, Cl
Cl 86).
86). Blood gases
gases
registered
no
no prior
prior seizures,
seizures, cyanotic
cyanotic episodes,
episodes, chestchest pain,
pain, headache,
headache, or or revealed
enterprises. In 2007, only 280 labor inspectorsmild
revealed partially
partially
4 compensated
compensated metabolic
metabolic alkalosis
alkalosis with
with mildall
blurring
blurring of of vision.
vision. HeHe regained
regained consciousness
consciousness shortlyshortly after
after and
and hypoxemia.
hypoxemia. The
The patient
patient was
was noted
noted
commissioned to monitor 800,000 registered firms in the to
to be
be hypothyroid
hypothyroid based
based
was
was brought
brought to to aa private
private physician,
physician, whose
whose assessment
assessment was was aa on
on elevated
elevated
country. Thisserum
serum
implies thyroid-stimulating
thyroid-stimulating
that there is inadequate hormone
hormone number (TSH)
(TSH) and and
of
“heart
“heart problem”.
problem”. He He waswas prescribed
prescribed unrecalled
unrecalled medications
medications markedly
markedly decreased
decreased serum
serum free
free thyroxine
thyroxine
labour inspectors who will monitor all registered firms in the (FT4).
(FT4). The
The exact
exact
taken
taken forfor aa few
few months
months and and eventually
eventually discontinued
discontinued when when values
values are
country. are shown
shown in in Tables
Tables 11 and and 2. 2.
the
the syncopal
syncopal episode
episode did did not
not recur.
recur. Upon
Upon admission
admission to
to
The objective of this study was the
the wards,
wards, the
the topatient
patient
provide was
wasamanaged
managed
detailed
In
In the the next
next fourfour years,
years, the the patient
patient would would develop
develop as
as having
having congestive
congestive heart
heart failure
failure
profile and statistics on occupational injuries in the from
from cardiomyopathy
cardiomyopathy
intermittent,
intermittent, progressive
progressive exertional
exertional dyspneadyspnea and and bipedal
bipedal secondary
secondary to
Philippines. toTheacquired
acquired
latest hypothyroidism.
hypothyroidism.
national data on Oral Oral loop loop diuretics,
occupational diuretics,
injury
edema.
edema. LaterLater onon this
this would
would be be accompanied
accompanied by by generalized
generalized angiotensin-converting
angiotensin-converting enzyme
enzyme
in the country was 2007, and as such, analysis was limited (ACE)
(ACE) inhibitors,
inhibitors, beta-
beta-
_______________
body
body weakness,
weakness, anorexia,
anorexia, and and constipation,
constipation, severesevere enough
enough to to blockers,
blockers, statins,
statins, and
and levothyroxine
levothyroxine were
were started.
started. Electrolyte
Electrolyte
up to this year. There were also years prior to 2007 not
correction
correctioninwas
available was instituted.
instituted.
the national The
The sections
database sections
of the Bureau of
of Endocrinology
Endocrinology
of Labor and
Corresponding author: Jinky Leilanie D. Lu, MOH, PhD
and
and Cardiovascular
Cardiovascular Diseases Diseases were were co-managing
co-managing the the patient
patient
National Institutesauthor:
Corresponding
Corresponding of Health
author: Ma.
Ma. Czarlota
Czarlota Acelajado-Valdenor,
Acelajado-Valdenor, M.D.
M.D. Employment Statistics. In line with this, this study also
University
Department
Department of the
of Philippines
Medicine Manila
of Medicine together
together withwith the the General
General MedicineMedicine service.
service.
includes some recommendations that will be able to enhance
625 Pedro GilGeneral
Philippine
Philippine St., Ermita,
General Manila 1000 Philippines
Hospital
Hospital He
He soon
soon developed
developed respiratory respiratory failure,
failure, upon upon which
which the the
Telephone: +632Manila,
52642661000 the recording of occupational injuries and accidents in the
Taft
Taft Avenue,
Avenue, Manila, 1000 Philippines
Philippines considerations
considerations were were acute
acute pulmonary
pulmonary congestion,
congestion, nosocomial
nosocomial
Email: jinky_lu@yahoo.com
Telephone:
Telephone: +632
+632 554-8488
554-8488 country.
pneumonia,
pneumonia, to to rule
rule outout an an acute
acute coronary
coronary event. event. He He was
was later
later
Email:
Email: czarlota@yahoo.com
czarlota@yahoo.com

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 Heart Failure and Short Stature
Occupational Injuryinina the
43 year-old male
Philippines

Table 1. Initial LaboratoryMethods

Results being employed in sectors other than their degree courses,
Hospital-based and population-based data on types of decreased by 1.1% from 6,621 in 2009 to 6,298 in 20105
CBC Blood chem. Urinalysis ABG
injury such as motor vehicle crashes, falls, burns, drowning, (Figure 2).
Reference Reference Result Color straw pH 7.408
poisoning, and suicides were Result
included in the study to obtain The Philippines has a relatively young population and
Value Value
comparative
WBC statistics for occupationally
5-10 4.5 RBS related injuries
3.9-6.1 young
6.3 workforce. In
Transp 2009, 45%
Clear of the total
pCO2 number
49.1 of
compared
RBC to 4-6
overall injuries in the country. A thorough4.27-6.07
HGBA1C and employed
6.4 persons were 25 1.010
Sp Gravity to 30 years pO2 old. This70 was
HGB
systematic review
120-150 of literature,
90 includingBUNarticles, surveys,
2.6-6.4 5.0
followed by personspH aged 20 to8.0 HCO3There were
24 years old. 31.3 21.6
HCTstudies, 0.38-0.48
case and other data 0.27on injuriesCREA 53-115
in the Philippines 123 males and
million Sugar15 millionNEG females O2 sat
employed 93.62010,
in
MCV 80-100 FL ALB 34-50 32 Protein NEG FiO2 21%
available electronically was also performed. Newspaper registering a male-female employment ratio of 1.44:1.0. This
MCH 27-31 PG TAG 0.34-1.7 0.82 RBC 0-1 Temp 36.9
reports
MCHC on injuries were cited. Data were
320-360 G/L HDLgathered mainly
0.91-1.56 means
0.67 that for WBC
every 1.44 males,
0-2 there is only 1 female
from 5 (Figure 3).
RDWthe records of the Bureau of Labor
11.5-15.5% LDLand Employment
1.1-3.8 employed
4.21 Cast PBS
PLT
Statistics 200-400 of the Inc
(BLES) Department TOTAL
of CHOL
Labor 4.2-5.2
and 5.25 Epith cell Rare Slight poikilocytosis,
RETIC
Employment 0.005-0.015
(DOLE), the Labor Force AST Survey of15-37 the 95 Bacteria Occ’l acanthocytes, ovalocytes,
SEG 50-70% 48 ALT 30-65 91 Mucus th Rare slight toxic granulation,
National Statistics Office, the Occupational Safety and
LYMPH 20-44% 50 Alk po4 184 Crystals Rare slight anisocytosis
Health
MONO Center 2-9%(OSHC), the 2 NationalNAElectronic Injury
140-148 136.9 Am urates
Surveillance
EO System (NEISS)
0-4% 0 under the K Department of
3.6-5.2 3.35
BASO (DOH),
Health 0-2% 0
the Overseas Employment CLStatistics (OES)
100-108
of 86
BLAST 0% Overseas 0Employment CA++ 2.12-2.52 2.37
the Philippine Administration
P 2.27
(POEA), and the International Labor Organization
MG++ (ILO).0.74-1 0.83
In this study, occupational injuries were presented by
category: by incapacity for work, by frequency rate, severity
rate, and average workdays lost, by major occupational Source: National Statistics Office, 20105
group,2.by type ofFunction
injury, by cause of injury, by part of body fat pad. Cardiac enzymes were not consistent with an acute
Table Thyroid Tests
injured, and by agent of work-related injury. coronary event (Table
Figure 1. Country’s 3), however,
Labor intravenous
Force in 2009 to 2010 (IV) heparin
Reference Value Result (overlapping with oral warfarin) was still given to cover for
Free T4 (0.8-2.0) 0.02 ng/dL
Results the presence of a possible LV thrombus as demonstrated
TSH (0.4-6.0) 24.75 Uiu/ml
by rheologic stasis on cardiac ultrasound. Medications
Labor and Employment Statistics were shifted to IV diuretics and inotropes; oral digoxin was
The current population of the Philippines is 94 million. started. IV antibiotics were given for possible pulmonary
infection. The patient later on showed improvement, and was
The country’s Gross National Product (GNP) is P2,478.8
eventually weaned off from ventilatory support, extubated,
billion (US$56.34B) and the Gross Domestic Product (GDP)
is P2,205.5 billion (US$50B). 5
Out of the estimated total population of 60.2 million Table 3. Cardiac Enzymes
consisting of Filipinos 15 years old and above in 2010, 36.5 Reference Range (mmoL) Result
million were employed. The employment rate was 92.7%, Qualitative
Source: National Statistics Office, 20105 POSITIVE
and the labor force participation rate was at 64.5% (as of Troponin I
January 2010).5 CK-MB2. Unemployment0-6.0
Figure Rate in 2009 to 2010 1.14
The labor force comprises potential workers, either CK-TOTAL 21-232 543

