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

Patient experience is the interaction with the healthcare system and is one of the three pillars of quality in healthcare. Its assessment provides an opportunity to assure quality of care, meet patients’ expectations, direct strategic decision making, and document benchmarks for healthcare organizations.

The onset of the pandemic pushed the employees’ clinic to institute new processes and focus on COVID-19 screening and monitoring of affected employees. The clinic used patient feedback to improve its services.

A survey tool was developed and released by the clinic in June 2020 to elicit feedback and improve its services. Most items were yes/no questions and patients were asked to rate based on a Likert scale of 0-5 for the other items. They were also given space for their additional comments/feedback.

The study described the experience of patients utilizing the COVID-19 services of the employees’ clinic of a tertiary hospital.

This was a cross-sectional study that involved a retrospective review of all data retrieved from the feedback forms from those who availed the COVID-19 services of the employees’ clinic, namely consultation, swabbing, and/ or telemonitoring, from June 2020 to December 2021.

A total of 4,136 feedback forms were retrieved from the employees’ clinic. There were 1,598 forms from consultation, 1,268 forms from swabbing and 1,270 forms from telemonitoring. A total of 456 comments were positive and 275 were negative. Most forms listed receiving an introduction from their physician/nurse (92.74%) and received instructions for swabbing (90.43%) during consultation. For swabbing, most received information regarding their schedule (95.43%). Almost all forms listed receiving SMS or calls (98.74%) and information regarding returnto- work or admission (96.14%) from the telemonitoring service. Only about half were able to discuss fears and anxieties (48.76%) during consultation and about twothirds (68.93%) received information regarding their RT-PCR results. Feedback stated that the clinic staff were respectful and courteous, and the service hours were convenient. However, concerns with data privacy were apparent.

Overall patient experience was generally positive despite the rapidly changing processes of the clinic.

BACKGROUND

Infection from SARS-CoV-2 have transient and long-term complications. Persistent symptoms postrecovery with perceptions of overall physical and mental health status are crucial information to construe on follow-up care.

To describe the clinical profile, general, and mental health outcomes of hospital staff who recovered from COVID-19 at follow-up 12 weeks or more post-convalescent.

This was a cross-sectional study on follow-up of hospital staff who recovered from COVID-19. Study population included staff or health care workers of a COVID-19 referral tertiary hospital, who had laboratoryconfirmed COVID-19 via RT-PCR. Informed consent was obtained through phone calls and google forms. Data collection was through a self-administered, on-line google form or voice-call interviewer-assisted questionnaire. Analysis was done with Stata 17 using frequencies, proportions, and cross-tabulations.

Persistent symptoms reported several months post-recovery from COVID-19 included fatigue (25%), difficulty of breathing (23%), muscle weakness (16%), nasal congestion (12%), cough (10%), sore throat (5%), anosmia (3%), and ageusia (2%). Symptoms of physical and mental fatigue post-COVID-19 were reported by 25% (N = 93) with extreme fatigue reported by four staff. Fifteen percent (N = 57) reported that they feel that their workload or schedule needed modification after recovery. Feelings of isolation, depression, and anxiety were the most common mental health issues reported. Screening using validated tools showed that depressive symptoms were present in 45% (N = 145) and anxiety in 18% (N = 53).

Healthcare workers who recovered from COVID-19 for at least 12 weeks or more described their health status as comparable to their overall health one year before the infection. Physical and mental health symptoms reported 12 weeks post-recovery include fatigue, breathlessness, anxiety, and depression and were described in various levels of severity.

