Intraperitoneal migration of lippes loop (Intrauterine Device): A case report

@#Intrauterine device use as contraceptionoffers the benefits of being affordable, long- acting, highly effective, and reversible. However, like any foreign body, it can be prone to certain complications, at times, with very serious consequences. Migration is the rarest but most feared complication. This is a report of the case of 72-year old woman with anine-month history of right lower quadrant abdominal pain. Work ups pointed to a migrated intrauterine device.The patient subsequently underwent laparoscopic removal of the foreign body with omental biopsy which laterrevealed metastatic adenocarcinoma from a primary ovarian malignancy.

Double Trouble: A case of synchronous high-grade serous carcinoma of the fallopian tube and borderline mucinous tumor of the ovary / Philippine Journal of Obstetrics and Gynecology

@#A 55‑year‑old, Gravida 2 Para 2 (2002), presented with postmenopausal vaginal bleeding. Workups pointed toward ovarian malignancy with distant metastasis (pleural effusion). Exploratory laparotomy, bilateral salpingo‑oophorectomy, surgical staging, and appendectomy were performed. On histopathological examination, synchronous high‑grade serous carcinoma of the right fallopian tube and borderline mucinous tumor of the left ovary were diagnosed. Primary fallopian tube carcinomas are very uncommon, while synchronous tumors of the female genital tract are extremely rare. Furthermore, there is a paucity of literature discussing the occurrence of synchronous primary malignancies arising from the fallopian tube and the ovary. It is crucial to differentiate primary malignancies from metastatic cancers to determine accurate staging and prognosis, as well as to assign appropriate treatment strategies. Immunohistochemistry and molecular testing play vital roles as adjunctive diagnostic tools to histologic examination in determining the origins of these tumors and distinguishing primary tumors from metastasis.

Time intervals from the first symptom to surgery of ovarian malignancies in a tertiary government hospital

@#<p style="text-align: justify;"><strong>Objective.</strong> This is a cross-sectional study aimed to determine the time intervals from the first symptom to surgery of 37 patients with ovarian malignancies who underwent surgery at a tertiary government hospital from June to October 2019.</p><p style="text-align: justify;"><strong>Methods.</strong> Structured interviews of patients and chart reviews were conducted to identify the intervals and the reasons behind such. The data were analyzed using Stata/SE 14.1, with the time intervals presented as medians and the reasons as frequencies. Multinomial logistic regression analysis established the association of time intervals with the extent of surgery and final stage of ovarian malignancies.</p><p style="text-align: justify;"><strong>Results.</strong> The median Total Time Interval from the first symptom to surgery was 214 days. The longest delay was the Total System Interval (from the first visit at the tertiary hospital to surgery) with a median of 70 days. This was followed closely by Patient Interval (from the first symptom to consult with the initial physician) with a median of 64 days. A distant third was the Initial Physician Interval (from the consult with the initial physician to the first visit at the tertiary hospital) with a median of 29 days. Most common reasons for the delays were the patients not acknowledging the gravity of their condition for the Patient Interval; choice to go to other hospitals, distance and laboratory works or diagnostics for the Initial Physician Interval; waiting for laboratory work-ups for the First System Interval; and waiting for other departments' clearance for the Second System Interval. The most common first symptom was abdominal enlargement. The length of interval and the final stage (p=0.056 for Stage III and p=0.162 for Stage IV)) as well as extent of surgery (p=0.093) did not show significant association.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The time interval from first symptom to surgery showed a median of 214 days. The greatest delay is contributed by Total System Interval followed by Patient Interval due to varying reasons. Length of time intervals, however, was not found to be significantly associated with the extent of surgery and final stage</p>

Comparative Evaluation of Completeness of Traditional Narrative versus Electronic Synoptic Operative Reports for Ovarian, Peritoneal and Fallopian Tube Cancer Surgery in a Tertiary Government Hospital

@#Objective. This study aimed to compare the completeness and ease of use of narrative reports (NR) submitted by residents compared to electronic synoptic reports (SR) by gynecologic oncology fellows for patients who underwent ovarian, fallopian, and peritoneal cancer surgery. Methods. We conducted a cross-sectional study in the Department of Obstetrics-Gynecology of the Philippine General Hospital from August to November 2019. We assessed the NRs and electronic SRs for completeness of data using quality indicators. Results. The average percentage of completeness of quality indicators is 77.1% (35.7/65). Eight indicators were absent in all NRs. Reporting of residual lesions was low (29.1%). The mean time to accomplish SRs (10.4 minutes) was significantly shorter than the mean time to accomplish NRs (21.9 minutes) (p value = 0.0001). SRs were assessed to be superior to NRs in several areas of surgery for quality, completeness and timeliness. Conclusion. This study showed that the NRs should be improved and periodic audit must be done to maintain quality assurance. The use of SR appears to be favorable and superior in terms of time required to accomplish.

