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   Table of Contents - Current issue
May-June 2021
Volume 45 | Issue 3
Page Nos. 87-133

Online since Saturday, September 4, 2021

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Depression, anxiety, and stress levels in pregnant women who do not have access to regular antenatal services due to existing COVID-19 community quarantine measures and their perception on telemedicine p. 87
Nicole Marie M. Acriche, Geraldine Isabelle B. Uyheng
BACKGROUND: The COVID-19 pandemic has brought about mental anguish to the general population. This pandemic has changed the way we deliver healthcare. The enhanced community quarantine measures have caused the institution to close the outpatient department, leading to apprehensions among patients. Shifting to telemedicine to reach out to the patients as an alternative to face-to-face prenatal services is the current practice. OBJECTIVES: This study was conducted to assess the level of depression, anxiety, and stress in pregnant women enrolled under obstetric (OB) service who now have no access to regular antenatal services, as well as to determine the acceptance of telemedicine as a satisfactory alternative to regular prenatal visits. MATERIALS AND METHODS: This is a descriptive study among patients currently enrolled under OB service in a tertiary hospital in Cebu City and Mandaue City. Respondents have been provided the social media page and given prenatal checks by phone calls from the OB resident doctors since March 2020. A data collection form was filled up online consisting of three parts: (1) the mother's sociodemographic and obstetrical information, (2) a validated tool, the depression, anxiety, and stress-21 scale to assess depression, anxiety, and stress, and (3) query on whether telemedicine has helped alleviate depression, anxiety, and stress. RESULTS: Among the 196 patients surveyed, 21.94% were found to be moderately to severely depressed, 35.2% were moderately to severely anxious, and 8.61% were moderately to severely stressed. About 96.43% of the patients felt that telemedicine alleviated depression, anxiety, and stress during this crucial time. CONCLUSION: The level of depression, anxiety, and stress among the patients was generally normal or low. However, 21.93%, 35.2%, and 8.61% were found to be moderately to severely depressed, anxious, and stressed, respectively. Telemedicine was found to be a satisfactory alternative to regular prenatal visits. Respondents accepted telemedicine for the following reasons: unwilling to go to the hospital for fear of contracting the virus, fear of certain lockdown measures such as no available public transportation and no crossing of borders were allowed.
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An evaluation of the awareness, perceptions, and practice of ultrasound and the use of telesonography among obstetrics and gynecologic sonologists in the Philippines during COVID-19 pandemic p. 97
Melissa D Amosco, Lara Marie G. David-Bustamante, Maria Febi B. De Ramos, Ireene G Cacas-David
BACKGROUND: Major changes in the practice of medicine have been adopted due to the COVID-19 pandemic and have not spared the practice of ultrasound among obstetrician–gynecologists, considered to have higher risk due to unique attributes of an ultrasound examination. OBJECTIVES: This study evaluated the awareness, attitudes, perceptions, and practices of the obstetric–gynecologic sonologists in the country during the pandemic, including the use of telesonography. METHODOLOGY: A descriptive, cross-sectional survey was conducted through a self-administered, structured questionnaire using an online survey software. RESULTS: There were 120 respondents with postresidency training in ultrasound (54.2%) or in maternal and fetal medicine (43.3%), practicing in different regions, and mostly with teaching affiliations (56.7%). Most are aware of the guidelines on the practice of ultrasound this pandemic and they perceived themselves to be especially vulnerable to the infection. They admitted having feelings of stress, sadness, and depression, and their concerns centered on being infected and potentially transmitting it to their family. These perceptions translated to specific practices that include use of level 3 personal protective equipment, patient screening, triaging, and use of physical barriers to minimize environmental and contamination. While most are consistent with guidelines, some practices are neither based on sound scientific evidence nor correctly adhered to, including noncompliance with appropriate ultrasound transducer cleaning and disinfection. Regarding telesonography, only half of the respondents had good knowledge, with most having informal sources of information on the technology. Although the respondents have a good attitude toward it, only a few (15.8%) admitted to using it, mainly to confer with an expert or colleague (38.3%), and for teaching purposes (11.7%). CONCLUSIONS: Obstetric–gynecologic sonologists in the Philippines are aware of the risks and have the same attitudes and perspective on COVID-19 infection as other health-care providers. Specific practices have been modified; however, the use of telesonography is not among the changes adopted.
