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

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

Introduction: Cancer patients are more susceptible to coronavirus disease-19 (COVID-19) infection because they are immunosuppressed by their disease or therapy, most of them have coexisting medical conditions, and they frequently visit hospitals for treatment and surveillance. Objective: The objective of this study was to determine the prevalence of COVID-19 infection among gynecologic oncology patients receiving treatment in a COVID-19 referral hospital. Materials and Methods: A descriptive, cross-sectional study involving 47 gynecologic cancer patients receiving treatment from June 2020 to December 2020 was performed. All patients underwent SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) swab test and symptom and exposure assessment before the start of cancer treatment. Patients with negative SARS-CoV-2 RT-PCR swab test results received their planned treatment, and a repeat swab test and triage assessment were done midtreatment and after treatment. Results: Five (10.6%) patients had positive baseline SARS-CoV-2 RT-PCR swab results, but all proceeded with treatment after negative results were obtained. Only 1 (2.13%) patient had a positive SARS-CoV-2 RT-PCR swab test result at midtreatment. All patients had no COVID-19-associated symptoms and none of them tested positive for COVID-19 infection posttreatment. Conclusion The prevalence of COVID-19 infection among gynecologic cancer patients receiving cancer treatment is 2.13%. All patients who had positive SARS-CoV-2 RT-PCR swab test results at baseline or midtreatment were able to continue and complete treatment. There were no severe clinical events or mortalities among those affected with COVID-19 infection.
COVID-19

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.

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.

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.

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.
COVID-19

This document offers guidance to help the ophthalmologist plan for the safe resumption of elective surgical care. There are 4 sections: (I) COVID-19 Awareness, (II) Preparedness, (III) Patient Issues, and (IV) Delivery of Safe and High-Quality Care. Each section contains key issues to be addressed before elective surgery may be safely reinstituted. Understanding the capabilities of health facilities (e.g., testing, operating rooms) as well as the potential limitations in manpower and supplies will remain important, while keeping an eye out on subsequent waves of COVID-19.
COVID-19

With the resumption of elective surgeries during this COVID-19 pandemic, surgeons and facilities should implement infection prevention and control measures to ensure the safety of patients and health care workers. This advisory highlights the key principles, risk stratification considerations, and recommended approach regarding Covid-19 testing prior to elective ophthalmic surgeries.
COVID-19

Key Findings There is some short-term benefit from the use of mesenchymal stem cell therapy for severe COVID-19 in a lowquality, small randomized controlled trial (RCT). Further studies, ideally with good quality RCTs, are needed to confirm benefit and safety. • Mesenchymal stem cells (MSCs) are non-hematopoietic adult stem cells that are able to self-renew and differentiate into various cells of any cell lineage. MSCs have the ability to migrate (homing) to damaged tissue for repair and regeneration, as well as signal other cells to help in tissue repair. It can effect cellular differentiation, consequently shifting the immune system from Th1 to Th2 responses.1,2 • A recent review showed improved disease-associated parameters in experimental acute respiratory distress syndrome (ARDS).3 • We found three studies (one case report, one prospective cohort, and one small randomized controlled trial) reporting the effects of MSC on COVID-19. Based on low-quality evidence, it appeared that human umbilical cord blood-derived MSC, given after failure to improve with standard treatment, had beneficial effects in terms of earlier onset of clinical improvement among individuals with severe or critical COVID-19. However, 28-day clinical improvement and mortality were not significantly different compared to standard treatment. There was no reported adverse reaction. • There are 52 registered and ongoing clinical trials to investigate the efficacy and safety of mesenchymal stem cells as treatment for COVID-19. • Mesenchymal stem cell therapy is not included in any of the existing guidelines for the treatment of COVID-19.
Covid-19