1.Endoscopy in a COVID-19 referral National University Hospital: A single-center experience and recommendations
John Mark K. Torres ; Eric B. Yasay ; Ma. Lourdes O. Daez ; Mark Anthony A. de Lusong
Acta Medica Philippina 2021;55(2):247-255
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
2.Respiratory manifestations, radiologic findings and respiratory management of hospitalized children with COVID-19 among different age groups: A systematic review.
Maria Cristina H. LOZADA ; Fides Roxanne M. CASTOR ; Kevin L. BAUTISTA
Acta Medica Philippina 2022;56(5):111-118
Objective: This paper aims to determine the respiratory manifestations, radiologic findings, and management of coronavirus-19 (COVID-19) among the hospitalized children of different age groups based on a systematic review of literature.
Methodology: We searched the MEDLINE, Google Scholar, Cochrane, and MedRvrix databases for relevant studies on pediatric COVID-19 done between January 1 to May 25, 2020. Data on demographic features, pulmonary symptoms, chest imaging findings, and oxygen support were extracted in a data abstraction form and analyzed among the different pediatric age groups.
Results:?Sixteen studies were included in this systematic review, with a total of 61 patients. Thirty-nine patients (64%) belong to the 2 to 12 year age group. Cough was the most commonly reported respiratory symptoms among children older than one month. Most of the patients, particularly adolescents, had asymptomatic or mild infection. On chest imaging, infiltrates and ground-glass opacities were the most common abnormalities. Oxygen supplementation via nasal cannula, non-invasive ventilation, and mechanical ventilation was noted in three cases.
Conclusion: Our systematic review shows that COVID-19 can present with a spectrum of respiratory manifestations and disease severity as well as a variety of radiologic abnormalities across different pediatric age groups. Whilemost children do not develop hypoxemia warranting oxygen supplementation, a severe respiratory infection can still manifest in children. Asymptomatic and milder infections are common and highlight the need for appropriate respiratory precautions. More pediatric studies on the pulmonary manifestations and management of children with COVID-19 can aid in a better understanding of this novel disease.
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3.The role of GnRH agonists in the management of large myomas during a pandemic.
Stella Marie L. JOSE ; Ina S. LRABON
Philippine Journal of Reproductive Endocrinology and Infertility 2022;19(1):7-12
This paper shall present a case of a 42-year-old nulligravid who complained of chronic pelvic pain, vaginal bleeding and palpable abdominal mass secondary to multiple large myomas. Due to the logistical and health restrictions in most hospitals during the peak of the COVID-19 pandemic, elective surgery was postponed and a temporizing medical management was instituted in the form of GnRH agonist, which afforded relief. This paper shall also discuss the mechanism of action of GnRH agonist, and its crucial role as an essential medical treatment option for patients with debilitating conditions such as myoma uteri.
COVID-19
4.Evaluation of urine L-FABP Point of care kit in the Philippines as predictive marker of clinical severity of COVID-19 (EPOCH COVID study)
Alberto Chua ; Lynn Gomez ; Rontgene Solante ; Kay Beltran ; Eric Chua ; Renz Pasilan ; Erika Chan ; Nica Lee ; Ann Celestyn Uichanco ; Micaela San Diego ; Abegail Danasen
Philippine Journal of Internal Medicine 2022;60(4):238-242
Background:
The search for simple clinical and laboratory markers to help predict the clinical severity of patients presenting with COVID-19 has prompted this study to look at the predictive value of urine L-FABP (Liver Type-Fatty Acid Binding Protein) point-of-care test kit at the initial presentation of COVID-19 patients to the hospital.
Methods:
The validation study prospectively included 109 consecutive patients with mild to moderate COVID-19, mean
age of 52.2 years (range 19-84) presenting at the Emergency Rooms of 4 participating Metro-Manila hospitals from February to April 2021, with available data for analysis for 103 patients. Urine L-FABP POC (Point-of-Care) test and other clinical parameters and the level of severity of COVID-19 were determined at Day 0, Day 4 and Day 7. Computations for Sensitivity, Specificity, Positive and Negative Predictive values and Likelihood ratios were performed.
Results:
Twenty-three patients tested positive for urine L-FABP, out of the 103 patients analyzed, while 80 tested negative. Of the 23 patients who tested positive for urine L-FABP, 6 has progressed in severity, while 17 did not progressed. Of the 80 patients who tested negative for urine L-FABP, 13 progressed, while 67 did not progressed in severity. Giving a Sensitivity of 31.58%, Specificity of 79.76%, Positive predictive value of 26.09%, Negative predictive value of 83.75%. Combining urine L-FABP and initial clinical parameters like SIRS (Systemic Inflammatory Response Syndrome) criteria to predict progression of severity yielded a higher Specificity of 91.67 % and Negative Predictive value of 84.62%.
Conclusions
The study shows the utility of initial urine L-FABP POC test as a negative screening test in triaging adult
patients presenting to the ER with mild to moderate COVID-19. Patients at the ER with a negative urine L-FABP test, will most likely not progressed to severe COVID-19. Combining clinical parameters like SIRS Criteria with the urine L-FABP result can increase the negative predictive value.
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5.A rapid review on the sensitivity of SARS-CoV-2 RT-PCR done on different clinical specimens
Denise L. Sembrano ; Frangelo Conrad P. Tampus ; Leonila F. Dans ; Anna Lisa T. Ong-Lim
Pediatric Infectious Disease Society of the Philippines Journal 2021;22(1):26-39
Background:
RT-PCR using respiratory tract specimens, most commonly nasopharyngeal swab (NPS), has been used to confirm the diagnosis of COVID-19. NPS is a relatively invasive procedure that causes patient discomfort and risks viral transmission. Other specimens are therefore being investigated for the detection of SARS-CoV-2 RNA.
