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

Background and Objectives: The immediate post-discharge period of COVID-19 patients is a vulnerable state due to several complications that may arise during this time. Some patients get readmitted shortly after being discharged while others report persistence of symptoms, develop specialized needs, or observe a decline from their baseline functional capacity. Information on the outcomes of post-COVID discharge patients in our institution is currently lacking. This study described the outcomes of patients with COVID-19 after their discharge from the service areas of Philippine General Hospital. Methods: This study is a retrospective chart review involving charts of all adult patients discharged from the PGH COVID service areas last August 2021 to October 2021. Data from their follow up consults at 1 week, 1 month, and 3 months post-discharge were reviewed. Baseline characteristics and post-discharge outcomes including post-COVID symptoms, special care needs, mortality, rehospitalization, emergency consult, level of dependence, and ability to return to work were assessed. Results: A total of 171 patient charts were included. The mean age of patients was 53.7 years. Most were male (60.2%), unemployed (59.7%), non-smoker (55%), hypertensive (57.9%), diabetic (50.2%), and obese (50.2%). Most of them were oxygen requiring (80%) and with severe to critical COVID infection (72.5%) during admission. At 3 months post-discharge, 113 (66%) were stable and able to complete the follow up, 8 (4.6%) died, 9 (5.2%) got readmitted, and 41 (23.9%) were lost to follow up. Among those who were able to follow up after 3 months, 84 (74%) were asymptomatic. Among those who remained symptomatic, the most common symptoms were dyspnea, fatigue, and cough. After 3 months, 100 (88%) did not require special care needs, 100 (88%) were fully independent, and 45 (39.8%) were able to return to baseline work. Conclusions Despite the majority of patients having severe to critical COVID infection during admission, most were asymptomatic within 3 months post-discharge. In those who developed persistent symptoms, dyspnea, cough, and fatigue were the most common symptoms identified regardless of COVID severity. Majority did not require special care needs.
COVID-19

Background: The COVID-19 pandemic and its effects such as community restrictions, lockdowns, and unemployment have greatly affected the household food security status in urban poor communities leading to poor accessibility of sufficient nutritious food and subsequently affecting the nutrition of children. Objectives: This present study aims to determine the prevalence of household food insecurity in households with children aged 0-10 amid the COVID-19 pandemic in an urban poor community in Quezon City. Methodology: A descriptive cross-sectional study was done to evaluate the food security status and experiences of households amid the COVID-19 pandemic. Results: A total of 405 households were surveyed to answer questions designed to determine their general profile relative to their food security experiences during the pandemic. It was observed that the majority of the households in the urban poor community belong to Class D earning between PhP 8,001.00 - PhP 15,000.00. The heads of these households as well as caregivers mostly belong to the high school graduate level. Based on the conducted survey, it was revealed that 59.5% of the households were severely food insecure (90% CI: 55.4-63.4) and only 4.2% ( 90% CI: 2.8-6.2) were food secure. Conclusion The prevalence of food insecurity in the urban poor community is determined to be high, with 31.6% households having moderate food insecurity, while only 4.2% households are food secure. The majority of surveyed households were anxious and uncertain about their food supply, and also reported experiencing varying levels of food insecurity related to sufficiency of food quality.
COVID-19

Introduction: The coronavirus pandemic has affected millions worldwide. Better understanding of COVID-19 in pediatric hematology-oncology patients in a resource-limited setting is crucial to improve care as the pandemic ensues. Objectives: This study describes the clinical profile and outcomes of pediatric hematology oncology patients with COVID-19 seen at the Philippine General Hospital (PGH). Methods: A retrospective, descriptive review of pediatric hematology oncology patients with COVID-19 seen between March 2020 to March 2021 in PGH was done. Results: Forty patients were identified. Seventeen percent had non-malignant hematologic conditions, 40% had leukemias, and 42.5% had solid tumors. Fever and cough were the most common manifestations. Seventy-six percent were on treatment, 9% were newly diagnosed, and 7% were in relapse or disease progression. Fifty-five percent had mild COVID-19; 5% and 2.5% had severe and critical COVID-19, respectively. Thirty-seven percent were asymptomatic. Cancer-related therapy was placed on hold for most patients. There were two mortalities, none was due to COVID-19. Conclusion Results suggest that patients with hematologic and oncologic conditions have a mild course, with majority showing recovery from COVID-19. Delays in cancer-related therapy however, may contribute to disease progression and mortality.
COVID-19

OBJECTIVE

To describe the treatment outcomes of patients who underwent tube pericardiostomy for all etiologies of non-traumatic massive pericardial effusion or tamponade during the COVID-19 pandemic and determine the association between patient profile and treatment outcomes.

