BACKGROUND AND OBJECTIVES

The global pandemic caused by Coronavirus Disease 2019 (COVID-19) has affected millions, with growing evidence of the potential role of ocular tissues in viral transmission. At the time of writing, local data regarding the phenomenon was limited. This study investigated external ocular manifestations in patients with COVID-19 at a referral center in the Philippines, examined correlations between demographics, systemic manifestations, and laboratory results with ocular manifestations, and determined their timing relative to systemic symptoms.

METHODS

This single-center, descriptive cross-sectional study was carried out from December 8 to 18, 2020 at the adult COVID-19 wards of the Philippine General Hospital involving 72 participants. Data collection involved relevant clinical history taking and performing gross eye examination. The prevalence of ocular manifestations was described with 95% confidence intervals. Correlations between ocular manifestations and quantitative variables were analyzed with point-biserial correlation, and associations with qualitative variables were tested using chi-square or Fisher’s exact tests.

RESULTS

Among participants, 31.9% presented with ocular manifestations with foreign body sensation as the most prevalent ocular symptom (11.1%) and conjunctival hyperemia as the most prevalent ocular finding (19.4%). The median age of patients with ocular manifestations was 41 years old with a higher prevalence in the male population (73.9%, CI=95%, p=0.001). No significant correlation was observed between presence of external ocular manifestations and the different systemic and ocular co-morbidities as well as with COVID-19 clinical classification. Among those who experienced symptoms, majority (29.2%) of the patients experienced systemic symptoms prior to the onset of ocular symptoms. Ocular complaints may present as the sole manifestation (13.9%). Several laboratory parameters were measured and only temperature and AST levels showed a low positive correlation with the presence of ocular manifestations. 

CONCLUSION

Ocular manifestations occur in roughly one third of patients with COVID-19 based on this study population. With some individuals presenting with ocular signs or symptoms as the initial and sole manifestation, healthcare practitioners must exercise caution and remain vigilant in managing patients who present as such. At the time of writing, this is the first local study investigating the different external ocular manifestations in patients with COVID-19. There is a need to pursue more robust studies and conduct more local investigations which will guide both ophthalmologists and other practitioners in strengthening existing guidelines regarding precautionary practices, clinical diagnosis, and management of COVID-19 patients.

Human ; Sars-cov-2 ; Covid-19 ; Philippines ; Adult ; Association ; Classification ; Collection ; Confidence Intervals ; Coronavirus ; Cross-sectional Studies ; Data Collection ; Demography ; Diagnosis ; Disease ; Exercise ; Eye ; Foreign Bodies ; History ; Hospitals ; Hospitals, General ; Hyperemia ; Laboratories ; Male ; Morbidity ; Ophthalmologists ; Pandemics ; Patients ; Population ; Prevalence ; Referral And Consultation ; Role ; Sensation ; Temperature ; Time ; Tissues ; Volition ; World Health Organization ; Writing

BACKGROUND

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospitalized cancer patients. The Khorana and Padua risk scores are widely used tools for predicting VTE, but their comparative performance in hospitalized cancer patients has not been fully assessed. This study aims to evaluate the predictive performance of these two risk assessment models in predicting VTE in hospitalized patients with malignancy.

METHODS

This cross-sectional study was conducted at a tertiary hospital between January 2022 and December 2023. A total of 200 hospitalized patients with malignancy were enrolled. Their baseline demographics, medical history and diagnostic data were collected. Patients were stratified into risk categories using the Khorana and Padua models, and their predictive abilities were assessed through sensitivity, specificity and area under the curve (AUC) analyses. The diagnosis of deep vein thrombosis (DVT) was confirmed with evidence of an intraluminal deep venous filling defect on CT or catheter venography, or a deep vein thrombus identified by color Doppler. Pulmonary embolism (PE) was diagnosed by pulmonary angiography showing an intraluminal filling defect of the pulmonary artery visualized through computed tomography pulmonary angiography or magnetic resonance imaging.

RESULTS

The Khorana score demonstrated a sensitivity of 83.3%, specificity of 77.5% and an AUC of 0.81. The Padua score showed a sensitivity of 76.7%, specificity of 85.5% and an AUC of 0.79. Both models showed good predictive accuracy. However, the Khorana score having a high sensitivity makes it suitable for identifying high-risk patients, while the Padua score having a high specificity makes it better at ruling out low-risk patients.

