Outcomes of Hospitalizations Among Patients with Systemic Lupus Erythematosus in a Tertiary Government Hospital in the Philippines

@#INTRODUCTION: There is no documentation of the causes of hospitalization among lupus patients in the Philippines in recent times and this study hopes to fill in this knowledge gap. Thus, this study reports the outcomes of hospitalizations among patients with systemic lupus erythematosus (SLE) admitted at the charity wards of the University of the Philippines-Philippine General Hospital (UP-PGH). METHODS: A retrospective chart review was done on all admitted patients with SLE from January 2015 to December 2015 admitted at UP-PGH, the national referral center and tertiary training government hospital in Manila, Philippines. RESULTS: There were a total of 81 SLE patients meeting the inclusion criteria. SLE admission comprised 3.1% (138/4408) of admitted charity cases in our department. The most common reasons for hospitalizations are infection (64.1%), lupus activity (60.3%), and lupus activity with infection (47.4%). The mean duration of hospitalization was 12.4 (SD 8) days. Patients with organ damage from lupus were mostly able to fully recover (20%) while those admitted due to more than one reason mostly had partial recovery (95.2%). Infection is the top leading cause of death (6%). Serositis [OR 0.11, 95% confidence interval (CI) 0.02- 0.63] and number of ACR SLE criteria fulfilled on diagnosis (OR 0.47, 95% CI 0.22- 0.997) were likely to have poor outcome of hospitalization. The over-all cohort’s survival on admission was 100.0%, 98.8%, 97.4%, and 92.5% for one, two, six, and more than 15 days of admission, respectively. CONCLUSION: Our cohort confirms the results of previous studies suggesting that infection and disease activity were the top reasons for hospitalization among lupus patients whether living from emerging and developed nations. Indeed, the morbidity and mortality of our patients remains a great challenge not just among physicians but with the government and various stakeholders.

Bamboo node as an unusual cause of Dysphonia in a Filipino patient with mixed Connective Tissue Disease

Introduction@#Bamboo node is a rare vocal cord pathology causing dysphonia among patients with autoimmune disorders. These “bamboo-joint-like” transverse deposits on the vocal cords interfere with the vibratory cycle during phonation leading to voice hoarseness. A review of Schwemmle from 1993-2009, showed seven cases of bamboo node among patients with mixed connective tissue disease (MCTD). With the patient’s consent, this case is presented to contribute to current knowledge about MCTD.@*Case Presentation@#A 36-year-old Filipino female developed voice hoarseness one year after she was diagnosed with MCTD. Videostroboscopic findings revealed bilateral bamboo nodes, vibratory defects, and amplitude abnormalities. Treatment with prednisone, methotrexate, hydroxychloroquine, along with voice rest and speech therapy resulted in normalization of amplitude, mucosal wave and vibratory behavior during repeat videostroboscopy.@*Conclusion@#To date, this is the first known case of bamboo nodes associated with MCTD in a Filipino patient. This case highlights the importance of properly investigating the symptom of hoarseness among patients with rheumatologic diseases. A multidisciplinary approach involving the rheumatologist, otorhinolaryngologist, and speech therapist play an important role in the complete care of this patient.