1.The prevalence of COVID-19 infection among gynecologic oncology patients receiving cancer treatment in a COVID-19 referral hospital
Renee Riza Cartago Medalla ; Jericho Thaddeus P. Luna
Philippine Journal of Obstetrics and Gynecology 2023;47(4):199-205
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
2.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
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.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.
COVID-19
5.COVID-19 guidance on the resumption of eye surgery
Jacqueline H. King ; Jubaida M. Aquino ; Rachelle G. Anzures ; John Mark S. de Leon ; Maria Victoria A. Rondaris ; Maria Donna D. Santiago ; Cynthia V. Verzosa
Philippine Journal of Ophthalmology 2021;46(1):2-14
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
6.COVID-19 testing recommendations prior to elective ophthalmic surgeries
Jacqueline H. King ; Jubaida M. Aquino ; Rachelle G. Anzures ; John Mark S. de Leon ; Maria Victoria A. Rondaris ; Maria Donna D. Santiago ; Cynthia V. Verzosa
Philippine Journal of Ophthalmology 2021;46(1):15-19
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
7.Should Mesenchymal Stem Cell Therapy be used in the treatment of COVID-19?
Namnama P. Villarta-De Dios ; Evelyn S. S. Osio-Salido
Acta Medica Philippina 2020;54(Rapid Reviews on COVID19):86-100
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
8.Use of Renin-Angiotensin System Antagonists in patients with hypertension and COVID-19 infection: A rapid review and meta-analysis
Rowena Natividad S. Flores-Genuino ; Charissa Mia Salud-Gnilo ; Evelyn Osio-Salido
Acta Medica Philippina 2020;54(Rapid Reviews on COVID19):102-118
Key Findings
Among patients with confirmed COVID-19 infection and hypertension, there is insufficient evidence that RAS
antagonists are associated with mortality or severe COVID-19 disease.
• There is uncertainty with regards to the safe use of renin-angiotensin system (RAS) antagonists, such as
angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), for COVID-19 patients
with hypertension and other comorbidities (heart failure, chronic kidney disease) because of two possible
contradictory mechanisms 1) upregulation of ACE2 receptors that may facilitate the virus entry into the lung.
and 2) control of unabated angiotensin II levels reducing acute lung injury.
• Based on very low-quality retrospective cohort studies, there is insufficient evidence that RAS antagonists are
associated with increased mortality (6 studies) or severe disease (10 studies) among patients with confirmed
COVID-19 infection and hypertension.
• There are 36 ongoing studies (21 RCTs, 1 single-arm trial, 4 prospective cohorts, 4 retrospective cohorts, 4 casecontrol, and 2 cross-sectional) on this topic.
• The European Society of Cardiology (ESC) Council on Hypertension, the International Society of Hypertension
(ISH) and the joint statement by the American College of Cardiology (ACC), American Heart Association (AHA),
and Heart Failure Society of America (HFSA) all caution against discontinuing RAS-related treatments in
patients with hypertension who become infected with COVID-19.
Covid-19
9.Which dialysis method should be used for patients with COVID-19?
Patricia Maria Gregoria Mina-Cuañ ; o ; Cary Amiel G. Villanueva ; John Jefferson V. Besa ; Andrew Rufino M. Villafuerte ; Jayson M. Villavicencio ; Vincent Anthony S. Tang ; Lia M. Palileo-Villanueva
Acta Medica Philippina 2020;54(Rapid Reviews on COVID19):120-124
Key Findings
• Very low-quality evidence from a single retrospective study suggests that continuous renal replacement
therapy (CRRT) may reduce mortality among COVID-19 patients on invasive mechanical ventilation. Guidelines
recommend CRRT for critically ill patients to minimize the risk of possible transmission, if this option is available.
• Although uncommon, acute kidney injury (AKI) can occur in association with coronavirus disease 2019
(COVID-19) and is associated with increased in-hospital mortality.
• There are currently no published or ongoing clinical trials directly comparing dialysis modalities for acute
kidney injury in COVID-19 patients.
• In reducing the risk of transmission during dialysis: currently, there are no studies comparing one dialysis
modality to another. The method of dialysis is still primarily determined by the clinical picture of the patient, the
expertise of the center, and the resources available. The American Society of Nephrology (ASN) recommends
CRRT over intermittent hemodialysis (IHD) for critically ill patients with COVID-19 to minimize patient contact
when it is available, and resources allow. Otherwise, intermittent hemodialysis may be done provided that,
infection control measures are strictly followed.
• Several international and local guidelines recommend strict adherence to infection prevention and control
measures (e.g. hand hygiene, physical distancing, proper use of personal protective equipment (PPE), and
cohorting of patients) who are undergoing dialysis.
Covid-19
10.Rapid review on the use of oral fatty acid supplements in the prevention or as adjunct treatment of COVID-19
Rowena Natividad S. Flores-Genuino ; Marquis Von Angelo Syquio G. Joson ; Belen L. Dofitas
Acta Medica Philippina 2020;54(Rapid Reviews on COVID19):901-945
Key Findings
There is lack of clinical evidence supporting the role of oral fatty acid supplements as prevention and adjunctive
therapy for COVID-19.
Long-chain polyunsaturated fatty acids (PUFAs) mediate inflammation and adaptive immune responses. Omega-3
fatty acids promote anti‐inflammatory effects and reduce influenza virus replication.
No clinical evidence supporting the use of oral fatty acid supplements as prevention and adjunctive therapy of
COVID-19 was found.
We found indirect evidence from one systematic review on acute respiratory distress syndrome (ARDS) and two
longitudinal cohort studies on community-acquired pneumonia that showed non-significant and inconsistent
results.
The most common known side effects of omega-3-fatty acids are gastrointestinal in nature. They may also cause
allergy and affect blood clotting if taken with other medications that affect clotting.
There are 2 ongoing clinical trials on eicosapentaenoic fatty acids as an adjunctive therapy to standard oral
nutrition supplements or standard of care in COVID-19 patients.
WHO Interim guidelines, CDC interim guidelines, Infectious Diseases Society of America COVID-19 treatment
guidelines, and the American Thoracic Society did not give any recommendation on the use of nutritional
supplements in patients with COVID-19.
Covid-19