CONCLUSION

Both the Khorana and Padua scores are valuable tools for predicting VTE in hospitalized cancer patients, but the Khorana score may be more effective for cancer-specific risk stratification. Further prospective studies are needed to confirm these findings.

Human ; Male ; Female ; Morbidity ; Neoplasms ; Thromboembolism ; Venous Thromboembolism

BACKGROUND

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospitalized cancer patients. The Khorana and Padua risk scores are widely used tools for predicting VTE, but their comparative performance in hospitalized cancer patients has not been fully assessed. This study aims to evaluate the predictive performance of these two risk assessment models in predicting VTE in hospitalized patients with malignancy.

METHODS

This cross-sectional study was conducted at a tertiary hospital between January 2022 and December 2023. A total of 200 hospitalized patients with malignancy were enrolled. Their baseline demographics, medical history and diagnostic data were collected. Patients were stratified into risk categories using the Khorana and Padua models, and their predictive abilities were assessed through sensitivity, specificity and area under the curve (AUC) analyses. The diagnosis of deep vein thrombosis (DVT) was confirmed with evidence of an intraluminal deep venous filling defect on CT or catheter venography, or a deep vein thrombus identified by color Doppler. Pulmonary embolism (PE) was diagnosed by pulmonary angiography showing an intraluminal filling defect of the pulmonary artery visualized through computed tomography pulmonary angiography or magnetic resonance imaging.

RESULTS

The Khorana score demonstrated a sensitivity of 83.3%, specificity of 77.5% and an AUC of 0.81. The Padua score showed a sensitivity of 76.7%, specificity of 85.5% and an AUC of 0.79. Both models showed good predictive accuracy. However, the Khorana score having a high sensitivity makes it suitable for identifying high-risk patients, while the Padua score having a high specificity makes it better at ruling out low-risk patients.

CONCLUSION

Both the Khorana and Padua scores are valuable tools for predicting VTE in hospitalized cancer patients, but the Khorana score may be more effective for cancer-specific risk stratification. Further prospective studies are needed to confirm these findings.

Human ; Male ; Female ; Morbidity ; Neoplasms ; Thromboembolism ; Venous Thromboembolism

BACKGROUND: Prospective evidence on how offspring number influences morbidity and mortality remains limited. This study investigated the associations between number of offspring and morbidity and mortality risks among 0.5 million Chinese adults. METHODS: By using data from the China Kadoorie Biobank (CKB; n = 512,723, an approximately 12-year follow-up), sex-stratified phenome-wide association study (PheWAS) analyses were conducted to investigate associations between offspring number (without vs . with offspring; more than one vs . one offspring) and risks of ICD10-coded morbidity and mortality. Sex-specific adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated by Cox proportional-hazards models. RESULTS: Among 210,129 men and 302,284 women aged 30-79 years, 1,338,837 incident events were recorded. PheWAS results revealed that offspring number was associated with disease risks across multiple systems. Cox models showed that childless men ( vs . one offspring) had higher risks for nine of 36 diseases, while childless women for five of 37. Each additional offspring was associated with reduced risks of mental and behavioral disorders in men (aHR [95% CI] = 0.93 [0.87-0.98]) and both mental and behavioral disorders (aHR [95% CI] = 0.93 [0.89-0.97]) and breast cancer (aHR [95% CI] = 0.82 [0.78-0.86]) in women. However, each additional offspring was associated with a 4% increase in the risk of cholelithiasis and cholecystitis in women (aHR [95% CI] = 1.04 [1.02-1.07]). Among 282,630 patients, 44,533 deaths were documented. Childless patients had higher mortality risk in both men (aHR [95% CI] = 1.37 [1.28-1.47]) and women (aHR [95% CI] = 1.27 [1.15-1.41]). For men, each additional offspring reduced mortality by 4% (aHR [95% CI] = 0.96 [0.95-0.98]), while for women, the lowest risk was observed among those with three to four offspring ( Pnonlinear <0.0001). CONCLUSIONS Offspring number is closely linked to morbidity and mortality risks. Further research is warranted to verify our findings and clarify the underlying mechanisms involved.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; China/epidemiology* ; Morbidity ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Family Characteristics ; Mortality ; East Asian People

INTRODUCTION AND OBJECTIVE

The endoscopic management of staghorn calculi is very challenging owing to its complex anatomical configuration. The authors analyzed the clinical efficacy and safety of a single upper pole access PCNL (SUPA-PCNL) for Guy Stone Score (GSS) 3-4 staghorn calculi.

