COVID-19 Outcome: A One Year Follow-Up Study of Patients who Recovered from COVID-19 at Lung Center of the Philippines

Introduction: To date, the Philippines had tallied more than 3 million COVID-19 cases with 91.5% recovery rate and 1.72% mortality rate. Some patients who recovered from COVID-19 are left struggling with symptoms which persist through weeks, months and even a year. Objective(s): To determine the clinical outcome after 1 year of COVID-19 recovered patients in terms of persistent symptoms, functional capacity, and survival status and their relationship with disease severity. Method(s): This is a cross sectional-analytical study. Subjects include those who were discharged improved from April - August 2020 at Lung Center of the Philippines. Their clinical outcome after 1 year which include persistent symptoms, functional capacity and survival status were determined and analyzed. Result(s): A total of 100 subjects were included in this study. Forty-three subjects had persistent symptoms. Fatigue (28.6%), depression (13.3%), and brain fog (11.2%) were the most frequently reported symptoms. Ninety-two (92.9%) patients had none to negligible functional capacity limitations. Ninety-seven (97%) patients survived after 1 year. Higher proportion of patients with persistent fatigue and difficulty of breathing were noted as the severity increases. Higher proportion of patients with functional scale 1-2 were noted in moderate severity group as compared to the severe and critical severity group. Conclusion(s): This one-year follow-up study of COVID-19 recovered patients revealed high proportion of survivors, very few with significant functional capacity limitations, and some with persistent symptoms. Favorable clinical outcomes after 1 year were evident in less severe disease.

Covid-19 Outcome: A One-Year Follow-Up Study of Patients Recovered from Covid-19 Infection at Lung Center of the Philippines

Introduction: To date, the Philippines had tallied more than 3 million COVID-19 cases with 91.5% recovery rate and 1.72% mortality rate. Some patients who recovered from COVID-19 are left struggling with symptoms which persist through weeks, months and even a year.Objectives: To determine the clinical outcome after 1 year of COVID-19 recovered patients in terms of persistent symptoms, functional capacity, and survival status and their relationship with disease severity.Methods: This is a cross sectional-analytical study. Subjects include those who were discharged improved from April - August 2020 at Lung Center of the Philippines. Their clinical outcome after 1 year which include persistent symptoms, functional capacity and survival status were determined and analyzed.Results: A total of 100 subjects were included in this study. Forty three subjects (43.9%) had persistent symptoms. Fatigue (28, 28.6%), depression (13, 13.3%), and brain fog (11, 11.2%) were the most frequently reported symptoms. Ninety two (92.9%) patients had none to negligible functional capacity limitations. Ninety seven (97%) patients survived after 1 year. Persistent symptoms of fatigue and difficulty of breathing, as well as functional capacity differ across COVID-19 disease severities. Higher proportion of patients with persistent fatigue and difficulty of breathing were noted as the severity increases. Higher proportion of patients with functional scale 1-2 (no to negligible functional limitation) were noted in moderate severity group as compared to the severe and critical severity group.Conclusions: This one-year follow-up study of COVID-19 recovered patients revealed high proportion of survivors, very few with significant functional capacity limitations, and some with persistent symptoms. Favorable clinical outcomes after 1 year were evident in less severe disease. Care for patients with COVID-19 infection does not conclude at the time of hospital discharge, and interdisciplinary cooperation is needed for comprehensive care of these patients in the outpatient setting.

Invasive pulmonary aspergillosis in patients with acute respiratory syndrome by COVID-19.

Patients with COVID-19 who are admitted to intensive care unit (ICU) are at high risk of developing secondary infections, including invasive fungal infections such as invasive pulmonary aspergillosis (IPA). The main purpose was to analyse the putative COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients in our setting. In these patients, we performed mycological culture in bronchoalveolar lavage (BAL) for isolation of Aspergillus sp. We followed the AspICU algorithm to diagnose putative IPA. Moreover, we considered relevant the positivity of Galactomannan in BAL. We diagnosed putative IPA in 3 patients. The common features of these 3 patients were: more than 21 days of stay in ICU, severe acute respiratory distress syndrome (ARDS) and treatment with steroids (1 mg/kg per day). Therefore, CAPA has to be systematically considered although a new algorithm to diagnose it is needed to treat patients in early stages in order to avoid catastrophic outcomes.

Worldwide use of HPV self-sampling for cervical cancer screening.

