Background and Objective: Convalescent plasma therapy (CPT) may reduce the risk of disease progression among patients with COVID-19. This study was undertaken to evaluate the efficacy and safety of CPT in preventing ICU admission among hospitalized COVID-19 patients. Methods: In this open-label randomized controlled trial, we randomly assigned hospitalized adult patients with COVID-19 in a 1:1 ratio to receive convalescent plasma as an adjunct to standard of care or standard of care alone. The primary endpoint was ICU admission within first 28 days of enrolment. Primary safety endpoints include rapid deterioration of respiratory or clinical status within four hours of convalescent plasma transfusion and cumulative incidence of serious adverse events during the study period including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), severe allergic reactions, and transfusion-related infections. Results: A total of 22 patients were assigned to receive convalescent plasma as an adjunct to standard of care and 22 to receive standard of care alone. The median time from onset of COVID-19 symptoms to study enrolment was eight days (IQR, 4 to 10). Two patients (9.1%) in the CPT group and one patient (4.5%) in the control group were admitted to the ICU. The primary outcome measure, ICU admission, was not different between the two groups (q-value >0.9). No patient who received convalescent plasma had rapid deterioration of respiratory/clinical status within four hours of transfusion and none developed TRALI, TACO, anaphylaxis, severe allergic reactions, or transfusion-related infections. There was also no significant difference in the secondary outcomes of 28-day mortality (two patients in the CPT group and none in the control group, q-value >0.90), dialysis-free days, vasopressor-free days, and ICU-free days. Conclusions Among hospitalized COVID-19 patients, no significant differences were observed in the need for ICU admission between patients given CPT as adjunct to standard of care and those who received standard of care alone. Interpretation is limited by early termination of the trial which may have been underpowered to detect a clinically important difference.
COVID-19 ; COVID-19 Serotherapy

Background and Introduction. The RxBox is a telemedicine device that measures and transmits vital signs to remote experts. It has been deployed to primary care health centers (PCHC) in the Philippines serving disadvantaged populations, to decrease morbidity and mortality due to common diseases and poor access to care. Factors affecting its adoption by healthcare workers is unknown.

Materials and Methods. The study determined social and behavioral factors that affect adoption of a telemedicine device into the clinical workflow using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. This is a mixed methods research using review of records, survey and focused group discussions.

Results and Discussion. RxBox telemedicine devices were installed in 79 primary care health centers (PCHC) and were used a total of 15,705 times within the study period. An ordinary least squares regression analysis using the combined site and individual-level data showed that among the UTAUT parameters, only compatibility, facilitating conditions, and social factors have significant relationships with intent-to-use of the RxBox. The innovation assisted primary care health workers in their clinical responsibilities, improved the stature of their PCHC in the community, and helped in the care for patients. Training and technology support after deployment as well as encouragement by peer and champions (the PCHC physician, local government leaders) reinforced continuous use after training. Users described the experienced improvements in quality of services provided by the PCHC and the consequent benefits to their patients.

Conclusions. These factors should be accounted for in designing strategies to reinforce health workers' attitudes and enhance support towards acceptance and use of novel telemedicine devices into clinical routine in local health centers. Lessons are immediately useful for local leaders in low- and lower middle-income countries that suffer disproportionately from unnecessary maternal deaths and mortality due to non-communicable diseases. This contributes to the body of knowledge and should bolster national-level advocacy to institute an enabling policy on telehealth Information Communication Technology (ICT) and use of Filipino innovations towards health systems strengthening. Results can be used by implementers, evaluators, and regulators of health ICT, especially in resource-poor settings. Likewise, the study can encourage more research in the field to spur more dynamic local health ICT and biomedical device industries.

Primary Health Care

Background: Despite the rigorous and extremely competitive selection process of medical students at the University of the Philippines College of Medicine (UPCM), a few still performed poorly in academics that resulted in delayed graduation or failure to graduate at all. Methodology: Factors potentially associated with delayed graduation and failure to graduate among UPCM medical students were analyzed using univariate and multivariable logistic regression with their demographic and pre-admission academic profiles, namely, Pre-medical General Weighted Average Grade (PGWAG), National Medical Admission Test Scores (NMATs), interview scores, pre-med courses, the school graduated from, and admissions categories as predictors. Objective: The objective of this study was to identify the factors that predict the likelihood of not graduating and delayed graduation among the medical students of 24 classes of the UPCM. Results: The odds of delayed graduation and failure to graduate were increased by lower PMGWAG, NMAT score, interview score, admission through the special categories, being a non-UP graduate, and with BS Psychology as pre-med course. Conclusion The predictors of poor academic performance based on delayed graduation and failure to graduate were the PMGWAG, NMAT, interview scores, admissions category, pre-med course, and the school graduated from. It is recommended that the minimum admissions requirements for PMGWAG be increased particularly among the candidates in the special categories. The selection process in the special categories must put some bearing on the PMGWAGs and NMATs of their applicants.
Education, Medical ; Academic Performance

