Hospital In Manila Research Articles

Determination of Liver Function Tests and Liver Ultrasonographic Findings in Patients with Leptospirosis in a Tertiary Hospital.

Leptospirosis is an important zoonotic disease commonly found in tropical or sub-tropical countries. The most severe form is Weil's syndrome which presents with jaundice, renal failure, and bleeding diatheses. Although jaundice occurs in 38% of patients with leptospirosis, no studies in Asia have focused on the liver biochemical profile of these patients. Characterization of liver biochemical profile and ultrasonographic findings may shed more light on the disease process. Identification of liver biochemical parameters that portend a poor prognosis may also allow for early aggressive intervention. To describe the liver biochemical profile and liver ultrasonographic findings in adult patients with laboratory-confirmed leptospirosis, admitted at a tertiary hospital in Manila, Philippines. The association of clinical and laboratory features with clinical outcomes (i.e., severe liver injury, Weil's syndrome, and mortality) was also investigated. This retrospective cross-sectional study reviewed all available cases of adult patients with laboratory-confirmed leptospirosis admitted in the Philippine General Hospital from January 2009 to August 2018. The clinical features, liver biochemical profiles, and ultrasound findings were recorded and analyzed. Comparison between the means of each group based on clinical outcome (i.e., mortality, Weil's syndrome) was done via Students' t-test for continuous variables, and calculation of the Odds Ratio for categorical variables. Total and direct bilirubin levels were elevated in patients with leptospirosis compared to serum amino-transferases and alkaline phosphatase levels which were only mildly elevated. Abdominal ultrasound showed typically un-enlarged livers with normal parenchymal echogenicity, normal spleens, and non-dilated biliary trees. Dyspnea was associated with an increased odds for mortality. Although jaundice was present in 39.5% of patients and significantly associated with severe liver injury, this was not associated with mortality. Liver biochemical test values did not differ among patients who expired and those who survived to discharge. The presence of myalgia and abdominal pain increased the odds for Weil's syndrome. To date, no local studies have fully described the liver biochemical profile of patients with leptospirosis. Our findings are compatible with previous studies showing that leptospirosis typically presents with predominantly elevated direct bilirubin from cholestasis and systemic infection. Contrary to previous literature, however, our study found no association between jaundice and mortality.

Clinical Characteristics and Outcomes of an Intensive Maternal Care Unit in a Tertiary Hospital in the Philippines

Objectives. This is the first study that provides an overview of the characteristics of a specialized Intensive Maternal Care Unit (IMU) that caters to obstetric-related conditions in the Philippines. This study aims to describe the different kinds of cases admitted into this facility, the different medical and surgical interventions employed, length of hospital stay, and maternal and fetal outcomes of these patients.Methods. This is a cross-sectional descriptive study based on a chart review of medical records and admissioncharts of patients admitted to the Intensive Maternal Unit of a tertiary hospital in Manila from January 2017 toDecember 2019.Results. There were a total of 17,185 obstetric admissions from 2017-2019. There were a total of 841 admissions(4%) into the Intensive Maternal Unit, with an average of 280 admissions per year. The average length of Intensive Maternal Unit stay was 10.46 days and the average length of hospital stay was 12.98 days. Maternal outcomes were the following: 56.89% were discharged undelivered while 38.92% delivered on their initial admission. The maternal mortality rate was 2.39% among those admitted to the IMU. Among those discharged undelivered, 43% were re-admitted, 6% were admitted twice, and 4% were admitted three times. The most common reason for admission was pregnancy-related hypertensive diseases (34%). Blood transfusion (2.4%), the use of ventilator support (0.6%), and the use of inotropic drugs (0.6%) were the major medical interventions. Cesarean section was the most common surgical intervention, seen in 54.49% of patients. Most neonates were admitted to the neonatal ICU (23.95%), at an average pediatric age of 33 weeks, with an average length of stay in the Neonatal ICU of 12.33 days.Conclusion. Pregnant women are a special group of patients with different needs compared to the general patient population. Pregnancy-associated hypertensive disease is the most common cause of admission to the IMU and hospitals should be able to cater to these patients who will present in their institutions, as this may lead to poor maternal and neonatal outcomes. An Intensive Care Unit dedicated to complicated obstetric care in institutions is recommended to cater to high-risk pregnancies.

