A Descriptive Study on the Clinical Profile and Outcomes of Patients with COVID-19 and Tuberculosis Co-infection.

Background: Tuberculosis (TB) control has been a challenge in the country and its overall health impact remains significant. COVID-19 has caused significant morbidity and mortality especially among hospitalized patients. TB and COVID-19 co-infection (COVID-TB) may cause more catastrophic consequences and outcomes among afflicted individuals and management may be daunting. There is limited local data on COVID-TB. Objectives: The clinical profile of COVID-TB patients who were admitted were described. Comparison of the clinical outcomes was also done versus the general admitted COVID-19 patients without concomitant TB in the same institution. Relevant patient outcomes were reported which included admission to an intensive care unit (ICU), length of hospital stay, and mortality rate. Methods: This is a descriptive study on the demographics and clinical outcomes of patients admitted in the Philippine General Hospital (PGH) for COVID-19 with TB co-infection from March 2020 to September 2020. We aimed to characterize patients with COVID-TB and analyzed their outcomes. Results: There was a total of 79 patients who were admitted for COVID-19 (confirmed with RT-PCR) with TB co-infection during the study period. Majority of them were males (70.9%) with a median age of 54 (IQR 42 to 64) years. In terms of TB affliction, 75 (94.9%) patients were identified to have pulmonary tuberculosis. Majority of patients had at least one co-morbid illness with hypertension (16.5%), diabetes mellitus (13.9%), and heart failure (11.4%) as the most common. Respiratory symptoms (dyspnea and cough) were the predominant presenting complaint during hospital admission. Majority of the patients were classified as severe (8 or 10.1%) and critical (36 or 45.57%) COVID-19 disease. Fifty-six (70.9%) were bacteriologically confirmed tuberculosis. Radiologic imaging studies revealed findings consistent with pulmonary tuberculosis in 70 (88.61%) through plain radiograph. Forty-seven underwent HRCT and 46 of these (97.8%) had findings suggestive of PTB. Overall, 61 patients (77%) subsequently required oxygen supplementation. The in-hospital mortality within the study population was 36.7% (29/79) in contrast to the general COVID patients admitted in the same period which revealed significantly less fatality at 17.5% (35/200). The length of hospital stay was found to be 21.1 days ± 14.75 days across all study patients, and with median of 20 days for surviving patients. TB treatment outcomes were tracked in the 50 surviving COVID-19 patients where cure was declared in 8/50 (16%) while 22/50 (44%) successfully completed their six-month treatment regimen. Conclusions: This study of COVID-TB provides an initial evaluation of the potential association between active TB infection and COVID-19 severity and mortality. The data generated from this study may be a starting point to assess the interaction of these two diseases. Furthermore, bidirectional screening may be recommended even at hospitals' triage areas since both diseases may have similar presentations.

Prevalence of anxiety and depression among Filipino patients with chronic obstructive pulmonary disease: A multi-center study

BACKGROUND: One under-explored area in chronic obstructive pulmonary disease (COPD) patients is anxiety and/or depression, which may have negative impact in the patients' condition. This is possibly the first study to possibly assess the burden of anxiety and depression in COPD patients in the Philippines. STUDY DESIGN: This is a prospective descriptive survey in three tertiary care hospitals in Manila, Philippines. PARTICIPANTS: A total of 204 patients were enrolled in the study with the following inclusion criteria: Filipino patients who are aged more than or equal to 40 years with a diagnosis of COPD (documented post-bronchodilator FEV1/FVC ratio less than 0.7) by a physician seen at the outpatient clinics of three tertiary care hospitals with no primary diagnosis of asthma, no previous lung volume reduction surgery, lung transplantation or pneumonectomy and at least finished Grade 2 education. Exclusion criteria include pregnant patients and patients previously diagnosed to have an anxiety, depression, or on any anti-depressant medications. METHODS: Descriptive statistics was obtained with frequency and percentages of the demographic and physiologic variables in the study by tabulation and graph. The prevalence of anxiety and depression was determined by calculating the percentage of each patient with a score of 8 or higher on the Hospital Anxiety and Depression Scale (HADS) with validated Tagalog version, respectively. RESULTS: The prevalence of anxiety in Filipino COPD patients is 47.55%. The prevalence of depression in Filipino COPD patients is 31.37%. CONCLUSION: The prevalence of depression in Filipino COPD patients is comparable to the prevalence of depression from other general medical conditions nationwide according to the study of Batar (31.37% vs. 31%). Anxiety is slightly more prevalent in COPD from other general medical conditions (47.55% vs. 36%). A study on the risk factors of anxiety and depression among Filipino COPD patients is recommended.

