BACKGROUND

Perimyocarditis due to inflammation of the pericardium and myocardium results in myocellular damage. Myocarditis, or myocardial inflammation, occurs after cardiac injury. Gallbladder edema, in the absence of cholecystitis, may occur in numerous conditions including cardiac inflammation.

A 28-year-old previously healthy female presented with chest pain, orthopnea, exertional dyspnea and a history of fever. She also reported intermittent right upper quadrant pain. Physical exam revealed a pericardial friction rub. Electrocardiogram (ECG) showed sinus rhythm with nonspecific ST-T changes; troponin I was elevated. Echocardiography demonstrated segmental wall motion abnormalities, pericardial thickening and preserved systolic function. Initially managed as acute coronary syndrome, she was later diagnosed with perimyocarditis. On the second hospital day, she developed recurrence of right upper quadrant abdominal pain. Abdominal ultrasound revealed gallbladder edema with pericholecystic fluid, but no stones. Liver enzymes were elevated. Acalculous cholecystitis was considered and cholecystostomy offered instead due to aspirin therapy. However, repeat imaging showed resolution of cardiac and gallbladder findings, and surgery was deferred. Cardiac MRI postdischarge was unremarkable.

Perimyocarditis may present with gallbladder edema mimicking acalculous cholecystitis, potentially leading to unnecessary surgical intervention. This case emphasizes the importance of considering cardiac etiologies in atypical abdominal presentations.

OBJECTIVE

To describe the first biopsy-proven case of ocular cicatricial pemphigoid (OCP) in a young, Filipino male – an atypical presentation for this disease.

This is a case report.

A 34-year-old healthy Filipino male presented with a 2-year history of intermittent eye redness, foreign body sensation, and tearing. Slit lamp examination revealed symblepharon formation and fornix shortening of both eyes. Excision of symblepharon with ocular surface reconstruction using amniotic membrane graft was performed, and the conjunctival specimen was sent for immunohistochemical analysis. Direct immunofluorescence was performed which confirmed strong linear deposits of IgG and fibrinogen along the basement membrane zone, confirming diagnosis of OCP. Early diagnosis and prompt treatment is even more important in the younger population as OCP tends to progress more rapidly, and is associated with more severe manifestations. If left untreated, OCP may progress to symblepharon or, in severe cases, ankyloblepharon formation.

OCP is a rare, sight-threatening, chronic, autoimmune disease that involves inflammation and cicatrization of the conjunctiva, which typically affects older females and is rarely seen in younger populations. This case report highlights the need for increased awareness among clinicians in the Philippines to consider OCP as a differential diagnosis for chronic conjunctivitis, even in patients outside the typical demographic. Early recognition and confirmatory biopsy are essential to prevent progressive ocular surface scarring and vision-threatening complications.

BACKGROUND

Non-Alcoholic Fatty Liver Disease (NAFLD) is common in Type 2 Diabetes Mellitus (T2DM). The FIB-4 index is one of the most-studied non-invasive biomarkers that combines age and laboratory parameters (platelet count, alanine-and aspartate- aminotransferase) to evaluate underlying hepatic fibrosis. This study aims to determine the diagnostic value of Fibrosis-4 (FIB-4) index scoring in screening for non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus, which is a high-risk population in development of advance fibrosis.

A single center, analytical cross-sectional study was conducted among adult T2DM patients with and without NAFLD seen at the Out-Patient Department (OPD) and those with NAFLD enrolled under the Liver Disease Databank of the Liver Disease and Transplant Center in collaboration with Research and Biotechnology Division at St. Luke’s Medical Center, Quezon City. Medical history was obtained by reviewing charts of eligible patients using data collection form. Liver ultrasound was used as the reference standard in the diagnosis of NAFLD. The FIB-4 index was calculated with this formula: age (years) x AST (U/L)/(platelets (10^9/L) x ALT (U/L)^1/2.

