PURPOSE

To report the technical details and outcomes of a case of cervical cancer in pregnancy treated with reduced standard radiation volume via Intensity Modulated Radiation Therapy (IMRT).

METHODS

A 33-year-old G4P3 (3003) was diagnosed with cervical squamous cell carcinoma at 17 weeks of gestation. She had a 5-year history of intermittent post-coital bleeding and an incidental finding of a cervical mass during prenatal ultrasound. Internal examination revealed a 6-cm mass with no extension to the upper vagina and pliable bilateral parametria, leading to a staging of IB3. A multidisciplinary meeting with a gynecologic oncologist, radiation oncologist, medical ethicist and the patient was held wherein different treatment options were discussed. She consented to definitive external beam radiation therapy (EBRT) with concurrent cisplatin and was administered during 19-25 weeks of gestation using IMRT. A prescribed dose of 45 Gy in 25 fractions was delivered to the entire cervix with a 1-cm geometric expansion covering the lower uterus, and upper vagina as well as the pelvic lymph nodes, followed by four fractions of brachytherapy.

RESULTS

The patient tolerated treatment with only grade 1 gastrointestinal and genitourinary adverse effects. After completion of concurrent chemoradiation, she underwent induction of labor and delivered a nonviable fetus. Three months post-treatment, MRI found no evidence of disease. At 15 months follow-up, she remains asymptomatic with no palpable disease.

CONCLUSION

This report demonstrates that treating only the involved uterus may be considered in cases wherein giving the full radiation dose to the whole uterus may lead to significant toxicities and eventual treatment interruption.

Human ; Female ; Adult: 25-44 Yrs Old ; Pregnancy Trimester, Second ; Radiotherapy ; Radiation ; Pregnancy ; Neoplasms

Primary cutaneous lymphoma are non-Hodgkin lymphomas with no evidence of extracutaneous disease. Classified into cutaneous T-cell lymphoma and cutaneous B-cell lymphoma from the WHO-EORTC classification 2018. 10 cases per million inhabitants per year worldwide are seen, wherein 20-25% are primary cutaneous B-cell lymphomas, with PCFCL having 12% frequency. Only 17 cases of cutaneous B cell lymphoma are recorded in the Philippines from 2011 to 2023. This rare case will add to the minimal data on the disease in the Philippines.

A 70-year old, Filipino male presenting with nodules, papules and plaques on the nose, forehead, preauricular areas, and temples of the face. Histopathologically, it showed atypical lymphoid follicles which were positive for CD20 and Bcl6 and negative for Bcl2, MUM-1, Cyclin D1, CD10 and CD5. Since there was no extracutaneous involvement, the final diagnosis was Primary Cutaneous Follicle Center Cell Lymphoma. He was treated with external beam radiation therapy with complete response, and no recurrence seven months after radiation therapy.

PFCL presents as papules, plaques, or tumors with a predilection for the scalp, forehead, and posterior torso. On dermoscopy, salmon-colored area and pro-eminent serpentine vessels, some having white circles with scales and arborizing vessels. Histologically, it expresses CD20 and Bcl-6, and predominantly Bcl-2 negative, but some cases show positive cells. Imaging and work-up ruled out systemic involvement Local radiation shows a close to 100% response rate.

PCFCL is still a rare disease nationwide.

Human ; Male ; Aged: 65-79 Yrs Old

Introduction: ILeptospirosis is an important zoonotic disease commonly found in tropical or sub-tropical countries. The most severe form is Weil's syndrome which presents with jaundice, renal failure, and bleeding diatheses. Although jaundice occurs in 38% of patients with leptospirosis, no studies in Asia have focused on the liver biochemical profile of these patients. Characterization of liver biochemical profile and ultrasonographic findings may shed more light on the disease process. Identification of liver biochemical parameters that portend a poor prognosis may also allow for early aggressive intervention. Objective: To describe the liver biochemical profile and liver ultrasonographic findings in adult patients with laboratoryconfirmed leptospirosis, admitted at a tertiary hospital in Manila, Philippines. The association of clinical and laboratory features with clinical outcomes (i.e., severe liver injury, Weil’s syndrome, and mortality) was also investigated. Methods: This retrospective cross-sectional study reviewed all available cases of adult patients with laboratoryconfirmed leptospirosis admitted in the Philippine General Hospital from January 2009 to August 2018. The clinical features, liver biochemical profiles, and ultrasound findings were recorded and analyzed. Comparison between the means of each group based on clinical outcome (i.e., mortality, Weil’s syndrome) was done via Students’ t-test for continuous variables, and calculation of the Odds Ratio for categorical variables. Results: Total and direct bilirubin levels were elevated in patients with leptospirosis compared to serum aminotransferases and alkaline phosphatase levels which were only mildly elevated. Abdominal ultrasound showed typically un-enlarged livers with normal parenchymal echogenicity, normal spleens, and non-dilated biliary trees. Dyspnea was associated with an increased odds for mortality. Although jaundice was present in 39.5% of patients and significantly associated with severe liver injury, this was not associated with mortality. Liver biochemical test values did not differ among patients who expired and those who survived to discharge. The presence of myalgia and abdominal pain increased the odds for Weil's syndrome. Conclusion To date, no local studies have fully described the liver biochemical profile of patients with leptospirosis. Our findings are compatible with previous studies showing that leptospirosis typically presents with predominantly elevated direct bilirubin from cholestasis and systemic infection. Contrary to previous literature, however, our study found no association between jaundice and mortality.
Leptospirosis

