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

Objective: This paper aims to determine the respiratory manifestations, radiologic findings, and management of coronavirus-19 (COVID-19) among the hospitalized children of different age groups based on a systematic review of literature.

Methodology: We searched the MEDLINE, Google Scholar, Cochrane, and MedRvrix databases for relevant studies on pediatric COVID-19 done between January 1 to May 25, 2020. Data on demographic features, pulmonary symptoms, chest imaging findings, and oxygen support were extracted in a data abstraction form and analyzed among the different pediatric age groups.

Results:?Sixteen studies were included in this systematic review, with a total of 61 patients. Thirty-nine patients (64%) belong to the 2 to 12 year age group. Cough was the most commonly reported respiratory symptoms among children older than one month. Most of the patients, particularly adolescents, had asymptomatic or mild infection. On chest imaging, infiltrates and ground-glass opacities were the most common abnormalities. Oxygen supplementation via nasal cannula, non-invasive ventilation, and mechanical ventilation was noted in three cases.

Conclusion: Our systematic review shows that COVID-19 can present with a spectrum of respiratory manifestations and disease severity as well as a variety of radiologic abnormalities across different pediatric age groups. Whilemost children do not develop hypoxemia warranting oxygen supplementation, a severe respiratory infection can still manifest in children. Asymptomatic and milder infections are common and highlight the need for appropriate respiratory precautions. More pediatric studies on the pulmonary manifestations and management of children with COVID-19 can aid in a better understanding of this novel disease.

This paper shall present a case of a 42-year-old nulligravid who complained of chronic pelvic pain, vaginal bleeding and palpable abdominal mass secondary to multiple large myomas. Due to the logistical and health restrictions in most hospitals during the peak of the COVID-19 pandemic, elective surgery was postponed and a temporizing medical management was instituted in the form of GnRH agonist, which afforded relief. This paper shall also discuss the mechanism of action of GnRH agonist, and its crucial role as an essential medical treatment option for patients with debilitating conditions such as myoma uteri.

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 and its effects such as community restrictions, lockdowns, and unemployment have greatly affected the household food security status in urban poor communities leading to poor accessibility of sufficient nutritious food and subsequently affecting the nutrition of children. Objectives: This present study aims to determine the prevalence of household food insecurity in households with children aged 0-10 amid the COVID-19 pandemic in an urban poor community in Quezon City. Methodology: A descriptive cross-sectional study was done to evaluate the food security status and experiences of households amid the COVID-19 pandemic. Results: A total of 405 households were surveyed to answer questions designed to determine their general profile relative to their food security experiences during the pandemic. It was observed that the majority of the households in the urban poor community belong to Class D earning between PhP 8,001.00 - PhP 15,000.00. The heads of these households as well as caregivers mostly belong to the high school graduate level. Based on the conducted survey, it was revealed that 59.5% of the households were severely food insecure (90% CI: 55.4-63.4) and only 4.2% ( 90% CI: 2.8-6.2) were food secure. Conclusion The prevalence of food insecurity in the urban poor community is determined to be high, with 31.6% households having moderate food insecurity, while only 4.2% households are food secure. The majority of surveyed households were anxious and uncertain about their food supply, and also reported experiencing varying levels of food insecurity related to sufficiency of food quality.
COVID-19

The question, “what does life mean?" used to be considered as a paradigm of philosophical investigation. As a researcher, life is meaningless without paradigm and perspective. These are indispensable in peoples' lives as we encounter research in our daily lives. According to James Tartaglia (Veal, 2017), when properly defined, the topic of life's purpose is "the keystone of philosophy," serving to "lock its traditional preoccupations in place" and "allow them to bear weight in an intellectual culture dominated by science." He also contends that we should consider this idea as he rejects the premise of the question and draw the conclusion that "life is meaningless." More precisely, James Tartaglia is one philosopher who is not at all happy about it; in fact, he appears to be absolutely furious about it, as readers who have read this journal's recent symposium on Thaddeus Metz's book Meaning in Life: An Analytic Study would be aware. What enrages Tartaglia the most, it seems, is that the "traditional" topic of life's meaning has been completely disregarded by what he refers to as the "new paradigm" in analytic philosophy, which is purportedly devoted to exploring this question. He further states that the conventional question of life's purpose is not only the only genuine, legitimately philosophical inquiry of life's meaning, but it is also the most important one.
COVID-19

Reintegration is an integral part of nursing care. Nurses play a critical role in contributing support, dependence, and continuity of care from rehabilitation to reintegration. While the reintegration of patients is a concept often used in nursing, its theoretical origin has remained unclear. This article aimed to conduct a concept analysis of reintegration for the development of nursing as a discipline and improve nursing care and health outcomes. The evolutionary strategy to concept analysis of Roger was utilized, which resulted in the characteristics of reintegration as to its attributes, antecedents, consequences, and exemplar in nursing practice in the context of COVID-19. The capacity to adapt, reorganize, offer support, and build a network of resources are attributed to the concept of reintegration. Antecedents include rehabilitation, survivorship from illnesses, trauma, and injuries, and disruption of social and physical functional performances and activities. The identified consequences include transition to recovery, quality of life, independence, successful adaptation, job satisfaction, holistic care, and continuity of care. The new conceptual definition of reintegration emerged. Reintegration is a process of nursing care among patients who demand assistance and support before transitioning to regain normality or on their way to being restored to the community in the presence of adaptation from health adversities. The patient in all areas is cared for holistically, offering support to meet his needs and overcome challenges in terms of physical, mental, social, and emotional aspects. Concept analysis is as essential as operationalizing a concept in the nursing discipline.
COVID-19

Background: The search for simple clinical and laboratory markers to help predict the clinical severity of patients presenting with COVID-19 has prompted this study to look at the predictive value of urine L-FABP (Liver Type-Fatty Acid Binding Protein) point-of-care test kit at the initial presentation of COVID-19 patients to the hospital. Methods: The validation study prospectively included 109 consecutive patients with mild to moderate COVID-19, mean age of 52.2 years (range 19-84) presenting at the Emergency Rooms of 4 participating Metro-Manila hospitals from February to April 2021, with available data for analysis for 103 patients. Urine L-FABP POC (Point-of-Care) test and other clinical parameters and the level of severity of COVID-19 were determined at Day 0, Day 4 and Day 7. Computations for Sensitivity, Specificity, Positive and Negative Predictive values and Likelihood ratios were performed. Results: Twenty-three patients tested positive for urine L-FABP, out of the 103 patients analyzed, while 80 tested negative. Of the 23 patients who tested positive for urine L-FABP, 6 has progressed in severity, while 17 did not progressed. Of the 80 patients who tested negative for urine L-FABP, 13 progressed, while 67 did not progressed in severity. Giving a Sensitivity of 31.58%, Specificity of 79.76%, Positive predictive value of 26.09%, Negative predictive value of 83.75%. Combining urine L-FABP and initial clinical parameters like SIRS (Systemic Inflammatory Response Syndrome) criteria to predict progression of severity yielded a higher Specificity of 91.67 % and Negative Predictive value of 84.62%. Conclusions The study shows the utility of initial urine L-FABP POC test as a negative screening test in triaging adult patients presenting to the ER with mild to moderate COVID-19. Patients at the ER with a negative urine L-FABP test, will most likely not progressed to severe COVID-19. Combining clinical parameters like SIRS Criteria with the urine L-FABP result can increase the negative predictive value.
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