COVID-19 commonly manifests with respiratory symptoms but is reported to involve other organs including the skin. This is a case of a 58-year-old male diagnosed with mild COVID-19 infection via reverse transcriptase polymerase chain reaction (RT-PCR) nasopharyngeal swab (NPS). He initially presented with symptoms of fever, cough, colds, sore throat, anosmia, ageusia, myalgia, and diarrhea. Maculopapular cutaneous lesions appeared on the extremities on the 3rd day of illness and were described as pruritic and blanching. The patient was managed conservatively with oral hydration and vitamin supplementation. During home isolation, symptoms were monitored via telemedicine. He recovered and was asymptomatic 36 days from the onset of symptoms. During the early part of the pandemic, further diagnostic testing was challenging due to the restrictions that were implemented. However, careful history, modified physical examination, and monitoring through teleconsultation proved to be very useful. Documenting the course and outcome of COVID-19 patients with skin manifestations would help facilitate timely diagnosis and treatment, as well as anticipate the possible prognosis of patients who present with a similar clinical pattern.

OBJECTIVE

To describe the treatment outcomes of patients who underwent tube pericardiostomy for all etiologies of non-traumatic massive pericardial effusion or tamponade during the COVID-19 pandemic and determine the association between patient profile and treatment outcomes.

Data were obtained from patients with massive pericardial effusion or cardiac tamponade who underwent surgical drainage from January 1, 2020, to September 1, 2022, in the University of the Philippines – Philippine General Hospital (UP-PGH). These patients’ demographic and clinical profiles, and treatment outcomes were evaluated using frequencies and percentages. Chi-squared and Fisher’s tests determined the differences between COVID (+) and (-) groups. Odds Ratio was used to assess the risk of complications and mortality.

The study population comprised 90 patients with a mean age of 45 years. 54.4% were females. Fifteen (16.67%) were COVID-19 (+) and 75 (83.33%) were COVID-19 (-). Most of the patients were of O+ blood type (34.4%), with no smoking history (67.8%) and no COVID-19 vaccination (76.7%). Common comorbidities were cancer (70%), tuberculosis infection (32.2%), and hypertension (25.6%). No significant difference was found between the two study groups. The presentation was subacute (one week to three months) (62.2%), with the most common symptoms of dyspnea (81.1%), orthopnea (61.1%), and cough (52.2%). Tachycardia (80%) and tachypnea (57.8%) were the most common presenting signs. Hypotension was found more frequently among COVID-19 (+) patients (46.7% vs. 12.0%, p = 0,003, 95% CI). Most patients had abnormal WBC, coagulopathy, elevated inflammatory markers, and cardiac biomarkers. Sinus tachycardia, regular sinus rhythm, ST-T wave changes, and low voltage QRS were common ECG findings. The most common chest X-ray results were pleural effusion (80%), pneumonia (71.1%), and enlarged cardiac border (42.2%). Majority of echocardiographic findings were large effusion (>2 cm) (97.8%), RV collapse (40%), and RA collapse (23.3%). An average of 628 ml of pericardial effusion was drained, predominantly serous and exudative. One specimen yielded a positive AFB culture. 6.7% showed carcinoma cells on fluid cytology. The pericardium was normal in 78.9%. 10.0% of the pericardial biopsy specimen had carcinoma, with metastatic cancer being the most common etiology. The most common cancers were lymphoma (22.7%), breast (25.8%), and lung (16.7%). Hospital length of stay was 18 days in COVID-19 (+) patients and 12 days in COVID (-). The complication and in-hospital mortality rate in the COVID-19 (+) compared to the (-) group (86.7% vs. 73.3% and 46.7% vs. 41.3%, respectively) were not statistically significant. The most common complications were respiratory failure (60%), shock (53.3%), and nosocomial pneumonia (40%). There was no association between clinical factors and the risk for complications. Any complication increased the risk for mortality (OR 15.0, 95% CI 3.2-19.7, p=0.002). The presence of hypertension (OR 0.08, 95% CI 0.02 to 0.4, p=0.001) and subacute duration (OR 0.3, 95% CI 0.09 -0.9, p=0.045) decreased the mortality risk.

Profiles were similar in both groups. There was no association between patient profile and complications. Having COVID-19 did not affect patient outcome. The presence of any complication increases the risk of mortality. In-hospital mortality was high at 42.2%.