actually employed or unemployed. The labor force

participation rate is the proportion of the total number of
persons in the labor force to the total population (15 years
old and above). The employment rate is the proportion of
Figure
the total1.number
Electrocardiogram
of employed upon admission
persons to the total number of
persons in the labor force. Underemployment is a term used
to designate a worker whose current employment leads him
transferred to the intensive care unit (ICU) for ventilatory
to desire to have additional hours of work in their present
support and closer monitoring. On bedside cardiac ultrasound,
job or in an additional job, or to have a new job with longer
there was a finding of eccentric left ventricular hypertrophy,
working hours.5
global hypokinesia with depressed overall systolic function
The country's labor force grew by 1.8% from 37,824 in
with concomitant spontaneous echo contrast on left ventricular
2009 to 38,508 in 2010 (Figure 1). The employment rate
(LV) cavity suggestive of rheologic stasis, the ejection fraction
decreased by 0.5% as of April 2010, whereas the
was 25%, with moderate mitral regurgitation, moderate
unemployment
aortic regurgitationrate increased
with aortic bysclerosis,
0.5% coinciding with the
severe tricuspid Source: National Statistics Office, 20105
economic crisis that started in the United States
regurgitation with mild pulmonary hypertension, pulmonaryof America.
The underemployment
regurgitation, rate,pericardial
and minimal defined aseffusion
the rateor
ofpericardial
graduates Figure
Figure 2.
3. Chest radiograph
Employment on by
Ratio admission
Gender

VOL. 45
VOL. 43 NO.
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2011 ACTA MEDICA
ACTA MEDICA PHILIPPINA
PHILIPPINA 45
13
Occupational Injury in the Philippines CASE REPORT

Overseas employment Heart is alsoFailure

significantand Short
because of itsStature
estate, in a 43 and
renting year-old
business male activities had the highest
contribution to dollar remittance to the country–thus decrease at 60.57% from 1,022 cases in 2003 to 403 in 2007.
Katerina
boosting T. Leyritana
the local economy–as 1
, Ma.
wellCzarlota M. Acelajado-Valdenor
as the attendant issues On the 1
, Amado
other hand, O. Tandoc private III2education
and Agnes D. Mejia
services had1 the
on occupational hazards and safety. While the Department highest increase at 76.54% (Figure 4).
of Foreign Affairs 1
Department
reportsof that
Medicine,
thereCollege
are ofabout
Medicine
7.38andtoPhilippine
8 General
TheHospital,
BLES-DOLE University of the Philippines
records report 26,289 Manila non-fatal cases in
million Filipino migrants throughout
2
Department theof Pathology,
world, College
there ofare Medicine, University
2000, and 20,270 of the Philippines
cases in Manila
2007. Among the non-fatal cases,
about 1.2 million Overseas Filipino Workers (OFW) 26,110 cases led to temporary disability in 2000 and 20,109
employed in major land groupings. The Middle East has the temporary disabilities in 2007. It is alarming to note that out
highest number of OFWs (669,042), followed by Asia of the reported cases of occupational injury, 178 resulted in
(260,995) and the Americas (31,146).6 death in 2000 and 116 resulted in death in 2007. These
statistics only show the reported cases which may
Occupational Injury Presentation
and Hazard ofExposure
the case require
underestimateregular the laxative
total use.
number There of was also aoccurring
fatalities report of as two a
This is a case ofinjuries
Occupational a 43-year-old male presenting
are a global with short
problem. According more
result syncopal
of occupational episodes. He was
injuries. brought disability
Permanent to anotherisdoctor
also a
stature
to the and heartHealth
World failure. Organization
The patient was admitted
(WHO) andat the in a private
grave hospital where
consequence the assessment
of occupational was still
injury. a “heart
Permanent
medicine ward
International of the
Labor Philippine (ILO),
Organization General7 1.1Hospital (PGH)
million people problem”. The patient
disabilities registered at 179was againand
in 2000 prescribed
162 in 2007unrecalled
(Table 1).
for annually
die dyspnea. due Thisto paper will unsafe
hazardous, investigate several issues:
and unhealthy work medications and again was lost to follow-up. This time,
differentiating Out
environments. congenital from acquired
of the estimated hypothyroidism,
250 million accidents in however,
Table 1. Cases symptoms were persistent.
of occupational injuries Heinlater consulted by
all industries at
the workplace,
the relationship aboutbetween
300,000 resulthypothyroidism
in partial or and complete the another
incapacity local
forhospital,
work in 2000 where andhe2007
was admitted and managed
cardiomyopathies,
loss of capacity and to the
worktherapeutic
and to optionsgeneratein patients
income. as a case of anemia and bronchial asthma. He was discharged
with cardiomyopathy secondary to hypothyroidism.
Occupational injuries are therefore costly for the worker, the slightly improved
Type of Injury after four
with Workdays days, only
Lost to have recurrent
2000 2007 heart
The patient had been born full term
company, and the local economy. In 2003, ILO reported thatto a then 31-year- failure
Fatal symptoms, prompting admission 178 at PGH. 116
Non-fatal 26, 289 20,270
old Gravida
there 4 Para358,000
were about 3 (G4P3),fatal theand
4th of
3379 million
siblings,non-fatal
with an Upon admission the patient was
Permanent 179
in mild 162 respiratory
apparently unremarkable delivery at home
occupational accidents in the world. Given these statistics, it
3 facilitated by distress, with
Temporary stable vital signs and no note
26,110 of fever. Pertinent
20,109
ais traditional birth attendant. He was
necessary that preventive and control measures be noted to be normal physical
Total Cases exam
with findings
Workdays included
Lost short stature,
26,467 thick lips,
20,386 non-
at birth. The patient was allegedly at
implemented at work to prevent hazardous exposures, and par with age both pitting periorbital
Source: Bureau edema,
of Labor and dry
Employment skin, a displaced
Statistics apical
(BLES) Integrated impulse,
Survey, 2010 1