METHODS

Prospective data collection was done on 56 consecutive patients who with GSS 3-4 staghorn calculi. All cases were treated with a standardized technique of a single upper pole access PCNL in the prone position. The patient demographics, stone characteristics, perioperative and postoperative outcomes were analyzed.

RESULTS

The cohort exhibited diversity in age (51.7+12), gender (male to female ratio of 5.5:4.5) comorbidities, and stone burden (4.82+1.96 cm). SUPA-PCNL demonstrated a high median stonefree rate (99.5%, IQR 90-100) with minimal complications, low blood loss with a of 200cc (IQR 100-300), and median hospital stay of 3.5 days (IQR 3-5). Stone characteristics did not significantly influence outcomes. A subset required secondary treatments (12%, n=7), but overall morbidity was low (16%, n=9): (7% n=4) of which required blood transfusion, and (9% n=5) due to sepsis. The following factors were associated with increased odds of perioperative morbidity: preoperative creatinine >3 mg/dl (OR 4.19 95% Cl 0.59 – 29.71 p=0.152) and a history of endoscopic surgery (OR 7.33 95% Cl 1.20-44.96 p=0.031).

CONCLUSION

SUPA-PCNL is effective and safe for the treatment of staghorn calculi. In select patients, this approach obviates the need for a multi-tract access or an endoscopically-combined intrarenal surgery (ECIRS).

Human ; Nephrolithotomy, Percutaneous ; Morbidity ; Staghorn Calculi

OBJECTIVES

To describe the treatment outcomes of patients who underwent open repair of infrarenal abdominal aortic aneurysm (AAA) and to determine the risk factors affecting morbidity and mortality.

METHODS

Data were obtained from patients with infrarenal AAAs who underwent open surgical repair at the University of the Philippines-Philippine General Hospital (UP-PGH) from January 2013 to October 31, 2023. These patients’ demographic and clinical profile, and treatment outcomes were evaluated using frequencies and percentages. Student’s t-test and chi-square test were used for the inferential analysis. Multivariable logistic regression analysis was used to identify factors associated with in-hospital mortality and morbidity.

RESULTS

In this study, 131 patients underwent open surgical repair of AAA. 82.4% of the patients were males, and 45.8% were between 61-70 years old. The majority of them had hypertension (81.4%) and were smokers (75%). The mortality rate was 17.6%, while the morbidity rate was 35.9%. For elective operations, the mortality was 8.9%, and for ruptured aneurysms, it was 56.5%. Eleven factors associated with mortality included ruptured aneurysm (OR=11.5, 95%CI=4.1 to 32.2), decreased hemoglobin (OR=1.1, 95%CI=1.05 to 1.2), decreased hematocrit (OR=1.1, 95%CI=1.06 to 1.4), emergency surgery (OR=10.3, 95%CI=2.9 to 36.3), higher volume of blood loss (OR=1.5, 95%CI=1.5 to 1.9), higher red cell transfusion (OR=1.3, 95%CI=1.1-1.5), intraoperative cardiopulmonary (CP) arrest (OR=15.9, 95%CI=1.6 to 159.2), need for multiple inotropes (OR=2.7, 95%CI=1.5-4.8), intraoperative hypotension (OR=3.6, 95%CI=1.4-9.7), juxta-renal location (OR=5.0, 95%CI=1.2 to 10.0), and presence of any complication (OR=5.7, 95%CI=2.1-15.1). Seven factors associated with morbidity included ruptured aneurysm (OR=3.9, 95%CI=1.5 to 9.8), decreased preoperative hemoglobin (OR=1.2, 95%CI=1.1 to 1.4), decreased preoperative hematocrit (OR=1.5, 95%CI=1.1 to 1.7), elevated preoperative creatinine (OR=1.1, 95%CI=1.06 to 1.9), higher intra-operative blood loss (OR=1.4, 95%CI=1.1 to 1.6), higher red cell transfusion (OR=1.6, 95%CI=1.3-2.1), and preexisting chronic renal disease (OR=3.3, 95%CI=1.4 to 7.5). Other preoperative and intraoperative factors did not show a significant association with mortality or morbidity.