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Practice of minimally invasive gynecologic surgery in the Philippines during the COVID-19 Pandemic p. 111
Maria Antonia E. Habana, Prudence V Aquino-Aquino, Jennifer A Aranzamendez, Marinella Agnes G. Abat, Anna Belen I. Alensuela, Jean S Go-Du, Ma Asuncion A. Fernandez, Joan Tan-Garcia, Gladys G Tanangonan, Anne Marie C. Trinidad, Chiaoling Sua-Lao
OBJECTIVE: This study aims to establish baseline information on the practice of minimally invasive gynecologic surgery (MIGS) among Filipino gynecologic endoscopists amid the COVID-19 pandemic. MATERIALS AND METHODS: An online survey was conducted among Fellows of the Philippine Society for Gynecologic Endoscopy (PSGE) practicing in private and government hospitals in the Philippines after informed consent. The survey had five subsections: (1) demographic data, (2) impact of COVID-19 pandemic on MIGS practice, (3) changes of practice during the COVID-19 pandemic, and (4) changes in the conduct of surgery and postoperative care. RESULTS: A total of 119 out of 144 PSGE Fellows based in the Philippines participated in the survey, 83% were Fellows in both laparoscopy and hysteroscopy. The majority had more than 15 years of practice and were practicing in the National Capital Region. Surgeries were canceled initially but have since resumed. The majority were hysteroscopy cases, the most common being polypectomy. Majority of the respondents reduced their clinic hours and appointments. Most have used telemedicine for consultations. Use of face masks, face shields, and personal protective equipment (PPE) were the top precautions taken in the clinics. Screening and precautions per guidelines inside the operating room setting were observed. Modifications during surgery include the use of smoke evacuators, minimizing energy device use, and wearing enhanced PPE. CONCLUSION: The volume of laparoscopy and hysteroscopy cases was greatly reduced during the pandemic. The pandemic has disrupted the practice of MIGS both in the outpatient clinics and the operating rooms. Most of the changes made are congruent to local and international automotive task force guidelines. Precautionary measures and screening procedures must remain in place to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to patients and health-care workers.
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A deadly twist detorted p. 117
Aries Glenn B. Superable, Meliza M Lampitoc, Zoraida R Umipig-Guevara
Intestinal obstruction secondary to sigmoid colon volvulus in pregnancy is a rare but serious complication of pregnancy with significant maternal and fetal mortality. We report the first case in this institution of volvulus of the sigmoid colon in a pregnant patient on her 30th week age of gestation that was successfully managed conservatively with flexible colonoscopic decompression and detorsion. The presenting signs and symptoms seen in this patient are the same as with a nonpregnant patient and are often nonspecific. Hence, a high level of suspicion is essential for early diagnosis. Fetal and maternal mortality rates are higher during pregnancy if the diagnosis is delayed.
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Malignant transformation of a mature teratoma with concurrent cervical carcinoma versus squamous cell carcinoma of the cervix with ovarian metastasis: A diagnostic dilemma p. 122
Ina Felize A. Ramajo, Andrea M Gaddi, Cynthia G Gueco
Mature cystic teratoma of the ovary may occur in 10%–20% of women during their lifetime. Its biological behavior is benign, while 0.17%–2% of them may undergo malignant transformation. Various histological types of malignant transformation include Squamous cell carcinoma (SCC), adenocarcinoma, small cell carcinoma, sarcoma, malignant melanoma, and mixed histology. SCCA of the cervix occurs more commonly at ages 45–55. This is mainly caused by human papillomavirus 16 and 18. This tumor spreads to local then regional lymph nodes and can have hematogenous spread to bone and lungs, rarely to the ovaries. This report is of a 75-year-old Gravida 9 Para 9 (9009) with an enlarging pelviabdominal mass, managed as a case of ovarian new growth with later findings of cervical cancer. The case merits presentation because of the dilemma in diagnosis.
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Tumor recurrence in a previous abdominal incision site in a patient with endometrial adenocarcinoma: A case report p. 128
Patricia Marie T. Fernandez, Jericho Thaddeus P. Luna
Endometrial cancer is frequently diagnosed at an early stage and exhibits a good prognosis. However, 10%–15% of tumors recur usually within 3 years. Common sites of recurrence are the vaginal vault and pelvis. Only a number of case reports exist for tumor recurrence in a previous incision site. We present a case of a 71-year-old Filipino woman, a diagnosed case of Endometrial Adenocarcinoma Stage III A, FIGO Grade 1, who underwent surgical management, chemotherapy, and radiation therapy 9 years prior, presenting with an abdominal mass at the inferior aspect of the previous surgical scar with the foul-smelling discharge of 1-year duration. Physical examination revealed a 6 cm × 4 cm, friable, movable, nontender abdominal mass, with associated edema of the mons pubis. Surgical resection showed that the mass was confined to the abdominal wall, with no extension beneath the fascia and no evidence of tumor in the pelvic and abdominal cavity. Histological examination revealed a moderately differentiated adenocarcinoma in the abdominal wall, confirming tumor recurrence in an atypical location, probably arising from the previous incision site.
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