Objective. To determine the diagnostic accuracy of self-collected snorted and spit saliva in detecting COVID-19 using RT-PCR (ssRT-PCR) and lateral flow antigen test (ssLFA) versus nasopharyngeal swab RT-PCR (npRT-PCR). Methods. One hundred ninety-seven symptomatic subjects for COVID-19 testing in a tertiary hospital underwent snort-spit saliva self-collection for RT-PCR and antigen testing and nasopharyngeal swab for RT-PCR as reference. Positivity rates, agreement, sensitivity, specificity, and likelihood ratios were estimated. Results. Estimated prevalence of COVID-19 using npRT-PCR was 9% (exact 95% CI of 5.5% - 14.1%). A higher positivity rate of 13% in the ssRT-PCR assay suggested possible higher viral RNA in the snort-spit samples. There was 92.9% agreement between ssRT-PCR and npRT-PCR (exact 95% CI of 88.4% to 96.1%; Cohen’s Kappa of 0.6435). If npRT-PCR will be assumed as reference standard, the estimated Sensitivity was 83.3% (exact 95% CI of 60.8% to 94.2%), Specificity 93.9% (exact 95% CI of 89.3% to 96.5%), Positive predictive value of 57.7% (exact 95% CI of 38.9% to 74.5%), Negative predictive value of 98.2% (exact 95% CI of 95% to 99.4%), positive likelihood ratio of 3.65 (95% CI of 7.37 to 24.9), negative likelihood ratio of 0.178 (95% CI of 0.063 to 0.499). There was 84.84% agreement (95% exact CI of 79.1% to 89.5%; Cohen’s Kappa of 0.2356) between ssLFAvs npRT-PCR, sensitivity of 38.9% (exact 95% CI of 20.3% to 61.4%), specificity of 89.4% (exact 95% CI of 84.1% to 93.1%), PPV of 26.9% (95% CI of 13.7% to 46.1%), NPV of 93.6% (exact 95% CI of 88.8% to 96.4%), LR+ of 3.67 (95% CI of 1.79 - 7.51), LR – of 0.68 (95% CI of 0.47 - 0.99). Conclusion. Our data showed that snort-spit saliva RT-PCR testing had acceptable diagnostic performance characteristics and can potentially be used as an alternative to the standard nasopharyngeal/oropharyngeal swab RT-PCR test for COVID-19 in certain situations. However, our data also showed that snort-spit saliva antigen testing using lateral flow assay did not offer acceptable performance.
Saliva ; SARS-CoV-2 ; Reverse Transcription ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVE: To identify the glaucoma clinical practice patterns among the members of the Philippine Glaucoma Society (PGS) from 2015 to 2016 using an online survey. METHODS: An online link was sent to each consenting PGS member which directed them to two poll sites. These sites asked questions about demographics and their preferred clinical practice patterns. Frequency and percent distributions were used to analyze the data. RESULTS: There was a high response rate from PGS members at 97% (42 out of 43 members). More than half of respondents (51%, n=22) defined glaucoma as glaucomatous optic neuropathy with an evident visual field loss. IOP was routinely measured by 90% (n=38) of the respondents with majority preferring to use the Goldmann applanation tonometer (GAT) (98%, n=41). Gonioscopy was done on all new patients by all PGS members but only 62% did regular gonioscopy on follow-up consultations. Most of the respondents relied on the 90D lens (88%) to assess the optic nerve. Visual field examination (VFE) was routinely requested by all respondents. Pachymetry and anterior segment optical coherence tomography (AS-OCT) were used sparingly at only 43% and 12% respectively. Appositional angle closure was addressed by performing laser iridotomy with majority of the respondents preferring a site that is covered by the upper eyelid (57%). Prostaglandin analogues were the top choice as first-line monotherapy for eyes with open-angle glaucoma. Majority of the respondents (55%) opted to do laser trabeculoplasty (LTP) as an adjunct to medical therapy. Mitomycin-C was the preferred intraoperative antimetabolite for trabeculectomy by 98% (n=41). Ahmed (71%, n=30) was the more favored glaucoma drainage device (GDD) by our respondents over Baerveldt (19%, n=8). CONCLUSION: This survey showed majority of the glaucoma practices of PGS members appear to adhere to the current clinical practice guidelines.
Philippines ; Glaucoma ; Tetrahymenina ; Surveys and Questionnaires

