A 36-year old nulligravid who initially presented with a one-week history of flu-like symptoms suddenly developed behavioral changes, agitation and irritability. Diagnostic tests were done and empiric treatment for viral encephalitis were initiated. Symptoms persisted with progressive unresponsiveness and episodes of seizure. Hypoventilation from dysautonomia required mechanical ventilation. Elevated levels of immunoglobulin on cerebrospinal fluid (CSF) and deterioration despite treatment raised suspicion for an autoimmune encephalitis. A referral to a gynecologist to rule out an ovarian focus was done. Ultrasound and biopsy established the presence of ovarian teratoma. The diagnosis of anti-N-methy-D-Aspartate receptor encephalitis was confirmed when the patient's serum and CSF tested positive for these antibodies. In addition, her CSF was also positive for anti-alpha-amino-3-hydroxy-5-methylisoxazole-4 propionic acid receptor (Anti-AMPar) antibodies. In the Philippines, this was the second documented case of Anti-NMDar encephalitis associated with ovarian teratoma and the first to have antibodies present causing encephalitis.

Human ; Female ; Adult ; Anti-n-methyl-d-aspartate Receptor Encephalitis ; Hashimoto's Encephalitis ; Aspartic Acid Receptor ; Teratoma, Ovarian ; Hashimoto Disease ; Ovarian Neoplasms ; Primary Dysautonomias

For any company or organization, its service delivery mirrors its effectiveness in attaining its goals. For a health care institution, this is health service delivery. Why should health service delivery be a priority of any health care institution or organization The World Health Organization (WHO) talks about improving the quality of patient-centered health service as the road to achieving universal health coverage and the Sustained Development Goals (SDGs).1 The US Agency for International Development (USAID) embarked on ASSIST, Applying Science to Strengthen and Improve Systems, a five year project designed to improve health and social services in USAID-assisted countries.2 It is imperative that health service delivery is designed in such a way that it is based on the best scientific evidence for a particular disease, is made easily accessible, and one that follows a structure or system that will support its delivery. The USAID further puts an even broader concept called governance for quality health care and service delivery. These include use of policy and strategies, effective regulation, engaging non-state actors, garnering political will, pursuing reliable data, culture of continuous improvement, promoting knowledge sharing, and linking financing to quality.2 Health service delivery as a research agenda, therefore, is not only confined to looking for treatment interventions based on the best evidence. It should also consider addressing access and availability of the health service, and the institutional architecture to support a quality health service or intervention. Defining of roles and responsibilities of personnel at various levels of care within the organization and the aligning of other resources necessary for delivery are vital parts of it also. In the Philippines, the National Unified Health Research Agenda (NUHRA) came about as it reflects the health needs of the Filipinos. The NUHRA creates a template for health research in these specific areas in a 5-year scope.3 The Philippine General Hospital (PGH) has included health service delivery as one of its top research agenda. In the past 4 years that it has established such, many of the research outputs have addressed specific disease interventions, hospital processes, and personnel welfare and readiness. There are still, however, a lot of gaps and questions that remain to be addressed. The papers on this fourth issue of the PGH for Acta Medica Philippina are diverse in scope but are all products of the authors’ questions that needed addressing in order to improve delivery of care to the PGH patients. May the impact of the results of these research endeavors truly make a difference in the lives of the patients the National University Hospital serves.

Ovotesticular disorder of sex development (OT-DSD), previously known as true hermaphrodite, is a rare disorder of sexual differentiation in which the gonads of an individual are characterized by the presence of both mature ovarian and testicular tissues. The diagnosis has traditionally been applied only if an individual has 1) histologically verified ovarian follicles or proof of their prior existence (e.g. corpora albicantia) and 2) seminiferous tubules or spermatozoa. This paper introduces you to a 14 year-old, who presented with primary amenorrhea and enlarging abdominal mass, underwent exploratory laparotomy, salphingooophorectomy, histologically diagnosed as a possible case of a true hermaphrodite and chromosomally diagnosed as 45XO/46XY who developed endodermal sinus tumor, a germ cell tumor, considered highly malignant.

