Clinical features and outcomes of COVID-19 patients admitted at a tertiary hospital in Cebu City, Philippines.

INTRODUCTION: The World Health Organization has categorized coronavirus disease 2019 (COVID-19) into mild, moderate, severe, and critical illness severities to guide clinical decision-making. This study aimed to describe the clinical characteristics, complications, and outcomes of COVID-19 patients by illness severity, at a tertiary healthcare center in Cebu City, Philippines. METHODOLOGY: This was a retrospective, observational cohort study that examined clinical information of patients with confirmed COVID-19 infection admitted between March and September 2020. RESULTS: Data from 901 admitted patients were analyzed, with 185 (20.5%) classified as mild, 429 (47.6%) as moderate, 223 (24.7%) as severe, and 64 (7.1%) as critical. The frequency of male gender, advancing age, co-morbidities (hypertension and diabetes mellitus), inflammatory marker elevation (LDH, CRP, Ferritin, Procalcitonin), and elevated mean white blood cell counts with relative neutrophilia and lymphopenia increased with COVID severity. Severe and critical cases of COVID presented with more diffuse lung involvement in chest radiographs and abnormal electrocardiographic patterns such as ischemic changes, PVCs, PACs, and sinus tachycardia. The most common complications on admission were ARDS (10.9%), AKI (10.1%), shock (6.6%), and cardiac arrest (6.3%). Mortality rates were highest in critical cases (82.8%). Severe and critical COVID-19 cases were predominant on final disposition, rising to 62.5% of the study population from 32.1% on admission. CONCLUSIONS: This study highlights key differences in clinical characteristics, complications, and outcomes between illness severities. Risk prediction models are needed for disease progression and poor outcomes.

Association Between Metformin Use and Mortality among Patients with Type 2 Diabetes Mellitus Hospitalized for COVID-19 Infection.

INTRODUCTION: Metformin has known mechanistic benefits on COVID-19 infection due to its anti-inflammatory effects and its action on the ACE2 receptor. However, some physicians are reluctant to use it in hypoxemic patients due to potential lactic acidosis. The primary purpose of the study was to determine whether metformin use is associated with survival. We also wanted to determine whether there is a difference in outcomes in subcategories of metformin use, whether at home, in-hospital, or mixed home/in-hospital use. OBJECTIVES: This study aimed to determine an association between metformin use and mortality among patients with type 2 diabetes mellitus hospitalized for COVID-19 infection. METHODOLOGY: This was a cross-sectional analysis of data acquired from the COVID-19 database of two tertiary hospitals in Cebu from March 1, 2020, to September 30, 2020. Hospitalized adult Filipino patients with type 2 diabetes mellitus who tested positive for COVID-19 via RT-PCR were included and categorized as either metformin users or metformin non-users. RESULTS: We included 355 patients with type 2 diabetes mellitus in the study, 186 (52.4%) were metformin users. They were further categorized into home metformin users (n=109, 30.7%), in-hospital metformin users (n=40, 11.3%), and mixed home/in-hospital metformin users (n=37, 10.4%). Metformin use was associated with a lower risk for mortality compared to non-users (p=0.001; OR=0.424). In-hospital and mixed home/in-hospital metformin users were associated with lower mortality odds than non-users (p=0.002; OR=0.103 and p=0.005; OR 0.173, respectively). The lower risk for mortality was noted in metformin, regardless of dosage, from 500 mg to 2 g daily (p=0.002). Daily dose between ≥1000 mg to <2000 mg was associated with the greatest benefit on mortality (p≤0.001; OR=0.252). The survival distributions between metformin users and non-users were statistically different, showing inequality in survival (χ2=5.67, p=0.017). CONCLUSION: Metformin was associated with a lower risk for mortality in persons with type 2 diabetes mellitus hospitalized for COVID-19 disease compared to non-users. Use of metformin in-hospital, and mixed home/in-hospital metformin use, was also associated with decreased risk for mortality. The greatest benefit seen was in those taking a daily dose of ≥1000 mg to <2000 mg.

Delayed onset bioabsorbable screw reaction, intact screw extrusion and Pseudomonas aeruginosa tibial tunnel osteomyelitis years after arthroscopic anterior cruciate ligament reconstruction using hamstring graft.

Postoperative reaction and infection after anterior cruciate ligament (ACL) reconstruction is a rare complication. We report two cases of bioabsorbable screw extrusion and Pseudomonas aeruginosa tibial tunnel infection in 17/18-year-old men, 2 and 4 years after ACL reconstruction, respectively. They underwent tibial tunnel debridement, removal of the still intact poly-L-D-lactic acid bioabsorbable screw and subsequent wound closure. Physical examination findings confirmed patency of the hamstring graft. Culture guided antibiotics were completed, and wounds healed unremarkably. Both returned to previous level of activity. Successful treatment is achieved through a logical sequence of management, as well as a multidisciplinary approach to prevent unnecessary secondary procedures and morbidity.

Refractory Burkholderia cepacia bacteraemia from a consolidation pneumonia lasting more than 7 weeks, successfully treated with systemic antibiotics and nebulised meropenem.

We present a case of a 55-year-old Filipino man who was transferred from another institution where he was recently diagnosed with Crohn's disease but not started on any immunosuppressants. He underwent laparoscopic cholecystectomy with T-tube placement a few weeks prior to admission. On workup, abdominal CT scan was unremarkable, but blood cultures on the third hospital day grew Burkholderia cepacia Antibiotic regimen was shifted to ceftazidime and levofloxacin. The bacteraemia and febrile episodes persisted despite removal of the central line and T tube. White blood cell scan and chest CT scan showed left-sided consolidation pneumonia. Blood cultures continued to grow B. cepacia despite shifting to meropenem and trimethoprim-sulfamethoxazole. Meropenem nebulisation at 250 mg every 12 hours was added to the regimen on the third week then oral minocycline was added on the fourth week due to persistence of bacteraemia. He subsequently developed a small vegetation on the aortic valve, so amikacin was added. Fever lysed on the sixth week, but the B. cepacia bacteraemia persisted, clearing only on the 51st hospital day. The patient was discharged with a plan to continue antibiotics, including meropenem nebulisation, for 6 more weeks. On follow-up, the patient had no recurrence of fever. There was also resolution of consolidation on chest CT scan and disappearance of vegetation on echocardiography.