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.

Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma in a 76-year-old Filipino Male: A case report

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma (PCAECTCL) is a rare subtype of cutaneous T-cell lymphoma characterized by widely distributed ulcerated lesions, epidermotropic infiltrates of CD8+ cytotoxic T cells, aggressive course, high tendency to spread to extranodal sites, poor response to conventional therapies and unfavorable prognosis.</p><p style="text-align: justify;"><strong>CASE REPORT:</strong> We report a 76-year-old Filipino male presenting with eight-month history of erythematous scaly patches evolving into widespread ulcerated nodules, unresponsive to topical and systemic steroids. Histopathology revealed prominent epidermotropism and lichenoid infiltrate of atypical lymphocytes. Immunohistochemistry showed positivity for CD3, CD8, Ki67 (5-15%), CD7, CD2; indeterminate for TIA-1, with high background staining; and was negative for CD20, CD30, CD4, CD5, CD56, granzyme-B, TdT, Epstein-Barr encoding region in situ hybridization (EBER-ISH), consistent with PCAECTCL. No overt metastasis was detected. The patient underwent interferon alfa 2B therapy followed by three full cycles of CHOP chemotherapy. Improvement was seen as thinning of plaques and nodules and re-epithelialization of ulcers however, severe anemia and leukopenia ensued with therapy. He then succumbed to septic shock secondary to pneumonia during the height of the COVID-19 pandemic.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This case emphasizes that despite accurate diagnosis, polychemotherapy, and favorable response to therapy, complications may still arise contributing to the poor prognosis and low fi ve-year survival rate of this condition.</p><p style="text-align: justify;"><strong>KEYWORDS:</strong> T-cell lymphoma, CD8 positive, neoplasms</p>

Assessing the impact of a physician resiliency and wellness program to physician burnout levels in a pediatric department of a tertiary hospital: A pilot study of the I-CARE program

@#<p><strong>Background:</strong> Physician burnout is a growing problem worldwide. Several interventions aimed at lowering burnout rates among physicians have been implemented. To date, there is no established structured program to combat burnout in the Philippine General Hospital. This study evaluated the effectiveness of the I-CARE program, a physician resilience and wellness program which adapted the different components of the international programs for the Philippine setting.</p><p><strong>Objective:</strong> To evaluate the effectiveness of the I-CARE program in reducing medical residents' burnout level.</p><p><strong>Methods:</strong> After key components of the I-CARE program were identified, the program was implemented in 2 phases. The first phase involved training of consultants to hone their facilitation skills. The second phase was a before-and-after study of the I-CARE program. The participants' burnout level was measured before and after the program using the Maslach Burnout Inventory.</p><p><strong>Results:</strong> The I-CARE program was implemented in the Department of Pediatrics from March to August 2020. There was no significant change in the overall burnout levels of 59 pediatric residents after the I-CARE implementation (p=0.32). This may be due to several challenges encountered during the implementation, such as time constraints, the increased workload caused by the COVID-19 pandemic, and the lack of physical meetings due to the restrictions of the pandemic. However, the feedback of the administrators, facilitators and residents was generally positive. All the interviewed participants recommended the continuation of the I-CARE program in the Department of Pediatrics.</p><p><strong>Conclusion:</strong> The I-CARE program shows potential in promoting mental health and emotional wellness among physicians in training.</p>

Surface judgments, profound questions: A homosexual male's Phlebotomy experience

Background and Objectives@#Two of the authors, one heterosexual and one homosexual, both voluntarily donated blood to a well-known health institution in the Philippines. As they were filling out the paperwork, one of the authors' attention was called by one of the questions in the form: “Nakipagtalik ka na ba sa iyong kauri?,” which can be literally translated as “Have you had sex with your own kind?”. This erroneously phrased question was the sole question interrogated and problematized in the study.@*Methodology@#Reviews of Standpoint Theory and the methodology associated with it and, in effect, used in the study, formed part of the critique, divided into individual narrations and interpretations by each author. A third co-author, a hematologist, lent her insight on the logistics and issues of phlebotomy. Institutional ethnography was brought to bear on the narratives@*Results and Conclusion@#This three-author collaboration is presented as a claim that an interdisciplinary approach may open new vistas to a phenomenon that has long existed but been ignored. Reviews of Standpoint Theory and curriculum planning for health professionals are recommended.