SYNOPSIS: Splenic artery aneurysm (SAA) is an extremely rare vascular pathology. They are clinically important because of their potential for life-threatening rupture. The pathogenesis is not completely understood and its cause remains unknown. The size of SAA rarely exceeds three centimeters and giant SAA (measuring more than 10 centimeters) are extremely rare. We present a case of SAA larger than 12 centimeters, discuss its management and provide relevant literature. To our knowledge, this is the biggest reported SAA and the first documented case of a giant SAA in the Philippines.
CASE SUMMARY: A 58-year-old male with history of essential hypertension and remote history of abdominal trauma was admitted for pain and a pulsatile mass at epigastrium and left upper abdomen. Examination of the abdomen noted pulsatile, nontender, fairly delineated mass at the left hypochondrium, a bruit was appreciated in the area, Traube's space was dull and splenic percussion sign was negative. Laboratory tests showed normal CBC and bleeding parameters, mild azotemia (that improved after hydration) and unremar kable elect rocardiogram
and echocardiogram results. A multislice computed tomography scan with contrast of the abdomen revealed 10.0 x 6.4 centimeters aneurysmal dilatation at the distal third of the splenic artery with intraluminal thrombus formation. The diagnosis was splenic artery aneurysm. Patient underwent splenic aneurysmectomy, splenectomy and di s tal pancreatectomy Gross examinat ion showed an unruptured 12.2x8.0x6.0 centime ters fusiform splenicarteryaneurysm. Histopathology showed hyal inization and focal destruction of aneurysmal wall and this confirmed the diagnosis. Eight months postoperatively, patient was in good health.
CONCLUSION: Early diagnosis and prompt definitive treatment is necessary in its management. This can only be instituted if SAA is considered in the differential diagnosis for pulsatile left hypochondriac mass.

Human ; Male ; Middle Aged ; Abdomen ; Abdominal Cavity ; Aneurysm ; Azotemia ; Diagnosis, Differential ; Dilatation ; Early Diagnosis ; Hypertension ; Multidetector Computed Tomography ; Pain ; Pancreatectomy ; Philippines ; Spleen ; Splenectomy ; Splenic Artery ; Thrombosis

Swyer syndrome is a form of complete gonadal dysgenesis, characterized by a 46, XY karyotype with female phenotype. They present with primary amenorrhea and absence of secondary sexual characteristics. It is believed to be due to SRY gene deletions or mutations. They are born with female external genitalia and not suspected until puberty fails to occur. This paper presents a case of 22-year old female with female external genitalia, an infantile uterus and cervix and streak gonads and absent secondary sexual characteristics, who presented with primary amenorrhea. Gonadotropin levels are elevated with low estradiol levels. Karyotype showed a normal male 46,XY. Since the streak gonads have the propensity for tumor development in 20-30% of the cases, laparoscopic bilateral gonadectomy with salpingectomY was done which showed gonadoblastoma on the right gonad. Early diagnosis is crucial in the initiation of treatment to prevent osteoporosis and enhance development of secondary sexual characteristics and eventually initiation of menstruation. In-vitro fertilization using donor oocyte has proven to be successful in some reported cases.

Human ; Female ; Young Adult ; Gonadoblastoma ; Estradiol ; Menstruation ; Salpingectomy ; Amenorrhea ; Cervix Uteri ; Gene Deletion ; Gonadal Dysgenesis, 46,xy ; Gonads ; Turner Syndrome ; Puberty ; Oocytes ; Gonadotropins

Objectives: To determine the burden of COVID-19 related mental health problems such as anxiety and/or depression among caregivers of children and adolescents with neurodevelopmental disorders in a government tertiary hospital. Materials and Methods: This is a cross-sectional study conducted at the Out-patient Department of PCMC. Caregiver data sheet and HADS-P forms were given to eligible caregivers. Results: A total of 102 caregivers were included. The prevalence of significant risk for anxiety disorder among caregivers of children and adolescents with neurodevelopmental disorders is 34.31% (n=35), 1.96% (n=2) for depression and 3.92% (n=4) for both anxiety and depression. Using logistic regression, marital status of common law partner and female sex have significant association with depression and anxiety; the number of household members has a direct association to significant risk for both anxiety and depression. Conclusion Female sex and common law partnership as marital status are associated with 2-3 times of having significant risk for anxiety or depression. The number of household members is correlated with an increased significant risk of having both anxiety and depression. Screening caregivers using appropriate tests would identify caregivers at significant risk for anxiety and depression and further create intervention programs.
Anxiety ; Depression ; Caregiversl ; Neurodevelopmental Disorders ; COVID-19 ; Mental Health

