INTRODUCTION

Acute coronary syndrome (ACS) and end-stage renal disease (ESRD) are both prevalent globally. The diagnosis and management of ACS in ESRD is difficult because the interplay of cardiovascular and renal disease is complicated. The guidelines for ACS may not be applicable to the ESRD population because the trials from which these are drawn mostly excluded ESRD patients.

To determine the clinical profile and outcomes of CKD patients on dialysis admitted for ACS in the Philippine General Hospital (PGH).

We did a retrospective cohort study and employed a retrospective review of electronic medical records among ESRD patients presenting with ACS in PGH from May 2021 to November 2023. The collected data was analyzed using univariate and bivariate statistics using PRISM software.

A total of 48 patients with ESRD were admitted for ACS in this study – 8 with STEMI and 40 with NSTEMI. The mean age was 61 years old and 33 (68.8%) were male. Among those with STEMI, six (75%) presented with Kilip II or more. While among those with NSTEMI, 17 (42.5%) had a GRACE score >140 and 27 (67.5%) had an NSTEMI TIMI risk score >2. On average, the patients were on hemodialysis for 31 months prior to admission. The most common comorbidities were hypertension (91.7%) and heart failure (83.3%). On admission, 18 (37.5%) presented with SBP >160, 7 (14.6%) patients presented with shock, and 4 (8.3%) patients presented with cardiac arrest. 38 (79.2%) patients had anemia on admission. 21 (43.8%) patients had left ventricular hypertrophy on electrocardiogram while 34 (70.8%) patients had cardiomegaly on chest radiography. The average left ventricular ejection fraction on echocardiogram was 46% and 27 (90%) patients had segmental wall motion abnormalities. The most common angiographic finding was 3-vessel coronary artery disease seen in 50% of patients. Almost all patients received dualantiplatelet therapy, high dose statin, and beta-blocker. The mortality rate was high at 43.8% with cardiovascular causes being the most common cause of death.

This study demonstrates the high mortality rate among patients with ESRD presenting with ACS. Our study portrays that patients with ESRD present with higher risk features including abnormalities in vital signs, laboratories, imaging, high prognostications score, and high in-hospital morbidity.

BACKGROUND AND OBJECTIVES

Staphylococcus aureus poses a significant public health threat globally, where both community and hospital-acquired infections are prevalent. The escalating antimicrobial resistance highlights the urgent need for alternative therapies. Hence, traditional medicine using plant extracts offers a potential avenue for novel antibacterial agents. This systematic review aimed to evaluate the existing literature on the antibacterial properties of Philippine plants against S. aureus to provide focus on drug development of a plant-derived antibacterial for this pathogen.

Following PRISMA guidelines, a comprehensive search was conducted in PubMed/Medline, SCOPUS, and Herdin databases. Inclusion criteria encompassed in-vitro studies evaluating the antibacterial activity of crude plant extracts sourced from Philippines plants against S. aureus. Data extraction and quality assessment were performed independently by two reviewers, with discrepancies resolved by the third and fourth reviewers.

Of the 413 initial studies identified, nine (9) met the eligibility criteria. The highest zone of inhibition was demonstrated by Lippia micromera L. leaf essential oil at 26.3±1.5 mm, while moderate antibacterial activity was shown by essential oils from Alpinia elegans, Piper quinqueangulatum, and Alpinia cumingii at MIC values of 512 µg/mL, 512 µg/mL, and 1,024 µg/mL, respectively. Other Philippine plants showed a wide range of activity, with MIC values between 50 ?g/mL and 25 mg/mL, MBC values from 78 to 5000 ?g/mL, and ZOI ranging from 5 to 38 mm. However, the overall quality of evidence in these other studies are compromised by bias and incomplete reporting.

Leaf essential oils from Alpinia elegans, Piper quinqueangulatum, and Alpinia cumingii demonstrated moderate antibacterial activity against S. aureus. Additionally, the essential oils of Lippia micromera L., Plectranthus amboinicus Lour. Spreng, and Cymbopogon citratus exhibited antibacterial activity against both S. aureus and Methicillin-resistant S. aureus (MRSA) in disk diffusion assays. Majority of the studies gathered had high risk of bias according to the quality assessment criteria tool used in the study. Thus, this systematic review also emphasizes the need for improved methodological rigor on reported in-vitro antibacterial studies.

