Rationale. COVID-19 pandemic disease, can be transmitted during gastrointestinal procedures, via aerosolized droplets, and via fecal shedding. Both international and local endoscopy societies have issued strategies to alleviate the risk to endoscopy personnel. However, several barriers against the implementation of these recommendations exist thus individual center’s policies are employed whenever applicable. Objectives. This narrative study aims to describe the current experience and set-up in the endoscopy unit of a COVID referral center, discuss the stratification of patients for endoscopy, the operational management of the personnel and endoscopy unit in line with the adapted local and international guidelines and offer endoscopists a quick reference guide to adapt endoscopy practice during the pandemic in a resource-limited setting. Methodology. This paper reviews and consolidates current endoscopy guidelines and describes the single-center experience of Philippine General Hospital. Results. In resource-limited settings, with uncertainties of prolonged COVID-19 impact to healthcare, modification of practice, adherence to strategies and recommendations, empowerment of workforce, establishing the sustainability of resources, training, and service to patients, are essential components to combat current dilemma brought about by this pandemic. Conclusion. Integration of current local and international guidelines encompass all aspects of endoscopy practice during the pandemic. The recommendations cited are aimed to guide other resource-limited endoscopy units for potential changes and guidance in the overall practice.
COVID-19

Background: The COVID-19 pandemic has immobilized and impaired the operation of hospitals, clinics, and other health-care facilities leaving a plethora of patients and persons-at-risk in a more precarious position. Cancer patients were vulnerable to infections and complications due to the nature of the malignancy. Their caregivers were likewise predisposed to infection while taking care of them. This paper focused on determining the concerns of both gestational trophoblastic neoplasia (GTN) patients and their caregivers and identified possible factors of improvement in the delivery of essential cancer care. Objective: The objective of the study was to describe the different concerns of GTN patients and their caregivers during chemotherapy and other adjunctive treatments during the COVID-19 pandemic in a Tertiary Government Hospital. Materials and methods: A qualitative type of research was employed in this research, for which an in-depth interview was used. A total of 12 respondents, 6 patients and 6 caregivers, were interviewed using a semi-structured pretested questionnaire. Results: Findings showed that infection with COVID-19, financial and logistical constraints exacerbated by the pandemic were the main concerns of both patients and caregivers. Other concerns recorded include change in their attending physician, survivability of the patient, and the availability of caregivers. Conclusions Despite the recorded apprehensions from the patients and caregivers, there was a general satisfaction in the delivery of health care at the Division of Trophoblastic Diseases due to the clarity in the follow-up and treatment schedules which have been optimized through the revised guidelines and protocols set by the division to adapt to the COVID-19 pandemic.
COVID-19 ;

Key Findings There is some short-term benefit from the use of mesenchymal stem cell therapy for severe COVID-19 in a lowquality, small randomized controlled trial (RCT). Further studies, ideally with good quality RCTs, are needed to confirm benefit and safety. • Mesenchymal stem cells (MSCs) are non-hematopoietic adult stem cells that are able to self-renew and differentiate into various cells of any cell lineage. MSCs have the ability to migrate (homing) to damaged tissue for repair and regeneration, as well as signal other cells to help in tissue repair. It can effect cellular differentiation, consequently shifting the immune system from Th1 to Th2 responses.1,2 • A recent review showed improved disease-associated parameters in experimental acute respiratory distress syndrome (ARDS).3 • We found three studies (one case report, one prospective cohort, and one small randomized controlled trial) reporting the effects of MSC on COVID-19. Based on low-quality evidence, it appeared that human umbilical cord blood-derived MSC, given after failure to improve with standard treatment, had beneficial effects in terms of earlier onset of clinical improvement among individuals with severe or critical COVID-19. However, 28-day clinical improvement and mortality were not significantly different compared to standard treatment. There was no reported adverse reaction. • There are 52 registered and ongoing clinical trials to investigate the efficacy and safety of mesenchymal stem cells as treatment for COVID-19. • Mesenchymal stem cell therapy is not included in any of the existing guidelines for the treatment of COVID-19.
Covid-19

