Background: Recurrent gynecological clear cell carcinoma (rGCCC) has a low objective response rate (ORR) to chemotherapy. Previous preclinical and clinical data suggest a potential synergy between immune checkpoint inhibitors and bevacizumab in rGCCC.Dostarlimab, a humanized monoclonal antibody targeting programmed cell death protein 1 (PD-1), combined with the anti-angiogenic bevacizumab, presents a novel therapeutic approach. This study will investigate the efficacy of dostarlimab +/− bevacizumab in rGCCC. Methods DOVE is a global, multicenter, international, open-label, randomized phase 2 study of dostarlimab +/− bevacizumab with standard chemotherapy in rGCCC. We will enroll 198 patients with rGCCC and assign them to one of three groups in a 1:1:1 ratio: arm A (dostarlimab monotherapy), B (dostarlimab + bevacizumab), and C (investigator’s choice of chemotherapy [weekly paclitaxel, pegylated liposomal doxorubicin, doxorubicin, or gemcitabine]). Patients with disease progression in arm A or C will be allowed to cross over to arm B. Stratification factors include prior bevacizumab use, prior lines of therapy (1 vs. >1), and primary site (ovarian vs. non-ovarian). Key inclusion criteria are histologically proven recurrent or persistent clear cell carcinoma of the ovary, endometrium, cervix, vagina, or vulva; up to five prior lines of therapy; disease progression within 12 months after platinumbased chemotherapy; and measurable disease. Key exclusion criteria are prior treatment with an anti–PD-1, anti–programmed death-ligand 1, or anti–programmed death-ligand 2 agent.The primary endpoint is progression-free survival determined by investigators. Secondary endpoints are ORR, disease control rate, clinical benefit rate, progression-free survival 2, overall survival, and toxicity. Exploratory objectives include immune biomarkers.

Background: Recurrent gynecological clear cell carcinoma (rGCCC) has a low objective response rate (ORR) to chemotherapy. Previous preclinical and clinical data suggest a potential synergy between immune checkpoint inhibitors and bevacizumab in rGCCC.Dostarlimab, a humanized monoclonal antibody targeting programmed cell death protein 1 (PD-1), combined with the anti-angiogenic bevacizumab, presents a novel therapeutic approach. This study will investigate the efficacy of dostarlimab +/− bevacizumab in rGCCC. Methods DOVE is a global, multicenter, international, open-label, randomized phase 2 study of dostarlimab +/− bevacizumab with standard chemotherapy in rGCCC. We will enroll 198 patients with rGCCC and assign them to one of three groups in a 1:1:1 ratio: arm A (dostarlimab monotherapy), B (dostarlimab + bevacizumab), and C (investigator’s choice of chemotherapy [weekly paclitaxel, pegylated liposomal doxorubicin, doxorubicin, or gemcitabine]). Patients with disease progression in arm A or C will be allowed to cross over to arm B. Stratification factors include prior bevacizumab use, prior lines of therapy (1 vs. >1), and primary site (ovarian vs. non-ovarian). Key inclusion criteria are histologically proven recurrent or persistent clear cell carcinoma of the ovary, endometrium, cervix, vagina, or vulva; up to five prior lines of therapy; disease progression within 12 months after platinumbased chemotherapy; and measurable disease. Key exclusion criteria are prior treatment with an anti–PD-1, anti–programmed death-ligand 1, or anti–programmed death-ligand 2 agent.The primary endpoint is progression-free survival determined by investigators. Secondary endpoints are ORR, disease control rate, clinical benefit rate, progression-free survival 2, overall survival, and toxicity. Exploratory objectives include immune biomarkers.

