OBJECTIVES

A growing body of evidence points to a positive association between periodontitis and
various systemic diseases, including cardiovascular diseases (CVD), hypertension, and rheumatoid arthritis. However,
there is limited data on the prevalence and odds of having systemic conditions among Filipino periodontal patients.
Thus, this study aimed to determine the association of periodontal disease with systemic conditions among Filipino
patients at a university dental clinic.

METHODS

The periodontal and medical charts of all patients who underwent periodontal consult at a university
dental clinic within two academic years were reviewed. Periodontal diagnoses which had originally been assigned
using the 1999 classification of periodontal diseases were reclassified based on the 2018 European Federation
of Periodontology-American Academy of Periodontology classification. Listed medical conditions in the patients’
charts were self-reported. The prevalence of various systemic conditions in 715 periodontitis cases was compared
to that of 834 control patients without periodontitis. Fisher’s exact test was performed to evaluate the difference
in the prevalence of comorbidities between groups, while adjusted odds ratios (AOR) were computed using logistic
regression analysis, accounting for age, sex, educational attainment, and smoking status.

RESULTS

The prevalence of having at least one systemic condition was significantly higher among periodontitis patients
(44.5%) compared to non-periodontitis patients (36.3%). Compared to controls, a significantly higher number of
periodontitis cases had two systemic comorbidities (P=0.001). The prevalence of hypertension (18.6% versus 5.04%),
CVD including hypertension (20.42% versus 6.95%), arthritis (9.37% versus 3.0%), and diabetes mellitus (5.73% versus
0.84%) were all significantly higher in patients with periodontitis compared to non-periodontitis controls.
The odds of having CVD (AOR=1.81), hypertension (AOR=2.14) and diabetes (AOR=3.05) were higher in periodontitis cases. Meanwhile, the prevalence of asthma (9.23% versus 5.31%), respiratory diseases including asthma (12.95% versus 8.25%), and allergies (18.82% versus 13.71%) were significantly higher in non- periodontitis patients compared to periodontitis cases.

CONCLUSION

Periodontitis patients were more likely to present with CVD, hypertension, and diabetes mellitus. On the other hand, no association was found between periodontitis and respiratory diseases, as well as between periodontitis and asthma.

Human ; Male ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Regression (psychology) ; Respiratory Tract Diseases ; Regression Analysis ; Periodontal Diseases ; Cardiovascular Diseases

Hyalinizing clear cell carcinoma of the salivary gland is a rare neoplasm, accounting for only less than 1% of malignancies arising from the salivary gland. It is molecularly defined by the expression of the EWSR-ATF1 fusion oncogene. To date, there has been no previous studies published yet in the Philippines regarding the existence of this tumor. In this paper, we present a case of a 70-year-old elderly female who had a 10-year history of a gradually enlarging left lateral neck mass. Histopathologic examination showed a tumor arranged of cords, nests, and trabeculae of monomorphic round cells with abundant clear to lightly eosinophilic cytoplasm surrounded by thick hyalinized collagen bundles. Immunohistochemistry and molecular studies were done which revealed a positive p63 staining, negative SMA and S100, and an EWSR1 rearrangement in Fluorescence in situ hybridization (FISH), thus, confirming the diagnosis.

Human ; Female ; Aged: 65-79 Yrs Old ; Carcinoma ; Immunohistochemistry

Basal cell carcinoma, the most common human malignancy, has a rare incidence of metastases ranging from 0.0028-0.55%. We report a case of a 74-year-old female with a 10-year history of an enlarging anterior thigh nodule. Wide resection and inguinal lymph node dissection revealed an infiltrative basal cell carcinoma with lymph node metastasis due to the presence of basaloid cells, limited peripheral palisading, loose stroma, extensive spread, perineural invasion and immunoreactivity to p40, BerEP4, and GATA3.

Human ; Female ; Aged: 65-79 Yrs Old ; Carcinoma, Basal Cell ; X-ray

Ocular cicatricial pemphigoid (OCP) is a chronic bilateral, blinding, cicatrizing form of conjunctivitis with relapsing and remitting periods. It has strong evidence for an immune type II hypersensitivity that leads to subconjunctival fibrosis and extensive systemic bullae formation. To the best knowledge of the authors, this is the first reported case of direct immunofluorescence (DIF) assay-proven OCP in an elderly Filipino man.

