Background. The features and outcome of hepatobiliary tuberculosis (HBTB) have not been extensively reportedin children. Objective. To describe the clinical, biochemical, radiologic, microbiologic and histologic features and outcome ofchildren diagnosed with HBTB. Methods. Data of HBTB patients aged 0-18 years were collected by review of medical records and as they wereadmitted. Cases were classified as bacteriologically-confirmed (positive AFB smear, TB culture or PCR of bile/livertissue) or clinically-diagnosed (clinical, histologic and/or radiologic evidence). Results. A total of 36 patients were included (mean age: 13yrs; 64% males): three bacteriologically-confirmed and33 clinically-diagnosed. Most common signs/symptoms were weight loss (69%), fever (67%), hepatomegaly (61%)and jaundice (53%). Of the total, 68% had hypoalbuminemia, 50% increased transaminases and 47% prolongedprothrombin time. Fifteen (42%) patients were AFB positive on various microbiologic specimens. Most commonimaging finding was hepatic calcification (64%). Of 11 patients with liver biopsy, seven (64%) had chronic/granulomatous inflammation. All 36 were managed medically. Eight were lost to follow up, six died, and 22 (61%)are alive, nine with complete resolution of liver disease. Conclusion. Hepatobiliary tuberculosis presents with non-specific clinical and biochemical findings. Severalinvestigations are necessary to confirm the diagnosis. Overall response to anti-TB treatment is satisfactory withpossible resolution of liver disease.

Background. Human Pegivirus (HPgV), previously called Hepatitis G virus or GB virus C, is an RNA virus. It can be transmitted vertically (mother to infant), parenterally and sexually. HPgV share common routes of transmission to other viruses such as Hepatitis B virus, Hepatitis C virus and Human Immunodeficiency virus (HIV) thus co-infection is usually observed. Risk groups of HPgV include injection drug users, HIV-positive individuals, multi-transfused patients, hemodialysis patients, hemophiliacs, chronic liver disease patients and organ transplant recipients. The clinical significance of HPgV is not yet established and warrants further studies. Research on HPgV in the Philippines is scarce and has not been updated for over 10 years. There is no published data on HPgV prevalence in Filipino pediatric population specifically among risk groups like multi-transfused children with decompensated liver disease secondary to biliary cirrhosis and liver transplant pediatric patients. The lack of local data warrants conduct of this study.Objective. To determine the presence of HPgV RNA, HPgV E2 antibody (anti-E2) and HBsAg among Filipino children with decompensated liver disease secondary to biliary cirrhosis (DBC) and liver transplant pediatric patients (LTP).Methods. Included were 15 children with DBC and 15 LTP recruited from the Section of Pediatric Gastroenterology, Hepatology and Nutrition of the UP PGH. All patients’ sera were tested for HPgV RNA by Real Time RT-PCR, HPgV anti-E2 by Enzyme-linked Immunosorbent Assay (ELISA) and hepatitis B surface antigen (HBsAg) by immunochromatographic test. Twenty age and sex matched children with no history of liver disease and blood transfusion served as controls.Results. All patient and control samples were negative for HPgV RNA. HPgV anti-E2 was detected in 6 of 15 LTP, 5 of 15 DBC and 1 of 20 controls. HBsAg was detected in 2 of 15 LTP, 5 of 15 DBC and 0 of 20 controls. Four patients (two LTP, two DBC) were positive for both HPgV anti-E2 and HBsAg.Conclusion. This study showed that a proportion of liver transplant patients and those with decompensated biliary cirrhosis are positive for HPgV anti-E2, which indicates that these individuals previously had HPgV infection but is now resolved. Possible source of infection is infected blood from the blood transfusions, infected transplant organ or infected mother. Since routine HPgV screening is not yet recommended for the general population, blood donors and organ donors, the confirmation of exact source of infection may be difficult. Co-infection with HBsAg was also observed in both risk groups which suggests that at some point in time, these children were infected by both HPgV and HBV and also the possibility of simultaneous infection by the two viruses. This study provides preliminary data on the proportion of HPgV infection in Filipino children belonging to two of the HPgV risk groups. Studies with a larger and more significant sample size to determine HPgV prevalence as well as studies regarding the pathogenicity of HPgV are warranted. As this may provide basis for routine HPgV screening among risk groups and blood donations in the future.

