OBJECTIVES: This review aims to provide recent reports of best practices for the treatment of OCD in the ASEAN region . METHODS: Thirty nine treatment articles between 1990 & 2002 were randomly selected and comparisons were made with regards to types of treatment and their successes . RESULTS: Cognitive and Behavior Therapies , especially Exposure and Response Prevention were found to be favourable methods in the treatment of OCD, in a comparison to other methods of psychological interventions . CONCLUSIONS: Psychological therapies for OCD are essential in the maintenance of gains , especially when combined with pharmocotheraphy . Further clinical studies in Asia are needed to supplement the growing demands in psychological intervention of OCD.
OBSESSIVE-COMPULSIVE DISORDER

BACKGROUND: Preterm birth is a major public health problem and cervical length measurement using transvaginal ultrasound is the gold standard for predicting its occurrence. However, its cost and the limited availability of equipment and trained sonologists has limited its use only for screening for high risk patients and those with history of preterm birth. Those patients without risk factors are not recommended for routine screening although they constitute the majority of spontaneous preterm deliveries. The newly marked cervicometer, Cervilenz©, an easy-to-use and cheaper device, has been found to be comparable to transvaginal ultrasound in predicting preterm birth and may be used to universally screen all patients regardless of their risk status,however, at present, it is only available in the United Sates.
OBJECTIVE: This study aims to determine if an improvised cervicometer such as the insertion tube of an intrauterine device can also be used as a screening tool for predicting spontaneous preterm birth in uncomplicated pregnancies.
METHODS: The cervical length of 126 patients at 14 to < 37 weeks age of gestation were measured and patients were followed up until delivery.
RESULTS: It was found that those with short cervical length of < 25mm were not an increased risk of preterm birth (p-value > 0.05 at Cl 95%). The negative predictive value was found to be 100%, 95%, 88% at <32, <34, and Cervilenz© studies.
CONCLUSION: An improvised cervicometer such as the insertion tube of an intrauterine device can be used as a screening tool for predicting spontaneous preterm birth in uncomplicated pregnancies.

Autism Spectrum Disorder (ASD) is a phenotypically heterogenous group of neurodevelopmental syndromes characterized by a wide range of impairments in socialcommunication and restricted and repetitive behaviors. (1) The majority of individualswith ASD go through puberty and experience the same physical and psychosexual aspectsof sexual development as their peers. However, there are notable problems with regardsto sexuality especially at the start of puberty when the development of social skillscannot keep up with the increasing social demands, and the difficulties of formingromantic and sexual relationships become evident. (2)The case presented here is a 26-year-old male with a history of engaging in paraphilicactivities that showed the complexities of ASD (Asperger Syndrome) in their sexualbehavior.PJPCASE REPORTTYING IT ALL TOGETHER:CASE OF AUTISM SPECTRUM DISORDER WITH PARAPHILIC ACTIVITIESMELANIE TONGOL, MDTHE MEDICAL CITYDEPARTMENT OF PSYCHIATRY34 · PJP 2023 · Volume 4 (1-2) · ISSN 2980-4884CASE PRESENTATIONChief ComplaintJay was a 26-year-old Filipino male, Christian,single, seeking consult for intrusive thoughts withthemes of bondage & discipline, dominance& submission and sadism &masochism (BDSM).History of Present IllnessJay described himself as curious, ambitious, andpeculiar. Despite trying to be sociable andextroverted, he had difficulty connecting withfriends and he often ended up alone. This hasbeen a recurring experience since childhood.Five years prior to consult, Jay’s excitement washyped, as a female chatmate opened up thetopic of BDSM.He shared his long-term fantasies of tying up agirl and subjecting her to pain, humiliation andsexual stimulation, which was never realizedgiven his Christian belief that it was wrong.After meeting someone who shared his hiddendesires, he was able to muster the strength to liveout his fantasies and met with the said chatmate.They planned their BDSM roles and restrictions,with Jay as the dominant and the chatmate assubmissive. On the day of their meeting, Jaypacked ropes in his bag, as he remembered hispast fascination with them when he was still aboy scout. he met his chatmate at the deliveryarea of a mall and there began his string of novel sexual pursuits. He started binding herhands and legs behind her. Both lying on thefloor, fully clothed, he kept on tying her as if hewas in a trance. Merely having his partner
Autism Spectrum Disorder ; Asperger Syndrome

