Introduction: Extraskeletal Ewing sarcoma (EES) is a rare subtype of Ewing Sarcoma. It is more common in older age group compared with Classic Ewing Sarcoma that is seen in pediatric patients. It usually presents in the upper extremities, hips, and pelvis. The breast is an unusual primary location for this tumor, and there are very few reported cases in the literature. In the Philippines, there have been no reported cases yet of EES primary to the breast in the pediatric age group. Case Description: This is a case of a right upper chest mass from a 13-year-old male noted with progression of size for the past 8 months associated with pain. A biopsy was done in the initial consult and yielded unremarkable results, hence management with unrecalled antibiotics and pain medications. Continuous worsening of symptoms led to consultation at our institution, wherein a non-tender, non-erythematous, non-movable, firm, 15 x 13 cm mass was noted at the right chest during his ER consult and subsequent admission. CT scan with contrast revealed a right chest wall mass (16.8 x 18.1 x 9.5 cm) with focal areas of intrathoracic extension and associated pleural thickening. The patient subsequently underwent an incision biopsy for further workup. Microscopically, sheets and cords of small round blue cells are seen with scant to ample amphophilic cytoplasm, increased nuclear to cytoplasmic ratio, coarse chromatin pattern, and inconspicuous nucleoli set in a background of fibrocollagenous stroma. About 5-10 mitoses are also seen per 10 high-power fields, some of which are atypical. Based on the patient’s medical history, radiographic findings and histomorphologic characteristics of the case, the primary working diagnosis for this case is a malignant small round blue cell neoplasm. Immunohistochemistry studies showed strong, diffuse, membranous, and cytoplasmic immunoreactivity to CD99, while the rest of the immunohistochemical stains (Desmin, Myogenin, Chromogranin, CD45, and SALL4) yielded negative results. Additionally, NKX2.2 was also performed which showed strong, diffuse, nuclear immunoreactivity to the neoplastic cells. The case is compatible with the diagnosis of Ewing Sarcoma. Subsequent molecular test on ESWR1 via Fluorescence in-situ hybridization (FISH) revealed an ESWR gene break apart, which further supports the diagnosis of Ewing Sarcoma. Six months after the biopsy, and having completed 3 cycles of chemotherapy, the patient subsequently underwent excision of the mass. The excised tumor was submitted for histopathologic evaluation, which showed good response (89% treatment effect, mainly composed of extensive necrosis). There is no involvement of the adjacent rib bone, and all surgical margins are negative for tumor; thus, this has been signed out as a case of Extraskeletal Ewing Sarcoma of the Breast. Discussion: Extraskeletal Ewing Sarcoma (EES) is a highly aggressive tumor seen among 12% of patients with Ewing Sarcoma (ES). It has a wide anatomic distribution.Typically, it is most common on the upper extremities, hips and pelvic area. It is also seen more among older age group, usually in the 4th decade of life in some of the reported cases, in comparison with classic ES. The breast is an unusual location for the tumor for both adult and pediatric patients. Most tumors of the breast commonly seen in the pediatric age group are metastatic processes, which include rhabdomyosarcoma and lymphoma. CD99 is an important and essential immunohistochemical stain (IHC) in the diagnosis of Ewing sarcoma; 95% of cases of ES has a diffuse, strong membranous expression. NKX2.2 is also useful in the diagnosis, as it is more specific with ES. S100, ERG and FL1 can also be used to support the diagnosis of ES. Molecular testing is also a requirement and helpful in the diagnosis of EES. The tumor is associated with FET-ETS fusion genes. EWSR1-FLI1 fusion is the most common genetic alteration with EES which resulted from translocation in the t(11;22)(q24;q12). Other mutation of the tumor include ESWR-ERG1. EES primary to the breast has a poorer prognosis despite multimodal treatments in comparison to EES located in different sites with a good prognosis. There have been nineteen (19) reported cases of EES primary to the breast. This accounts for less than 1% of overall cases for EES. Currently, there have been no reported cases of EES primary to the breast in the local setting. Conclusion Ewing sarcoma should still be considered as one of the main differential diagnoses for pediatric patients presenting with soft tissue mass in the breast as well as in other locations. Due to its aggressive clinical course, prompt diagnosis can help increase survivability, surveillance of recurrence, and metastasis.
Child ; Sarcoma, Ewing ; Mutation