Key Findings Among patients with confirmed COVID-19 infection and hypertension, there is insufficient evidence that RAS antagonists are associated with mortality or severe COVID-19 disease. • There is uncertainty with regards to the safe use of renin-angiotensin system (RAS) antagonists, such as angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), for COVID-19 patients with hypertension and other comorbidities (heart failure, chronic kidney disease) because of two possible contradictory mechanisms 1) upregulation of ACE2 receptors that may facilitate the virus entry into the lung. and 2) control of unabated angiotensin II levels reducing acute lung injury. • Based on very low-quality retrospective cohort studies, there is insufficient evidence that RAS antagonists are associated with increased mortality (6 studies) or severe disease (10 studies) among patients with confirmed COVID-19 infection and hypertension. • There are 36 ongoing studies (21 RCTs, 1 single-arm trial, 4 prospective cohorts, 4 retrospective cohorts, 4 casecontrol, and 2 cross-sectional) on this topic. • The European Society of Cardiology (ESC) Council on Hypertension, the International Society of Hypertension (ISH) and the joint statement by the American College of Cardiology (ACC), American Heart Association (AHA), and Heart Failure Society of America (HFSA) all caution against discontinuing RAS-related treatments in patients with hypertension who become infected with COVID-19.
Covid-19

Key Findings • Very low-quality evidence from a single retrospective study suggests that continuous renal replacement therapy (CRRT) may reduce mortality among COVID-19 patients on invasive mechanical ventilation. Guidelines recommend CRRT for critically ill patients to minimize the risk of possible transmission, if this option is available. • Although uncommon, acute kidney injury (AKI) can occur in association with coronavirus disease 2019 (COVID-19) and is associated with increased in-hospital mortality. • There are currently no published or ongoing clinical trials directly comparing dialysis modalities for acute kidney injury in COVID-19 patients. • In reducing the risk of transmission during dialysis: currently, there are no studies comparing one dialysis modality to another. The method of dialysis is still primarily determined by the clinical picture of the patient, the expertise of the center, and the resources available. The American Society of Nephrology (ASN) recommends CRRT over intermittent hemodialysis (IHD) for critically ill patients with COVID-19 to minimize patient contact when it is available, and resources allow. Otherwise, intermittent hemodialysis may be done provided that, infection control measures are strictly followed. • Several international and local guidelines recommend strict adherence to infection prevention and control measures (e.g. hand hygiene, physical distancing, proper use of personal protective equipment (PPE), and cohorting of patients) who are undergoing dialysis.
Covid-19

Key Findings There is lack of clinical evidence supporting the role of oral fatty acid supplements as prevention and adjunctive therapy for COVID-19. Long-chain polyunsaturated fatty acids (PUFAs) mediate inflammation and adaptive immune responses. Omega-3 fatty acids promote anti‐inflammatory effects and reduce influenza virus replication. No clinical evidence supporting the use of oral fatty acid supplements as prevention and adjunctive therapy of COVID-19 was found. We found indirect evidence from one systematic review on acute respiratory distress syndrome (ARDS) and two longitudinal cohort studies on community-acquired pneumonia that showed non-significant and inconsistent results. The most common known side effects of omega-3-fatty acids are gastrointestinal in nature. They may also cause allergy and affect blood clotting if taken with other medications that affect clotting. There are 2 ongoing clinical trials on eicosapentaenoic fatty acids as an adjunctive therapy to standard oral nutrition supplements or standard of care in COVID-19 patients. WHO Interim guidelines, CDC interim guidelines, Infectious Diseases Society of America COVID-19 treatment guidelines, and the American Thoracic Society did not give any recommendation on the use of nutritional supplements in patients with COVID-19.
Covid-19

At present, there is insufficient evidence to support the use of BCG vaccine as prophylaxis for COVID-19. Bacillus Calmette Guerin (BCG) vaccine is an attenuated microorganism derived from bovine tubercle bacillus and is being given to prevent severe tuberculosis. BCG vaccination may enhance production of antibodies and pro-inflammatory cytokines such as interleukin (IL)-1β and tumor necrosis factor (TNF). BCG may lead to increased CD4 and CD8 T-cell activity on subsequent viral infection. Ecological studies on the effect of BCG vaccination policy on COVID-19 outcomes have conflicting results and are prone to bias from confounders. There is insufficient evidence on the efficacy and safety of BCG vaccine for COVID-19 prophylaxis. Thirteen clinical trials are ongoing among high-risk groups (healthcare workers, elderly, police officers) to evaluate the efficacy and safety of BCG vaccine in preventing COVID-19 and its severe symptoms. WHO does not recommend the use of BCG vaccine as prophylaxis against COVID-19. Adverse events of BCG vaccine range from mild local cutaneous reactions to systemic adverse events such as abscess, lymphadenopathy and osteomyelitis.
Covid-19

