Human ; Research ; Information Dissemination ; Reference Standards

Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is a mesenchymal tumor which lies along the spectrum of smooth muscle neoplasm of the uterus. This type of neoplasm has morphologic features intermediate between the benign leiomyoma and the malignant leiomyosarcoma but is characterized by distinct pathologic findings. STUMPs are rare and standardized treatment for these neoplasms remains to be controversial as its behavior and clinical course is unpredictable and response to various treatments remains to be challenging up to this time. Due to the rarity of these cases, consensus on the standardized treatment on the best surgical approach and adjuvant therapy has not been reached. This study presents a 40-year-old nulligravida who had initial surgical resection of uterine mass but had recurrence of a suprapubic mass with complete treatment of eight cycles of doxorubicin and now presenting with stable disease.

Desmoplastic small round cell tumor (DSRCT) is a rare and highly aggressive soft-tissue sarcoma that commonly presents late in the disease due to its nonspecific symptoms. Due to its rarity, there is still no standardized treatment regimen. A multimodal approach remains to be the cornerstone of treatment-complete cytoreductive surgery, chemotherapy, and radiotherapy. Despite advances in treatment, use of targeted and immunotherapy, an improved survival rate remains to be elusive. This paper presents a case of DSRCT in a 21-year-old Filipino patient as well as a review of the related literature of reported DSRCT cases in females and the emerging therapies for the disease.

Objective: The aim of this study was to assess research productivity on preterm birth (PTB) in Southeast Asian (SEA) countries and its correlation with socioeconomic characteristics and burden of disease. Methods: A systematic review of preterm birth publications by SEA authors indexed in Scopus, PubMed, ClinicalTrials. gov, and Cochrane was done. Case reports, cohorts, control trials, reviews and cost analysis studies done by SEA researches involving pathophysiology, diagnosis, management, and complications of preterm birth was included in the study while published letters to editors were excluded. The correlation of bibliometric indices, namely Scopus citations, and PlumX metrics indices (citations, usage, captures, mentions, and social media), with socioeconomic status and burden of preterm birth in SEA countries were analyzed by computing for the correlation coefficient (r) and p-value at an alpha of 0.05. Results: Thailand had the highest number of publications and the highest count across all bibliometric indices among all countries in SEA. The percent gross domestic product (GDP) per capita allotted for research and development (R & D) had direct correlation with publications and captures while crude birth rates had indirect correlation with publications, citations, and captures. Neonatal mortality had indirect correlation with publications and captures. Conclusion Support for research and development is essential to increase research productivity in SEA, which in turn may help in finding solutions to decrease the rate of preterm birth in the region.
Bibliometric Analysis ; Bibliometrics ; Preterm Birth ; Premature Birth ; Gross Domestic Product ; Asia, Southeastern

Tuberculosis can coexist with malignancy in the same organ, but cancer with TB in the cervix is rare. This is a case of cervical tuberculosis diagnosed in a cervical cancer patient after concurrent chemoradiotherapy and brachytherapy. This is the case of a 38-year-old G2P2 (2002) diagnosed with squamous cell carcinoma, large cell non-keratinizing cervix, Stage IIIB. The patient underwent concurrent chemoradiotherapy and brachytherapy. One month after the last brachytherapy dose, the attending physician noted a nodularity on the anterior lip of the cervix. A cervical punch biopsy was done to rule out tumor persistence. The histopathology revealed chronic granulomatous inflammation with Langhan’s type multinucleated giant cells consistent with tuberculous infection. She was diagnosed with cervical tuberculosis, postulated to be from latent TB reactivation, and was given Anti-Koch’s medication for six months. After receiving Anti-Koch’s treatment, the cervical nodularity was no longer appreciated, and the rest of the cervix was smooth on palpation. Her Pap Test was negative for any intraepithelial lesion and was declared with no evidence of carcinoma. A possible latent TB infection should always be screened in cancer patients from high-burden areas or those with close contact treated for tuberculosis because immunosuppression during cancer treatment can cause the reactivation of tuberculous disease. Cervical tuberculosis complicating cervical malignancy is treatable with Anti-Koch’s therapy and has not been shown to affect the course of the carcinoma.
Latent Tuberculosis

Intrauterine device use as contraceptionoffers the benefits of being affordable, long- acting, highly effective, and reversible. However, like any foreign body, it can be prone to certain complications, at times, with very serious consequences. Migration is the rarest but most feared complication. This is a report of the case of 72-year old woman with anine-month history of right lower quadrant abdominal pain. Work ups pointed to a migrated intrauterine device.The patient subsequently underwent laparoscopic removal of the foreign body with omental biopsy which laterrevealed metastatic adenocarcinoma from a primary ovarian malignancy.
Intrauterine Devices ; Ovarian Neoplasms ; Adenocarcinoma