Objective:
To determine the sensitivity of non-respiratory tract specimens in detecting SARS-CoV-2 RNA in patients with COVID-19.
Methodology:
This review summarized the results of eight studies obtained from a literature search done in May 2020 in PubMed MEDLINE, Cochrane Library and MedRxiv. Two independent investigators reviewed and appraised the studies that were included, and pooled estimates of sensitivity for each specimen were determined using Stata’s Metaprop function
Results:
The sensitivity in detecting SARS-CoV-2 RNA in non-respiratory tract specimens of diagnosed COVID-19 patients are as follows: Saliva 77% (95% CI 71-83%), stool/rectal swab/anal swab 22% (95% CI 22-37%), blood/serum/plasma 2% (95% CI 1-3%), and urine 22% (95% CI 18-25%).
Conclusion
SARS-CoV-2 RNA is detected in saliva, stool/rectal swab/anal swab, blood/serum/plasma and urine. Among these, saliva has the highest estimated sensitivity. However, more studies are needed to correct the heterogeneity brought about by factors such as timing of specimen collection, disease severity and treatment.
COVID-19
6.Maternal and Neonatal Clinico-Demographic profile and outcomes during the COVID-19 Pandemic at the Chinese General Hospital and Medical Center
Maria Ronallaine D.L. Bello ; Shirley Kwong-Buizon
Pediatric Infectious Disease Society of the Philippines Journal 2021;22(2):46-54
Background:
COVID-19 is an ongoing health concern that hospitals have struggled to keep up with, given its increasing burden with the passage of time. Considerations for the management of COVID-19 should be made especially for pregnant patients and their neonates.
Objectives:
To determine COVID-19 prevalence and the clinical profile of mothers admitted for childbirth at Chinese General Hospital and Medical Center from May 2020 to July 2020. The profile and outcomes of neonates born to these mothers were likewise studied.
Materials and Method:
A descriptive cross-sectional study was done that included mothers admitted for childbirth who had SARS-CoV-2 RT PCR swab test and their neonates. A total of 408 medical records of mother and neonate dyads were reviewed. Relevant variables such as the patients’ demographic profile, clinical characteristics, co-morbidities and the maternal and neonatal outcomes were obtained. Frequency distributions were made to assess the prevalence of COVID-19 among the patients, as well as maternal and neonatal outcomes.
Results:
Twenty-two (5.39%) mothers tested positive for COVID-19, while all neonates (n = 22) that underwent RT-PCR swab at the 24th hour of life had negative results. Of the 22 COVID-19 positive mothers, 2 (9.09%) were symptomatic upon admission while 20 (90.09%) were asymptomatic. The following were the key trends among those mothers who tested positive for COVID-19: (1) 81.82% were from ages 20-39 years old, (2) 72.73% were multigravida mothers, (3) 54.55% had normal spontaneous delivery, (4) diabetes mellitus was the only noted comorbidity. Key findings on the neonatal outcomes observed in the study population of both COVID-19 positive and negative cases, include: (1) majority of neonates had an APGAR score of greater than 7 at 1st and 5th minute of life; (2) higher frequency of neonates with Ballard’s score of more than 37 weeks AOG; (3) more male neonates as compared to female neonates; (4) a normal birth weight for majority of cases; (5) 45.45% of neonates born to COVID positive mothers had a length of stay of <48 hours as compared to 72.8% of neonates born to COVID negative mothers; and (6) neonatal pneumonia as the most common comorbid condition in both cases.
Conclusion
This study noted a prevalence of 5.39% COVID-19 positive mothers. SARS-CoV-2 virus was not detected in all of the neonates born to COVID-19 affected mothers. Neonates delivered to COVID-19 positive mothers had similar trends in the neonatal outcomes when compared to neonates delivered to mother who were COVID-19 negative.
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8.Teaching clinical medicine during the pandemic: Experiences and insights.
Journal of Medicine University of Santo Tomas 2022;6(1):939-942
The Covid pandemic nearly brought our lives into a different dimension beyond our imagination. Measures to ensure the safety of everyone have never been stricter. The education system had to deal with similar restrictions. Everyone shifted to online virtual classes, which has never been easy to both the teachers and students. Not only are we concerned of our responsibilities as educators but responsive to the needs of students and patients as well during these times of uncertainties. This article briefly describes my personal insight on teaching medicine and how patients continue to take part in the learning process of students despite restrictions.
Covid-19
9.The association between perceived level of COVID-19-related eHealth literacy and adherence to preventive practices against COVID-19 infection among adult patients in healthway family clinics in Marikina and Rizal: An analytical cross-sectional study
Ma. Regina Luz D. Misa ; Naikko Ves D. Nery
The Filipino Family Physician 2022;60(2):223-227
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.
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10.Triple ripples: The Neuropsychiatric aftermath of COVID-19 infection
Maria Carmela M. Alipio ; Anna Aurelia Noel-Cortes
The Philippine Journal of Psychiatry 2022;3(1-2):16-25
This case illustrates the myriad neuropsychiatric symptoms associated with the direct and indirect
exposure to COVID-19 infection. The disruption in our daily routines, the uncertainty brought on by the
then novel and unknown condition, the specter of death and the “horror” stories that spread through the
grapevine during the lockdown shook the foundations of our existence. To make matters even worse, the
government protocols required those infected to move away from the comfort of the familiar and the
emotional support of family and friends.
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