Prevalence of HIV infection in the Philippines remains low. This may be partly due to reliance on passive reporting for surveillance. The algorithm for laboratory testing for HIV infection has become more stringent in the sense that the screening assays are repeated in the confirmatory centers, before Western Blot is performed. This has been due to the high rate of false positives before 2005. Nucleic Acid Amplification testing (NAAT) has been performed routinely for blood banking purposes in other countries. In a few pilot studies, it has proven useful in identifying those cases in the early stage of the infection, which are missed on testing by antibody-based assays. The assay may prove useful in knowing whether false negatives happen with the current testing algorithm in the Philippines. Coupled with the detuned assay, identification of new cases may be critical for prevention of transmission, surveillance of cases, and early medical management if needed.

Hiv Infections ; Prevalence ; Philippines ; Blood Banks ; Blotting, Western ; Antibodies ; Nucleic Acid Amplification Techniques ; Algorithms ; Nucleic Acids

Objective: This study aimed to determine the demographic profiles of admitted COVID-19 patients, the association of coagulation and platelet tests on COVID-19 severity and compare the coagulation and platelet profile across the spectrum of the disease in terms of severity among adult COVID-19 patients admitted to the Philippine General Hospital from March 2020 to December 2022. : Methodology. Medical records of a sample of adult COVID-19 patients admitted to the emergency room of the Philippine General Hospital from March 2020 to December 2022 were reviewed. The demographics, initial COVID-19 diagnosis and initial coagulation and platelet test results were gathered and tabulated. Comparison of the initial coagulation and initial platelet results were made per disease category. Results: Three hundred eighty-five (385) patients were included; 194 were males, and 191 were females. The mean age of all patients was 56.18 years old. There was a total of 30 patients classified as mild and 105 patients are under moderate category. 141 patients were classified as severe, whereas 109 patients were classified as critical. Platelet count test and Activated Partial Thromboplastin Time (APTT) were mostly normal in all disease categories. Prothrombin time was normal in a majority of patients from the mild and severe categories. INR and D-dimer were all elevated mostly in all disease categories. Conclusion Platelet counts and APTT were mostly normal in all disease categories. Prothrombin time and D-dimer had a significant association with disease severity. Platelet count, APTT and INR did not show significant association with disease severity. Prothrombin time, APTT, INR and D-dimer means had significant differences versus disease categories.
Partial Thromboplastin Time ; OVID-19 ; Patient Acuity

Objective: This study aimed to determine the accuracy, sensitivity and specificity of frozen section (FS) in the diagnosis of uterine neoplasm in a tertiary government training hospital. Methodology: This is a retrospective validation study from 2004-2015 involving cases of uterine lesions from gynecologic surgeries. All histopathologic results of frozen and paraffin sections were retrieved and reviewed. Chi square test with 2x2 Fischer Exact test adjustment was used to check for associations. Accuracy indices of FS tool were estimated such as sensitivity, specificity, likelihood ratios, negative and positive predictive values, and overall accuracy. A p-value of < 0.05 alpha is considered significant. Results: A total of 143 uterine specimens were submitted for frozen section analysis. The utilization rate of FS is 1% per year. The FS results were correlated with the final histopathologic diagnosis with 96% agreement rate. Utilizing a median number of 3 sections per specimen provides an overall accuracy rate of 97%. The accuracy rate of FS is equal between combined benign-premalignant and malignant cases at 96%. The accuracy rate is not statistically affected by the procedure by which the specimen was taken, as well as the source and gross morphology of the specimen. Moreover, a minimum of 11 sections per specimen is needed to obtain an accuracy rate of 99-100%. The accuracy rate particularly for endometrial lesions is between 94 and 100%. Conclusion Accuracy rates of frozen section on uterine lesions are high regardless of the sampling procedure and source of the specimen. Increasing the number of sections during FS parallels that of the final histopathologic diagnosis. FS for uterine lesions is a vital and cost-effective intraoperative decision tool to maximize care of patients.
Frozen Sections

Background and Objectives: The use of conventional microscopy still forms the basis for the morphologic evaluation of erythrocytes despite widespread use of automated tests in the hematology laboratory. This requires a considerable length of time and expertise, and have the potential of becoming a source of errors and delay in reporting. Advances in image processing and machine learning in recent years have shown acceptable performance characteristics and have promising applications in the diagnostic laboratory. Use of these newly-developed technologies can address the stated problems and provide an alternative approach in the microscopic analysis of erythrocytes. Methodology: This prospective validation study compared digital image analysis using a machine-learning based image recognition algorithm with conventional microscopy performed by a trained microscopist, which served as the reference standard. Random deidentified anticoagulated peripheral blood samples submitted to the hematology laboratory were assessed. Results: A total of 956 erythrocytes were evaluated after image processing using support vector machine and routine microscopy as classifiers of erythrocytes into three categories: size, central pallor, and shape. The tested software was able to achieve a strong level of agreement compared to conventional microscopy, having kappa values ranging from 0.81 to 0.86. Accuracy for size, central pallor and shape were 89.88%, 93.72% and 87.89%, respectively. Conclusion: The validated image recognition software is an acceptable diagnostic test in determining erythrocyte morphology in peripheral blood smears. Its integration can potentially minimize hands-on time and improve the diagnostic laboratory workflow. Registration Philippine Health Research Registry (PHRR) ID: PHRR191211-002348; University of the Philippines Manila Research Ethics Board (UPMREB): 2019-356-01.
Microscopy

Introduction: To date, there are no reference intervals for prothrombin time (PT) and activated partial thromboplastin time (APTT) based on “normal” Filipino adults. The common practice in most laboratories is to adopt manufacturer provided values or foreign literature even if the importance of establishing or at least verifying laboratory reference intervals has been stressed by Clinical Laboratory Standards Institute (CLSI). Objectives: Here we aim to describe our experience in using a simple non-parametric method to generate reference intervals for PT and APTT, from healthy Filipino volunteer blood donors. Methodology: We used a de novo, a priori non-parametric estimation method following the CLSI guidelines on establishing reference intervals. Results: The non-parametric lower reference limit for PT is 12.55 seconds, with 90% confidence interval of 12.3 to 12.75 seconds. While the non-parametric upper reference limit for PT is 16.15 seconds, with 90% confidence interval of 15.55 to 16.55 seconds. The non-parametric lower reference limit for activated partial thromboplastin time is 26.12 seconds, with 90% confidence interval of 22.95 to 27.1 seconds, and the non-parametric upper reference limit for activated partial thromboplastin time is 37.44 seconds, with 90% confidence interval of 36.75 to 38.65 seconds. The PT and APTT reference intervals were different from foreign sources and manufacturer provided values in terms of interval width and values of the reference limits by 2 to 4 seconds. Conclusion and Recommendations Estimation of coagulation reference intervals from volunteer health blood donors is doable, simple, and practical. Collaborative multi-center efforts may be done to expand the pool of reference individuals that are included and increase the representativeness of the reference intervals generated. This simple method can also be used to generate reference intervals for other clinical laboratory assays and may also be extended to at least verify reference intervals in special populations like pregnant women, the elderly, and the pediatric population.
Prothrombin Time ; Partial Thromboplastin Time