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Intravascular papillary endothelial hyperplasia mimicking sister Mary Joseph nodule in a patient with ovarian carcinoma.

Tina Elaine M. Resuello ; Charlene Marie Ang-Tiu

Journal of the Philippine Medical Association.2022;101(1):1-5.

Intravascular Papillary Endothelial Hyperplasia (IPEH) is a rare benign vascular lesion of the skin and subcutaneous tissues that results from the proliferation of endothelial cells within a blood vessel. In this article, we present the case of an IPEH mimicking a Sister Mary Joseph Nodule on the umbilicus of a 53-year old female patient with ovarian cancer. A diagnostic workup was performed with a computerized tomography of abdominal cavity and pelvis showing an expansive cystic tumor formation with probable ovarian origin. Two separate histopathologic readings were done on the cutaneous lesion which revealed contradicting findings of benign versus malignant tumors. Immunohistochemical stains done showed that the lesion was positive for ERG and negative for epithelial differentiation markers. No surgical intervention was done at the time of consultation as a cutaneous metastasis was primarily considered initially. It is crucial to rule out a diagnosis of Sister Mary Joseph nodule, especially in a background of ovarian carcinoma as it may mimic vascular lesions occurring on the umbilicus. Immunohistochemical staining is a significant tool to precisely diagnose such lesions so that it is neither inadequately nor aggressively managed.

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Pain catastrophizing as a predictor for postoperative opioid requirements for breakthrough pain in patients undergoing elective surgery admitted in a private institution from January 2021 to June 2021

Jeena Megan T. Tanco

Journal of the Philippine Medical Association.2022;101(1):6-13.

BACKGROUND: Post-operative pain management is a major challenge encountered by anesthesiologists. Opioids remain to be the most frequently administered analgesic for acute pain despite its many untoward side effects. Little is known about pre-operative pain perception and the psychophysiologic aspects of pain control and response, such as Pain Catastrophizing. The observer aims to identify if pain catastrophizing could be a good predictor for post- operative opioid requirement for breakthrough pain. METHODS: Patients scheduled for elective surgery were stratified pre-operatively as Catastrophizers and Non- Catastrophizers using the Pain Catastrophizing Scale (PCS). Their patient profile, and total opioid consumption in the following stages of surgery: intra- operatively, recovery room admission, and the first post-operative day, were recorded and converted to morphine equivalent doses. RESULTS: The comparative analysis of the morphine equivalent doses between catastrophizers and non- catastrophizers show that it is significantly different between the two groups of patients for opioid consumption for breakthrough pain in the recovery room and on the first post-operative day. The values suggest that there are significantly higher doses in catastrophizers than in the non-catastrophizers. CONCLUSION Pain Catastrophizers were shown to require a significantly higher amount of opioids for breakthrough pain during recovery room admission and first post-operative day versus Non-Catastrophizers. This finding is consistent with the existing literature suggesting that pain catastrophizing is a predictor of post-operative opioid consumption in patients undergoing various elective surgeries.

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Effect of regular progression of diet, early oral feeding and early oral feeding with Domperidone on post cesarean diet tolerance in a Tertiary Hospital

Lucky Faith A. Dequina

Journal of the Philippine Medical Association.2017;96(1):1-7.

The rate of admission in the Obstetrics and Gynecology Department in a tertiary hospital in Quezon City is continuously increasing, sometimes more than its bed capacity. An average of 2-3 mothers occupying a single bed with their newborn children can be overwhelming, to the point where the comfort hygiene and wellness of the patients after delivery are sacrificed. It is important for us to find a way in which the ward can accommodate all patients without any risk of losing the comfort that the hospital can offer during their stay. A faster patient turnover can at least help in this kind of situation. This study aims to investigate if early feeding can lead to early return of normal bowel function which could mean shorter hospital stay due to lesser post-operative discomfort and early ambulation. A randomized, three arm study was done in a tertiary hospital from June 2016 to September 2016. Ninety three women who underwent elective Cesarean Section were admitted and were randomly assigned into three groups. Group A had regular progression of diet, Group B were those who were fed early and Group C those who were given Domperidone before they were fed early. The primary outcome would be the time to regular diet tolerance. Secondary outcomes include the time of first flatus, time to ambulation out of bed, duration of intravenous infusion, duration of indwelling foley catheter and finally, length of hospital stay.
Tertiary Care Centers ; Domperidone ; Pregnancy

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A retrospective study on the accuracy of Sassone Lerner and IOTA simple rules in determining malignancy of ovarian masses in a Tertiary Hospital Ob-GYN Ultrasound Diagnostic Unit

Arriane R. Morales

Journal of the Philippine Medical Association.2017;96(1):8-17.

