Chronic ; Intermittent Positive-Pressure Breathing

WATER HYDROXIDES INORGANIC CHEMICALS OXYGEN COMPOUNDS OXIDES TRANSITION TEMPERATURE TEMPERATURE THERMODYNAMICS PHYSICAL PHENOMENA ANGIOFIBROMA NEOPLASMS ; VASCULAR TISSUE NEOPLASMS BY HISTOLOGIC TYPE NEOPLASMS THERAPEUTICS THERAPY

Adrenal Cortex Hormones ; therapeutic use ; Aged ; Anti-Infective Agents ; therapeutic use ; Anti-Inflammatory Agents ; therapeutic use ; Atropine ; therapeutic use ; Dexamethasone ; therapeutic use ; Eye Infections ; complications ; drug therapy ; Female ; Fluoroquinolones ; therapeutic use ; Glucocorticoids ; therapeutic use ; Humans ; Mydriatics ; therapeutic use ; Ophthalmia, Sympathetic ; drug therapy ; etiology ; Prednisolone ; therapeutic use ; Scleral Buckling ; adverse effects ; Triamcinolone ; therapeutic use

INTRODUCTION: In the management of type 2 diabetes, insulin is often started late, when there is failure to achieve good control on maximum oral agents. Clinical inertia to insulin initiation and intensification is widely prevalent in our local setting resulting in poor control of diabetes. This study looked into a stepwise insulin combinations treatment algorithm used in an Endocrinology referral clinic at the University of Santo Tomas Hospital (USTH). It aimed to demonstrate the clinical course of the patients , determine the degree of HbA1c reduction, and show the associated extent of hypoglycemia and weight gain.

METHODS: This is a retrospective chart review of 104 patients that used the following stepwise treatment: Oral regimen; Regimen A: basal+oral; Regimen B: basal+premeal bolus TID±oral; Regimen C: premixed aspart 70/30 or lispro 75/25 TID or BID with prelunch bolus, ± oral; Regimen D: premixed 70/30 BID+premeal bolus TID ± oral; Regimen E: premixed 70/30 BI +premeal bolus TID+basal ±oral. All received automatic snacking two hours after main meals to prevent hypoglycemia. Patients were educated on proper diet and exercise. Data was analyzed using paired t-test, frequencies and percentages.

RESULTS: Most ended on the intensive insulin regimens D 57(55%), and E 18 (17%). Significant HbA1c reduction was demonstrated as follows: Regimen A (n=8):1.376±0.919 (p=0.000), Regimen B (n=18):2.320±2.177 (p=0.000), Regimen D (n=57):2.197±2.158 (p=0.000), Regimen E (n=18):2.684±1.689 (p =0.000). Overall mean weight gain was 1.070 ± 11.435 kg (p=0.335). Ten, nonsevere hypoglycemia events were reported.

CONCLUSION: The use of this stepwise insulin combinations treatment algorithm exerted significant HbA1c reduction, with minimal events of hypoglycemia, and statistically insignificant weight gain. Hence, this is a feasible tool that may be used as a guide for intensification of insulin treatment.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Insulin Lispro ; Insulin ; Diabetes Mellitus, Type 2 ; Regimen B ; Weight Gain ; Hypoglycemia ; Antineoplastic Combined Chemotherapy Protocols ; Diet ; Algorithms

RATIONALE: The liver is the most common site of metastasis from colorectal cancer. Curative intent liver metastasectomy has shown improvement in overall survival. This manuscript will present the long-term oncologic outcomes of hepatic metastasectomy for colorectal cancer with resectable liver metastasis. METHODS: Data of patients with resectable liver metastases from colorectal cancer who underwent hepatic resection at the Philippine General Hospital over a 10-year period was reviewed. The primary outcome investigated was overall survival. RESULTS: Thirty patients were included in the study. The median overall survival was 20 months, with a 2-year and 5-year overall survival rate of 40% and 6.67% respectively. Eleven (36.67%) patients had disease recurrence, with a median disease-free survival of 16 months. A significant difference in survival was seen between patients with synchronous and metachronous liver metastasis (20.38 and 36.78 months respectively, p=0.0393) and in patients given adjuvant chemotherapy at any time in relation to the occurrence of the liver metastases versus patients who did not receive any adjuvant treatment (34.08 and 18.59 months respectively, p=0.0349). Trends towards improved overall survival were seen in patients 50 years old or less (36.86 versus 21.78 months, p=0.0837) and in patients with a clinical risk score of 2 or less (29.65 versus 19.62 months, p=0.1823), which may show significance in a higher powered study CONCLUSION Improved overall survival was observed among patients with colorectal liver metastases undergoing hepatic metastasectomy compared to no liver resection.
Metastasectomy ; Philippines

