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The aim of this study was to determine the predictors of mortality and describe laboratory trends among adults with confirmed COVID-19.The medical records of adult patients admitted to a referral hospital with COVID-19 were retrospectively reviewed. Demographic and clinical characteristics, and laboratory parameters, were compared between survivors and non-survivors. Predictors of mortality were determined by multivariate analysis. Mean laboratory values were plotted across illness duration.Of 1215 patients, 203 (16.7%) had mild, 488 (40.2%) moderate, 183 (15.1%) severe, and 341 (28.1%) critical COVID-19 on admission. In-hospital mortality was 18.2% (0% mild, 6.1% moderate, 15.8% severe, 47.5% critical). Predictors of mortality were age ≥ 60 years, COPD, qSOFA score ≥ 2, WBC10 × 10The overall mortality rate was high. Predictors of mortality were similar to those of other reports globally. Marked inflammation and worsening pulmonary and renal function were evident among non-survivors by the 2nd-3rd week of illness.

Excerpts: "It has often been said that there is no one more afraid of radiation than the radiologist. From Day 1 of residency training, radiologists-to-be are taught that excess radiation can cause cancer and a multitude of other medical conditions. After Hiroshima, Nagasaki and Chernobyl, history has shown that excess doses of radiation can cause cancer..." "The Computed Tomography (CT) Scan machine was invented in 19724 and used commercially soon thereafter. Since then, there was an incredible leap in the practice of medicine. Head injuries and trauma cases became routinely evaluated using CT. In recent years, CT has become the standard in screening for paranasal sinus disease, lung disease and coronary artery disease. Computed Tomography has become accessible and affordable. CT scan procedures are covered by health insurance in most First World countries..." [However, there are important questions which need to be raised:] "How much radiation does a patient receive with each CT Scan procedure? Should we be alarmed by the amount of radiation that a patient receives with each CT Scan procedure? Is the CT Scan really safe?" Unfortunately, it is not that easy to answer these questions. It is not ethical to do a randomized control study on the effect of radiation on humans by intentionally irradiating them without any expected benefits. We have to content ourselves with data on radiation doses obtained in previous studies." Read the complete article in the attached pdf...

BACKGROUND AND PURPOSE: Effective communication among health care providers within an institution is vital for ensuring patient safety. A radiologist’s competence in identifying critical findings is just as important as being able to relay this information to the primary provider in a timely manner so that appropriate interventions can be initiated in life-threatening emergencies. This study aims to obtain baseline data regarding effective communication of critical findings between radiology and the primary health care providers. MATERIALS AND METHODS: Based on the Massachusetts’s Coalition for Prevention of Medical Errors safe practice recommendations, a communication protocol was developed. Certain selected cranial critical findings (new hemorrhage, new herniation, acute brain edema, acute stroke and findings suggestive of meningitis or abscess) were used in the critical findings protocol. Total communication time (TCT) in the relay of critical findings included time from CT scan order to scan (OS time), time from scan to interpretation (SI) and time from interpretation to relay (IR). All these times were recorded and compared to the standard 60 minutes using percent compliance, mean time, median time and standard deviation. RESULTS: Seventy-nine (79) critical findings were recorded and relayed in a 30-day period. There was 100% (79/79) compliance with the relay of critical findings to the primary care team and 97.5% (77/79) success rate in direct communication of critical findings within 60 minutes of identification. The mean OS time was 155.09 (±134.43) minutes, mean SI time was 46.54 (±44.01) minutes, and mean IR time was 9.13 (±12.04) minutes. The average time elapsed from CT study acquisition to direct notification was 57.0 (± 45.80) minutes. CONCLUSION: Effective communication of critical findings using a protocol adopted from set standards of safe practice recommendations is achievable in our institution. The proposed protocol exhibited compliance to and performed well against established benchmarks. The timely identification and delivery of critical findings to the primary care team is central to patient management and should be practiced in our setting. Keywords: critical finding, effective communication, cranial CT, standards

To describe the clinical profile and outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19) across the spectrum of disease severity.This retrospective study included adult patients with confirmed COVID-19 infection admitted to a referral hospital. Descriptive statistics, tests for trend, Kaplan-Meier curve and log-rank test were used to compare characteristics and outcomes across disease severity categories.Of 1500 patients with COVID-19, 14.8% were asymptomatic, 13.5% had mild disease, 36.6% had moderate disease, 12.3% had severe disease and 22.7% had critical disease. Asymptomatic patients were admitted for a concurrent condition or for isolation. Patients aged60 years, male gender and with co-morbidities had more severe disease. Fever, cough, shortness of breath, malaise, gastrointestinal symptoms and decreased sensorium were more common in patients with severe disease. Bilateral pulmonary infiltrates were common (51.1%), with sicker patients having more abnormal findings. The overall mortality rate was 15.1%. Adopting a symptom-based strategy reduced the length of hospitalization from a median of 13 [interquartile range (IQR) 7-21] days to 9 (IQR 5-14) days.The clinical profile and outcomes for this cohort of patients with COVID-19 was consistent with published reports. Asymptomatic infection was common, and universal testing may be a valuable strategy in the correct context, given the implications for infection control. A symptom-based strategy was found to reduce the length of hospitalization considerably.