Diagnosis and management of basal cell carcinoma: interdisciplinary consensus statements of Jose R. Reyes Memorial Medical Center, a Department of Health Tertiary Hospital in Manila, Philippines.

Basal cell carcinoma (BCC) is the most common cutaneous malignancy. Multiple risk factors are associated in the development of BCC, with ultraviolet light and genetics playing major roles. The departments of dermatology, medical oncology, ophthalmology, otorhinolaryngology, head and neck surgery, plastic surgery, and radiation oncology of the Jose R. Reyes Memorial Medical Center, Manila, Philippines, have convened and formulated consensus statements on the diagnosis and management of BCC patients seen in the institution. The summary of the recommendations is: (1) Surgery is the treatment of choice for BCC. The range of margins (2-4 mm) depends on the type of BCC. (2) Mohs micrographic surgery (MMS) is indicated for high risk BCC. (3) Topical treatment with imiquimod or 5-flourouracil (5-FU) may be used for superficial BCC. (4) Destructive methods (cryotherapy, curettage and electrodessication, photodynamic therapy) may be used for low risk BCC. (5) Medical and/or radiation therapy is advised for cases where surgery is contraindicated or tumor is not amenable to surgery. Metastasis of this malignancy is rare. Follow-up, which may continue up until 2 years, is recommended for high risk BCC.

Nurses’ stress, anxiety, depression, and burnout in the workplace: A correlational study

Nursing burnout has been linked to stress, anxiety, and depression. Increased stress and anxiety have been closely related to burnout. This study's major goal has been to determine the association of these variables in the context of nursing practice. This descriptive correlational study aimed at determining the relationship between stress, anxiety, and depression with burnout among the 307 purposive nurse samples from participating government and private hospitals in Manila, Pampanga, and Tarlac, Philippines collected between March and June 2020 using a 21-item Depression Anxiety Stress Scale (DASS-21) and a 16-item Oldenburg Burnout Inventory (OLBI) instruments. Mostly with a normal level of stress, anxiety, and depression, the nurses had been also found to have a moderate level of overall burnout and were moderately disengaged, and exhausted. Using IBM SPSS v.26, the study utilized Pearson product-moment correlation which found that nurses’ stress had significant relationships (p=.000) with burnout, disengagement, and exhaustion; anxiety to burnout, disengagement, and exhaustion; and depression with burnout, disengagement, and exhaustion. The degree of stress, anxiety, and depression has significantly shown direct correspondence which calls for a deeper examination of sources and factors. Nurses' experience of burnout is associated with the service-oriented features of the profession. The emphasis is on the need for treatments to guarantee that burnout does not lead to higher staff turnover, degraded health care, decreased productivity, and decreased professional fulfillment. A systems approach to burnout prevention and treatment should investigate the relevant factors that are addressed in the organizational, group, and individual efforts. This study offers a remarkable hypothetical underpinning for nurses' ability to handle stressful workplace situations with resilience and professionalism.

Clinical, epidemiological, and spatial features of human rabies cases in Metro Manila, the Philippines from 2006 to 2015.

Rabies remains a public health problem in the Philippines despite the widespread provision of rabies vaccines and rabies immunoglobulin (RIG) as post-exposure prophylaxis (PEP). Detailed descriptions of recent human rabies cases in the Philippines are scarce. This study aimed to describe the clinical, epidemiological, and spatial features of human rabies cases between January 1, 2006, and December 31, 2015. We conducted a retrospective hospital-based case record review of all patients admitted to one referral hospital in Manila who received a clinical diagnosis of rabies. During the 10-year study period there were 575 patients (average 57.5 cases per year, range 57 to 119) with a final diagnosis of rabies. Most patients were male (n = 404, 70.3%) and aged ≥ 20 years (n = 433, 75.3%). Patients mostly came from the National Capital Region (n = 160, 28.0%) and the adjacent Regions III (n = 197, 34.4%) and IV-A (n = 168, 29.4%). Case mapping and heatmaps showed that human rabies cases were continuously observed in similar areas throughout the study period. Most patients had hydrophobia (n = 444, 95.5%) and/or aerophobia (n = 432, 93.3%). The leading causative animals were dogs (n = 421, 96.3%) and cats (n = 16, 3.7%). Among 437 patients with animal exposure history, only 42 (9.6%) had been administered at least one rabies vaccine. Two patients (0.5%), young children bitten on their face, had received and a full course of rabies vaccine. Human rabies patients were continuously admitted to the hospital, with no notable decline over the study period. The geographical area in which human rabies cases commonly occurred also did not change. Few patients received PEP and there were two suspected cases of PEP failure. The retrospective design of this study was a limitation; thus, prospective studies are required.

