Background: Virgin coconut oil (VCO) has anti-viral and anti-inflammatory properties, making it a potential therapeutic candidate against COVID-19 infection. Objective: To determine the efficacy and safety of VCO as adjunctive therapy for hospitalized patients with COVID-19. Methods: We conducted a randomized, open-label controlled trial involving laboratory-confirmed COVID-19 patients admitted at the Philippine General Hospital. The study participants were randomized to the intervention group who received virgin coconut oil with local standard of care, or to the control group who received local standard of care alone. Results: We enrolled 39 participants into the VCO group and 38 participants into the control group. Significantly fewer participants in the VCO group had abnormal CRP levels at the end of treatment compared to control. (relative risk [RR] 0.75, 95% confidence interval [CI] 0.58 to 0.95; p=0.02) No significant difference was found in the duration of hospital stay (mean 9.33 days for VCO vs. 10.29 days for control; p=0.45) and time to symptom resolution (mean 6.8 days for VCO, vs. 6.74 days for control; p=0.91). Although the proportion of patients who developed the secondary outcomes of mortality, need for ICU admission, need for invasive ventilation, and negative viral conversion was lower in the VCO group, results did not reach statistical significance. The VCO group had larger reduction in the inflammatory markers ferritin, lactate dehydrogenase, TNF-alpha, IP-10 and IL-6, but results did not reach statistical significance. Adverse events were significantly higher in the VCO group (RR 4.87, 95% CI 1.14 to 20.79; p=0.03). Conclusion This clinical trial on hospitalized patients showed significant benefit in CRP levels of participants given VCO compared to control. There was no significant benefit in the use of VCO as adjunctive therapy in reducing duration of hospital stay. Larger studies are needed to conclusively demonstrate the effect of VCO on other clinical outcomes and inflammatory markers.
COVID-19 ; Clinical Trial

This clinical pathway for the diagnosis and risk stratification of patients presenting with acute chest pain, including acute coronary syndromes, provides recommendations and algorithms for clinicians to diagnose, risk stratify, and manage acute chest pain in adult patients. The writing committee reviewed existing international and local guidelines. Modifications to the algorithm following face-to-face and virtual meetings resulted in expert decisions written as recommendations and presented in a flow diagram format. The USTH Chest Pain Pathway provides guidance based on current guidelines and recommendations on assessing and evaluating acute chest pain, tailored to local needs and institution-specific facilities. We recommend its use to ensure quality patient care in the hospital.
Acute Coronary Syndrome|critical Pathways

OBJECTIVE: This study determined the mean overall adherence to the clinical pathway formulated by the Section of Pulmonology together with the Division of Burns for adult burn patients at high risk for inhalation injury admitted at the UP-PGH ATR Burn Center in a two-year period METHODOLOGY: A retrospective cohort study regarding adherence to the clinical pathway of acutely burned adult patients at high risk for inhalation injury admitted at the UP-PGH ATR Burn Center between August 2016 to July 2018 was conducted. Medical records were reviewed and an adherence checklist was used to assess each item in the clinical pathway. For the adherence and patient profile, descriptive statistics were used. RESULTS: This pilot assessment study showed acceptable rates of adherence and implementation of the clinical pathway. Overall, 60% of the cases followed the clinical pathway completely. While 26.67% had acceptable rates of compliance (more than half of items adhered), while 13% of the cases scored adhered to less than half of the items. CONCLUSION The pathway has been shown to be a feasible clinical pathway that can be implemented in a tertiary hospital setting.
Burns

Tuberculosis (TB) is a major health issue in the Philippines. TB-Care was introduced in 2011 to tackle pulmonary TB among the urban poor in Payatas, Quezon City, Philippines. We evaluated the efficacy of TB-Care in increasing treatment success and compliance rates. This retrospective case series reviewed 44 patients with pulmonary TB enrolled in TB-Care from 2013 to 2014. Diagnosis and treatment of pulmonary TB was made in accordance with World Health Organization guidelines. Treatment outcomes included cure, completed treatment, successfully treated, failed treatment and transferred to another facility. 14 (73.7%) out of 19 patients tested were bacteriologically cured. The average 100% compliance rate was 90.8% over six months. The programme successfully treated 39 (88.6%) patients. This was comparable to the overall national treatment success rate of 90% for Philippines and 79% for Singapore, with higher compliance rates than were previously reported in this community.

