Background: Since the start of SARS-CoV-2 pandemic, a post-infection hyperinflammatory process in children with features similar to Kawasaki disease, termed multisystem inflammatory syndrome in children (MIS-C),1 was identified. Thousands of MIS-C cases have already been reported worldwide.2 As possible cases of MIS-C in neonates were increasingly identified, multisystem inflammatory syndrome in neonates (MIS-N) as a distinct entity was proposed as neonates may not manifest all the typical features described in older children. Case Presentation: We describe the case of a previously well term neonate with sudden signs of bowel obstruction who later had multisystem involvement (cardiac, gastrointestinal, and hematologic). The baby was born to a 23-yearold multigravida with an unremarkable prenatal history except for COVID-19 infection during her 34th week age of gestation. The mother presented with mild respiratory symptoms and resolved with supportive management. Our patient was born stable, then had sudden manifestations of feeding intolerance on the 16th day of life and upon work-up had moderate anemia, elevated inflammatory and cardiac markers, ileus, and dilatation of proximal left coronary artery. RT-PCR for SARS-CoV2 was negative. The baby was managed with intravenous immunoglobulin (IVIG) and steroids, with rapid clinical and laboratory parameters improvement thereafter. Conclusion MIS-N is still evolving as a disease entity with no clear, directed guidance yet on diagnosis and management. Management is extrapolated from treatment of MIS-C. Additional case reports and series are warranted to increase awareness and enable better understanding of the disease pathology among clinicians for timely investigation, diagnosis, and management.
SARS-CoV-2

Introduction: Movement restrictions and changes in medical education around the world due to the Coronavirus 2019 pandemic have been sources of stress, which affect sleep and compound the demands of medical education. In the Philippines, stay-at-home orders were implemented in the National Capital Region on 15 March 2020, and despite various readjustments and re-definitions, remain in effect to date, March 2022. Objectives. This cross-sectional study aims to determine the sleep quality and daytime sleepiness of Filipino medical students during prolonged stay-at-home orders, to compare them with pre-pandemic evaluations, and to explore associations between scores and participant characteristics. Methods: The medical student population of a state-run university in the City of Manila was included, while those on a leave of absence were excluded. The Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index which measure excessive daytime sleepiness and sleep quality, respectively, were disseminated via Google Forms from April to May 2021. Results: Response rate was 87.75% (n=709) with a mean age of 22.9 ± 2.0 years and a 1:1.09 male-to-female ratio. Among the respondents, 41.18% had excessive daytime sleepiness, and was significantly higher for first-year premedicine students. Compared to pre-pandemic scores, daytime sleepiness decreased during the pandemic. On the other hand, 62.34% of the respondents had poor sleep quality, with global scores being significantly higher for the first-year pre-medicine students. Relationships between participants' characteristics and their scores were extremely weak, while a moderately significant correlation existed between global daytime sleepiness and sleep quality scores. Conclusion Both excessive daytime sleepiness and poor sleep quality remain prevalent during prolonged stay-athome orders. These reflect the effect of the pandemic on stress inherent to medical education, and may be additional facets to be regarded in evaluating the general well-being of medical students.
SARS-CoV-2

Objective: This study aims to determine the clinical profile and course on follow-up of newborns delivered to a SARS-CoV-2 positive mother from two private tertiary hospitals. Methodology: This is a retrospective, cross-sectional study. A chart review of all neonates delivered to SARS-CoV-2 positive mothers was conducted. Subsequent interview was done to determine their clinical course and neurologic status at 3-, 6-, 9-, 12-, and 15-month-old. Data collected was presented as frequencies, percentages, or proportions. Results: Out of the 67 newborns born to SARS-CoV-2 positive mothers, three neonates tested positive for SARS-CoV-2. All three were delivered to mothers with mild symptoms, were full term, with good APGAR score and appropriate for gestational age. One was eventually intubated and managed as COVID-19 confirmed critical. Among the SARS-CoV-2 negative newborns, majority had an unremarkable neonatal outcome. Thirty-six neonates were available for follow-up: 1 expired due to aspiration pneumonia at 2 months of age, 4 were readmitted for pneumonia, UTI, acute gastroenteritis, and cow’s milk allergy. Twenty-one had infection at one point prior to this study follow-up but were all mild not requiring admission. Two had abnormal head size, while 2 had developmental delay, these 4 infants with neurological findings on follow-up were all RT-PCR negative at birth. Conclusion Maternal COVID-19 infection does not necessarily result to a neonatal infection. For those neonate swith mild symptoms, SARS-CoV-2 causality could not be established. On follow-up, there were a few who developed significant problems that have long-term implications in the overall growth and development of the child.
SARS-CoV-2