Telerehabilitation as a Method for Achieving Competencies in Physical and Rehabilitation Medicine Residency Training in a Developing Country: A Protocol for a Pilot Mixed-Methods Study.

BackgroundIn the second year of the COVID-19 pandemic, Physical and Rehabilitation Medicine (PRM) residents in a developing country continue to face a lack of in-person clinical exposure and learning opportunities. With the unprecedented shift to virtual care, it remains uncertain whether residents can achieve PRM competencies using telerehabilitation as a method of instruction.ObjectiveTo determine the PRM residents' ability to achieve competencies through telerehabilitation, as perceived by different stakeholders (residents, chief residents, training officers, and department heads).MethodsThis will be a pilot mixed-methods study, employing concurrent triangulation, in the Department of Rehabilitation Medicine in one large private medical center and one large government hospital in Manila, Philippines. There will be two phases of online data collection upon approval by their respective research ethics board. The first phase will involve an online Likert-scale questionnaire to obtain the residents' self-perceived attainment of competencies and learning of PRM topics and skills specified by the International Society of Physical and Rehabilitation Medicine and the Philippine Board of Rehabilitation Medicine. The results of the survey will then be summarized and presented in a focus group discussion (FGD) with the department heads, training officers, and chief residents of the two institutions in an attempt to explain the residents' perceptions on their competencies achieved through virtual care. Afterwards, the qualitative data obtained from the FGD will then be thematically analyzed, and mixed methods integration will be employed to generate knowledge and recommendations.DiscussionIt is hypothesized that the majority of the residents had little to no experience with telerehabilitation pre-pandemic. Suddenly telerehabilitation was used to augment clinical training during the pandemic. It is uncertain whether telerehabilitation can help residents achieve competencies in the different domains of training, namely: patient safety and quality patient care; medical knowledge and procedural skills; interpersonal and communication skills; practice- and systems-based learning and improvement; reintegration of people with disabilities into the society; medical ethics and public health; quality assurance; policies of care and prevention for disabled people; and professionalism. The study results can provide insights on the aspects of a PRM curriculum that may have to be modified to ensure the training program is sensitive and appropriate to the changing training needs of the residents amid the pandemic and similar crises that may disrupt in-person clinical encounters in the future.

Pediatric Hepatic Abscess: A Ten-year Review of the Features and Outcome at the Philippine General Hospital

Objective. Hepatic abscess is a rare childhood infection with incidence of 1 to 140 per 105 admissions. It has signs and symptoms that mimic other liver diseases. This study determined the clinical, biochemical, microbiologic and imaging features and outcome of children diagnosed with hepatic abscess at a tertiary hospital in Manila.
 Method. We conducted a review of medical records of admitted patients aged ≤18 years diagnosed with hepatic abscess in a tertiary referral center from 2007–2018. A diagnosis was confirmed if with (1) fever; (2) imaging study of solitary or multiple hepatic focus; AND (3) at least one more sign or symptom. We computed for mean (SD) for continuous variables or n (%) for categorical variables.
 Result. We included 40 patients out of 559, 583 pediatric admissions during the study period (0.007%), with a mean age of 8 years (SD 6.5), and 57% of whom were males. Thirty-seven (92%) were probable pyogenic in etiology, while three were tuberculous abscess. The most common signs and symptoms were fever (100%), abdominal mass (31%), abdominal distension (34%) and weight loss (31%). Majority had anemia (63%) and leukocytosis (89%). The most common imaging finding was a solitary mass (58%) with right lobe (80%) involvement. Nine abscess aspirates yielded Staphylococcus aureus (3), Mycobacterium tuberculosis (3), Klebsiella pneumoniae (1) and no growth (2). All patients were medically treated but eight also required percutaneous/surgical drainage. Majority (36) were discharged improved; four were improving but left before treatment completion.
 Conclusion. Majority had pyogenic hepatic abscess, presenting with non-specific clinical and laboratory features. Most abscess were solitary and involved the right lobe. Limited abscess aspirates yielded Staphylococcus aureus and Mycobacterium tuberculosis. Prognosis is favorable with treatment.