Health Service Delivery as a Research Agenda

@#For any company or organization, its service delivery mirrors its effectiveness in attaining its goals. For a health care institution, this is health service delivery. Why should health service delivery be a priority of any health care institution or organization The World Health Organization (WHO) talks about improving the quality of patient-centered health service as the road to achieving universal health coverage and the Sustained Development Goals (SDGs).1 The US Agency for International Development (USAID) embarked on ASSIST, Applying Science to Strengthen and Improve Systems, a five year project designed to improve health and social services in USAID-assisted countries.2 It is imperative that health service delivery is designed in such a way that it is based on the best scientific evidence for a particular disease, is made easily accessible, and one that follows a structure or system that will support its delivery. The USAID further puts an even broader concept called governance for quality health care and service delivery. These include use of policy and strategies, effective regulation, engaging non-state actors, garnering political will, pursuing reliable data, culture of continuous improvement, promoting knowledge sharing, and linking financing to quality.2 Health service delivery as a research agenda, therefore, is not only confined to looking for treatment interventions based on the best evidence. It should also consider addressing access and availability of the health service, and the institutional architecture to support a quality health service or intervention. Defining of roles and responsibilities of personnel at various levels of care within the organization and the aligning of other resources necessary for delivery are vital parts of it also. In the Philippines, the National Unified Health Research Agenda (NUHRA) came about as it reflects the health needs of the Filipinos. The NUHRA creates a template for health research in these specific areas in a 5-year scope.3 The Philippine General Hospital (PGH) has included health service delivery as one of its top research agenda. In the past 4 years that it has established such, many of the research outputs have addressed specific disease interventions, hospital processes, and personnel welfare and readiness. There are still, however, a lot of gaps and questions that remain to be addressed. The papers on this fourth issue of the PGH for Acta Medica Philippina are diverse in scope but are all products of the authors’ questions that needed addressing in order to improve delivery of care to the PGH patients. May the impact of the results of these research endeavors truly make a difference in the lives of the patients the National University Hospital serves.

The development of the Philippine General Hospital as a referral center in the COVID-19 Pandemic: A qualitative study

@#Background. The University of the Philippines-Philippine General Hospital (UP-PGH) was designated as a COVID Referral Center for one cluster in Metro Manila during the pandemic. We reviewed and described how UP-PGH prepared for this endeavor. This can serve as reference for similar events in the future. Methods. We conducted a qualitative cross-sectional study with 20 key informant interviews and 5 focus group discussions involving 32 hospital front liners. All proceedings were transcribed and analyzed manually following the conceptual framework. Minutes of meetings, memoranda, and other official materials and communications were also reviewed. Results. The salient points of both internal (operations, structure, staff, supplies, and continuation of regular services) and external aspects (relation with other hospitals, the local government, the national health authority, and the general public) were enumerated and elaborated. Both best practices and areas needing improvement were identified. Conclusion and Recommendations. The UP-PGH tried its best to prepare and respond to the COVID-19 pandemic by protecting its hospital personnel and delivering evidence-based and quality care to patients. The response was not a perfect one and there were certain aspects for improvement.

Squamous cell carcinoma of the cervix with cranial metastasis: A case report / Philippine Journal of Obstetrics and Gynecology

@#Squamous cell carcinoma is the most common female genital tract malignancy that typically spreads to the pelvic organs first by direct extension, and less commonly to distant sites through lymphangitic and hematogeneous spread. We report on a 47-year-old woman diagnosed with squamous cell carcinoma who underwent concurrent chemoradiation, presenting with a fronto-parietal scalp mass which on histopathologic examination also shows squamous cell carcinoma, likely metastatic.