A total of 305 adult patients with type 2 diabetes mellitus were included in the study. The prevalence of non-alcoholic fatty liver disease based on ultrasound among diabetic patients is 76.07%. The median age (p = 0.0204), AST (p < 0.00001), ALT (p < 0.00001) were significantly higher in patients with NAFLD than those without. Platelet count (p = 0.0002) was significantly lower in patients with NAFLD than those without. The proportion of patients with low platelet count, high AST and high ALT were significantly higher in patients with NALFD than those without. In this study, the FIB-4 index cutoff score for screening of NAFLD is ≥0.76, which has an accuracy of 66.23%, sensitivity of 75%, specificity of 38.3%, PPV of 79.46% and NPV of 32.56% in detecting fatty liver.

A FIB-4 index value of ≥0.76 has an acceptable sensitivity for screening NAFLD even in the absence of fibrosis among patients with T2DM. However, due to its low specificity, additional tests to establish NAFLD diagnosis may be required.

Human ; Diagnostic Tests, Routine ; Urolithiasis ; Urologists

BACKGROUND

The impact of the COVID-19 pandemic on respiratory virus activity in children has been studied globally, but no published study in the Philippines has provided viral profiling and epidemiological data on children during and after the pandemic’s peak.

To identify respiratory pathogens detected using a multiplex RT-PCR assay (BioFire® Respiratory 2.1 Panel) among pediatric patients with respiratory symptoms admitted to St. Luke’s Medical Center–Global City during (March 2020–February 2022) and after (March 2022–March 2023) the peak of the COVID-19 pandemic; to compare the prevalence of these pathogens between the two periods; and to assess the clinico-demographic characteristics, diagnostic test results, and clinical outcomes of patients with single-pathogen infections versus co-infections.

A single-center, cross-sectional study was conducted through a retrospective chart review of pediatric patients with respiratory symptoms tested using a multiplex RT-PCR assay (BioFire® Respiratory 2.1 Panel) at St. Luke’s Medical Center–Global City from March 2020 to March 2023.

Of 739 children, 92.02% were positive for at least one respiratory pathogen, mostly viruses. Rhinovirus/enterovirus (50.59%), RSV (19.71%), and COVID-19 (12.50%) were the most common. COVID-19 and Influenza A were more prevalent during the peak, while rhinovirus/enterovirus and adenovirus were higher post-peak. Most patients were male, aged 1–5 years, and cough (89.99%) was the most common symptom. Normal leukocyte, CRP, and procalcitonin levels were observed in 70.09%, 47.31%, and 68.25%, respectively. No significant differences were noted in diagnostic test results based on pathogen detection. Antibiotics were given to 53.31% of patients, and 99.86% were discharged. The average length of stay was 3.69 days.

The prevalence of respiratory pathogens among children admitted to our institution during and after the peak of the COVID-19 pandemic predominantly consisted of viruses, showing statistically significant differences. Rhinovirus/enterovirus and RSV were the leading respiratory pathogens in both periods. The peak group showed a higher prevalence of COVID-19 and Influenza A whereas the post-peak group exhibited a higher prevalence of rhinovirus/enterovirus and adenovirus. Single viral infections were more prevalent compared to co-infections

Ophthalmology

Human ; Optic Nerve Diseases ; Optic Neuropathy, Ischemic ; Ophthalmologists

BACKGROUND

Due to the COVID-19 outbreak, schools had to switch online. The sudden transition to blended teaching and learning (BTL) poses challenges for students and teachers, especially for health science programs that require hands-on practical experience. The validity, reliability, and responsiveness of these self-report questionnaires (SRQs) should be established to ensure the accuracy of the results as intended by the SRQ.

This study critically appraised, compared, and summarized the psychometric properties of SRQ evaluating BTL among health science university students. This review determined the SRQ’s reliability, internal consistency, various forms of validity (content, criterion, construct), and responsiveness.

