BACKGROUND: Out of pocket expenses still comprises a major share in health financing. A reactive approach in COVID-19 treatment may be problematic for the patient’s finances. National health insurance systems like PHIC have COVID-related care benefits, but whether these offer sufficient coverage is unknown. OBJECTIVES: This study aims to describe the hospitalization costs incurred by pediatric COVID-19 patients admitted at a Filipino tertiary pediatric hospital, to determine the major cost drivers of hospitalization, and to determine how various payment methods provide coverage in paying for hospitalizations costs. METHODS: Financial statements of pediatric COVID-19 patients were reviewed, from which costs were categorized. Deductions were also compared with total hospitalization to determine adequacy of various financial assistance programs. RESULTS: Fifty-six charts and financial statements were reviewed for a 9-month period. Majority of the patients are of the 1-month to 6-year-old group (39.3%), of critical severity (66.1%), and with comorbidities (76.8%). Aggregated hospitalization costs of all COVID-19 patients amounted to PHP 9.5 million; medical costs accounted for the majority of the hospital costs at 35.40%. Mean total hospitalization cost per patient was determined to be PHP 170,170 and mean daily cost was PHP 16,870. PHIC COVID-19 packages may provide deducted as much as 90.56% of the overall costs, but only 28.6% of patients were able to avail of this privilege. Out-of-pocket expenditure remains at 33% of the total hospitalization cost. CONCLUSION: COVID-19 hospitalization in this institution mainly consists of the 1-month to 6 years old, and the costs in the average can reach up approximately PHP 170,000, as basic medical fees drive the majority of the costs. Patients with no known comorbids tend to have higher costs of care but more data is needed to elaborate on the trend. Availing PHIC packages can greatly ameliorate the financial burden of hospitalization. However, checks in timely and accurate filing of claims should be in place to assure those that can avail this assistance are rightfully supported. RECOMMENDATIONS A larger patient base with equal representation of patient categories is recommended in order to determine more comprehensive cost patterns and make significant associations.

BACKGROUND: There are numerous studies on adult patients admitted for COVID-19 but there is paucity of local data in children.

OBJECTIVE: This study aims to determine the clinical presentation and outcome of children admitted for COVID-19.

METHODOLOGY: This is a retrospective review of medical records of patients 0 to 18 years old with COVID-19 admitted in Philippine Children's Medical Center (PCMC). Descriptive statistics summarized the clinical profile of the patients. Pearson's Chi-Square and Fischer's Exact Test were used for data analysis.

RESULTS: There were 100 confirmed COVID-19 pediatric patients admitted at PCMC from March 2020 to March 2021. Most were within the 0-4 years of age (52%). Fever (63%), respiratory symptoms (31%), and shock (28%) were the predominant clinical manifestations. Most (78%) had no exposure to symptomatic household contacts but all came from communities with known local transmission. Fourteen cases of hospital-acquired COVID-19 were also identified. Out of the 100 cases, 53 had critical COVID-19 on admission and 82 had co-morbidities, mostly neurologic, hematologic and infectious diseases. Seventy-four patients recovered and 26 patients died.

Fever (p-value=0.014) and shock (p-value=0.000), thrombocytopenia or thrombocytosis (p=0.030) and electrolyte imbalances (p=0.045) were significantly associated with critical COVID-19. There was no significant association between the presence of co-morbid conditions on admission and clinical outcome. O2 support by facemask (p=0.001) or by mechanical ventilator (p=0.001), and inotropic support (p=0.000) were significantly associated with mortality.

CONCLUSION: Children admitted for COVID-19 infection generally recover but those with critical COVID-19 is highly associated with mortality.

Human ; Male ; Female ; Adolescent (a Person 13-18 Years Of Age) ; Pre-adolescent (a Child 6-12 Years Of Age) ; Child

Thyroid involvement in Langerhans Cell Histiocytosis (LCH) is rare. We report a 10-year-old Filipino male who presented with a rapidly enlarging goiter. Computed tomography scan showed thyroid and bilateral submandibular masses with malignant features, pulmonary blebs and hepatic cysts. Ultrasound-guided core needle biopsy findings were consistent with LCH and chemotherapy was initiated. This case demonstrates that LCH should be considered in patients with goiter. Multidisciplinary management is warranted to achieve proper diagnosis and institute timely treatment.
Histiocytosis, Langerhans-Cell ; Thyroid Gland

Background: and Purpose Visual hallucinations (VH) and subjective cognitive complaints (SCC) are associated with cognitive impairment (CI) in Parkinson’s disease. Our aims were to determine the association between VH and SCC and the risk of CI development in a cohort of patients with Parkinson’s disease and normal cognition (PD-NC). Methods: Patients with PD-NC (total score of >80 on the Parkinson’s Disease Cognitive Rating Scale [PD-CRS]) recruited from the Spanish COPPADIS cohort from January 2016 to November 2017 were followed up after 2 years. Subjects with a score of ≥1 on domain 5 and item 13 of the Non-Motor Symptoms Scale at baseline (V0) were considered as “with SCC” and “with VH,” respectively. CI at the 2-year follow-up (plus or minus 1 month) (V2) was defined as a PD-CRS total score of <81. Results: At V0 (n=376, 58.2% males, age 61.14±8.73 years [mean±SD]), the frequencies of VH and SCC were 13.6% and 62.2%, respectively. VH were more frequent in patients with SCC than in those without: 18.8% (44/234) vs 4.9% (7/142), p<0.0001. At V2, 15.2% (57/376) of the patients had developed CI. VH presenting at V0 was associated with a higher risk of CI at V2 (odds ratio [OR]=2.68, 95% confidence interval=1.05–6.83, p=0.039) after controlling for the effects of age, disease duration, education, medication, motor and nonmotor status, mood, and PD-CRS total score at V0. Although SCC were not associated with CI at V2, presenting both VH and SCC at V0 increased the probability of having CI at V2 (OR=3.71, 95% confidence interval=1.36–10.17, p=0.011). Conclusions VH were associated with the development of SCC and CI at the 2-year follow-up in patients with PD-NC.