Objectives: To evaluate abnormal Papanicolau smear results at the Philippine General Hospital (PGH) for the past four years by comparing abnormal smear cytology with histologic interpretations. Possible causes of discrepant results were also determined.

Methods: All Pap smears released as abnormal from January 2014 to December 2017 and the corresponding available biopsies were retrieved. Discrepancy between cytologic and histology diagnosis was assessed and pairs with major discordance were reviewed.

Results: There were a total of 30,237 conventional pap smears signed out of which 239 (0.79%) were abnormal and only 56 (23%) had a subsequent tissue biopsy. The overall concordance rate is 75% while strict or absolute concordance rate is 32%. The overall discordance rate is 25%. Positive predictive value is highest for pap smears signed out as atypical glandular cells favor neoplastic (AGC-NEO) (100%), followed by malignant (93%), high grade squamous intraepithelial lesion (HSIL) (83%), and then atypical squamous cells cannot exclude an HSIL (ASC-H) and atypical squamous cell of undetermined significance (ASCUS), both at 67%.

Conclusions: Considering that the Philippine General Hospital is a referral and academic center, we have a low percentage of abnormal pap smears compared to other developing countries and even a lower percentage of patients who had subsequent biopsies. Cytohistologic correlation detected interpretative as well as sampling errors, and the aim is to work on these deficiencies by improving quality assurance protocols and modifying current local practices of both pathologists and clinicians.

Human

OBJECTIVE: To describe the demographic and clinical profile of patients who underwent refractive surgery screening.

METHODS: Medical records of patients who sought consult for refractive surgery from January 2010 to December 2014 at a refractive center were reviewed and analyzed. The preoperative clinical conditions, optical characteristics of myopes and hyperopes, refractive screening tests, and causes for disqualification were determined.

RESULTS: A total of 1215 patients who sought consult for refractive surgery had a mean age of 36.45 ± 11.60 years. Seven hundred ten (58.44%) were females and 860 (70.78%) were Filipinos. Nine hundred eighty eight (81%) were myopes. The mean manifest refractive spherical equivalent (MRSE) for myopic patients was -4.41D±2.98 with mean uncorrected distance vision (UCDVA) of 20/400 (logMAR 1.26) and mean best-corrected distance vision (BCDVA) of 20/20 (logMAR 0.02). For hyperopic patients, the mean MRSE was +1.33D±3.76 with mean UCDVA of 20/40 (logMAR 0.33) and mean BCDVA of 20/20 (logMAR 0.001). Reasons for disqualification from undergoing a refractive procedure included thin cornea (5.27%), irregular corneal topography (2.39%), steep cornea (0.78%), high refractive errors (0.41%), optic nerve (0.41%), and retina (0.25%) pathologies.

CONCLUSION: Patients who underwent screening for refractive surgery were young, mostly female, with myopic refractive errors. LASIK remained the most popular refractive surgery procedure. 

Human ; Male ; Female ; Adult ; Keratomileusis, Laser In Situ ; Corneal Topography ; Hyperopia ; Myopia ; Refractive Errors ; Optic Nerve ; Retina ; Cornea ;

OBJECTIVE: To evaluate the visual and refractive outcomes of LASIK, PRK, phakic IOL, and Supracor as treatment for errors of refraction, including presbyopia, performed at a private eye center.

METHODS: This is a retrospective, single-center, single-surgeon study that reviewed the surgical outcomes of patients who underwent LASIK, PRK, phakic IOL, and Supracor from January 2010 to December 2014. Main outcome measures were postoperative uncorrected and corrected distance, intermediate, and near visual acuity (for Supracor), and mean manifest-refraction spherical equivalent (MRSE) of patients who had at least 1 month follow up. Complications and enhancements were analyzed independently.