physically
governments andshould
mentally comeuntilupeightwithyears old and
policies whenlaws he wasfor crackles on both lung fields, and bilateral non-pitting bipedal
said to have stopped growing in height. He was brought to edema.As for There thewas
frequency
also a rate3 cmofxinjury, it was estimated
3 cm reducible umbilical to
workplace safety and health.
a private doctor, whose diagnosis was undisclosed, and he occur atHowever,
hernia. six injury cases
there wasper 500 full-time
no pallor, no neckworkers. In the
vein distention,
was given medications to increase height, which the patient following
no apparent years, the frequency
congenital rate of injury
malformations, no declined
cardiac to 4.07
murmurs
Local Situationer
tookIn for only in 2003,
and and further
no clubbing. There declined
was also to no
2.79 in of
note 2007. The severity
an anterior neck
the one month with
Philippines, no improvement.
there were 58,720Through cases the of
years, the patient was apparently well, although still of short rate of injury in the year 2000 was relatively high registering
mass.
occupational injury in 2003, and 46,570 cases in 2007. The
stature, with thick lips, coarse facial the
features andnumber
dry skin. 44 Laboratory
per 500 full-time workupworkers. This led to an
showed cardiomegaly withaverage
pulmonary of 8
manufacturing industries registered highest of
He was notably slow in ambulation. He was said to have workdays lost
congestion, due dextroscoliosis,
thoracic to occupational and injuries in all types
atheromatous aorta of
by
cases at 40,498 cases in 2003 and 30,790 cases in 2007. Real
bronchial asthma at age 15 years, and since then he had been industries
chest (Table 2).
radiograph, and left ventricular hypertrophy by 12-lead
taking salbutamol tablets occasionally for bouts of dyspnea electrocardiogram (12-L ECG) (Figures 1 and 2), normocytic
occurring one to two times annually. normochromic anemia (Hgb 90 mg/dL), dyslipidemia, and
The patient’s symptoms started in 2001 when he was pre-renal azotemia (serum creatinine 123 mmoL). Electrolytes
reported to have sudden loss of consciousness. During this on admission showed slight hyponatremia, hypokalemia,
time, the patient did not have any symptoms of heart failure; and hypochloremia (serum Na 136, K 3.35, Cl 86). Blood gases
no prior seizures, cyanotic episodes, chest pain, headache, or revealed partially compensated metabolic alkalosis with mild
blurring of vision. He regained consciousness shortly after and hypoxemia. The patient was noted to be hypothyroid based
was brought to a private physician, whose assessment was a on elevated serum thyroid-stimulating hormone (TSH) and
“heart problem”. He was prescribed unrecalled medications markedly decreased serum free thyroxine (FT4). The exact
taken for a few months and eventually discontinued when values are shown in Tables 1 and 2.
the syncopal episode did not recur. Upon admission to the wards, the patient was managed
In the next four years, the patient would develop as having congestive heart failure from cardiomyopathy
intermittent, progressive exertional dyspnea and bipedal secondary to acquired hypothyroidism. Oral loop diuretics,
edema. Later on this would be accompanied by generalized angiotensin-converting enzyme (ACE) inhibitors, beta-
body weakness, anorexia, and constipation, severe enough to blockers, statins, and levothyroxine were started. Electrolyte
correction was instituted. The sections of Endocrinology
and Cardiovascular Diseases were co-managing the patient
Corresponding author: Ma. Czarlota Acelajado-Valdenor, M.D.
Department of Medicine together with the General Medicine service.
Philippine General
Source: Bureau of Labor Hospital
and Employment Statistics (BLES) Integrated Survey, 20101 He soon developed respiratory failure, upon which the
Taft Avenue, Manila, 1000 Philippines considerations were acute pulmonary congestion, nosocomial
Telephone: +632 554-8488 pneumonia, to rule out an acute coronary event. He was later
Figure 4. Cases of occupational injuries by major industry, 2003 and
Email: czarlota@yahoo.com 2007

12 ACTA MEDICA
46 ACTA MEDICA PHILIPPINA
PHILIPPINA VOL.45
VOL. 43NO.
N0. 43 2009
2011
 Heart Failure and Short Stature
Occupational Injuryinina the
43 year-old male
Philippines

Table
Table 1.
2. Initial
Cases Laboratory Results
of occupational injuries by frequency rate per Hospital-Based Records of Injuries including Vehicular
500 workers, and severity rate per 500 workers in the years Accidents
CBC Blood chem. Urinalysis ABG
2000, 2003, and 2007 According to hospital records, a total of 9,521 injury
Reference Result Color
Reference Result cases were reported for thestraw
first quarterpH
of 2010 7.408
at 77
Value Value
Occupational Injury
WBC 5-10
2000
4.5
2003
RBS
2007
3.9-6.1 government
6.3 and private
Transp hospitals
Clear all over
pCO2the Philippines.
49.1
Total Occupational Injuries8 69,208 58,720 46,570
RBC
Frequency Rate4-6(%)1 5.70
HGBA1C
4.07 2.79
4.27-6.07 Injuries
6.4 most commonly
Sp Gravity occurred1.010 on thepO2 road (44.4%) 70 or at
HGB
Fatal 1 120-150 90
0.04 BUN
0.03 0.02 2.6-6.4 5.0
home (22.9%), pH
and were 8.0
leisure-relatedHCO3 (20.2%); 31.3
many
HCTfatal1
Non 0.38-0.48 0.27
5.66 CREA
4.04 2.77 53-115 123
occurred at an Sugar NEG
unknown location O2 sat Work-related
(17.8%). 93.6
MCV Permanent80-100 FL
Incapacity 0.04 ALB
0.02 0.02 34-50 32 Protein NEG FiO2 21%
injuries were reported at 7.8%. The injuries were reported to
MCHTemporary27-31 PG
Incapacity 5.62 TAG
4.02 2.75 0.34-1.7 0.82 RBC 0-1 Temp 36.9
MCHC rate (%)320-360
Severity 1 G/L 43.69 HDL
27.31 19.050.91-1.56
mostly
0.67 occur between
WBC 4:00PM 0-2 and 7:59PM. Of the total
RDW Days Lost
Average 11.5-15.5%
1
8 LDL
6.79 6.92 1.1-3.8 injuries,
4.21 0.47% ledCastto death.9 PBS
PLT Bureau of Labor
Source: 200-400
and Employment Statistics TOTAL Survey,
Inc (BLES) Integrated CHOL200284.2-5.2
, 20101 5.25
Vehicular Epith cell wereRare
accidents the mostSlight
common cause of
poikilocytosis,
RETIC 0.005-0.015 AST 15-37 95 with 3,077
injury, Bacteria
cases (FigureOcc’l 5). This was followed
acanthocytes, by
ovalocytes,
SEGSuperficial 50-70%injuries and 48 open wounds ALT were the 30-65 most 91 Mucus th Rare
mauling with 1,757 cases (14.83%) andslight toxic granulation,
contact with sharp
LYMPH type
common 20-44%
of injury in 2000, 50 2003 Alk
andpo42007 but this 184 Crystals Rare
MONO 2-9% 2 NA 140-148 objects
136.9 with 1,130 cases (13.06%). Theslight
Am urates
anisocytosis
highest number of
declined by 28.6% from 14,925 cases in 2000 to 10,517 cases
EO 0-4% 0 K 3.6-5.2 injuries
3.35 recorded were in Central Luzon (34.1%), followed by
inBASO
2003 and 0-2% it further declined 0 by 10.4%
CL in 2007. Acute 100-108 86 Region (13.5%). More males (83%) than females (17%)
Davao
poisoning
BLAST and0% infections rapidly 0 increased
CA++ by 2.39 times 2.12-2.52 2.37
were injured. Meanwhile, the most common types of injury
from 2003 to 2007. Other serious injuries P were burns, 2.27
MG++with 2,065 0.74-1 were
0.83 open wounds/lacerations at 3,821 cases (40.1%),
corrosions, scalds, and frostbites, registering cases
abrasions at 3,361 cases (35.3%), and contusions at 1,618
in 2007. Fractures also registered at 1,839 cases in 2007.
cases (17%).10 (Figure 6)
(Table 3)
fat pad. Cardiac enzymes were not consistent with an acute
Table 2. Thyroid Function Tests
Table 3. Cases of occupational injury by type in the years coronary event (Table 3), however, intravenous (IV) heparin
2000, 2003, and 2007Reference Value
in all industries Result (overlapping with oral warfarin) was still given to cover for
Free T4 (0.8-2.0) 0.02 ng/dL
the presence of a possible LV thrombus as demonstrated
TSH (0.4-6.0) 24.75 Uiu/ml
Type of Injuries 2000 2003 2007 by rheologic stasis on cardiac ultrasound. Medications
Superficial Injuries and Open Wounds 14, 925 11,609 10,517
were shifted to IV diuretics and inotropes; oral digoxin was
Fractures 1,151 1,927 1,839
Dislocations, Sprains and Strains 2,789 3,336 2,366 started. IV antibiotics were given for possible pulmonary
Amputations 354 547 234 infection. The patient later on showed improvement, and was
Concussion and Internal Injuries 1,963 1,048 694 eventually weaned off from ventilatory support, extubated,
Burns, Corrosions, Scalds and Frostbites 1,944 2,300 2,065
Acute Poisoning and Infections 347 221 750
Foreign Body in the Eye 1,793 1,848 1,565 Table 3. Cardiac Enzymes
Others 1,202 430 356 Source: National Electronic Injury Surveillance System (NEISS)- Department of
Total 26,468 23,265 20,386 Health (DOH), 2010a9 Reference Range (mmoL) Result
Source: Bureau of Labor and Employment Statistics (BLES) Integrated Survey, 20101 Qualitative POSITIVE
Figure 5. IDistribution of injury cases by cause of injury in
Troponin
From 2000 to 2007, injuries to the upper extremities had CK-MB March, 2010 (N=9,521)
January- 0-6.0 1.14
CK-TOTAL 21-232 543
the highest number of cases followed by injuries to the lower
extremities and head. Injury to the head is a disturbing
statistic as such injuries may lead to serious consequences.
The least number of injuries were to the neck. (Table 4)