CONCLUSION

The open repair of an infrarenal AAA is linked to high overall mortality (17.6%) and morbidity (35.9%). The mortality rate for elective repair was 8.9%, but it significantly increased to 56.5% in cases of ruptured aneurysms. Factors with very high Odds Ratio such as emergency surgery, ruptured aneurysm, cardiac arrests during surgery, complex juxtarenal anatomy, and postoperative complications can lead to a high chance of mortality. Healthcare professionals should be vigilant and focus on early detection and repair of abdominal aneurysms to prevent emergency surgery, rupture, and mortality. It is crucial to prevent acute kidney injury, acute respiratory failure, and pneumonia, as these are common complications of open repair.

Human ; Morbidity ; Mortality

INTRODUCTION

The social determinants of health refer to an individual's social, political, and economic situation and environment, which can have an impact on their health. On the other hand, disability-adjusted life years (DALYs) reflect the mortalities and morbidities incurred due to disease and injury.

OBJECTIVES

This study aims to analyze the social determinants of health indicators and their association with communicable, non-communicable, and injury-related DALYs and deaths.

METHODS

Data from World Health Organization, World Bank, and International Labor Organization were used and considered for the 17 Social Determinants of Health categories. Logistic regression was used to determine the relationship of social determinants of health indicators with communicable, non-communicable, and injury-related DALYs and deaths.

RESULTS

Results show that an increase in the population, monetary poverty, adult illiteracy, and fine particulate matter increase IPNN DALYs. This study also found correlations of socioeconomic factors to NCD deaths and DALYs attributable to the environment. NCD DALYs and deaths are found to increase with the number of poor living with 3.10 dollars a day, while median daily per capita income, and increase in persons above retiring age receiving pension decrease NCD DALYs attributable to the environment. Focusing on injury DALYs and deaths, an increase in the number of poor living at 3.10 dollars a day, non-agricultural informal employment, and total average concentration of f ine particulate matter increases injury DALYs while the latter is observed to decrease when there is an increase in the medial daily per capita income, agricultural employment outside the formal sector, and vulnerable persons covered by social assistance.

CONCLUSION

Socio-economic factors such as income, employment, education, and social welfare program affect morbidity, disability, and mortality.

Human ; Social Determinants Of Health ; Disability-adjusted Life Years ; Injury ; Wounds And Injuries ; Morbidity ; Mortality

INTRODUCTION

The social determinants of health refer to an individual's social, political, and economic situation and environment, which can have an impact on their health. On the other hand, disability-adjusted life years (DALYs) reflect the mortalities and morbidities incurred due to disease and injury.

OBJECTIVES

This study aims to analyze the social determinants of health indicators and their association with communicable, non-communicable, and injury-related DALYs and deaths.

METHODS

Data from World Health Organization, World Bank, and International Labor Organization were used and considered for the 17 Social Determinants of Health categories. Logistic regression was used to determine the relationship of social determinants of health indicators with communicable, non-communicable, and injury-related DALYs and deaths.

RESULTS

Results show that an increase in the population, monetary poverty, adult illiteracy, and fine particulate matter increase IPNN DALYs. This study also found correlations of socioeconomic factors to NCD deaths and DALYs attributable to the environment. NCD DALYs and deaths are found to increase with the number of poor living with 3.10 dollars a day, while median daily per capita income, and increase in persons above retiring age receiving pension decrease NCD DALYs attributable to the environment. Focusing on injury DALYs and deaths, an increase in the number of poor living at 3.10 dollars a day, non-agricultural informal employment, and total average concentration of f ine particulate matter increases injury DALYs while the latter is observed to decrease when there is an increase in the medial daily per capita income, agricultural employment outside the formal sector, and vulnerable persons covered by social assistance.

CONCLUSION

Socio-economic factors such as income, employment, education, and social welfare program affect morbidity, disability, and mortality.

Human ; Social Determinants Of Health ; Disability-adjusted Life Years ; Injury ; Wounds And Injuries ; Morbidity ; Mortality

BACKGROUND AND OBJECTIVE

Closed tube thoracostomy is one of the most common hospital procedures known for its effectivity and safety; however, complications may occur, leading to poor patient outcomes. To date, the burden of morbidity among patients who underwent closed tube thoracostomy in the Philippines remains unknown. Therefore, this study aims to determine the in-hospital morbidity rate among patients who underwent closed tube thoracostomy in a tertiary government hospital.

