Telemedicine usability and satisfaction among pediatric rheumatology patients and their caregivers during COVID-19 pandemic

Background@#The 2019 coronavirus disease pandemic opened an opportunity to explore the role of telemedicine in pediatric rheumatology clinic as well as patient satisfaction with virtual visits.@*Objective@#To determine the usability and satisfaction rate of telemedicine among pediatric rheumatology patients and their caregivers.@*Method@#A cross-sectional online survey was conducted among patients and caregivers consulting via telemedicine at a pediatric rheumatology clinic of University of the Philippines – Philippine General Hospital (UP – PGH), a tertiary government hospital. Collected data included socio-demographics and the validated Telehealth Usability Questionnaire (TUQ).@*Results@#There were 39 (55.7%) patients and 31 (44.3%) primary caregivers included in the study. Across all usability factors, the response of primary caregivers did not significantly differ from those of patients. The average scores across all questions for both patients and primary caregivers were 5.96±1.19 and 6.04±1.34, respectively. This showed a high level of agreement that they were highly satisfied with telemedicine experience. Among the different usability factors, questions related to usefulness obtained the highest mean score for both patients (6.11±1.17) and primary caregivers (6.12±1.38). While the lowest mean score was observed on questions related to reliability, 5.65±1.33 for patients and 5.89±1.31 for primary caregivers.@*Conclusion@#Pediatric rheumatology patients as well as their caregivers are generally highly satisfied with telemedicine during this time of pandemic. With high patient and caregiver satisfaction, telemedicine could be an option for ambulatory patient care even after pandemic.

A randomized controlled trial of center-based and home-based exercise programs among patients with rheumatoid arthritis

Background@#Rheumatoid arthritis (RA) patients benefit from aerobic and strengthening exercises. @*Objective@#To compare the effectiveness of a home exercise program against center-based aerobic and strengthening exercises on the grip strength, endurance, function, and fatigue among patients with RA. @*Methodology@#In this assessor-blind, randomized trial, 50 RA patients were assigned to either center-based physical therapy (CPT) or home exercise program (HEP) that included aerobic and strengthening exercises performed for four weeks. The grip strength, 6-minute walk test (6MWT), health assessment questionnaire disability index (HAQ-DI), and the multidimensional assessment of fatigue (MAF) index were determined at weeks 0 (baseline), 2 and 4 weeks.

SLICC-based Phenotype of Juvenile Systemic Lupus Erythematosus in the Philippines

Objective@#To describe the clinical profile of Filipino pediatric SLE patients as determined using the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria. @*Methods@#We checked which among the SLICC criteria were fulfilled by Filipino pediatric SLE patients when we examined them and their case records, as part of a nationwide genetic study on SLE conducted from October 2015 to March 2017. @*Results@#Ninety-seven (out of 321) who were diagnosed to have SLE before 19 years of age were evaluated.The mean age of the population at the time of evaluation was 19.8 ± 6.9 years. Females comprised 94% of our population. Mean age of onset was 14.4 ± 2.7 years, while the mean age of diagnosis was at 14.5 ± 2.6 years. Acute cutaneous rash was found in 87%; oral ulcers 65%; renal disorder 63%; non-scarring alopecia 61%; arthritis 58%; chronic cutaneous rash 36%; leukopenia 35%; hemolytic anemia 34%; serositis 25%; thrombocytopenia 23%, and neurologic disorder 8%. Anti-nuclear antibody was present in 85%; low complement 32%; anti-dsDNA 28%; direct Coombs’ 16%; antiphospholipid antibody 3%; and anti-Smith antibody 1%. Kidney biopsy was performed in only 14% (14/97) of patients, of whom 27% had class III histopathologic characteristic.@*Conclusions@#Filipino pediatric SLE patients typically present with mucocutaneous, renal, and musculoskeletal involvement. Cardiopulmonary and neurologic manifestations are found to be less common among them. Finally, renal biopsy is not commonly performed among these patients.

