OBJECTIVES

A growing body of evidence points to a positive association between periodontitis and
various systemic diseases, including cardiovascular diseases (CVD), hypertension, and rheumatoid arthritis. However,
there is limited data on the prevalence and odds of having systemic conditions among Filipino periodontal patients.
Thus, this study aimed to determine the association of periodontal disease with systemic conditions among Filipino
patients at a university dental clinic.

METHODS

The periodontal and medical charts of all patients who underwent periodontal consult at a university
dental clinic within two academic years were reviewed. Periodontal diagnoses which had originally been assigned
using the 1999 classification of periodontal diseases were reclassified based on the 2018 European Federation
of Periodontology-American Academy of Periodontology classification. Listed medical conditions in the patients’
charts were self-reported. The prevalence of various systemic conditions in 715 periodontitis cases was compared
to that of 834 control patients without periodontitis. Fisher’s exact test was performed to evaluate the difference
in the prevalence of comorbidities between groups, while adjusted odds ratios (AOR) were computed using logistic
regression analysis, accounting for age, sex, educational attainment, and smoking status.

RESULTS

The prevalence of having at least one systemic condition was significantly higher among periodontitis patients
(44.5%) compared to non-periodontitis patients (36.3%). Compared to controls, a significantly higher number of
periodontitis cases had two systemic comorbidities (P=0.001). The prevalence of hypertension (18.6% versus 5.04%),
CVD including hypertension (20.42% versus 6.95%), arthritis (9.37% versus 3.0%), and diabetes mellitus (5.73% versus
0.84%) were all significantly higher in patients with periodontitis compared to non-periodontitis controls.
The odds of having CVD (AOR=1.81), hypertension (AOR=2.14) and diabetes (AOR=3.05) were higher in periodontitis cases. Meanwhile, the prevalence of asthma (9.23% versus 5.31%), respiratory diseases including asthma (12.95% versus 8.25%), and allergies (18.82% versus 13.71%) were significantly higher in non- periodontitis patients compared to periodontitis cases.

CONCLUSION

Periodontitis patients were more likely to present with CVD, hypertension, and diabetes mellitus. On the other hand, no association was found between periodontitis and respiratory diseases, as well as between periodontitis and asthma.

Human ; Male ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Regression (psychology) ; Respiratory Tract Diseases ; Regression Analysis ; Periodontal Diseases ; Cardiovascular Diseases

Congenital divided nevus of the eyelids is a rare form of melanocytic nevus which involves contiguous portions of the upper and lower eyelid margins unilaterally, hence the term ‘kissing nevus’. While usually present at birth, these nevi may also appear later in life. When the mass enlarges, it may cause cosmetic issues to the patient, as well as functional problems such as mechanical ptosis, ectropion, and epiphora.

We report three cases of congenital divided nevus of the eyelids, all presenting with unilateral upper and lower hyperpigmented lid masses since birth. The first case had an upper lid mass measuring 11 mm x 19 mm, and a lower lid mass measuring 55 mm x 47 mm, with both masses extending into the palpebral conjunctiva, and causing severe ptosis and corneal neovascularization due to chronic irritation. The second case presented with hyperpigmented masses at the lateral third of the right upper eyelid measuring 8 mm x 17 mm and of the lower eyelid measuring 9 mm x 15 mm on the lower lid with lashes growing through the masses. There was extension of the mass into the palpebral conjunctiva. The third case presented with a 23 x 18 mm hyperpigmented, well-circumscribed, verrucated mass at the medial half of the upper eyelid crossing the eyelid margin, and a 15 x 13 mm lesion at the medial third of the lower lid with the same characteristics, with small crusty lesions and clotted blood. All three patients underwent excision biopsy with lid reconstruction using full thickness skin grafts from the supraclavicular area. Six months postoperatively, the first case underwent a repeat full thickness skin graft due to graft contraction, and also received two sessions of fractional carbon dioxide (CO2 ) laser, two sessions of intralesional triamcinolone injections, and silicone gel application with further improvement of graft healing and scarring. The second case also underwent two sessions of intralesional steroid injection for scar management. During follow-up, which spanned 13 months for the first case, 10 months for the second case, and two months for the third case, improved functional and cosmetic outcomes were observed.