Figure4.1. Cases
Table Electrocardiogram upon
of occupational admission
injuries by part of the body
injured in the years 2000, 2003, and 2007 in all industries
transferred to the intensive care unit (ICU) for ventilatory
Part of the Body 2000 2003 2007
support
Head
and closer monitoring. On bedside 3,486
cardiac
3,875
ultrasound,
2,626
there
Neck was a finding of eccentric left137 ventricular
170 hypertrophy,
263
global
Back hypokinesia with depressed651 overall 992
systolic function
739
Trunk or Internal Organs
with concomitant spontaneous echo 354 contrast on 484 643
left ventricular
Upper Extremities 13,678 10,366 10,212
(LV)
Lowercavity suggestive of rheologic stasis,
Extremities 6,256 the6,695ejection fraction
5,158 Source: National Electronic Injury Surveillance System (NEISS) - Department of
was
Whole 25%,
Body with moderate
or Multiple mitral 969
Sites Equally regurgitation,
683 moderate
745 Health (DOH), 2010a9
aortic
Injuredregurgitation with aortic sclerosis, severe tricuspid
Others
regurgitation with mild pulmonary 934 -
hypertension, -
pulmonary Figure 6. Distribution of injury cases by type of injury in
Total 26,465 23,265 20,386
regurgitation, andand
minimal pericardial effusion or pericardial Figure 2. Chest radiograph on admission
Source: Bureau of Labor Employment Statistics (BLES) Integrated Survey, 20101 January- March, 2010 (N=9,521)

VOL. 45
VOL. 43 NO.
N0. 432009
2011 ACTA MEDICA
ACTA MEDICA PHILIPPINA
PHILIPPINA 47
13
Occupational Injury in the Philippines CASE REPORT