A 68-year-old male presented with bilateral corneal conjunctivalization, symblepharon, ectropion, conjunctival hyperemia testing positive with conjunctival biopsy for basement membrane antibodies with DIF for the left eye, while turning out negative for the right eye. He was managed as a case of OCP, both eyes, and was given topical steroids and antibiotics. Oral Dapsone was started by Dermatology and Rheumatology Services.

OCP is a rare autoimmune and blinding disease. Early diagnosis and prompt treatment are vital as ocular complications permanently affect the quality of life of patients as seen in our patient. DIF assay remains the gold-standard for diagnosis. Systemic immunosuppression is the mainstay of treatment. Adjunctive supportive topical medication may be given to alleviate ocular discomfort. A multidisciplinary approach is essential to provide holistic care to each patient.

Human ; Male ; Aged: 65-79 Yrs Old ; Ocular Cicatricial Pemphigoid ; Pemphigoid, Benign Mucous Membrane ; Direct Immunofluorescence Assay ; Fluorescent Antibody Technique, Direct

Myeloid sarcoma is a tumor that demonstrates extramedullary proliferation of myeloid blasts with or without maturation. It may present as an isolated tumor or may have peripheral or marrow involvement. The diagnosis of myeloid sarcoma is highly challenging as it may mimic other tumors.

A 71-year-old woman with an Eastern Cooperative Oncology Group (ECOG) performance score of 2 presented with a progressively enlarging right facial mass that had been growing for 18 months. Initially, it appeared as a 1x1 cm erythematous pustular lesion. A core biopsy suggested carcinoma, but COVID-19 delayed immunohistochemical (IHC) testing.

As the mass grew, eventually covering more than half of her face, a CT scan revealed a large, multilobulated mass involving the periorbital areas, nose, and upper lip. A repeat biopsy showed atypical round cell proliferation, and immunohistochemical staining confirmed myeloid sarcoma with CD34 and CD117 positivity. Bone marrow aspiration and biopsy ruled out leukemia.

The diagnosis of non-leukemic myeloid sarcoma was established. The patient was referred to plastic surgery, ophthalmology, and otorhinolaryngology for co-management of the mass. Initial treatment began with azacitidine, a hypomethylating agent. However, after completing only one cycle of chemotherapy, she declined further treatment for personal reasons, choosing not to continue with the planned therapeutic regimen.

Non-leukemic myeloid sarcoma of the face in an elderly patient is rare. Diagnosis was confirmed via biopsy and immunohistochemical studies. Treatment with azacitidine was chosen based on the patient’s ECOG score of 2. However, there is no consensus on its management, and the role of systemic chemotherapy remains debated. Continuous monitoring for progression to acute myeloid leukemia (AML) is crucial, as early detection significantly impacts prognosis and informs treatment decisions.

Human ; Female ; Aged: 65-79 Yrs Old ; Sarcoma, Myeloid ; Leukemia, Myeloid, Acute

BACKGROUND AND OBJECTIVE

Type II Diabetes Mellitus remains a pressing public health concern among Filipino adults, particularly prevalent in urban households belonging to the middle to richest wealth population. As body composition influences glucose metabolism, understanding the potential of anthropometric parameters is vital in predicting fasting blood sugar. This study aims to generate and find the most appropriate model that can detect likelihood of elevated FBS using different anthropometric parameters.

METHODS

The data set from 2018-2019, 2021 Expanded National Nutrition Survey of Department of Science and Technology - Food and Nutrition Research Institute, consisting of 14,655 adults aged 18–65 years from 33 highly urbanized cities (HUCs) was used in this study. While controlling for study variables, multiple logistic regression was used to determine significant predictors affecting the fasting blood sugar (FBS) status of these adults.

