BACKGROUND

This case report describes a rare presentation of double-vessel Spontaneous Coronary Artery Dissection (SCAD) in a 54-year-old male. One dissection occurred in a coronary artery with atherosclerotic plaque deposition, while the second vessel exhibited dissection without evidence of plaque deposition, trauma or iatrogenic manipulation such as percutaneous coronary intervention. The patient, a known hypertensive and dyslipidemic, had a prior diagnosis of heart failure with reduced ejection fraction (HFrEF). He presented with progressively worsening shortness of breath and orthopnea (two-pillow orthopnea for three years. An initial coronary angiogram was recommended due to a high suspicion of underlying coronary artery disease (CAD).Subsequent diagnostic workup revealed multisegmental wall motion abnormalities on 2D echocardiography with Doppler imaging. Laboratory tests, including electrolytes, were unremarkable. A follow-up coronary angiogram revealed mild to moderate CAD in the left anterior descending (LAD) artery and spontaneous coronary artery dissection involving both the LAD and the right coronary artery (RCA). The patient was managed conservatively with aspirin and discharged on a regimen of sacubitril/valsartan, ivabradine, trimetazidine, and rosuvastatin. As typically seen in SCAD cases, conservative medical management was preferred over invasive procedures such as PCI or coronary artery bypass grafting (CABG), which are reserved for select clinical situations.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Arteries ; Dissection ; Hospitals ; Male ; Patients ; Research Report ; Tertiary Care Centers

BACKGROUND

This case report describes a rare presentation of double-vessel Spontaneous Coronary Artery Dissection (SCAD) in a 54-year-old male. One dissection occurred in a coronary artery with atherosclerotic plaque deposition, while the second vessel exhibited dissection without evidence of plaque deposition, trauma or iatrogenic manipulation such as percutaneous coronary intervention. The patient, a known hypertensive and dyslipidemic, had a prior diagnosis of heart failure with reduced ejection fraction (HFrEF). He presented with progressively worsening shortness of breath and orthopnea (two-pillow orthopnea for three years. An initial coronary angiogram was recommended due to a high suspicion of underlying coronary artery disease (CAD).Subsequent diagnostic workup revealed multisegmental wall motion abnormalities on 2D echocardiography with Doppler imaging. Laboratory tests, including electrolytes, were unremarkable. A follow-up coronary angiogram revealed mild to moderate CAD in the left anterior descending (LAD) artery and spontaneous coronary artery dissection involving both the LAD and the right coronary artery (RCA). The patient was managed conservatively with aspirin and discharged on a regimen of sacubitril/valsartan, ivabradine, trimetazidine, and rosuvastatin. As typically seen in SCAD cases, conservative medical management was preferred over invasive procedures such as PCI or coronary artery bypass grafting (CABG), which are reserved for select clinical situations.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Arteries ; Dissection ; Hospitals ; Male ; Patients ; Research Report ; Tertiary Care Centers

Lichen planus (LP) is a chronic inflammatory dermatosis with a prevalence of 0.1%-4%, typically affecting individuals aged 30-60 years. Isolated lip involvement is uncommon, seen in 0.51%-8.9% of cases, predominantly in middle-aged men. We report a 58-year-old male with well-controlled diabetes who developed isolated lower lip LP, initially misdiagnosed as herpes simplex virus infection and unresponsive to oral acyclovir. Dermoscopy and histopathology confirmed the diagnosis. The patient was managed with a novel regimen: Tacrolimus 0.1% ointment (morning) and tretinoin 0.025% cream (night), alongside sunscreen and petroleum jelly. After 4 weeks, marked improvement was observed with flattened lesions and reduced pruritus. This case underscores the potential efficacy of combining a calcineurin inhibitor and a retinoid as a corticosteroid-sparing alternative for localized LP. Clinically, this approach offers a valuable treatment option for patients with lip LP showing suboptimal response to initial corticosteroid therapy, minimizing steroid-related adverse effects and improving therapeutic outcomes.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Complementary Therapies ; Lichen Planus ; Tacrolimus ; Tretinoin

This case report presents a 22-year-old male with Pornography-Induced Psychogenic Erectile Dysfunction (ED), highlighting the growing prevalence of this condition in young men and emphasizing the importance of recognizing and addressing it in primary care settings. The patient presented with the primary complaint of an inability to sustain an erection, with erections lasting only for approximately one minute. He had an unremarkable past medical and family history, was a previous smoker, and engaged in occasional alcoholic beverage consumption. Psychological assessment revealed moderate erectile dysfunction, problematic use of pornography, and minimal anxiety.