Burn cases can be Heart

both a Failure
cause and and a typeShortof injury.Stature Theinconstruction
a 43 year-old is another malehazardous industry in the
There were 120 cases (1.26%) of burn injuries as a cause of Philippines. The construction workers are exposed to several
injury,Katerina T. Leyritana
and 146 cases (15.3%) 1as , Ma.
a typeCzarlota
of injury.M.9 InAcelajado-Valdenor
UP-PGH hazards 1
, Amado
such asO. Tandoc
falls from III and Agnes
heights,
2 abrasions D. Mejiafrom 1sharp
Burn Unit in 1995, a total of 211 patients were admitted due tools, vibration from drilling equipment, electrocution from
to burn injuries. 1
Department
In anotherof Medicine,
study, College of Medicinepatients
sixty-eight and Philippinelive
General Hospital,
wires, eyeUniversity
and lung of the Philippines
irritation Manila
from cement dust,
suffered burn injuries secondary
2
Department of Pathology,
to electrical injury.College
11 of Medicine, University of
asbestosis the Philippines
from Manila
asbestos-containing paints especially in
Cases of homicides and suicides as a form of intentional stripping off old paints and ceilings, noise-induced hearing
injury also exist in the Philippines. The most recent report loss from noisy machines and mixers, cuts and lacerations
included 11,240 cases of homicide and 885 cases of suicide in from nail, hammer and saw accidents, respiratory problems
1998.12 from varnish, thinners and paints, gastrointestinal problems
from eating unhygienic food, and generally unhealthy
Occupational Injuries Presentation of the case
- Local Research require
condition regular
fromlaxative
crammed use. living
There was also alack
quarters, report of oftoilet
two
This is a case of ainjuries
Occupational 43-year-old and male presenting
accidents occur withinshortall more syncopal
facilities, episodes.
and sleeping at He
the was brought site
construction to another
itself.16 doctor
OHSC
stature
occupationaland heart
groups failure. The patient
and across industry was admitted
types. The study at the
of in a private
reported that hospital
51 deaths where andthe assessment
eight injuries wasoccurredstill a among
“heart
medicine
Lu (2009)13ward revealsof thethatPhilippine
work-related General Hospital injuries
occupational (PGH) problem”.
constructionThe patientin was
workers again prescribed
22 workplace incidentsunrecalled
in 2010.
for dyspnea. inThis
are prevalent paper will
the electronic investigate
industries. The several issues:
results showed medications
Eleven of the andtotalagainnumberwas lostof todeathsfollow-up. occurred This time,
in a
differentiating congenital between
a significant association from acquired muscle hypothyroidism,
injury and the however,
construction symptoms
area.17 Inwere Aprilpersistent.
2010, the TradeHe laterUnion consulted
Congress at
the relationship
vibration hazard from between
tools, low hypothyroidism
back injury and and the
excessive another local hospital,
of the Philippines where reported
(TUCP) he was admitted
five deaths and managed
in Cebu
cardiomyopathies,
work, eye strain and andpoor the illumination,
therapeutic options slippinginand patients
poor as a case of anemia
construction sites and and bronchial
10 deathsasthma.from miningHe wasaccidents
discharged in
with cardiomyopathy secondary to
housekeeping, falls and slippery and uneven floors. hypothyroidism. slightly improved after four days, only
Nueva Vizcaya. A recent incident in the Philippines is
18 to have recurrent heart
the
The patientanhad
Furthermore, been bornstudy
international full term to a thenassembly
in electronics 31-year- failure
reported symptoms,
case involving prompting the useadmission at PGH.gondola that
of an electric
old Gravida 4 Para 3 (G4P3), the
showed certain types of injuries such as burns from 4 th
of 9 siblings, with an killed 10 workers at a construction projectmild
Upon admission the patient was in respiratory
in Makati City.
apparently unremarkable delivery at
soldering iron or hot plate; cuts due to razors, tweezers, home facilitated by distress, with stable vital signs and
The workers died of multiple fractures, head trauma, no note of fever. Pertinentand
aknives;
traditional birth due
eye strain attendant.
to workHe wassmall
with noted to be
parts, normal
computer physical
blunt trauma. exam findings
Overloading, included short stature,
mechanical defect thickandlips, non-
lack of
at birth. The
monitors, patient was
microscopes; andallegedly
eye injuries at par
fromwith age both
splashes and pitting
personal periorbital
protective edema,
equipmentdry skin,likea displaced
a harness apicaland hardimpulse,
hats
physically
contamination and mentally until eightused
with chemicals yearssuch old when he was
as alcohol, crackles
were theon bothreasons
main lung fields, for theandaccident.
bilateral19non-pitting
A similar incidentbipedal
said to have stopped growing
soldering fumes, cleaning solvents. in height.
14 He was brought to edema. There was also a 3 cm x 3
happened in Malaysia wherein three workers were injured, cm reducible umbilical
a private
Another doctor,
study whose
among diagnosis
seafarerswas from undisclosed, and he
different countries hernia.
related However,
to the use there was no pallor,
of a gondola. 20 no neck vein distention,
was given medications to increase
including the Philippines showed that 9.1% of the all height, which the patient no apparent congenital malformations,
The mining industry is also beset with no cardiac
hazards,murmurs injuries,
took for only one month with no improvement.
seafarers were injured at one point or another during the Through the and no clubbing. There was also
accidents and deaths. A survey in a gold mining no note of an anterior
operation neckin
years, the patient was apparently well,
course of their work. Among the injured, 4.3% had at least 1 although still of short mass.
Benguet revealed that out of the 88 workers employed, 65
stature,
day with thick15lips,
of incapacity. The coarse
most common facial featuresinjuriesand dry skin.
reported by hadLaboratory workup showed
suffered injuries, cardiomegaly
mostly lacerations, with pulmonary
crushing injuries,
He was notably slow in ambulation. He
the seafarers were slips, trips, and fall-related injuries (43%), was said to have congestion, thoracic dextroscoliosis, and atheromatous
bruises, and fractures. The prevalence of injury and accident aorta by
bronchial asthma at age 15
followed by fractures and sprains (42%). years, and since then he had been chest
in the said mining operation was found high at 74%. 12-lead
radiograph, and left ventricular hypertrophy by21 On the
taking salbutamol tablets occasionally
Rural workers including farmers and fisherfolks usually for bouts of dyspnea electrocardiogram
other hand, the Institute (12-L ECG) (Figures 1 and
for Occupational Health,2), normocytic
and Safety
occurring one
experience a towidetwo range
times annually.
of occupational hazards.16 The normochromic
Development (IOHSAD) anemia (Hgb 90 mg/dL),
reported 11 casesdyslipidemia,
of deathand of
The patient’s symptoms started in
farmers experience pesticide-related illnesses, injury to the 2001 when he was pre-renal azotemia (serum creatinine
miners in the second half of 2007 alone. Two miners 123 mmoL). Electrolytes
died of
reported
eyes due to to have sudden
pesticide lossskin
mists, of consciousness. During this
allergies and dermatoses, on admission
suffocation showed
in Tuba, slight and
Benguet, hyponatremia,
two more miners hypokalemia,
died in
time, the patient did not have any symptoms
injuries from sharp objects, accidents form agricultural of heart failure; and hypochloremia (serum Na 136,
Mankayan, Benguet due to the collapse of an undergroundK 3.35, Cl 86). Blood gases
no prior seizures,
implements and cyanotic
tractors,episodes, chest pain,
gastrointestinal headache,
diseases or
form revealed partiallytwo
tunnel. Another compensated
miners died metabolic alkalosis
in Itogon, Benguetwith mild
after
blurring of vision. He regained consciousness
contact with microbes and biologic agents in soil and water, shortly after and hypoxemia.
inhaling poisonous gas used in their mining operations.based
The patient was noted to be hypothyroid 22
was brought
skin cancers toand a private physician,
cataracts form whose prolonged assessment
exposure wastoa on elevated
The service serum thyroid-stimulating
sector, which includes hormone the(TSH) and
nursing
“heart problem”. He was prescribed unrecalled medications markedly decreased serum free thyroxine (FT4). The exact
sunlight, musculoskeletal disorders such as back pain from profession, encounters occupation-related injuries that are
taken for a few months and eventually discontinued when values are shown in Tables 1 and 2.
heavy work, bad body biomechanics such as excessive different from the injuries in the agricultural and
the syncopal episode did not recur. Upon admission to the wards, the patient was managed
lifting, bending, twisting, pushing and pulling, snake bites, manufacturing industries. In a study among Filipino nurses,
In the next four years, the patient would develop as having congestive heart failure from cardiomyopathy
insect bites, and respiratory illnesses due to exposure to 40% of the 4,800 nurses all over the Philippines had
intermittent, progressive exertional dyspnea and bipedal secondary to acquired hypothyroidism. Oral loop diuretics,
extreme weather conditions. In the agricultural sector,
1 experienced at least one injury (e.g., back injury and
edema. Later on this would be accompanied by generalized angiotensin-converting enzyme (ACE) inhibitors, beta-
pesticide poisoning is one cause of occupational injury. needlestick injuries) in 2008. Most of those who were injured
body weakness, anorexia, and constipation, severe enough to blockers, statins, and levothyroxine were started. Electrolyte
Occupational acute pesticide poisoning in the Philippines did not report the injury. They considered the injury either
correction was instituted. The sections23 of Endocrinology
accounted for about 4% of the total injuries recorded in 2007. insignificant or a routine part of their job.
and Cardiovascular Diseases were co-managing the patient
On the other author:
Corresponding hand, Ma. theCzarlota
fisherfolk also experience
Acelajado-Valdenor, M.D.similar OFWs also face hazardous conditions. About 2,000
Department of Medicine together with the General Medicine service.
hazards and illnesses, suffering injuries from explosives, Filipinos migrate each day to work in 182 countries
Philippine General Hospital He soon developed respiratory failure, upon which the
splinters, sharp tools, prolonged immersion of hands and worldwide. However, occupational hazards have been so
Taft Avenue, Manila, 1000 Philippines considerations were acute pulmonary congestion, nosocomial
feet in water
Telephone: +632and exposure to polluted water (e.g., red tide).16
554-8488 prevalent that hundreds of thousand of Filipinos are
pneumonia, to rule out an acute coronary event. He was later
Email: czarlota@yahoo.com

12 ACTA MEDICA
48 ACTA MEDICA PHILIPPINA
PHILIPPINA VOL.45
VOL. 43NO.
N0. 43 2009
2011
 Heart Failure and Short Stature
Occupational Injuryinina the
43 year-old male
Philippines