Data were obtained from patients with massive pericardial effusion or cardiac tamponade who underwent surgical drainage from January 1, 2020, to September 1, 2022, in the University of the Philippines – Philippine General Hospital (UP-PGH). These patients’ demographic and clinical profiles, and treatment outcomes were evaluated using frequencies and percentages. Chi-squared and Fisher’s tests determined the differences between COVID (+) and (-) groups. Odds Ratio was used to assess the risk of complications and mortality.

The study population comprised 90 patients with a mean age of 45 years. 54.4% were females. Fifteen (16.67%) were COVID-19 (+) and 75 (83.33%) were COVID-19 (-). Most of the patients were of O+ blood type (34.4%), with no smoking history (67.8%) and no COVID-19 vaccination (76.7%). Common comorbidities were cancer (70%), tuberculosis infection (32.2%), and hypertension (25.6%). No significant difference was found between the two study groups. The presentation was subacute (one week to three months) (62.2%), with the most common symptoms of dyspnea (81.1%), orthopnea (61.1%), and cough (52.2%). Tachycardia (80%) and tachypnea (57.8%) were the most common presenting signs. Hypotension was found more frequently among COVID-19 (+) patients (46.7% vs. 12.0%, p = 0,003, 95% CI). Most patients had abnormal WBC, coagulopathy, elevated inflammatory markers, and cardiac biomarkers. Sinus tachycardia, regular sinus rhythm, ST-T wave changes, and low voltage QRS were common ECG findings. The most common chest X-ray results were pleural effusion (80%), pneumonia (71.1%), and enlarged cardiac border (42.2%). Majority of echocardiographic findings were large effusion (>2 cm) (97.8%), RV collapse (40%), and RA collapse (23.3%). An average of 628 ml of pericardial effusion was drained, predominantly serous and exudative. One specimen yielded a positive AFB culture. 6.7% showed carcinoma cells on fluid cytology. The pericardium was normal in 78.9%. 10.0% of the pericardial biopsy specimen had carcinoma, with metastatic cancer being the most common etiology. The most common cancers were lymphoma (22.7%), breast (25.8%), and lung (16.7%). Hospital length of stay was 18 days in COVID-19 (+) patients and 12 days in COVID (-). The complication and in-hospital mortality rate in the COVID-19 (+) compared to the (-) group (86.7% vs. 73.3% and 46.7% vs. 41.3%, respectively) were not statistically significant. The most common complications were respiratory failure (60%), shock (53.3%), and nosocomial pneumonia (40%). There was no association between clinical factors and the risk for complications. Any complication increased the risk for mortality (OR 15.0, 95% CI 3.2-19.7, p=0.002). The presence of hypertension (OR 0.08, 95% CI 0.02 to 0.4, p=0.001) and subacute duration (OR 0.3, 95% CI 0.09 -0.9, p=0.045) decreased the mortality risk.

Profiles were similar in both groups. There was no association between patient profile and complications. Having COVID-19 did not affect patient outcome. The presence of any complication increases the risk of mortality. In-hospital mortality was high at 42.2%.

Reintegration is an integral part of nursing care. Nurses play a critical role in contributing support, dependence, and continuity of care from rehabilitation to reintegration. While the reintegration of patients is a concept often used in nursing, its theoretical origin has remained unclear. This article aimed to conduct a concept analysis of reintegration for the development of nursing as a discipline and improve nursing care and health outcomes. The evolutionary strategy to concept analysis of Roger was utilized, which resulted in the characteristics of reintegration as to its attributes, antecedents, consequences, and exemplar in nursing practice in the context of COVID-19. The capacity to adapt, reorganize, offer support, and build a network of resources are attributed to the concept of reintegration. Antecedents include rehabilitation, survivorship from illnesses, trauma, and injuries, and disruption of social and physical functional performances and activities. The identified consequences include transition to recovery, quality of life, independence, successful adaptation, job satisfaction, holistic care, and continuity of care. The new conceptual definition of reintegration emerged. Reintegration is a process of nursing care among patients who demand assistance and support before transitioning to regain normality or on their way to being restored to the community in the presence of adaptation from health adversities. The patient in all areas is cared for holistically, offering support to meet his needs and overcome challenges in terms of physical, mental, social, and emotional aspects. Concept analysis is as essential as operationalizing a concept in the nursing discipline.
COVID-19

