OBJECTIVES: Healthcare workers are at the center of the pandemic, dealing with cases while being at risk of acquiring the infection themselves, causing work-related stress. Despite this, they continue reporting for duty. This paper aims to determine the factors that affect resilience of pediatric healthcare-workers in close contact with patients suspected with COVID infection and its association to sleeping disturbance during the first two years of COVID – 19 pandemic in a tertiary hospital in the Philippines. METHODOLOGY: This is a cross-sectional study. Healthcare-workers who render bedside patient care for those suspected or with COVID-19 infection, not diagnosed with any mental health illness, and fit the inclusion criteria were chosen through purposive sampling and asked to answer questionnaires with demographic survey, BRS and PSQI tool. RESULTS: Among 89 participants, females were predominant (60.67% ). Majority were in the 30- 39 age group (44.94%) and are nurses (40.45%) or doctors (39.33%) who were single (76.40%). Many have normal resilience as measured from their BRS scores with an average PSQI per category equal to or exceeded 5.00. The correlation coefficient was at -0.338 (p-value 0.001) between the BRS and PSQI scores, indicating that a significant negative correlation exists between the two scores. CONCLUSION Normal resilience was reported in the majority of the healthcare workers. All study participants had poor sleep quality as determined in the overall average PSQI score. A negative correlation between resilience and sleep quality was observed, denoting that poor sleep quality can be associated with lower resilience, and vice versa. However, temporality cannot be assumed with this study.
COVID-19

Background: Telemedicine has proven essential during COVID-19. However, concerns remain about the rural municipalities in the country such as those from the Cordillera Administrative Region (CAR), wherein perceived barriers by Municipal Health Officers (MHOs) include poor internet connectivity and inadequacy of the current telemedicine service. Objective: This study aimed to assess the extent of Telemedicine use and perspectives in terms of perception, attitudes and perceived barriers among MHOs in CAR during COVID-19. Methods: This is an analytical cross-sectional study that used a validated online questionnaire to 62 MHOs and DTTBs in CAR. Logistic regression analysis was employed to determine the effect of sociodemographic factors and physician perceptions and attitudes on the extent of Telemedicine use. Results: Most MHOs use Telemedicine frequently in their practice for 0-1 year during COVID-19. There is no significant effect of sociodemographic factors to the extent of Telemedicine use except for IT expertise which had a negative influence on the extent of use [prevalence (p=0.011), frequency (p=0.013), length of use (p=0.044)]. Generally, MHOs agree that telemedicine is beneficial for them in performing consults with a positive effect on frequency (p=0.004) and length of use (p=0.009). There is positive attitude towards telemedicine, however, with no significant effect on extent of use (p=0.352, p=1.00, p=0.484). Compromised decision-making and network issues are the most prevalent perceived barriers that limit MHOs to practice Telemedicine. Conclusion and Recommendation This study showed that during COVID-19, there is good utilization of Telemedicine among MHOs in CAR. MHOs perceive Telemedicine as beneficial in their work and positive attitude remains. However, presence of barriers makes them apprehensive to fully incorporate it in their practice. Study results can contribute to policy-making on telemedicine as it is a key player in e- health to improve access to healthcare services in the attainment of the goal of Universal Healthcare.
COVID-19

Background: RT-PCR using respiratory tract specimens, most commonly nasopharyngeal swab (NPS), has been used to confirm the diagnosis of COVID-19. NPS is a relatively invasive procedure that causes patient discomfort and risks viral transmission. Other specimens are therefore being investigated for the detection of SARS-CoV-2 RNA. Objective: To determine the sensitivity of non-respiratory tract specimens in detecting SARS-CoV-2 RNA in patients with COVID-19. Methodology: This review summarized the results of eight studies obtained from a literature search done in May 2020 in PubMed MEDLINE, Cochrane Library and MedRxiv. Two independent investigators reviewed and appraised the studies that were included, and pooled estimates of sensitivity for each specimen were determined using Stata’s Metaprop function Results: The sensitivity in detecting SARS-CoV-2 RNA in non-respiratory tract specimens of diagnosed COVID-19 patients are as follows: Saliva 77% (95% CI 71-83%), stool/rectal swab/anal swab 22% (95% CI 22-37%), blood/serum/plasma 2% (95% CI 1-3%), and urine 22% (95% CI 18-25%). Conclusion SARS-CoV-2 RNA is detected in saliva, stool/rectal swab/anal swab, blood/serum/plasma and urine. Among these, saliva has the highest estimated sensitivity. However, more studies are needed to correct the heterogeneity brought about by factors such as timing of specimen collection, disease severity and treatment.
COVID-19