Introduction: The coronavirus pandemic has affected millions worldwide. Better understanding of COVID-19 in pediatric hematology-oncology patients in a resource-limited setting is crucial to improve care as the pandemic ensues. Objectives: This study describes the clinical profile and outcomes of pediatric hematology oncology patients with COVID-19 seen at the Philippine General Hospital (PGH). Methods: A retrospective, descriptive review of pediatric hematology oncology patients with COVID-19 seen between March 2020 to March 2021 in PGH was done. Results: Forty patients were identified. Seventeen percent had non-malignant hematologic conditions, 40% had leukemias, and 42.5% had solid tumors. Fever and cough were the most common manifestations. Seventy-six percent were on treatment, 9% were newly diagnosed, and 7% were in relapse or disease progression. Fifty-five percent had mild COVID-19; 5% and 2.5% had severe and critical COVID-19, respectively. Thirty-seven percent were asymptomatic. Cancer-related therapy was placed on hold for most patients. There were two mortalities, none was due to COVID-19. Conclusion Results suggest that patients with hematologic and oncologic conditions have a mild course, with majority showing recovery from COVID-19. Delays in cancer-related therapy however, may contribute to disease progression and mortality.
COVID-19

Background. Newborn screening (NBS) is a procedure for the immediate detection of genetic, metabolic, and endocrine disorders in neonates and is crucial for prompt treatment should such disorders be identified. In the Philippines, Republic Act 9288 requires health workers to properly inform mothers regarding NBS and its importance before the procedure.

Objective. To determine the knowledge, attitude, and awareness of primiparous postpartum mothers towards NBS Methods: A survey questionnaire was administered to primiparous mothers from Wards 15 and 16 of the Philippine General Hospital from April 11 through May 14, 2017. Results of primiparous postpartum mothers with or without previous prenatal check-ups were then compared.

Results. We surveyed 160 mothers, with half (56.3%) aged between 20 and 29 years. There were 149 mothers with and 11 without prenatal checkups. Mothers with previous prenatal checkups were more likely to be aware of NBS than those without prenatal checkups. Knowledge on NBS of mothers with previous prenatal checkups was higher on average compared to those without previous prenatal checkups. There was no significant difference in attitude between mothers with or without prenatal checkups.

Conclusion. Prenatal checkups increased the awareness and knowledge of primiparous mothers' towards NBS, and thus can be a potent vehicle where healthcare providers may inform the mother on the process and purpose of this procedure.

Neonatal Screening ; Knowledge ; Awareness ; Attitude

OBJECTIVE: This study aimed to determine the knowledge, attitudes and practices (KAP) of a selected population of patients on herbal dietary supplements (HDS).
METHOD: Methodological triangulation was used to generate a conceptual framework on HDS KAP. A survey of 175 patients was performed to measure knowledge and attitudes regarding HDS and SPSS was used for data analysis. Inverviews and focus group discussions (FGDs) were conducted to further explore the attitudes and practices, and constant comparison method was used for analysis of responses.
RESULTS: Respondents were generally aware of HDS. Majority of survey respondents believed that HDS are different from conventional drugs (52.0%, p<0.05). However, knowledge on the role of the Food and Drug Administration (FDA) in regulating HDS and understanding of "No Approved Therapeutic Claims" were poor.
The attitude toward HDS was generally positive. Majority (64.0%, p<0.05) were positive toward their perceived health benefits as claimed for the prevention of diseases, while a smaller percentage (46.9%, p<0.05) believed in their benefit for the treatment of diseases. A favorable attitude regardings HDS safety was observed due to the idea of their being "herbal" and "natural".
Among the survey respondents, only 22% were HDS users. Family was shown to promote use while cost deterred their use.
CONCLUSION: Individual knowledge and attitudes on HDS exert significant influence toward HDS practices. Factors that promote use are poor knowledge and positive attitudes toward HDS. Good knowledge seems to lead to judicious use or non-use.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Focus Groups ; United States Food And Drug Administration ; Awareness ; Perception ; Safety ; Attitude ; Dietary Supplements

INTRODUCTIONMore than half of all deaths in Singapore occur in hospitals. Little is known about the quality of care received by dying patients in hospitals. The Liverpool Care Pathway (LCP) provides a framework of providing good end-of-life care for dying patients and has been used with success in the United Kingdom (UK). In this study, we investigate whether adoption of a modified LCP in a Singapore hospital translated to better end-of-life care for cancer patients.

MATERIALS AND METHODSThe LCP was adapted and implemented as a pilot project on an oncology ward in Singapore General Hospital. A baseline review of 30 consecutive death records was performed, followed by a 4-month pilot and post-implementation audit of 30 consecutive patients on the adapted LCP.

RESULTSFive types of end-of-life symptoms were analysed. There was only 1 uncontrolled symptom at death in the post-implementation group compared to 24 uncontrolled symptoms in the retrospective audit group. The prescription of breakthrough medications for symptom control increased from 21% in the retrospective audit group to 79% in the post-implementation group. Inappropriate monitoring was discontinued in 25 patients in the post-implementation group compared to none in the retrospective audit group. The documentation of resuscitation status and religion of the patient was improved, achieving full documentation in the post-implementation group.

CONCLUSIONThis study shows promising results for improving end-of-life care in cancer patients with a protocol-based pathway in a Singapore hospital. Extension of this care pathway to other settings should be explored to maximise its benefits to patients dying from all causes in hospital.

Critical Pathways ; standards ; Diffusion of Innovation ; Female ; Hospital Mortality ; Hospitals, Public ; Humans ; Male ; Medical Audit ; Middle Aged ; Neoplasms ; Quality Improvement ; Retrospective Studies ; Singapore ; Terminal Care ; standards ; Tertiary Care Centers ; United Kingdom