This study aims to determine the prevalence of depression and anxiety among Obstetrics and Gynecology residents-in-training during the COVID-19 pandemic.

A cross-sectional study was conducted among Obstetrics and Gynecology residents from December 2020 to January 2021. Participants answered a 37-question survey consisting of sociodemographic and occupational data, as well as the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder – 7 (GAD-7). The prevalence of the symptoms of depression and anxiety were computed.

A total of 120 (52.6%) residents, 62 from private hospitals and 58 from government hospitals completed the online survey. The overall prevalence of depression among Obstetrics and Gynecology residents was 42.5%, while the overall prevalence of anxiety was 31.7%. Three residents who had suicidal ideations were advised to seek counsel from a mental health professional.

The symptoms of depression and anxiety are common among OBGYN residents in selected tertiary hospitals in the National Capital Region during the COVID-19 pandemic. Quarterly surveys should be carried out for the trainees to increase awareness of depression and anxiety.

The study will help give a more objective look at the effects of vaccines versus COVID-19 by comparing imaging findings of unvaccinated versus vaccinated patients. It may demonstrate the use of CT imaging in the screening for COVID-19 pneumonia in the different sub-groups of patients, as well as to help determine severity patterns of pneumonia in vaccinated and unvaccinated patients which may guide future assessment of the disease.

A retrospective study on COVID-19 positive adult in patients from a tertiary hospital who underwent chest CT from 2020 to 2021 was conducted. Multiple variables were collected (demographics, vaccination status, etc). Continuous data was presented using means and standard deviations, while categorical variables were presented using frequencies and percentages. For categorical variables, statistical differences between groups were determined using Pearson's chi-square test or Fisher's exact test; and for continuous variables, student's t test and analysis of variance.

All 174 subjects were included in this study (68 females and 106 males) have pneumonia (77 mild, 75 moderate, and 22 severe). 113 were fully vaccinated, 4 were partially vaccinated, and 57 were unvaccinated. Based on the study, vaccinated group had mean scores of 8.637, while the other group had a mean score of 11.934. The difference was statistically significant, which implies that the vaccinated group had lower pneumonia severity scores.

100% of the patients reviewed had pneumonia and patients with complete vaccination status had less severe cases of pneumonia on Chest CT.

The coronavirus disease (COVID-19) is a global pandemic that caused millions of deaths worldwide. There is no standard risk stratification score for COVID 19 pneumonia. This study aims to determine the accuracy of the MuLBSTA score in predicting the risk of mortality in COVID-19 confirmed moderate to critical pneumonia cases.

A total of 168 COVID-19-confirmed moderate to critical pneumonia patients admitted at Cardinal Santos Medical Center from January 1, 2021 to April 30, 2021 were included by chart review. The MuLBSTA score was determined for each patient using the following information: age, smoking history, co-morbidities, complete blood count, sputum culture, blood culture, chest xray and chest CT scan. All clinical outcomes were based on patient status by the end of the hospital stay (survival versus death). Thereafter, logistic regression was done using the MuLBSTA score and mortality to determine any correlation. In addition, modified regression was used to find any correlation with the MuLBSTAscore and patient co-morbidities as predictors of mortality. Chi-square tests of independence were conducted to assess the specific cut-off values of the MuLBSTAscore in predicting mortality.

The MuLBSTAscore is a significant predictor of mortality (73.08%) and survivability (66.67%). It was determined that the MuLBSTA score's accuracy in predicting mortality increases with diabetics [b = .26, p < .05]. In addition, the intervention of hemoperfusion can skew the predictive accuracy of the scoring [b = -.45, p <.01]. The study showed that a MuLBSTA score of 8 as a cut-off value to delineate high risk patients was more accurate in COVID-19 pneumonia patients compared to the previously established score cut-off of 12 in viral pneumonia [1].

The MuLBSTA score may be used for risk stratification in predicting mortality in COVID-19 pneumonia, especially among diabetic patients. A MuLBSTA score of 8 proves to be the more accurate cut-off in assessing risk of mortality in COVID-19. However, hemoperfusion makes the MulBSTAscore inapplicable.

Broad  Panel Respiratory Multiplex PCR (Pneumonia Panel) tests a panel of bacteria and viruses associated with community acquired pneumonia (CAP) which help streamline antimicrobial therapy. Recently, pneumonia panel aids clinicians in early streamlining of antimicrobials as opposed to waiting for bacterial culture results [2].

To determine whether the use of pneumonia panel improves the overall survival rate, length of hospital stay, and number of antibiotic free days among hospitalized CAP patients.

In this RCT, adult patients admitted for CAP were randomized to perform pneumonia panel and sputum culture (pneumonia panel group) versus sputum culture only (control group). The results were relayed to the medical team and were incorporated into the medical records. Length of hospital stay, antibiotic free days in day 28, and mortality rates were the primary outcomes measured.

