OBJECTIVE: This study described bronchiectasis profiles at the Philippine Children’s Medical Center (2021-2023). MATERIALS AND METHODS: A retrospective chart review at PCMC analyzed the demographic profile, imaging, management and outcome of patients with bronchiectasis enrolled in the Chronic Lung Disease Program from 2021-2023. Results: Twenty seven patients were included in this study. Most patients were diagnosed after the age of six and showed female predominance. The most common symptom at the time of diagnosis was chronic cough (81.5%) with pulmonary tuberculosis (51.9%) as the most common etiology. All patients were treated with cyclic azithromycin. Pseudomonas aeruginosa was the prevalent microorganism isolated in the sputum and tracheal aspirate samples of the patients (56.5%). Conclusion Patients with bronchiectasis were more commonly diagnosed in children past age of six with more prevalence in females. The most common symptom was chronic cough followed by fever, dyspnea and weight loss. Pulmonary tuberculosis and recurrent respiratory infections were noted to be the most common etiology with the left lower lobe most affected in HRCT. The most common phenotype seen was cystic, which is irreversible and a sign of progressive bronchiectasis, which may point to a late diagnosis. This emphasizes the need for physicians to have a high index of suspicion in patients with chronic or recurrent respiratory symptoms. All patients were treated with an oral macrolide with 25-31% of patients with decreased and/or absent symptoms. Pseudomonas aeruginosa was the prevalent microorganism isolated in the sputum and tracheal aspirate samples of the patients, which should be taken into account when treating for exacerbation.
Human ; Male,Female ; Infant newborn: First 28 days after birth ; Infant: 1-23 months ; Child Preschool: 2-5 yrs old ; Child: 6-12 yrs old ; Bronchiectasis ; Patients ; Tuberculosis ; Infections

Miliary tuberculosis (TB) is a disseminated form of TB resulting from the lymphohematogenous spread of Mycobacterium tuberculosis (MTb). Since pregnancy-related TB lacks the typical respiratory symptoms, clinicians might overlook the condition, complicating early diagnosis and treatment. This is a case of a 39-year-old multigravida, who presented with vaginal bleeding in the second trimester. She was admitted for tocolysis and correction of severe anemia. On the 6th hospital day, there was a note of febrile episodes accompanied by productive cough. Chest X-ray revealed miliary spread, eventually detecting MTb on sputum GeneXpert. At 19-week age of gestation, she delivered to an abortus. Histopathology of the endometrial tissues revealed caseating granulomas, consistent with tuberculous etiology. The disease’s severity, stage of the pregnancy at the time of diagnosis, and the existence of extrapulmonary dissemination might influence the outcome of pregnancy.

OBJECTIVE: To investigate the short-term effectiveness of the anterior and middle columns in thoracolumbar tuberculosis reconstructed with whole autogenous spinous process-laminar bone through posterior approach. METHODS: The retrospective study included 78 patients with thoracolumbar tuberculosis who underwent posterior approach surgery and anterior and middle column bone graft reconstruction between January 2012 and May 2023. Based on the type of autogenous bone graft used, patients were divided into group A (whole autogenous spinous process-laminar bone graft, 38 cases) and group B (autogenous structural iliac bone graft, 40 cases). There was no significant difference of baseline data, such as age, gender, disease duration, involved segment of spinal tuberculosis, and preoperative erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Oswestry disability index (ODI), visual analogue scale (VAS) score, the American Spinal Injury Association (ASIA) grade, segmental kyphotic angle, and intervertebral height between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stays, ESR, CRP, VAS score, ODI, bone fusion time, ASIA grade for neurological status valuation, postoperative complications, change of segmental kyphotic angle, change of intervertebral height were recorded and compared between the two groups. RESULTS: The operation time in group A was significantly shorter than that in group B ( P<0.05); there was no significant difference in intraoperative blood loss, postoperative drainage, and hospital stays between the two groups ( P>0.05). All patients in the two groups were followed up 14-110 months (mean, 64.1 months); there was no significant difference in the follow-up time between the two groups ( P>0.05). The ESR, CRP, ODI, and VAS score at each time point after operation in both groups significantly improved when compared with those before operation, and further improved with the extension of time, the differences were significant ( P<0.05). There was no significant difference between the two groups ( P>0.05) except that the VAS score of group A was significantly better than that of group B at 3 days after operation ( P<0.05). There was no significant difference in fusion time between the two groups ( P>0.05). The neurological function of most patients improved after operation, and there was no significant difference in ASIA grade between the two groups at last follow-up ( P>0.05). There was no significant difference in segmental kyphosis angle and intervertebral height between the two groups at each time point ( P>0.05), and no significant difference in segmental kyphosis angle, intervertebral height correction and loss were found between the two groups ( P>0.05). In group A, there was 1 case of incision fat liquefaction and 1 case of incision infection; in group B, there was 1 case of deep venous thrombosis, 2 cases of pleural effusion, and 10 cases of pain in bone harvesting area; in both groups, there were 2 cases of gout caused by hyperuricemia. There was a significant difference in the incidence of pain in bone harvesting area between the two groups ( P<0.05), and there was no significant difference in the incidence of other complications between the two groups ( P>0.05). CONCLUSION Whole autogenous spinous process-laminar bone grafting is equivalent to structural iliac bone graft in reconstruction of the anterior and middle columns in thoracolumbar tuberculosis through posterior approach, effectively supporting the stability of the anterior and middle columns of the spine, while resulting in shorter operation time and less postoperative pain in bone harvesting area.
Humans ; Tuberculosis, Spinal/surgery* ; Thoracic Vertebrae/surgery* ; Lumbar Vertebrae/surgery* ; Bone Transplantation/methods* ; Retrospective Studies ; Male ; Female ; Treatment Outcome ; Plastic Surgery Procedures/methods* ; Adult ; Middle Aged ; Transplantation, Autologous ; Operative Time ; Ilium/transplantation*