OBJECTIVE: Profiling of burn patients with inhalational injury will lead to better practices in the immediate and supportive management of their injuries. The goal of this study was to determine demographic and clinical factors associated with mortality in burn patients with inhalational injury admitted at Philippine General Hospital - Alfredo T. Ramirez (PGH - ATR) Burn Center from 2008 to 2013. METHODS: All patients who were admitted from 2008 to 2013 were included in the study. The patient database was searched for cases of burn patients with inhalation injury. Medical records were reviewed for further analysis. This study was exempted from review by the University of the Philippines Manila Research Ethics Board. RESULTS: Out of 1900 burn patients included in the study, 134 presented with concomitant inhalation injury with a prevalence rate of 7.0% and with a mortality rate of 38.06%. The study showed that the following variables: 1) percent total body surface area (%TBSA), 2) length of time from injury to resuscitation, 3) nebulization with N-acetylcysteine, 4) development of pneumonia, 5) administration of systemic antibiotics, and 6) performance of bronchoscopy correlated significantly with patient outcomes (p<0.05). Other variables did not show significant correlations with outcomes. The study also revealed that most of the patients were males with a mean age of 30.62, who sustained severe burns usually greater than 39% TBSA. CONCLUSION Poorer prognostic indicators include: 1) larger burnt body surface area, 2) delayed intubation, 3) delayed resuscitation, and 4) development of pneumonia.
Burns

OBJECTIVE: This study aimed to describe the demographic profile of patients admitted at the UP-PGH ATR Burn Center from August 2013 - July 2015, and correlate it with outcomes of burn injury.
METHODS:  A  retrospective  study  of  patients  admitted  at  the  UP- PGH  ATR  Burn  Center  from  August  2013  to  July  2015  was conducted,  using  the  data  in  the  Integrated  Surgical  Information System. Descriptive statistics was used to summarize the clinical characteristics of patients. Logistic regression analysis determined the significant predictors of mortality. STATA 12.0 was used for data analysis.
RESULTS:The age groups most commonly involved were: 1 operation). Ninety-one percent (91%) of the admitted burn patients improved; 9% of the patients died. The most common cause of death was multiple organ dysfunction syndrome (40%). Significant factors associated with mortality included: 1) percent total body surface area, 2) inhalational injury and 3) involvement of the head, lower extremities and perineum.
CONCLUSION:  Burns  continue  to  be  a  big  burden  to  developing countries. To confront the burden of burns especially in developing countries  like  the  Philippines,  key  primary  preventive  measures should be implemented and be a priority for public health advocates.

Human ; Male ; Female ; Multiple Organ Failure ; Perineum ; Cause Of Death ; Burns ; Hospitalization ; Head ; Lower Extremity

OBJECTIVE: To present a complicated case of abdominal wall reconstruction after tumor extirpation using an anterolateral thigh free flap.

METHODS: This is a report of a case managed at the Philippine General Hospital last September 2016

RESULTS: A 25-year old male, diagnosed case of recurrent colon adenocarcinoma, underwent wide excision of recurrent abdominal wall tumor with fistula, resulting to 15cm x 30cm full thickness soft tissue abdominal wall defect with exposed bowels. A free anterolateral thigh fasciocutaneous flap was designed and elevated to cover the abdominal wall defect. Recipient vessels (contralateral deep inferior epigastric artery and veins) were anastomosed with donor vessels (descending branch of lateral circumflex femoral artery and veins). The donor site was closed with split thickness skin grafting.

CONCLUSION:The free anterolateral thigh flap allows for coverage of complicated recurrent abdominal wall malignancies, allowing for a single-stage surgery, with little donor site morbidity and shorter hospital stay.

Human ; Male ; Adult ; Free Tissue Flaps ; Thigh ; Abdominal Wall ; Skin Transplantation ; Epigastric Arteries ; Femoral Arter ; Abdominoplasty ; Veins ; Peritoneal Neoplasms ; Fistula ; Adenocarcinoma ; Colon

Toxic leucoencephalopathy (TLE) is a rare neurological complication of heroin abuse. 'Chasing the dragon' is an inhalational mode of heroin abuse that originated in Southeast Asia. Intriguingly, no cases of TLE have been reported from this region, although the inhalational mode of heroin abuse is common. We herein report the case of a middle-aged man with a history of polysubstance abuse who presented with progressive neurological symptoms and progressed to an uncommunicative state. While the initial impression was that of iatrogenic parkinsonism, diffuse leucoencephalopathy with sparing of the cerebellum was noted on magnetic resonance imaging. In view of his history of inhalational heroin abuse close to the onset of the neurological symptoms, a diagnosis of TLE was made. No clinical improvement was noted with administration of a dopaminergic agent. This is the first known case of delayed TLE following heroin inhalation from Southeast Asia with the unusual feature of cerebellar sparing.
Administration, Inhalation ; Brain ; pathology ; Disease Progression ; Heroin ; administration & dosage ; Heroin Dependence ; complications ; Humans ; Leukoencephalopathies ; chemically induced ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nervous System Diseases ; chemically induced ; Singapore