Background: Recurrent gynecological clear cell carcinoma (rGCCC) has a low objective response rate (ORR) to chemotherapy. Previous preclinical and clinical data suggest a potential synergy between immune checkpoint inhibitors and bevacizumab in rGCCC.Dostarlimab, a humanized monoclonal antibody targeting programmed cell death protein 1 (PD-1), combined with the anti-angiogenic bevacizumab, presents a novel therapeutic approach. This study will investigate the efficacy of dostarlimab +/− bevacizumab in rGCCC. Methods DOVE is a global, multicenter, international, open-label, randomized phase 2 study of dostarlimab +/− bevacizumab with standard chemotherapy in rGCCC. We will enroll 198 patients with rGCCC and assign them to one of three groups in a 1:1:1 ratio: arm A (dostarlimab monotherapy), B (dostarlimab + bevacizumab), and C (investigator’s choice of chemotherapy [weekly paclitaxel, pegylated liposomal doxorubicin, doxorubicin, or gemcitabine]). Patients with disease progression in arm A or C will be allowed to cross over to arm B. Stratification factors include prior bevacizumab use, prior lines of therapy (1 vs. >1), and primary site (ovarian vs. non-ovarian). Key inclusion criteria are histologically proven recurrent or persistent clear cell carcinoma of the ovary, endometrium, cervix, vagina, or vulva; up to five prior lines of therapy; disease progression within 12 months after platinumbased chemotherapy; and measurable disease. Key exclusion criteria are prior treatment with an anti–PD-1, anti–programmed death-ligand 1, or anti–programmed death-ligand 2 agent.The primary endpoint is progression-free survival determined by investigators. Secondary endpoints are ORR, disease control rate, clinical benefit rate, progression-free survival 2, overall survival, and toxicity. Exploratory objectives include immune biomarkers.

BACKGROUND Hypertension is the most common risk factor for cardiovascular disease in the Philippines. Despite the availability of antihypertensive medications that are effective, safe, and tolerated by Filipino patients, the numbers of uncontrolled hypertensives are still increasing. Several factors play in the poor control of blood pressure, particularly resistant hypertension and hyperactive sympathetic nervous system. Renal denervation therapy is a novel device that has been shown to lower blood pressure in patients with resistant and difficult-to-treat hypertension and is deemed safe in clinical trials. A Philippine Working Group composed of specialists in cardiology, hypertension, vascular surgery, and clinical epidemiology has come up with consensus statements in identifying patients who will benefit from the procedure. Locally, there is a need to have hypertension centers treating uncontrolled and resistant hypertension and offer renal denervation therapy to appropriate Filipino patients.
Blood Pressure

Introduction: Social media has become a ubiquitous part of daily life. However, little is known about the influence of food-related social media content (FRSMC) on the eating habits of Malaysian undergraduates. This study explored FRSMC usage of undergraduates enrolled in a non-health program, its influence on eating habits, and how such social media content influences dietary behaviours. Method: This qualitative semi-structured interview study involved chemical engineering (CE) undergraduates at a university in Penang, Malaysia. The study was carried out from April 2021 to March 2022 during which ten participants were purposively selected. Based on precedent qualitative research sampling rule of thumb, this sample size of ten participants provided sufficient data saturation for an initial exploratory study. The interview sessions were recorded, transcribed, and thematically analyzed. Results: According to study findings, in terms of usage, food advertising and promotions; cooking tutorials and food and nutrition information are the most appealing types of FRSMC. With regards to eating habits, FRSMC can lead to healthy and unhealthy food choices. The study identified several perceived challenges, namely unrealistic and untrustworthy content, difficult and repetitive content, and algorithm-driven deviations from healthy diets. The effectiveness of FRSMC can be enhanced by creating trustworthy and engaging content. Conclusion: The study highlights that social media engagement can have both positive and negative impact on food choices among undergraduates. Some FRSMC are perceived to encourage and motivate undergraduates to adopt healthier dietary habits. Future research could involve a larger sample, representative of diverse socio-demographic groups in Malaysia.

BACKGROUND

Coronavirus disease 2019 (COVID-19) has been associated with acute liver injury presenting as increased liver enzymes, specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST). There is limited data in the prevalence of liver injury in COVID 19. We aim to determine the prevalence of acute liver injury among COVID-19 patients admitted in a tertiary hospital in the Philippines.

