BACKGROUND

The coronavirus disease (COVID-19) is a global pandemic that caused millions of deaths worldwide. There is no standard risk stratification score for COVID 19 pneumonia. This study aims to determine the accuracy of the MuLBSTA score in predicting the risk of mortality in COVID-19 confirmed moderate to critical pneumonia cases.

METHODOLOGY

A total of 168 COVID-19-confirmed moderate to critical pneumonia patients admitted at Cardinal Santos Medical Center from January 1, 2021 to April 30, 2021 were included by chart review. The MuLBSTA score was determined for each patient using the following information: age, smoking history, co-morbidities, complete blood count, sputum culture, blood culture, chest xray and chest CT scan. All clinical outcomes were based on patient status by the end of the hospital stay (survival versus death). Thereafter, logistic regression was done using the MuLBSTA score and mortality to determine any correlation. In addition, modified regression was used to find any correlation with the MuLBSTAscore and patient co-morbidities as predictors of mortality. Chi-square tests of independence were conducted to assess the specific cut-off values of the MuLBSTAscore in predicting mortality.

RESULTS

The MuLBSTAscore is a significant predictor of mortality (73.08%) and survivability (66.67%). It was determined that the MuLBSTA score's accuracy in predicting mortality increases with diabetics [b = .26, p < .05]. In addition, the intervention of hemoperfusion can skew the predictive accuracy of the scoring [b = -.45, p <.01]. The study showed that a MuLBSTA score of 8 as a cut-off value to delineate high risk patients was more accurate in COVID-19 pneumonia patients compared to the previously established score cut-off of 12 in viral pneumonia [1].

CONCLUSION

The MuLBSTA score may be used for risk stratification in predicting mortality in COVID-19 pneumonia, especially among diabetic patients. A MuLBSTA score of 8 proves to be the more accurate cut-off in assessing risk of mortality in COVID-19. However, hemoperfusion makes the MulBSTAscore inapplicable.

Covid-19 ; Mortality

Introduction: Septic shock is the most common type of shock encountered by internists and is the most common cause of death in non-coronary intensive care units. In the 2012 Surviving Sepsis Campaign, one recommendation is antibiotic administration within three hours from sepsis recognition. Several large-scale studies challenged this recommendation with contrasting results. The researchers aim to determine the impact of early antibiotic therapy (EAT) on mortality and outcome of patients and to determine institutional compliance to current sepsis recommendations. Methods: This retrospective single center study included septic patients at the emergency room from February 2013 to January 2015 and were grouped into the EAT group (lesser than or equal to three hours) and control group (more than three hours) antibiotic initiation from sepsis recognition). Primary outcomes are in-hospital mortality, time-to-antibiotics and extraction of blood culture prior to antibiotics. Secondary outcomes include length of hospital stay, use of vasopressors and mechanical ventilation and development of sepsis-related complications. Results: Two-hundred sixty-one patients were included with 53.26% overall mortality rate. The overall mean timeto-antibiotics is 355.1 minutes and time-to-blood culture is 434.64 minutes. Mean time-to-antibiotics were 115 and 556 minutes in the EAT and control group respectively. Mortality was significantly higher in the control group (43.7% vs. 61.3%, p=0.006). For the sepsis related complications, development of acute kidney injury (p=0.033) was higher in the EAT group and acute respiratory failure (p=0.009) was significantly increased in the control group. Conclusion Antibiotic administration within three hours from sepsis recognition significantly reduced in-hospital mortality. Timing of antibiotics and collection of blood cultures were delayed compared to current recommendations. Among the sepsis-related complications, prolonged time-to-antibiotics (>3 hours) is associated with risk of developing acute respiratory failure and subsequent need for mechanical ventilation.
Early antibiotic therapy ; Shock, Septic ; Sepsis ; Systemic Inflammatory Response Syndrome