Bone tuberculosis is one of the main lesions of extrapulmonary tuberculosis, and the affected site shows local pain and limited movement, and the severe patients face a higher risk of teratogenicity and disability. Especially in the context of the increasing spread of multidrug-resistant tuberculosis, it is particularly urgent to seek innovative treatment options. In recent years, vitamin D plays an important role in the prevention and treatment of bone tuberculosis, and the mechanism of action has been continuously explored. At the same time, vitamin D receptor gene polymorphism has also been found to be closely related to the susceptibility and risk of bone tuberculosis. This article reviewed the relationship between vitamin D and its receptor gene polymorphisms and the susceptibility to bone tuberculosis. It was found that vitamin D deficiency increased the susceptibility to bone tuberculosis in both adults and children, and multiple genotypes of vitamin D receptor had an effect on the susceptibility to bone tuberculosis, especially FokⅠ genotype. It may also be one of the reasons for the increase in the number of bone tuberculosis. Through the study of the relationship between vitamin D and its receptor gene polymorphism and the susceptibility to bone tuberculosis, some factors inducing bone tuberculosis can be avoided, and related new drugs can be more targeted, such as vitamin D supplements, gene receptor related antagonists, etc. To provide more systematic and targeted strategies for the prevention and treatment of bone tuberculosis.
Humans ; Receptors, Calcitriol/genetics* ; Genetic Predisposition to Disease ; Polymorphism, Genetic ; Vitamin D/metabolism* ; Tuberculosis, Osteoarticular/metabolism*

Tuberculosis is a global disease with a high prevalence rate in the Philippines. Frank hemoptysis often occurs later in the disease and is usually not massive since the availability of anti-Koch’s treatment. However, Rasmussen’s aneurysm, a pulmonary vascular complication secondary to tuberculosis from the weakening of the pulmonary arterial wall adjacent or within a tuberculous cavity, can be an uncommon cause of massive and potentially fatal hemoptysis.

A 35-year-old male patient presented with episodes of hemoptysis while being treated for pulmonary tuberculosis for two weeks. An episode of massive hemoptysis of ~400ml prompted his admission. Chest tomography with contrast showed bronchiectatic changes, cavitary formation, and an aneurysmal dilatation of the anterior segmental artery of the left upper lobe. He was diagnosed with Rasmussen’s aneurysm. A multidisciplinary team consisting of pulmonologists, interventional radiologists and thoracic surgeons planned for a surgical intervention as coil embolization was deemed to be difficult due to the wide neck character of the aneurysm. On re-admission after patient optimization, repeat chest tomography showed interval regression of pulmonary cavity with thrombosis of the previously identified Rasmussen’s aneurysm. Patient completed his 6-month antitubercular treatment with no further episodes of hemoptysis.