The study is a single center, retrospective cohort of all COVID-19 patients with baseline AST and ALT admitted at St. Luke’s Medical Center - Quezon City from January 2020 to December 2021. The population was divided into those with normal liver enzymes, mild (AST and/or ALT 1-3 times ULN), and severe (AST and/or ALT >3x ULN) acute liver injury. Association of liver injury to clinical outcome, COVID 19 disease severity, and length of hospital stay were determined. Among those with elevated AST/ALT, comparison of the levels before and after treatment with hepatoprotective agents were evaluated.

Among the 669 patients included in the analysis, 448 (67%) developed liver injury of which 50 (7.5%) had severe liver injury and 398 (59.5%) developed mild liver injury. Chi squared analysis showed that acute liver injury (OR:2.64,CI:1.90-3.69, p < 0.01) was associated with COVID-19 severity. However, acute liver injury was not associated with clinical outcome (p = 0.347) and length of hospital stay (p = 0.317). There was no association between the use of hepatoprotective agents and changes in level of transaminases (p=0.087).

This study revealed that mild liver injury is commonly found in patients with COVID-19 infection. Severity of liver injury is significantly associated with COVID-19 severity, but not with clinical outcome and length of hospital stay. In this study, treatment with hepatoprotective agents did not lead to a decrease in liver enzymes. Further evaluation is needed to recognize those patients at higher risk of complications and identify effective therapies in providing better clinical outcomes.

Background: Dermoscopy enhances detection of basal cell carcinoma (BCC), especially for the pigmented subtype common among Asians. However, there is limited data on dermoscopic features of BCC in Filipinos. Objectives: The objective of this study is to describe the clinicopathologic profile and dermoscopic features of BCC in Filipinos seen in a tertiary care clinic. Methods: A cross-sectional study was conducted in the Philippines from November 2019 to December 2021 in a tertiary care clinic. Fifty-three (53) lesions suspicious for BCC were analyzed using dermoscopy prior to histologic confirmation. Fifty (50) biopsy-proven BCC lesions were included in the analysis. Results: Lesions were more commonly seen in females (72.50%), and located on the head and neck (88%). The most common histopathologic subtype was nodular (74%). The most common dermoscopic features were large blue-gray ovoid nests (86%) and ulcerations (70%). Conclusion The most common BCC type among the study participants was nodular, with large blue-gray ovoid nests and ulceration seen on dermoscopy.
carcinoma, basal cell ; dermoscopy

Congenital syphilis is a worldwide public health concern. This occurs when an infected mother transmits the infection to the fetus during pregnancy or at birth.

We present a case of a 6-day-old male, term, born to a mother with secondary syphilis, via normal spontaneous delivery. Upon birth, patient was well and not in cardiorespiratory distress. However, cutaneous examination revealed multiple, well-defined vesicles and pustules on an erythematous background, some topped with erosions and crusts on the scalp, face, extremities, and trunk. Laboratory work-up and imaging were done which revealed congenital syphilis. He was managed with intravenous Penicillin (100,000iu) 160,000 IV for ten days, and wound healing was hastened by use of a coconut-based cellulose wound dressing on the erosions. He was then referred to a multispecialty team to assess and co-manage possible complications. Regular interval follow-up and repeat laboratory tests were advised for observation and for monitoring.

Congenital syphilis is caused by the bacterium Treponema pallidum. Sequelae include preterm birth, low birth weight, skin lesions, bone deformities, hepatosplenomegaly, anemia, and neurological problems. Diagnosis can be made on clinical suspicion combined with Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL). Aside from Penicillin G, wound care, nutritional build up, and close monitoring of growth and development with regular follow-ups are essential aspects in the management of congenital syphilis. With timely and adequate treatment, infants have a higher likelihood of complete resolution of symptoms, prevention of long-term complications, and improved overall health outcomes.