BACKGROUND

Diabetes mellitus (DM) is a significant and growing global health concern. Worldwide, 537 million adults have diabetes and 206 million of them are from the Western Pacific Region1. Local prevalence continues to remain high at 7.5%, with 4,303,899 adult Filipinos suffering from diabetes in 2021. DM significantly contributes to the growing burden of chronic kidney disease (CKD) worldwide with about 50% of end-stage renal disease (ESRD) being due to diabetic nephropathy alone. Likewise, 60% of Filipinos on maintenance dialysis have ESRD due to DM and hypertension. The primary care setting is the initial point of contact between healthcare providers and patients with type 2 diabetes, hence, the development of clinical practice guidelines that will provide guidance in caring for patients with stable complications of diabetes. The guideline is the first of 3 that are being developed by the Philippine Academy of Family Physicians for the diagnosis and management of adult patients with type 2 diabetes and stable microvascular complications – nephropathy, retinopathy and neuropathy.

This guideline aims to provide evidence-based recommendations on the diagnosis and management of adults with type 2 diabetes mellitus (T2DM) and early stage CKD and is divided into 5 main sections – Clinical Assessment, Diagnostic Tests, Pharmacologic Treatment, Non-pharmacologic Treatment and Patient Outcomes.

The method of guideline development followed the ADAPTE process. The Technical Working Group identified 19 key questions after consultation with colleagues and patients. Recommendations were adopted from high-quality clinical practice guidelines whenever applicable for most of the key clinical questions. On the other hand, the De Novo method of evidence review was used to answer key clinical questions for which recommendations from reviewed guidelines were not available. A modified GRADEPro was used in assessing the quality of evidence – high, moderate, low or very low. Following external review by a nephrologist, the draft recommendations were sent to the members of the consensus panel. Voting on whether to include or not by the consensus panel was facilitated to determine the strength of each recommendation – strong, moderate or weak.

After reviewing 3 high-quality clinical practice guidelines and the current evidence, the technical working group was able to develop 40 recommendations for the 19 key clinical questions.

BACKGROUND

The crop of novice nurses who are currently employed is a product of flexible learning who had limited contact hours with actual patients, which is contrary to those who graduated from traditional learning modalities. Hence, it is essential to evaluate how the impact of flexible learning modality has affected the practice preparedness levels of novice nurses in the hospital setting.

This study aimed to determine the level of practice preparedness and its associated factors among novice nurses who work in private hospitals.

The study utilized a cross-sectional survey design. Data was gathered from a total enumeration of ninety-four novice staff nurses who graduated from the flexible learning curriculum and are currently employed in private hospitals in Baguio City and La Trinidad. The tool used was a questionnaire in two parts. Part 1 consisted of questions related to demographic information and factors related to practice preparedness, and part 2 included the Nursing Practice Readiness Scale, with validity and reliability scores of >0.924 and 0.90, respectively. The data was analyzed using the SPSS V27 trial version. The protocol was approved by the Saint Louis University Research Ethics Committee.

Findings reveal that more novice nurses in private hospitals perceived themselves as well-prepared across all domains of practice preparedness: “Collaborative Interpersonal Relationship” (n=94, 100%); “Patient Centeredness” (n=92, 97.90%); “Self-regulation” (n=90, 95.70%); “Clinical Judgment and Nursing Performance” (n=78, 83.00%); and “Professional Attitudes” (n=76, 80.90%). There is a significant association between practice preparedness and the following factors: “Attended more than one Training/Seminars per year” (p=0.02), “Graduated from Private Schools” (p=0.03), and “Assigned in Regular Wards” (p=0.05). On the other hand, no significant association was found between practice preparedness and the following factors: “Sex” (p=0.61) and “Membership in Professional Organizations” (p=0.73).