Risk factors of COVID-19 vertical transmission among pregnant and non-pregnant Filipinos in Metro Manila: a multicentre cohort study protocol

IntroductionThe novel (COVID-19 was first reported to have originated in Wuhan, China, in December 2019. This new strain, SARS‐CoV‐2, has spread rapidly worldwide, prompting the WHO to declare the COVID-19...

Disease Knowledge and Functional Disability of a Cohort of Rheumatoid Arthritis in a Tertiary Government Hospital in Manila, Philippines

Background. Rheumatoid arthritis (RA) is a chronic and progressive disease resulting in disability and poor quality of life. Patients’ knowledge (PxK) of disease can contribute to better disease control, reduced disability, and improved quality of life. Objective. The objective of this study was to determine the disease knowledge and functional disability of a cohort of patients with RA. Methods. We conducted a cross-sectional study among patients with RA at the University of the Philippines -  Philippine General Hospital Arthritis Clinic. The subjects were recruited using convenience sampling over three months in 2019. We obtained demographic and disease characteristics, clinic attendance, patient knowledge, and functional status through chart review, a questionnaire, and a disability index. Descriptive statistics, 2-sample T-test, Pearson’s correlation, analysis of variance (ANOVA), and multiple linear regression analysis were used for data analysis. Informed consent was obtained before participation in the study. Results. Eighty percent (57/71) of recruited patients participated in the study. All were female, and the mean age was 51.6 years (±12.9). Most participants completed secondary education, were employed, had an average duration of RA of 8 (±6.8) years, had been consulting at the Arthritis Clinic for an average of 4.8 years (±3.8), and had moderate disease activity (49.1%). Most patients had American College of Rheumatology (ACR) class I or II functional status (50/57, 88%). The usual source of the patients' knowledge about RA was their physician. The mean knowledge score was 5.10 (±0.93) out of a perfect score of 9. Most patients were aware of their disease diagnosis and the non-communicable nature of RA. There was low awareness of the need for self-monitoring for disease flares or treatment adverse events and the extra-articular involvement in RA. The mean functional disability score was 6.65 ± 5.33, and the mean functional disability index (FDI) was 0.83 (±0.66). These correspond to mild functional disability (FD). There was no significant relationship between the total knowledge score and age, duration of disease, number of consultations in the past year, level of education, employment status, perceived level of disease knowledge, or the practice of asking their physician about illness. Perception of overall health status was associated with functional disability (p=0.001). Conclusion. Most of the patients in our cohort of RA patients had a mild functional disability and low knowledge scores. The study identified the gaps in our patients’ knowledge of disease and its management. A re-evaluation of existing educational and treatment strategies will be beneficial to enhance disease knowledge and improve health outcomes.

STAT3 as a Candidate Transcriptomic Prognosticator of Sepsis Severity Levels

Background. Sepsis is a life-threatening multiple-organ dysfunction caused by a dysregulated host response to infection and is the leading cause of death in non-cardiac intensive care facilities. Early reliable prediction of sepsis outcomes leads to cost-efficient resource allocation and therapeutic strategies. However, there are still no reliable markers to predict the outcome of patients at the initial stage of sepsis. Analyzing transcription profiles enables researchers to predict early outcomes using transcripts and their expression patterns. Transcriptomic profiling of septic patients has been done recently; however, analysis of prognostic outcomes is still scarce. Objective. This study aimed to determine transcriptional indicators that may be useful in the prognosis of the severity of sepsis. Methods. This is a prospective cohort study of Filipino patients admitted for sepsis at the national tertiary referral hospital in Manila, Philippines. We conducted differentially expressed gene analysis, network analyses, and area under the curve study of publicly available datasets of surviving vs. non-surviving sepsis patients to identify candidate prognosticator markers. Quantitative PCR was used to characterize the expression of each marker. A model using ordinal logistic regression analysis was done to determine which among the markers can best predict the outcome of sepsis severity. Results. We identified ACTB, RAC1, STAT3, and UBQLN1 as candidate mRNA prognosticators. The expression of STAT3, a gene involved in immunosuppression, is inversely correlated with the severity of sepsis. Conclusion. Transcriptomic markers such as STAT3 can predict the severity of patients with sepsis. Early detection of its inverse expression may prompt early and more aggressive management of patients.

