Despite of the widespread use of hydrogen and methane breath test, the variability in testing protocols, gas measurement techniques, and interpretation criteria continues to challenge the reproducibility and comparability across centers, especially in the Asia-Pacific region. The Asian Neurogastroenterology and Motility Association hence presents the first Asian monograph guiding application and interpretation of breath test. The monograph was formulated according to the framework of indications, preparatory process, performance, and interpretation of results, as well as future direction for research.

Background/Aims: Chronic constipation is prevalent yet under-diagnosed across Asia, compromising quality of life and burdening healthcare systems. Cultural stigma, varied diets, and limited access to standardized diagnostic tools delay timely care. Methods: The Bali Chronic Constipation Roundtable in November 2024, brought together experts from 11 Asian countries. The group reviewed epidemiological data, analyzed multinational questionnaire on clinical practice pattern, and conducted structured discussions to identify key barriers and propose region-specific recommendations. Results: Chronic constipation prevalence varies across Asia, ranging from 1.8% in India to 16.6% in Japan, with women and the elderly disproportionately affected. Under-reporting persists owing to cultural taboos and widespread self treatment with laxatives and traditional medications. Although the Rome IV criteria remains the global standard, they may not fully reflect Asian symptom profiles, and diagnosis is limited by scarce motility laboratories. First line therapies such as dietary-fiber optimization and osmotic laxatives are widely available, but newer pharmacotherapies (prucalopride, linaclotide, lubiprostone, and elobixibat) remain costly and unevenly accessible. Biofeedback for dyssynergic defecation is underutilized due to limited availability. Experts recommend expanded regional research on to refine diagnostic criteria, coupled with enhanced physician education and public awareness. They advocate accessibility to second-line and novel therapies that incorporate culturally attuned regional guidelines, and improved access to gastrointestinal motility testing. Conclusions The Bali Chronic Constipation Roundtable highlighted Asia’s need for region specific diagnostics and management. Addressing diagnostic and treatment gaps will improve outcomes, while ongoing researcher clinician policy collaboration must standardize guidelines, advance research, and ensure equitable care across Asia.

BACKGROUND

Intraoperative transfusion for gynecologic surgery, when appropriately used, can improve patient outcomes. However, when utilized incorrectly, blood transfusion can worsen patient outcomes and increase patient cost. This study aimed to evaluate the blood transfusion practices of tertiary hospitals in the Philippines.

The study utilized a cross-sectional design wherein prospective data were gathered through multiple sources across seven tertiary-level hospitals. Women admitted to undergo gynecologic surgery were recruited based on a set of criteria. A chart review was conducted, and blood utilization indices were calculated. Outcomes were compared between public versus private facilities and transfused versus nontransfused patients.

Among 514 patients, 79.7% underwent cross-matching and 75.1% received transfusions. Adverse events were rare, with no transfusion-related deaths. The overall crossmatch-to-transfusion ratio (C/T ratio) was 2.8, exceeding the 2.5 optimal benchmark; all public hospitals recorded a C/T ratio >2.5, whereas private centers had more efficient usage. Six hospitals met acceptable benchmarks for transfusion probability and transfusion index. Open abdominal procedures, particularly hysterectomy, accounted for the most blood used. Transfused patients had longer operative times, greater blood loss, lower preoperative hemoglobin, and more frequently involved resident physicians in training. Public hospitals recorded higher cross-match and transfusion rates, greater resident physician participation, and broader use of general anesthesia.

Results of the study highlight the importance of monitoring blood transfusion parameters to optimize blood utilization. The observed differences between public and private institutions in the country highlight the urgent need for standardized and evidence-based practice to ensure efficient transfusion protocols nationwide.

The sternalis muscle is a rare supernumerary muscle representing a normal anatomical variant in the anterior thoracic musculature. Due to wide variation in its morphology and relative unfamiliarity among radiologists, it has been implicated in the misdiagnosis of breast masses on mammography. A 23-year-old male with no significant medical history was referred to our institution for further management of painless bilateral breast enlargement since adolescence. Physical examination revealed breasts of slightly prominent size but there was no palpable breast lump. Mammography work-up found symmetrical, well-defined soft tissue masses projected over the posteromedial aspect of both breasts. Imaging findings were consistent with bilateral sternalis muscles, unusually hypertrophic in size due to intense upper body weight training by the patient. This case highlights the importance of recognizing the usual and unusual presentations of the sternalis muscles on mammography to avoid any unnecessary work-up.

