Identifying predictive factors and clinical outcomes for high-risk pneumonia among hospitalized pediatric patients with measles in a national tertiary infectious disease hospital from January 2019 to December 2019: A cohort study

Background@#Measles surged worldwide in 2019, which recorded the highest number of cases in the last 23 years. In the Philippines, the peak of the outbreak occurred in January-February 2019.1-3 Pneumonia was the most common severe complication and cause of death of measles. Age, sex, area of residence, immunization history, nutrition status and presence of comorbidities may contribute to the development of high-risk pneumonia in measles patients, affecting clinical outcomes.@*Objective@#This study aimed to determine predictive factors for high-risk pneumonia among hospitalized pediatric patients with measles and clinical outcomes in San Lazaro Hospital from January 2019 to December 2019.@*Methods@#A cohort study was conducted through a review of medical records of pediatric patients with measles admitted at San Lazaro Hospital from January 2019 to December 2019. The following data were extracted: demographic data, immunization history, nutrition status, presence of comorbidities, development of high-risk pneumonia, and clinical outcomes were extracted. Logistic regression was done to determine the factors associated with development of high-risk pneumonia.@*Results@#A total of 530 medical records were reviewed, and 27.9% of these documented severe pneumonia. Most of the patients were less than 5 years of age (84.53%) and were residing in Metro Manila (85.47%). Majority (73.40%) had no vaccination for measles. Chi-square test showed that the variables of age (p=0.001), measles vaccination status (p=0.011), BMI-for-age (p=0.005), weight-for-age (p=0.027), and weight-for-height (p=0.004) were significantly different between those who developed high-risk pneumonia and those who did not. However, in the final multiple logistic regression analysis, only nutritional status was predictive of high-risk pneumonia. Patients with severe wasting were 1.85 times (p=0.010) and patients who were overweight were 4.24 times (p=0.003) more likely to develop high-risk pneumonia. There was also a significant difference in clinical outcomes between those without high-risk and with high-risk pneumonia (p=<0.001). All mortality cases had high-risk pneumonia, were less than 5 years of age, and were unvaccinated.@*Conclusion@#Age, measles vaccination status and nutrition status were the factors identified to be associated with high-risk pneumonia among pediatric patients with measles. Thus, it is important to encourage parents to vaccinate their children against measles and to promote proper nutrition.

The predictive value of chest x-ray and plain chest CT scan as adjunct screening tools for COVID-19 patients in a national tertiary infectious disease hospital from March 1 to November 30, 2020

Background@#COVID-19 is diagnosed via Real Time Reverse Transcription Polymerase Chain Reaction (RT-PCR), with plain chest CT and chest x-ray as adjuncts. In the Philippines, chest x-ray is used as initial screening in assessing potential COVID-19 cases, with plain chest CT scan not routinely used due to higher cost and decreased availability.@*Objective@#This study determined the validity of chest x-ray and plain chest CT as initial screening tools for admitted COVID-19 patients from March 1 to November 30, 2020, at San Lazaro Hospital, comparing these with RT-PCR testing for COVID-19 as initial basis for considering a patient as a possible case of COVID-19.@*Methods@#This was a cross-sectional study of radiographic literature of admitted COVID-19 patients from March 1 to November 30, 2020, at San Lazaro Hospital, all with confirmatory RT-PCR, chest X-rays, and plain chest CTs. Baseline chest x-rays, with initial plain chest CT results, were compared with RT-PCR results. A tally was made, noting radiographic findings on both Chest X-ray and Plain Chest CT most frequently seen among patients with corresponding positive real time RT-PCR results.@*Results@#Chest X-rays done < 2 days from admission revealed involvement of both lungs, with infiltrates located centrally and peripherally, with major predilection for both lower lobes. Plain chest CT was similar, with ground glass opacities as the most common finding, consolidation second. Chest x-ray had a sensitivity of 88.11%, plain chest CT 94.71%. Sensitivity of combined chest x-ray and plain chest CT was 86.78%. Specificity and predictive value were not computed due to non-inclusion of admitted patients with COVID negative RT-PCR swab.@*Conclusion@#Chest X-ray and plain chest CT are useful modalities with high sensitivity in screening patients with fever, cough, and colds on admission. However, initial chest x-ray and plain chest CT scan results do not translate into a prognosis without context of initial diagnostics and management done during confinement.