ABSTRACT The SARS-CoV-2 outbreak in Wuhan (China) has become a global pandemic. Various variants of SARS-CoV-2 have been detected and the variant number of the virus continues to grow. A particular SARS-CoV-2 variant can be detected in a country that was never infected before by the virus. Furthermore, a specific SARS-CoV-2 variant, which has been detected before in a country, can be detected too in another country. The emergence of SARS-CoV-2 variants is mainly caused by mutations and recombinations. The emergence of a SARS-CoV-2 variant in a country (which was never infected before by the virus), of course, can be explained easily as it is caused by the effect of the viral spread among countries, although there may be another explanation. On the other hand, the emergence of a SARS-CoV-2 variant (which has been previously detected in a country) in another country, always has been explained only as it is caused by the effect of the viral spread between countries. However, maybe it is caused by another factor. A literature review was performed to look for the explanation related to the emergence of a certain SARS-Cov-2 variant (which is already detected before in another country) in a country. Based on the literature review results related to the RNA virus genome and its mutation as well as its recombination, it is easy to explain the cause/agent of the emergence of a SARS-CoV-2 variant (which has been previously detected elsewhere) in another country. In this case, the emergence of a SARS-CoV-2 variant (which has been previously detected elsewhere) in a country may be caused by mutations and/or recombinations in addition to the probability that it may also occur due to the spread of the virus among countries; so the emergence of SARS-CoV-2 variant that has been previously detected elsewhere in other countries does not only occur due to the spread of the virus.
SARS-CoV-2

Introduction: Movement restrictions and changes in medical education around the world due to the Coronavirus 2019 pandemic have been sources of stress, which affect sleep and compound the demands of medical education. In the Philippines, stay-at-home orders were implemented in the National Capital Region on 15 March 2020, and despite various readjustments and re-definitions, remain in effect to date, March 2022. Objectives. This cross-sectional study aims to determine the sleep quality and daytime sleepiness of Filipino medical students during prolonged stay-at-home orders, to compare them with pre-pandemic evaluations, and to explore associations between scores and participant characteristics. Methods: The medical student population of a state-run university in the City of Manila was included, while those on a leave of absence were excluded. The Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index which measure excessive daytime sleepiness and sleep quality, respectively, were disseminated via Google Forms from April to May 2021. Results: Response rate was 87.75% (n=709) with a mean age of 22.9 ± 2.0 years and a 1:1.09 male-to-female ratio. Among the respondents, 41.18% had excessive daytime sleepiness, and was significantly higher for first-year premedicine students. Compared to pre-pandemic scores, daytime sleepiness decreased during the pandemic. On the other hand, 62.34% of the respondents had poor sleep quality, with global scores being significantly higher for the first-year pre-medicine students. Relationships between participants' characteristics and their scores were extremely weak, while a moderately significant correlation existed between global daytime sleepiness and sleep quality scores. Conclusion Both excessive daytime sleepiness and poor sleep quality remain prevalent during prolonged stay-athome orders. These reflect the effect of the pandemic on stress inherent to medical education, and may be additional facets to be regarded in evaluating the general well-being of medical students.
SARS-CoV-2

Introduction: In order to suppress the COVID-19 virus, several vaccines have been developed. The administration of COVID-19 vaccines entails its acceptance. However, misinformation and vaccine uncertainty are main factors that affect vaccine acceptance. This study aimed to determine the most trusted health information source, the most frequently accessed health information source, and health literacy of older adults within Metro Manila. Methods: This study employed a quantitative non-experimental design utilizing correlational and descriptive approaches. Convenience sampling was utilized via Facebook to recruit participants. The survey was adapted from four different questionnaires and went through reliability testing and expert validation. Results The researchers collected responses from a total of 123 participants. The participants were noted to have an overall high level of acceptance for the COVID-19 vaccine ( 4.10, SD ± 0.22). The study revealed that doctors were the highly trusted health information source (( =3.69, SD ± 1.30), followed by government health agencies (( =3.18, SD ± 0.73), whereas religious organizations and leaders (( =2.45, SD ± 0.48) were the least trusted sources. However, despite being the least trusted source, religious organizations and leaders were shown to be positively related (p=0.049) and highly predictive of COVID-19 vaccine acceptance. The most frequently accessed health information source, health workers, have a weak correlation (r=.323) and were found to be significantly positively related (p=0.008) and highly predictive of the acceptance of the COVID-19 vaccine. The credibility of health information sources is likely to influence their selection, influencing decisions and behaviors.
SARS-CoV-2 ; Geriatrics

BACKGROUND

Multisystem inflammatory syndrome in children (MIS-C) is the most severe pediatric disease associated with COVID19 for which the optimal therapeutic strategy remains unknown. There have been studies that aim to describe treatment outcomes but have conflicting findings. Evidence is urgently needed to support treatment decisions for MIS-C.

This study aims to compare the effectiveness of intravenous immunoglobulins (IVIG) plus corticosteroids versus IVIG alone as initial therapy in MIS-C, in terms of decrease in left ventricular dysfunction, decrease in inotropic support, reduced need for adjunctive immunomodulatory treatment, favorable fever course, decrease in mechanical ventilator use, decrease in admission to the pediatric intensive care unit, and decrease in coronary artery aneurysm.

