OBJECTIVES: COVID-19, SARS-COV-2, Nasopharyngeal RT-PCR, Saliva RT-PCR, Children, 0- 18 years old. METHODOLOGY: A metanalysis was done to synthesize the diagnostic accuracy of saliva RT-PCR compared to the nasopharyngeal RT-PCR in the detection of SARS-COV 2 in pediatric patients ages 0-18 years old. Five studies published from January to September 2021 were analyzed using the "midas" command of STATA14. MIDAS command is a comprehensive program of statistical and graphical routines for undertaking meta-analysis of diagnostic test performance in Stata. The index and reference tests (gold standard) are dichotomous. Primary data synthesis is performed within the bivariate mixed-effects regression framework focused on making inferences about average sensitivity and specificity. RESULTS: The World Health Organization’s acceptable sensitivity and specificity for products used in COVID-19 diagnostics is ≥ 80% and ≥ 97% respectively. The results of this metanalysis showed the pooled sensitivity of Saliva RT-PCR as compared to the Nasopharyngeal RT-PCR is at 87% (81-92% at 95% CI) and the pooled specificity is at 97% (95% CI: 96-98%). CONCLUSION This metanalysis demonstrates that saliva can be used as an alternative specimen for SARS-COV-2 diagnostic testing in children. Aside from the acceptable pooled specificity and sensitivity, the use of saliva offers several advantages. However, the authors recommend to include more studies for future metanalysis research, to further increase sample size, and to include both symptomatic and asymptomatic pediatric age group participants. A future prospective research study comparing the two diagnostic modalities is likewise recommended.

Hemoglobin Bart's hydrops fetalis, characterized by a deletion of all four a-globin genes is the most severe and lethal form of Thalassemia disease. Mortality rate usually ranges from 60-100% of cases. Given the poor overall prognosis, most countries resort to pregnancy termination or expectant management as the only options to offer affected pregnancies.
This paper presents a case of the successful management of a primigravid, diagnosed with hydrops fetalis at 29 4/7 weeks age of gestation. She delivered successfully to a live, preterm, baby boy who was later found out to have hydrops fetalis due to Hemoglobin Bart's disease, and currently, continues to thrive past eight months of age.
This report aims to improve the clinicians' knowledge regarding the work up and management of pregnant patients diagnosed with hydrops fetalis, and increase the clinician's awareness on the epidemiology, importance of targeted screening, and diagnosis of Alpha-Thalassemia in Filipino patients.

Human ; Female ; Adult ; Alpha-thalassemia ; Hydrops Fetalis ; Hemoglobin Bart's ; Hemoglobin, Sickle ; Anemia, Sickle Cell ; Prognosis

INTRODUCTION: Malnutrition is a state of deficiency of the proper micro and macronutrients to meet daily nutritional requirement. Hospital malnutrition is associated with higher infection, impaired wound healing, and increased morbidity and mortality, especially in patients with type 2 diabetes mellitus (T2DM).

OBJECTIVES: To determine the comprehensive baseline nutrition status of hospitalized patients and the prevalence of malnutrition in patients with T2DM in Makati Medical Center (MMC).

METHODS: A prospective cross-sectional study involving T2DM patients admitted at MMC from October to December 2014. Malnutrition risk and status were assessed with Subjective Global Assessment (SGA) and clinical parameters.

RESULTS: A total of 150 adults with T2DM were assessed with the Comprehensive Nutrition Assessment Form (CNAF) using SGA, Nutritional risk level showed 37% has moderate risk while 63% has high risk for malnutrition. Nutritional status showed that 55% has mild to moderate malnutrition and 45% of patients have severe malnutrition. Factors significantly associated with high nutritional risk for malnutrition were SGA C (P<0.001), abnormal BMIunderweight and obese class2 (P<0.001), lower albumin (P=0.005) and lower total lymphocyte count (P<0.001). Factors associated to nutritional status were: weight change (P=0.004), functional capacity (P=0.017), disease and nutritional requirements (P<0.001), and presence of edema or ascites (P=0.012).

CONCLUSION: Malnutrition is highly prevalent in the acute hospital setting, 37% has moderate risk while 63% has high risk for malnutrition. While 55% has mild to moderate malnutrition and 45% of patients has severe malnutrition. Significant factors associated with malnutrition were SGA C, abnormal BMI, low albumin and low total lymphocyte count. Factors associated with severity of malnutrition were weight change, functional capacity, disease and nutritional requirements and presence of edema or ascites.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Nutrition Assessment ; Nutritional Status ; Diabetes Mellitus, Type 2 ; Ascites ; Body Weight ; Obesity ; Edema ; Wound Healing