Human ; Female ; Adolescent ; Ovotesticular Disorders Of Sex Development ; Sex Differentiation ; Endodermal Sinus Tumor ; Amenorrhea ; Laparotomy ; Gonads ; Sexual Development ; Seminiferous Tubules ; Spermatozoa ; Ovarian Follicle

BACKGROUND: Epithelial ovarian carcinoma is the most lethal of the gynecologic malignancies. Recent theories on the etiopathogenesis of epithelial ovarian carcinoma supported the presence of occult, early stage neoplasms in the fimbriated end of the fallopian tube even before development of ovarian carcinoma. This study is interested in correlating opportunistic salpingectomy or tubal ligation as a possible effective prevention strategy in the occurrence of epithelial ovarian carcinoma.

OBJECTIVE: To determine the association between the occurrence of epithelial ovarian carcinoma and a previous history of tubal ligation and/ or salpingectomy

METHODS: This is a case-control study involving chart review of patients who underwent total hysterectomy with bilateral salpingoophorectomy with a histologically verified epithelial ovarian cancer (cases) and patients who underwent same surgical procedure for benign gynecologic conditions specifically myoma uteri and adenomyosis with normal ovaries on final histology report (controls). The association between the occurrence of epithelial ovarian carcinoma and previous tubal ligation and/or salpingectomy was determined using appropriate statistical methods.

RESULTS: A total of 558 patients were included in this review. They were divided into 158 post-surgical patients with histologically verified epithelial ovarian cancer (cases) and 400 post-surgical patients for benign gynecologic conditions with normal ovaries on final histology report (controls). Adjusted for age, parity and obesity the odds of developing epithelial ovarian carcinoma in subjects without previous tubal ligation and/or salpingectomy is 29%.

CONCLUSION: The result of the study showed that tubal ligation and/or salpingectomy reduces the risk of developing epithelial ovarian carcinoma hence for patients at average risk of ovarian cancer, risk-reducing salpingectomy should be discussed and at the time of abdominal or pelvic surgery. It must also be included in the counseling of women planning a hysterectomy for benign indications to conserve ovarian function and prevent ovarian epithelial carcinoma.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Pregnancy ; Salpingectomy ; Sterilization, Tubal ; Fallopian Tubes ; Adenomyosis ; Parity ; Hysterectomy ; Ovariectomy ; Ovarian Neoplasms ; Obesity ; Myoma

BACKGROUND: Epithelial ovarian carcinoma is the most lethal of the gynecologic malignancies. Recent theories on the etiopathogenesis of epithelial ovarian carcinoma supported the presence of occult, early stage neoplasms in the fimbriated end of the fallopian tube even before development of ovarian carcinoma. This study is interested in correlating opportunistic salpingectomy or tubal ligation as a possible effective prevention strategy in the occurrence of epithelial ovarian carcinoma.

OBJECTIVE: To determine the association between the occurrence of epithelial ovarian carcinoma and a previous history of tubal ligation and/ or salpingectomy

METHODS: This is a case-control study involving chart review of patients who underwent total hysterectomy with bilateral salpingoophorectomy with a histologically verified epithelial ovarian cancer (cases) and patients who underwent same surgical procedure for benign gynecologic conditions specifically myoma uteri and adenomyosis with normal ovaries on final histology report (controls). The association between the occurrence of epithelial ovarian carcinoma and previous tubal ligation and/or salpingectomy was determined using appropriate statistical methods.

RESULTS: A total of 558 patients were included in this review. They were divided into 158 post-surgical patients with histologically verified epithelial ovarian cancer (cases) and 400 post-surgical patients for benign gynecologic conditions with normal ovaries on final histology report (controls). Adjusted for age, parity and obesity the odds of developing epithelial ovarian carcinoma in subjects without previous tubal ligation and/or salpingectomy is 29%.