BACKGROUND AND OBJECTIVES: In September 2009, Metro Manila was hit by a heavy rainfall typhoon Ketsana inundating several cities of Metro Manila causing an outbreak of leptospirosis. We analyzed the prognostic factors associated with mortality among leptospirosis patients admitted after the typhoon at nine tertiary hospitals from September to November 2009.
METHODS: We reviewed the charts of patients with probable and confirmed leptospirosis. Confirmed leptospirosis was based on any of the following: positive leptospiral culture of blood or urine, single high leptospira microagglutination titer (MAT) of 1:1600 or a fourfold rise in MAT antibody titers or seroconversion. Patients with negative serology or cultures but with history of wading in floodwaters plus any of the following signs and symptons: fever, headache, myalgia, conjunctival suffusion, diarrhea and abdominal pain, jaundice, oliguria and changes in sensorium were considered probable cases.
RESULTS: We analyzed 332 probable and 259 confirmed leptospirosis patients. Mean age was 37.95± 14.09, mostly males (80.2%). Almost all patients (98%) waded in floodwaters. Majority had moderate to severe form of leptospirosis (83%). Acute renal failure was the most common complication (87.1%). Mortality was 11.3% mostly due to pulmonary hemorrhage. On multivariate analysis of confirmed and probable cases, the factors independently associated with mortality were pulmonary hemorrhage (OR 2.75, 95% CI 1.46 to 5.20), severity of the disease (OR 3.85, 95% CI 1.60 to 9.26), thrombocytopenia (OR 3.16, 95% CI 1.22-8.16), duration of illness before admission (OR 0.88, 95% CI 0.78-0.99) and age (OR 1.03, 95% CI 1.00-1.06).
CONCLUSION: Pulmonary hemorrhage remains a poor prognostic factor and strong predictor of mortality among patients with severe leptospirosis. Early consult through heightened awareness of the public and prompt recognition of leptospirosis among clinicians can decrease the risk for progression to complications of leptospirosis and mortality.

 

Human ; Male ; Female ; Adult ; Adolescent ; Hemorrhage ; Mortality ; Serology ; Abdominal Pain ; Acute Kidney Injury ; Cyclonic Storms ; Diarrhea ; Disease Outbreaks ; Fever ; Headache ; Jaundice ; Leptospira ; Leptospirosis ; Multivariate Analysis ; Myalgia ; Oliguria ; Philippines ; Prognosis ; Seroconversion ; Tertiary Care Centers ; Thrombocytopenia

OBJECTIVE: Renal allograft recipients are at higher risk of developing tuberculosis (TB) as compared to the general population. The infection also carries with it a significant morbidity and mortality. However, data is limited regarding its incidence and risk factor analysis in our setting. This study determined the incidence, characteristics and risk factors of post-transplant TB in National Kidney and Transplant Institute (NKTI).
METHODS: This is a retrospective study involving chart review of 1,621 renal allograft recipients from 2003-2009. We recorded demographic information, transplant characteristics, median time to diagnosis of TB and forms of TB.
RESULTS: The incidence of TB in renal allograft recipients is 2.6%. Median time to diagnosis of TB after transplant is 21 months (one to 105 months). Risk factors identified in this study were previous history of TB (OR 4.15, 95% CI 1.4-12.2), one episode of rejection (OR 2.33, 95% CI 1.2-4.6) and subsequent use of methylprednisolone as antirejection therapy (OR 2.36, 95% CI 1.3-4.4). Patients given a tacrolimus based regimen (OR 0.5, 95% CI 0.24-1.03) and those without episode of rejection (OR 0.43, 95% CI 0.22-0.84) had less tendency to develop post-transplant TB. There were no sufficient evidence to prove association between onset of TB and use of isoniazid prophylaxis, use of induction immunosuppression and type of immunosuppression. Eighty one percent (81%) had pulmonary and 19% had extrapulmonary forms of TB.
CONCLUSION: Incidence of TB among renal allograft recipients is lower as compared to other high TB burden countries but is still higher as compared to the general Filipino population. The study identified multiple risk factors for post-transplant TB. Prevention of these diseases and identification of patients at risk are as important as early diagnosis and treatment of post-transplant TB.

Human ; Male ; Female ; Middle Aged ; Adult ; Isoniazid ; Tacrolimus ; Methylprednisolone ; Kidney Transplantation ; Tuberculosis ; Immunosuppression ; Transplantation, Homologous

Background. Emergence of multidrug-resistant tuberculosis (MDR-TB) poses a major challenge to prevailing disease management. MDR-TB arises from mutations in several genes comprising the resistance determining regions, including rpoB, katG and gyrA. Objective. To detect and characterize mutations in rpoB, katG and gyrA. Methods. Thirty selected Mycobacterium tuberculosis isolates from the IDS-PGH were subjected to PCR amplification and sequencing. Sequences were compared to the wild type strain H37Rv. Results. Mutations were detected in codons 512, 513, 516, 522, 526, 531 and 533 of rpoB, codons 280, 281, 315 and 333 of katG, and codons 90 and 94 of gyrA sequences. The most frequently mutating codons for rpoB, katG and gyrA were 531, 315 and 94, respectively. A clustering analysis of the sequences showed occurrence of seven, four and three clusters for the genes rpoB, katG and gyrA, respectively. The eight clusters obtained from the concatenated sequences of the three genes represent the eight potential genotypes of local strains. One cluster represents the wild type strain genotype, another cluster represents the XDR strain genotype, and six clusters represent the MDR strain genotypes. Conclusion. These findings indicate the utility of multiple RDR sequence analysis in both identifying specific drug resistance mutation and genotyping of various M. tuberculosis isolates.
TUBERCULOSIS ; THERAPEUTICS ; THERAPY