OBJECTIVES:To determine the agreement between 1) ear examination findings of the otorhinolaryngologist using an otoscope and trained elementary school nurses using a penlight, 2) hearing screening findings of the otorhinolaryngologist and elementary school nurses, both using the Philippine National Ear Institute (PNEI) Method of 512 Hz Tuning Fork Test (TFT) and 3) PNEI Method of 512 Hz TFT findings and screening audiometry findings.
METHODS:In this continuing study, nurses residing in the venue of the study, and previously trained in ear examination using a penlight and hearing screening using the PNEI 512 Hz TFT, conducted these in school children who attended the hearing screening and medical mission. Otoscopy, PNEI Method of 512 Hz TFT, and screening audiometry were then conducted on the children by the otolaryngologist. The nurses and the otolaryngologist performed independent and blinded assessments.
RESULTS:Eighteen nurses and ninety children participated in the study. Data subjected to Kappa statistics showed good agreement between nurses and otorhinolaryngologist's findings in the examination of the external canal and tympanic membrane and in PNEI Method of 512 Hz TFTs, and between the PNEI Method of 512 Hz TFT and screening audiometry.
CONCLUSION:PNEI methods of penlight ear examination and 512 Hz TFT may be effective tools for early detection of common ear conditions and hearing screening in Filipino school children. These may be conducted in the school setting not only by otorhinolaryngologists but also by adequately trained school nurses.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Diagnosis ; Nurses ; Hearing ; Audiometry ; Child ; Ear Diseases ; Early Diagnosis ; Humans ; Otolaryngologists ; Otoscopes ; Otoscopy ; Philippines ; Religious Missions ; Schools ; Tympanic Membrane ; Hearing Tests

The Philippine Council for Health Research and Development-Department of Science and Technology (PCHRD-DOST), and the Philippine College of Surgeons (PCS) signed a Memorandum of Agreement on 1 June 1999, whereby both agreed to support the formation of Evidence-Based Clinical Practice Guidelines (EBCPGs) on specific areas of surgical care in the Philippines. The areas were to be specified by the PCS, and those areas should have a reasonably large potential of improving the quality of patient care throughout the country, and can be implemented nationwide in both government and private health facilities The first clinical area selected was on when to refer for preoperative cardiac evaluation for elective noncardiac surgery, and when would the intraoperative presence of a cardiologist be beneficial. A Technical Working Group (TWG) was appointed, which: 1) searched and appraised the evidence; 2) prepared a first draft EBCPG; 3) presented the evidence to a Panel of Experts; 4) supervised the panel using the nominal group technique (6 November 1999 - PCS Building); and 5) prepared the second draft EBCPG based on the consensus recommendations of the panel. All processes strictly conformed to the methods of evidence-based guidelines formation specified by evidence-baesd medicine texts The second draft EBCPG was presented on 11 December 1999 during the 55th Clinical Congress of the PCS, and the final draft approved by the PCS Board of Regents on 29 January 2000 Literature search was conducted through the MEDLINE, COCHRANE Library an the HERDIN Database. A total of 2,156 titles, 427 abstracts and 77 full text articles were appraised. Data from 23 prospective cohort studies were encoded into the software COCHRANE Review Manager (RevMan), Version 3.0 for Windows (updated October 7, 1996). Tables were generated which contained authors, outcome rates, relative risks and the 95% confidence intervals of the relative risks. Three perioperative outcomes were identified-cardiac morbidity, cardiac death, and overall cardiac events

Human ; Risk ; Cardiologists ; Surgeons ; Research ; Publications ; Patient Care ; Health Facilities

Objective: To investigate the effects of hepatitis B virus (HBV) genotype and mutations on the development of hepatocellular carcinoma (HCC) and to establish a new qualified HCC risk scores. Methods: A cohort study enrolling patients with chronic HBV infection was conducted. HBV genotypes were identified by nested multiplex PCR. HBV mutations in the basic core promoter region and PreS region were sequenced after PCR amplification. Scores on risk factors were set based on nomogram. Results: Totally, 1 525 patients were followed-up in this research. A total of 1 110 patients infected with genotype C were followed-up for 8.52 (Q(R): 5.36-11.68) years on average, of whom the incidence of HCC was 11.93/1 000 person-years. In genotype C HBV infected patients, male gender, aged 40 years and over, and four DNA mutations (T1674CG, A1762T/G1764A, A3120T, and A2962G) can increase the risk of HCC (P<0.05); interferon therapy can reduce the risk of HCC (P<0.05). A new HCC predicting model was established according to the results. After validation, the predicted disease-free survival rate was consistent with the real one. Conclusions: Hepatitis B virus genotypes and mutations were closely associated with HCC. The new risk scoring system can well predict HCC occurrence in genotype C HBV infected patients.
Adult ; Aged ; Carcinoma, Hepatocellular/virology* ; China/epidemiology* ; Cohort Studies ; DNA, Viral/genetics* ; Female ; Genotype ; Hepatitis B virus/genetics* ; Hepatitis B, Chronic/complications* ; Humans ; Liver Neoplasms/virology* ; Male ; Middle Aged ; Mutation ; Predictive Value of Tests ; Risk Factors ; Sensitivity and Specificity

The incidence of kidney stones is common in the United States and treatments for them are very costly. This review article provides information about epidemiology, mechanism, diagnosis, and pathophysiology of kidney stone formation, and methods for the evaluation of stone risks for new and follow-up patients. Adequate evaluation and management can prevent recurrence of stones. Kidney stone prevention should be individualized in both its medical and dietary management, keeping in mind the specific risks involved for each type of stones. Recognition of these risk factors and development of long-term management strategies for dealing with them are the most effective ways to prevent recurrence of kidney stones.
Calcium Oxalate ; Diagnosis ; Epidemiology ; Humans ; Hypercalciuria ; Hyperoxaluria ; Incidence ; Kidney Calculi* ; Kidney* ; Nephrolithiasis ; Recurrence ; Risk Factors ; United States