CONCLUSION: The result of the study showed that tubal ligation and/or salpingectomy reduces the risk of developing epithelial ovarian carcinoma hence for patients at average risk of ovarian cancer, risk-reducing salpingectomy should be discussed and at the time of abdominal or pelvic surgery. It must also be included in the counseling of women planning a hysterectomy for benign indications to conserve ovarian function and prevent ovarian epithelial carcinoma.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Pregnancy ; Salpingectomy ; Sterilization, Tubal ; Fallopian Tubes ; Adenomyosis ; Parity ; Hysterectomy ; Ovariectomy ; Ovarian Neoplasms ; Obesity ; Myoma

OBJECTIVE: To review the POGS statistics on Maternal Mortality Rate and causes of direct and indirect maternal deaths from 2012 to 2014.
BASIC PROCEDURE: Data were retrieved friom the Integrated Statistical Information System, or ISIS, of POGS, and compliance in its use was assessed. Twenty four hospitals were chosen based on completeness of data and highest number of admissions.
RESULTS: Maternal Mortality Rate for the three-year period was 296 per 100,000 livebirths. The top causes of direct maternal deaths were hypertension, hemorrhage and infection. The top three causes of indirect maternal deaths were hypertension, hemorrhage and infection. The top three causes of indirect maternal deaths were cardiac, pulmonary and vascular.
CONCLUSION: Maternal Mortality Rate from 2012 to 2014 was reviewed. The low compliance submitting complete forms from POGS-accredited hospitals made the Committee on Nationwide Statistics strongly recommend an enhancement of the use of the electronic data-based system.

Human ; Female ; Maternal Death ; Maternal Mortality ; Hemorrhage ; Hospitals ; Hypertension ; Heart

Objective: To determine the prevalence of HPV high risk positivity among women patients ages 30 to 65 with biopsyproven external genital warts (condyloma acuminata) specifically for HPV 16, HPV 18, and for other high risk types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66/68, 73, and 82. Methodology: A cross-sectional study was conducted at the Department of Obstetrics and Gynecology Out-Patient Services of the Philippine General Hospital involving 57 women, 30 to 65 years old, with biopsy proven external genital warts or condyloma acuminata. These women underwent human papillomavirus (HPV) genotyping test for the high risk types (HR-HPV) from cervical samples using the automated polymerase chain reaction (PCR) technology. Results: Fifteen out the 57 subjects had at least one of the HR-HPV types for an overall prevalence of 26.3%. Of the 15, 8 (53.3%) had at least 2 HR-HPV types with one subject having the most number of types at 6. Among the strains, the most common is HPV 51 and 52 each with a prevalence of 8.77% followed by HPV 53 and 59 at 7% each. HPV 16 and 18 each only had a 3.5% prevalence the same as HPV 58, 73, and 82. HR-HPV positivity was most common in the 30 to 39 age group (80%), and equally in the nulligravid and the secundigravid (40% each). None had current or past cigarettesmoking history and 33% had some form of hormonal contraception. Conclusion The overall prevalence of high risk HPV (HR-HPV) among these 57 Filipino women with external genital warts is 26.3%. The higher prevalence of HPV 51, 52, 53, and 59 over HPV 16 and 18 in this group does not follow the usual epidemiological characteristics reported about this disease.
Outpatients ; Human papillomavirus 16 ; Philippines ; Papillomaviridae

Squamous cell carcinoma is the most common female genital tract malignancy that typically spreads to the pelvic organs first by direct extension, and less commonly to distant sites through lymphangitic and hematogeneous spread. We report on a 47-year-old woman diagnosed with squamous cell carcinoma who underwent concurrent chemoradiation, presenting with a fronto-parietal scalp mass which on histopathologic examination also shows squamous cell carcinoma, likely metastatic.
Uterine Cervical Neoplasms ; skull ; scalp