A comprehensive treatment plan was implemented, incorporating lifestyle modifications, pharmacotherapy and psychological interventions (Motivational Interviewing, Brief Strategic Therapy, and Educational Counseling). The patient demonstrated a positive response to treatment, with significant improvements in both erectile function and control over pornography consumption, as evidenced by follow-up assessments.

This case underscores the need for healthcare professionals to routinely inquire about pornography consumption habits when assessing patients with ED, particularly young men. It emphasizes the importance of a thorough assessment, including medical, psychological, and sexual history, for accurate diagnosis and effective treatment.

Furthermore, it demonstrates the value of an integrated treatment approach, addressing both physical and psychological factors, for optimal outcomes. Finally, it highlights the importance of patient education to enhance treatment adherence and motivation for change.

Human ; Male ; Young Adult: 19-24 Yrs Old ; Erotica ; Pornography

BACKGROUND

Keloids and hypertrophic scars are overgrowth of fibrous tissue after damage to the skin. There have been various published treatment modalities for these lesions. Currently, there are still no published studies on the use of laser-assisted drug delivery for hypertrophic scars and keloids in the Philippine setting.

OBJECTIVE

To determine the efficacy and safety of laser-assisted drug delivery versus intralesional steroid injection alone for the treatment of keloid and hypertrophic scar.

METHODS

This was a single center, randomized single-blind controlled study. Participants were randomly assigned into a control group (intralesional steroid injection) or a treatment group (laser-assisted drug delivery). The procedure was done monthly for four sessions. Assessment of lesions using the Vancouver Scar Scale was done at baseline and monthly post-sessions.

RESULTS

A total of 42 participants completed the study, which was divided into two groups of 21 samples each. Results showed that the mean difference in overall skin score from baseline to fourth treatment session was significantly lower in the laser-assisted drug delivery group than the intralesional group (–0.48±0.75 vs. –0.24±0.54, t=2.31, p=0.026). No adverse events were noted throughout the study period.

CONCLUSION

It is a promising option to use non-ablative fractional CO2 laser-assisted drug delivery as the treatment outcome was comparable to using intralesional steroid injection as monotherapy for keloids and hypertrophic scars.

Human ; Keloid ; Scars, Hypertrophic ; Cicatrix, Hypertrophic

BACKGROUND

Although higher education institutions (HEIs) are expected to contribute much in the larger communities, it cannot be denied that the employees have the qualities and characteristics with genuine interest to help the institution, other individuals, and the communities surrounding them. Studying teamwork, moral sensitivity, and work engagement is essential in determining how they affected with the organizational management, training of students, and achieving the goals of the college.

OBJECTIVES

The objective of this study was to determine the level of teamwork, moral sensitivity, and work engagement and the relationship between them among faculty members, school administrators, and supporting staff in a government HEI in the Philippines.

METHODS

A cross-sectional design was employed involving 49 employees in a government HEI. Three self-report scales were used in gathering the data: TeamSTEPPS Teamwork Perceptions Questionnaire, Ethical Sensitivity Scale, and Utrecht Work Engagement Scale. Data were analyzed using Spearman’s rho correlations, point biserial correlations, and eta correlations.

RESULTS

Participants reported high levels of perceived teamwork, moral sensitivity, and work engagement. Marital status was significantly and positively correlated with moral sensitivity and work engagement, whereas employment status was significantly and positively correlated with teamwork and moral sensitivity. Moreover, moral sensitivity was significantly and positively correlated with teamwork and work engagement.

CONCLUSIONS

College employees who reported high levels of moral sensitivity are associated with high levels of teamwork and work engagement. Strategies to maintain and enhance teamwork, moral sensitivity, and work engagement are recommended through various activities such as team-building workshops, staff development, and/or leadership trainings.

