Occult Breast Carcinomas (OBCs) are rare. History and physical examination alone may lead to misdiagnosis hence inappropriate investigative and treatment modalities. Diagnosis is difficult without tissue biopsy and extensive immunohistochemical staining. Presented here is a 74-year-old Filipino male with a 2-month history of axillary mass with erythematous skin, initially assessed as hidradenitis suppurativa failing to resolve with antibiotics. An excision biopsy revealed adenocarcinoma within the lymph nodes. Immunohistochemical stains confirmed a breast primary. Radiologic imaging showed no breast lesions and no distant metastasis. Axillary node dissection done showed metastasis to 5 in 14 nodes harvested, classifying him as OBC Stage IIIA (cT0pN2M0). He completed whole breast radiotherapy and chemotherapy. No tumor recurrence was documented thereafter. Although misdiagnosis is common, OBC is a condition to consider in male patients presenting with axillary lymphadenopathy.

Vulvar Rhabdomyosarcoma (VR) is a rare gynecological cancer primarily found in children. This case report discusses the diagnosis, treatment, and management complexities of a 19-year-old patient with a slow-growing vulvar lesion.

A 19-year-old female with obesity and non-alcoholic fatty liver disease presented with a left vulvar lesion measuring 11 x 7 x 7 cm that was noticed five months ago. Core needle biopsy of the lesion revealed findings consistent with rhabdomyosarcoma. A Positron Emission Tomography-Computed Tomography (PET-CT) scan showed a hypermetabolic 8.3 x 6.7 x 6.7 cm mass in the left vulvar area, extending to the vagina, rectal wall, and anal region along with enlarged left inguinal lymph nodes.

The patient was treated with the Intergroup Rhabdomyosarcoma Study-IV (IRS-IV) protocol for 16 weeks with vincristine, dactinomycin, and cyclophosphamide. Concurrent chemoradiotherapy was administered between weeks 9-14, followed by continuation chemotherapy until week 28. Interim PET-CT scan prior to concurrent chemoradiotherapy revealed a reduced mass size to 3.8 x 2.8 cm and resolved left inguinal lymphadenopathy.

Despite completing treatment, the patient reported persistent back pain and mobility issues three weeks later. A subsequent PET-CT scan showed hypermetabolic lesions at vertebral locations C6, T9, T12, and L1-L3, along with the left ischium and bilateral femoral shafts. Thoracic vertebrae biopsy confirmed rhabdomyoblasts. Patient underwent palliative radiotherapy and spinal stabilization then proceeded with second line therapy with 1 cycle of GemcitabineDocetaxel but showed progression of symptoms described as persistent bleeding (hematuria) and neutropenia. Further diagnostics done to the patient showed possible bone marrow involvement. Unfortunately, the patient expired owing to symptoms of cancer progression.

The management of adult-onset VR presents a significant therapeutic challenge, largely attributable to the scarcity of clinical trials and tailored treatment regimens for this specific age group. Outcomes documented in existing literature for adult VR cases present with recurrence, disease progression, and mortality. The treatment landscape in adults is complicated by comorbidities which may influence both the therapeutic choices and outcomes. Given these intricate challenges, this case echoes the need for research efforts aimed at developing management protocols specifically designed for adults with VR.

BACKGROUND AND OBJECTIVE

Within a decentralized health system, barangay health workers (BHWs) are often the first point of contact for Filipinos seeking care. Despite their importance, BHWs are neglected in the health value chain. The study seeks to examine the lived experiences of BHWs, particularly their journey in navigating their roles within the community and the health system that encompasses their day-to-day realities, challenges, motivations, and the meanings they derive from their work.

The study draws on seven focus group discussions (FGDs) with BHWs (n=50), residents (n=7), and local government officials and health workers (n=7) of San Miguel, Bulacan. The qualitative data collected were analyzed using thematic analysis.

Findings show that BHWs perform many roles, which are not limited to health and are dependent on orders from their superiors. Guidelines are vague in appointing BHWs, with personal connections valued more than technical qualifications. Their accreditation is hardly conferred any significance. There is also a lack of formal and structured training. The informality of these processes leads to an absence of quality assurance on rendered health services. The non-provision of incentives and benefits stipulated in RA 7883 also places their health and lives at risk. Furthermore, BHW’s commitment to serve is used to excuse the inadequacy of their compensation and excessive workload.