Highlights • Parametrial boost (PMB) is indicated for persistent parametrial and pelvic sidewall disease. This study aims to identify demographic, clinical, and treatment-related characteristics associated with treatment of PMB. Two factors were found significant: pelvic sidewall invasion at diagnosis and more chemotherapy cycles received. No significant difference in outcomes was observed between those treated with PMB and not., Objective The aim of this study is to identify demographic, clinical, and treatment-related characteristics associated with the prescription of parametrial boost (PMB) in cervical cancer patients undergoing definitive chemoradiation. Materials/Methods A retrospective chart review of 132 non-metastatic cervical cancer patients treated with definitive chemoradiation from May 2017 to December 2019 was performed. Demographic, clinical, and treatment characteristics were obtained and compared between those who received PMB and those who did not. Clinical outcomes (pelvic recurrence, tumor persistence, distant metastases, and median survival time) were also gathered and compared. Statistical software was used for analysis, with a p

Purpose: To describe the radiographic findings of hospitalized adult Filipino COVID-19 patients on serial chest x-ray imaging. Method: We performed a retrospective review of records and chest x-rays of eligible adult Filipinos with confirmed COVID-19 admitted from 1 March 2020 to 31 July 2020. Demographics, clinical outcomes, and chest radiographic findings were recorded. Serial chest x-ray findings were correlated with the clinical outcome. Results: From 144 adult patients (93 males and 51 females), a total of 785 chest x-rays were reviewed (144 baseline and 641 follow-up). The most common finding overall is ground-glass opacity. The most common distribution pattern is bilateral, patchy/diffuse involvement of the central/peripheral zones. In x-rays taken after the third admission day, reticular opacities become more common than consolidation. The radiographic extent score was higher for deceased patients compared to the survivors at Day 7–9 (6 vs 4.4, p-value = 0.0011), Day 10–12 (5.9 vs 4.3, p-value = 0.0079) and Day 13–15 (5.5 vs 4.1, p-value = 0.0297). The presence of endotracheal tubes (68 % vs 7.5 %, p-value < 0.001) and pleural effusion (70 % vs. 36 %, p-value = 0.0004) were higher among the deceased. Reticular opacities were more common for discharged patients (50 % vs 30 %, p-value = 0.0021). Conclusion: Ground-glass opacities with bilateral, patchy/diffuse involvement of the central/peripheral zones are the most common findings. The presence of endotracheal intubation, pleural effusion, and persistently elevated radiographic extent scores are typically seen in deceased patients. Serial chest radiography with radiographic extent scoring is a useful tool in monitoring COVID-19 for hospitalized adult patients.

In the disclosure process, the words we use are important and will ultimately impact the way the diagnosis is received.

Background Despite multimodality treatment, the prognosis of glioblastoma (GBM) has remained poor. Intraoperative radiation therapy (IORT) offers additional local control by directly applying a radiation source to the resection margin, where most recurrences occur. Methods We performed a systematic review on the oncologic outcomes and toxicities of IORT for GBM in the era of modern external beam radiation therapy (EBRT) and chemotherapy with temozolamide. Results Four studies representing 123 patients were included. Majority (81%) were newly diagnosed, and gross total resection was reported in 13–80% of cases. IORT modalities included electrons from a linear accelerator (LINAC) and photons from a 50-kV x-ray device. Median doses were from 12.5 to 20 Gy for electron-based studies and 10–25 Gy for photon-based studies. Adjuvant treatment consisted of 46–60 Gy post-operative EBRT in electron-based studies and the Stupp protocol in photon-based studies. Complications included radiation necrosis (2.8–33%), infection, hematoma, perilesional edema, and wound dehiscence. Median time to local recurrence was 9.9–16 months and the reported overall progression-free survival was 11.2–12.2 months. Median overall survival was 13–14.2 months for the electron-based studies and 13.8–18 months for the photon-based studies. Conclusion IORT resulted in improved local control and comparable overall survival rates with the Stupp protocol. Although photon-based IORT had better results than electron IORT, this may be due to improvements in other forms of adjuvant treatment rather than the IORT modality itself. The overall effect of IORT on GBM treatment is still inconclusive due to the small number of patients and heterogeneous reporting of data.