Table 1. Initial
reported yearlyLaboratory Resultsvarious forms of hazardous
to have suffered 10,000.28 The Philippine data does not show the rate of eye
conditions at the hands of their employers.24 Occupational injury and illness in the agricultural sector. There are various
CBC Blood chem. Urinalysis ABG
hazards for OFWs come in the form of contract violations, eye irritants in the agricultural sector such as dust, sand,
Reference Result
rape, sexual Reference Result
harassment, harassment, mysterious deaths, tools, branches, Color straw
allergenic agents, pH
pesticides, 7.408
wind, sun,
Value Value
unsafe
WBC working 5-10
conditions, and
4.5
labor violations.
RBS The women
3.9-6.1 water,
6.3 and insects. 29
TranspThese irritants
Clear can also
pCO2cause infections,
49.1
migrant
RBC workers
4-6 are said to be the mostHGBA1C
vulnerable as4.27-6.07
they allergic
6.4 reactions, eye irritation,
Sp Gravity 1.010and corneal pO2 and other 70 eye
HGB
are subjected 120-150
to sexual and physical
90 BUNas in the case
abuse, 2.6-6.4
of 5.0 28 Many pH
trauma. of these eye8.0injuries HCO3 are hazards 31.3from
HCT
domestic 0.38-0.48and some0.27
helpers, CREA prey to white
also become 53-115 123
pesticide exposure. Sugar
30 NEG O2 sat 93.6
MCV 80-100 FL ALB 34-50 32 Protein NEG FiO2 21%
slavery.25 In the agricultural sector, pesticide poisoning is one
MCH 27-31 PG TAG 0.34-1.7 0.82 RBC 0-1 Temp 36.9
MCHC 320-360 G/L HDL 0.91-1.56 cause
0.67 of occupational WBC injury. As 0-2 shown above, occupational
RDW 11.5-15.5% Discussion LDL 1.1-3.8 acute
4.21 pesticide poisoning
Cast in the Philippines accounted PBS for
PLTThe review above showsIncthat thereTOTAL
200-400 were CHOL 4.2-5.2
26,467 injury 5.25 4% of the
about Epith cellinjuries Rare
total recorded Slight
in 2007. In Ecuador,
poikilocytosis,
RETIC
cases in 2000 0.005-0.015
and 26,289 cases in 2007. AmongAST 15-37
the non-fatal 95 is also Bacteria
which an agricultural Occ’lsociety,acanthocytes,
occupational acute
ovalocytes,
SEG 50-70% 48 ALT 30-65 91 Mucus th Rare
cases, 26,110 cases led to temporary disability in 2000 and pesticide poisoning occurred in 171 slight toxicper
cases granulation,
100,000
LYMPH 20-44% 50 Alk po4 184 Crystals Rare
20,109
MONOtemporary2-9% disabilities2 in 2007. Out NA of the reported
140-148 agricultural
136.9 workers
Am urates during the years slight 1991 anisocytosis
to 1992. In the
cases
EO of occupational
0-4% injuries,
0 178 resulted
K in death in 3.6-5.2
2000, U.S.,
3.35 243 agricultural workers suffered lost-work-time
BASO
and 0-2% in death in 2007.
116 resulted 0 CL
The reported severity100-108
rate 86
injuries, and about 5% of these cases resulted in permanent
ofBLAST
injury in 0%the Philippines 0 was 19 injuryCA++
cases per2.12-2.52
500 2.37
disability. 31 The most common cause of occupational injury
P 2.27
workers in 2007, and an incidence rate ofMG++ seven cases per 500
0.74-1 among
0.83 farmers in the U.S. were musculoskeletal in nature,
workers. These severity and incidence rates, however, do not caused by activities that required constant bending, twisting,
show segregation by occupational groupings. There are carrying heavy items, and repetitive motions during long
some occupational groupings that would register higher in work hours.
injuries compared to other fat pad.
The Cardiac
review enzymes
also showed were the not occupational
consistent with an acute
injuries of
Table 2. Thyroid Function Tests occupations. In China, for
instance, the severity ratio of occupational injuries in coronary event (Table 3), however, intravenous
nurses in the Philippines. Nurses experience at least (IV) heparin
one
Reference Value Result (overlapping with oral warfarin) was stillthe
given to cover for
construction
Free T4 In Iran, the injury rate
was 82.7.26(0.8-2.0) 0.02is lower than
ng/dL injury per year. In Brazil, a study among country’s health
inTSH
the Philippines at 18 injury cases per24.75 500Uiu/ml
workers in the presence of a possible LV thrombus
workers showed that the most frequently experienced injury as demonstrated
(0.4-6.0)
2004,27 and the incidence rate was four cases per 1000 by
was rheologic
percutaneous stasisneedlestick
on cardiacinjury. ultrasound.
This type Medications
of injury
persons from 2002 to 2006. were shifted to IV diuretics and inotropes;
posed a high risk of HIV transmission to the health oral digoxin was
The average workdays lost in the Philippines in 2007 started.
workers. IV
32 antibiotics were given for possible pulmonary
was 6.92 days. The data on workdays lost in the Philippines infection.
ExcessiveThe patient
hours of later on showed
work and heavy improvement,
workload can and lead
was
eventually weaned off from ventilatory support, extubated,
is not segregated according to the type of injury. The figure to fatal accidents or trigger suicide attempts. The reported
can well go up for serious injuries and accidents. In China, death of a garment worker in one hospital in Cavite,
for instance, occupational injuries particularly in the Table 3. Cardiac
Philippines wasEnzymes
alleged to be due to overfatigue from
chemical industry resulted in a mean of 69 workdays lost.26 work.33 In 1998, there wereRange
Reference 885 cases
(mmoL)of suicide recorded in
Result
Occupational injuries in all industries in the Philippines the Philippines.
Qualitative
12 In Japan, reports cited a sharp increase in
POSITIVE
are most commonly caused by stepping on, striking against, “karojisatsu”
Troponin I or work-related suicide. According to the
or being struck by objects, followed by being caught in or CK-MB Police Agency Statistics
National 0-6.0 in Japan, out 1.14of the 31,042
between objects, and instances of being struck by flying or CK-TOTAL
suicides in 2001, 1,756 were 21-232alleged to be company-related,
543

falling objects. In another study, factors such as fatigue, including employees who had been reprimanded by
number of jobs, family problems, and use of medication employers and superiors for work-related faults and errors.
were found to be responsible for causing 53.6% of all There are more cases of company- and work-related suicides
occupational accidents.2 In China, the major causes of injury in Japan. A Toyota Motor Corp employee in Japan took his
Figure
among 1.the Electrocardiogram
workers in the upon admission
chemical industry were being own life in 1988 due to overfatigue.34 The same was the fate
struck by flying or falling objects, collision and being of another Japanese national who had worked 17 months
compressed by mechanical or other objects and equipment.26 without a day off, and only half an hour's sleep a night.35 In
transferred to the intensive care unit (ICU) for ventilatory
Furthermore, in China, falls from heights, falls on the same Britain, a family doctor hanged herself due to stress at
support and closer monitoring. On bedside cardiac ultrasound,
level, and traffic accidents were prevalent in the construction work.33 A woman working in a shoe factory in Indonesia
there was a finding of eccentric left ventricular hypertrophy,
industry.26 The review of data in the Philippines shows died after doing excessive overtime.35
global hypokinesia with depressed overall systolic function
similar incidents of falls from height. Given the generalities of data and statistics gathered
with concomitant spontaneous echo contrast on left ventricular
In the Philippines, 14.9% of the total injuries in the and documented by the Bureau of Labor and Employment
(LV) cavity suggestive of rheologic stasis, the ejection fraction
Philippines in 2007 were eye injuries. In the United States, Statistics and concerned agencies of the Department of Labor
was 25%, with moderate mitral regurgitation, moderate
agricultural
aortic workers with
regurgitation experience
aortic eye injuriessevere
sclerosis, and illness at a
tricuspid and Employment, data collection needs to be improved, with
rate of 8.7 per 10,000 workers, and this is twice
regurgitation with mild pulmonary hypertension, pulmonary as high as the data segregation according to industry groupings, measures
rate in the general working population in the U.S.
regurgitation, and minimal pericardial effusion or pericardial at 3.8 per to ensure
Figure that data
2. Chest is representative
radiograph on admission on a national scale, and

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Occupational Injury in the Philippines CASE REPORT