BHWs take on diverse roles, from community organizers to healthcare providers, and are confronted with significant challenges encompassing politicization, inadequate training, and insufficient compensation. The study concludes with policy recommendations to improve the conditions of the neglected BHWs, with particular attention to coordinating, capacitating, compensating, career pathing, and connecting them to the health system.

Objective: Intestinal remnant chylomicrons (CMs) are involved in cardiovascular residual risk and the atherogenic process. Microsomal triglyceride transfer protein (MTTP) catalyzes the assembly of lipids to apolipoprotein B48, generating CMs. Dysbiosis could alter this behavior. This study investigated the chemical composition of CMs and their associations with intestinal MTTP and gut fat depots in a diet-induced dysbiosis animal model. Methods: Male Wistar rats were fed either a standard diet (control, n=10) or a high-fat high-sucrose diet (HFSD, n=10) for 14 weeks. Measurements included serum glucose, lipid-lipoprotein profile, free fatty acids (FFAs), lipopolysaccharide (LPS) and the Firmicutes/ Bacteroidetes (F/B) ratio in stool samples, via real-time quantitative polymerase chain reaction.Lipid content in isolated CMs (ultracentrifugation d <0.95 g/mL) was assessed, and MTTP, cell intestinal fat content (CIF), histology, apoB mRNA and tight junction (TJ) proteins were analyzed, in intestinal tissue. Results: Compared to control, HFSD rats showed higher levels of LPS, triglycerides (TGs), non-high-density lipoprotein cholesterol (HDL-C) levels, TG/HDL-C ratio, FFAs, and the F/B ratio. HFSD CMs showed increased TG and phospholipids. TJ proteins levels were lower in the HFSD group, while histological scores showed no differences. CIF was increased in the HFSD group. No significant differences in apoB mRNA were found. MTTP expression was higher in the HFSD group, and directly correlated with CM-TG and inversely correlated with CIF. Conclusion Our findings imply that gut TG content may constitute an important determinant of the secretion of TG-rich CMs, promoted by MTTP, with increased atherogenic potential.

Objective: Childhood obesity, affected by dietary choices, increases cardiovascular risk.Obesity is associated with inflammation and altered glucose, iron and lipid metabolism. This study explores connections between dietary habits, plasma fatty acid profile, cardiovascular risk factors and childhood obesity. Methods: We conducted a case-control study including 20 children and adolescents with obesity and 20 controls. Anthropometric parameters and food frequency questionnaires were registered. Glucose metabolism, iron parameters, lipid profile, fatty acids profile, and lipoprotein-associated phospholipase A 2 (Lp-PLA2 ), cholesteryl ester transfer protein and paraoxonase 1 (PON 1) activities were evaluated. Correlation, regression and mediation analyses were performed. Results: The group with obesity consumed more bakery products and less cereals, and presented higher myristic, palmitoleic, margaric and gamma-linolenic acids, along with lower linoleic, arachidic, gadoleic, eicosatrienoic and eicosapentaenoic (EPA) acids (p<0.05). They also exhibited altered glucose metabolism, a more atherogenic lipid profile, higher Lp-PLA2 and lower PON 1 activities (p<0.05). Consumption of several food groups correlated with metabolic alterations. Different correlations between pro-inflammatory, antiinflammatory and obesity-related fatty acids, and cardiometabolic biomarkers were found, including: myristic acid with Lp-PLA2 (r=0.32, p<0.05), EPA acid with hs-CRP (r=−0.36, p<0.05) and gadoleic acid with PON1 (r=0.39, p<0.05). Mediation analyses revealed fatty acids and cardiometabolic markers as mediators of the association between dietary habits and obesity. Conclusion Children and adolescents with obesity presented disrupted glucose and lipid metabolism, vascular inflammation, attenuated antioxidant function and altered fatty acid composition. Direct and indirect associations between dietary habits, fatty acids, cardiometabolic markers and the presence of obesity were found.