Ultrasonography has been established as one of the important diagnostic tools in detecting and classifying ovarian masses. Several studies have been made in determining the sensitivity and specificity of the different scoring systems as to determining the malignancy of ovarian masses. In a tertiary hospital ultrasound diagnostic unit, three scoring systems are utilized namely Lerner, Sassone and IOTA simple rules. With this reason, it is important to determine and compare the sensitivity and specificity on the most utilized ultrasound scoring systems in determining malignancy of ovarian masses. A single center observational, analytical, cross-sectional study utilizing review of the transvaginal or pelvic ultrasound results of women with ovarian masses that were scored using Sassone, Lerner and IOTA Simple Rules in a tertiary hospital ultrasound diagnostics unit from January 2013 to June 2016 was done. The sensitivity, specificity, positive and negative predictive values of each scoring system utilized was determined and compared with the histopathologic result. Out of the 111 ovarian masses that were included in the study, 44 ovarian masses were scored using Lerner Scoring system with a sensitivity, specificity, positive and negative predictive values of 100%, 65% 22.2% and 100%. 105 ovarian masses screened using Sassone Scoring System showed a sensitivity, specificity, positive and negative predictive values of 100%, 68%, 20.5% and 100%. A total of 33 out of the 111 ovarian masses were scored using the IOTA scoring system with a sensitivity, specificity, positive and negative predictive values of 100%, 85.6%, 55.5% and 100%. In conclusion, IOTA simple rules had a high sensitivity and specificity compared to Sassone or Lerner Scoring System. However, we cannot fully conclude that individual specificity will be better than combined tests since there is limited number of ovarian masses analyzed.
Retrospective Studies ; Tertiary Care Centers ; Ovarian Neoplasms ; Ultrasonography

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Bullying and its association with depression, anxiety and stress among adolescents aged 12-18 years old of a Public High School in Quezon City

Elizabeth L. Romano

Journal of the Philippine Medical Association.2017;96(1):18-26.

Bullying is a form of aggression characterized by negative behavior intended to harm or distress others occuring repeatedly and involving an imbalance in the strength and power of the parties involved. It has become increasingly recognized in the pediatric age group because of the implications it has on the psychosocial health of children. Involvement in bullying be it a victim, a bully and a bully-victim has been associated with depression, anxiety and psychosomatic symptoms in the pediatric age group. Adolescents being a vulnerable stage, when afflicted with depression can have long-term serious effects on their mental health and functioning. There are numerous studies on bullying in Western countries. However, in the Philippines, there are few studies on bullying and its psychological effects on children. Bullying being a culture-based phenomenon, studies conducted in the Philippine setting is warranted. The aim of the study is to provide data on the prevalence of bullying and its associated psychological effects of depression, anxiety and stress on adolescents. It aims to investigate the association between being a victim of bullying to depression, anxiety and stress in adolescents.
Bullying ; Adolescent ; Depression

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Guidelines for adolescent preventive services: Screening tool for a student wellness program

Myrissa Lacuna-Alip

Journal of the Philippine Medical Association.2017;96(1):27-31.

Human development is " process of enlarging people's choices to lead a long and healthy life, to be educated and to enjoy a decent standard of liv- ing" (UNDP 1990). Basic services such as health, social welfare, education and housing are essential to achieve this. Health is a very powerful element for social protection and inclusion. Good health enables individuals to work and participate fully in their communities, allow people to have better chances for employment and support themselves financially.

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Intensifying health promotion efficiency through relevant flipchart use: A primary health care learning empowerment for community health workers of the Municipality of Sto. Tomas, Batangas, Philippines

Elmer M. Angus ; Alicia Genuino ; Ariel Paredes ; Mathanael Ron Semilla ; Peter Ante ; Jo-Ann Marie Mendoza ; Jelyn Rose Benito ; Jinette Lillian Carreon ; Rina Ricci Ilarde

Journal of the Philippine Medical Association.2017;96(1):32-46.

Primary Health Care is the essential care based on practical, scientifically sound and socially acceptable method and technology made universally accessible to individuals and families in the community through their full participation and at a cost they and the community can afford to maintain in the spirit of self-reliance and self-determination. Last September, 1978 at Alma Ata, an international conference on primaiy health care was done and they declared that Health is a fundamental human right and that the attainment of the highest possible level of health is a most important world wide social goal and that the people have the right and duty to participate individually and collectively in the planning and implementation of their health care.
Primary Health Care ; Health Promotion ; Community Health Workers

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A deadly tear to fear: An interesting case presentation

Marianne Ginellee G. Faustino ; Elmer M. Angus

Journal of the Philippine Medical Association.2017;96(1):47-57.