RESULTS: Data were analyzed from 1,366 eyes of 771 patients. LASIK was the most commonly performed procedure (68%), followed by PRK (18.3%), Supracor (10.2%), and phakic IOL (3.7%). The postoperative mean MRSE at 1 month for LASIK, PRK, and phakic IOL were -0.08 ± 0.36, +0.06 ± 0.52 and -0.11 ± 0.44, respectively. The mean postoperative logMAR uncorrected distance visual acuity (UDVA) at 1 month for LASIK, PRK, and phakic IOL were 0.02 ± 0.10, 0.07 ± 0.12, 0.001 ± 0.09, respectively. In the Supracor group, the mean preoperative and postoperative spherical equivalent were +1.12 ± 0.8 and -0.76 ± 0.62, respectively. The mean postoperative logMAR UDVA and uncorrected near visual acuity (UNVA) for Supracor were 0.24 ± 0.19 and 0.02 ± 0.08, respectively. The most common postoperative complication was symptomatic dry eye (13%). Regression and off-target outcomes occurred in 24 (1.8%) and 13 eyes (1%), respectively. Overall enhancement rate was 2%.

CONCLUSION: LASIK remained to be the most common refractive procedure, with femtosecond laser-created flap becoming the norm. Refractive and visual outcomes showed good efficacy with all the refractive procedures. Complication and enhancement rates were low.

Human ; Adult ; Keratomileusis, Laser In Situ ; Presbyopia ; Visual Acuity ; Eye ; Surgeons ; Postoperative Complications ; Outcome Assessment (health Care)

INTRODUCTION: The use of neoadjuvant chemoradiotherapy (CRT) and total mesorectal excision (TME) has shown promising results in the management of locally advanced rectal carcinoma, and is associated with improvement in local control, disease free survival (DFS) and overall survival (OS). However, these clinical endpoints cannot be properly assessed due to poor follow up among many patients. Other endpoints such as negative circumferential resection margins (CRM), pathologic complete response (pCR) and sphincter-preserving surgery (SPS) may serve as indirect means of assessing successful treatment. This study reports the experience of the Philippine General Hospital (PGH) Colorectal Polyp and Cancer (CRPoCan) Study Group in using neoadjuvant CRT and TME in the management of locally advanced rectal carcinoma, towards quality care.
METHODS: The Integrated Surgical Information System (ISIS) database of the Department of Surgery, PGH was queried for rectal cancer patients with pretreatment clinical stage II and III disease that underwent neo-adjuvant CRT followed by TME between January 2008 and December 2009. The final surgical pathology reports of the subjects were reviewed for treatment response. Response was categorized as: (1) positive or negative CRM; and (2) with or without pCR. The study assessed whether SPS was done.
RESULTS: Of 140 potential neoadjuvant CRT patients followed by TME, 82 patients completed the treatment. Thirty two of the patients who completed treatment (39%) were eligible since the other 50 patients (61%) had no post-operative histopathology results. Among those eligible, 10 patients (31%) had pCR. Only 1 patient had a positive CRM. Of the 14 patients whose tumor distance was ?5cm from the anal verge, only 1 patient underwent SPS. The small sample size was mainly attributed to low resources or treatment. Non-availability of post-operative histopathology results was due to poor record keeping.
CONCLUSION: The PGH CRPoCan Study Group's use of neoadjuvant CRT followed by TME for locally advanced rectal carcinoma has resulted in acceptable numbers of pCR and clear CRM but has not translated into an increased number of SPS. Despite the limitations of the study, the institutionalization of the multidisciplinary team in the PGH CRPoCan Study Group and the implementation of the ISIS database program are considered the first steps towards quality health care.

Human ; Male ; Female ; Neoadjuvant Chemoradiotherapy ; Total Mesorectal Excision ; Polyp ; Surgical Pathology ; Rectal Cancer

A case of a 74-year-old male with unilateral nasal obstruction, recurrent epistaxis and a right intranasal mass is presented. It was initially diagnosed as hemangioma but final histopathology report revealed oncocytic carcinoma. Oncocytic carcinoma is a rare tumor of the salivary glands with very few reported cases, most of which involve the parotid gland. It has a tendency to recur with inadequate excision. Diagnosis is histopathologic. It is to be emphasized that adequate tissue samples should be taken in order to provide a definite diagnosis from biopsy, and subsequently institute proper definitive management.

Human ; Male ; Aged ; Parotid Gland ; Nasal Obstruction ; Epistaxis ; Salivary Glands ; Biopsy ; Hemangioma ; Neoplasm Recurrence, Local