KEY FINDINGS There is conflicting evidence on the efficacy of intravenous immunoglobin G in the treatment of COVID-19 patients with severe disease. Intravenous immunoglobulin G (IVIg) is a mixture of polyclonal immunoglobulin G (IgG3, IgG4) antibodies as well as variable amounts of proteins; IgA, IgE and IgM antibodies isolated and pooled from healthy donors. IgG is involved in viral neutralization, modulates anti-inflammatory cytokines and cytokine antagonists. Immediate adverse effects of IVIg include flu-like syndrome, dermatologic side effects, arrhythmia, hypotension, and transfusion-related acute lung injury (TRALI). Delayed adverse effects can involve any organ which could be severe or even lethal There was a retrospective study (Yun Xie 2020) and several case reports that described recovery of COVID positive patients with severe disease. However, a retrospective study showed that immunoglobulin G with steroids and antivirals did not improve COVID patients with acute respiratory distress syndrome (Liu Y 2020). Similarly, another study showed no significant difference in the 28- and 60-day mortality between the IVIg and non-IVIg groups but subgroup analyses reported that in those with critical COVID illness, 28 day mortality is decreased with IVIg (Shao Z). There are eight registered clinical trials on the use of intravenous immunoglobulin G in COVID-19 patients.

Objective. To determine if the CD14/-159 and the TNFα/-308 single nucleotide polymorphisms (SNPs) are associated with the development of Idiopathic Neonatal Hepatitis (INH) in Filipino children. Methods. Genomic DNA from 33 patients diagnosed with INH and 33 age- and sex-matched controls, children without any liver disease, were recruited. Baseline serum total bilirubin (TB), direct bilirubin (DB), and alkaline phosphatase (ALP) of the patients were obtained from their medical records. Genotypes for CD14/159 and TNFα/-308 were determined via PCR and direct sequencing. Results. No significant difference was seen between the frequency of the CD14/-159 T allele (p=0.86) nor the TNFα/-308 A allele (p=0.62) between INH patients and controls. There was also no significant difference between the genotypic distribution of the INH and control populations for both CD14/-159 (p=0.54) and TNFα/-308 (p=0.62). There were also no significant differences noted between the different genotypes of CD14/159 and TNFα/-308 and levels of alkaline phosphatase (p=0.65, p=0.91), total bilirubin (p=0.89, p=0.75), and direct bilirubin (p=0.93, p=0.68). Conclusion. In this preliminary study, CD14/-159 and TNFα/-308 showed no association with the development of INH among Filipinos.

Objective. To describe the clinical, biochemical, microbiologic, radiologic and histological features and outcome of intestinal TB.Methods. Medical records of patients diagnosed with intestinal TB were reviewed. Cases were considered bacteriologically-confirmed if intestinal tissue was positive on smear culture or polymerase chain reaction (PCR); and clinically-diagnosed if with clinical, histologic, and radiologic evidence of extra-pulmonary TB. Results. Fifteen patients [Mean (SD) age: 13 (4) years; 53% females] were included. One was bacteriologicallyconfirmed; and fourteen were clinically-diagnosed. Fever (87%) and abdominal pain (73%) were commonly seen. Seven (47%) had anemia, 5 (33%) leukocytosis and 10 (71%) hypoalbuminemia. Eleven (73%) were positive on smear or TB PCR of various specimens. Nine of 10 (90%) patients with an abdominal CT scan had thickening of bowel loops. Three with intestinal biopsy demonstrated caseation granuloma. Fourteen patients were given quadruple anti-TB medications. Six had surgery, 8 had no disease-related complications, 4 died of sepsis and 3 were lost to follow up.Conclusion. Intestinal TB presents with non-specific clinical and laboratory features. Radiologic findings may provide a clue to the diagnosis. Histologic confirmation in intestinal tissue was only seen in a few cases. The prognosis was favorable for patients who completed the anti-TB treatment.