Community-oriented health care during a COVID-19 epidemic: A consensus statement by the PAFP task force on COVID-19

Initial Planning@#Statement 1: A Community-oriented Health Care Plan that contains tasks and activities related to the community organization, environment, health care and social processes in order to mitigate the effect of the COVID-19 epidemic on the community should be developed. Statement 2: The plan should also include adjustments needed to continue the delivery of other health services i.e. maternal and child health, immunization, treatment of other communicable and non-communicable disease but with strict COVID-19 transmission precautions.@*Adjustment in the Community Organization and Environment@#Statement 3: A local task force should be organized to develop and implement the community health plan. The task force should be recognized and supported by the whole community. Statement 4: A facility in the barangay that can be used for isolation in case that a member will be diagnosed to have mild COVID-19. A hospital facility for referral of high-risk cases should also be identified and an emergency referral and transport plan should be established. Statement 5: All community health workers should wear appropriate personal protective equipment in the process of performing their community health work. Statement 6: Households in the community who have members at high-risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition should be identified and advised to take extra precautions i.e. personal hygiene, wearing mask and physical distancing. Statement 7: During the declared community quarantine period by the community or higher-level authority, all community members and household should be advised to stay at home, limit celebrations and community gatherings@*Performance of Routine Tasks and Activities@#Statement 8: A community-directed information, education and communication (IEC) plan should be developed and implemented for the following: a) Informing every household in the community on the basic and accurate information about COVID-19 and the community plan. b) Encouraging everyone to practice personal hygiene that includes regular and appropriate hand washing, daily bath, coughing and sneezing etiquette, wearing of mask, minimizing hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. c) Encouraging everyone to clean everyday frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol. d) Encouraging everyone to report and seek help to the community health worker if a household member is exposed and developed mild symptoms of COVID-19@*What to Do When a Member or Household is Exposed or Diagnosed COVID-19@#Statement 9: If there is a household whose member is exposed to a COVID-19, the person should be encouraged to stay home preferably in a room or area adequate for isolation, wear mask and maintain at least 2 meters physical distance from other family members. Statement 10: Other household members should be advised to watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person is low risk but there is difficulty of breathing or worsening of symptoms or if the person is high risk i.e. elderly or with existing chronic disease and symptoms appear, they encouraged to inform the community health worker and facilitate the necessary referral and transport arrangement to the hospital. Call first before going. Statement 11: If the symptoms are mild, continue home isolation or in the isolation facility identified by the community, take over-thecounter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Family members and community health workers are encouraged to provide psychological and social support to isolated patients. Discontinuation of isolation can be done if symptoms resolve within 14-21 days@*Epidemiology and Surveillance@#Statement 12: The municipal or city health office should be provided daily with a situation report of the implementation of communityoriented health care for COVID-19. Situation report should include: a) The number of exposed, number of diagnosed cases, number of mild cases, number of cases referred to the hospital and number of cases recovered or died in the community. b) Brief description of best practices

Family-focused home care plan during a COVID 19 epidemic: A consensus statement by the PAFP task force on COVID 19

Initial Planning@#Statement 1: Develop a Family-focused Care Plan that contains tasks and activities related to the family structure, home environment and processes in order to mitigate the effect of the COVID-19 epidemic@*Adjustment in the Family Structure and Home Environment@#Statement 2: Identify a Family Caregiver who will remind the family to follow and implement the plan. Make sure this person is supported by all the members of the family. Statement 3: Identify a room or area that can be used for isolation in the event that a family member will be exposed to a diagnosed COVID-19 patient. Statement 4: Identify those who are at risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition and advice to take extra precaution. Statement 5: During the declared community quarantine period, all family members should stay at home, limit family celebrations, avoid home parties with outside guests, cancel travels as much as possible and be ready to have more members staying at home@*Performance of Routine Tasks and Activities @#Statement 6: Practice personal hygiene that includes regular and appropriate hand washing, daily bath, cough and sneezing etiquette, minimize hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. Statement 7: Daily cleaning of frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol@*What to Do When a Member is Exposed@#Statement 8: Advice an exposed family member to stay home and in the room or area allocated for isolation, wear mask and maintain at least 2 meters physical distance from the other family members. Make sure their clothing, personal belongings and other things that they usually hold is cleaned regularly and not touch by other members. Statement 9: Watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person exposed is low risk and there is difficulty of breathing or worsening of symptoms, consult your family doctor. If the person is high risk i.e. elderly or with exiting chronic disease and symptoms appear, consult your family doctor right away. Call first before going to the clinic or hospital. Statement 10: If the symptoms are mild, continue home quarantine, take over-the-counter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Other family members are encouraged to provide psychological and social support to an exposed and isolated member. Statement 11: Symptoms usually resolved within 14 days, after which home quarantine can be discontinued between 14-21 days. If symptoms persist beyond 14 days consult your family doctor for advice

Rabies post-exposure prophylaxis compliance of bite patients: The San Lazaro Hospital Animal B.I.T.E. (Bite Injury Treatment Experience) study