Key Findings While chest x-ray is readily available and may precede RT-PCR test, chest x-ray has low sensitivity early in the COVID-19 disease and shows non-specific lung abnormalities in COVID-19 patients. Chest x-ray is part of the initial diagnostic tool used on COVID-19 patients in some hospitals as it yields fast results compared with reverse transcription-polymerase chain reaction (RT-PCR). Chest Computed Tomography (CT) has been reported to be more sensitive than chest x-ray in determining the presence of COVID-19. Chest x-ray findings in confirmed COVID-19 patients show: Normal lung findings early in the illness and in mildly symptomatic patients. Typical ground-glass opacities and consolidation in the lung periphery. Lung abnormalities are non-specific and may likewise be present in other infections and coronavirus-types of pneumonia. The American College of Radiology (ACR), Center for Disease Control and Prevention (CDC), Canadian Association of Radiologists (CAR), Canadian Society of Thoracic Radiology (CSTR), and British Society of Thoracic Imaging do not recommend the use of chest x-ray to diagnose COVID-19. The Fleisher Society, composed of radiologists and pulmonologists in ten countries, does not recommend a chest x-ray for patients suspected of mild COVID-19. A chest x-ray is recommended for patients with moderate to severe COVID-19 needing immediate triage and patients at high risk for disease progression. Despite presence of chest x-ray findings suggesting COVID-19, RT-PCR test remains the standard diagnostic procedure.
Covid-19

There is conflicting evidence on the efficacy of intravenous immunoglobin G in the treatment of COVID-19 patients with severe disease. Intravenous immunoglobulin G (IVIg) is a mixture of polyclonal immunoglobulin G (IgG3, IgG4) antibodies as well as variable amounts of proteins; IgA, IgE and IgM antibodies isolated and pooled from healthy donors. IgG is involved in viral neutralization, modulates anti-inflammatory cytokines and cytokine antagonists. Immediate adverse effects of IVIg include flu-like syndrome, dermatologic side effects, arrhythmia, hypotension, and transfusion-related acute lung injury (TRALI). Delayed adverse effects can involve any organ which could be severe or even lethal There was a retrospective study (Yun Xie 2020) and several case reports that described recovery of COVID positive patients with severe disease. However, a retrospective study showed that immunoglobulin G with steroids and antivirals did not improve COVID patients with acute respiratory distress syndrome (Liu Y 2020). Similarly, another study showed no significant difference in the 28- and 60-day mortality between the IVIg and non-IVIg groups but subgroup analyses reported that in those with critical COVID illness, 28 day mortality is decreased with IVIg (Shao Z). There are eight registered clinical trials on the use of intravenous immunoglobulin G in COVID-19 patients.
Covid-19

Introduction: Cancer patients are more susceptible to coronavirus disease-19 (COVID-19) infection because they are immunosuppressed by their disease or therapy, most of them have coexisting medical conditions, and they frequently visit hospitals for treatment and surveillance. Objective: The objective of this study was to determine the prevalence of COVID-19 infection among gynecologic oncology patients receiving treatment in a COVID-19 referral hospital. Materials and Methods: A descriptive, cross-sectional study involving 47 gynecologic cancer patients receiving treatment from June 2020 to December 2020 was performed. All patients underwent SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) swab test and symptom and exposure assessment before the start of cancer treatment. Patients with negative SARS-CoV-2 RT-PCR swab test results received their planned treatment, and a repeat swab test and triage assessment were done midtreatment and after treatment. Results: Five (10.6%) patients had positive baseline SARS-CoV-2 RT-PCR swab results, but all proceeded with treatment after negative results were obtained. Only 1 (2.13%) patient had a positive SARS-CoV-2 RT-PCR swab test result at midtreatment. All patients had no COVID-19-associated symptoms and none of them tested positive for COVID-19 infection posttreatment. Conclusion The prevalence of COVID-19 infection among gynecologic cancer patients receiving cancer treatment is 2.13%. All patients who had positive SARS-CoV-2 RT-PCR swab test results at baseline or midtreatment were able to continue and complete treatment. There were no severe clinical events or mortalities among those affected with COVID-19 infection.
COVID-19