BACKGROUND AND OBJECTIVE

Foreign body (FB) ingestion is a common pediatric concern in the Philippines, but local studies on flexible endoscopic management are lacking. This study aimed to describe the clinical profile and outcomes of children referred for flexible endoscopic management and identify factors associated with poor outcomes.

METHODS

This retrospective cohort study included 145 patients aged

RESULTS

Most FB ingestions (96.55%) were accidental, with coins as the most common FB (56.55%). Patients were admitted an average of 40.42 hours post-ingestion and referred for endoscopy within 9.28 hours. Flexible endoscopy was performed in 44.83% of cases, with a 98.46% success rate and an average procedure time of 32.25 minutes. Spontaneous passage occurred in 50.34% of cases. Poor outcomes were linked to age 48 hours; OR: 15.43, p = 0.0181), and prolonged procedures (>30 minutes; OR: 12, p = 0.0318). Good outcomes were associated with unremarkable physical exams (OR: 0.078; p = 0.0018), early admission (CONCLUSION

Flexible endoscopy is effective and safe for FB extraction in children. Early admission and timely intervention significantly improve outcomes, while delays and prolonged procedures increase the risk of complications.

Human ; Adolescent: 13-18 Yrs Old ; Child: 6-12 Yrs Old ; Foreign Bodies ; Endoscopy ; Child ; Retrospective Studies ; Aged ; Cohort Studies ; Eating ; Methods ; Numismatics ; Patients ; Philippines ; Physical Examination ; Time

Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE.

This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion.

Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

Human ; Male ; Child Preschool: 2-5 Yrs Old ; Endoscopy ; Propofol ; Dexmedetomidine ; Sleep Apnea, Obstructive ; Anesthetics ; Apnea ; Consensus ; Paper ; Patients ; Pharmaceutical Preparations ; Research Report ; Sleep ; Sleep Apnea Syndromes ; World Health Organization

A unicornuate uterus with a non-communicating rudimentary horn is a rare Müllerian duct anomaly that is frequently underdiagnosed because of its variable clinical presentation and the limitations of conventional imaging modalities. Although not considered a direct cause of infertility, it may coexist with other reproductive pathologies and contribute to adverse reproductive outcomes. Presented here is a case series of three infertile women aged 30–36 years who were diagnosed with a unicornuate uterus and non-communicating rudimentary horn during fertility evaluation. Patient A presented with primary infertility, cyclic pelvic pain, endometriosis, and bilateral tubal disease; Patient B had a seven-year history of primary infertility and was initially suspected to have unilateral tubal obstruction; and Patient C was referred with a presumed diagnosis of uterine didelphys and was subsequently found to have a unicornuate uterus with a non-communicating rudimentary horn and ipsilateral renal agenesis. In all three cases, preoperative imaging failed to establish the definitive diagnosis, which was confirmed intraoperatively through laparoscopy, chromotubation, and hysteroscopy. Patients A and B underwent laparoscopic excision of the rudimentary horn with ipsilateral salpingectomy, while Patient C underwent only ipsilateral salpingectomy. Hysteroscopic transillumination was utilized in one case to facilitate safe laparoscopic dissection and delineation of the hemiuterine anatomy. All patients had uneventful postoperative recovery and were subsequently counseled regarding fertility options. This case series highlights the diagnostic challenges posed by unicornuate uterus with a non-communicating rudimentary horn, emphasizes the importance of a high index of suspicion during infertility work-up, and demonstrates the value of minimally invasive surgical management and hysteroscopic transillumination in selected cases. Early recognition and individualized treatment may help reduce reproductive complications and improve fertility counseling and management.

Human ; Female ; Adult: 25-44 Yrs Old ; Infertility, Female ; Laparoscopy ; Salpingectomy ; Hysteroscopy ; Pathology ; Endometriosis ; Fallopian Tube Diseases ; Transillumination ; Uterine Didelphys

Appendicitis is one of the most commonly encountered general surgery emergencies worldwide and has been extensively studied. However, anatomical variations in the position of the appendix may result in atypical clinical presentations, leading to diagnostic difficulty and delays in management. Reported here is a case of subhepatic appendicitis in a young adult patient who successfully underwent laparoscopic appendectomy. Subhepatic appendicitis is a rare surgical entity that should be considered in patients presenting with right upper quadrant abdominal pain. Contrast-enhanced computed tomography and laparoscopy are valuable tools in the diagnosis and management of this uncommon condition.

