Southern Philippines Medical Center Journal of Health Care Services

Characteristics and Outcomes of Pediatric and Adult Non-Traumatic Out-Of-Hospital Cardiac Arrest (OHCA) in Southern Philippines Medical Center (SPMC) in COVID-19 Pandemic

Kenneth Doya Nonesa — 2023-12-21

This study aimed to describe the clinical, pre-hospital, and epidemiological characteristics and survival of Pediatric and Adult Non-Traumatic Out-Of-Hospital Cardiac Arrest (OHCA) in Southern Philippines Medical Center (SPMC) during the time of the COVID- 19 pandemic. Data extracted from the cardiac arrest registry form derived from the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network (CRN) based on Utstein standard data elements from March 2020 – December 2020 were used. Return of spontaneous circulation, survival–to–discharge, and CPC were the primary outcomes. Descriptive statistics and correlational analysis were used. 177 pediatric (13%) and adult (87%) OHCA patients were received in the ED, with a median age of 52 years, 69% were males. 68% were witnessed arrest, 80% happened at their residences. 75% were transported with private vehicle, and 11% were EMS facilitated. 62% attempted resuscitation en route, with 8% receiving shock advice, 0% receiving advance airway and drugs. Only 0.5% ROSC at the scene. 10% were transported with resuscitation and 90% without attempt. All OHCA received were pulseless, no spontaneous breathing despite ongoing resuscitation from prehospital transport. Only 1 patient sustained ROSC, admitted to ICU but expired on his 6th post-arrest hour. Correlations were not calculated for the hospital outcome variables as there were no sufficient data. Indirect effects contributed to the deranged OHCA incidences which we share the same with other countries. While this pandemic continues to challenge the EMS, it needs a second look that will rebuild the old and solid chain of survival.

A Case of a 15-year-old Female with Primary Renal Ewing Sarcoma.

John Lorenz Mirhan — 2023-12-22

Ewing sarcoma is a primitive neuroectodermal tumor of bone, most commonly seen in pediatric patients. While extraskeletal Ewing sarcoma is not unheard of, some sites are more rarely seen than others.

This report describes the case of a 15-year-old female who initially presented with an abdominal mass with no associated symptoms. Initial workup and biopsy of this patient yielded a diagnosis of nephroblastoma (Wilms tumor). The tumor was surgically removed, but recurrence prompted chemotherapy for Wilms tumor. External pathologic review yielded a diagnosis of poorly differentiated renal cell carcinoma with focal papillary features. Metastatic tumors were surgically removed, while further testing of the specimens and through immunohistochemistry and molecular and genetic testing demonstrated the presence of the EWSR-FLI1 fusion gene which confirmed the diagnosis of Ewing sarcoma. The patient’s chemotherapy protocol was shifted to one specific for Ewing sarcoma. However, patient opted to discontinue treatment and expired 3 months after.

This case is interesting due to the diagnostic dilemmas that compounded the treatment of the patient. Moreover, the site of the tumor makes it an extremely rare presentation, in which only 150 cases were reported in existing literature.

Atypical polymorphic eruption in pregnancy confirmed with a negative C4d immunohistochemistry: a case report

Andrea Isabel Contreras — 2023-10-16

Polymorphic eruption in pregnancy (PEP)is one of the most common dermatoses in pregnancy but is currently an underreported condition. It is important to distinguish this from pemphigoid gestationis (PG) due to their difference in pathophysiology and prognosis. This is a case of a 40-year-old female with a more than one year history of pruritic, tense vesicles and erythematous urticarial plaques on the face, gradually spreading to the chest, abdomen, and bilateral upper and lower extremities, with no other associated signs and symptoms. Lesions initially started in the first trimester of pregnancy, had transient resolution upon delivery, and had recurrence in the post-partum period. Skin biopsy findings were suggestive of pemphigoid gestationis. Further workups however were consistent with polymorphic eruption in pregnancy with the direct immunofluorescence and C4d immunohistochemistry yielding negative results. Patient was started on high potency topical corticosteroids and oral antihistamines which brought about significant improvement. When presented with multiple vesicles in a pregnant woman and during the post-partum period, an initial diagnosis of pemphigoid gestationis is commonly made. However, an atypical presentation of polymorphic eruption in pregnancy must be considered as a close differential, hence it is important to perform the necessary laboratory workups which include histopathology, direct immunofluorescence, and immunohistochemistry studies. To distinguish PG from PEP is necessary for proper patient appraisal regarding the course and prognosis of her condition.

Pemphigus Foliaceus: A Rare Case of Exfoliative Dermatitis

Jay Mohamad Ryan Aquino — 2023-12-28

A 51-year-old female, diagnosed case of Pemphigus foliaceous in 2019 and was previously admitted in this institution and was given topical and systemic corticosteroids with tapered dosing of Prednisone prior to being lost to follow-up. One month prior, patient was brought in for consult due to multiple bullae and erythematous, well-defined plaques with whitish scaling and erosions on the face, anterior trunk and extremities associated with pain and burning sensation. Laboratory work up was requested with non-contributory findings. Skin punch biopsy was done which revealed intraepidermal blister with few acantholytic cells, suggestive of Pemphigus Foliaceous. Direct immunofluorescence was also done which showed deposit of immunoglobulin G and C3 in the superficial intercellular space. Hence, a final diagnosis of exfoliative dermatitis (ED) secondary to PF was considered. She was started with topical corticosteroids on affected areas which she applied for a few weeks. However, patient was lost to follow up. One week prior, persistence of the lesions with associated chills, pain and tenderness prompted consultation and was subsequently admitted. Cutaneous examination revealed generalized erythema with overlying scales moist crusts and erosions involving over 90% of the body surface area, over the face trunk and extremities. No oral lesions appreciated. There were few areas of sparing over the legs. Nikolsky sign was positive. Patient was started on prednisone 70mg/day (1mkD) and was gradually tapered at 1.5mkD, and azathioprine 100mg/day(1.5mkD) along with topical corticosteroids. In summary, she was managed with systemic corticosteroids initially and later with the addition of azathioprine. She responded although very slowly and complete remission was attained in 5 months.