Objective: Intestinal remnant chylomicrons (CMs) are involved in cardiovascular residual risk and the atherogenic process. Microsomal triglyceride transfer protein (MTTP) catalyzes the assembly of lipids to apolipoprotein B48, generating CMs. Dysbiosis could alter this behavior. This study investigated the chemical composition of CMs and their associations with intestinal MTTP and gut fat depots in a diet-induced dysbiosis animal model. Methods: Male Wistar rats were fed either a standard diet (control, n=10) or a high-fat high-sucrose diet (HFSD, n=10) for 14 weeks. Measurements included serum glucose, lipid-lipoprotein profile, free fatty acids (FFAs), lipopolysaccharide (LPS) and the Firmicutes/ Bacteroidetes (F/B) ratio in stool samples, via real-time quantitative polymerase chain reaction.Lipid content in isolated CMs (ultracentrifugation d <0.95 g/mL) was assessed, and MTTP, cell intestinal fat content (CIF), histology, apoB mRNA and tight junction (TJ) proteins were analyzed, in intestinal tissue. Results: Compared to control, HFSD rats showed higher levels of LPS, triglycerides (TGs), non-high-density lipoprotein cholesterol (HDL-C) levels, TG/HDL-C ratio, FFAs, and the F/B ratio. HFSD CMs showed increased TG and phospholipids. TJ proteins levels were lower in the HFSD group, while histological scores showed no differences. CIF was increased in the HFSD group. No significant differences in apoB mRNA were found. MTTP expression was higher in the HFSD group, and directly correlated with CM-TG and inversely correlated with CIF. Conclusion Our findings imply that gut TG content may constitute an important determinant of the secretion of TG-rich CMs, promoted by MTTP, with increased atherogenic potential.

Objective: Childhood obesity, affected by dietary choices, increases cardiovascular risk.Obesity is associated with inflammation and altered glucose, iron and lipid metabolism. This study explores connections between dietary habits, plasma fatty acid profile, cardiovascular risk factors and childhood obesity. Methods: We conducted a case-control study including 20 children and adolescents with obesity and 20 controls. Anthropometric parameters and food frequency questionnaires were registered. Glucose metabolism, iron parameters, lipid profile, fatty acids profile, and lipoprotein-associated phospholipase A 2 (Lp-PLA2 ), cholesteryl ester transfer protein and paraoxonase 1 (PON 1) activities were evaluated. Correlation, regression and mediation analyses were performed. Results: The group with obesity consumed more bakery products and less cereals, and presented higher myristic, palmitoleic, margaric and gamma-linolenic acids, along with lower linoleic, arachidic, gadoleic, eicosatrienoic and eicosapentaenoic (EPA) acids (p<0.05). They also exhibited altered glucose metabolism, a more atherogenic lipid profile, higher Lp-PLA2 and lower PON 1 activities (p<0.05). Consumption of several food groups correlated with metabolic alterations. Different correlations between pro-inflammatory, antiinflammatory and obesity-related fatty acids, and cardiometabolic biomarkers were found, including: myristic acid with Lp-PLA2 (r=0.32, p<0.05), EPA acid with hs-CRP (r=−0.36, p<0.05) and gadoleic acid with PON1 (r=0.39, p<0.05). Mediation analyses revealed fatty acids and cardiometabolic markers as mediators of the association between dietary habits and obesity. Conclusion Children and adolescents with obesity presented disrupted glucose and lipid metabolism, vascular inflammation, attenuated antioxidant function and altered fatty acid composition. Direct and indirect associations between dietary habits, fatty acids, cardiometabolic markers and the presence of obesity were found.

Advances in neuromuscular medicine have ushered in a new era of discovery and research. Innovations have emerged in fascicular electrodiagnosis, high-frequency musculoskeletal ultrasound, and treatments for neuromuscular diseases. This article discusses the latest discoveries impacting neuromuscular medicine. These include the development of fascicular nerve clinics, the integration of artificial intelligence, and explorations in space medicine. In education, neuromuscular fellowships are being established to meet these evolving needs. Just as the historic journey to the moon spawned a new space race, neuromuscular medicine has entered a period of renaissance.

Hemosuccus pancreaticus (HP) is characterized by hemorrhage from the pancreatic duct through the major duodenal papilla. It represents the least common cause of upper gastrointestinal bleeding (UGIB), occurring in approximately 1 in 1,500 cases and predominantly affecting men. A 58-yearold woman with a history of recurrent pancreatitis presented with severe epigastric pain, vomiting, and diarrhea. Laboratory tests revealed hyperamylasemia. Imaging indicated acute necrohemorrhagic pancreatitis with peripancreatic fluid collections. Despite interventions including drainage and antibiotic therapy, she developed massive hematemesis and hemodynamic instability. Computed tomography indicated active bleeding in the peripancreatic region, and angiography confirmed a diagnosis of HP. Embolization of the gastroduodenal artery was performed; however, the patient died of multiorgan failure. HP, although rare, should be considered in patients with chronic pancreatitis and intermittent UGIB. Diagnosing HP can be challenging, requiring collaboration between gastroenterologists and interventional radiologists. Early intervention is crucial due to the high mortality rate associated with severe cases.