Measles outbreak in the Philippines: epidemiological and clinical characteristics of hospitalized children, 2016-2019

SummaryBackgroundMeasles outbreaks increased worldwide during 2017-19. The largest outbreak in the World Health Organisation Western Pacific region occurred in the Philippines where first-dose measles-containing vaccine (MCV1) coverage had reduced to 75% in 2018. The aim of this study was to summarise paediatric measles admissions to the national infectious diseases referral hospital in Manila during 2016 to 2019.MethodsA retrospective single-centre observational study including 5,562 children aged under five years admitted with measles from January 2016 to December 2019. We summarised sociodemographic and clinical characteristics, vaccine status, reported exposures, and outcomes. Univariable and multivariable logistic regression analyses were undertaken to assess associations between different characteristics of hospitalised children and death.FindingsThe median age of children hospitalised with measles was 11 months (interquartile range: 7-28). 84·5% of cases were reported not to have received any MCV. The risk of mortality was 3·2%, with 41% of deaths occurring among children aged less than 9 months. No children died who had received two MCV. The following characteristics were significantly associated with mortality in the multivariable analysis: age group, residence outside of the national capital region, not having received any MCV, duration between onset of fever and hospital admission of 7-14 days compared with 0-3 days, not receiving vitamin A supplementation, having pneumonia, and gastroenteritis.InterpretationThe Philippines remains at risk of future measles epidemics. Routine immunization needs to be strengthened and earlier timing of MCV1 requires further evaluation to reduce measles incidence and mortality.

P7‐45: Non‐pulmonary medicine specialists' knowledge, attitude and practice in the diagnosis of chronic obstructive pulmonary disease (COPD) in a Tertiary Hospital in Manila, Philippines

P7‐45: Non‐pulmonary medicine specialists' knowledge, attitude and practice in the diagnosis of chronic obstructive pulmonary disease (COPD) in a Tertiary Hospital in Manila, Philippines

JOB BURNOUT AND PERFORMANCE OF STAFF NURSES IN SELECTED HOSPITALS IN METRO MANILA

This study was conducted to determine the job burnout and performance of staff nurses in selected tertiary hospitals in Manila using the Oldenburg Burnout Inventory. Results showed that there’s: a high degree of agreement in relation to burnout of the staff-nurses in terms of exhaustion and disengagement; an average level of performance of the staff nurses in terms of task performance, contextual performance, and counter-productive behavior; significant differences between the degrees of agreement in relation to job burnout of the staff-nurses (disengagement and exhaustion) when they are grouped according to nurse-patient ratio and census per area; significant relationships between the degree of agreement in relation to job burnout (disengagement) and overall level of performance of the staff nurses. Researchers pursued this study because some of their colleagues have lost the enjoyment of their job; that they feel that their efforts were being unnoticed; and feel overworked. Through this study, the degree of agreement in relation to job burnout of the staff nurses and their level of performance was determined. This paved a way for the development of new plans and programs to help staff nurses overcome their feelings of burnout, making them more energetic and enthusiastic in performing their job.

Epidemiological and clinical characteristics of the first 500 confirmed COVID-19 inpatients in a tertiary infectious disease referral hospital in Manila, Philippines

BackgroundThe Philippines has been one of the most affected COVID-19 countries in the Western Pacific region, but there are limited data on COVID-19-related mortality and associated factors from this setting. We aimed to describe the epidemiological and clinical characteristics and associations with mortality among COVID-19-confirmed individuals admitted to an infectious diseases referral hospital in Metro Manila.Main textThis was a single-centre retrospective analysis including the first 500 laboratory-confirmed COVID-19 individuals admitted to San Lazaro Hospital, Metro Manila, Philippines, from January to October 2020. We extracted clinical data and examined epidemiological and clinical characteristics and factors associated with in-hospital mortality. Of the 500 individuals, 133 (26.6%) were healthcare workers (HCW) and 367 (73.4%) were non-HCW, with HCW more likely presenting with milder symptoms. Non-HCW admissions were more likely to have at least one underlying disease (51.6% vs. 40.0%; p = 0.002), with hypertension (35.4%), diabetes (17.4%), and tuberculosis (8.2%) being the most common. Sixty-one (12.2%) died, comprising 1 HCW and 60 non-HCW (0.7% vs. 16.3%; p < 0.001). Among the non-HCW, no death occurred for the 0–10 years age group, but deaths were recorded across all other age groups. Compared to those who recovered, individuals who died were more likely to be older (p < 0.001), male (p = 0.015), report difficulty of breathing (p < 0.001), be HIV positive (p = 0.008), be intubated (p < 0.001), categorised as severe or critical (p < 0.001), have a shorter mean hospital stay (p < 0.001), or have an additional diagnosis of pneumonia (p < 0.001) or ARDS (p < 0.001).ConclusionOur analysis reflected significant differences in characteristics, symptomatology, and outcomes between healthcare and non-healthcare workers. Despite the unique mix of cohorts, our results support the country’s national guideline on COVID-19 vaccination which prioritises healthcare workers, the elderly, and people with comorbidities and immunodeficiency states.