Objectives: 1) To present a case of a patient with aortic dissection. 2) To show how the case arrived to its plausible diagnosis. 3) To discuss other illnesses discovered in the case. Case Summary This is a case of a 54-year old, female, Filipino, Catholic, who presented with severe chest pain, substernal in location, with pain intensity of 8/10 associated with diaphoresis and dyspnea leading to fainting spells. Initial impression was cardiogenic shock secondary to Non-ST elevated myocardial infarction. On physical examination, the patient was drowsy and in cardio-respiratory distress. She had symmetrical chest expansion and no retractions were noted. Clear breath sounds were noted in all lung fields. She had an adynamic precordium with normal rate and regular rhythm, however with distant heart sounds. There was no murmur, heave or thrill appreciated. Vital signs at the emergency room showed a blood pressure of 110/80 which eventually became 80/50 mmH, respiratory rate of 22 cycles per minute, heart rate of 80-100 beats per minute and was febrile. Patient was scheduled for a stat coronary angiography, however on further reassessment, repeat ECG showed resolution of the inferolateral wall ischemia but this could not explain her fluctuating blood pressure. When the patient underwent the scheduled bedside 2D echo, a moderate cardiac tamponade was discovered with a 4.5 cm aortic dissection. With these findings, patient underwent aortic repair, graft insertion with evacuation of hematoma. She was discharged stable and with no recurrence of chest pain.
Cardiac Tamponade ; Aortic Dissection

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Confusion in deglutition: A case of Botulinum Toxin Ingestion

Amihan S. Singson

Journal of the Philippine Medical Association.2017;96(1):58-61.

Purpose: To report on a case of dysphagia secondary to botulinum toxin ingestion. Method: Case report Result: A 30-year-old female with no comorbidities, presented with dysphagia associated with ptosis and diplopia 12 hours after ingestion of double dead pork. Probable diagnoses of a neurologic, esophageal problem or a neoplasm were initially considered. Ancillary procedures to support diagnoses were performed including esophagogastroduodenoscopy, cranial CT scan and Facial and Extremity Nerve Conduction Velocity which all revealed unremarkable results. A possible polyneuropathy specifically foodborne toxicity was considered given a history of dysphagia, ptosis and diplopia with consumption of double dead pork. Confirmatory stool culture studies revealed Clostridium botulinum, hence appropriate antibiotics and supportive therapy were provided which led to the patient's recovery. Conclusion Early diagnosis and a high index of suspicion is important in cases with unfamiliar presentations, therefore a careful history and physical examination is warranted. Foodborne botulinum toxicity is a public health matter that should be addressed. Proper food handling and storage must always be practiced.
Public Health ; Deglutition Disorders ; Deglutition Disorders ; Botulism

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Delayed prosthesis fitting in an elderly with congenital lower limb deficiency: A case report

Jhoana Marie J. Zambrano

Journal of the Philippine Medical Association.2017;96(1):62-70.

Congenital anomalies, including limb deficiency, affect approximately 7.9 million newborns annually. Fitting the prosthesis at an early stage will aid the patient to achieve two-legged standing, to develop reciprocating gait and to attain an optimal body image. A 64-year-old female diagnosed with congenital limb deficiency, right, using a customized shoe was admitted for prosthetic management at the study hospital. Patient underwent inpatient prosthetic training with physical and occupational therapy. Psychological evaluation was done to assess for depression and anxiety and to determine the patient's response to the prosthesis. The Prosthesis Evaluation Questionnaire (PEQ), an instrument to measure prosthesis-related quality of life and functional outcome, was administered. 3D motion analysis was done to observe the temporospatial parameters of the patient's gait with and without the prosthesis. The patient had generally positive response towards her prosthesis based on PEQ administered 1 month after the provision of prosthesis. Psychological evaluation showed that the patient had improved general outlook after the provision of the prosthesis. Patient had slower self-selected walking speed compared to transtibial amputee using prosthesis. Early fitting and fabrication of prosthesis is recommended for the patient with congenital amputation. Studies showed that delayed fitting of prosthesis may decrease acceptance and use of prosthesis. However, provision of properly fitted prosthesis may still improve the quality of life of the patient who is already functionally independent without it. More than increase in physical activity, participation in leisurely activities that promote social interaction motivates elderly patients to use their prosthesis more often.
Lower Extremity ; Prosthesis Fitting

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