Background: The prone position has been seen to benefit patients experiencing acute respiratory distress syndrome. However, performing this position in pregnant patients has been difficult and raises safety concerns. Objective: The current study aimed to test the use of a supportive pillow (Prone Pillow for Pregnant Patients or 4P) to address concerns regarding pregnant patients in prone position. Methods: The study prospectively evaluated the use of the prone pillow for patient comfort and usability among healthcare workers with qualitative and quantitative measures. Results: A total of three patients were recruited alongside 16 healthcare workers assisting pregnant patients to the prone position. Overall, awake pregnant patients found the pillow to be comfortable while healthcare workers perceived the pillow to be useful in improving quality of care among awake and intubated pregnant patients. Conclusion The 4P is a potentially useful and beneficial product in placing pregnant patients in the prone position during episodes of acute respiratory distress. However, due to the limited sample size, more clinical trials are needed to evaluate the impact of this innovation in improving patient and healthcare worker safety.
Covid-19

Objectives: The use of a scoring system that integrates various factors helps in decision-making and triage for Medically Necessary, Time Sensitive (MeNTS) surgical procedures during the COVID-19 pandemic. This study aimed to determine the clinical characteristics and outcomes of cases who were screened and underwent elective gynecologic surgery at a tertiary hospital using the MeNTS tool for prioritization. Methods: A cross sectional study was carried out using data collected through medical chart review of all gynecologic cases screened in a 6-month period, from June 18, 2020 to December 18, 2020. Results: A total of 155 gynecologic cases were screened, with 134 (86.4%) MeNTS cases and 21 (13.5%) non-MeNTS cases. The median length of stay (5 days), the median operating room time (3 hours and 30 minutes), and median estimated blood loss (400ml) were within the acceptable expected outcome as with the scoring system, albeit with some cases (53%) requiring blood transfusion attributed to low baseline hemoglobin levels. There were no cases with post-operative COVID-19 transmission, needing ICU care and intubation, nor mortalities reported. Conclusions The MeNTS scoring system allowed efficient handling of the backlog of elective gynecologic cases with minimal morbidity and absence of mortality. The study supports the utility of this scoring system in addressing the need of the healthcare system not just to optimally utilize and fairly allocate hospital resources but also to ensure the safety of the patient with the best health service delivery during the pandemic.
Covid-19

Background and Objectives: The immediate post-discharge period of COVID-19 patients is a vulnerable state due to several complications that may arise during this time. Some patients get readmitted shortly after being discharged while others report persistence of symptoms, develop specialized needs, or observe a decline from their baseline functional capacity. Information on the outcomes of post-COVID discharge patients in our institution is currently lacking. This study described the outcomes of patients with COVID-19 after their discharge from the service areas of Philippine General Hospital. Methods: This study is a retrospective chart review involving charts of all adult patients discharged from the PGH COVID service areas last August 2021 to October 2021. Data from their follow up consults at 1 week, 1 month, and 3 months post-discharge were reviewed. Baseline characteristics and post-discharge outcomes including post-COVID symptoms, special care needs, mortality, rehospitalization, emergency consult, level of dependence, and ability to return to work were assessed. Results: A total of 171 patient charts were included. The mean age of patients was 53.7 years. Most were male (60.2%), unemployed (59.7%), non-smoker (55%), hypertensive (57.9%), diabetic (50.2%), and obese (50.2%). Most of them were oxygen requiring (80%) and with severe to critical COVID infection (72.5%) during admission. At 3 months post-discharge, 113 (66%) were stable and able to complete the follow up, 8 (4.6%) died, 9 (5.2%) got readmitted, and 41 (23.9%) were lost to follow up. Among those who were able to follow up after 3 months, 84 (74%) were asymptomatic. Among those who remained symptomatic, the most common symptoms were dyspnea, fatigue, and cough. After 3 months, 100 (88%) did not require special care needs, 100 (88%) were fully independent, and 45 (39.8%) were able to return to baseline work. Conclusions Despite the majority of patients having severe to critical COVID infection during admission, most were asymptomatic within 3 months post-discharge. In those who developed persistent symptoms, dyspnea, cough, and fatigue were the most common symptoms identified regardless of COVID severity. Majority did not require special care needs.
COVID-19

