It has been considered that viral infections predispose patients to bacterial infections due to immunosuppression.3 However, it is still unclear what exact roles co-infections play in patients with COVID-19 infection1. Centers for Disease Control and Prevention defines co -infection as an infection concurrent with the initial infection. This report discusses a case of meningoencephalitis presenting with seizures. Notable in this case was the detection of SARS-CoV-2 RNA and Salmonella in the CSF.
Coronavirus

Objectives. The ongoing Coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems worldwide. This study aimed to document the effect of COVID-19 on osteosarcoma treatment pathways in the Philippine General Hospital (PGH) and determine if there were any delays. Method. A retrospective review of osteosarcoma patients treated at the PGH from January 1, 2019 – January 1, 2020 (pre-COVID-19) was compared to those treated during the COVID-19 pandemic from March 1, 2020 – September 1, 2020. Rates of diagnosed osteosarcoma, admission for chemotherapy, admission for surgery, treatment abandonment, metastatic disease on presentation, 1-year mortality, and amputation were calculated and compared between the two groups. Results. From March to September 2020, 11 newly diagnosed osteosarcoma patients sought consult at the PGH. Only one patient sought consult during the initial 3-4 months of the study, suggesting that patients delayed seeking healthcare during the period of enhanced community quarantine. Patients seen during the pandemic had a higher rate of metastatic disease on presentation, reflecting the delay in diagnosis. Due to COVID-19 restrictions early in the pandemic, osteosarcoma patients were coordinated and referred to outside hospitals for intravenous chemotherapy and surgery. Normalization of services (hospital admissions, limb salvage surgeries) were seen at the later stages of the study, corresponding to the loosening of the quarantine. Conclusions. Osteosarcoma patients experienced delays in seeking consult, diagnosis, and treatment at the PGH due to the COVID-19 pandemic. Early indicators suggest worse outcomes for these patients due to the delays. Strategies employed during the pandemic, such as networking of care and telemedicine, may help in future outbreaks.
Coronavirus ; COVID-19 ; Coronavirus Infections ; Pandemics ; Osteosarcoma

No abstract available.
Coronavirus* ; Korea ; Middle East*

Coronavirus Infections ; epidemiology ; Humans

Key Findings Asymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur. • Manifestations of COVID-19 are highly varied and may include asymptomatic cases, who do not manifest with any signs and symptoms despite testing positive for COVID-19 by viral nucleic acid tests. Pre-symptomatic cases are infected individuals who are still in their incubation period, hence do not exhibit any symptoms yet but eventually develop symptoms. • As of June 2020, only 586 (2.8%) of the 20,990 active cases in the Philippines were classified as asymptomatic, but it is unclear whether cases are pre-symptomatic or carriers (true asymptomatic). • Based on 36 observational studies (case reports, case series, cross-sectional and cohort studies) and 9 statistical modeling analysis, asymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur. However, 3 studies reported no transmission from pre-symptomatic and asymptomatic cases. • Studies on viral load comparing symptomatic cases with pre-symptomatic and asymptomatic cases reported contradicting results. The duration of viral shedding was significantly longer for symptomatic patients compared to asymptomatic patients but similar for asymptomatic and pre-symptomatic patients. • Therewas no difference in the transmission rates of symptomatic and asymptomatic cases. However,the estimated infectivity and probability of transmission was higherfor symptomatic cases compared to asymptomatic cases, but results were imprecise due to a wide confidence interval. • The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recognize the possibility of pre-symptomatic and asymptomatic transmission. According to WHO, current evidence suggests asymptomatic cases are less likely to transmit the virus than symptomatic cases.
Coronavirus ; Covid-19

