Clearing the Fog: A Systematic Review on Cognitive Dysfunction in COVID-19

ObjectiveThe systematic review aims to examine the association between COVID-19 and cognitive dysfunction, including the link between the severity of COVID-19 and the occurrence of cognitive impairment and the potential pathophysiological mechanisms related to brain fog among COVID-19 patients. MethodsPubMed, Oxford University Press, ProQuest Health and Medical Complete, ScienceDirect, Ovid, HERDIN, Google Scholar, and Cochrane Library databases were accessed to retrieve literature using the PRISMA guidelines. ResultsAfter critical appraisal, thirteen full journal articles were included in the study. The studies showed the most frequent cognitive impairment are attention, memory, and executive function in COVID-19 patients. Compared with healthy controls (HC) in 3 out of 4 studies, cognitive impairment was only evident in COVID-19 patients. Furthermore, two studies showed no correlation between brain fog and depression, and five studies showed a link between the severity of COVID-19 infection and cognitive impairment. Cases ranging from mild to severe illness presented manifestations of brain fog. However, a disparity in the evidence of the pathophysiology of COVID-19 and cognitive dysfunction exists, prompting the need to investigate further. Additionally, recent studies provide insufficient evidence for direct central nervous system invasion, and there are emerging studies that contrast the presumed pathogenesis of neurological complications from neuroinflammation. ConclusionThere is an association between COVID-19 and cognitive dysfunction. Manifestation of cognitive dysfunction is present regardless of illness severity. Moreover, there are existing pathophysiological mechanisms of the Coronavirus that lead to cognitive dysfunction in COVID-19 patients; however, additional studies are required to substantiate such mechanisms further. PROSPERO Registration NumberCRD42022325669

Implementation of Unassisted and Community-Based HIV Self-Testing (HIVST) during the COVID-19 pandemic among Men-who-have-sex-with-Men (MSM) and Transgender Women (TGW): A Demonstration Study in Metro Manila, Philippines

ObjectiveThe study aimed to demonstrate the feasibility of an unassisted and community-based HIV self-testing (HIVST) distribution model and to evaluate its acceptability among men-having-sex-with-men (MSM) and transgender women (TGW). MethodsOur observational study focused on implementing the HIVST service in Metro Manila, Philippines. Convenience sampling was done with the following inclusion criteria: MSM or TGW, at least 18 years old, and had no previous HIV diagnosis. Individuals taking HIV Pre-exposure Prophylaxis (PrEP), on Antiretroviral Therapy (ART), or female sex at birth were excluded. The implementation of the study was online using a virtual assistant and delivery system via courier due to COVID-19-related lockdowns. Feasibility was measured by the number of HIVST kits successfully delivered and utilized and the HIV point prevalence rate. Moreover, acceptability was evaluated by a 10-item system usability scale (SUS). HIV prevalence was estimated with linkage to care prioritized for reactive participants. ResultsOut of 1,690 kits distributed, only 953 (56.4%) participants reported their results. Overall HIV point prevalence was 9.8%, with 56 (60.2%) reactive participants linked to further testing. Furthermore, 27.4% of respondents self-reported, and 13.4% of the reactive participants were first-time testers. The HIVST service had an overall mean {+/-} standard deviation SUS score of 81.0 {+/-} 13.0, rendering the HIVST kits very acceptable. ConclusionsHIVST is acceptable and feasible to MSM and TGW. Online platforms are an innovative and effective way to deliver HIVST service during a pandemic. However, messaging to entice people to use the kit must be differentiated based on their age, gender identity and expression, and previous HIVST experience to offer the service efficiently to the target populations.

Wastewater-Based Epidemiology and Whole-Genome Sequencing for Community-Level Surveillance of SARS-CoV-2 in Selected Urban Communities of Davao City, Philippines: A Pilot Study

