INTRODUCTION: Current evidence supports a central role of inflammation in the pathogenesis of atherosclerosis and diabetes. Diabetes Mellitus (DM) type 2 is an inflammatory atherothrombotic condition associated with high prevalence of thrombotic cardiovascular disease. In patients with DM, this inflammation is
reflected by elevated plasma C-reactive protein (CRP) levels. High specificity (hsCRP) is considered as a strong predictive of cardiovascular risks and death. Some evidence showed that CRP may represent an active participant in atherogenesis. Among the DM risk factors (like hypertension, atherogenic dyslipidemia, insulin resistance, impaired fibrinolysis, inflammatory profile), inflammation is the neglected one. Moringa oleifera (M.oleifera) has been suggested to exert anti-inflammatory and hypoglycemic property.

OBJECTIVE: To determine the effect of M.oleifera leaves supplementation on the hsCRP, and HgbA1c levels of diabetics of Ospital ng Maynila Medical Center DM clinic

METHODS: We performed a prospective quasi experimental study on 56 adult diabetics who were given 12-weeks supplementation of M.oleifera. Plasma hsCRP and serum HgbA1c were compared before and after treatment with M.oleifera.

RESULTS: The over all population mean prehsCRP is 3.38 mg/dl (95% CI 2.77-3.99). Supplementation of
M.oleifera decreased significantly (p<0.0001) the posthsCRP to 1.69 mg/dl (95% CI 1.28-2.09). The mean pre-HgbA1c of 6.96% (95% CI 6.64-7.09) was reduced post-HgbA1c to 6.06% (95% CI 5.88-6.24).The mean reduction of 0.6% in HgbA1c was significant (p-value   <0.0001).     

CONCLUSION: Our study confirms that diabetics may have additional benefit from intake of M.oleifera leaves by reducing hsCRP and by improving blood sugar control as evidenced by the reduction of Hgba1c.

Human ; Male ; Female ; Middle Aged ; Adult ; Moringa Oleifera ; C-reactive Protein ; Cardiovascular Diseases ; Atherosclerosis ; Diabetes Mellitus, Type 2 ; Hemoglobin A, Glycosylated ; Dyslipidemias ; Hypertension

BACKGROUND: Valid and reliable assessment of pain is essential in the management of rheumatologic conditions. Standardized pain assessment scales have been developed and used in clinical trials, but remain underutilized in clinical practice.

OBJECTIVE: To evaluate the use of the different pain assessment scales: Numeric Rating Scale (NRS), Verbal Descriptive Scale (VDS),Visual Analog Scale (VAS) and Wong Baker Face Scale (FACES) among adult patients with musculoskeletal pain seen in the Rheumatology Out-Patient Clinic in a tertiary government hospital in Manila, Philippines.

METHODS: This is a cross sectional study of adult patients with symptoms of musculoskeletal pain seen in a rheumatology out-patient clinic. The patients answered the different pain assessment scales and ranked them according to ease of use and preference. We checked for correlation of results of the different pain assessment scales using Spearman correlation.     

RESULTS: Ninety-four patients are included in this study. Eighty-one percent are females, with mean age of 52 (±SD 14.12) years old. Majority (73%) have low level of education. Forty-one percent have rheumatoid arthritis, 21% have osteoarthritis and 12% have gout. NRS is preferred and ranked easiest to use by 41.5% of patients. FACES is a close second; preferred by 39.4% and considered easy to use by 36.2% VAS ranks last on over-all preference and ease of use. On subgroup analysis, VDS was preferred by male patients while FACES was preferred by those with low educational status. The pain score obtained using NRS was significantly correlated with VDS, VAS, and FACES (p=<0.005).     

CONCLUSION: The NRS is a validated tool that is easy to use and preferred by patients. The FACES is a good alternative if the patient has difficulty with the NRS. We recommend the use of these pain scales in clinical practice in the Philippines to standardize the assessment and monitoring of pain among patients with rheumatic conditions

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Pain Measurement ; Musculoskeletal Pain ; Rheumatology ; Osteoarthritis ; Arthritis, Rheumatoid ; Rheumatic Diseases ; Gout

INTRODUCTION: Postprandial lipemia characterized by a rise in triglyceride-rich lipoproteins after eating, is associated with increased risk of cardiovascular disease. Among diabetic patients, postprandial lipemia is often overlooked once fasting lipid parameters are within target. The aim of the study is to determine the correlation of glycemic control and postprandial hyperglycemia with postprandial lipemia among patients with type 2 diabetes mellitus (DM). The result of the study may have important implications on how dyslipidemia should be completely addressed.

METHODOLOGY: A clinic-based retrospective chart review of 102 patients with recorded fasting and postprandial blood measurements was performed. Subjects included adult patients with type 2 DM whose fasting lipid parameters were controlled with diet and/or medications. Plasma glucose and glycosylated hemoglobin (HbA1C) were independent variables while triglyceride, total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) were dependent variables. Pearson correlation was used to determine the strength of relationships among the variables mentioned. A p-value

RESULTS: Of the 102 patients, 52.9% and 47.1% were achieving their target HbA1C and twohour postprandial plasma glucose, respectively. The postprandial level of plasma glucose, mean triglyceride, total cholesterol, LDL and HDL were 196.39 mg/dL, 189.06 mg/dL, 177.07 mg/dL, 122.40 mg/dL and 34.83 mg/dL, respectively. HbA1C has strong positive correlation with postprandial lipemia (Pearson's r=0.40) while the two-hour plasma glucose has moderate positive correlation (Pearson's r=0.34) with postprandial lipemia. Both relationships were considered significant (p-value <0.05).

CONCLUSION: A significant correlation of glycemic control and postprandial hyperglycemia with postprandial lipemia was observed. Our data suggest that despite achievement of optimal fasting lipid parameters, poor control of diabetes is positively correlated with abnormal elevation of postprandial triglyceride. Addressing both postprandial hyperglycemia and lipemia may improve cardiovascular outcome.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Hemoglobin A, Glycosylated ; Diabetes Mellitus, Type 2 ; Lipoprotein Triglyceride ; Lipoproteins ; Hyperlipidemias ; Dyslipidemias ; Hyperglycemia ; Cholesterol ; Cardiovascular Diseases

BACKGROUND: The leading cause of mortality in the country is heart disease with a rate of 94.5 deaths per 100,000 Filipinos. Multi-vessel coronary artery disease (MV-CAD) patients carry an increased procedural risk especially those with increased lesion complexity or unfavorable anatomy.
OBJECTIVE: The study aims to determine the variables that will predict procedural success and clinical outcome among MV-CAD patients undergoing percutaneous coronary intervention
SETTING: Philippine Heart Center, Quezon City, Philippines
METHODOLOGY: This retrospective cohort study obtained data from the four-year Philippine Heart Center Registry consisting of 1,030 patients who underwent Multi-Vessel Percutaneous Coronary Intervention (MVPCI) from January 2009 to January 2012 at the Cardiac Catheterization Laboratory.
RESULTS: Significant predictors for improved procedural success and reduced risk for major cardiovascular events was evident in male patients, those with mild diastolic dysfunction (grade I or II) and patients on statin therapy. The variables with unfavorable procedural and clinical outcome are female patients, those with unstable angina, STEMI, heart failure, COPD, the need for IABP counterpulsation and a left main artery coronary lesion.
CONCLUSION: The results reflect a local "real-life scenario" providing important information on the predictors of outcome among Filipino patients with multi-vessel disease undergoing percutaneous coronary intervention. The information obtained is clinically relevant for both cardiologist and interventionist providing an important risk stratification and contributing to the holistic delivery of cardiovascular care.

Human ; Male ; Female ; Middle Aged ; Coronary Artery Disease ; St Elevation Myocardial Infarction ; Percutaneous Coronary Intervention ; Angina, Unstable ; Heart Failure ; Cardiac Catheterization ; Pulmonary Disease, Chronic Obstructive

INTRODUCTION: Hepatorenal syndrome (HRS) is a functional renal impairment associated with advanced cirrhosis. The best treatment is liver transplantation; however, many patients die before this can be done. Terlipressin improves renal function in HRS, but recent studies have shown similar effects with the cheaper and more readily available norepinephrine. This review included randomized trials comparing noradrenaline to terlipressin for patients with type 1 HRS, as defined by the International Ascites Club.

OBJECTIVE: To determine the safety and effectiveness of noradrenaline in the management of HRS in terms of 1) reducing mortality, 2) reversal and 3) occurrence of adverse events

METHODOLOGY: For this meta-analysis paper, the researchers utilized an electronic search of databases and manual scanning of reference lists were performed. Standardized eligibility assessment was performed independently by three reviewers. Review Manager 5.0.23 was used to calculate odds ratios (OR) with 95% confidence intervals (CIs) as well as I2 values for inter-trial heterogeneity. Standardized eligibility assessment was performed independently by three reviewers.

RESULTS: Thirty-six articles were found after electronic and manual searching. Three were assessed for validity and included in the final analysis. The total number of patients across all trials was 95. Noradrenaline was found not to differ from terlipressin in terms of 15-day survival rate (OR 01.17; 95% CI: 0.51-2.66), reversal of HRS (OR1.07; 95% CI: 0.47-2.44), and a post-hoc analysis on disease-free survival (OR 0.78; 95% CI: 0.34-1.79). Results of sensitivity analysis were consistent with the previous findings (15-day survival: OR=1.21 95% CI = 0.52-2.83; HRS reversal: OR= 1.33, 95% CI = 0.56-3.13; disease-free survival: 1.35, CI =0.56-3.25). Only transient adverse effects were noted with either drugs.

CONCLUSION: There is inconclusive evidence that noradrenaline and terlipressin are significantly different in the reversal of HRS and reduction of mortality. Larger trials on noradrenaline or a non-inferiority trial may be needed to establish the equivalence of noradrenaline with terlipressin.

Hepatorenal Syndrome ; Terlipressin ; Norepinephrine ; Survival Rate ; Liver Transplantation ; Ascites ; Disease-free Survival ; Lypressin ; Liver Cirrhosis ; Renal Insufficiency

BACKGROUND: Priapism is a rare complication seen in one to five percent of adult leukemic patients. The word 'Priapism' is related to Priapus, the Greek and Roman God of procreation whose symbol was an erect phallus.

CLINICAL PRESENTATION: The patient is a 22-year-old male with no known co-morbidities presenting with one month intermittent, unstimulated, painful penile erection with no other associated symptoms which resolves spontaneously, until nine hours prior to admission when symptoms recurred and persisted. Patient had no history of trauma and no drug intake.

PHYSICAL FINDINGS: Patient was awake, in pain and tachycardic. There was note of pallor and splenomegaly. The penis was erect, firm, swollen and tender with superficial venous engorgement. The rest of the physical examination was unremarkable.

LABORATORY WORK UP: Complete blood count showed anemia and leukocystosis. Peripheral blood smear revealed markedly increased white blood cells with predominance of mature and immature cells belonging to granulocytic series. There was splenomegaly on ultrasound. Genetic testing showed an abnormal male karyotype of 46 chromosomes including translocation (9;22).

TREATMENT: Corpora cavernosa aspiration was done. Terbutaline was given. Patient was started and maintained on hydroxyurea and presently enrolled in Imitanib study.

OUTCOME: There was resolution of priapism after the corpus cavernosa aspiration and initiation of hydroxyurea and the white blood cell count had decreased after initiation of hydroxyurea.

Human ; Male ; Adult ; Priapism ; Hydroxyurea ; Terbutaline ; Pallor ; Splenomegaly ; Hyperemia ; Penile Erection ; Leukocyte Count ; Penis ; Blood Cell Count ; Leukocytes ; Anemia ; Pain

BACKGROUND: Infectious diseases remain a significant cause of morbidity and mortality. Cefpirome, a fourth generation Cephalosporin, is a potent antibiotic against a wide variety of organisms that may be used alone or in combination with other antimicrobials to combat various infections.

OBJECTIVE: This is a post-marketing surveillance study documenting the safety and efficacy of cefpirome among Filipino patients.

METHODOLOGY: This was a multicenter, open-label, noncomparative study involving 402 patients who received at least one dose of cefpirome. Safety and efficacy data were gathered.

RESULTS: Cefpirome was used as monotherapy in majority of the cases. Pneumonia (76%) was the most frequent indication for the use of this drug. The most commonly utilized dosage regimen was 2.0 grams every 12 hours for a mean of 4.2 days. This was associated with a successful clinical outcome in almost 90% of cases. There was almost negligible side effect reported.

CONCLUSION: The use of cefpirome was shown to be safe and well-tolerated with associated successful clinical outcomes among Filipino patients. 

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Cefpirome ; Anti-bacterial Agents ; Anti-infective Agents ; Cephalosporins ; Communicable Diseases ; Pneumonia ; Morbidity

OBJECTIVE: This study was undertaken to determine whether there is a significant association between aortic arch calcification (AAC) on digital chest radiography (DCXR) and cerebrovascular disease (CVD) by computed tomography of the brain plain (BCT). It also aimed to determine if DCXR may be used to predict stroke.
RESEARCH DESIGN: Retrospective Cross Sectional Chart Review Design
METHODOLOGY: All the 483 patients who underwent DCXR and BCTs at the Doctors Hospital, Inc. from January 2010 to December 2012 were included in the study. Demographic data and risk factors for atherosclerosis and CVD were obtained and analyzed. The DCXR were graded by three radiologists and its association with CVD on BCT using the Chi Square Test of Independence was done. Krusskall Wallis Test was employed. Cochrane Inter rater validity between the three readers was tested. Odds ratio, sensitivity and specificity of DCXR to diagnose CVD on BCT were then determined.
RESULTS: Of the 483 patients included in the study, 52.8% were females with an average age of 65.86±14.46 years old. Patients of the older age group had a higher AAC grade (3) and had more infarcts on BCT. Although risk factors for AAC on DCXR and CVD on BCT were hypertension, dyslipidemia and renal disease, these were not statistically significant. Cross sectional analysis of variables showed that patients with an AAC grade of 1 was highly associated with infarcts and an AAC grade of 2 was associated with hemorrhagic stroke (p=0.0200). A statistically significant inter rater agreement was noted among the three radiologists that read the DCXR.
CONCLUSION: The AAC grade (1) on DCXR is significantly associated with infarcts on BCT scan with a high specificity and strong positive predictive value. Larger studies may be necessary to determine the association of the other AAC grades (2 and 3) with the types of stroke.

Human ; Male ; Female ; Aged ; Aorta, Thoracic ; Radiographic Image Enhancement ; Tomography, X-ray Computed ; Radiography, Thoracic ; Atherosclerosis ; Cerebrovascular Disorders ; Stroke ; Hypertension ; Dyslipidemias ; Brain ; Radiologists

INTRODUCTION: Diabetes mellitus is rapidly increasing worldwide but the greatest increase is expected in developing countries including the Philippines. It is of public health concern to monitor countrywide prevalence of diabetes as it leads to significant cardiovascular-related mortality as well as significant complications such end stage renal disease, blindness, lower leg amputations and blindness.
METHODOLOGY: This is a national survey to estimate the prevalence of diabetes and pre-diabetes using the criteria of the World Health Organization through a stratified multi-stage sampling design representing each of the 17 regions in the country.
RESULTS AND DISCUSSION: The national prevalence of diabetes in the year 2008 was 7.2% (6.5-7.9); impaired glucose tolerance 7.0% (6.1-7.8) and impaired fasting glucose was 2.2% (2.2-3.1). There was a greater prevalence of individuals with diabetes in the urban areas at 8.5% (7.5-9.5) compared to the rural areas at 5.7% (4.6-6.8). Diabetes is slightly more preponderant among females at 7.4% (6.4-8.3) compared to males at 7.0% (6.1-8.0).
CONCLUSION: The prevalence of diabetes mellitus in the Philippines is rising with the prevalence in 2008 at 7.2%. The prevalence of pre-diabetes exceeds that of diabetes mellitus at approximately 10.2%.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Glucose Intolerance ; Fasting ; Prediabetic State ; Diabetes Mellitus ; Amputation ; Kidney Failure, Chronic ; Blindness ; Glucose

OBJECTIVE: Renal allograft recipients are at higher risk of developing tuberculosis (TB) as compared to the general population. The infection also carries with it a significant morbidity and mortality. However, data is limited regarding its incidence and risk factor analysis in our setting. This study determined the incidence, characteristics and risk factors of post-transplant TB in National Kidney and Transplant Institute (NKTI).
METHODS: This is a retrospective study involving chart review of 1,621 renal allograft recipients from 2003-2009. We recorded demographic information, transplant characteristics, median time to diagnosis of TB and forms of TB.
RESULTS: The incidence of TB in renal allograft recipients is 2.6%. Median time to diagnosis of TB after transplant is 21 months (one to 105 months). Risk factors identified in this study were previous history of TB (OR 4.15, 95% CI 1.4-12.2), one episode of rejection (OR 2.33, 95% CI 1.2-4.6) and subsequent use of methylprednisolone as antirejection therapy (OR 2.36, 95% CI 1.3-4.4). Patients given a tacrolimus based regimen (OR 0.5, 95% CI 0.24-1.03) and those without episode of rejection (OR 0.43, 95% CI 0.22-0.84) had less tendency to develop post-transplant TB. There were no sufficient evidence to prove association between onset of TB and use of isoniazid prophylaxis, use of induction immunosuppression and type of immunosuppression. Eighty one percent (81%) had pulmonary and 19% had extrapulmonary forms of TB.
CONCLUSION: Incidence of TB among renal allograft recipients is lower as compared to other high TB burden countries but is still higher as compared to the general Filipino population. The study identified multiple risk factors for post-transplant TB. Prevention of these diseases and identification of patients at risk are as important as early diagnosis and treatment of post-transplant TB.

Human ; Male ; Female ; Middle Aged ; Adult ; Isoniazid ; Tacrolimus ; Methylprednisolone ; Kidney Transplantation ; Tuberculosis ; Immunosuppression ; Transplantation, Homologous