Background: Pooled testing has been implemented on a limited scale, mainly for screening and surveillance in populations with a low prevalence of COVID-19 to save on limited resources. Objective: To determine the diagnostic accuracy of pooled compared with individual RT-PCR testing for SARS-CoV-2 in individuals suspected of COVID-19. Methods: We searched websites of living CPGs on COVID-19 (Australian COVID-19, COVID NMA, CEBM Oxford), Philippine DOH HTA, databases (PubMed, CENTRAL, medRXIV/bioRXIV), and Clinicaltrials.gov for studies that used pooled testing on individuals suspected of COVID-19. When appropriate, we pooled data for sensitivity and specificity and obtained the range and median of other data, such as positive predictive value and resource savings. We did a priori subgroup analysis for pool size, presence or absence of symptoms and use case, type of specimen, cutoff for positivity, type of kit, and post hoc subgroup analysis for method of pooling and timing of processing. Results: We included 21 studies: 6 diagnostic accuracy studies, and 15 clinical validation studies. Studies had varying populations, index test kit and performance characteristics, positivity rate (0.02 to 15%), and pool size (5 to 16). There was moderate pooled sensitivity, 81% (95% CI 72, 88; I2=73.6%; 6 studies, 776 pools) and high pooled specificity, 99% (95% CI, 98 to 100; I2=1.84%; 5 studies, 666 pools). Positive predictive value based on 21 studies ranged from 67% to 100%. Resource savings in the number of test kits used ranged from 49 to 89%. Identified harms of pooled testing were delayed turnaround time for positive samples and laboratory errors. Conclusion There is moderate sensitivity and high specificity with pooled testing for the screening of individuals with suspected COVID-19. We recommend further studies to validate the utility based on community prevalence and other test variables.
COVID-19 ; Coronavirus

Objective: To present the current evidence on the effect of zinc as adjunct therapy on COVID-19 related outcomes. Methods: A literature search among peer-reviewed, non-peer-reviewed, and guideline practice databases was done until December 26, 2020, with an updated search done on February 13, 2021. Evidence was synthesized among studies that fulfilled the inclusion criteria, and the quality of evidence was determined using GRADEpro. Results: This review used two randomized controlled trials and three retrospective cohort studies. Pooling of the retrospective cohort studies showed that adjunct zinc therapy significantly reduces the risk of mortality or transition to hospice care among COVID-19 patients (OR 0.56, 95% CI 0.38-0.81; I2=p=0.002; very low quality of evidence). However this was not supported by one RCT (N=191) which showed no significant difference in death (RR 0.99, 95% CI, 0.30-3.31; p=0.99], need for mechanical ventilation (RR 0.66, 96% CI, 0.19-2.26; p=0.58] and recovery after 28 days (RR 0.94, 95% CI 0.55-1.62; p=0.83) in patients with COVID-19 given zinc as adjunct treatment together with hydroxychloroquine (HCQ) and azithromycin (AZT) versus HCQ and AZT alone (moderate quality of evidence). A second RCT (N=108) showed no significant difference in the hospitalizations (RR 1.44, 95% CI 0.36, 5.71; p=0.61) and meant several days needed to reach a 50% reduction in symptoms in ambulatory patients with COVID-19 given adjunct zinc gluconate versus standard of care alone (mean difference of -0.80, 95% CI, -2.55-0.95, p=0.37; low quality of evidence). In this study, there were 10 participants in the zinc group with adverse effects, mostly gastrointestinal in origin. Conclusion There is still insufficient evidence to support the use of Zinc as an adjunct therapy in patients with COVID-19 both in inpatient and outpatient settings due to inconsistent benefits and potential adverse effects.
COVID-19 ; Coronavirus ; Zinc