Background: COVID-19 is an ongoing health concern that hospitals have struggled to keep up with, given its increasing burden with the passage of time. Considerations for the management of COVID-19 should be made especially for pregnant patients and their neonates. Objectives: To determine COVID-19 prevalence and the clinical profile of mothers admitted for childbirth at Chinese General Hospital and Medical Center from May 2020 to July 2020. The profile and outcomes of neonates born to these mothers were likewise studied. Materials and Method: A descriptive cross-sectional study was done that included mothers admitted for childbirth who had SARS-CoV-2 RT PCR swab test and their neonates. A total of 408 medical records of mother and neonate dyads were reviewed. Relevant variables such as the patients’ demographic profile, clinical characteristics, co-morbidities and the maternal and neonatal outcomes were obtained. Frequency distributions were made to assess the prevalence of COVID-19 among the patients, as well as maternal and neonatal outcomes. Results: Twenty-two (5.39%) mothers tested positive for COVID-19, while all neonates (n = 22) that underwent RT-PCR swab at the 24th hour of life had negative results. Of the 22 COVID-19 positive mothers, 2 (9.09%) were symptomatic upon admission while 20 (90.09%) were asymptomatic. The following were the key trends among those mothers who tested positive for COVID-19: (1) 81.82% were from ages 20-39 years old, (2) 72.73% were multigravida mothers, (3) 54.55% had normal spontaneous delivery, (4) diabetes mellitus was the only noted comorbidity. Key findings on the neonatal outcomes observed in the study population of both COVID-19 positive and negative cases, include: (1) majority of neonates had an APGAR score of greater than 7 at 1st and 5th minute of life; (2) higher frequency of neonates with Ballard’s score of more than 37 weeks AOG; (3) more male neonates as compared to female neonates; (4) a normal birth weight for majority of cases; (5) 45.45% of neonates born to COVID positive mothers had a length of stay of <48 hours as compared to 72.8% of neonates born to COVID negative mothers; and (6) neonatal pneumonia as the most common comorbid condition in both cases. Conclusion This study noted a prevalence of 5.39% COVID-19 positive mothers. SARS-CoV-2 virus was not detected in all of the neonates born to COVID-19 affected mothers. Neonates delivered to COVID-19 positive mothers had similar trends in the neonatal outcomes when compared to neonates delivered to mother who were COVID-19 negative.
COVID-19

Background: The global economy has been severely affected by the COVID-19 pandemic which proved to be more than a public health crisis. Volume and gross income have also declined in the health service sector including the diagnostic imaging and radiotherapy divisions of the radiology departments in other countries. Objective: This study determined the change in volume and gross income of the Radiology Department of a tertiary hospital which was designated as a COVID-19 referral center in the Philippines. Methodology: Monthly records of the profit centers of the Radiology Department were reviewed noting the volume and gross income one year before and during the first year of the pandemic. Results: Records were successfully retrieved for the volume of procedures and revenue for each profit center from one year before the pandemic (from March 1, 2019 to February 28, 2020) and the first year of the pandemic (from March 1, 2020 to February 28, 2021). There was a total reduction of 120,046 procedures conducted and Php 84,837,614.16 in revenues generated between the two periods. This is equivalent to a 61.98% (range: 47.92% to 83.37%) decrease in the volume of procedures and a 45.02% (range: 31.08% to 77.86%) decrease in revenue. These changes were found to be statistically significant. Conclusion The COVID-19 pandemic caused a decline of all profit centers in the Radiology Department. The decline was associated with changes in quarantine restrictions. Data from this study may help the administration of the institution or other institutions to conduct their own studies and cope with future pandemics of similar magnitude or further surges of the current pandemic on decisions regarding budget and resource allocation.
COVID-19

The Philippine COVID-19 Living Clinical Practice Guidelines (CPG) is a set of guidelines that provides up-to-date evidence-based recommendations on COVID-19 treatment, diagnosis, infection prevention and control. This living guideline follows the Department of Health’s Manual for Clinical Practice Guideline Development1 and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Approach.2 The diagram below is a summary of the treatment regimens gathered from the Philippine COVID-19 Living Recommendations website. The recommendation for each drug regimen is based on the assessment and literature review done by the Living CPG Task Force (LCTF).3 The LCTF follows the classification of quality of evidence enumerated and described in Box 1.
COVID-19

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.
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Covid-19

The Covid pandemic nearly brought our lives into a different dimension beyond our imagination. Measures to ensure the safety of everyone have never been stricter. The education system had to deal with similar restrictions. Everyone shifted to online virtual classes, which has never been easy to both the teachers and students. Not only are we concerned of our responsibilities as educators but responsive to the needs of students and patients as well during these times of uncertainties. This article briefly describes my personal insight on teaching medicine and how patients continue to take part in the learning process of students despite restrictions.

This case illustrates the myriad neuropsychiatric symptoms associated with the direct and indirect exposure to COVID-19 infection. The disruption in our daily routines, the uncertainty brought on by the then novel and unknown condition, the specter of death and the “horror” stories that spread through the grapevine during the lockdown shook the foundations of our existence. To make matters even worse, the government protocols required those infected to move away from the comfort of the familiar and the emotional support of family and friends.
COVID-19