Prevalence of high-risk HPV in women with biopsy-proven Condyloma Acuminata / Philippine Journal of Obstetrics and Gynecology

Objective@#To determine the prevalence of HPV high risk positivity among women patients ages 30 to 65 with biopsyproven external genital warts (condyloma acuminata) specifically for HPV 16, HPV 18, and for other high risk types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66/68, 73, and 82.@*Methodology@#A cross-sectional study was conducted at the Department of Obstetrics and Gynecology Out-Patient Services of the Philippine General Hospital involving 57 women, 30 to 65 years old, with biopsy proven external genital warts or condyloma acuminata. These women underwent human papillomavirus (HPV) genotyping test for the high risk types (HR-HPV) from cervical samples using the automated polymerase chain reaction (PCR) technology.@*Results@#Fifteen out the 57 subjects had at least one of the HR-HPV types for an overall prevalence of 26.3%. Of the 15, 8 (53.3%) had at least 2 HR-HPV types with one subject having the most number of types at 6. Among the strains, the most common is HPV 51 and 52 each with a prevalence of 8.77% followed by HPV 53 and 59 at 7% each. HPV 16 and 18 each only had a 3.5% prevalence the same as HPV 58, 73, and 82. HR-HPV positivity was most common in the 30 to 39 age group (80%), and equally in the nulligravid and the secundigravid (40% each). None had current or past cigarettesmoking history and 33% had some form of hormonal contraception. @*Conclusion@#The overall prevalence of high risk HPV (HR-HPV) among these 57 Filipino women with external genital warts is 26.3%. The higher prevalence of HPV 51, 52, 53, and 59 over HPV 16 and 18 in this group does not follow the usual epidemiological characteristics reported about this disease.

A study on the factors affecting the use of the POGS-Nationwide Statistics System (PNSS) among Philippine Obstetrical and Gynecological Society (POGS)-accredited institutions in 2016 / Philippine Journal of Obstetrics and Gynecology

Objective@#To evaluate the factors affecting the use of the POGS PNSS across institutions. @*Basic Procedure@#A cross-sectional study was done by the POGS Committee on Nationwide Statistics from November 2017 to April 2018. Eight representative institutions were chosen from POGS accredited institutions for service and training from the NCR, Luzon, Visayas, and Mindanao, based on the classifications of I. Complete Data, II. Incomplete Data, III. Wrong Format, and IV. No Data. Hospitals with the most number of admissions under each category were chosen. Interviews with chairpersons of the departments, Focus Group Discussions (FGD) with the OB-GYN residents, and actual direct observations of how data were encoded in the PNSS were done.@*Results@#All the chairpersons and Ob-Gyn residents of the selected institutions were aware of the importance of the PNSS especially in generating vital nationwide statistics like Maternal Mortality and Morbidity Rates. They had several pertinent suggestions on how improvement of the PNSS, like harmonization of classification of diseases with PHIC and ICD codes, and to include other co-morbidities in the system.@*Conclusion@#The factors affecting the use of POGS-PNSS in 2016 include: good attitude and compliance among POGSaccredited institutions, but there is a need to address multiple diagnosis including medical co-morbidities. Final diagnosis also needs to be PHIC-compliant, and there is a need to address the Data Privacy Act with the use of eMR (electronic medical records).

Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer: A case-control study / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Epithelial ovarian carcinoma is the most lethal of the gynecologic malignancies. Recent theories on the etiopathogenesis of epithelial ovarian carcinoma supported the presence of occult, early stage neoplasms in the fimbriated end of the fallopian tube even before development of ovarian carcinoma. This study is interested in correlating opportunistic salpingectomy or tubal ligation as a possible effective prevention strategy in the occurrence of epithelial ovarian carcinoma.OBJECTIVE: To determine the association between the occurrence of epithelial ovarian carcinoma and a previous history of tubal ligation and/ or salpingectomyMETHODS: This is a case-control study involving chart review of patients who underwent total hysterectomy with bilateral salpingoophorectomy with a histologically verified epithelial ovarian cancer (cases) and patients who underwent same surgical procedure for benign gynecologic conditions specifically myoma uteri and adenomyosis with normal ovaries on final histology report (controls). The association between the occurrence of epithelial ovarian carcinoma and previous tubal ligation and/or salpingectomy was determined using appropriate statistical methods.RESULTS: A total of 558 patients were included in this review. They were divided into 158 post-surgical patients with histologically verified epithelial ovarian cancer (cases) and 400 post-surgical patients for benign gynecologic conditions with normal ovaries on final histology report (controls). Adjusted for age, parity and obesity the odds of developing epithelial ovarian carcinoma in subjects without previous tubal ligation and/or salpingectomy is 29%.CONCLUSION: The result of the study showed that tubal ligation and/or salpingectomy reduces the risk of developing epithelial ovarian carcinoma hence for patients at average risk of ovarian cancer, risk-reducing salpingectomy should be discussed and at the time of abdominal or pelvic surgery. It must also be included in the counseling of women planning a hysterectomy for benign indications to conserve ovarian function and prevent ovarian epithelial carcinoma.