The sternalis muscle is a rare supernumerary muscle representing a normal anatomical variant in the anterior thoracic musculature. Due to wide variation in its morphology and relative unfamiliarity among radiologists, it has been implicated in the misdiagnosis of breast masses on mammography. A 23-year-old male with no significant medical history was referred to our institution for further management of painless bilateral breast enlargement since adolescence. Physical examination revealed breasts of slightly prominent size but there was no palpable breast lump. Mammography work-up found symmetrical, well-defined soft tissue masses projected over the posteromedial aspect of both breasts. Imaging findings were consistent with bilateral sternalis muscles, unusually hypertrophic in size due to intense upper body weight training by the patient. This case highlights the importance of recognizing the usual and unusual presentations of the sternalis muscles on mammography to avoid any unnecessary work-up.

The sternalis muscle is a rare supernumerary muscle representing a normal anatomical variant in the anterior thoracic musculature. Due to wide variation in its morphology and relative unfamiliarity among radiologists, it has been implicated in the misdiagnosis of breast masses on mammography. A 23-year-old male with no significant medical history was referred to our institution for further management of painless bilateral breast enlargement since adolescence. Physical examination revealed breasts of slightly prominent size but there was no palpable breast lump. Mammography work-up found symmetrical, well-defined soft tissue masses projected over the posteromedial aspect of both breasts. Imaging findings were consistent with bilateral sternalis muscles, unusually hypertrophic in size due to intense upper body weight training by the patient. This case highlights the importance of recognizing the usual and unusual presentations of the sternalis muscles on mammography to avoid any unnecessary work-up.

BACKGROUND

This first clinical practice guideline (CPG) on osteoporosis prevention and management in the Philippines is the output of a shared undertaking by a multidisciplinary CPG development team spearheaded by the Osteoporosis Society of the Philippines Foundation, Inc. and joined by the Philippine Academy of Family Physicians; the Philippine College of Endocrinology, Diabetes, and Metabolism; the Philippine Orthopedic Association; the Philippine Obstetrics and Gynecological Society and the Philippine Rheumatology Association. This guideline seeks to augment and update the "Consensus statements on osteoporosis diagnosis, prevention and management in the Philippines," initially published in 2011, incorporating evidence-based practices developed in the last decade.

The steering committee formulated and prioritized clinical questions based on meetings and stakeholder consultations. A PICO (population, intervention, comparator, outcome) format was used to develop clinical questions and guide the systematic search for evidence. The development of guidelines followed the ADAPTE process. Once completed, panel discussions were done using the Evidence to Decision Framework. After the panel discussions, the final recommendations were revised.

Thirty-four recommendations were formulated to address 27 clinical questions related to screening, prevention, diagnosis, pharmacologic and nonpharmacologic treatment, surgical management, follow-up, and continuity of care. With these recommendations, the developers aim to establish a standard of care in the prevention, diagnosis and management of osteoporosis and fragility fractures in both in-patient and out-patient cases that are appropriate to the Philippine context. Specifically, the CPG development group aims to use these recommendations to define the standard of care for osteoporosis as part of universal healthcare services once the program is implemented nationally. Relevant stakeholders may also use the recommendations to inform public and private payor policies for patients with fragility fractures, as well as by local government units or private companies looking to establish orthogeriatric centers with fracture liaison services.

This guideline is helpful for physicians and other allied health personnel in screening, diagnosis, management and prevention of primary osteoporosis and fragility fractures among postmenopausal women and older men.

AIDS-related Kaposi sarcoma (KS) progresses rapidly with early mucosal and systemic involvement. Early diagnosis and treatment are crucial as they significantly impact the outcome. This is a case of disseminated cutaneous and gastrointestinal KS in a 24-year-old Filipino male living with HIV, presenting with hyperpigmented violaceous subcutaneous nodules, odynophagia, progressive dysphagia, and symptomatic anemia. Capsule endoscopy demonstrated utility in diagnosing gastrointestinal KS lesions, highlighting its crucial role when conventional upper endoscopy was challenging due to oropharyngeal involvement. Diagnostic limitations, mainly the unavailability of human herpesvirus-8 (HHV-8) immunohistochemical stain, were addressed through high clinical suspicion. Multidisciplinary approach including chemotherapy with liposomal doxorubicin, radiotherapy, and supportive care eventually yielded good clinical response. This case emphasizes the importance of early diagnosis, timely intervention, and long-term surveillance in achieving favorable outcomes for patients with KS despite some diagnostic limitations.
Human ; Sarcoma, Kaposi, HIV, Acquired Immunodeficiency Syndrome, Liposomal Doxorubicin

Humans ; Carcinoma, Hepatocellular/epidemiology* ; Liver Neoplasms/epidemiology* ; Prothrombin ; Biomarkers