Background/Aims: Vedolizumab is indicated for moderately-to-severely active ulcerative colitis (UC) and Crohn’s disease (CD). Because multiple factors may result in different pharmacokinetics and clinical efficacies, understanding determinants of vedolizumab clearance may enhance dose and treatment strategies. The aim was to characterize vedolizumab pharmacokinetics in Asian and non-Asian UC and CD patients. Methods: Population pharmacokinetic analysis for repeated measures, using data from 5 studies, was conducted using nonlinear mixed-effects modeling. A Bayesian estimation approach in NONMEM 7.3 was utilized to leverage the predominantly sparse data available for this analysis with results from a prior population pharmacokinetic analysis of vedolizumab. Results: Vedolizumab pharmacokinetics were described by a 2-compartment model with parallel linear and nonlinear elimination. Using reference covariate values, linear elimination half life of vedolizumab was 24.7 days for anti-vedolizumab antibody (AVA)-negative patients and 18.1 days for AVA-positive patients; linear clearance (CLL) was 0.165 L/day for AVA-negative patients and 0.246 L/day for AVA-positive patients; central (Vc) and peripheral compartment volumes of distribution were 3.16 L and 1.84 L, respectively. Interindividual variabilities (percent coefficient of variation) were 30.8% for CLL and 19% for Vc; interoccasion variability on CLL was 20.3%; residual variance was 17.8%. For albumin, body weight and AVA, only extreme values were identified as potentially clinically important predictors of CLL. The effect of race (Asianon-Asian) and diagnosis (UC/CD) on CLL was negligible and likely not of clinical importance. Conclusions Pharmacokinetic parameters were similar in Asian and non-Asian patients with moderately-to-severely active UC and CD. This analysis supports use of vedolizumab flat-fixed dosing in these patients. (Clinicaltrials.gov Identifiers: NCT00783718 (GEMINI 1); NCT00783692 (GEMINI 2). CCT 101; NCT02039505 and CCT-001; NCT02038920)

Type 2 diabetes prevalence is rising rapidly in Southeast Asia (SEA) where urbanization and adoption of 'western' behavioral lifestyles are attributed as predominant risk factors. The Southeast Asian diaspora to the United States has resulted in a sizable portion of migrant and US born SEAs, with approximately 4 million Filipino Americans, 2 million Vietnamese-Americans, Cambodians (330,000), and Thai (300,000) as the most populous. Their longer exposure to a western lifestyle and participation in clinical studies with other racial/ethnic groups, provide opportunities to evaluate etiologic factors which might inform trends and intervention opportunities among residents of Southeast Asia.

Epidemiologic studies in the US have identified higher T2D prevalence among Filipinos (16.1%) compared to groups perceived to be at highest risk for T2D, namely Latinos (14.0%), Black (13.7%), and Native Americans (13.4%), while SEAs (including Burmese, Cambodian, Indonesian, Laotian, Malaysian, and Thai, 10.5%) and Vietnamese (9.9%) had higher T2D risk compared to Whites (7.7%), despite their absence of general obesity. Asian-Americans, including SEAs, East and South Asians, collectively have higher rates of undiagnosed T2D compared to other racial/ethnic groups in the US. Almost half (44%) of Filipinos with newly diagnosed T2D have isolated post-challenge hyperglycemia and will remain undiagnosed if current screening practices remain limited to measures of glycosylated hemoglobin and fasting plasma glucose.

The University of California San Diego Filipino Health Study found excess visceral adipose tissue accumulation, low ratio of muscle to total abdominal mass area, low adiponectin concentration, multiparity (?6 live births), and sleep insufficiency (

Human ; Emigration And Immigration ; Adiposity ; Asia, Southeastern

BACKGROUND: Amphotericin B is used in pediatrics for severe fungal infections despite its known nephrotoxic side effects. Tubular injury and renal vasoconstriction range from 15-58% with exact risk factors that predispose children to developing these complications still undefined. OBJECTIVES: To determine the risk factors for nephrotoxicity with deoxycholate Amphotericin B treatment among children 6 months-18 years old at the Philippine Children‘s Medical Center from 2006-2017 METHODS: This is a retrospective case-control study of 150 patients. Cases had decrease in eGFR by at least 25% and/or developed hypokalemia after at least one dose of Amphotericin. Those who did not develop nephrotoxicity were considered controls. Risk factors evaluated were age, sex, nutritional status, underlying medical condition, cumulative dose, concomitant use of nephrotoxic drugs used, treatment with diuretics and intravenous hydration. Results were analyzed using univariate and multivariate regression models. RESULTS: Using logistic regression, underlying malignancy had the highest odds ratio of 33.1 and nutritional status of z score=0 showed the lowest at 0.158. Duration of treatment >14 days had 1.75 times chance of developing nephrotoxicity while total cumulative dose >7.1 mg/kg had 1.5 times more chance of developing nephrotoxicity. Subjects given diuretics had 5.5 times more odds, while those not given concomitant nephrotoxic medications were 5.33% less likely to develop renal toxicity. CONCLUSION: Risk factors for nephrotoxicity were malignancy as an underlying medical condition, duration of amphotericin treatment of >14 days, cumulative dose >7.1 mg/kg and diuretic use. Normal nutritional status and no other concomitant nephrotoxic medication use had lesser odds of developing nephrotoxicity. RECOMMENDATIONS Clinicians should consider these risk factors, institute measures to monitor occurrence of nephrotoxicity and the need for alternative fungal therapy in these children. With identification of the population at risk, prospective research on determining the specific onset of renal effects and possible intervention is recommended.
Amphotericin B