Eighty participants completed the study. There was no significant difference in the length of hospital stay (p-value 0.073, 95% C.I.), duration of antibiotic therapy (p-value 0.332, 95% C.I.), and mortality rates (p-value 0.570, 95% C.I.) between the 2 groups.

Routine use of pneumonia panel does not significantly reduce length of hospital stay, duration of antibiotic therapy, and mortality rates among admitted patients with moderate to severe CAP. The benefit of pneumonia panel was seen on early detection of drug resistant pathogen resulting in early antibiotic escalation and shorter duration of antibiotic therapy. Further studies are necessary to show its benefit in the high risk population.

Post-ERCP pancreatitis (PEP) remains the most common complication following endoscopic retrograde cholangiopancreatography (ERCP). Rectal indomethacin is one of the recommended medications given to prevent pancreatitis in high-risk patients undergoing ERCP.

This study aims to evaluate the effectiveness of diclofenac in preventing PEP, to compare its different routes of administration, and to determine the severity of pancreatitis in patients who develop PEP.

Databases from PubMed, ScienceDirect and COCHRANE Library were searched for randomized controlled trials (RCTs) comparing diclofenac with placebo in the prevention of PEPup to August 2020. Risk ratio at 95% Confidence Intervals (CI) were calculated to evaluate the incidence of the interested outcomes.

Eleven RCTs with a total population of 2,012 were reviewed in this study. Diclofenac was associated with a significant reduction in overall risk of PEP compared with patients with placebo (RR = 0.59; 95%, 0.47 0.74; P < 0.000001), with a mild heterogeneity (P = 0.05; I2 = 41%). Subgroup analyses showed that rectal diclofenac was the superior choice to significantly reduce the overall incidence of PEP(RR = 0.34; 95%, 0.23-0.51; P < 0.000001).

Rectal diclofenac significantly reduces the risk of PEPand therefore, should be recommended as routine for clinical use in adult patients who will undergo ERCP.

Multisystem inflammatory syndrome in children (MIS-C) is the most severe pediatric disease associated with COVID19 for which the optimal therapeutic strategy remains unknown. There have been studies that aim to describe treatment outcomes but have conflicting findings. Evidence is urgently needed to support treatment decisions for MIS-C.

This study aims to compare the effectiveness of intravenous immunoglobulins (IVIG) plus corticosteroids versus IVIG alone as initial therapy in MIS-C, in terms of decrease in left ventricular dysfunction, decrease in inotropic support, reduced need for adjunctive immunomodulatory treatment, favorable fever course, decrease in mechanical ventilator use, decrease in admission to the pediatric intensive care unit, and decrease in coronary artery aneurysm.

Published articles reporting MIS-C treatment outcomes were searched through various databases. A structured data extraction was employed and risk of bias was assessed with Newcastle-Ottawa Scale. Corticosteroid effects were reported as pooled odds ratio and forest plots were generated for each outcome.

The effect on the components of hemodynamic support showed no significant difference between the two treatment groups: left ventricular dysfunction (P -value= 0.86), inotrope use (P -value = 0.65), mechanical ventilator use (P -value = 0.21), and admission at the PICU (P -value = 0.87). However, initial treatment with IVIG plus corticosteroids, was associated with a more favorable fever course (P -value = < 0.02), less use of adjunctive immunomodulatory therapy (P -value = < 0.00001), and less incidence of coronary artery aneurysm (P -value = < 0.04).

Initial treatment with IVIG plus glucocorticoids was associated with a more favorable fever course, less use of adjunctive immunomodulatory therapy, and less incidence of coronary artery aneurysm than IVIG alone.

Malignant melanoma is most commonly found on the skin and rarely occurs in the rectal region. This case illustrates that rectal melanoma can be misdiagnosed as hemorrhoids. It also aims to add knowledge to possible treatment options for rectal melanoma.

We report a case of a 77-year-old Filipino adult presenting with rectal bleeding for three weeks. He underwent sigmoidoscopy that showed thrombosed hemorrhoids; however, subsequent surgical excision biopsy histopathology and immunohistochemistry revealed features compatible with malignant melanoma (HMB45, Melan A, and Cytokeratin positive; CDX2 negative). Staging workup done, including abdominal magnetic resonance imaging (MRI) with IV contrast and chest computed tomography (CT), showed distant metastases. He was then started on pembrolizumab but follow up imaging showed recurrence of the rectal melanoma and progression of metastases. Molecular testing done revealed c KIT/ CD117 positive results, hence, treatment was shifted to imatinib.