Human ; Female ; Adult: 25-44 Yrs Old ; Laparoscopy ; Appendectomy ; Appendix ; Appendicitis ; Abdominal Pain

INTRODUCTION

Dual antiplatelet therapy (DAPT) with aspirin plus P2Y12 receptor inhibitor has become a cornerstone in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) for the prevention of stent thrombosis. However, aspirin intolerance poses a problem in the lack of guideline-based alternatives with proven benefit. In this study, we aim to determine the efficacy and safety of cilostazol-based DAPT as an alternative treatment for aspirin among patients undergoing PCI.

METHODS

A comprehensive literature search was performed. All studies that investigated cilostazol as an alternative to aspirin on top of P2Y12 inhibitors for patients undergoing PCI were included. Outcomes of interest in this meta-analysis were reduction of major adverse cardiovascular events (MACE) and bleeding.

RESULTS

Three cohort studies including 1,227 patients on cilostazol and 1,480 on aspirin, both with a P2Y12 inhibitor were analyzed. Pooled estimates showed no significant difference in MACE (OR 1.32, 95% CI 0.79–2.23; p = 0.29) or acute myocardial infarction (OR 0.94, 95% CI 0.46–1.89; p = 0.85) between groups. However, cilostazol-based DAPT was associated with significantly less bleeding (OR 0.52, 95% CI 0.27–0.99; p = 0.05). All outcomes were statistically homogeneous (p>0.1, I²CONCLUSION

Cilostazol compared to aspirin, both on top of a P2Y12 receptor inhibitor, is as efficient in the reduction of MACE and acute myocardial infarction; and even safer in terms of bleeding. Cilostazol-based DAPT may serve as an alternative to standard DAPT among aspirin-intolerant patients undergoing PCI.

Human ; Male ; Female ; Cilostazol ; Percutaneous Coronary Intervention ; Hemorrhage ; Aspirin ; Angioplasty

INTRODUCTION

Dual antiplatelet therapy (DAPT) with aspirin plus P2Y12 receptor inhibitor has become a cornerstone in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) for the prevention of stent thrombosis. However, aspirin intolerance poses a problem in the lack of guideline-based alternatives with proven benefit. In this study, we aim to determine the efficacy and safety of cilostazol-based DAPT as an alternative treatment for aspirin among patients undergoing PCI.

METHODS

A comprehensive literature search was performed. All studies that investigated cilostazol as an alternative to aspirin on top of P2Y12 inhibitors for patients undergoing PCI were included. Outcomes of interest in this meta-analysis were reduction of major adverse cardiovascular events (MACE) and bleeding.

RESULTS

Three cohort studies including 1,227 patients on cilostazol and 1,480 on aspirin, both with a P2Y12 inhibitor were analyzed. Pooled estimates showed no significant difference in MACE (OR 1.32, 95% CI 0.79–2.23; p = 0.29) or acute myocardial infarction (OR 0.94, 95% CI 0.46–1.89; p = 0.85) between groups. However, cilostazol-based DAPT was associated with significantly less bleeding (OR 0.52, 95% CI 0.27–0.99; p = 0.05). All outcomes were statistically homogeneous (p>0.1, I²CONCLUSION

Cilostazol compared to aspirin, both on top of a P2Y12 receptor inhibitor, is as efficient in the reduction of MACE and acute myocardial infarction; and even safer in terms of bleeding. Cilostazol-based DAPT may serve as an alternative to standard DAPT among aspirin-intolerant patients undergoing PCI.

Human ; Male ; Female ; Cilostazol ; Percutaneous Coronary Intervention ; Hemorrhage ; Aspirin ; Angioplasty

BACKGROUND AND OBJECTIVE

Evidence regarding the impact of performing endoscopy within 12 hours of variceal bleeding (VB) on outcomes is inconclusive, and there is a lack of local data on this topic. This study aimed to determine if the timing of endoscopy is associated with clinical outcomes.

METHODS

This was a single-center retrospective cohort study which included adult cirrhotic patients admitted for VB from January 2016 to September 2022. The primary outcomes were in-hospital and 6-week mortality. Secondary outcomes included 5-day rebleeding, length of hospital stay (LOS), and blood transfusion requirements (BTR). The relationships between timing of endoscopy and outcomes were evaluated using regression analysis.