Heart Failure
more rigorous dissemination andand
to both public Short
privateStature in a 43
stakeholders andyear-old
the governments maleof the receiving and
sectors. Meanwhile, companies and establishments should sending countries to promote decent work among migrant
Katerina
be more T. Leyritana
cognizant of and more1
, Ma.readily
Czarlota M. Acelajado-Valdenor
comply with their workers.
1
, Amado O. Tandoc
An overseas work III2policy
and Agnes D. Mejia
position that 1covers
responsibilities towards occupational health and safety. occupational health and safety should be forged with
Departmentfor
Provisions and sanctions
1
of Medicine, College of Medicine
non-compliance should andalsoPhilippine
be General Hospital,
countries takingUniversity of the Philippines
in our labor force. This Manila
bilateral agreement
enforced. Given the current Department of Pathology, College of Medicine,
is University of the Philippines Manila
2
limited number of inspectors now initiated and being forged between the Philippines
nationwide, only 280 in all, monitoring 800,000 registered and the Republic of Korea, and the same should be pursued
firms in the country, it is virtually impossible to implement with other countries.
and enforce occupational safety rules and regulations.
_________________
Conclusions
The data of Presentation
occupational ofinjuries the casein the Philippines Acknowledgment
require regular laxative use. There was also a report of two
Acknowledgment is cited for Ms. Diana Estolero, my research
This ismajor
revealed a casetrends
of a 43-year-old
in injuries, malecausespresenting
of injurieswith
and short
rates more syncopal episodes. He was brought to another doctor
assistant, for assistance given to this manuscript.
stature
and and heart
severity failure.
of injury. The patient
However, the data waslack
admitted at the
more specific in a private hospital where the assessment was still a “heart
medicine
and ward information
segregated of the Philippine Generaland
per industry Hospital (PGH)
occupational problem”. The patient was again prescribed unrecalled
____________
for dyspnea.
grouping, Thisaspaper
as well will investigate
identification several
of risk factors issues:
associated medications and again was lost to follow-up. This time,
differentiating
with congenital
these injuries. from acquired
Therefore, hypothyroidism,
injury surveillance and however,
References symptoms were persistent. He later consulted at
the relationship
documentation between
of injury caseshypothyroidism
should be improved, and and the another
1. Bureaulocal hospital,
of Labor where he was
and Employment admitted
Statistics, Labstatand managed
Updates. 14 (5)
cardiomyopathies, and the therapeutic
research into risk factors at work should be conducted. All options in patients as a case of anemia
[Online]. 2010 [citedand2010bronchial asthma.
Sept]. Available He was discharged
from www.bles.dole.gov.ph/.
2. Ghods AA, Alhani F, Anosheh M, Kahoei M. Epidemiology of
with cardiomyopathy
these efforts should secondarylead to to hypothyroidism.
prevention strategies and slightly improved after four days, only to have recurrent heart
occupational accidents in Semnan (2002-2006). Journal of Semnan
The patient had been
guidelines on occupational injuries inborn full termthe to a then 31-year-
Philippines. Also, failure symptoms,
University of Medical prompting admission
Sciences. 2009; at PGH.
10(2):95-100.
old Gravida
there is a 4need Para to3 (G4P3),
standardizethe 4ththe of 9nomenclature
siblings, with for an 3. Upon
Barcelona admission the patient
NS. Work-Related was inClaim
Injuries, Illnesses mild respiratory
Millions of Lives,
apparently unremarkable delivery at home
occupational injuries, starting from the primary data sources facilitated by distress,
Dollarswith stable
Yearly. vital signs
[Online]. 2009 and no 2010
[cited note Oct].
of fever. Pertinent
Available from
http://www.americanchronicle.com/articles/view/104066.
a traditional
(company birthwhich
clinics) attendant.
are theHe baseswasof noted to be data.
the national normal physical
4.
exam findings included short stature, thick lips, non-
Estrella-Gust D. National Profile on Occupational Health and Safety
at birth. The patient was allegedly at
It is suggested that data collection on occupational par with age both pitting periorbital edema, 2006
(Philippines). [Online]. dry skin,
[citeda displaced
2010 Sept].apical impulse,
Available from
physically and mentally until eight years
injuries be on a national scale, and not merely a randomized old when he was crackles on both lung fields, and bilateral non-pitting bipedal
www.ilosafetyconference2009.org.
5. National Statistics Office, Labor Force Survey. Labor Force Statistics. In
said to have stopped growing in height.
collection of data from small, medium and large industries. He was brought to edema. There was also a 3 cm x 3 cm reducible umbilical
Bureau of Labor and Employment Statistics (BLES).
a private doctor, whose diagnosis was
Data on occupational safety and health should also include undisclosed, and he hernia. However,
[Online]. there[cited
2010 was no pallor,
2010 no neck vein
Aug]. distention,
Available from
was given
the medications
agricultural sector,to the increase height,sector,
informal which andthe patient
small no apparent congenital malformations, no cardiac murmurs
http://www.bles.dole.gov.ph/HTML%20FILES/keylabor.html.

enterprises which are also important sectors in the

took for only one month with no improvement. Through the and
6. no clubbing.
National There
Statistical was also
Coordination no (NSCB).
Board note ofOverseas
an anterior neck
Employment
Statistics (OES) of the Philippine Overseas Employment Administration
years, the patient
Philippine economy. was apparently well, although still of short mass.
(POEA): Number of Deployed Land Based Overseas Filipino Workers by
stature, with thick
Overseas workers lips,are
coarse facial features
an important segment andof dry skin.
the labor Laboratory
Year and Major workupWorldshowed
Groupings. cardiomegaly
[Online]. 2009 with pulmonary
[cited 2010 July].
He was notably slow in ambulation. He
force considering their critical size and the value of their was said to have congestion,
Availablethoracic dextroscoliosis, and atheromatous aorta by
from http://www.nscb.gov.ph/.
bronchial asthma
remittances to the at age 15 years, and
Philippines. since then
Currently, OFWs he hadarebeennot chest
7. radiograph,
Haspels N, de losand left ventricular
Angeles-Bautista hypertrophy
F, Boonpala by 12-lead
P, Bose C. Action against
child labour: Strategies in education: Country experiences in the
taking salbutamol tablets occasionally
covered by the occupational health and safety surveillancefor bouts of dyspnea electrocardiogram (12-L ECG) (Figures 1 and 2), normocytic
mobilization of teachers, educators and their organizations in combating
occurring one
structure of tothetwoPhilippines.
times annually. 36 There is a need for normochromic anemia
child labour. ILO/IPEC, Geneva. (Hgb 90 1999.mg/dL), dyslipidemia, and
The patient’s symptoms
occupational safety nets for these workers started in 2001 while
when working
he was pre-renal
8. Bureauazotemia
of Labor and (serum creatinine
Employment 123 mmoL).
Statistics, Electrolytes
Labstat Updates. 16 (6)
[Online]. 2002 [cited 2010 Sept]. Available from www.bles.dole.gov.ph/.
reported to have sudden loss of consciousness.
abroad, and when returning from an occupationally related During this on admission showed slight hyponatremia, hypokalemia,
9. National Electronic Injury Surveillance System (NEISS)-Department of
time, the patient did not have any symptoms
illness or injury. The Overseas Workers’ Welfare Association of heart failure; and hypochloremia
Health (DOH). Vehicular (serum Na 136,
Accidents, K 3.35,
Leading Cl 86).
Cause Blood[Online].
of Injuries. gases
no prior seizures,
provides training cyanotic
and education episodes, chest pain,
programs headache,
to OFWs prior orto revealed
2010a partially
[cited 2010 compensated
Sept]. Available from metabolic alkalosis with mild
www.doh.gov.ph./
blurring
deployment to other countries. Occupational health and
of vision. He regained consciousness shortly after and hypoxemia. The patient
10. National Electronic Injurywas noted to
Surveillance be hypothyroid
System (NEISS)-Departmentbased of
Health (DOH) (2010) Motorcycle, Waveboard Top Causes of Injuries for
was
safetybrought
is one ofto athe
private
trainingphysician,
programs; whose assessment
however, was a
the training on elevated serum thyroid-stimulating hormone (TSH) and
2nd Quarter of 2010. [Online]. 2010b. [cited 2010 Sept]. Available from
“heart problem”. He was prescribed unrecalled medications markedly decreased serum free thyroxine (FT4). The exact
www.doh.gov.ph./
should also include how to report to their employer the
taken for a few months and eventually discontinued when values
11. Acostaare AS,
shown in Tables
Azarcon-Lim 1 and 2.AT. Survey of electrical burns in
J, Ramirez
illnesses/accidents that might happen to them due to work
the syncopal episode did not recur. Upon admission
Philippine to the Ann
General Hospital. wards, the Sci.
N Y Acad patient was managed
1999; 888:12–8.
risks. In case the employer fails to notify the Labor 12. Western Pacific Region Health Databank (WPRO). Philippines.
In the next four years, the patient would develop as having congestive heart failure from cardiomyopathy
Department, the employee may then go to the nearest office [Online]. 2004 [cited 2010 Oct]. Available from
intermittent, progressive exertional dyspnea and bipedal secondary to acquired hypothyroidism. Oral loop diuretics,
http://www.wpro.who.int/NR/rdonlyres/5EB6BF5D-31BD-4E5C-8F69-
branch of the Employees Compensation Division and should
edema. Later on this would be accompanied by generalized angiotensin-converting
3FCF2B4BB532/148/phl.pdf.enzyme (ACE) inhibitors, beta-
fill in and submit a Notification of Accident Form. They 13. Lu J. Effect of Work Intensification and Work Extensification on
body weakness, anorexia, and constipation, severe enough to blockers, statins, and levothyroxine were started. Electrolyte
should be advised to keep a file of their medical records and Women’s Health in the Globalised Labour Market. Journal of
correction wasWomen’s
International instituted.
Studies.The 2009; sections
10(4):111-26.of Endocrinology
documentation.37 There should be a detailed procedure for
and Cardiovascular
14. Azaroff LS, Levenstein Diseases
C, WegmanwereDH. co-managing the health
the occupational patientof
reporting/documentation
Corresponding author: Ma. Czarlota of work-related
Acelajado-Valdenor, injuries
M.D. and
Department of Medicine together withAsians
Southeast the General
in Lowell:Medicine service.
a descriptive study. Int J Occup Environ
illnesses. Binghay (2006),38 in his study among the Overseas Health. 2004: 10(1):47-54.
Philippine General Hospital He soon developed respiratory failure, upon which the
Filipino Seafarers, recommended that there should be 15. Jensen OC, Sorensen JF, Canals ML, Y Hu, Nikolic N, Mozer AA. Non-
Taft Avenue, Manila, 1000 Philippines considerations
fatal occupationalwereinjuries
acute related
pulmonaryto slips,congestion,
trips and fallsnosocomial
in seafaring.
ongoing and
Telephone: +632aggressive
554-8488 social dialogue among the major
pneumonia,
Am J Ind Med. to rule
2005;out an acute coronary event. He was later
47(2):161–71.
Email: czarlota@yahoo.com