BACKGROUND: Osteoporosis in men is markedly underdiagnosed and undertreated despite higher morbidity and mortality associated with fractures. This study aimed to characterize adult Filipino men with osteopenia, osteoporosis and prevalent fractures. METHODS: A cross-sectional study of 184 Filipino men ≥50 years screened for bone mineral density was performed. Age, weight, body mass index (BMI), Osteoporosis Self-Assessment Tool for Asians (OSTA) score, smoking status, family history of fracture, diabetes mellitus, physical inactivity, and T-score were considered. RESULTS: Of the 184 patients, 40.2% and 29.9% have osteopenia and osteoporosis. Sixteen (21.6%) and 18 (32.1%) osteopenic and osteoporotic men have fragility hip, spine, or forearm fractures. Men aged 50 to 69 years have the same risk of osteoporosis and fractures as those ≥70 years. While hip fractures are higher in osteoporotic men, vertebral fractures are increased in both osteopenic and osteoporotic men. Mere osteopenia predicts the presence of prevalent fractures. A high risk OSTA score can predict fracture. A BMI <21 kg/m2 (P<0.05) and current smoking are associated with osteoporosis. CONCLUSION: A significant fraction of Filipino men with osteopenia and osteoporosis have prevalent fractures. Our data suggest that fractures occur in men <70 years even before osteoporosis sets in. Low BMI, high OSTA score, and smoking are significant risk factors of osteoporosis.
Adult* ; Asian Continental Ancestry Group ; Body Weight ; Bone Density* ; Bone Diseases, Metabolic ; Cross-Sectional Studies ; Diabetes Mellitus ; Forearm ; Hip ; Hip Fractures ; Humans ; Male ; Mortality ; Multiple Endocrine Neoplasia Type 1 ; Osteoporosis* ; Risk Factors ; Self-Assessment ; Smoke ; Smoking ; Spine ; Tertiary Care Centers*

OBJECTIVE: The paper aimed to described and document the multidisciplinary process being ascribed to in the care of the colorectal cancer patient at the UP-PGH as conducted by the UP-PGH Colorectal Cancer and Polyp Study Group.

METHODS: A description of the multidisciplinary team (MDT) process is presented. Data supplementing the documentation of the MDT process were, likewise, presented.

RESULTS: In 2008, 214 rectal cancer patients were admitted and managed by the Division of Colorectal Surgery. Of these, 52 patients with mid- to low-rectal tumors eventually underwent resection of the primary lesion. Forty-one (79%) underwent a sphincter-saving operation. Only 11 APRs were performed. Our APR rate was, thus, at 21 percent. Among the 52 patients, 18 underwent neoadjuvant treatment with 10 subjected to chemoradiotherapy prior to surgery, a pathologic complete response was observed in 4 patients.

CONCLUSION: With the increasing incidence of colorectal malignancies and the continuing collection of evidence supporting multimodality approach, the role of multidisciplinary team in the management of these cancers has come to the fore. UP-PGH Colorectal Cancer and Polyp Study Group has shown that the multidisciplinary team approach may be implemented amidst institutional and financial limitations without compromising the delivery of quality and efficacious cancer management.

Human ; Colorectal Neoplasms ; Neoadjuvant Therapy ; Colorectal Surgery ; Rectal Neoplasms ; Chemoradiotherapy ; Colonic Neoplasms ; Polyps ; Patient Care Team

To assess the effects of a single supraphysiological postnatal administration of a progestogen on uterine glands in dogs, 10 females were randomly assigned to a medroxyprogesterone acetate 35 mg (MPA; n = 6) or placebo (n = 4) group within the first 24 h of birth. The safety of the treatment was also evaluated. A transient mild clitoris enlargement appeared in MPA-treated females. Microscopic postpubertal uterine assessment revealed the presence of uterine glands in all cases without significant differences in the area occupied by the glands per µm2 of endometrium nor in the height of the uterine epithelium.
Animals ; Animals, Newborn ; Clitoris/drug effects ; Dogs ; Epithelium/*drug effects ; Female ; Medroxyprogesterone Acetate/*pharmacology ; Organ Size/drug effects ; Random Allocation ; Sexual Maturation/drug effects ; Uterus/*drug effects

OBJECTIVE: This study was conducted to document the prevalence of psychiatric morbidity among chronically ill medical patients in selected hospitals in the Philippines. METHODS: This is a cross-sectional study of the chronically medically ill patients seen in selected Primary are Evaluation of Mental Disorders (PRIME-MD), 774 patients were screened for mental disorders. The prevalence of each of the psychiatric disorders were calculated using the formula for estimation of a proportion for stratified random sampling. The differences in the sample size from each of the study sites were taken into consideration in the estimation of the sitespecific prevalence of mental disorders. The 95 percent confidence intervals of the prevalence rates were computed. RESULTS: Almost half of the patients (47.8 percent) were diagnosed with at least one of the psychiatric disorders elicited from the PRIME-MD. Thirty two percent had depressive disorder, followed by anxiety disorder, somatoform disorders, alcohol-related disorder and eating disorder. According to hospital site, the overall prevalence rate of psychiatric disorder was noted to be highest at the Davao Medical Center. CONCLUSION: The overall prevalence of psychiatric disorder noted in this study was higher than that described in foreign literature, the most common of which was depression.
Human ; Male ; Female ; MENTAL DISORDERS ; CHRONIC DISEASE ;

Background::Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods::We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) ( n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) ( n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with 13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression. Results::The change in T50 at 3 months correlated with %TBWL at 3 months for IGB ( P = 0.01) and ESG ( P = 0.01) but with greater impact on %TBWL in IGB compared to ESG ( R2 = 0.42 vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB ( P = 0.01) but not ESG ( P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mL vs. 183.00 ± 217.13 mL, P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB ( P = 0.26) or ESG ( P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG ( P = 0.06) but not IGB ( P = 0.19). Conclusion::IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.