Introduction: An effective participatory community nutrition programme to improve poor food intake and sub-optimal complementary feeding practices in the Philippines is wanting. The use of the recipe trial as an approach was explored. Methods: The protocol was conducted nine times in three communities in the provinces of Camarines Sur, Iloilo, and Zamboanga del Sur among 83 caregivers of children 6-8, 9-11, and 12-23 months old. The protocol implemented followed these steps: (1) Preparatory activities; (2) Recipe Trial 1 (RT1); ( 3) Recipe Trial 2 (RT2); and (4) Follow-up visit. Results: The use of the modified RT to improve complementary feeding was evaluated in terms of the quality of the improved recipes and the overall feasibility of the RT technique. The RT1s identified rice porridge as complementary food usually prepared in the three areas across age groups, followed by cooked rice mixed with broth from the family pot. The RT2s facilitated the caregivers’ modification of the 12 complementary foods from the three communities. Nutrient content was improved while maintaining acceptability among caregivers and their children. The follow-up visits showed that the adoption of the recipes at the households was limited to a few caregivers. Conclusions: The modified RT protocol has good potential to help alleviate poor nutrition among infants and young children in the Philippines. Minor improvements, characterised by an increase in local adoption and provision of enabling mechanisms from the local government units should contribute to the success of its implementation.
Caregivers ; Infant Nutritional Physiological Phenomena ; Philippines

The median nerve in its normal course in the arm crosses the brachial artery from lateral to medial side. It then passes superficial to the brachialis muscle and then enters the cubital fossa. During routine cadaveric dissection of the right upper limb, an unusual variation in the course of the median nerve was observed. The median nerve in the arm crossed the brachial artery from medial to lateral side and passed deep to the brachialis muscle. It then emerged from beneath the brachialis muscle and entered the cubital fossa. In the cubital fossa, it ran medial to the brachial artery as the normal course of the nerve. Further distribution of median nerve in the forearm and hand was observed to be normal. The anomaly reported here may result in the compression of the median nerve deep to the brachialis and hence resulting in mechanical disadvantages in the flexion at the wrist joint.

Scrotal Leiomyoma is an extremely rare benign tumor originating from the tunica dartos muscle. It usually presents as a solitary, painless, unilateral, slow growing mass that is occasionally pedunculated. We report a case of a 31-year-old man, presenting clinically with multiple papules resembling Angiokeratoma of Fordyce but with a histopathologic diagnosis of Scrotal Leiomyoma. Scrotal Leiomyoma has not been reported to present clinically in this manner and our report is probably the first of its kind.

Objective: This study aimed to describe mental health practice patterns, perceptions, perceived responsibility, confidence, barriers, and supports of pediatric residents in a tertiary government hospital to arrive at recommendations in enhancing their mental health competencies. Methodology: As part of needs and baseline assessment within an existing collaboration, written self-administered questionnaires were distributed among pediatric residents of the hospital. Frequency of answers were tallied to see clustering and trends. RESULTS: Most of the 37 Pediatric residents had positive perceptions i.e. 78.83% - 83.78% and planned to incorporate all aspects mental healthcare in their future practice as consultants i.e. 89.19 %- 97.29 %. However, they did not get to practice or apply it as much during training. All respondents perceived that diagnosing the neurodevelopmental disorders of Autism Spectrum, Attention Deficit and Hyperactivity, Intellectual Disability and Learning was their responsibility. When it came to confidence in diagnosing other psychiatric disorders less than half to 3/5 (45.9%- 64/9%) were confident or very confident in doing so. Approximately three fifths (56.75% -67.56%) of them were confident in managing neurodevelopmental disorders. There was an even lower proportion i.e. one fourth (16.21% - 32.43%) of pediatric residents who were confident in managing other psychiatric disorders. Time was the most often perceived barrier while more exposure and training were the supportive factors for integrating mental healthcare into practice. Conclusion With such positive perceptions already in place, programs to improve knowledge and skills can be developed to increase confidence, focusing on diagnosing and managing psychiatric conditions. Target areas as guided by this research can be on how to use screening tools and psychotropics, diagnosing anxiety and behavioral addictions, and managing psychosis and trauma. These should be incorporated in a time-efficient manner into usual patient interviews. Training and added exposure can be utilized in the short-term as well as institutionalization of collaboration, liaison, and feedback systems in the future.
Mental Health