This case series highlights the outcomes of the most common surgical technique done for congenital divided nevi of the eyelids. Congenital divided nevi are usually diagnosed clinically and malignant degeneration is rare, hence lid reconstruction may be done without frozen section. The cases in the series were treated due to cosmetic and functional purposes, hence the importance of continuous post-operative follow-up to monitor for graft dehiscence, scar development, recurrence of the mass, malignant degeneration, and development of lid malposition. Additional procedures for scar management, such as CO2 laser and intralesional steroid injections, may be necessary to further enhance outcomes in complex cases. All three cases in this series exhibited improved functional and cosmetic outcomes post-operatively, with significant reduction in ptosis and scarring. Longterm follow-up revealed satisfactory recovery with minimal complications, with no recurrence nor malignant degeneration.

Human ; Male ; Female ; Adult: 25-44 Yrs Old ; Young Adult: 19-24 Yrs Old ; Nevus ; Nevus, Pigmented

BACKGROUND AND OBJECTIVE

The incidence of ischemic stroke typically increases with age; however, recent studies have shown a concerning trend of stroke cases among adults under the age of 45. This neurologic condition is called “Stroke in the Young” (SITY). SITY poses public health concerns due to its long-term consequences on individuals and their families. Despite significant impact, published literature on SITY among Filipinos is scarce. Given the potential differences in genetic background and lifestyle, the clinical characteristics and outcomes of SITY Filipinos may vary considerably from other populations. Therefore, the aim of this study is to describe the clinical features and outcomes of ischemic SITY Filipinos.

METHODS

The study was a two-center, five-year retro- spective cohort design involving 19- to 45-year-old  patients admitted between January 1, 2017, and December 31, 2022, diagnosed clinically and radiologically with ischemic stroke for the first time. Medical records were reviewed, including demographic data, stroke symptoms, cardiovascular or non-cardiovascular risk factors, and laboratory results. Ischemic stroke subtypes were categorized into cardioembolic, small artery occlusion, stroke of other determined causes, and stroke of undetermined cause through the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Functional outcomes on hospital discharge were assessed by the Modified Rankin Scale (mRS). All data were analyzed using descriptive statistics in the Statistical Package for the Social Sciences (SPSS software, version 29).

RESULTS

A total of 205 cases of ischemic SITY were chart reviewed. The mean age was 37.30, with a female predominance of 68.3%. The most reported cardiovascular risk factors were obesity (56.6%), hypertension (51.2%), heavy alcohol consumption (36.5%), and diabetes mellitus type 2 (19.5%). Concurrently, the non-cardiovascular risk factors identified were pregnancy, particularly in the postpartum period (4.8%), use of estrogen-containing pills (4.8%), and migraine without aura (4.4%). Based on TOAST classification, small vessel occlusion (42.1%) and large artery atherosclerosis (30.2%) were the most frequent ischemic stroke subtypes of SITY Filipino females. Mostly showed no symptoms of disability (35.1%) on hospital discharge.

CONCLUSION

This study highlights the difference in the clinical profile of young Filipino adults with ischemic stroke. Contrary to previous studies, ischemic stroke was more predominant among young females. Aside from hypertension, obesity has emerged as the leading cardio- vascular risk factor for ischemic SITY. Moreover, noncardiovascular risk factors, specific to females (pregnancy, use of estrogen-containing pills, and migraine), were also identified in the study. With regards to stroke subtypes, small vessel occlusion and large artery atherosclerosis were frequently seen in young female patients. These f indings suggest a need for gender-specific approaches in the evaluation, management, and prevention of ischemic SITY.

Human ; Young Adult: 19-24 Yrs Old ; Ischemic Stroke

INTRODUCTION

Left ventricular remodeling is an adaptive response to aging and cumulative exposure to risk factors for cardiovascular disease. With the rising prevalence of cardiovascular disease in the younger population, a timely risk identification is warranted.