RESULTS

In 140 patients, 5.7% underwent urgent endoscopy (?12 hours). The overall median door-to-endoscopy time (DET) was 39.4 hours (IQR 20.0-73.4). The overall in-hospital mortality, 6-week mortality, and 5-day rebleeding rates were 12.9%, 11.4%, and 8.6%, respectively, without significant variability at different DET (p >0.05). Prolonged LOS was evident when endoscopy was delayed to >12 hours from admission (3.5 [IQR 2.25-5.75] vs 6 days [IQR 4-9.75], p = 0.021), while BTR was greater starting at endoscopies performed at >24 hours from admission (1 [0-2] vs 2 units [1-3], p = 0.000). Delayed endoscopy was significantly correlated with LOS (Beta 0.316, SE 0.011, p = 0.000) and BTR (Beta 0.214, SE 0.469, p = 0.003), but not with mortality and early rebleeding.

CONCLUSION

Timing of endoscopy may be independent of mortality and early rebleeding. Timely endoscopy may shorten hospitalization and decrease need for blood transfusion. Other factors affecting clinical outcomes may be at play.

Human ; Cirrhosis ; Fibrosis ; Endoscopy

BACKGROUND AND OBJECTIVE

Foreign body (FB) ingestion is a common pediatric concern in the Philippines, but local studies on flexible endoscopic management are lacking. This study aimed to describe the clinical profile and outcomes of children referred for flexible endoscopic management and identify factors associated with poor outcomes.

METHODS

This retrospective cohort study included 145 patients agedRESULTS

Most FB ingestions (96.55%) were accidental, with coins as the most common FB (56.55%). Patients were admitted an average of 40.42 hours post-ingestion and referred for endoscopy within 9.28 hours. Flexible endoscopy was performed in 44.83% of cases, with a 98.46% success rate and an average procedure time of 32.25 minutes. Spontaneous passage occurred in 50.34% of cases. Poor outcomes were linked to age 48 hours; OR: 15.43, p = 0.0181), and prolonged procedures (>30 minutes; OR: 12, p = 0.0318). Good outcomes were associated with unremarkable physical exams (OR: 0.078; p = 0.0018), early admission (CONCLUSION

Flexible endoscopy is effective and safe for FB extraction in children. Early admission and timely intervention significantly improve outcomes, while delays and prolonged procedures increase the risk of complications.

Human ; Adolescent: 13-18 Yrs Old ; Child: 6-12 Yrs Old ; Foreign Bodies ; Endoscopy ; Child ; Retrospective Studies

Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE.

This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion.

Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

Human ; Male ; Child Preschool: 2-5 Yrs Old ; Endoscopy ; Propofol ; Dexmedetomidine ; Sleep Apnea, Obstructive

OBJECTIVE

The aim of this study was to determine the different attitudes and perception of obstetrics and gynecology residents on laparoscopic skills training.

METHODS

A cross-sectional research was conducted in a tertiary hospital’s Department of Obstetrics and Gynecology using a survey questionnaire. The respondents were resident physician trainees using population sampling. An approval to use the survey questionnaire from its developer was obtained. Descriptive statistics was used for analysis of the demographic profile. Pearson product moment correlation was used to determine correlation between expectancy-value constructs, simulation use and surgical experience.

RESULTS

The average hours the residents spent in simulation laparoscopic exercises was 11 h in the last 12 months and at least 1 h per week with supervision (76%). The reasons for using laparoscopic simulation include skill development (94%), proximity to the simulation lab (90%), free time (85%), recommendation of attending surgeon (84%), and requirement for rotation (84%). Among the expectant value constructs, only intrinsic interest utility value (r = −0.390) showed statistical correlation suggesting a weak negative correlation with simulation use. Hours of simulation use were significantly negatively correlated with self-efficacy for learning skills required to become proficient at minimally invasive surgery (MIS) (r = −0.390) and self-efficacy for learning sufficient MIS skills to perform procedures safely (r = −0.351).

CONCLUSIONS

The residents were motivated to do well and had greater self-belief and enjoyed performing and mastering the laparoscopic skills training. The residents’ perception revealed that there was an improvement in their MIS skills with the laparoscopic simulation exercises in the short time they spent in the simulation. Despite the residents’ positive attitude and perceptions, voluntary participation was limited. The most commonly cited barriers to the access of the surgical knowledge improvement laboratory and laparoscopy simulation unit were the lack of time due to the workload, conflicting schedules, and COVID-19 pandemic restrictions. Supervision of the residents is of great importance to provide guidance and motivation to the residents in improving their technical skills and performance in the operating room.

Human ; Minimally Invasive Surgery ; Minimally Invasive Surgical Procedures