Acute myeloid leukemia (AML) is a heterogeneous clonal disorder of myeloid precursors arrested in their maturation, creating a diverse disease entity with a wide range of responses to historically standard treatment approaches. While significant progress has been made in characterizing and individualizing the disease at diagnosis to optimally inform those affected, progress in treatment to reduce relapse and induce remission has been limited thus far. In addition to a brief summary of the factors that shape prognostication at diagnosis, this review attempts to expand on the current therapies under investigation that have shown promise in treating AML, including hypomethylating agents, gemtuzumab ozogamicin, FLT3 tyrosine kinase inhibitors, antisense oligonucleotides, and other novel therapies, including aurora kinases, mTOR and PI3 kinase inhibitors, PIM kinase inhibitors, HDAC inhibitors, and IDH targeted therapies. With these, and undoubtedly many others in the future, it is the hope that by combining more accurate prognostication with more effective therapies, patients will begin to have a different, and more complete, outlook on their disease that allows for safer and more successful treatment strategies.
Aminoglycosides ; administration & dosage ; Antibodies, Monoclonal, Humanized ; administration & dosage ; Elafin ; genetics ; Histone Deacetylase Inhibitors ; therapeutic use ; Humans ; Isocitrate Dehydrogenase ; Leukemia, Myeloid, Acute ; drug therapy ; genetics ; pathology ; Proto-Oncogene Proteins c-pim-1 ; metabolism ; TOR Serine-Threonine Kinases ; genetics

Background: Pulmonary TB in children remains to be a burden in the Philippines. Diagnosis remains to be a challenge for pediatricians due to its paucibacillary nature, difficulty in obtaining specimens, cost of test as well as the varied sensitivity of the different tests available. Gastric aspirate (GA), commonly used for bacteriological diagnosis of pulmonary tuberculosis (PTB) in children, involves an invasive procedure that may cause discomfort and sometimes require admission. Nasopharyngeal aspirate (NPA), on the other hand, can be easily and non-invasively obtained but is currently not a recommended specimen for testing for PTB. Objectives: This study aims to determine the accuracy of NPA GeneXpert in diagnosing PTB among pediatric patients 0-18 years old with presumptive TB using GA GeneXpert as the initial screening test and GA TB culture as gold standard. Methodology: This prospective, cross-sectional diagnostic study involved collection of single NPA and GA specimens for GeneXpert and TB culture in 100 patients with presumptive PTB seen at a tertiary government hospital in the Philippines. Results: Of the one hundred pediatric patients (mean age 6 ± 5.63 years) enrolled, 50 were clinically diagnosed PTB, 16 bacteriologically-confirmed and 34 were not PTB disease. Sensitivity, specificity and predictive values with 95% confidence intervals of the NPA GeneXpert were determined compared to GA GeneXpert and GA culture. Sensitivity, specificity, positive and negative predictive values of the NPA GeneXpert compared to GA GeneXpert were 70%, 96.67%, 70% and 96.67%, respectively. While NPA GeneXpert compared to GA TB culture were 40%,91.58%, 20% and 96.67%, respectively. Conclusion GeneXpert testing on a single NPA specimen is a highly specific and rapid test that can be used to diagnose PTB in pediatric patients, particularly where gastric aspiration or mycobacterial culture is not feasible.
Tuberculosis, Pulmonary

Objective: Electrocardiogram (ECG) interpretation skills are of critical importance for diagnostic accuracy and patient safety. In our emergency department (ED), senior third-year emergency medicine residents (EM3s) are the initial interpreters of all ED ECGs. While this is an integral part of emergency medicine education, the accuracy of ECG interpretation is unknown. We aimed to review the adverse quality assurance (QA) events associated with ECG interpretation by EM3s. Methods: We conducted a retrospective study of all ED ECGs performed between October 2015 and October 2018, which were read primarily by EM3s, at an urban tertiary care medical center treating 56,000 patients per year. All cases referred to the ED QA committee during this time were reviewed. Cases involving a perceived error were referred to a 20-member committee of ED leadership staff, attendings, residents, and nurses for further consensus review. Ninety-five percent confidence intervals (CIs) were calculated. Results: EM3s read 92,928 ECGs during the study period. Of the 3,983 total ED QA cases reviewed, errors were identified in 268 (6.7%; 95% CI, 6.0%–7.6%). Four of the 268 errors involved ECG misinterpretation or failure to act on an ECG abnormality by a resident (1.5%; 95% CI, 0.0%–2.9%). Conclusion A small percentage of the cases referred to the QA committee were a result of EM3 misinterpretation of ECGs. The majority of emergency medicine residencies do not include the senior resident as a primary interpreter of ECGs. These findings support the use of EM3s as initial ED ECG interpreters to increase their clinical exposure.