In agreement with existing studies, practice preparedness is multifactorial. However, what this study contributes are new factors that are favorable in making novice nurses more confident in performing their roles and responsibilities. These include being a graduate of private schools, being assigned to regular wards, and attending professional training/seminars more than once annually. Advantageously, these factors that promote practice preparedness are modifiable.

Objectives: The study aimed to analyze the core capacities to implement World Health Organization International Health Regulations (IHR) in 6 countries: Indonesia, Cambodia, Vietnam, the Dominican Republic, Ghana, and the Republic of Korea. Methods: Secondary data from relevant databases and reports, including the electronic State Party Self-Assessment Annual Reporting mechanism and global health security index, were used to assess health security in these countries. Descriptive statistics summarized the basic features of the scores, and a strengths, weaknesses, opportunities, and threats (SWOT) analysis wassubsequently performed to identify factors affecting health security scores while highlighting key similarities and differences between countries. Results: Early warning and event management emerged as the primary strength in most countries.Common opportunities included international commitments and immunization programs.In contrast, many countries shared weaknesses related to the policy, legal, and normative frameworks for IHR implementation, as well as challenges in human resources, chemical event management, and radiation emergency preparedness. Recurring threats involved issues such as biosafety, biosecurity, dual-use research and the culture of responsible science, infection control practices, coordination between public health and security authorities, laboratory supply chain vulnerabilities, and communication with healthcare workers during public health emergencies. Conclusion In order to counter future global health threats, countries should prioritize enhancing surveillance capacity (early warning and event management) as well as the immunization indicator (vaccination rates for human and animal diseases, including the national vaccine delivery system).

Objectives: The study aimed to analyze the core capacities to implement World Health Organization International Health Regulations (IHR) in 6 countries: Indonesia, Cambodia, Vietnam, the Dominican Republic, Ghana, and the Republic of Korea. Methods: Secondary data from relevant databases and reports, including the electronic State Party Self-Assessment Annual Reporting mechanism and global health security index, were used to assess health security in these countries. Descriptive statistics summarized the basic features of the scores, and a strengths, weaknesses, opportunities, and threats (SWOT) analysis wassubsequently performed to identify factors affecting health security scores while highlighting key similarities and differences between countries. Results: Early warning and event management emerged as the primary strength in most countries.Common opportunities included international commitments and immunization programs.In contrast, many countries shared weaknesses related to the policy, legal, and normative frameworks for IHR implementation, as well as challenges in human resources, chemical event management, and radiation emergency preparedness. Recurring threats involved issues such as biosafety, biosecurity, dual-use research and the culture of responsible science, infection control practices, coordination between public health and security authorities, laboratory supply chain vulnerabilities, and communication with healthcare workers during public health emergencies. Conclusion In order to counter future global health threats, countries should prioritize enhancing surveillance capacity (early warning and event management) as well as the immunization indicator (vaccination rates for human and animal diseases, including the national vaccine delivery system).

Objectives: The study aimed to analyze the core capacities to implement World Health Organization International Health Regulations (IHR) in 6 countries: Indonesia, Cambodia, Vietnam, the Dominican Republic, Ghana, and the Republic of Korea. Methods: Secondary data from relevant databases and reports, including the electronic State Party Self-Assessment Annual Reporting mechanism and global health security index, were used to assess health security in these countries. Descriptive statistics summarized the basic features of the scores, and a strengths, weaknesses, opportunities, and threats (SWOT) analysis wassubsequently performed to identify factors affecting health security scores while highlighting key similarities and differences between countries. Results: Early warning and event management emerged as the primary strength in most countries.Common opportunities included international commitments and immunization programs.In contrast, many countries shared weaknesses related to the policy, legal, and normative frameworks for IHR implementation, as well as challenges in human resources, chemical event management, and radiation emergency preparedness. Recurring threats involved issues such as biosafety, biosecurity, dual-use research and the culture of responsible science, infection control practices, coordination between public health and security authorities, laboratory supply chain vulnerabilities, and communication with healthcare workers during public health emergencies. Conclusion In order to counter future global health threats, countries should prioritize enhancing surveillance capacity (early warning and event management) as well as the immunization indicator (vaccination rates for human and animal diseases, including the national vaccine delivery system).