RESULTS

The above normal status of each anthropometric parameter, in the models for BMI (aOR=2.33; pCONCLUSION

There is no single anthropometric parameter that can truly discern the status of elevated FBS. However, it appears the use of waist circumference and waist-hip ratio have the potential to be an indicator especially in settings where the evaluation of the actual FBS of the individuals is not feasible. Future research suggests exploring possible interaction of BP, and FBS, diet quality and adequacy, and the effectiveness of having multiple anthropometric parameters in one model.

Human ; Male ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Diabetes Mellitus, Type 2

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.

Human ; Male ; Aged: 65-79 Yrs Old ; Lymphadenopathy

Contarini’s syndrome refers to the occurrence of bilateral pleural effusion which has different causes for each hemithorax. Based on extensive literature search, this is a rare finding and to date, only two published cases have recorded tuberculous effusion on one side. In this paper, the authors aim to present a case of Contarini’s syndrome, and to give emphasis that such condition with different etiologies exists and should be considered in managing bilateral effusion. This is a case of a 69-year-old female with a 7-week history of dyspnea, 2-pillow orthopnea, fever, and right-sided chest discomfort. Patient sought consultation and was prescribed with Diclofenac and Cefalexin with no relief. Patient was then admitted and intubated due to worsening dyspnea. Patient was managed as COVID-19 confirmed critical with viral myocarditis, CAP-HR, and diabetic ketoacidosis. Initial chest x-ray showed right-sided pleural effusion. Thoracentesis was done and revealed exudative pleural fluid (PF) with WBC of 20,000 with neutrophilic predominance and negative RT-PCR MTB. Cytology revealed acute inflammatory pattern. Klebsiella pneumoniae ESBL was isolated. Antibiotics were shifted to levofloxacin and meropenem. Repeat chest x-ray showed left-sided pleural effusion. Thoracentesis was done and revealed exudative PF with WBC of 1,680 with neutrophilic predominance. No organism was isolated. RT-PCR for MTB was detected. Thus, anti-TB therapy was initiated. However, ETA TB culture showed resistance to isoniazid, rifampicin, and pyrazinamide. Patient was referred to PMDT for MDR-TB treatment. Bilateral effusion has resolved with no recurrence, and with uneventful removal of bilateral chest tubes. Patient was eventually extubated and transferred to the ward. Patient however developed HAP, was re-intubated and eventually expired due to the septic shock from VAP. This case report highlights the importance of weighing risk versus benefit in deciding to perform bilateral thoracentesis when there is a clinical suspicion of an alternate or concurrent diagnosis.

Human ; Female ; Aged: 65-79 Yrs Old ; Pleural Effusion ; Thoracentesis ; Covid-19

Augmentation intestinal cystoplasty is usually the preferred method. However, this is complicated by mucus production, recurrent infection and cystolithiasis. In this report, the authors present a unique case of laparoscopically-assisted ureterocystoplasty and describe the operative technique and its advantages.

A 68-year-old female with a contracted urinary bladder and a solitary functioning kidney was diverted with a percutaneous nephrostomy tube for the past ten years. She consulted for a possible reconstructive procedure.

After a comprehensive preoperative evaluation, she underwent laparoscopically-assisted ureterocystoplasty. The operative time was 265 minutes with minimal blood loss. She had an unremarkable postoperative course. On follow-up, a voiding diary revealed urine volume of around 300 milliliters at 3 hour intervals, preservation of renal function, and no evidence of urinary infection.

Ureterocystoplasty was done using a combination of minimally invasive and open techniques. This procedure spared the patient a lifelong diversion with a nephrostomy tube and provided a better quality of life.

Human ; Female ; Aged: 65-79 Yrs Old ; Nephrostomy, Percutaneous

Repair of complex aortic aneurysms such as those involving the thoracoabdominal and pararenal aorta presents a formidable challenge for surgeons with significant perioperative morbidity and mortality. A hybrid procedure combining renovisceral debranching with endovascular aneurysm exclusion has been developed as an alternative approach for high-risk patients. This paper reports our initial experience with hybrid repair for these complex aortic diseases in three high-risk patients.

Human ; Male ; Aged: 65-79 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aorta ; Aortic Aneurysm ; Endovascular Procedures