Introduction: Spontaneous acute subdural hematoma (ASDH) is rare and comprises 2.6% of all ASDH. In one recent study, only 178 spontaneous ASDH were documented. However, only 1 case was attributed to dural arteriovenous fistula (dAVF). Vascular malformations cause less than 10% of subarachnoid hemorrhage (SAH). Spontaneous ASDH and SAH occurring together are extremely rare. Literature is scarce on cases with dAVF of the occipital lobe as a cause of simultaneous spontaneous ASDH and SAH. Objective: This paper aims to present a case of a spontaneous acute subdural hematoma and subarachnoid hemorrhage caused by a dural arteriovenous fistula of the occipital lobe, along with its clinical presentation, diagnosis, and treatment. Case Summary: A 44-year-old Filipino male with no history of trauma presented with severe headache, vomiting, and decreasing sensorium – CT scan revealed acute parenchymal bleed in the left occipital lobe with subarachnoid extension and subdural hematoma in the left fronto-parieto-temporal convexity along the tentorium cerebelli and posterior interhemispheric falx. Due to the location of the lesion seen on the CT scan and the gender distribution, Arteriovenous malformation (AVM) was initially considered, thus proceeded to computed tomography angiogram (CTA) to establish the diagnosis of vascular anomaly, however, revealed dAVF instead. Four-vessel angiogram was done to assess the tributaries of the dAVF and confirmed the diagnosis. Complete obliteration of dAVF of the occipital lobe was done with Onyx Embolization in one session. Conclusion This is the first case of Borden type II, Cognard type IIa+IIb dAVF, as reported in this institution. Although extremely rare as a cause of SAH and ASDH, dAVF should be considered a differential diagnosis in patients with no identifiable common cause of the new onset of severe headache and poor neurologic status.
Subarachnoid Hemorrhage

INTRODUCTION

For detecting myocardial injury in severe and critical COVID-19, the electrocardiogram (ECG) is neither sensitive nor specific, but in a resource-poor environment, it remains relevant. Changes in the ECG can be a potential marker of severe and critical COVID 19 to be used for predicting not only disease severity but also the prognosis for recovery.

The admitting and interval ECGs of 1333 COVID-19 patients were reviewed in a 2-year, single-center, retrospective cohort study. Each was evaluated for 29 predefined ECG patterns under the categories of rhythm; rate; McGinn-White and right ventricular, axis, and QRS abnormalities; ischemia/infarct patterns; and atrioventricular blocks before univariate and multivariate regression analyses for correlation with disease severity, need for advanced ventilatory support, and in-hospital mortality.

Of the 29 ECG patterns, 18 showed a significant association with the dependent variables on univariate analysis. Multivariate analysis revealed that atrial fibrillation, heart rate greater than 100 beats per minute, low QRS voltage, QTc of 500 milliseconds or greater, diffuse nonspecific T-wave changes, and “any acute anterior myocardial infarction” ECG patterns correlate with disease severity, need for advanced ventilatory support, and in-hospital mortality. S1Q3 and S1Q3T3 increased the odds of critical disease and need for high oxygen requirement by 2.5- to 3-fold. Fractionated QRS increased the odds of advanced ventilatory support.

The ECG can be useful for predicting the severity and outcome of more than moderate COVID-19. Their use can facilitate rapid triage, predict disease trajectory, and prompt a decision to intensify therapy early in the disease to make a positive impact on clinical outcomes.

INTRODUCTION: COVID 19 has become the most important public health issue today. It has the potential to significantly affect the mental health of frontline healthcare workers (HCW) putting them at a higher risk of developing psychological problems especially to those who acquired COVID19 infection. OBJECTIVES: To determine the level of depression, stress, anxiety and coping strategies among Filipino HCWs with confirmed COVID-19 infection and its association with demographic and clinical profiles. STUDY DESIGN: Single center Descriptive study materials and methods consisted of 114 Filipino HCW with COVID 19 infection. Data were collected utilizing the Filipino translation of DASS 21 and Filipino Coping Strategy scale. RESULTS: There was a significant increase of HCWs with moderate depression, anxiety, and stress. A large proportion of the HCWs were also severely depressed, severely anxious and severely stress. Majority of the COVID19 positive HCWs were nurses accounting to 35%. More likely, the occupation was significantly associated with their degree of depression and stress. Hypertension associated significantly with elevated stress while having diabetes was instrumental for the depression, anxiety and stress. Moreover, appreciation was more felt at the workplace, then at home. While discrimination was prevalent in the community, workplace and social media. Religiosity ranked the most sought coping strategy. CONCLUSION: The study has found that a large percentage of HCWs had moderate level and a notable portion of respondents had severe to extremely severe level in each of the psychological domains in which factors such as gender, occupation, comorbidities, area of assignment and disease severity have brought significant impact. Discrimination is prevalent in the community and surprisingly in the workplace. In contrast, appreciation was felt more at home and in the workplace. Religiosity was shown to be the top coping strategy among HCWs who tested positive.
COVID-19 ; Adaptation, Psychological