Bullous systemic lupus erythematosus and membranous lupus nephritis in a Filipino child

@#<p style="text-align: justify;">Bullous eruptions are rare cutaneous manifestations of systemic lupus erythematosus. We report a case of an 8-year old Filipino girl with vesiculobullous systemic lupus erythematosus (SLE) and membranous lupus nephritis on kidney biopsy who presented with clinical nephrotic features of generalized edema, proteinuria, hypoalbuminemia and hyperlipidemia. The 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE were met. Immunohistopathologic examination of the skin lesion revealed a sub-epidermal split with neutrophilic infiltrates along the dermo-epidermal junction, moderate perivascular, periadnexal and interstitial infiltrates composed of predominantly neutrophils with neutrophilic dusts, lymphocytes, plasma cells, rare eosinophils and increased dermal mucin. Direct immunofluorescence showed strong continuous linear IgG deposits along the basement membrane and weak linear IgM and IgA deposition along the basement membrane zone (BMZ). To our knowledge, this is the first report of vesiculobullous SLE in a Filipino child. This case is a rare form of cutaneous lupus in children. Bullous SLE (BSLE) should be considered in the differential diagnosis of children presenting with generalized bullous eruptions.</p>

Cardiac involvement in Kawasaki disease patients: A retrospective study

Background@#Kawasaki disease is a self-limited disease but it can lead to potentially fatal cardiac complications if not detected and managed accordingly. @*Objective@#To determine the incidence of cardiac involvement in patients with Kawasaki disease admitted in PGH @*Methods@#Medical records of patients with KD admitted from January 2012 to December 2013 were reviewed. Demographic, clinical, laboratory, chest radiographic, electrocardiographic, and echocardiographic data were recorded. The course, management, length of hospital stay, clinical outcome, duration of OPD follow-up, and medications were evaluated. @*Results@#Thirty-eight patients with mean age of 2.67 ± 2.26 years old, 66% males with KD were included. Fifty-nine percent had cardiac involvement, and among those with cardiac involvement, 68% have coronary artery dilatation. Seventy-six percent of cases received intravenous immunoglobulin (IVIG) with 55% receiving IVIG within 10 days of illness. The initial cardiac findings resolved in the subsequent 2d-echo after IVIG except for some coronary artery abnormalities, which resolved in 5 ± 3.11 months during follow-up. There was no mortality. The possible predictive factors for the development of cardiac abnormalities published in other studies were not found to be significantly associated in this study population. @*Conclusion@#The incidence of cardiac involvement in patients with Kawasaki disease among children admitted in PGH is 59% with68% having coronary artery dilatation, higher than in other published studies.

Corrigendum to “Determination of normative reference for the definition of sarcopenia among Filipinos” Osteoporos. Sarcopenia 2 (2016) 186–190

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Determination of normative reference for the definition of sarcopenia among Filipinos

BACKGROUND: At present, there is no normative value that can be used in the definition of sarcopenia in the Philippines. OBJECTIVE: We identified the reference cut-off values for: 1) muscle mass using bioimpedance analysis; 2) grip strength; 3) usual gait speed; 4) timed get-up-and-go; and 5) short physical performance battery in the Philippines in order to adapt the European Working Group on Sarcopenia in Older People (EWGSOP) criteria for the definition of sarcopenia. METHODS: Two hundred seventy six (135 males and 141 females) healthy Filipino adults, between 20 and 40 years, were included in this cross sectional study. A Fresenius Body Composition Monitor was used to measure lean tissue mass (LTM) and lean tissue index (LTI). A dynamometer was used to measure grip strength. Usual gait speed, timed get-up-and-go, and short physical performance battery were also determined. RESULT: The normative references for males and females, respectively, for LTI were 17.10 + 2.337 kg/m² and 12.63 + 2.119 kg/m²; for usual gait speed were 1.06 + 0.251 m/sec and 0.930 + 0.144 m/sec; and for grip strength were 39.76 + 7.567 kg and 26.68 + 5.243 kg. The sarcopenia cut-points for the males and females, respectively, for LTI were <12.50 kg/m² and <8.33 kg/m²; for usual gait speed were <0.55 m/sec and <0.65 m/sec; and for grip strength were <24.54 kg and <16.10 kg. CONCLUSION: This study presents cut-points for the determination of sarcopenia at-risk population among Filipinos.