Carotid web was described more than 50 years ago as an atypical fibromuscular dysplasia (FMD) subtype with highly supporting pathological evidence as intimal FMD. In the following decades, the transition from catheter angiography or digital subtraction angiography (DSA) to non-invasive imaging techniques and the dramatic decrease in pathological procedures contributed to the gradual loss of this information. Currently, attention on the carotid web has increased due to its association with cryptogenic ischemic stroke. In fact, the underlying hypothesis is that the morphological features of the carotid web may determine a thrombogenic potential with artery-to-artery embolism. The pathology of the carotid web allowed identification of small thrombi embedded in the web pouch, and the features of thrombi endovascularly retrieved from intracranial arteries are very similar. The diagnosis of carotid web is usually made by non-invasive techniques, such as computed tomography angiography, ultrasound, and magnetic resonance imaging, requiring the concordance of two different techniques for confirming the diagnosis. DSA is usually considered in cases of diagnostic uncertainty and when interventional treatment of ischemic stroke or carotid web is considered. Treatment options in symptomatic cases include medical therapy (single or dual antiplatelets) or interventional approach (surgery or stenting), but there are no randomized controlled trials about therapy. The main aim of this review is to present the current knowledge on carotid web, retrieving historical data and angiographic classifications of FMD, as well as to discuss the biological plausibility of the association with stroke in symptomatic cases and the need for an updated classification of FMD, together with prospective data.

Carotid web was described more than 50 years ago as an atypical fibromuscular dysplasia (FMD) subtype with highly supporting pathological evidence as intimal FMD. In the following decades, the transition from catheter angiography or digital subtraction angiography (DSA) to non-invasive imaging techniques and the dramatic decrease in pathological procedures contributed to the gradual loss of this information. Currently, attention on the carotid web has increased due to its association with cryptogenic ischemic stroke. In fact, the underlying hypothesis is that the morphological features of the carotid web may determine a thrombogenic potential with artery-to-artery embolism. The pathology of the carotid web allowed identification of small thrombi embedded in the web pouch, and the features of thrombi endovascularly retrieved from intracranial arteries are very similar. The diagnosis of carotid web is usually made by non-invasive techniques, such as computed tomography angiography, ultrasound, and magnetic resonance imaging, requiring the concordance of two different techniques for confirming the diagnosis. DSA is usually considered in cases of diagnostic uncertainty and when interventional treatment of ischemic stroke or carotid web is considered. Treatment options in symptomatic cases include medical therapy (single or dual antiplatelets) or interventional approach (surgery or stenting), but there are no randomized controlled trials about therapy. The main aim of this review is to present the current knowledge on carotid web, retrieving historical data and angiographic classifications of FMD, as well as to discuss the biological plausibility of the association with stroke in symptomatic cases and the need for an updated classification of FMD, together with prospective data.

Carotid web was described more than 50 years ago as an atypical fibromuscular dysplasia (FMD) subtype with highly supporting pathological evidence as intimal FMD. In the following decades, the transition from catheter angiography or digital subtraction angiography (DSA) to non-invasive imaging techniques and the dramatic decrease in pathological procedures contributed to the gradual loss of this information. Currently, attention on the carotid web has increased due to its association with cryptogenic ischemic stroke. In fact, the underlying hypothesis is that the morphological features of the carotid web may determine a thrombogenic potential with artery-to-artery embolism. The pathology of the carotid web allowed identification of small thrombi embedded in the web pouch, and the features of thrombi endovascularly retrieved from intracranial arteries are very similar. The diagnosis of carotid web is usually made by non-invasive techniques, such as computed tomography angiography, ultrasound, and magnetic resonance imaging, requiring the concordance of two different techniques for confirming the diagnosis. DSA is usually considered in cases of diagnostic uncertainty and when interventional treatment of ischemic stroke or carotid web is considered. Treatment options in symptomatic cases include medical therapy (single or dual antiplatelets) or interventional approach (surgery or stenting), but there are no randomized controlled trials about therapy. The main aim of this review is to present the current knowledge on carotid web, retrieving historical data and angiographic classifications of FMD, as well as to discuss the biological plausibility of the association with stroke in symptomatic cases and the need for an updated classification of FMD, together with prospective data.

BACKGROUND

Pneumococcal vaccination has been widely used for the prevention of pneumococcal disease, with two types of vaccines available since 2009. With the World Health Organization (WHO) recommendation of incorporating pneumococcal conjugate vaccines (PCVs) in National Immunization Programs (NIPs) worldwide, a ten-valent PCV (PHiD-CV) was initially introduced in the Philippines in 2012. This, however, transitioned to the use of the 13-valent PCV (Prevnar) subsequent to the recommendation of the Formulary Executive Council in 2014.

This review aimed to present evidence on pneumococcal disease and vaccine inclusion in the Philippine NIP from 2005 - 2021.

This narrative review compiled articles on Pneumococcus from January 2005 to October 2021, sourcing literature from databases such as BIOSIS Preview, CAB Direct, Embase, Google Scholar, and others.