Human ; Work Engagement

BACKGROUND

Cervical cancer is a common malignancy among Filipino women, treated through surgery, chemotherapy, or radiation. To improve outcomes and reduce costs, the European Society of Gynaecological Oncology (ESGO) established 15 quality indicators for its surgical management. The aim of the study was to evaluate the quality of cervical cancer surgeries at a tertiary government hospital in the Philippines, using ESGO quality indicators.

METHODS

A descriptive retrospective review was conducted on medical records of early-stage cervical cancer patients who underwent radical surgery from January 1, 2019, to December 31, 2021. Data were collected using ESGO’s 15 quality indicators. Incomplete records were excluded from the study. Descriptive statistics and Kaplan–Meier analysis were used.

RESULTS

Fifty-four patients underwent surgery, averaging 18 cases per year. Most surgeries (75.93%) were supervised by certified gynecologic oncologists, and 85.2% were discussed in multidisciplinary conferences. All patients had appropriate preoperative assessments and metastatic imaging. Pathology reports met the required standards, and lymph node staging was achieved in all cases. Adequate lymph node harvest was 68.18% (pelvic) and 65.91% (paraaortic). Fertility counseling was provided, although none pursued fertility-sparing treatment. Surgical complications included two vesicovaginal fistulas (3.7%). Clear margins were achieved in 92.59%, with 24.30% upstaged postoperatively. Adjuvant chemoradiotherapy rates were highest in 2019 (93.33%). No recurrences were noted for stage IB1 after a median 34-month follow-up.

CONCLUSION

The surgeries met ESGO quality standards, demonstrating that these indicators can be adapted locally, ensuring quality assurance in care.

Human

Although commonly seen in the ovary, fallopian tube, peritoneum, and endometrium, the serous carcinoma histology is considered a rare subtype when seen in the cervix. The prevalence of cervical adenocarcinoma, including serous carcinoma, varies between 5% and 15% of all cervical malignancies. A thorough literature study revealed only 113 cases of serous carcinoma of the cervix, highlighting its infrequency relative to other cervical cancer variants. As a subtype of adenocarcinoma, serous carcinoma of the cervix has aggressive characteristics and usually unfavorable prognosis, more so its clinicopathological characteristics are relatively unclear because of its rarity and limited number of cases and reviews seen in literature. This is a case of a 44-year-old G3P3 with a primary complaint of heavy vaginal bleeding. The diagnosis of serous carcinoma of the cervix was made by histopathological evaluation, confirmed by immunostaining. With physical examination and diagnostic imaging confirming an early stage disease, the patient successfully underwent primary surgical management.

Human ; Female ; Uterine Cervical Neoplasms

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Robotic liver transplantation represents a cutting-edge technique that may surpass traditional open surgery. Nonetheless, it introduces unique anesthetic challenges, including extended pneumoperitoneum, restricted patient access, and a risk of undetected blood loss. This article describes an anesthetic approach and patient outcomes for the first four total robotic liver transplants performed at a tertiary university hospital in Portugal, along with inaugural procedures of their kind in Europe. We retrospectively analyzed surgical and anesthetic data from four patients who underwent total robotic liver transplantation from February to April 2024. Data encompassed clinical profile, preoperative assessment, surgical and anesthesia details, postoperative course, and outcomes. Patients’ age ranged from 51 to 69 years. Their cirrhosis was primarily due to alcohol use, hepatitis C virus infection, hepatocellular carcinoma, or nonalcoholic steatohepatitis. General anesthesia was administered. Hemodynamic monitoring and goal-directed fluid therapy were conducted using a PiCCO system. Blood loss varied from 1,000 to 5,000 mL. Blood products were transfused as needed. All donor livers underwent hypothermic oxygenated machine perfusion before transplantation. After surgery, two patients were immediately extubated, while two required extended ventilation. Hospital stays ranged from 10 to 40 days. The 30-day survival rate was 100%. This initial case series affirmed the feasibility and safety of total robotic liver transplantation for carefully selected patients, yielding favorable short-term results. Anesthetic management can rely on proactive strategies, acute situational awareness, and effective multidisciplinary collaboration.