A case study of Mosaic Trisomy 13 in a 2-year-old Filipino child

@#Mosaic trisomy 13 is estimated to occur in 5% of all trisomy 13 cases. Presentation of trisomy 13 mosaicism is highly variable, with cases that may present with a normal phenotype and intellectual function, to cases with grossly abnormal features and profound developmental delays. We present a 2-year-old female with trisomy 13 mosaicism, who presented with small for gestational age (SGA), polydactyly, ventricular septal defect (VSD), and poor oral feeding.

Identifying challenges to quality in preconception health care among women of reproductive age in Lipa City, Batangas

Background@#Preconception care is a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management. These interventions emphasize factors that must be addressed before conception or early in pregnancy in order to have maximal impact. Preconception health care is a key intervention in improving maternal and neonatal health care. Identification of specific needs of population-at-risk remains crucial in developing quality preconception health care programs in the Philippines. @*Objectives@#This paper: 1) described the preconception health status of women of reproductive age in selected communities in Lipa City Batangas; 2) identified the perceived preconception needs of women of reproductive age in selected communities; 3) determined the significant challenges to the provision of appropriate preconception health care; and 4) provided recommendations to address the gaps and challenges. @*Methods@#A total of 4,357 women of reproductive age were interviewed using a preconception checklist tool previously developed by researchers from Peking University (China), American University of Beirut (Lebanon), and University of the Philippines Manila (Philippines). Eleven Focus Group Discussions (FGDs) on various aspects of preconception health care were conducted among women of reproductive age from communities and workplaces (industries/factories, government offices, schools, entertainment centers, health centers). Thematic analyses of the data from the FGDs were performed. Recommendations for overcoming identified challenges to quality services were presented. @*Results@#There are salient gaps in preconception health care, particularly in micronutrient intake, immunization status, family planning and infectious diseases screening in both urban and rural communities. The study also showed major gaps in medical and educational services, particularly for adolescents. @*Conclusion@#Health and social challenges in the preconception health care delivery system for women of reproductive age in Lipa City Batangas were identified, including the prioritization of at-risk groups and development of strategies to address preconception health care gaps in both urban and rural settings. The alarming increasing rate of teenage pregnancy must be given highest priority with integration of safe and healthy pregnancy in the curriculum. The development of programs for men and women recognizes that parenthood is a partnership. To guarantee a successful program on preconception health care services, government must utilize an inter-sectoral and interdisciplinary approach with the participation of various stakeholders and sectors, both government and private. The engagement of women of reproductive age in planning provides a dynamic feedback for the relevance of the planned programs.

Early experience of gynecologic robotic surgery in a tertiary government hospital / Philippine Journal of Obstetrics and Gynecology

Background@#Robotic surgery is a form of minimally invasive surgery wherein the surgeon controls the camera and instruments in a console, remote from the operating room table. Currently, the system in place is the da Vinci Surgical System which was approved by the United States Food and Drug Administration in 2000 for laparoscopic surgery. Since its approval in 2005 for Gynecologic procedures, the da Vinci Surgical System has been used for hysterectomies, lymph node dissections, sacrocolpopexies, myomectomies, and cerclage.@*Objective@#This paper presents the initial seven cases of benign gynecologic diseases operated on utilizing the da Vinci Surgical System in our institution – six hysterectomies and one myomectomy.@*Methodology@#Seven gynecologic surgeries that utilized the da Vinci Surgical System in 2019 until the first quarter of the year 2020 were done. Medical records of the seven patients were reviewed.@*Results@#The average docking time was 38 minutes (range: 25 – 65 minutes) and the average console time was 227 minutes (range: 175 – 345 minutes). The average blood loss was 576 cc (range: 80 – 1200 cc). No cases converted to an abdominal laparotomy and no morbidities were reported. While two cases underwent blood transfusion intraoperatively, all cases were stable post-operatively and were for discharge after two days. On follow-up, all patients were stable with an unremarkable clinical course.@*Conclusion@#Our initial experience demonstrates that robotic surgery appears as a viable alternative to traditional approaches. As more cases are to be done in the future, fine-tuning of the logistical set-up and surgical skills are expected, as well as venturing into other gynecologic diseases such as malignancies. Further research must be conducted on various aspects of robotic surgery, such as but not limited to outcome comparison with traditional and other laparoscopic approaches, long term outcomes, patient safety, and patient experience and preference, among others.