Early into the pandemic, medical attention centered on the immediate need for intensive medical care of patients diagnosed to have coronavirus 2019 (COVID-19). As more data emerged on the best medical care possible, attention was also given to the complications and long-term sequelae of COVID-19.
COVID-19

Background: The internet contains both accurate and false coronavirus-related information. Is the public equipped with electronic health literacy in navigating online material to make informed health decisions? Objective: This study measured Filipino adults’ perceived level of COVID-19-related eHealth literacy, and how this affects their adherence to preventive practices against COVID-19 infection. Methods: In this analytical cross-sectional study, data were collected from 345 adult respondents who were patients, and their companions, consulting in Healthway Family Clinics in Marikina and Rizal. They answered self-administered electronic questionnaires in English or Filipino. The data collection tool was adapted from the Coronavirus-Related eHealth Literacy Scale (CoV-eHEALS) with permission from the authors. Pearson correlation determined the relationship between mean CoV-eHEALS and mean Protective Behavior Adherence (PBA) score. ANOVA determined the relationship of CoV-eHEALS and PBA with sociodemographic variables. Results: Higher Covid-related eHealth literacy is associated with better adherence to protective behaviors against COVID-19. The overall mean CoV-eHEALS is 23.67 while the overall mean PBA score is 3.81 (r=0.32). Younger age, female sex, and high educational attainment are associated with high CoV-eHEALS. Female sex and high educational attainment are associated with high PBA score Conclusion eHealth literacy is essential for COVID-19 awareness since it influences the public‘s engagement in preventive behavior. Sociodemographic variables should be considered in health education, targeting individuals of younger age, male sex, and lower education. Evaluation of the reliability of online sources Filipinos use to gather health-related information is a possible focus for future research.
COVID-19

BACKGROUND: The practice of Unang Yakap or Essential Intrapartum and Newborn Care (EINC) during the COVID-19 pandemic poses a safety concern with regards to a newborn’s exposure to their COVID-19 suspected mother. OBJECTIVES: This study aims to describe the experiences of COVID-19-suspected mothers and explore the factors influencing their decision to allow healthcare professionals to practice full EINC. Specifically, it aims to: 1) describe the experiences of mothers prior to, during, and immediately after delivery, and during postpartum care leading to their decision; and 2) explore the factors that influence the participant’s decision to practice EINC amidst the pandemic. METHODOLOGY: For this phenomenological case study, online interviews with nine (9) participants were conducted using a 13-item questionnaire describing their experience. Thematic analysis using the inductive and semantic approach was conducted to identify the common themes or factors. RESULTS: Of the nine (9) participants, five (5) experienced EINC, while four (4) did not. The COVID-19 status and the choice to undergo Unang Yakap were not a causal relationship. Two main influences, mother-related factors, and hospital-related factors, were identified and were found to have weight in decision-making. The mother-related factors include prior knowledge and perception towards EINC, COVID-19 status, personal beliefs, and information from social media; while the hospital-related factors are hospital facilities, hospital protocols, and HCW-patient relationship. CONCLUSION By delineating the different factors that influence mothers’ decisions, this study allows for the identification of possible bottlenecks in the practice of EINC, as well as effective and efficient means to encourage its practice.
COVID-19

Background: The global economy has been severely affected by the COVID-19 pandemic which proved to be more than a public health crisis. Volume and gross income have also declined in the health service sector including the diagnostic imaging and radiotherapy divisions of the radiology departments in other countries. Objective: This study determined the change in volume and gross income of the Radiology Department of a tertiary hospital which was designated as a COVID-19 referral center in the Philippines. Methodology: Monthly records of the profit centers of the Radiology Department were reviewed noting the volume and gross income one year before and during the first year of the pandemic. Results: Records were successfully retrieved for the volume of procedures and revenue for each profit center from one year before the pandemic (from March 1, 2019 to February 28, 2020) and the first year of the pandemic (from March 1, 2020 to February 28, 2021). There was a total reduction of 120,046 procedures conducted and Php 84,837,614.16 in revenues generated between the two periods. This is equivalent to a 61.98% (range: 47.92% to 83.37%) decrease in the volume of procedures and a 45.02% (range: 31.08% to 77.86%) decrease in revenue. These changes were found to be statistically significant. Conclusion The COVID-19 pandemic caused a decline of all profit centers in the Radiology Department. The decline was associated with changes in quarantine restrictions. Data from this study may help the administration of the institution or other institutions to conduct their own studies and cope with future pandemics of similar magnitude or further surges of the current pandemic on decisions regarding budget and resource allocation.
COVID-19