An increasing body of evidence supports the validity of self-sampling as an alternative to clinician collection for primary Human Papillomavirus (HPV) screening. Self-sampling effectively reaches underscreened women and can be a powerful strategy in low- and high-resource settings for all target ages. This work aims to summarize the current use of HPV self-sampling worldwide. It is part of a larger project that describes cervical cancer screening programmes and produces standardized coverage estimates worldwide. A systematic review of the literature and official documents supplemented with a formal World Health Organisation country consultation was conducted. Findings show that the global use of HPV self-sampling is still limited. Only 17 (12%) of countries with identified screening programs recommend its use, nine as the primary collection method, and eight to reach underscreened populations. We identified 10 pilots evaluating the switch to self-sampling in well-established screening programs. The global use of self-sampling is likely to increase in the coming years. COVID-19's pandemic has prompted efforts to accelerate HPV self-sampling introduction globally, and it is now considered a key element in scaling up screening coverage. The information generated by the early experiences can be beneficial for decision-making in both new and existing programs.

Standard Radiotherapy Fractionation Toxicity Versus Ultra-Hypofractionation In Breast Cancer

Purpose or Objective Radiotherapy is an essential treatment in the local control of breast cancer. Standard treatment is currently carried out in 15 daily sessions. At present, following the results of the phase III Fast-Foward trial and in view of the situation triggered by COVID-19, the number of sessions has been reduced to 5. The RHEMA (extreme hypofractionated radiotherapy in breast cancer) study has been initiated in Spain. It is a multi-hospital study designed to determine the evolution of the change in fractionation. The hypothesis is that the change in fractionation does not increase acute toxicity. The aim of the study was to determine whether there are differences in acute skin toxicity in breast cancer patients who receive adjuvant radiotherapy according to the different fractionation schedules applied. Materials and Methods We retrospectively analysed skin toxicity in patients treated with glandular radiotherapy at the end of treatment and one month later. Out of 75 patients treated with the ultra-hypofractionated schedule, 58 patients with a follow-up of more than 1 month were compared with 38 patients who received the standard schedule, all of whom were treated in 2020 in the Multihospital Clinical Unit of Radiation Oncology of Aragon. In the case of the ultra-hypofractionated treatment, as indicated in the GEORM (Spanish group of breast radiation oncology) guidelines at the beginning of the pandemic, was carried out in 5 sessions with a total dose of 26 Gy over the breast and 29 Gy over the tumour bed, while the standard treatment, consisted in 15 sessions with a total dose of 40.5 Gy over the breast and 48 Gy over the tumour bed. Results The median age was 61 years in the standard group and 63.4 years in the ultra-hypofractionated group. No significant differences were observed in the histological profile. Differences were found in toxicity at the end of treatment, being significantly higher in the standard group (p 0.03). On the other hand, no differences were found in toxicity one month after the end of treatment. Grade 2 toxicity appeared in 2 patients from the ultra-hypofractionated group and 4 from the standard group, with no significant difference (p 0.943). There were no differences in the development of grade 1 toxicity and no grade 3 or higher toxicity was observed. Conclusion It can be concluded that the use of the ultra-hypofractionation schedule compared to standard treatment was not associated with an increase in acute skin toxicity in our series. This is a change in fractionation that could be adopted as a routine treatment in radiation oncology departments after verifying the results with a larger number of patients and a longer follow-up.

[Invasive pulmonary aspergillosis in patients with acute respiratory syndrome by COVID-19]. / Aspergilosis pulmonar invasiva en pacientes con síndrome de distrés respiratorio por COVID-19.

Patients with COVID-19 who are admitted to intensive care unit (ICU) are at high risk of developing secondary infections, including invasive fungal infections such as invasive pulmonary aspergillosis (IPA). The main purpose was to analyse the putative COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients in our setting. In these patients, we performed mycological culture in bronchoalveolar lavage (BAL) for isolation of Aspergillus sp. We followed the AspICU algorithm to diagnose putative IPA. Moreover, we considered relevant the positivity of galactomannan in BAL. We diagnosed putative IPA in 3 patients. The common features of these 3 patients were: more than 21 days of stay in ICU, severe acute respiratory distress syndrome (ARDS) and treatment with steroids (1 mg/kg per day). Therefore, CAPA has to be systematically considered although a new algorithm to diagnose it is needed to treat patients in early stages in order to avoid catastrophic outcomes.