Introduction: Convalescent plasma therapy (CPT) is a type of experimental passive immunotherapy with a sizable background in viral outbreaks. Although there has been documented favorable outcomes in using CPT in the treatment of viral illnesses, its use in COVID-19 is still experimental. Objectives: To determine if adding convalescent plasma to standard of care is associated with better clinical outcomes than giving standard of care alone to severe and critical COVID-19 patients admitted in a tertiary hospital in Cebu City. Methods: This is a retrospective cohort study conducted in a tertiary hospital in Cebu between March to September 2020. The data of a total of 22 COVID-19 patients who received convalescent plasma therapy plus standard treatment regimen based on the institution's interim guideline were identified by chart review. The demographic information, laboratory results, management and outcome data from this group were collated, matched with and compared to 43 critically ill COVID-19 patients who received COVID-19 standard treatment regimen only. Results: Both the CPT and non-CPT groups are comparable in terms of the socio-clinical variables, inflammatory marker levels, laboratory test results and therapeutic interventions. However, there is no relationship between the level of inflammatory markers and the illness day to which CPT was given. Additionally, the outcomes also differ significantly in terms of duration of admission, severity of illness, critical care support and mortalities. The control group has shorter hospital admissions, more patients with critical illness and more mortalities. The intervention arm, however, has more recoveries but longer duration of critical care. Conclusion Convalescent Plasma Therapy added to standard treatment is not associated with improved clinical outcomes among Filipino patients with severe or life-threatening COVID-19 infection admitted in a tertiary hospital in Cebu City.
COVID-19 ; Retrospective Studies

Introduction: The sociodemographic factors have a substantial impact on COVID 19 and understanding the characteristics and clinical presentation of COVID-19 is essential for diagnosis, management, prevention, and targeting clinical care and allocating resources. Objectives: To determine the socio-clinical profile, hospital outcomes and predictors of mortality of patients with COVID19 in Perpetual Succour Hospital from March to September 2020. Study Design: Retrospective observational study Materials and Methods: The population consisted of 368 COVID 19 admitted patients in a tertiary hospital in Cebu City from March to September 2020. Data collection was done by reviewing the charts of the patients and analyzing for descriptive statistics. Results: The COVID 19 patients were predominantly elderly males, smokers, with hypertension and diabetes. Smoking had a significant association with the mortalities. Cough, fever and dyspnea were the common manifestations. Intubated patients had a high mortality. Age, APACHE II and SOFA score, CRP level showed significant association with mortality. Acute kidney injury was the prevalent complication and respiratory failure was the primary cause of death. Majority of the admitted patients were classified as moderate and were discharged alive. Conclusion COVID 19 has a high recovery rate but poses a risk for the elderly, smokers and those with comorbidities. The manifestations mimic those of a respiratory infection and clinical parameters would usually be typical. Furthermore, acute kidney injury is common for infected patients, with respiratory failure and the need for intubation leading to increased morbidity and mortality.
COVID-19 ; Mortality

Introduction: Acute kidney injury (AKI) is a lethal complication of critical illness characterized by the rapid loss of the kidney's excretory function encountered in 50% of intensive care unit (ICU) admissions. Its impact on the outcome of critically ill patients makes AKI a significant cause of morbidity and mortality. Objectives: To develop and validate an acute kidney injury risk prediction score based on routinely available variables and common laboratories of admitted critically-ill septic Filipino patients. Methods: This is a prospective cohort study conducted in a tertiary hospital in Cebu from February to September 2020. The data of 2545 patients were identified by chart review but only 607 patients with a quick Sepsis Organ Failure Assessment Score (qSOFA) score of >2 were included in the pre-screening. After stratified sampling, a total of 198 septic ICU patients were enrolled. Demographic profile, laboratory results and outcome data were collated. Variables were screened then stepwise forward elimination was done to identify the significant predictors. An AKI risk score model was developed with binomial regression analysis by identifying independent prognostic factors. The diagnostic ability of the model was determined by the Area under the Receiver Operating Characteristics (AuROC). Results: AKI developed in 155 (78%) patients. The significant predictors for Acute Kidney Injury were age, hypertension, atherosclerotic cardiovascular disease, weight, white blood count, creatinine, and BUN. An AKI prediction model with a cut off score of 161.9 was made with a fair diagnostic ability for predicting AKI at 0.79 based on AuROC. Conclusion The developed risk prediction tool using routinely available variables is found to be fairly accurate to predict the development of AKI among critically ill septic patients.
Acute Kidney Injury ; Sepsis