Introduction: The coexistence of two global pandemics, COVID-19 and type 2 diabetes mellitus, has been implicated with worse prognosis. The association of diabetes and worse outcome in viral infections stems from the detrimental effect of hyperglycemia to the control of viremia and different components of the host response. This study aimed to describe the epidemiological and clinical characteristics of confirmed COVID-19 patients and establish the association of baseline glycemic status and COVID-19 outcomes among persons with type 2 diabetes. Methodology: A single center, retrospective study among adult persons with type 2 diabetes diagnosed with COVID-19 in Makati Medical Center from March 1 to August 31, 2020. A total of 156 medical records (26%) out of 584 confirmed cases were reviewed. Data were collected on diabetes status, comorbid conditions and laboratory findings. Both Cox proportional hazards models and logistic regression models were fitted. To assess the factors associated with mortality as a dichotomous endpoint (died/survived), binary logistic regression was performed. On the other hand, a time-to-mortality analysis was performed using Cox regression. For the effect estimate, we refer to hazard ratios in the Cox proportional hazards model and odds ratios in the logistic regression models. All analyses were adjusted for age and sex and two models were additionally adjusted for any presence of comorbidity. Results: A total of 156 COVID-19 patients with diabetes were analyzed. Upon admission, 13% were in diabetic ketosis, 4% were in a state of DKA, and 2% had hypoglycemia. About 5%, 33%, 26%, and 36% of patients had mild, moderate, severe, and critical COVID-19, respectively. Between non-survivors and survivors, the latter group were significantly younger in age (p<.003) and had less ICU admissions (p<.001). Although DKA status upon admission seemed to result in increased odds of non-survival (cOR 5.8 [95% CI 1.1-30.7]), no other feature in the glycemic history was significantly associated with mortality outcome after having adjusted for age and sex. Death in this study was limited to patients with severe or critical disease. Conclusion The risk of mortality is five times greater among patients admitted with diabetic ketoacidosis. The incidence of complications were also significantly greater and mortality was limited to patients with severe or critical disease.
Diabetes Mellitus ; Coronavirus

Introduction: Musculoskeletal complaints have been observed in the recovery phase of patients with moderate-to-severe coronavirus disease 2019 (COVID-19). We noted several referrals for physical rehabilitation at the University of the Philippines-Philippine General Hospital (UP-PGH), a designated COVID-19 referral center. These observations resembled the musculoskeletal manifestations associated with poorer outcomes reported in other coronavirus studies. Objectives: The study determined the musculoskeletal signs and symptoms of adults in the recovery phase of moderate to severe COVID-19 using the COVID Musculoskeletal Assessment Tool (CMAT). Methods: This was a three-phased, prospective, descriptive study of adults admitted for COVID-19 at the UP-PGH. Phase 1 was the development of the CMAT based on a review of related literature and patient charts, and patient interviews. The tool was pretested and validated in Phase 2 before it was used in the evaluation of study participants in Phase 3 of the research. Data was encoded using Microsoft® Excel 2007 and analyzed using STATA, Version 12.0 (Texas, USA). Descriptive statistics were used to summarize the variables collected for the study. Results: A cohort of 40 patients admitted at the UP-PGH for moderate-to-severe COVID-19 infection was evaluated using the CMAT. Most of the patients had an average age of 55 years and were males. Majority resided in an urban area, reached high school education, and were ambulatory before their illness. The most common comorbidities were hypertension and diabetes. All patients required oxygen support. Based on the CMAT, majority of the participants complained of muscle pain, generalized weakness, and easy fatigability. Other common findings were neck-shoulder and lower limb pain, dyspnea on exertion, limited mobility in the trunk, hips, and knees, joint pains, and decreased muscle strength. Half of the participants needed a wheelchair or walker to ambulate. These findings may be due to the COVID-19 disease and to prolonged confinement in bed. Only one patient underwent physical therapy through bedside instructions. Conclusion Musculoskeletal signs and symptoms were common in the patients recovering from COVID-19 disease. The COVID-19 Musculoskeletal Assessment Tool facilitated the evaluation of patients and the recording of results. Early referral for medical rehabilitation and timely intervention are strongly recommended.
COVID-19 ; Coronavirus ; Myalgia

No abstract available.
Coronavirus ; Humans ; Korea ; Pneumonia