Following a 10-step procedure based on COSMIN guidelines, we conducted a systematic review of SRQs used by health science university students to evaluate blended teaching and learning. Studies were eligible if they reported psychometric properties of SRQs related to blended learning among university health science students; exclusions included studies focusing on perceptions, attitudes, self-efficacy, and satisfaction, as well as articles such as biographies, editorials, and conference materials. Searches covered multiple electronic databases until April 26, 2023, including PubMed, EMBASE, Web of Science, MEDLINE (OVID), PsycInfo, CINAHL, EBSCOHOST, ERIC, Scopus, Science Direct, Google Scholar, JSTOR, Acta Medica Philippina, Philippine Journal of Health Research and Development, and HERDIN, managed through Zotero. Two independent reviewers performed database searches, title and abstract screening, and full-text evaluations, with a third reviewer resolving any disputes. The COSMIN Risk of Bias Checklist was employed to evaluate included studies on the development and various measurement properties of SRQs. The reviewers assessed SRQ standards, including validity, reliability, internal consistency, measurement error, responsiveness, interpretability, and feasibility. Data extraction and result tabulation were independently completed, with content comparison by two health education experts. This evaluation categorized the SRQs into three quality and validity levels.

The study examined five articles; four were rated as 'doubtful' and one as 'inadequate' in the overall development of SRQ. All four 'doubtful' studies demonstrated questionable content validity when university students were asked about the questionnaire's relevance, comprehensiveness, and comprehensibility. Only half of these studies achieved an 'adequate' rating for content validity based on expert opinions on relevance and comprehensiveness. All but one study scored from 'very good' to 'adequate' in structural validity. Three out of the four studies scored a very good rating for internal consistency, while one was deemed 'inadequate' in internal consistency, cross-cultural validity, and reliability. Three out of four studies scored 'very good' on construct validity, but all overlooked criterion validity and responsiveness. Conducted in various locations, including Australia, Romania, Turkey, and Taiwan, these studies highlighted both common characteristics and limitations in questionnaire development according to the COSMIN guidelines. Four studies were deemed reliable and valid for BTL constructs (Category A); Wu et al. requires further validation (Category B). Study limitations included heterogeneity in populations, settings, and questionnaire versions, potential subjective bias in SRQ content comparison, and the evolving nature of SRQs in blended learning contexts.

The systematic review reports the development and evaluation of SRQs for BTL while identifying gaps in their applicability to health science programs. The Blended Learning Scale (BLS) of Lazar et al. and the Blended Learning Questionnaire (BLQ) of Ballouk et al. showed an ‘adequate' rating for content validity. BLS revealed very good structural validity, internal consistency, and adequate content validation. Although the BLQ lacked Confirmatory Factor Analysis, it yielded valuable constructs for evaluating health sciences students' experiences in BTL. Both tools require improvements on recall period, completion time, interpretability, and feasibility. The review underscores the necessity for cont inuous assessment and enhancement of such instruments in BTL, advocating a rigorous scale development process. Furthermore, it encourages the customization of teaching and learning evaluation tools to suit specific institutional contexts while promoting further validation of these questionnaires across different populations in future research.

BACKGROUND

Due to the COVID-19 outbreak, schools had to switch online. The sudden transition to blended teaching and learning (BTL) poses challenges for students and teachers, especially for health science programs that require hands-on practical experience. The validity, reliability, and responsiveness of these self-report questionnaires (SRQs) should be established to ensure the accuracy of the results as intended by the SRQ.

This study critically appraised, compared, and summarized the psychometric properties of SRQ evaluating BTL among health science university students. This review determined the SRQ’s reliability, internal consistency, various forms of validity (content, criterion, construct), and responsiveness.