Safety and efficacy of cefpirome among Filipino patients

BACKGROUND: Infectious diseases remain a significant cause of morbidity and mortality. Cefpirome, a fourth generation Cephalosporin, is a potent antibiotic against a wide variety of organisms that may be used alone or in combination with other antimicrobials to combat various infections. OBJECTIVE: This is a post-marketing surveillance study documenting the safety and efficacy of cefpirome among Filipino patients. METHODOLOGY: This was a multicenter, open-label, noncomparative study involving 402 patients who received at least one dose of cefpirome. Safety and efficacy data were gathered. RESULTS: Cefpirome was used as monotherapy in majority of the cases. Pneumonia (76%) was the most frequent indication for the use of this drug. The most commonly utilized dosage regimen was 2.0 grams every 12 hours for a mean of 4.2 days. This was associated with a successful clinical outcome in almost 90% of cases. There was almost negligible side effect reported. CONCLUSION: The use of cefpirome was shown to be safe and well-tolerated with associated successful clinical outcomes among Filipino patients. 

Screening for diabetes mellitus in patients diagnosed with pulmonary tuberculosis

BACKGROUND: The epidemic of diabetes mellitus (DM) poses a threat for global tuberculosis (TB) control.   OBJECTIVE: This study attempts to assess the value of screening for diabetes in patients with pulmonary tuberculosis and reviews the disease burden, clinical and radiographic manifestations,rates of sputum smear positivity and time to conversion,treatment outcomes and fatality rates,in the local setting.METHODS: This is a prospective observational cohort study involving adults diagnosed with pulmonary tuberculosis at the PTSI TB DOTS out-patient clinic, regardless of sputum-smear status, from July 2011-November 2012. A diabetes screening tool was used and patients were screened for presence of DM. Treatment outcomes were also determined.RESULTS: Of the 38 patients enrolled, seven (18.4%,95% confidence interval 7.7-34.3) were diagnosed with DM. This is higher than the estimated 12.9% in 2010 and 14.4% projected estimate in 2030 in our country by a report of WHO as well as in reported prevalence of DM among patients with PTB in large studies done in China (12.4%) and India (13%). There was no significant difference noted in the basic profile,clinical and radiographic presentation,sputum conversion and treatment outcomes among patients with DM and without DM who were being treated for PTB.CONCLUSION: This study demonstrates the value and feasibility of screening for DM among patients with PTB. Although the findings of this study are consistent with most of previous similar studies, the estimate on the true prevalence of DM may not be very accurate because of the small sample size. Hence,a multi-center study with a larger sample size must be conducted to more accurately measure the true prevalence of DM among patients with TB and to determine associations of various clinical and radiographic presentations and clinical outcomes.

A survey of knowledge, attitudes and practices of sedation and analgesia among medical residents and pulmonary fellows-in-training at the University of the Philippines-Philippine General Hospital

BACKGROUND: Providing sedation and analgesia for patients especially in the intensive care units remains difficult and controversial for clinicians and many institutions.OBJECTIVE: The purpose of this study is to describe the knowledge, attitudes and practices on sedation and analgesia among medical residents and pulmonary fellows-in-training in a tertiary care hospital.METHODS: The research design is a prospective descriptive survey of 67 participants.RESULTS: Midazolam is the preferred sedative agent for continuous infusion. The top two reasons why sedation is used according to the knowledge of the study participants were agitation and patient comfort. Monitoring neurologic status is the primary reason why sedation is not used. Majority of the medical residents said that 50% of the mechanically ventilated patients require continuous intravenous sedation. On the other hand, pulmonary fellows-in-training said that 50-75% of mechanically ventilated patients require continuous intravenous sedation. Twenty three participants (34.32%) have used a sedation scale, of which majority uses Ramsay Sedation Scale. Morphine is the preferred analgesic agents of the study participants. Unavailability of analgesic agents is the top reason why analgesia is not used.CONCLUSION AND RECOMMENDATION: The medical residents and pulmonary fellows-in-training showed differences inknowledge, attitudes and practices with regard to use of sedation and analgesia. To increase their knowledge and improve their practice, they should be given medical education and training in sedation and analgesia.

Treatment outcomes of patients with superior vena cava syndrome who received high dose radiotherapy at UP - PGH from 2009 - 2011

BACKGROUND: 85% of cases of Superior Vena Cava Obstruction (SVCO) are caused by malignancy. Radiation therapy (RT) is an effective therapeutic modality for SVCO localized in the thorax, especially for obstructive causes. OBJECTIVE: To determine the clinical profile and outcomes of patients who received radiation treatment at UP-PGH from January 1, 2009 - December 31, 2001. METHODS: Records of patients with SVCO were reviewed. The patient's demographic profiles were collected. Outcomes were labaled as recovered, improved, not improved and died based on standard definitions. STUDY DESIGN: Retrospective, descriptive study. STUDY SETTING: Philippine General Hospital STUDY POPULATION: UP-PGH patients with SVCO from 2009-2011. RESULTS: The majority of the referrals were from general medicine (50%) and the most common symptom was dyspnea (73%); however, it took the patients 2-4 weeks from the onset of symptoms to seek consult. 36% of patients had lung adenocarcinoma with disseminated disease at diagnosis. The majority (73%) showed symptomatic response after receiving the SVC dose. CONCLUSION: The importance of multidisciplinary approach to patient care cannot be overemphasized. Improvement in signs and symptoms, particularly with that of dyspnea, was noted in 72.5% of patients after receiving radiation therapy. Of the 8 patients who followed up for completion therapy, 5/8 of them reported significant improvement.