Background@#Post-exposure prophylaxis (PEP) is the most important means of preventing rabies. Intradermal PEP was developed to improve compliance, still, many recipients fail to complete this regimen@*Objective@#To determine the non-monetary factors contributing to non-compliance to PEP among patients in the Animal Bite Treatment Center (ABTC) of San Lazaro Hospital (SLH).@*Methods@#This was an analytical, cross-sectional study. The authors randomly reviewed patient records of SLH-ABTC for one-year period. We characterized the cases according to World Health Organization (WHO) parameters. They determined the day intervals between exposure, first consultation, PEP initiation and follow-up visits. Statistical analyses used were descriptive statistics, χ2 test for independence and binary logistic regression.@*Results@#The authors evaluated 667 records. Patients mostly had Category III exposures (76.91%, 95%CI: 73.92%80.62%). The chances of completing active immunization were more likely among patients exposed to unvaccinated animals (OR=1.85, 95%CI: 1.21-2.84, p=0.004). The chances of receiving passive immunization were higher for injuries on the head/neck regions (OR=8.18, 95%CI: 2.4-27.9, p=0.001). Overall, compliance to PEP was 70.21% and 40.70% for Categories II and III exposures, respectively. PEP compliance was moderately dependent on the exposure category (χ2=38.14, df=1, p<0.001, φ=0.25.@*Conclusion@#Category II exposure patients had better compliance than Category III, since rabies immunoglobulins are not required. The authors did not identify any factors that significantly affected Category II regimen compliance. Among Category III patients, compliance was better if the injuries were bite-inflicted while those who were exposed from “healthy”looking animals were less likely to comply.

Predictive diagnostic value of the Tourniquet Test and Correlation of Laboratory Profile for the Diagnosis of Dengue Infection among patients <18 years old admitted at San Lazaro Hospital from September 2015 to November 2015

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Tourniquet test has been widely used locally and internationally as the cheapest, fastest and most efficient way of diagnosing dengue infection. This is so efficient that the World Health Organization has been active in promoting this as a diagnostic tool for tropical countries like the Philippines.<br /><strong>OBJECTIVE:</strong> To determine the accuracy of the tourniquet test in the diagnosis of dengue infection among patients aged<br /><strong>METHODOLOGY:</strong> The retrospective research design was utilized. These variables were included: the socio-demographic and clinical variables as to the patients' age, gender, body mass index and the presence of co-morbid conditions, clinical manifestations (duration of fever, headache, abdominal pain, rashes and bleeding episodes, hemoglobin level, WBC, Platelets, NS1, IgG, IgM and Hematocri values). Once these were noted, the researcher coded the results. Coding was done in Microsoft Excel.<br /><strong>RESULTS:</strong> Patients were mostly in the 12 to 17 years age group, males (54.1%), in the normal weight category (88.1%) and had no co-morbid conditions (77.1%). Clinical manifestations of dengue included fever of ? 4 days (56%); abdominal pain (61.5%); and gum bleeding (56.4%). As regards laboratory profile of patients, low hemoglobin levels were observed (77.5%); low WBC count (78.9%); low platelet counts (100%); positive for NS1 (71.1%); positive for Immunoglobulin G (82.6%) and Immunoglobulin M (85.3%). There was a 65% accuracy of cases when tourniquet test was performed among patients with dengue. There was a strong correlation between dengue infection and WBC (r=0.915; p=0.028); platelets (r=0.663; p=0.003); hematocrit (r=0.57; p<0.01); Non-Structural Protein 1 (r=.753; p=.031); IgG (r=0.566;p=0.002); IgM (r=0.510; p=0.009) and Tourniquet test (r=0.513; p=0.045). No significant correlation was observed for cases of dengue infection and hemoglobin (r=0.026; p=0.702) and platelets (r=0.026; p=0.702).<br /><strong>CONCLUSIONS:</strong> The dengue infection was found mostly to be in the 12 to 17 years of age; predominantly males. BMI was not found to be significant factor for dengue infection since most cases were in the normal weight category. Clinical presentations of dengue infection commonly observed in this research were fever with a duration of 4 days and above, headache, abdominal pain and gum bleeding. Majority had abnormal levels of hemoglobin, low WBC, and low platelet count. Biomarkers for dengue infection noted in the study were positive NS1, presence of IgG and IgM. Tourniquet test yielded 655 accuracy if the number of petechiae cases is considered. This could indicate that as an initial tool foe diagnostics, presence of it could be considered for dengue infection. Strong correlation with tourniquet test, and laboratory parameters like WBC, platelets, hematocrit, NS1, IgG and IgM were found which are indicative that these variables have strong association to possible infection of dengue. Any abnormalities found within these laboratory parameters must be considered for dengue evaluation.</p>