BACKGROUND AND OBJECTIVE

Self-assessment and metacognition can be practiced with an exam wrapper (EW). EW is a structured, metacognitive, and self-regulated learning strategy that involves guided self-reflection on an exam already taken to improve study habits. This research describes how internal medicine (IM) residents at two tertiary private hospitals performed in written examinations using an EW. The relationship between the residents' metacognition, the exam wrapper, and exam performance was also determined.

This study employed a pre-experimental pre- and post-test design. The EW was constructed and tested for validity and reliability. It included (1) a description of study habits, (2) accuracy in self-efficacy perception and exam score prediction, (3) perceived reasons for exam mistakes, and (4) future study plans of residents. A complete enumeration of 24 IM residents was conducted. Respondents completed the Metacognitive Awareness Inventory (MAI) at the beginning of the study. The intervention consisted of (1) residents taking Exam 1: Gastroenterology, followed by EW; (2) Exam 2: Endocrinology and EW; then (3) Exam 3: Oncology, EW, and MAI. Scores were compared using a paired t-test or analysis of variance (ANOVA). The relationships between metacognition scores, the EW, and exam performance were determined using the Pearson correlation coefficient. The level of significance was set at p < 0.05.

The final EW comprises 16 items, with overall indices of content validity ratio of 0.72 and item-rated content validity of 0.8. The internal consistency coefficient is 0.65 (Kuder-Richardson 20). Nineteen out of 24 residents (79.17%) completed the study. Mean exam percentage scores were 57.97%, 42%, and 51.16% for Exams 1, 2, and 3, respectively. Exam 2 differed significantly from the other two exams (p = 0 and p = 0.04). EWs for the first two exams were not significantly different and revealed: (1) top study habits included studying right before an exam and skimming the textbook; (2) 68.42% vs. 63.16% accuracy of selfefficacy perception; (3) 26.32% vs. 31.58% accuracy of grade estimation; (4) 31.58% vs. 26.32% accuracy of error analysis; (5) most errors were due to not reading about the topic, and (6) most planned to “read more." Mean MAI scores were 36.79 ± 9.10 (pretest) and 36.05 ± 9.44 (post-test) (p = 0.81). All correlations were not statistically significant.

Residents performed poorly during exams, crammed their studies, preferred low-impact learning strategies, and lacked self-reflection skills and metacognition monitoring. Time issues related to reading or studying were common. There is no significant relationship between metacognition score and exam wrapper use or exam performance in IM residency trainees.

Parasitic dermoid cysts may form from autoamputation of the ovarian mass secondary to torsion or rupture. It may then reimplant in surrounding structures and undergo subsequent neovascularization and further growth. The true incidence of these cases is unknown, however, a study reported a 0.04% incidence among 1,007 cases of dermoid cysts. This report describes the case of a 30-year-old multigravida who presented with an ultrasound finding of an ovarian dermoid cyst, which, upon laparoscopic surgery, turned out to be a parasitic dermoid cyst adherent to the bladder, with grossly normal bilateral ovaries. Theories on the development of parasitic dermoid cyst are also presented.
Human ; Female ; Adult: 25-44 yrs old ; dermoid cyst ; laparoscopy

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic has disrupted the sports industry, resulting in the postponement of events worldwide. This posed a significant burden in the mental and emotional well-being of athletes due to uncertainties and diminished training levels. As an adaptation, bubble camps emerged as a new approach to resuming training and tournaments under stringent regulations of the COVID-19 protocols. In the national context, the University Athletic Association of the Philippines (UAAP) has adapted the bubble set-up by implementing antigen testing, RTPCR, and other health protocols as a prerequisite to bubble training. However, uncertainties in the future of sports continue to present as a psychological toll to the well-being of student-athletes despite the sense of normalcy instilled by bubble training. Existing literature on bubble training is grounded heavily on the quantitative assessments of an athlete's well-being in a bubble set-up and its effectiveness in mitigating COVID-19 transmission, thereby lacking insights that may be obtained from qualitative data. This study explored the experiences of UAAP Season 84 studentathletes in a bubble set-up by examining personal and contextual factors that impacted their well-being.