METHODS

This is a descriptive cross-sectional study of admitted patients who underwent closed tube thoracostomy at Bicol Medical Center from 2015 to 2020. Data were collected by reviewing medical charts.

RESULTS

A total of 376 patients were included in the study. Morbidity rate was 15.16% (95% CI: 11.69-19.19%), and majority were due to improper chest tube placement. Compared to those without complications, a higher proportion of patients with complications had pleural effusion and had chest tube failure (both p ≤0.05). The median operative time was also significantly longer in patients with complications compared to those without complications (p =0.0012). Mortality was significantly lower in patients with complications than those without complications. Total and postoperative length of stay were significantly longer in patients with complications than those without complications (pCONCLUSION

Complications after closed tube thoracostomy are common. Across all variables analyzed, only indication of chest tube insertion, operative time, and occurrence of chest tube failure were found to differ between patients with and without complications. Moreover, patients with complications had longer length of stay than those without. Reducing positional tube complications may help decrease in-hospital morbidity.

Morbidity ; Chest Tubes

Objectives: To describe the treatment outcomes of patients who underwent open repair of infrarenal abdominal aortic aneurysm (AAA) and to determine the risk factors affecting morbidity and mortality. Methods: Data were obtained from patients with infrarenal AAAs who underwent open surgical repair at the University of the Philippines-Philippine General Hospital (UP-PGH) from January 2013 to October 31, 2023. These patients’ demographic and clinical profile, and treatment outcomes were evaluated using frequencies and percentages. Student’s t-test and chi-square test were used for the inferential analysis. Multivariable logistic regression analysis was used to identify factors associated with in-hospital mortality and morbidity. Results: In this study, 131 patients underwent open surgical repair of AAA. 82.4% of the patients were males, and 45.8% were between 61-70 years old. The majority of them had hypertension (81.4%) and were smokers (75%). The mortality rate was 17.6%, while the morbidity rate was 35.9%. For elective operations, the mortality was 8.9%, and for ruptured aneurysms, it was 56.5%. Eleven factors associated with mortality included ruptured aneurysm (OR=11.5, 95%CI=4.1 to 32.2), decreased hemoglobin (OR=1.1, 95%CI=1.05 to 1.2), decreased hematocrit (OR=1.1, 95%CI=1.06 to 1.4), emergency surgery (OR=10.3, 95%CI=2.9 to 36.3), higher volume of blood loss (OR=1.5, 95%CI=1.5 to 1.9), higher red cell transfusion (OR=1.3, 95%CI=1.1-1.5), intraoperative cardiopulmonary (CP) arrest (OR=15.9, 95%CI=1.6 to 159.2), need for multiple inotropes (OR=2.7, 95%CI=1.5-4.8), intraoperative hypotension (OR=3.6, 95%CI=1.4-9.7), juxta-renal location (OR=5.0, 95%CI=1.2 to 10.0), and presence of any complication (OR=5.7, 95%CI=2.1-15.1). Seven factors associated with morbidity included ruptured aneurysm (OR=3.9, 95%CI=1.5 to 9.8), decreased preoperative hemoglobin (OR=1.2, 95%CI=1.1 to 1.4), decreased preoperative hematocrit (OR=1.5, 95%CI=1.1 to 1.7), elevated preoperative creatinine (OR=1.1, 95%CI=1.06 to 1.9), higher intra-operative blood loss (OR=1.4, 95%CI=1.1 to 1.6), higher red cell transfusion (OR=1.6, 95%CI=1.3-2.1), and preexisting chronic renal disease (OR=3.3, 95%CI=1.4 to 7.5). Other preoperative and intraoperative factors did not show a significant association with mortality or morbidity. Conclusion The open repair of an infrarenal AAA is linked to high overall mortality (17.6%) and morbidity (35.9%). The mortality rate for elective repair was 8.9%, but it significantly increased to 56.5% in cases of ruptured aneurysms. Factors with very high Odds Ratio such as emergency surgery, ruptured aneurysm, cardiac arrests during surgery, complex juxtarenal anatomy, and postoperative complications can lead to a high chance of mortality. Healthcare professionals should be vigilant and focus on early detection and repair of abdominal aneurysms to prevent emergency surgery, rupture, and mortality. It is crucial to prevent acute kidney injury, acute respiratory failure, and pneumonia, as these are common complications of open repair.
morbidity ; mortality