In patients with tuberculosis, hemoptysis results from involvement of the parenchyma, bronchiectasis, or erosion of residual cavities. Hemoptysis from the rupture of a dilated vessel such as Rasmussen’s aneurysm is a rare cause. Chest tomography with contrast is the imaging modality of choice as it demonstrates the focal pulmonary artery dilatation. Embolization or surgical lobectomy are typically utilized to control the bleeding. However, treatment with anti-tuberculous regimen may result already in regression and eventual thrombosis of the aneurysm. Watchful monitoring is imperative as massive hemoptysis may recur; radiologists and surgeons must be available at any time in case intervention is required.

BACKGROUND AND OBJECTIVE

Tuberculosis (TB) remains to be prevalent in the Philippines and globally. Female genital tuberculosis has devastating and permanent consequences, hence, timely and adequate treatment is needed. Since more data regarding optimal duration of treatment of genital tuberculosis are needed, this study compares the treatment response at six months and after at least nine months of treatment, with the intention of determining the most practical management for genital tuberculosis.

A retrospective chart review was conducted for newly diagnosed cases of genital tuberculosis who met the inclusion criteria. Treatment response was categorized into clinical, microbiologic, histologic, radiologic, and sonographic responses. Responses to treatment were evaluated as either partial or complete at the 6th month and after at least 9 months of treatment, and the proportions were compared.

Out of 140 charts retrieved, only 43 were included. Statistically significant difference was found only in clinical response, primarily due to patients who did not achieve resumption of menstruation within the f irst six months of treatment. The rest of the treatment responses and adverse drug events are equally the same for both time periods.

Results of this study show that the proportion of patients with microbiologic, histologic, radiologic, and sonographic response to treatment at the 6th month did not significantly differ to the proportion of patients who responded at the 9th or 12th month of treatment. This leads to a conclusion that the 6-month treatment regimen will be more practical in treating genital tuberculosis, except in amenorrheic premenopausal women who may warrant extension of treatment. Further studies on post-treatment rates of relapse and sonographic resolution are needed.

BACKGROUND AND OBJECTIVES

Hepatobiliarypancreatic tuberculosis (HBPTB) is a less common form of tuberculosis that often presents as malignancy or lithiasis. Advances in diagnostics and minimally invasive procedures have led to the detection of more patients with milder forms of TB requiring surgical management. Due to the low incidence rates and lack of standardized approaches, additional studies are needed to improve patient outcomes. This study examined the risk factors, diagnostic methods, and treatments for HBPTB patients at the University of the Philippines – Philippine General Hospital (UP-PGH) from January 1, 2014 to December 31, 2021.

This retrospective descriptive study utilized our institutional database to identify patients who underwent a surgical procedure for HBPTB and their associated risk factors. Inclusion criteria required biopsy or microbiologic proof of tuberculous involvement of the biliary tract or nearby structures.

Among a total of 45 patients, the most common admitting diagnosis were HBP tuberculosis (37.8%) and malignancy (35.6%). 47.6% of patients had a previous or concurrent TB exposure. Sixty percent had subclinical malnutrition indicated by normal weight and low albumin. The liver (37.8%) and the bile ducts (33.3%) were the most common organs involved. The most common surgical procedures done were ultrasound-guided liver biopsy, biliary enteric anastomosis, percutaneous transhepatic biliary drainage (PTBD), and endoscopic retrograde cholangiopancreatography with or without stenting (ERCP).

This study provides additional data for clinicians to tailor diagnostic and treatment plans accordingly. Striking a balance between surgical procedures and appropriate anti-tuberculous therapy (ATT) is essential for successful treatment. Local data can be useful to help identify tuberculosis patterns unique to Filipinos and highlight socio-economic factors contributing to this rare presentation of TB.

BACKGROUND AND OBJECTIVES

The Philippines faces challenges in the screening of tuberculosis (TB), one of them being the shortage in the health workforce who are skilled and allowed to screen TB. Deep learning neural networks (DLNNs) have shown potential in the TB screening process utilizing chest radiographs (CXRs). However, local studies on AIbased TB screening are limited. This study evaluated qXR3.0 technology's diagnostic performance for TB screening in Filipino adults aged 15 and older. Specifically, we evaluated the specificity and sensitivity of qXR3.0 compared to radiologists' impressions and determined whether it meets the World Health Organization (WHO) standards.