COVID-19 is moving to high-density, poor residential areas in Metropolitan Manila, Philippines

We describe three waves of COVID-19 infections in Manila. First, imported cases among Chinese nationals; second, infections amongst Filipinos residing in less densely populated areas; and third, infections amongst Filipinos residing in high-density areas. We highlight this using admissions data from the National Infectious Diseases hospital in Manila.

If Not COVID-19 What Is It? Analysis of COVID-19 versus Common Respiratory Viruses among Symptomatic Health Care Workers in a Tertiary Infectious Disease Referral Hospital in Manila, Philippines.

The COVID-19 global pandemic is entering its second year. In this short report we present additional results as a supplement to our previous paper on COVID-19 and common respiratory virus screening for healthcare workers (HCWs) in a tertiary infectious disease referral hospital in Manila, Philippines. We sought to understand what etiologic agents could explain the upper/lower respiratory tract infection-like (URTI/LRTI-like) symptoms exhibited by 88% of the 324 HCWs tested. Among the patients who had URTI/LRTI-like symptoms, only seven (2%) were positive for COVID-19, while 38 (13%) of the symptomatic participants were identified positive for another viral etiologic agent. Rhinovirus was the most common infection, with 21 (9%) of the symptomatic participants positive for rhinovirus. Based on these results, testing symptomatic HCWs for common respiratory illnesses in addition to COVID-19 should be considered during this time of global pandemic.

Classification of Childhood Glaucoma in Patients of a Government Tertiary Hospital in Manila, Philippines using the Childhood Glaucoma Research Network System

Background. Childhood glaucoma is a rare multifactorial disease with limited information regarding the demographics and characteristics in the Filipino setting. It can be categorized via the Childhood Glaucoma Research Network Classification scheme.&#x0D; Objective. Determine the clinical classification of patients diagnosed with childhood glaucoma in the ophthalmology service of a government tertiary hospital in Manila, Philippines.&#x0D; Methods. Medical records of all patients ≤16 years-old referred to Glaucoma Section of Philippine General Hospital from January 2015 to December 2017 were reviewed retrospectively and classified.&#x0D; Results. One-hundred four (104) eyes in 77 children were classified. Glaucoma associated with acquired conditions was the most prevalent in 44.2% of the patients with trauma consisting of 19.5% of all patients. Primary childhood glaucoma consisted of 15.6% and juvenile open-angle glaucoma was diagnosed in 5.2%. Glaucoma following cataract surgery was noted in 7.8% of patients. Trabeculectomy was the primary surgical intervention in 22.2% of eyes, with 78.9% of eyes reaching an IOP control of &lt;21mmHg on final follow-up.&#x0D; Conclusion. Glaucoma associated with acquired conditions was the most common childhood glaucoma in the patient population. Trabeculectomy was the most common surgery done. Trauma was the most prevalent cause of glaucoma from acquired conditions.