Published articles reporting MIS-C treatment outcomes were searched through various databases. A structured data extraction was employed and risk of bias was assessed with Newcastle-Ottawa Scale. Corticosteroid effects were reported as pooled odds ratio and forest plots were generated for each outcome.

The effect on the components of hemodynamic support showed no significant difference between the two treatment groups: left ventricular dysfunction (P -value= 0.86), inotrope use (P -value = 0.65), mechanical ventilator use (P -value = 0.21), and admission at the PICU (P -value = 0.87). However, initial treatment with IVIG plus corticosteroids, was associated with a more favorable fever course (P -value = < 0.02), less use of adjunctive immunomodulatory therapy (P -value = < 0.00001), and less incidence of coronary artery aneurysm (P -value = < 0.04).

Initial treatment with IVIG plus glucocorticoids was associated with a more favorable fever course, less use of adjunctive immunomodulatory therapy, and less incidence of coronary artery aneurysm than IVIG alone.

Background and Objective: Gastrointestinal (GI) manifestations among COVID-19 patients are common; however, their relation with patient outcomes remains unclear. The study, therefore, aims to determine the association of GI manifestation with in-hospital mortality among end-stage renal disease patients (ESRD). Methods: This is a retrospective cohort design. All 501 ESRD patients with COVID-19 and admitted to the National Kidney and Transplant Institute from June 2020 to 2021 were included. GI manifestation was defined as the presence of any of the following signs and symptoms on admission: dysgeusia, anorexia, abdominal pain, nausea, vomiting, diarrhea, and jaundice. The outcome of interest was in hospital mortality, defined as death due to any cause during hospital stay. Stata17 was used for data analysis. Results: The overall prevalence of GI manifestation was 58.08% (95% CI: 53.63-62.45). The most common symptoms were abdominal pain (27.15%), loss of appetite (24.35%), and nausea (19.76%). Patients with GI manifestation had a higher proportion of stroke, lower median systolic blood pressure, and a lower proportion of abnormal oxygen saturation and diastolic blood pressure than those without GI manifestation. Across all clinical outcomes, only hospital stay significantly differ between those with and without GI manifestation. In-hospital mortality was 31.14% (95% CI: 27.10-35.39%) and showed no significant association with GI manifestation (OR= 0.94, p=0.749). Conclusions GI manifestation was common among ESRD patients with moderate-to-severe COVID-19. The inhospital mortality rate is also high; however, GI manifestation was not associated with this outcome. Meanwhile, GI manifestation leads to longer hospital stay.
Kidney Diseases ; SARS-CoV-2

Background: The Panbio™ COVID-19 Ag Rapid Test is a Food and Drug Administration (FDA)-approved point-of-care test (POCT) used for SARS-CoV-2 detection which has met minimum sensitivity and specificity requirements by the World Health Organization (WHO). Objective: The study aimed to compare the clinical performance of a commercial lateral flow assay (LFA) to reverse transcriptase polymerase reaction (RT-PCR) in SARS-CoV-2 infection diagnosis Methodology: Clinical data and simultaneous LFA and RT-PCR samples collected from June 2021 to June 2022 were obtained to analyze the diagnostic accuracy of LFA compared to RT-PCR. Results: A total of 265 samples was obtained. 34.45% of RT-PCR positive samples were reliably detected by LFA. COVID-19 was reliably ruled out by LFA in 99.32% RT-PCR negative samples. LFA sensitivity among symptomatic patients with ≤7 days of illness was 51.61%, slightly higher than those with >7 days of illness (18.92%), and significantly higher than asymptomatic patients (16.67%). Asymptomatic subjects have a varied range of Ct-values, indicating different stages of infection or viral loads. Individuals with symptoms for more than 7 days have higher Ct-values, suggesting they are in later stages of infection or have lower viral loads. The probability of a positive LFA result decreases significantly when the Ct-value is beyond 28-30. Conclusion The LFA evaluated in this study did not show significant sensitivity and specificity during the early disease course wherein viral loads are suggestively high. However, its utility to accurately rule out COVID-19 is quite reliable in subjects with symptoms that are >7 days since Ct-values are suggestively beyond 28-30 which implies a significantly decreased probability of a positive LFA result.
COVID-19 ; SARS-CoV-2

Diabetes mellitus (DM) is a known risk factor for morbidity and mortality among patients with COVID-19 based on recent studies. While there are many local and international guidelines on inpatient management of diabetes, the complicated pathology of the virus, the use of glucose-elevating drugs such as glucocorticoids, antivirals and even inotropes, and various other unique problems has made the management of in-hospital hyperglycemia among patients with COVID-19 much more difficult than in other infections. The objective of this guidance is to collate and integrate the best available evidence that has been published regarding in-patient management of diabetes among patients with COVID-19. A comprehensive review of literature was done and recommendations have been made through a consensus of expert endocrinologists from the University of the Philippines-Philippine General Hospital (UP-PGH) Division of Endocrinology, Diabetes and Metabolism. These recommendations are evolving as we continue to understand the pathology of the disease and how persons with diabetes are affected by this virus.
COVID-19 ; SARS-COV-2