BACKGROUND AND AIM: Current standard diagnostic tests for leptospirosis are time-consuming and laborious. The urine DOT-ELISA for leptospirosis is a non-invasive, rapid test utilizing monoclonal antibody to detect leptospiral antigens in the urine. We aimed to determine the clinical utility of urine monoclonal antibody-based DOT-ELISA in the rapid diagnosis of leptospirosis compared with the standard microscopic agglutination test (MAT) and urine and blood cultures.

METHODS: This cross-sectional study was done in a university tertiary hospital in Manila, Philippines. We obtained specimens from patients for blood and urine cultures for leptospirosis, MAT and urine ELISA upon admission and 7 days later.

RESULTS: We included 117 patients over a 15-month period. The median duration of illness before inclusion was 9 days (IQR 7-14) and 64 percent received antibiotics before testing. During the acute phase of illness, the sensitivity, specificity, negative and positive predictive values of the urine ELISA compared to culture and MAT were 27.3 percent (95 percent CI 13.2-48.2 percent), 97.7 percent (95 percent CI 80.0-98.3 percent), 66 percent (95 percent CI 51.7-77.8 percent) and 75 percent (95 percent CI 40.9-92.5 percent), respectively. For patients with symptoms more than 7 days of illness, the sensitivity increased to 40.9 percent (95 percent CI 23.3, 61.3 percent) and the specificity increased to 97.5 percent (95 percent CI 87.1, 99.9 percent), with negative and positive predictive values of 75 percent (95 percent CI 61.8, 84.8 percent) and 90 percent (95 percent CI 59.6, 99.5 percent), respectively. On sub-analysis of the effect of antibiotic use, the sensitivity rates differed significantly among patients with antibiotic use versus for those without antibiotic use, 48.4 percent vs. 15.4 percent, respectively (p = 0.001). The specificity rates did not vary with antibiotic use, 98 percent vs. 97 percent.

CONCLUSION: The DOT-ELISA urine antigen test is highly specific with fair accuracy of 73 percent. Its low sensitivity makes it a poor screening test but its high specificity makes it a useful confirmatory test in the diagnosis of leptospirosis. (Author)

Leptospirosis

INTRODUCTION: Fungal peritonitis is uncommon but important complication of continuous ambulatory peritoneal dialysis (CAPD). It accounts for 5 percent-15 percent of the total burden of peritonitis in most CAPD units. At the National Kidney and Transplant Institute (NKTI), the incidence increased from 11 percent in 1997 to 21 percent in 2000. Since this complication is associated with severe morbidity, CAPD drop-out and death, measures to decrease or prevent its occurrence are necessary.

OBJECTIVES: (l) To determine if nystatin is effective as prophylaxis for fungal peritonitis in patients with an ongoing CAPD-related bacterial peritonitis; and (2) to determine the predisposing factors for fungal peritonitis

DESIGN: Randomized single-blinded trial

SETTING: National Kidney and Transplant Institute, tertiary renal referral center in the Philippines

METHODS: From June 2001 to December 2004, newly diagnosed patients with end-stage renal disease (ESRD) on CAPD were randomized to receive nystatin as prophylaxis for fungal peritonitis during their first bacterial peritonitis episode and for all successive episodes within the next 6 months. Group 1 patients received nystatin concomitantly with the antibiotics for bacterial peritonitis while Group 2 received antibiotics alone. The incidence and the time to development of fungal peritonitis were measured. Intention-to-treat analysis was used.

RESULTS: There were 133 eligible patients, of whom 74 patients were randomized to Group 1 and 59 patients were randomized to Group 2. Eighty-three patients completed the study: 47 in Group 1 and 36 in Group 2. The cumulative incidence of developing fungal peritonitis was 10.8 percent. Group 1 had a slightly lower incidence of fungal peritonitis compared to Group 2 (10.6 percent vs 11.1 percent) but this was not statistically significant (p-1.0). Nystatin prophylaxis delayed the time to develop fungal peritonitis by 5 months but this was not statistically significant (p-0.94). Among the potential risk factors studied, only the presence of diabetes mellitus was associated with the development of fungal peritonitis.

CONCLUSION: There were no significant differences in clinical outcomes in the two treatment groups. However, there appeared to be a delay in the development of fungal peritonitis with the use of nystatin prophylaxis within the first 5 months of a bacterial peritonitis episode. (Author)

Fungal Peritonitis ; Nystatin ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis