Siegfredo R. Paloyo

Facial nerve paralysis can be a debilitating condition involving aesthetic and functional deficits not to mention the emotional turmoil. Depending on the nature of injury, outcomes can vary as well as treatment options. Reanimation remains to be a daunting task, and while there are several new and refined reconstructive techniques being offered, there is still no gold standard procedure that will return normal facial nerve function. We present a case of a 43-year-old woman with a 6-year history of hemifacial weakness which she sustained after undergoing total parotidectomy and neck dissection for a left infra-auricular mass. She presented with incomplete closure of the left eye and drooping of the corner of her mouth. Lid loading with gold weight was used to correct the lagophthalmos, and dynamic reconstruction of the oral commissure was achieved using a minimally invasive orthodromic temporalis tendon transfer with a fascial lata graft extension. Postoperatively, the patient reported improvement of her symptoms with acceptable functional and cosmetic result at 2 years of follow-up.

Background: Fungating breast tumors represent a severe form of locally advanced breast cancer, frequently affecting women in low- and middle-income countries (LMICs). The optimal timing of reconstruction (immediate vs. delayed) following tumor resection remains controversial, especially in resource-constrained settings. Methods: A systematic review following PRISMA guidelines was conducted, searching PubMed, Cochrane Library, MEDLINE, and Google Scholar (January 2000-March 2024) for studies comparing immediate and delayed reconstruction in FBT patients. Eligible studies reported surgical complications, hospital stay, or adjuvant therapy timing. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: Six retrospective cohort studies from India, Pakistan, South Korea, and the United States met inclusion criteria. Reconstruction techniques varied, including skin grafts, advancement flaps, and myocutaneous flaps. Immediate reconstruction was more frequently performed but was often associated with higher complication rates in infected or unstable patients. Delayed reconstruction was generally reserved for those with poor clinical status. All studies carried at least a moderate risk of bias. Conclusion: Current evidence, though limited and heterogeneous, suggests that delayed reconstruction may offer a safer option for select FBT patients, particularly in LMICs. Prospective, standardized studies incorporating patient-reported outcomes are needed to inform clinical guidelines.

This essay examines the theological and vocational implications of a physician's experience of serious illness through the lens of Catholic anthropology and sacramental theology. When a practicing transplant surgeon unexpectedly underwent emergency open heart surgery for acute aortic dissection, the transition from healer to patient precipitated an existential reorientation. Drawing upon St. Augustine's understanding of human dependence upon grace, the Catechism's teaching on divine sustenance, and St. John Paul II's theology of redemptive suffering in Salvifici Doloris , this reflection explores how acute vulnerability disrupts professional identity while deepening it. Two devotional texts— Lead Me, Lord and Anima Christi —serve as interpretive anchors, illuminating the movement from disorientation to surrender and from autonomy to dependent agency. The essay argues that serious illness can purify and reform medical vocation by exposing the illusion of mastery and situating clinical practice within the primacy of grace. Rather than erasing professional identity, the experience of suffering may configure the physician more deeply to Christ and foster a more integrated understanding of healing as cooperation with divine providence. In this convergence of medicine and theology, vulnerability becomes not a negation of vocation but its refinement.

IntroductionCaustic ingestion is a global public health issue causing severe gastrointestinal injury. In the Philippines, it remains a frequent cause of hospital admission, both accidental and intentional. The COVID-19 pandemic, with its mental health impact, may have influenced these cases. This study assessed the effect of the pandemic on caustic ingestion at the University of the Philippines – Philippine General Hospital (UP-PGH).MethodsThis retrospective cohort study compared patients admitted for acute caustic ingestion during the pandemic (March 15, 2020–March 14, 2022) with the pre-pandemic period (March 15, 2018–March 14, 2020). Data on demographics, clinical presentation, diagnostics, and outcomes were collected from medical records. Statistical significance was set at p<0.05.ResultsA total of 456 patients were included: 348 pre-pandemic and 108 during the pandemic (p=0.0001). Mean age was similar, but pediatric cases increased (7.40% vs. 2.01%, p=0.0001). Hydrochloric acid ingestion was more frequent (40.74% vs. 24.7%, p=0.01), with larger volumes consumed (51.19 ± 66.8 mL vs. 14.83 ± 20.2 mL, p=0.00002). Patients presented with more severe symptoms, including vomiting (89.81% vs. 79.02%, p=0.03), abdominal pain (36.11% vs. 20.69%, p=0.00036), and emergency intubation (6.48% vs. 1.15%, p=0.00006). Surgical intervention (24.07% vs. 10.34%, p<0.05) and mortality (11.11% vs. 1.44%, p=0.001) were significantly higher during the pandemic.ConclusionWhile overall cases declined during the pandemic, severity and mortality increased, likely due to delayed care and stronger agents ingested. The rise in pediatric and intentional cases highlights the need for improved emergency response, mental health support, and regulation of corrosive substances.