This is a rare case of primary pachydermoperiostosis (PDP). A 28-year-old Filipino male presented with a lifelong history of enlarged hands and feet. He eventually developed symmetrical swelling of the ankles and knees associated with leg heaviness and knee pain with difficulty with ambulation, hence consult. His eldest brother also had the same “elephant-like” extremities. He had cutis vertices gyrata with a thickened corrugated hair pattern, deep lines on the forehead, deepened nasolabial folds, enlarged extremities especially distally, with coarse, thick skin, and prominent clubbing. The nails were convex “watch crystal-like.” The wrists, knees, and ankles were tender and enlarged, with massive effusion of the knees. All joints were devoid of warmth and erythema. Skeletal survey favored hypertrophic osteoarthropathy over acromegaly, with periosteal thickening of the metaphysis and digital clubbing. The filarial smear was negative for blood parasites. Skin biopsy showed keratoderma. Synovial fluid was non-inflammatory while arthroscopic synovial biopsy showed chronic inflammation eosinophilic amorphous tissue. Electrocardiogram, echocardiogram, thyroid function tests, complete blood count, peripheral blood smear, serum chemistries, coagulation tests, urinalysis, urine electrolytes, fecalysis, and chest CT scan were unremarkable. Whole abdomen ultrasound revealed the liver parenchymal disease. Hepatitis profile revealed chronic infection with hepatitis B, with low infectivity. The three major criteria for PDP (pachydermia, periostitis, and digital clubbing) were fulfilled. Possible secondary causes were either excluded or were non-contributory. He was started on analgesics and anti-inflammatory medicines. Repeated arthrocenteses drained liters of synovial fluid per knee, and along with intra-articular steroid injections and compressive bandages, temporarily relieved his bilateral knee pain. He was referred to rehabilitation to maximize his range of motion and to address body image issues. The patient remains on regular follow-up for periodic arthrocentesis. The option of anti-VEGF treatment and arthrotomy was explored as possibilities but were not deemed practical. PDP is a rare genodermatosis. Life span is not affected but the quality of life is dismal without supportive management, as there is no known cure. A multidisciplinary team composed of a rheumatologist, dermatologist, orthopedic surgeon, plastic surgeon, rehabilitation physician, and a psychiatrist should be available to assist in the needs of these patients.
Osteoarthropathy, Primary Hypertrophic

Background and Objective: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide. Likewise in the Philippines, the prevalence of CRC has shown to be increasing. Colonoscopy, a screening procedure for CRC, has parameters to gauge quality of detection. One of which is the Adenoma Detection Rate (ADR). Higher ADR has been linked to improved cancer detection. This study aimed to determine the ADR and Polyp Detection Rate (PDR) among Gastroenterology practitioners in a tertiary government university hospital in the Philippines, estimate ADR from PDR, and identify factors associated with ADR. Methods: An analytical, cross-sectional study among patients who underwent colonoscopy for the years 2021 and the first half of 2022 at the Central Endoscopy Unit (CENDU) of the Philippine General Hospital. Demographic data of fellows and consultants were collected through an online form, while those from patients were obtained from electronic records. Colonoscopy details and histopathology results were accessed through the hospital’s Open Medical Record System (MRS). ADR, PDR, and estimated ADR were computed using established formulas. To evaluate the strength of the relationship between the estimated and actual ADR, Pearson’s correlation coefficient was used. Chi-square analysis, Mann-Whitney U test, and Kruskal-Wallis H test were performed to identify the factors that might influence the ADR. A cut-off of p < 0.05 was considered statistically significant. Results: The total computed ADR of consultants and fellows combined is 22%. The difference between the ADRs of Gastroenterology consultants and Fellows-in-Training is statistically significant at 31.6% and 18.7%, respectively (p= 0.017). The total Polyp Detection Rate is 57.6% while the weighted group average Adenoma to Polyp Detection Rate Quotient (APDRQ) is 0.4085 or 40.85%. The estimated ADR has a moderate degree of correlation with the actual ADR when an outlier was excluded (r=0.521 (95% CI, 0.072-0.795, p=0.0266). Significant factors related to ADR include endoscopists’ years of practice (p=0.020), number of colonoscopies done (p=0.031), and patient tobacco use (p=0.014). Conclusion The overall ADR among consultants and fellows is at par with the standard guidelines. A moderate degree of correlation exists between actual and estimated ADR when an outlier is excluded; however, more studies are needed to determine the APDRQ in the wider local setting. Longer years in practice, total number of colonoscopies performed, and patient tobacco use are associated with increased ADR.
Adenoma ; Colonic Polyps ; Colorectal Neoplasms ; Colonoscopy

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

Objectives: To determine the frequencies of gastrointestinal manifestations and identity associations with outcomes among COVID-19 patients admitted in a tertiary hospital. Furthermore, it sought to determine conditions and risk factors that can be attributed to the development of these gastrointestinal symptoms. Materials and Methods: This was a retrospective cohort of 1212 adult patients admitted at the Philippine General Hospital from April to September 2020 for COVID-19 infection. Data were gathered from an established database and chart review. Frequencies of observations were tabulated and expressed in percentages. Analytical statistics via the Fisher's Exact test was used to determine associations. Results: A total of 597 observations of gastrointestinal symptoms was noted: diarrhea (16.4%), anorexia (13.3%), ageusia/dysgeusia/hypogeusia (7.7%), vomiting (4.5%), abdominal discomfort (4.7%), nausea (1.7%), and gastrointestinal bleeding (0.7% - [melena 0.5%, hematochezia 0.16%, hematemesis 0.08%]). Most of these patients had moderate COVID infection (38.37%). Gastrointestinal bleeding was significantly associated with the need for oxygen support (p = 0.009), invasive ventilation (p = 0.002), invasive ventilation (p= 0.001), ICU admission (p = 0.006) and mortality (p= 0.006). Anorexia was significantly associated with the need for oxygen support (p = <0.001), invasive ventilation (p= <0.001), renal replacement therapy (p = 0.003), ICU admission (p = <0.001) and mortality (p = <0.001). Vomiting was significantly associated with need for invasive ventilation (p = 0.023) and renal replacement therapy (p = 0.003). Conclusion Gastrointestinal manifestations can present among patients with COVID-19 infection and can affect overall prognosis.
Gastrointestinal Tract ; COVID-19 ; Tertiary Care Centers