HIV screening among patients with newly diagnosed solid and hematologic malignancies in a Tertiary Hospital in the Philippines

Objectives@#This preliminary study determined the prevalence of HIV infection among patients with newly diagnosed solid and hematologic malignancies at the Philippine General Hospital - Cancer Institute. @*Methods@#Adult Filipinos aged 19 years and above with biopsy- or imaging-confirmed malignancy and for chemotherapy, seen at the adult medical oncology and hematology clinic from January to September 2021 were included. Demographic and clinical data were obtained using a questionnaire. Rapid HIV screening was performed using blood extracted via finger prick. Pre- and post-test counselling were conducted. @*Results@#Of the 124 patients included in our study, majority were female (91, 73.4%), and 45 years old and above with a median age of 49 (20 – 74). Majority had solid tumors (121, 97.6%) with breast cancer being the most common (67, 54.0%) followed by colorectal (18, 14.5%), and head and neck cancer (14, 11.3%). Among those with hematologic malignancies, two had acute myelogenous leukemia and one had multiple myeloma. Six patients had AIDS-defining malignancies (NHL, cervical cancer). HIV risk factors and associated conditions were present in 18 patients (14.5%). Ten patients reported prior HIV testing. None of the patients tested positive for HIV. @*Conclusion@#The absence of HIV cases detected in our cohort may be due to the low prevalence of HIV risk factors and associated conditions. At this time, there is insufficient evidence to routinely recommend HIV testing among newlydiagnosed cancer patients. However, physicians are encouraged to offer HIV testing to cancer patients, especially to those with HIV risk factors, given the benefits of early detection and management of HIV.

Convalescent plasma as adjunctive therapy for hospitalized patients with COVID-19:The Co-CLARITY Trial

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.

Predictors and outcomes of hospitalized COVID-19 patients with liver injury

Objective@#To determine incidence, predictors, and impact of liver injury among hospitalized COVID-19 patients@*Methods@#This is a retrospective cohort study of hospitalized COVID-19 patients at the University of the PhilippinesPhilippine General Hospital. Liver injury (LI) was defined as ALT elevation above institutional cut-off (>50 u/L) and was classified as mild (>1x to 3x ULN), moderate (>3x to 5x ULN), or severe (>5x ULN). Significant liver injury (SLI) was defined as moderate to severe LI. Univariate analysis of SLI predictors was performed. The impact of LI on clinical outcomes was determined and adjusted for known predictors -age, sex, and comorbidities.@*Results@#Of the 1,131 patients, 565 (50.04%) developed LI. SLI was associated with male sex, alcohol use, chronic liver disease, increasing COVID-19 severity, high bilirubin, AST, LDH, CRP, and low lymphocyte count and albumin. An increasing degree of LI correlated with ICU admission. Only severe LI was associated with the risk of invasive ventilation (OR: 3.54, p=0.01) and mortality (OR: 2.76, p=0.01). Severe LI, male sex, cardiovascular disease, and malignancy were associated with longer hospital stay among survivors.@*Conclusion@#The liver injury occurred commonly among COVID-19 patients and was associated with important clinicodemographic characteristics. Severe liver injury increases the risk of adverse outcomes among hospitalized patients.

Characteristics and factors associated with mortality of 200 COVID-19 patients at a Philippine COVID-19 tertiary referral center

@# Objectives: To describe the clinical profile and factors associated with mortality among the first 200 patients confirmed to have COVID-19 infection admitted in the University of the Philippines – Philippine General Hospital (UP-PGH) Methodology: We conducted a retrospective review of adult patients with confirmed COVID-19 infection admitted in PGH, a designated COVID-19 referral center. Demographic, clinical data, and clinical outcomes were extracted from medical records. Frequencies and distributions of various clinical characteristics were described, and factors associated with mortality were investigated. Results: Of the 200 patients in our cohort, majority were male (55.5%), and more than half (58%) were over 60 years old. Underlying co-morbid illnesses (67.5%) included hypertension (49.5%), diabetes mellitus (26.5%), and cardiovascular disease (20.5%). Most frequent presenting symptoms were cough (69.0%), fever (58.5%), or shortness of breath (53.0%). Most patients presented with mild (n=41, 20.5%) to moderate illness (n=99, 49.5%) and only 60 were considered severely (n=32, 16.0%) or critically ill (n=28, 14.0%). Many (61%) received empiric antibiotics, while 44.5% received either repurposed drugs or investigational therapies for COVID-19. Bacterial co-infection was documented in 11%, with Klebsiella pneumoniae commonly isolated. In-hospital mortality was 17.5%, which was highest for critical COVID-19 (71.4%). Mortality was observed to be higher among patients age 60 and above, those requiring oxygen, ventilatory support and ICU admission, and among those who developed acute kidney injury, acute stroke, sepsis, and nosocomial pneumonia. Conclusion: Our study confirms that COVID-19 affects males, older individuals and those with underlying co-morbid conditions. Empiric antimicrobial treatment was given for majority of patients, despite documentation of bacterial infection in only 11%. K. pneumoniae was commonly isolated, reflecting local epidemiology. Mortality rate during this early period of the pandemic was high and comparable to other institutions. Factors associated with mortality were related to critical COVID-19 and are similar to other studies.