OBJECTIVES

This study aims to determine the prevalence of LV remodeling in young patients using transthoracic echocardiography, and to determine the association of their clinical profiles with LV remodeling.

METHODOLOGY

A retrospective cross-sectional design was utilized. Descriptive statistics using frequency and percentages was employed to describe the clinical profiles of patients; chi-square tests to assess the significance of associations of patients’ clinical profile with the LV remodeling patterns; and One-way Analysis of Variance (ANOVA) followed by post-hoc tests for significant F values to provide insights into the differences of means across various cardiac parameters.

RESULTS

Our study included 208 patients who had thoracic echocardiography from January 2021 to December 2022 at our institution. Majority were aged 31-40 years (64.4%), female (54.8%), and under the BMI classification of obese (52.9%). There were varying percentages per comorbidity, with hypertension (HPN) being the most prevalent. The presence of symptoms was also examined; however, it was not statistically significant. Age, sex, comorbidities, and presence of symptoms were not significantly associated with LV remodeling while BMI classification demonstrated a significant association (χ2 = 25.457, p = 0.003**). In this study, LV remodeling is already prevalent at 32.21% in young adults aged 18-40 years old. BMI classification demonstrated a significant association with LV remodeling pattern. Obesity showed a significant association with concentric remodeling pattern.

CONCLUSION

We found that LV remodeling is already prevalent in young adults aged 18-40 years old. BMI classification demonstrated a significant association with LV remodeling pattern. Obesity showed a significant association with concentric remodeling pattern.

Human ; Young Adult: 19-24 Yrs Old ; Transthoracic Echocardiography ; Echocardiography

Ovarian cancer in pregnancy is a rare occurrence. Of all ovarian malignancies, <1% comprise immature teratomas. We present the case of a 24-year-old primigravid with an incidental finding of an ovarian new growth during a routine first-trimester ultrasound. The mass was suspicious for malignancy due to an ultrasound finding of a cystically enlarged 8.2 cm × 5.8 cm × 6.2 cm mass, with solid components and with minimal color flow on Doppler. There was an interval increase in the said mass during the second trimester, with an elevated alpha-fetoprotein (AFP) level. The patient underwent surgery at 24 weeks gestation. Histopathology revealed Immature Teratoma, FIGO Grade 3, stage IC1. She delivered to a live, term baby boy through cesarean delivery. Postpartum, she completed four cycles of chemotherapy using bleomycin, etoposide and cisplatin (BEP), and was advised surveillance with serum AFP every 3 months. Due to the limited number of cases of ovarian cancer in pregnancy reported, management is individualized. Dilemma in terms of the timing of surgery, neonatal and maternal outcomes, timing and mode of delivery, and control of tumor metastasis through chemotherapy were met, hence, a multidisciplinary team and patient decision is crucial to achieve successful and desirable outcomes for the mother and the fetus. This is the first case of immature teratoma in pregnancy reported in our institution and in a local setting.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Alpha-fetoproteins ; Teratoma

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.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Histopathology ; Pathology ; Lupus Erythematosus, Systemic ; Scleroderma, Systemic

Objective:To determine the association of demographic profiles and clinical characteristics of patients with aural foreign bodies seen at the Emergency Room (ER) of the East Avenue Medical Center with clinical outcomes

Methods:
Design:Cross-Sectional Study
Setting:Tertiary Government Training Hospital
Participants:A total of 143 aural foreign body cases seen at the ER from January to December 2022 under the Department of Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) of East Avenue Medical Center were included in the study.