Objectives: To describe the clinical profile and factors associated with mortality among the first 200 patients confirmed to have COVID-19 infection admitted in the University of the Philippines – Philippine General Hospital (UP-PGH) Methodology: We conducted a retrospective review of adult patients with confirmed COVID-19 infection admitted in PGH, a designated COVID-19 referral center. Demographic, clinical data, and clinical outcomes were extracted from medical records. Frequencies and distributions of various clinical characteristics were described, and factors associated with mortality were investigated. Results: Of the 200 patients in our cohort, majority were male (55.5%), and more than half (58%) were over 60 years old. Underlying co-morbid illnesses (67.5%) included hypertension (49.5%), diabetes mellitus (26.5%), and cardiovascular disease (20.5%). Most frequent presenting symptoms were cough (69.0%), fever (58.5%), or shortness of breath (53.0%). Most patients presented with mild (n=41, 20.5%) to moderate illness (n=99, 49.5%) and only 60 were considered severely (n=32, 16.0%) or critically ill (n=28, 14.0%). Many (61%) received empiric antibiotics, while 44.5% received either repurposed drugs or investigational therapies for COVID-19. Bacterial co-infection was documented in 11%, with Klebsiella pneumoniae commonly isolated. In-hospital mortality was 17.5%, which was highest for critical COVID-19 (71.4%). Mortality was observed to be higher among patients age 60 and above, those requiring oxygen, ventilatory support and ICU admission, and among those who developed acute kidney injury, acute stroke, sepsis, and nosocomial pneumonia. Conclusion: Our study confirms that COVID-19 affects males, older individuals and those with underlying co-morbid conditions. Empiric antimicrobial treatment was given for majority of patients, despite documentation of bacterial infection in only 11%. K. pneumoniae was commonly isolated, reflecting local epidemiology. Mortality rate during this early period of the pandemic was high and comparable to other institutions. Factors associated with mortality were related to critical COVID-19 and are similar to other studies.

Setting The 3rd national tuberculosis (TB) survey in the Philippines in 2007 reported a significant decline in the prevalence of TB. Since then, more significant investments for TB control have been made, yet TB burden estimates from routine surveillance data remain relatively stable. Objective To estimate the prevalence of bacteriologically confirmed pulmonary TB in the Philippines amongst individuals aged ≥15 years in 2016. Design In March–December 2016, we conducted a population-based survey with stratified, multi-stage cluster sampling of residents in 106 clusters aged ≥15 years. Survey participants were screened for TB by symptom-based interview and digital chest X-ray. Those with cough ≥2 weeks and/or haemoptysis and/or chest X-ray suggestive of TB were requested to submit 2 sputum specimens for Xpert MTB/RIF, direct sputum smear microscopy using LED fluorescent microscopy, and mycobacterial solid culture (Ogawa method). Bacteriologically confirmed pulmonary TB was defined as MTB culture positive and/or Xpert positive. Results There were 46,689 individuals interviewed, and 41,444 (88.8%) consented to a chest X-ray. There were 18,597 (39.8%) eligible for sputum examination and 16,242 (87.3%) submitted at least one specimen. Out of 16,058 sputum-eligible participants, 183 (1.1%) were smear-positive. There were 466 bacteriologically confirmed TB cases: 238 (51.1%) Xpert positive, 69 (14.8%) culture positive, and 159 (34.1%) positive by both Xpert and culture. The estimated TB prevalence per 100,000 population aged ≥15 years was 434 (95% CI: 350−518) for smear-positive TB, and 1,159 (95% CI: 1,016−1,301) for bacteriologically confirmed TB. Conclusion This nationally representative survey found that the TB burden in the Philippines in 2016 was higher than estimated from routine TB surveillance data. There was no evidence of a decline in smear and culture positive TB from the 2007 survey despite significant investments in TB control. New strategies for case-finding and patient-centered care must be intensified and expanded.

We present a case of pathologically confirmed, relatively rare Pigmented Villonodular Synovitis (PVNS). The patient presented with knee and thigh swelling. While initially misdiagnosed, he eventually underwent an MRI and a biopsy. The MRI was helpful but not definitive. The biopsy confirmed PVNS. The patient underwent synovectomy and was subsequently referred for radiotherapy and physical therapy. Post-treatment MRI showed no evidence of disease.

Synovial haemangioma is a rare type of tumour for which only around 200 cases have been reported worldwide. It usually occurs in the female population during the second decade of life and most commonly affects the knee joint. Patients can complain of pain, recurrent knee swelling and limitation of motion. Since these lesions are uncommon and radilogical findings are nonspecific, physician awareness is low and diagnosis is often delayed, leading in turn to treatment delays and irreversible complications of the affected joint. We report four cases of synovial haemangioma of the knee seen over a period of 20 years (1993–2013). Age at presentation ranged from six to 43 years (mean of 22.7 years) with an equal male-to-female ratio. Average duration of symptoms prior to treatment was three years—patients were often misdiagnosed and appropriate treatment was subsequently delayed. Radiographs showed moderate to severe degenerative changes. Magnetic resonance (MR) imaging revealed poorly defined intra-articular contrast-enhancing lesions, all of which were of the localised type. Three patients underwent open synovectomy and en bloc excision of the lesion; the fourth deferred surgery but continues to be monitored. Follow-up ranged from one to 11 years; all four patients are doing well, with no signs of symptom recurrence or progression. Synovial haemangioma is a rare but treatable condition. It should remain a differential for any patient with recurrent knee-joint symptoms.