No abstract available.
Transplants* ; Vulvar Lichen Sclerosus*

BACKGROUND: Previous studies have investigated facial artery perforators, but have reported inconsistent results regarding lateral nasal artery (LNA) perforators. Although several authors have described the use of LNA perforators for ala nasi and nasal sidewall reconstruction, the literature contains little information regarding the cadaveric dissection of LNA perforators, and most previously published studies have focused on facial artery perforators. METHODS: Sixteen hemifaces from eight fresh cadavers were dissected to study the LNA perforators. After the dissection was performed, the total length and diameter of the LNA and its perforators were measured. The quantity and the distribution of the LNA perforators supplying the overlying skin were then assessed. LNA perforator flaps were used for reconstruction in 10 nasal and perinasal defects. RESULTS: The mean total lengths of the LNA and its perforators were 49.37 mm and 16.06 mm, respectively. The mean diameters of the LNA and its perforators were 2.08 mm and 0.91 mm, respectively. Based on our findings, we mapped the face to indicate zones with a higher probability of finding perforators. No infection, hematoma, or complete flap necrosis were observed after the procedures. CONCLUSIONS: Nasal reconstruction is a challenging procedure, and LNA propeller/V-Y perforator flaps are an excellent reconstructive option in certain cases. Based on our cadaveric study, we were able to identify an area in the upper third of the nasolabial groove with a high density of perforators.
Arteries* ; Cadaver ; Hematoma ; Nasolabial Fold ; Necrosis ; Perforator Flap* ; Skin ; Skin Neoplasms

Pulmonary arterionevous malformation (PAVMs) are a rare disorder with an incidence of 2-3/1,000,000 population. Approximately 70% of cases are associated with Osler-Weber-Rendu Disease. This intrapulmonary malformation causes hypoxemia and dyspnea largely attributed to the right to left shunting.

We present a case of 25-year-old male who was admitted for fever and headaches with chronic history of epistaxis, hemoptysis, cyanosis and clubbing. Central cyanocis and clubbing were evident with hypoxemia of 65%. Heart sounds and peripheral pulses were normal. There was no systolic bruit noted in the lung bases. Multiple telangiectasias were seen in the truncal area and abdomen. Chest x-ray revealed multi-chambered cardiomegaly with no opacifications. CBC showed erythrocytosis with hematocrits of 0.68-0.78. Transthoracic echocardiography showed intact interatrial and interventricular septum, with contrast study suggestive of intrapulmonary shunting. CT angiography revealed PAVMs in bilateral lung fields. Pulmonary angiography demonstrated diffuse PAVMS in the left lung with 3 large PAVMs with multiple feeders > 7mm and smaller PAVMs in the Right lower lobe. The diagnosis was Multiple Pulmonary Arteriovenous Malformation, Osler-Weber-Rendu Disease, Brain Abscess Left Temporoparietal area. Craniotomy with brain abscess evacuation was done. Left pneumonectomy or Right lobectomy was considered but was deemed unacceptable due to high morbidity and mortality. Endovascular coil embolization was done on the 3 large fistulas on the Left lobe. Post procedure, his arterial oxygenation improved to 96%. He has no recurrence of hemoptysis, no headaches and with less episodes of shortness of breath 2 months on follow-up. Diagnosing the complex diffuse intrapulmonary malformations requires a high index of suspicion among patients with chronic cyanosis, chronic history of bleeding, and brain abscess. Treatment of this condition and its associated complications remain a big challenge and should be highly individualized.

Human ; Male ; Adult ; Arteriovenous Malformations ; Embolization, Therapeutic ; Telangiectasia, Hereditary Hemorrhagic

Agricultural production is a major driver of the Philippine economy. Mass production of animal products, such as livestock and poultry farming, is one of the most prominent players in the field. Filipino farmers use veterinary medicinal products (VMPs) when raising agricultural animals to improve animal growth and prevent diseases. Unfortunately, the extensive use of VMPs, particularly antibiotics, has been linked to drug resistance in animals, particularly antibiotics. Antimicrobial gene products produced in animals due to the prolonged use of VMPs can passed on to humans when they consume animal products.This paper reviews information on the use of VMPs in the Philippines, including the regulations, their impact, challenges, and potential recommendations. The Philippines has existing legislation regulating VMP use. Several agencies were tasked to regulate the use of VMPs, such as the Department of Agriculture, the Department of Health, and the Philippine National Action Plan. Unfortunately, there is a challenge to implementing these regulations, which affects consumers. The unregulated use of VMPs influences the transmission of antibiotic residues from animals to crops to humans. This challenge should be addressed, with more focus on stricter regulation.