A 55‑year‑old, Gravida 2 Para 2 (2002), presented with postmenopausal vaginal bleeding. Workups pointed toward ovarian malignancy with distant metastasis (pleural effusion). Exploratory laparotomy, bilateral salpingo‑oophorectomy, surgical staging, and appendectomy were performed. On histopathological examination, synchronous high‑grade serous carcinoma of the right fallopian tube and borderline mucinous tumor of the left ovary were diagnosed. Primary fallopian tube carcinomas are very uncommon, while synchronous tumors of the female genital tract are extremely rare. Furthermore, there is a paucity of literature discussing the occurrence of synchronous primary malignancies arising from the fallopian tube and the ovary. It is crucial to differentiate primary malignancies from metastatic cancers to determine accurate staging and prognosis, as well as to assign appropriate treatment strategies. Immunohistochemistry and molecular testing play vital roles as adjunctive diagnostic tools to histologic examination in determining the origins of these tumors and distinguishing primary tumors from metastasis.
Fallopian Tubes ; Fallopian Tube Neoplasms ; Neoplasms, Cystic, Mucinous, and Serous

Objective. This is a cross-sectional study aimed to determine the time intervals from the first symptom to surgery of 37 patients with ovarian malignancies who underwent surgery at a tertiary government hospital from June to October 2019.

Methods. Structured interviews of patients and chart reviews were conducted to identify the intervals and the reasons behind such. The data were analyzed using Stata/SE 14.1, with the time intervals presented as medians and the reasons as frequencies. Multinomial logistic regression analysis established the association of time intervals with the extent of surgery and final stage of ovarian malignancies.

Results. The median Total Time Interval from the first symptom to surgery was 214 days. The longest delay was the Total System Interval (from the first visit at the tertiary hospital to surgery) with a median of 70 days. This was followed closely by Patient Interval (from the first symptom to consult with the initial physician) with a median of 64 days. A distant third was the Initial Physician Interval (from the consult with the initial physician to the first visit at the tertiary hospital) with a median of 29 days. Most common reasons for the delays were the patients not acknowledging the gravity of their condition for the Patient Interval; choice to go to other hospitals, distance and laboratory works or diagnostics for the Initial Physician Interval; waiting for laboratory work-ups for the First System Interval; and waiting for other departments' clearance for the Second System Interval. The most common first symptom was abdominal enlargement. The length of interval and the final stage (p=0.056 for Stage III and p=0.162 for Stage IV)) as well as extent of surgery (p=0.093) did not show significant association.

Conclusion. The time interval from first symptom to surgery showed a median of 214 days. The greatest delay is contributed by Total System Interval followed by Patient Interval due to varying reasons. Length of time intervals, however, was not found to be significantly associated with the extent of surgery and final stage

Background. The University of the Philippines-Philippine General Hospital (UP-PGH) was designated as a COVID Referral Center for one cluster in Metro Manila during the pandemic. We reviewed and described how UP-PGH prepared for this endeavor. This can serve as reference for similar events in the future. Methods. We conducted a qualitative cross-sectional study with 20 key informant interviews and 5 focus group discussions involving 32 hospital front liners. All proceedings were transcribed and analyzed manually following the conceptual framework. Minutes of meetings, memoranda, and other official materials and communications were also reviewed. Results. The salient points of both internal (operations, structure, staff, supplies, and continuation of regular services) and external aspects (relation with other hospitals, the local government, the national health authority, and the general public) were enumerated and elaborated. Both best practices and areas needing improvement were identified. Conclusion and Recommendations. The UP-PGH tried its best to prepare and respond to the COVID-19 pandemic by protecting its hospital personnel and delivering evidence-based and quality care to patients. The response was not a perfect one and there were certain aspects for improvement.
Pandemics ; Referral and Consultation ; Qualitative Research

For any company or organization, its service delivery mirrors its effectiveness in attaining its goals. For a health care institution, this is health service delivery. Why should health service delivery be a priority of any health care institution or organization The World Health Organization (WHO) talks about improving the quality of patient-centered health service as the road to achieving universal health coverage and the Sustained Development Goals (SDGs).1 The US Agency for International Development (USAID) embarked on ASSIST, Applying Science to Strengthen and Improve Systems, a five year project designed to improve health and social services in USAID-assisted countries.2 It is imperative that health service delivery is designed in such a way that it is based on the best scientific evidence for a particular disease, is made easily accessible, and one that follows a structure or system that will support its delivery. The USAID further puts an even broader concept called governance for quality health care and service delivery. These include use of policy and strategies, effective regulation, engaging non-state actors, garnering political will, pursuing reliable data, culture of continuous improvement, promoting knowledge sharing, and linking financing to quality.2 Health service delivery as a research agenda, therefore, is not only confined to looking for treatment interventions based on the best evidence. It should also consider addressing access and availability of the health service, and the institutional architecture to support a quality health service or intervention. Defining of roles and responsibilities of personnel at various levels of care within the organization and the aligning of other resources necessary for delivery are vital parts of it also. In the Philippines, the National Unified Health Research Agenda (NUHRA) came about as it reflects the health needs of the Filipinos. The NUHRA creates a template for health research in these specific areas in a 5-year scope.3 The Philippine General Hospital (PGH) has included health service delivery as one of its top research agenda. In the past 4 years that it has established such, many of the research outputs have addressed specific disease interventions, hospital processes, and personnel welfare and readiness. There are still, however, a lot of gaps and questions that remain to be addressed. The papers on this fourth issue of the PGH for Acta Medica Philippina are diverse in scope but are all products of the authors’ questions that needed addressing in order to improve delivery of care to the PGH patients. May the impact of the results of these research endeavors truly make a difference in the lives of the patients the National University Hospital serves.