Results: Of the 143 patients, majority (84; 58.74%) were males. Mean age was 21.92 years old with two peak incidences noted at ages 1-12 years old and 18-65 years old. Most of the patients were right-handed (134; 93.71%). Majority of the foreign bodies were animate (76; 53.15%) and were frequently found to be lodged on the right ear (86; 60.14%) with duration from lodgment to
extraction commonly within less than 24 hours (119; 83.22%). One hundred forty two (99.30%) patients had successful foreign body extraction, 60 (41.96%) had complications, specifically involving the external auditory canal (51; 35.66%) and tympanic membrane (6; 4.20%). Significant associations were found between age and type of foreign body [χ2 (3, N =143) = 31.24, p < .01] with a higher proportion of animate foreign bodies in adults and inanimate foreign bodies in children; sex and presence of complications [χ²(1, N = 143) = 5.41, p < .05] with males experiencing more complications than females; type and duration of foreign body [, χ²(2, N = 143) = 16.33, p < .01] with animate foreign bodies generally having a shorter duration of less than 24 hours compared to inanimate foreign bodies; and the duration of foreign body and presence of TM complications [χ²(4, N = 143) = 14.21, p < .01] with shorter durations (less than 24 hours) showing fewer TM complications. Males had higher odds of developing complications compared to females (OR = 2.315, 95% CI [1.105, 4.851])

Human ; Male ; Female ; Child: 6-12 Yrs Old ; Young Adult: 19-24 Yrs Old ; External Ear Canal ; Emergency Room ; Association

Congenital malformations of the uterus are rare. Pregnancies in these uterine abnormalities are usually associated with poor reproductive outcomes such as recurrent pregnancy losses, preterm birth and intrauterine growth restriction. Presented here is the case of a 21-year old G2P1(1001), who was diagnosed intraoperatively with a septate bicornuate uterus during her second Cesarean delivery. She had to undergo abdominal delivery for both her pregnancies due to malpresentation, and delivered live healthy babies with no gross structural defects. Pathophysiology and classification of congenital uterine malformations are discussed in the case, as well as the diagnostics and management for such conditions.
Human ; Female ; Young Adult: 19-24 yrs old ; Bicornuate uterus ; Septate Uterus ; Uterine anomalies

INTRODUCTION

A 23-year-old young female patient presenting with persistent diarrhea and eosinophilia, who had clinical improvement after administration of steroids.

CASE

A 23-year-old Filipino female, without comorbidities presented with abdominal pain, diarrhea and vomiting. Initial work-up showed peripheral eosinophilia. Computed tomography (CT) of the abdomen revealed massive ascites. An esophagogastroduodenoscopy (EGD) was done which revealed acute duodenitis. Gastric and duodenal biopsy revealed tissue eosinophilia. Total Immunoglobulin E (IgE) was elevated while work-up for intestinal parasitic infection was negative. On bone marrow biopsy, there was no eosinophilic infiltration. Oral prednisone was then started at 60mg/day and was subsequently tapered over 30 days resulting in resolution of symptoms.

CONCLUSION

This report illustrates a rare case of eosinophilic gastroenteritis (EGE). EGE may mimic a wide spectrum of gastrointestinal disorders, hence, prompt recognition of EGE and awareness of its clinical symptoms, diagnosis and treatment is important.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Eosinophilia ; Diarrhea

Gliomatosis peritonei (GP) is a condition characterized by the dissemination of mature glial tissues throughout the peritoneal cavity. It is usually associated with immature ovarian teratoma but presents with mature cystic teratoma (MCT) in 1% of cases. GP, associated with MCT, is a benign disorder. The majority of cases remain asymptomatic and rarely recur. Here, we present a case of a 22-year-old woman with a history of abdominal enlargement and severe abdominal pain who underwent exploratory laparotomy, peritoneal fluid cytology, bilateral salpingo-oophorectomy, appendectomy, omental biopsy, and Jackson-Pratt drain insertion with histopathologic result of GP with MCT. A month later, the patient had a recurrence of abdominal enlargement, necessitating a second surgery. Immunohistochemistry for histopathologic evaluation and diagnostic imaging are crucial in confirming the diagnosis and guiding the treatment strategy. A multidisciplinary team approach in monitoring and comprehensive support is significant in optimizing outcomes for patients with aggressive GPs associated with MCT. Further research and clinical experience are essential to establish a standardized guideline to improve the management and clinical outcome of this condition.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Salpingo-oophorectomy ; Peritoneal Cavity ; Appendectomy ; Abdominal Pain ; Ascitic Fluid ; Immunohistochemistry