Barriers to hand hygiene compliance in the medicine wards and intensive care unit of a tertiary teaching hospital in the Philippines

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Healthcare associated infections (HCAI) continue to be major problems in our institution. Studies have shown that hand hygiene remain to be the primary measure that prevents HCAI. This study aimed to measure hand hygiene compliance rate and determine factors affecting compliance.</p><p style="text-align: justify;"><strong>METHODS:</strong> Healthcare workers in the medicine wards and intesive care units (ICU) were directly observed for compliance to the World Health Organization hand hygiene guidelines. In a month period, subjects were selected by convenience sampling. Factors affecting hand hygiene compliance was investigated. Survey of infrastructure and hand hygiene products was concurrently done. Thereafter, self-administered survey was distributed to assess knowledge, attitudes and perceptions toward hand hygiene.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Overall hand hygiene compliance was 11%. Compliance was less likely for doctors, in the ward, and before patient contact. On the other hand, compliance was likely among nurses, in the ICU, before aseptic procedure, after exposure to body fluid, and after patient contact. Demand for hand hygiene was high with mean of 35 (SD=nine) opportunities per hour of patient care. Hand hygiene products are less available in the wards than in the ICU. Sinks are not in convenient locations. Hand hygiene posters were either not visible or lacking. Majority of the survey respondents know at most only two of the five hand hygiene indications.</p><p style="text-align: justify;"><strong>DISCUSSION:</strong> Access to hand hygiene products, training and education, and reminders in the workplace are among the basic requirements in the implementation of hand hygiene programs. With problems related to these three components, hand hygiene compliance is expected to be low.</p><p style="text-align: justify;"><strong>CONCLUSION: </strong>Low compliance to hand hygiene was associated with professional status, location and indication. Barriers to hand hygiene include inadequate and inaccessible sinks and hand hygiene products in the ward, high demand for hand hygiene, poor knowledge of hand hygiene, and lack of reminders in the workplace.</p>

Barriers to hand hygiene compliance in the medicine wards and intensive care unit of a tertiary teaching hospital in the Philippines

INTRODUCTION: Healthcare associated infections (HCAI) continue to be major problems in our institution. Studies have shown that hand hygiene remain to be the primary measure that prevents HCAI. This study aimed to measure hand hygiene compliance rate and determine factors affecting compliance.METHODS: Healthcare workers in the medicine wards and intesive care units (ICU) were directly observed for compliance to the World Health Organization hand hygiene guidelines. In a month period, subjects were selected by convenience sampling. Factors affecting hand hygiene compliance was investigated. Survey of infrastructure and hand hygiene products was concurrently done. Thereafter, self-administered survey was distributed to assess knowledge, attitudes and perceptions toward hand hygiene.RESULTS: Overall hand hygiene compliance was 11%. Compliance was less likely for doctors, in the ward, and before patient contact. On the other hand, compliance was likely among nurses, in the ICU, before aseptic procedure, after exposure to body fluid, and after patient contact. Demand for hand hygiene was high with mean of 35 (SD=nine) opportunities per hour of patient care. Hand hygiene products are less available in the wards than in the ICU. Sinks are not in convenient locations. Hand hygiene posters were either not visible or lacking. Majority of the survey respondents know at most only two of the five hand hygiene indications.DISCUSSION: Access to hand hygiene products, training and education, and reminders in the workplace are among the basic requirements in the implementation of hand hygiene programs. With problems related to these three components, hand hygiene compliance is expected to be low.CONCLUSION: Low compliance to hand hygiene was associated with professional status, location and indication. Barriers to hand hygiene include inadequate and inaccessible sinks and hand hygiene products in the ward, high demand for hand hygiene, poor knowledge of hand hygiene, and lack of reminders in the workplace.