It was seen that rectal melanoma is an aggressive disease; therefore, multidisciplinary management is crucial to yield the best possible outcome, despite its poor prognosis. Such as in this case, using immunotherapy (Pembrolizumab) and targeted therapy (Imatinib) still have inconsistent outcomes, thus, further studies should be pursued. In this patient, both pembrolizumab and imatinib post-surgery resulted to recurrence of the rectal tumor and progression of hepatic and osseous metastases.

Thirteen-and-a-half syndrome consists of a one-and-a half syndrome with an ipsilateral facial and trigeminal nerve palsy. This is due to lesions that affects the ipsilateral paramedian pontine reticular formation (PPRF) or the ipsilateral abducens nerve nucleus (VI), the contralateral medial longitudinal fasciculus (MLF), the facial nerve (VII), and the trigeminal nerve (V) .

This is a case of Thirteen-and-a-half syndrome and stress the importance of a proper neurologic exam to aid in the localization of lesions in the brain.

This patient was monitored during her admission. She underwent a plain cranial CT scan to confirm the suspected hemorrhage and supportive management was done to relieve her symptoms.

A 14-year-old female patient presented with a one day history of right-sided hemiparesis. There was associated binocular diplopia, dizziness, slurring of speech, dropping of the left lip, and three episodes of spontaneous projectile vomiting. Plain cranial CT scan showed a left-sided pontine hemorrhage, and she was then advised admission. There was exotropia of the right eye on primary gaze with -4 on adduction, abducting nystagmus on the right eye, horizontal gaze palsy on the left eye, no convergence, left facial weakness, and decreased left facial sensation with minimal improvement during her admission. On the 1-year follow up, there was significant improvement with full motility on the right eye and a -1 on abduction on the left eye.

This is a case of a Thirteen-and-a-half syndrome in a young female patient. A complete neuro-ophthalmological exam is paramount as it is both sight-saving and life saving.

Moyamoya angiopathy (MMA) is a rare cause of stroke, yet its incidence and outcomes are understudied in Southeast Asia, despite being the third most populous geographical region in the world. Our aim was to enhance understanding of MMA in this population and present a case from our experience

A systematic literature search on MMA in the Southeast Asian population was performed via PubMed, Scopus, and Wiley Online Library, including local journals and databases up until May 2024. Descriptive statistics were used to synthesize data. We also present a case of a 36 year-old Filipino female diagnosed with MMAfollowed by superficial temporal artery-middle cerebral artery (STA-MCA) bypass and resolution of symptoms.

Out of the 275 articles retrieved, 23 articles detailing 37 patients of Southeast Asian nationality were included in this review. Stroke predominated (76.3%, n=29) as initial presentation, followed by seizures (36.8%, n=14), movement disorders (n=4, 10.5%) and headaches (n=4, 10.5%). Treatment included antiplatelet therapy for 57.9% (n=22), and anti seizure medications for 26.3% (n=10) of cases. Only 21% (n=8) underwent surgical intervention, primarily via direct bypass. Outcomes based on the Modified Rankin Scale (MRS) showed 94.7% (n=36) had retained a functional score of MRS ≤2.

Our review underscores the scarcity of data on MMAin Southeast Asians, and highlights the varied clinical presentation. Effective management requires a tailored approach, with surgical management showing favorable outcomes. Future research should focus on longitudinal studies to assess long-term outcomes, explore the genetic and environmental factors, and develop standardized treatment protocols to improve patient care in this ethnically diverse population.

Lung cancer is the leading cause of cancer-related mortality worldwide with peak mortality rate occurring in patients aged 80 years and above. While NSCLC are often diagnosed at advanced stage when treatment options are few, access to treatment in elderly are even more limited due to treatment tolerability and potential toxicity. At present, Osimertinib is the first line treatment option for patients with metastatic NSCLC with EGFR mutations. Some adverse reactions are diarrhea, nausea, headaches, stomatitis, and rashes that lead to interruption or even stopping of the medication.

Here we present a case about an 89-year-old female with smoking history of 20 pack-years who initially presented at the emergency room with progressive shortness of breath. Chest radiograph showed right pleural effusion for which pigtail was inserted. Bronchoscopy revealed a completely obstructing mass at the right upper lobe. Her biopsy showed EGFR-mutated non-small cell lung adenocarcinoma. Patient underwent radiotherapy and was started on osimertinib 80mg daily. However, patient developed severe diarrhea for which her subsequent dosing was reduced to 40mg once daily. Repeat PET CT scan after 10 months showed significant reduction of the primary mass.

In patients with metastatic EGFR-mutated lung adenocarcinoma, Osimertinib proves to be an effective option and is associated with improved overall survival even on a low-dose. This dose reduction strategy may be an option especially for elderly patients with tolerability issues. Nonetheless, treatment choices should prioritize patients' functional status and comorbidities over age, underscoring the importance of personalized approaches despite chemotherapy's inherent risks.