The study employed a qualitative descriptive phenomenological approach based on Seligman's WellBeing Theory. A purposeful sampling technique was used to recruit UAAP student-athletes through online dissemination of Google Forms for recruitment. Only three student-athletes from UAAP fit the eligibility criteria. Data were collected through on-site and online interviews using a semi-structured interview guide to reveal a narrative of the student-athletes' bubble training experiences, common themes, and patterns. The NVivo software program was used for data analysis, utilizing a deductive thematic approach.

The lived experiences of three UAAP studentathletes were classified into six major themes: (1) Availability and Accessibility of Services; (2) Restrictions; (3) Mental Health; (4) Fostering Relationships; (5) Support Systems; and (6) Individual Growth. Accounts of both positive and negative training perceptions and outcomes regarding the bubble set-up were noted from all student-athletes. The set-up provided studentathletes with easy access to training facilities and services, eventual development of mental fortitude and  perseverance, improved interpersonal relationships, and opportunities for individual growth. However, the restrictions, isolation, internal and external pressures, and routinary nature of the set-up contributed to the elevated levels of stress and anxiety, eventually leading to fatigue and burnout.

The study elucidates on the multi-faceted experiences of UAAP student-athletes in bubble training, underpinning the essence of the adequacy of training services and facilities, enhanced support systems, and prompt policy development that caters to improving the holistic well-being of student-athletes amidst adverse changes in the trajectory of sports.

Vascular aging plays a key role in the induction of human aging and serves as the pathological basis for the occurrence and development of atherosclerosis (AS), myocardial fibrosis, and hypertension. Research suggests that vascular aging is the initiating link in the aging process of the body, and cellular senescence is a key mechanism of vascular aging. The process of vascular aging mainly involves the senescence of endothelial cells (ECs) and smooth muscle cells. This review, therefore, focuses on the molecular mechanisms related to telomere dysfunction, oxidative stress, and metabolic disorders involved in senescence of ECs, elaborating on the correlation between the senescence of endothelial cells and the development of vascular dysfunction, AS, myocardial fibrosis, hypertension, and other cardiovascular diseases (CVDs), and at the same time, systematically summarizes the relevant treatment strategies with western medicines, traditional Chinese medicine formulas, and monomers, to provide some theoretical reference for subsequent treatment and research.

Objective To analyze the degeneration parameters of the multifidus muscle at the disjunc-tion in patients with isthmus spondylolisthesis and its correlation with the degree of spondylolisthesis.Meth-ods A retrospective analysis was conducted on the medical records and MRI imaging data of 59 patients with isthmus spondylolisthesis who visited this hospital from January 2022 to July 2024.The degeneration parame-ters of multifidus muscle were selected and assessed as cross-sectional area(CSA)and percentage of fat infil-tration area(FIA%).CSA and FIA%of the multifidus muscle at the disjunction and the previous non-sliding disconnection segment were measured and compared using Image J software.The degree of spondylolisthesis was evaluated referring to the Meyerding standard,and the correlation was analyzed between CSA,FIA%of the multifidus muscle at the disjunction and the degree of spondylolisthesis.Results Among the 59 patients,there were 2 cases of L3 spondylolisthesis,27 cases of L4 spondylolisthesis and 30 cases of L5 spondylolisthe-sis.CSA of the multifidus muscle at the disjunction and the previous non-sliding disconnection segment were(882.22±236.01)mm2 and(845.59±263.37)mm2 respectively,the difference was not statistically significant(t=0.796,P=0.428).FIA%were 37.16%(25.56%,50.78%)and 33.26%(18.65%,43.04%)respective-ly,the difference was statistically significant(Z=-2.008,P=0.045).Among the 59 patients,50 cases(84.75%)had grade Ⅰ spondylolisthesis,9 cases(15.25%)had grade Ⅱ spondylolisthesis,there were no pa-tients with grade Ⅲ or Ⅳ spondylolisthesis.The degree of spondylolisthesis was correlated with FIA%(r=0.443,P<0.001),but not correlated with CSA(r=-0.188,P=0.153).Conclusion In patients with isth-mus spondylolisthesis,FIA%of the multifidus muscle at the disjunction is significantly higher than that in the previous non-sliding disconnection segment,and it is related to the degree of spondylolisthesis.However,CSA of the multifidus muscle at the disjunction showed no significant difference from that in the previous non-slid-ing disconnection segment and was not correlated with the degree of spondylolisthesis.FIA%is more accurate in assessing the severity of multifidus muscle degeneration than CSA.