A prospective cohort design was used to perform a study on comparing screening and diagnostic accuracies of qXR3.0 and two radiologist gradings in accordance with the Standards for Reporting Diagnostic Accuracy (STARD). Subjects from two clinics in Metro Manila which had qXR 3.0 seeking consultation at the time of study were invited to participate to have CXRs and sputum collected. Radiologists' and qXR3.0 readings and impressions were compared with respect to the reference standard Xpert MTB/RiF assay. Diagnostic accuracy measures were calculated.

With 82 participants, qXR3.0 demonstrated 100% sensitivity and 72.7% specificity with respect to the reference standard. There was a strong agreement between qXR3.0 and radiologists' readings as exhibited by the 0.7895 (between qXR 3.0 and CXRs read by at least one radiologist), 0.9362 (qXR 3.0 and CXRs read by both radiologists), and 0.9403 (qXR 3.0 and CXRs read as not suggestive of TB by at least one radiologist) concordance indices.

qXR3.0 demonstrated high sensitivity to identify presence of TB among patients, and meets the WHO standard of at least 70% specificity for detecting true TB infection. This shows an immense potential for the tool to supplement the shortage of radiologists for TB screening in the country. Future research directions may consider larger sample sizes to confirm these findings and explore the economic value of mainstream adoption of qXR 3.0 for TB screening.

BACKGROUND AND OBJECTIVE

The World Health Organization (WHO) reported that most of the tuberculosis (TB) cases are aged between 15 to 54 years old, the working population. This study described workplace policies on TB in selected low- and middle-income countries (LMIC) in Asia-Pacific.

Among the LMICs, countries wherein TB is a public health concern were included. Six policies written in English were included in this study and were reviewed based on the components of the TB workplace programs that were extracted from the WHO Guidelines for Workplace TB Control Activities.

The Philippine policy had the most number of components while those of Cambodia and Papua New Guinea had the least. Only the component on implementing environmental controls was common among the policies. Components on respecting patient rights and confidentiality, tailoring of workload to TB patient’s state of health, registration of all patients with TB diagnosis, reporting of cases to central NTP office, recording of standard treatment outcome, and inclusion of multidrug-resistant TB (MDR-TB) provisions were missing for the majority of the policy documents.

The workplace TB program policies included in this study can be reviewed and updated accordingly, with the coverage expanding to all workplaces. The policies can also integrate measures on COVID-19 as the pandemic has slowed the progress in TB control. With the similarities in the preventive measures against TB and COVID-19, this can be an avenue to develop integrated policies especially for workplaces.

BACKGROUND AND OBJECTIVE

Nontuberculous mycobacteria (NTM) lung disease appears like tuberculosis infection but is resistant to primary anti-tuberculosis drugs. Hence, patients whose sputum sample tests positive for acid-fast bacilli (AFB) and bacterial culture for several times should be assessed for colonization or infection with NTM in a damaged lung secondary to TB. In such cases, though drug-resistant TB may be adequately treated, treatment may need to be directed towards the NTM as well. In NTM therapy, the duration and choice of treatment agent is based upon the specific organism and disease extent. This study used one-step multiplex PCR (mPCR) assay for rapid differentiation of solid cultures in Ogawa medium as Mycobacterium tuberculosis (MTB) and/or NTM.

A total of 80 stocked isolates obtained from the Lung Center of the Philippines from January to December 2018 were screened for NTM in terms of growth in Ogawa medium, acid fastness, and MPT64 TB antigen test result. These were from sputum specimens of multidrug-resistant tuberculosis (MDR-TB) patients. DNA was extracted from cultures (n=55) grown in Ogawa medium and one-step mPCR was performed to identify NTM to the species level.

Out of 80 samples screened, a total of 55 isolates were identified as NTM. One-step mPCR identified 12.73% (7/55) as M. abscessus, 34.55% (19/55) as M. massiliense, 1.82% (1/55) as M. kansasii, and 50.91% (28/55) were identified only up to genus Mycobacteria spp. Neither M. avium complex nor M. intracellulare was identified among the samples tested.

One-step mPCR was able to identify isolates as MTB or NTM coinciding with the initial screening using MPT64 TB antigen test. Multiplex PCR has given a more specific identificati on to the species level. The use of mPCR in identifying MTB and clinically significant NTM’s is suitable for the adequate treatment of mycobacterial infection.