ABSTRACT AND KEYWORDSO_ST_ABSBackgroundC_ST_ABSOver 50 countries have used Wastewater-Based Epidemiology (WBE) and Whole-Genome Sequencing (WGS) of SARS-CoV-2 for monitoring COVID-19 cases. COVID-19 surveillance in the Philippines relies on clinical monitoring and contact tracing, with both having limited use in early detection or prediction of community outbreaks. Thus, complementary public health surveillance methods that can provide community-level infection data faster and using lesser resources must be explored. ObjectivesThis study piloted and assessed WBE and WGS as approaches for COVID-19 surveillance in low-resource and low-sanitation communities in Davao City, Philippines. MethodsWeekly wastewater samples were collected from six barangay community sewer pipes or creeks from November to December 2020. Samples were concentrated using a PEG-NaCl precipitation method and analyzed by RT-PCR to detect the SARS-CoV-2 N, RdRP, and E genes. In addition, SARS-CoV-2 RNA-positive samples were subjected to WGS for genomic mutation surveillance. Public data from clinical surveillance were also reviewed to interpret WBE data. ResultsTwenty-two of the 24 samples (91.7%) obtained from the six barangays tested positive for SARS-CoV-2 RNA. The cycle threshold (Ct) values were correlated with RNA concentration and attack rate. Thirty-two SARS-CoV-2 mutations were detected in WGS, including novel non-synonymous mutations or indels in seven SARS-CoV-2 genes and ten mutations previously reported in the Philippines. DiscussionSARS-CoV-2 RNA was detected in community wastewater from the six barangays of Davao City, even when the barangays were classified as having a low risk of COVID-19 transmission and no new cases were reported. Despite the fragmented genome sequences analyzed, our genomic surveillance in wastewater confirmed the presence of previously reported mutations while identifying mutations not yet registered in clinical surveillance. The local context of a community must be considered when planning to adopt WBE and WGS as complementary COVID-19 surveillance methodologies, especially in low-sanitation and low-resource settings.

A look at an urban tertiary hospital's indoor air pollutants using source apportionment of PM₂.₅

Background@#Ironically, the hospital which is believed to be a healthy and safe place can be dangerous to health. Pollutants such as particulate matter 2.5 microns (PM₂.₅) can be present in hospital indoor air and may adversely affect the health of the hospital occupants. @*Objective@#Possible sources of indoor PM₂.₅ in an urban tertiary care hospital in the Philippines are identified and apportioned in this study. @*Methods@#PM₂.₅ measurements were conducted in two naturally ventilated wards (NVWs), two mechanically ventilated wards (MVWs), and a roof deck near the hospital. Mass concentrations with analytical uncertainties of thirteen elements (Al, Na, S, Si, Cl, K, Ca, V, Fe, Zn, Br, Hg, Pb) from PM₂.₅ measurements were utilized with Positive Matrix Factorization (PMF) receptor model to identify and apportion possible sources of indoor PM₂.₅. @*Results@#In NVWs and MVWs, four types of sources were identified including sodium and chlorine sources, crustal emissions, anthropogenic sulfur sources, and road dust. Cleaning agents used in the hospital were identified as an anthropogenic indoor source of sodium while the other factors mainly came from outdoor sources. @*Conclusion@#The contribution of anthropogenic outdoor pollutants such as road dust and sulfur sources to indoor PM₂.₅ are highlighted in the study. The types of both indoor and outdoor sources of indoor PM₂.₅ can be influenced by the type of ventilation.

Validity study of the roll-over test and risk factors for Preeclampsia in four health districts of Surigao City, Philippines

Background@#The roll-over test is a simple, easily available clinical test using the sphygmomanometer to predict pregnancy-induced hypertension starting at 20 weeks age of gestation (AOG). However, the roll-over test is not part of the standard prenatal care in government health facilities even if health workers can easily perform the test.@*Objectives@#To validate the roll-over test at the 20th weeks of gestation and to determine the risk factors for preeclampsia in 4 health districts of Surigao City, a province in the CARAGA Region of the Philippines.@*Methods@#A total of 190 pregnant women without history of hypertension during their previous pregnancies from 4 health districts in Surigao City, Philippines were consecutively enrolled from May 2014 to October 2014 in a cross-sectional study design. The roll-over test was done using the method described in Williams Obstetrics and the validity of the roll-over test was measured. Bivariate and multivariate analyses were done to determine risk factors for preeclampsia.@*Results@#Seven of the 190 women developed preeclampsia. The sensitivity of the rollover test done at 20 weeks AOG was 43% and the specificity was 81%. Maternal age, history of urinary tract infection (UTI) and a positive roll-over test were associated with preeclampsia.@*Conclusion@#Pregnant women whose ages are <20 years or >29 years old, or who had a history of UTI, or a positive roll-over test are more likely to develop preeclampsia. Roll-over test has a low sensitivity at 20 weeks AOG. More studies are warranted to explore the improvement of its predictive value in other AOG.