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

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.

Objective: This study determined the capacity to treat retinoblastoma (RB) in the Philippines. Method: This was a cross-sectional study which included all Department of Health (DOH) hospitals and all government and private tertiary hospitals in the Philippines. An online modified questionnaire taken from the St. Jude Children’s Research Hospital study on RB assessment was emailed to 143 hospitals in all 17 regions. Primary outcome measures were human resources capacity, treatment capacity and education and network capacity. Availability, frequency and confidence of use were assessed for treatment capacity. An asset-based tier classification of hospitals was created based on the human resources capacity and treatment capacity. Results: This assessment survey had a 49% response rate. There were 3 regions that had zero correspondence. A general ophthalmologist, a subspecialized ophthalmologist, and a general pathologist were the most available physicians in the management of RB. Almost all respondents had the necessary diagnostic technology in their hospitals, but frequency and confidence of use were low. A quarter of the respondents (23%) used a standardized treatment protocol, while only 26% had established a referral network in their area. Tier classification was able to differentiate capacities for particular resources only. Only 23% of the participating hospitals have the capacity to treat RB through its trained human resources, available diagnostic and treatment technology, and education and network programs. Distribution of hospitals identified as tier I, II and III were 18%, 8%, and 41%, respectively. Conclusion Capacity to treat RB in the Philippines is evident only in a few hospitals, majority of which are located in the National Capital Region. However, tier 3 hospitals were identified in 10 other regions, making accessibility to RB care possible to patients in the provinces. Although human resource and technology are made available, utilization of these resources is low in many hospitals for the management of RB. Clinical practice guidelines for RB is still lacking. Connecting the different tiers in each region as a form of referral network can improve capacity and management of RB.
Retinoblastoma ; Therapeutics ; Surveys and Questionnaires

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

Cost of Illness ; Financial Stress ; Hepatitis B, Chronic ; Humans ; Perception ; Self Report

The subpulmonary ventricular exclusion (Fontan) could effectively improve the living quality for the children patients with a functional single ventricle in clinical. However, postoperative Fontan circulation failure can easily occur, causing obvious limitations while clinically implementing Fontan. The cavopulmonary assist devices (CPAD) is currently an effective means to solve such limitations. Therefore, in this paper the
Algorithms ; Child ; Feedback ; Heart-Assist Devices ; Hemodynamics ; Humans ; Models, Cardiovascular

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathies among reproductive aged women. It is associated with metabolic problems such as obesity, insulin resistance and dyslipidemia. Obesity in itself is associated with insulin resistance and dyslipidemia. However, it remains unclear whether lean and obese PCOS women share the same metabolic profiles. Objective: The aim of this study was to identify the prevalence of abnormal glucose metabolism and dyslipidemia across different categories of body mass index among women with PCOS Methods: A retrospective cross – sectional study included 160 PCOS patients covering the years 2015 to 2017 was performed. Fisher’s exact test, one-way analysis of variance using Fisher-Hayter multiple comparisons procedure and independent-test were used to compare the prevalence of disease among the different categories of body mass index (i.e. non-obese, overweight and obese). Results: Among obese patients, the prevalence of pre-diabetes was 39.33% (35/89) and Type II diabetes mellitus was 8.99% (8/89). Among overweight, pre-diabetes patients were at 16.67% (5/30), while diabetics were only 6.67% (2). Among the non-obese population, only 17.07% (7/41) were classified as pre-diabetics while only 2.44% (1/41) were considered diabetic. For the prevalence of dyslipidemia, overweight and obese patients had the most proportion of affected individuals, at 90% (27/30) and 87.64% (78/89), respectively. Conclusion Abnormal glucose metabolism and dyslipidemia are more prevalent among obese and overweight women compared to non-obese PCOS patients.
Polycystic Ovary Syndrome ; Body Mass Index ; Insulin Resistance ; Dyslipidemias