Following a 10-step procedure based on COSMIN guidelines, we conducted a systematic review of SRQs used by health science university students to evaluate blended teaching and learning. Studies were eligible if they reported psychometric properties of SRQs related to blended learning among university health science students; exclusions included studies focusing on perceptions, attitudes, self-efficacy, and satisfaction, as well as articles such as biographies, editorials, and conference materials. Searches covered multiple electronic databases until April 26, 2023, including PubMed, EMBASE, Web of Science, MEDLINE (OVID), PsycInfo, CINAHL, EBSCOHOST, ERIC, Scopus, Science Direct, Google Scholar, JSTOR, Acta Medica Philippina, Philippine Journal of Health Research and Development, and HERDIN, managed through Zotero. Two independent reviewers performed database searches, title and abstract screening, and full-text evaluations, with a third reviewer resolving any disputes. The COSMIN Risk of Bias Checklist was employed to evaluate included studies on the development and various measurement properties of SRQs. The reviewers assessed SRQ standards, including validity, reliability, internal consistency, measurement error, responsiveness, interpretability, and feasibility. Data extraction and result tabulation were independently completed, with content comparison by two health education experts. This evaluation categorized the SRQs into three quality and validity levels.

The study examined five articles; four were rated as 'doubtful' and one as 'inadequate' in the overall development of SRQ. All four 'doubtful' studies demonstrated questionable content validity when university students were asked about the questionnaire's relevance, comprehensiveness, and comprehensibility. Only half of these studies achieved an 'adequate' rating for content validity based on expert opinions on relevance and comprehensiveness. All but one study scored from 'very good' to 'adequate' in structural validity. Three out of the four studies scored a very good rating for internal consistency, while one was deemed 'inadequate' in internal consistency, cross-cultural validity, and reliability. Three out of four studies scored 'very good' on construct validity, but all overlooked criterion validity and responsiveness. Conducted in various locations, including Australia, Romania, Turkey, and Taiwan, these studies highlighted both common characteristics and limitations in questionnaire development according to the COSMIN guidelines. Four studies were deemed reliable and valid for BTL constructs (Category A); Wu et al. requires further validation (Category B). Study limitations included heterogeneity in populations, settings, and questionnaire versions, potential subjective bias in SRQ content comparison, and the evolving nature of SRQs in blended learning contexts.

The systematic review reports the development and evaluation of SRQs for BTL while identifying gaps in their applicability to health science programs. The Blended Learning Scale (BLS) of Lazar et al. and the Blended Learning Questionnaire (BLQ) of Ballouk et al. showed an ‘adequate' rating for content validity. BLS revealed very good structural validity, internal consistency, and adequate content validation. Although the BLQ lacked Confirmatory Factor Analysis, it yielded valuable constructs for evaluating health sciences students' experiences in BTL. Both tools require improvements on recall period, completion time, interpretability, and feasibility. The review underscores the necessity for cont inuous assessment and enhancement of such instruments in BTL, advocating a rigorous scale development process. Furthermore, it encourages the customization of teaching and learning evaluation tools to suit specific institutional contexts while promoting further validation of these questionnaires across different populations in future research.

Objective: To report a case of a migrating foreign body in the esophagus of a 65-year-old woman: its clinical presentation, diagnosis and management Methods: Design: Case Report Setting:Tertiary Government Training Hospital Patient: One Results: A 65-year-old woman consulted with a history of foreign body ingestion (chicken bone). Initial imaging confirmed the presence of the ingested object. Rigid esophagoscopy did not find the foreign body. Subsequent neck computed tomography (CT) scan revealed a hyperdense, spindle-shaped object situated lateral to the left esophagus. The foreign object was successfully retrieved via a lateral pharyngotomy approach without complication. Conclusion Migrating foreign bodies may initially present with minimal or nonspecific symptoms such as foreign body sensation or dysphagia but can progress to more overt signs. In such cases, CT offers superior localization compared to radiographs and is essential in guiding definitive surgical management to facilitate safe and effective foreign body retrieval. Rigid esophagoscopy remains a valuable tool for confirming migration and evaluating for mucosal injury or perforation. When endoscopic retrieval is unsuccessful, timely surgical intervention is critical to prevent serious complications.
Human ; Female ; Aged: 65-79 Yrs Old ; Esophagus ; Foreign Bodies ; Women