12 ACTA MEDICA
50 ACTA MEDICA PHILIPPINA
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VOL. 43NO.
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 Heart Failure and Short Stature
Occupational Injuryinina the
43 year-old male
Philippines

Table 1. Initial
16. Bureau Laboratory
of Working Results
Conditions Work Accident Injuries Report (WAIR) 36. WHO WPRO. Country Report Philippines. [Online].
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Available from CBCbwc.dole.gov.ph/. Blood chem. Urinalysis ABG
http://www.wpro.who.int/NR/rdonlyres/26CC7FD5-E412-4C99-BA13-
17. Occupational Safety and Health Center (OSHC) Report on the Fact- C24883B501B7/0/PHLcountryprofile.pdf
Reference
Finding Survey Result
on Building Construction. [Online]. 2002 [citedReference
2010 37. Result
Tellez C, CarnayColor
N, Tellez J, delastraw pH
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Valuefrom http://www.oshc.dole.gov.ph/.
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18.WBCTrade Union 5-10 4.5
Congress of the Philippines RBS Workplace accidents:
(TUCP). 3.9-6.1 6.32011 May]. Available
Transpfrom www.migrants.net/_pubs/migrantfocus.
Clear pCO2 49.1
RBC51 workers4-6 dead and eight others injured in HGBA1C 22 fatal accidents, 4.27-6.07
so far. 38. 6.4Binghay V. Ensuring
Sp GravityOccupational1.010 Health and
pO2Safety for Overseas
70
HGB [Online]. 120-150
2010 [cited 902010 BUN Available 2.6-6.4
Oct]. from 5.0Filipino pH
Seafarers. School 8.0 of HCO3 and
Labor 31.3
Industrial
HCThttp://www.tucp.org.ph/news/index.php/2010/04/workplace-accidents-
0.38-0.48 0.27 CREA 53-115 123Relations, Sugar
University ofNEG the O2 sat
Philippines. 93.6
[Online].
MCV 80-100 FL ALB
51-workers-dead-and-eight-others-injured-in-22-fatal-accidents-so-far/. 34-50 322006. Protein 2011 NEGMay].
[cited FiO2Available 21% from
19.MCH 27-31 PG readies plan vs repeat of
GMANews.TV.DOLE TAG 0.34-1.7
construction tragedy in 0.82 RBC 0-1 Temp
http://www.freewebpp.com/upsolair/Ensuring%20Occupational%20Hea 36.9
MCHC 320-360 G/L
Makati. [Online]. 2011 [cited 2011 HDL Feb]. Available 0.91-1.56
from 0.67 WBC 0-2
lth%20and%20Safety%20for%20Overseas%20Filipino%20Seafarers.pdf.
RDW LDL
http://www.gmanews.tv/story/212299/dole-readies-plan-vs-repeat-of-
11.5-15.5% 1.1-3.8 4.21 Cast PBS
PLTconstruction-tragedy-in-makati.
200-400 Inc TOTAL CHOL 4.2-5.2 5.25 Epith cell Rare Slight poikilocytosis,
20.RETIC
Department0.005-0.015 of Occupational Safety
AST and Health
15-37 95 Bacteria Occ’l acanthocytes, ovalocytes,
SEG(DOSH). 50-70% Accident Involving
48 Use ofALT Gondola. [Online]. 30-65 91 Mucus th Rare slight toxic granulation,
2008 [cited 2010 Feb].
LYMPH 20-44% 50 Alk Available
po4 from
184 Crystals Rare slight anisocytosis
http://www.dosh.gov.my/doshV2/index.php?option=com_content&view
MONO 2-9% 2 NA 140-148 136.9 Am urates
=article&id=105%3Aaccident-involving-use-of-
EO 0-4% 0 K 3.6-5.2 3.35
gondola&catid=84%3Asafety-alerts&Itemid=118&lang=en.
BASO 0-2% 0 CL
21. National Objectives for Health Philippines. Chapter 4 Reducing the
100-108 86
BLAST 0%
Burden of Disease. 0
[Online]. 2005-2010. CA++
[cited 2010 Oct]. Available 2.12-2.52
from 2.37
http://www.doh.gov.ph/. P 2.27
22. Institute for Occupational Health, and Safety MG++ Development (IOHSAD).0.74-1 0.83
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beyond-occupational-health-and-safety-orbit. fat pad. Cardiac enzymes were not consistent with an acute
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23. de2.Castro
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coronary event (Table 3), however, intravenous (IV) heparin
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Philippines. AAOHNJ. 2009; 57(4):149–157. (overlapping with oral warfarin) was still given to cover for
Free T4 (0.8-2.0) 0.02 ng/dL
24. Overseas Employment Statistics (OES). Number of Deployed Land the presence of a possible LV thrombus as demonstrated
TSH (0.4-6.0) 24.75 Uiu/ml
Based Overseas Filipino Workers by Year and Major World Groupings. by rheologic stasis on cardiac ultrasound. Medications
In National Statistical Coordination Board. [Online]. 2009 [cited 2010
were shifted to IV diuretics and inotropes; oral digoxin was
July]. Available from http://www.nscb.gov.ph.
25. Migrante International. International Alliance of Filipino Migrant started. IV antibiotics were given for possible pulmonary
Organizations. [Online]. 2010 [cited 2010 July]. Available from infection. The patient later on showed improvement, and was
http://migrante.tripod.com/#. eventually weaned off from ventilatory support, extubated,
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27. Ooshaksaraie M, Majid A, Yasir MS, Yahaya R. The impact of companies’
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Sci. 2009; 2(4):735–42. Qualitative POSITIVE
28. Luque JS, Monaghan P, Contreras RB. Implementation evaluation of a Troponin I
culturally competent eye injury prevention program for citrus workers CK-MB 0-6.0 1.14
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32. Grande Gimenez Marino C, El-Far F, Barsanti Wey S, Servolo Medeiros
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34. Thecavity suggestive
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http://www.hazards.org/workedtodeath/workedtodeath2.htm.
Figure 2. Chest radiograph on admission

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