BACKGROUND

Surgical treatments are the first-line therapy for basal cell carcinoma (BCC). However, for patients who are not candidates for surgery, non-surgical options, such as pulsed dye laser (PDL), may be considered.

This study aimed to review the existing literature on the efficacy, tolerability, and safety of PDL in the treatment of BCC.

A systematic review and meta-analysis of PDL for BCC were conducted. The primary outcomes assessed were clearance and recurrence rates. The secondary outcome was the incidence of adverse events.

The review included 11 studies (4 randomized controlled trials, 6 cohort studies, and 1 case series) comprising a total of 204 patients and 295 BCCs. Most BCCs were low-risk histologically and predominantly located on low-risk areas. The meta-analysis revealed an overall clearance rate of 69% and a recurrence rate of 32%, with follow-up periods ranging from 1 to 72 months. However, there was substantial and statistically significant heterogeneity across all studies. The most frequently reported adverse effects included pigmentary changes, primarily hypopigmentation, and varying degrees of scarring.

PDL is a safe and tolerable option for treating BCC, though it is not recommended as a sole treatment due to the higher clearance rates and lower recurrence rates associated with other modalities. PDL may be considered an alternative for non-surgical candidates with small or superficial BCCs. Further research is needed to establish standardized parameters for its use in BCC treatment.

Osteogenesis imperfecta (Ol) type V is distinct Ol phenotype that has recently been described. Patients with this phenotype present characteristically with interosseous membrane calcification and hyperplastic callus formation. We present the clinical and radiographic characteristics of two Filipino families diagnosed to have Ol type V. Through this review of cases, we aim to educate healthcare providers by highlighting salient clinical and radiographic features to aid in the recognition of this specific Ol phenotype, difficulties in diagnosis, current practices in management and fracture prevention, and issues in genetic counseling.

The treatment of haemorrhoids remains challenging: multiple treatment options supported by heterogeneous evidence are available, but patients rightly demand a tailored approach. Evidence for newer surgical techniques that promise to be less painful has been conflicting. We review the current evidence for management options in patients who present with varying haemorrhoidal grades. A review of the English literature was performed utilizing MEDLINE/PubMed, Embase, and Cochrane databases (31 May 2019). The search terms (haemorrhoid OR haemorrhoid OR haemorrhoids OR haemorrhoids OR “Hemorrhoid”[Mesh]) were used. First- and second-degree haemorrhoids continue to be managed conservatively. The easily repeatable and cost-efficient rubber band ligation is the preferred method to address minor haemorrhoids; long-term outcomes following injection sclerotherapy remain poor. Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence; nevertheless, posthaemorrhoidectomy pain is problematic. Stapled haemorrhoidopexy allows quicker recovery, albeit at the costs of higher recurrence rates and potentially serious complications. Transanal Haemorrhoidal Dearterialization has been promoted as nonexcisional and less invasive, but the recent HubBLe trial has questioned its overall place in haemorrhoid management. Novel “walk-in-walk-out” techniques such as radiofrequency ablations or laser treatments will need further evaluation to define their role in modern-day haemorrhoid management. There are numerous treatment options for haemorrhoids, each with their own evidence-base. Newer techniques promise to be less painful, but recurrence rates remain an issue. The balance continues to be sought between long-term efficacy, minimisation of postoperative pain, and preservation of anorectal function.