Measles Outbreak in the Philippines: Epidemiological and Clinical Characteristics of Hospitalized Children, 2016-2019

Background: Measles outbreaks increased worldwide during 2017-19. The largest outbreak in the World Health Organisation Western Pacific region occurred in the Philippines. The aim of this study was to summarise paediatric measles admissions to the national infectious diseases referral hospital in Manila during 2016 to 2019, and consider implications for the Philippines and the wider region. Methods: A retrospective single-centre observational study including 5,562 children aged under five years admitted with measles from January 2016 to December, 2019. We summarised sociodemographic and clinical characteristics, vaccine status, reported exposures and outcomes. Univariable and multivariable logistic regression analyses were undertaken to assess associations between different characteristics of hospitalised children and death. Findings: The median age of children hospitalised with measles was 11 months (interquartile range: 7-28). 84.5% of cases were reported not to have received any measles-containing vaccination (MCV). The case fatality rate was 3.2%, with 30% of deaths occurring among children aged less than 9 months. The following characteristics were associated with increased odds of death: admission during the period of the epidemic (adjusted odds ratio [AOR] 9.40, 95% CI 1.80-49.05), pneumonia (AOR 2.42, 95% CI 1.55-3.78), gastroenteritis (AOR 4.01, 95% CI 2.19-7.35), not receiving vitamin A supplementation (AOR 1.82, 95% CI 1.22-2.72), and not being vaccinated (AOR 2.09, 95% CI 1.07-4.07). Interpretation: No children died who had received two MCVs. MCV1 coverage in the Philippines declined to 72% in 2020. Routine immunization needs to be strengthened and earlier timing of MCV1 requires further evaluation to prevent further outbreaks. Funding Information: This work is in part funded by Nagasaki University (salary support for CS, KA, RN, KA, JS). Declaration of Interests: KM is a member of the WHO Strategic Advisory Group of Experts (SAGE) on Immunization. The other authors declare no conflicting interests Ethics Approval Statement: The study was approved by the SLH research ethics and review unit (Ref: SLH-RERU-2020-010-E Ver 2) and the School of Tropical Medicine and Global Health, Nagasaki University ethical committee (Ref: NU_TMGH_2020-106-0). This was a retrospective analysis of routinely collected anonymised data thus patient or caregiver consent was not required.

AIDS-Related Kaposi Sarcoma in a Tertiary University Hospital in Manila, Philippines: A Report of Six Cases

We report six cases of Kaposi sarcoma (KS) seen at the University of the Philippines–Philippine General Hospital, a tertiary university hospital with a 1,500-bed capacity in Manila, from 2017 to February 2020. All cases involved males (21–47 years old) infected with human immunodeficiency virus (HIV). Majority came from Metro Manila and had opportunistic infections at the time of KS diagnosis, most commonly pulmonary tuberculosis. Four patients presented with multiple hyperpigmented cutaneous patches. One patient had both cutaneous lesions and necrotic gingival mass. One patient presented with a gastrointestinal mass. One patient underwent systemic chemotherapy (liposomal doxorubicin) but was eventually lost to follow-up. Although considered the most common tumor arising from HIV-infected persons, KS is considered rare in the Philippines. No studies have been undertaken to determine its incidence. However, the incidence may be expected to rise due to the increasing number of Filipinos diagnosed with HIV daily.

Association of sarcopenia with osteoporosis in patients with chronic obstructive pulmonary disease

ObjectivesSystemic consequence of Chronic Obstructive Pulmonary Disease (COPD) is associated with progressive loss of muscle mass and function. Preliminary studies showed presence of sarcopenia in COPD leads to reduced pulmonary function and quality of life; studies on whether this condition results in consequent loss of bone mineral density (BMD) is still inconsistent. This study aims to examine the association of sarcopenia in COPD with osteoporosis. MethodsThis is a post-hoc analysis of a study on forty-one (n = 41) participants with COPD seen in a tertiary public hospital in Manila, Philippines who underwent pulmonary function test and dual-energy x-ray absorptiometry. Sarcopenia was defined using a Philippine-based criteria of low fat free mass index (FFMI) and low muscle strength - hand grip strength, and osteoporosis using World Health Organization T-score diagnostic criteria. ResultsThe prevalence of osteoporosis among COPD is 44%, and 63% in COPD with sarcopenia. There was no statistical difference seen in pulmonary function variables between COPD with and without osteoporosis. Significant positive correlations were observed between Forced Expiratory Volume in 1 s, FFMI, and appendicular lean muscle with total body BMD. Sarcopenia in COPD was associated with significantly increased risk for osteoporosis. ConclusionsHigh prevalence rate of osteoporosis, and even higher among sarcopenic Filipino COPD patients should be further studied. The findings also suggest that sarcopenia in COPD is associated with increased risk of osteoporosis, and osteoporosis alone does not seem to affect lung function.