In the Philippines, there was a shift in prevalent serotypes of Streptococcus pneumoniae among children under five following the introduction of PCV13 in the National Immunization Program in 2014, with serotype 14 becoming the most common by 2018, and a significant reduction in isolates reported in 2020, where only serotypes 5, 19A, and 23F were identified among invasive strains. The immunogenicity results of a potential vaccine candidate should be factored into the overall evidence when conducting a reassessment of PCV.

As part of the decision making about the inclusion of the PCVs in the NIP of the Philippines, various factors such as local epidemiology, vaccine supply, cost, and programmatic characteristics must be careful weighed. Enhancing laboratory and surveillance capacity are essential to provide evidencebased decision-making in terms of existing serotype distribution and antimicrobial resistance (AMR) profile in the country. With the introduction of a new affordable formulation of a 10-valent PCV offering a comparable serotype coverage, the reassessment of choice of PCV with the consideration of all three formulations, namely PCV13, PHiD-CV, and SIIPL-PCV, may be warranted.

BACKGROUND

Gestational diabetes mellitus (GDM) may increase fetal abdominal fat mass, but its correlation with fetal abdominal circumference (AC) is inconsistent. This study compares third trimester fetal AC between adult pregnant patients with and without GDM, and between those managed with diet modification alone versus insulin therapy.

This retrospective cohort study involved 354 Filipino adult pregnant patients at The Medical City admitted for delivery from January 2016 to May 2022. This included 180 patients with GDM, and 174 patients without GDM. One hundred sixteen (116) of the GDM patients were diet-managed, and 64 were insulin-requiring. Participants underwent third trimester fetal AC ultrasound and 75-gram oral glucose tolerance test (OGTT) between 24 to 28 weeks of gestation. The third trimester fetal AC, fetal outcomes and maternal outcomes between patient groups were analyzed using Stata 15.0.

The GDM group had higher rates of cesarean section delivery (70% vs 46.55%, pCONCLUSION

Third trimester fetal AC is significantly larger in women with GDM compared to non-GDM women, regardless of management method. Monitoring fetal AC during the third trimester is important for prenatal care in GDM pregnancies.

Overlap syndrome is a rare condition involving the coexistence of at least two distinct autoimmune diseases, such as systemic lupus erythematosus and systemic sclerosis. This condition has limited studies on epidemiology probably because it is often under-recognized. We present a 22-year-old Filipino female with a 10-month history of hyperpigmented patches on the malar surface and extremities, with associated photosensitivity, fatigue, pallor, arthralgia, and oral ulcers, and positive antinuclear antibody titer. She was treated with oral Prednisone in tapering doses, leading to clinical improvement. Eight months later, there was a recurrence of hyperpigmented patches on the face and extremities with skin tightening and diffuse hair loss, development of shiny skin with facial fold loss, a beak-like nasal appearance, and episodes of dyspnea and malaise. Consistent with scleroderma, the patient was started on mycophenolate mofetil (MMF) 500 mg daily, with close monitoring for disease progression and systemic involvement. Overlap syndrome remains under-recognized due to its variable presentation and rarity. Treatment is individualized based on the specific connective tissue diseases involved and the patient’s symptoms. Multidisciplinary care is crucial for timely management and to adjust treatment as needed, given the potential for life-threatening complications involving cutaneous and internal organs.

Background: To reduce maternal morbidity and mortality associated with hypertension, standards for maternal safety and efforts to implement a structured team approach have been undertaken. Following the formulation of a policy document, a maternal safety bundle was developed. The implementation of bundle components including eclampsia kits, clinical pathways, and educational module occurred in phases due to pandemic restrictions. An eclampsia kit and clinical pathways were implemented in 2020. An online lecture was launched in 2021 followed by in-person eclampsia simulation workshop beginning 2022. Objectives: This paper aims to report the early outcomes of a severe preeclampsia and eclampsia maternal safety bundle implementation in a private hospital between 2020 to 2023. Materials and Methods: Demographic information, posttest knowledge assessment and preand post- eclampsia workshop confidence scores were recorded. Structure, process, and outcome measures were determined. Descriptive statistics were used for participant demographics and score percentages. Paired t-Test with a significance level of P<0.05 was used to compare the pre- and post-simulation confidence scores. Summary data for outcome and process metrics were manually calculated. Summary categorical data was used for structure metrics. Results: Two hundred eighty-eight (288) participants completed the online didactic lecture. Average posttest knowledge assessment score was 88.1%, 88.88%, and 82.6% from 2020 to 2023. Ninety-nine participants completed the eclampsia simulation workshops. Mean post-simulation confidence scores were greater than mean pre-simulation confidence scores (42.3 vs. 39, p=0.0259 in 2022 and 41.975 vs 36.65, P=0.0035 in 2023). There is 100% compliance with timely management of severe hypertension and eclampsia prevention and a decreasing trend in hypertension related severe maternal morbidity rates. Conclusion A severe preeclampsia and eclampsia maternal safety bundle is a feasible quality improvement initiative that promotes peer learning, strengthens clinical competencies, and improves access to emergency resuscitation supplies. The results of this program evaluation may serve as a framework for implementing quality improvement initiatives on maternal safety.