Objective:To describe a novel approach for intractable Meniere's disease exclusively through a transcanal endoscopic ear surgery（TEES）. Methods:This retrospective chart review included patients with intractable Menière's disease who underwent endoscopic transcanal labyrinthectomy in the Department of Otolaryngology Head and Neck Surgery, Guangxi Hospital Division, First Affiliated Hospital, Sun Yat-sen University, between February 2023 and October 2024. The first 70-year-old woman and the other 67-year-old woman, who underwent multiple conservative treatment and chemical labyrinthectomy during outpatient and hospitalization, had frequent vertigo, tinnitus and severe sensorineural deafness. The TEES approach provided a wide exposure of the oval window. The incus and the stapes were removed, expanded the oval window. The perilymph was suctioned, The saccule, utricule, macula utriculi and macula sacculi were removed. The ampulla tissue of the three semicircular canal were destroyed with the right-angle crochet. The oval window was obliterated using the perichondrium of the tragal cartilage and cartilage. Results:Two patients underwent endoscopic transcanal labyrinthectomy, and no intraoperative or postoperative complications were observed. Vertigo was controlled in 2 patients during the follow-up of 6 to 12 months. Two patients complained of total hearing loss after surgery. Conclusion:Even though this study presents a limited number of cases, endoscopic transcanal labyrinthectomy is a promising, safe, and effective procedure in selected cases. Additional studies are needed to determine the risk-benefit profile of this technique.
Humans ; Aged ; Female ; Meniere Disease/surgery* ; Retrospective Studies ; Endoscopy/methods* ; Otologic Surgical Procedures/methods* ; Ear, Inner/surgery* ; Treatment Outcome

OBJECTIVE: Citri Reticulatae Pericarpium (Chenpi, CRP) is one of the most used traditional Chinese medicines with great medicinal, dietary and collection values, among which the Citrus reticulata cv. 'Chachi' (Citrus reticulata cv. Chachiensis) from Guangdong Xinhui is the geoherb of CRP. Xinhui CRP in the market was often counterfeited with other varieties or origins, molecular identification method can effectively distinguish different CRP varieties, but it's still a difficult problem to identify the same CRP variety from different origin. It is necessary to discover a new molecular marker to ensure the safe and effective application of Xinhui CRP. METHODS: We selected one of the most studied transcription factor families in Citrus genus, MYB, to design the specific candidate primers on the conserved region. The primers with good band repeatability and high polymorphism were screened for PCR amplification of the test materials, and the genetic similarity coefficient among different families, genera, species, and origins were calculated. The cluster analysis was performed by unweighted pair group method using arithmetic average (UPGMA). RESULTS: A total of ten MYB primers were screened out to identify Xinhui CRP from plants from different family (Panax ginseng and Morus alba), genus (Clausena lansium and Zanthoxylum schinifolium), and species (Citrus reticulata, C. sinensis and C. maxima). Furthermore, two from the ten primers, M1 and M10, were found to distinguish Xinhui CRP from other origins. There were 169, 113, 133 and 134 polymorphic bands in the identification of different families, genera, species, and origins respectively, and the accordingly polymorphism ration were 79.88%, 76.87%, 79.20% and 82.84%. Moreover, M1 was discovered to be the best primer to identify Xinhui CRP from other seven origins, the cluster analysis results based on the genetic similarity coefficients were consistent with the geographical distribution. CONCLUSION This study established a novel molecular identification method according to MYB transcription factor, which can analyze the potential parental relationship of CRP germplasm, as well as identify the quality and origins of Xinhui CPR.