Objectives: The study aimed to analyze the core capacities to implement World Health Organization International Health Regulations (IHR) in 6 countries: Indonesia, Cambodia, Vietnam, the Dominican Republic, Ghana, and the Republic of Korea. Methods: Secondary data from relevant databases and reports, including the electronic State Party Self-Assessment Annual Reporting mechanism and global health security index, were used to assess health security in these countries. Descriptive statistics summarized the basic features of the scores, and a strengths, weaknesses, opportunities, and threats (SWOT) analysis wassubsequently performed to identify factors affecting health security scores while highlighting key similarities and differences between countries. Results: Early warning and event management emerged as the primary strength in most countries.Common opportunities included international commitments and immunization programs.In contrast, many countries shared weaknesses related to the policy, legal, and normative frameworks for IHR implementation, as well as challenges in human resources, chemical event management, and radiation emergency preparedness. Recurring threats involved issues such as biosafety, biosecurity, dual-use research and the culture of responsible science, infection control practices, coordination between public health and security authorities, laboratory supply chain vulnerabilities, and communication with healthcare workers during public health emergencies. Conclusion In order to counter future global health threats, countries should prioritize enhancing surveillance capacity (early warning and event management) as well as the immunization indicator (vaccination rates for human and animal diseases, including the national vaccine delivery system).

Objectives: The study aimed to analyze the core capacities to implement World Health Organization International Health Regulations (IHR) in 6 countries: Indonesia, Cambodia, Vietnam, the Dominican Republic, Ghana, and the Republic of Korea. Methods: Secondary data from relevant databases and reports, including the electronic State Party Self-Assessment Annual Reporting mechanism and global health security index, were used to assess health security in these countries. Descriptive statistics summarized the basic features of the scores, and a strengths, weaknesses, opportunities, and threats (SWOT) analysis wassubsequently performed to identify factors affecting health security scores while highlighting key similarities and differences between countries. Results: Early warning and event management emerged as the primary strength in most countries.Common opportunities included international commitments and immunization programs.In contrast, many countries shared weaknesses related to the policy, legal, and normative frameworks for IHR implementation, as well as challenges in human resources, chemical event management, and radiation emergency preparedness. Recurring threats involved issues such as biosafety, biosecurity, dual-use research and the culture of responsible science, infection control practices, coordination between public health and security authorities, laboratory supply chain vulnerabilities, and communication with healthcare workers during public health emergencies. Conclusion In order to counter future global health threats, countries should prioritize enhancing surveillance capacity (early warning and event management) as well as the immunization indicator (vaccination rates for human and animal diseases, including the national vaccine delivery system).

The country’s cardiology centers have been producing subspecialists in the field of Invasive and Interventional Cardiology. To date, 11 hospitals and/or medical centers are involved in training these subspecialists in a 1 to 2-year program. And to this date, there have been no uniform standards and guidelines as to what comprises the basic and/or acceptable training outcomes for the interventionalist in training. This paper describes the development of the core curriculum for an interventional cardiovascular training program to prepare its trainees to be competent in performing invasive diagnostic and interventional cardiovascular procedures as part of comprehensive patient care. The task force for the core curriculum of the interventional training program gathered several officers and leaders of the PSCCI, the training heads of the various interventional programs in the country, as well as experts in the field of cardiology education. Through a series of meetings, consultations, and workshops, the task force laid out the template on which all the training programs would be based. Such a framework considered the international standards regarding minimum caseloads for interventional training and the peculiar situation of each training institution. International standards like the Core Cardiovascular Training Statement (COCATS 4) Task Force 10: Training in Cardiac Catheterizations and the 2020 EAPCI Core Curriculum for Percutaneous Cardiovascular Interventions served as the reference framework for key recommendations. A consensus was achieved that upheld the highest standards of competence without disenfranchising certain institutions due to intricacies and uniqueness of hospital set-up and training situation.

Human ; Health Promotion ; Persons