Mayer-Rokitansky-Kuster-Hauser syndrome, the second most common cause of primary amenorrhea, is a congenital anomaly caused by defective Mullerian duct development. It is the absence of uterus, cervix and upper two thirds of the vagina that results in primary amenorrhea. This is a case of a 42-year-old, nulligravid with primary amenorrhea complaining of acute abdominal pain. She has no co-morbidities or previous surgeries. Examination revealed an absent cervix and a left adnexal mass. Ultrasonography revealed an atrophic uterus with no endometrial stripe and cervix, with possible ovarian tumor versus myoma. Impression was mullerian agenesis with pelvoabdominal mass in torsion. She then underwent total abdominal hysterectomy with bilateral salpingectomy and adhesiolysis. Intraoperatively, there were two hemiuteri connected by a fibromuscular stalk. Left hemiuterus was dextrorotated, adherent to the sigmoid mesentery and peritoneum. Histopathology confirmed absence of endometrial cavity but with adenomyosis in bilateral uterine buds. Chromosomal analysis confirmed 46, XX karyotype.
Adenomyosis

Background: The global pandemic caused by COVID-19, the subsequent improvement in health situation caused by anti- COVID-19 vaccination and the developments in digital technology prompted changes in undergraduate medical education as to content delivery and assessment. This study determined the difference in the performance of first year medical students in traditional face-to face, online and Hyflex teaching strategy. Methods: A non-concurrent cohort study was done to determine the performance of students in three annual subjects in Year 1 undergraduate medical education for school years 2018 to 2023. One-way ANOVA at p=0.001 determined significance of differences of variables. Results: There was no difference in the profile of students as to their sex, pre-medicine course and scores in the National Medical Admission Test (NMAT). The performance in the written examinations in Anatomy and Physiology showed significant difference (p=0.001) when the conduct of examinations was shifted online on an emergency basis. There was no difference (p=0.001) in performance in the laboratory conference sessions in Physiology, as compared to the focused group discussion sessions in Biochemistry and practical examinations in Anatomy. Conclusion Significant difference in the performance of first year medical students was observed only during the emergency shift to online examinations, otherwise the performance was similar in traditional face-to face, online and Hyflex teaching strategy.

INTRODUCTION: In the Philippines, several health policies have been tailored to promote breastfeeding. Statistics show that despite efforts, breastfeeding prevalence remains low. This study aims to determine the demographics and associated barriers and enablers of breastfeeding among mothers living in Metro Manila. METHODS: The study used a cross-sectional analytical design through an online self-administered questionnaire on barriers and enablers answered by mothers between 15-49 years old, residing in Metro Manila. RESULTS: A total of 761 responses were included in the fnal analysis. Only age was found to be signifcantly associated with the practice of breastfeeding. Barriers identifed were 1) seeing breastfeeding as timeconsuming, 2) development of sore or tender nipples, 3) previously failed breastfeeding attempts, 4) poor latching on, and 5) not enough breastmilk production. Enablers identifed were 1) seeing the practice as a good way to bond with the child, 2) presence of breastfeeding areas at work or school, 3) previous success in breastfeeding experience, 4) support from hospital staff or midwives, 5) having knowledge on whom to contact when challenged with breastfeeding, and 6) knowledge of the benefts of breastfeeding on infant and maternal health. CONCLUSION Barriers and enablers towards breastfeeding may be target points for improvement of interventions aiming to increase prevalence of breastfeeding among mothers in Metro Manila.