BACKGROUND

COVID-19 pandemic led to a dramatic loss of human life worldwide and presented an unprecedented challenge to public health. One of the solutions in addressing the problem was mass vaccination in order to attain herd immunity. However, most people were hesitant to be vaccinated particularly due to their fear of the adverse events; hence the goal of this study was to determine the possible adverse events (AEs) experienced during administration of CoronaVac^TM COVID-19 Vaccine.

The objective of the study was to monitorthe occurrence of adverse events within one hour, two to 24 hours, and 25 to 72 hours after administration of the first and second dose of CoronaVac^TM COVID-19 Vaccine in a tertiary government hospital in Pangasinan.

This cross-sectional study was done from February to April 2021 at Region 1 Medical Center. Employees who received the two doses of Sinovac-CoronaVac^TM vaccine and gave their informed consent were included in the study. Participants were monitored closely for adverse events within 30 minutes following administration of the vaccine and were instructed to report any local and systemic AEs to the Hospital Epidemiology Center Office. Individuals were also followed up through telephone to investigate the occurrence of any complaints after 24 to 72 hours.

A total of 353 participants who received the complete doses of CoronaVac^TM were included in the study. The incidence of AEs was higher after the first dose compared with the second dose. After the first dose of CoronaVac^TM 12.5% reported AEs after the 1st hour, 14.2% two to 24 hours after the vaccine, and 1.4% on the 25^th hour up to the 72^nd hour. Pain on injection site was the most common adverse event during the first hour (8.2%). On the 2nd hour up to 24 hours, headache, and myalgia (14.2%) were more evident. Headache was reported in 1.1% of the participants after 25-72 hours of vaccination. After the second dose, only one participant reported multiple AEs such as fatigue, headache, rash and retroorbital pain (1, 0.7%).

In this study, 28.1% of the participants experienced adverse events afterthe first dose of CoronaVac^TM vaccine. AEs were higher after the first dose (28.1%) compared with the second dose (0.3%). Injection site pain was the most common adverse event during the first hour, then headache and myalgia during the 2^nd hour up to 24 hours, and headache on the 25^th – 72^nd hour after vaccination. Only one participant reported several AEs after the 2^nd dose of the vaccine.

BACKGROUND

Persistent symptoms following SARS-CoV-2 infection have increasingly been reported globally, although currently there are no available local epidemiological data on this. This study aimed to determine the prevalence, common manifestations, and clinical predictors of post COVID-19 condition among the pediatric population.

A cross-sectional analytical study adapting the ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium) Global COVID 19 – pediatric survey questionnaire was done. There were 356 patients with confirmed SARS-CoV-2 infection (RNA detected by RT-PCR/GeneXpert). Out of the 189 with complete data and who responded, 3 were excluded due to deaths during the acute infection. A total of 186 children aged 0-18 years old were enrolled and children of the same age group having SARS-CoV-2 negative result were included as control in 1:1 ratio. Univariate and multivariate regression analyses were performed to identify variables associated with post COVID-19 symptoms.

The prevalence of post COVID-19 condition was 15%. The most common presenting symptoms during the acute infection were fever and cough, while the common post COVID-19 symptoms included persistent cough (65%), rhinorrhea (55%) and loss of taste (3%). In the univariate analysis, the age group 5-11 years (OR 13.83, p value < 0.05) and hospitalization (OR 2.37, p value < 0.05) were statistically correlated with persisting symptoms. However, multivariate logistic regression analysis showed that hospitalization (aOR 4.1, p value < 0.05) was the only factor significantly associated with the persistence of symptoms.

Children less than 11 years old and male sex have a higher prevalence of persistent symptoms following acute COVID-19 infection. The age group 5-11 years old was identified as a clinical predictor of post COVID-19 condition along with those who were hospitalized.