Background: Stroke is a leading cause of morbidity and mortality not only in our country but in other countries as well imposing a substantial economic burden on individuals and society overall. The financial cost of stroke is considerable but few cost effectiveness studies are available to guide clinical practice. It is the aim of this research then to provide comparison of cost-effectiveness or cost-benefit in stroke care to cast new light on which methods are better than others. Objectives: To compare cost-effectiveness of Home care versus Hospital care program in stroke patients age 35-70 years old at General Hospital from January 1998 to January 1999. Perspective: The study was done in a program perspective for the General Hospital. Methods: A decision analysis based on available published information was formulated. The probable outcomes were 1) probability of survival, 2) probability of good quality of life, 3) probability of poor quality of life and 4) probability of mortality after 1 year. Effectiveness measure was evaluated as the product of 1 year survival and good quality of life for both home care and hospital-based care. The cost of each branch was then divided by these 2 outcomes. The cost-effectiveness was compared between the 2 alternative programs. Results: The probability of 1 year survival for home care is 0.84 while in hospital care, probability was higher at 0.87. The probability of dying from stroke in 1 year for home care was .16 while only 0.13 was noted in hospital care. It is apparent that hospital care is more effective than home care alternative. In contrast to the results of the decision analysis, the cost-effectiveness of home care was P56,900.45 per stroke patient with good quality of life in contrast to hospital care which was higher at P65,291.70 per stroke patient with good quality of life. Although hospital-based care was more effective, incremental analysis showed that the cost of the advantage was P669,462. Conclusion: Hospitals are more effective than home care based on probability analysis while cost-effectiveness analysis favors the home care alternative.
Human ; Aged ; Middle Aged ; Adult ; HOME CARE SERVICES ; COST-BENEFIT ANALYSIS ; STROKE

Obesity and overweight are considered health risks for non-communicable diseases. Most clinical practice guidelines suggest lifestyle modification as the primary management and as an adjunct to pharmacologic treatment. Using the SMART-EST goaloriented action plan and lifestyle medicine may improve weight reduction outcomes. The case presented had clinical criteria (3/5) for metabolic syndrome, diagnosed previously as obese stage II, asthma moderately uncontrolled, prediabetes, and mild dyslipidemia. Baseline weight and waist-to-hip ratio were taken and interpreted as obese stage II with a very severe risk for comorbidity. The diagnostics used were fasting plasma glucose, lipid profile, HbA1c, and 2-D echocardiography on the eight months of intervention only. Using the SMART-EST action plan plus Lifestyle medicine approaches as non-pharmacologic management for metabolic syndrome. There was an 11.4 % reduction in weight, improved fasting glucose, lipid profile, and 2-D echocardiography within the eight months of intervention.
Metabolic syndrome

Virilization is the masculinization and enhancement of male secondary sexual characteristics in females. The etiology may be of adrenal or ovarian in origin. This case report shows a 46 year old woman who presented with defeminizing and virilizing symptoms. Further laboratory investigations revealed increased serum androgen levels and normal CT scan of the adrenals and kidneys. An ovarian mass was confirmed by transrectal ultrasonography. Following a total abdominal hysterectomy and bilateral salpingooophorectomy, histopathological and immunohistochemistry studies on the left ovarian mass confirmed an androgen-secreting, steroid-cell tumor, not otherwise specified (NOS). Serum testosterone values abruptly declined to normal levels within 1 month post-surgery. This paper likewise discusses an extensive review of literature regarding this rare ovarian tumor.

Introduction (Panimula): Ang Rehiyong Awtonomo ng Bangsamoro sa Muslim Mindanao ay nagpapaigting sa kaparatan ng mga tao tulad ng katutubo at higit sa lahat ay mga muslim. Ang muslim ay ang tumatalima sa Islam at katuruan nito sa pamamagitan ng pagtanggap o pagsasaksi ( ٱلشَّھَادَة ) sa kaisahan ( توحید ) ng Allah ( سُبْحَانَھُوَتَعَالَى ) at bunga nito ang isang muslim ay nagiging bahagi ng relihiyon ( دین ) ng kapayapaan sapagkat ang kapayapaan sa arabe ( سلام ) ay nag mula sa kaparehas na salitang ugat ng Islam, ang ( سِلم ). Ngunit paano bibigyan ng mukha ang kapayapaan sa mga baklang sasailalim sa rehiyong ito sa kulturang hindi hinihikayat (Haram) ang pagpapahayag (gender expression) ng pagiging bakla? Objective (Layunin): Ang pananaw sa bakla ay hindi basta salita bagkus ay isang buong pananaw (holistikong pagtingin sa tao) o pilosopiyang nakapaloob sa kulturang Pilipino na maaring magamit upang maging tulay sa pilipinong kultura ng mga muslim na huhubog sa ating sariling karanasan ng totoong kapayapaan ang malayang kapayapaan Methodology (Pamamaraan): Ang papel na ito ay magtatangka na pagtalabin ang konsepto ng bakla sa konsepto ng Pilipinong muslim gamit ang pamamaraan at dulog ng paglalahad ng kasaysayan na may saysay (dulog ng Qasas قَصَص ) na may pagtindig sa tradisyon ni Ibn Khaldun ang pagsasaysay ng makatotohanang pagsasaysay na sa yaong dulog ay maaring magdulot ng tatlong bunga. Result (Bunga): (1) una, ito ay maaring magpalalim sa pag unawa (Verstehen) sa bawat isa at maging daan tungo sa karanasan ng malayang kapayapaan dahil ang paggamit ng kultura sa talakayan ay nakaugat at mas malapit sa sariling kultura't pananampalatayang Pilipino (2) ang paggamit ng katutubong kultura ay maaring maging mas mabisa sa pagpapalaganap ng kapayapaan dahil malapit ito sa kultura ng taong tatanggap (3) ang katutubong kultura ay malilinang dahil kasabay ng pananampalatayang Pilipino ay magagamit ito sa pagtindig ng kapayapaan na naaayon sa konteksto at pananaw ng mga Pilipino Conclusion (Tugatog) Sa pamamagitang ng paglalahad ng saysay sa kasaysayan makikita natin ang pagkakapareha ng katangiang bakla bilang banayad at mabuti na tumutugon sa katangian ng muslim bilang mabuti na may katangiang لِنْتَ at بِٱلْقِسْطِ na maaring magamit bilang tulay ng dalawan tradisyon.
Sexual and Gender Minorities ; Sexuality

Hiccups are a benign physiological feature affecting almost everyone at one time or another. They tend to be short-lived and do not affect quality of life; however, there are various pathologies that may present with long-lasting hiccups. These are grouped into 3 categories according to their duration: acute, persistent and intractable or protracted hiccups. Intractable hiccups last longer than 2 months and are usually associated with more severe conditions. The association between intractable hiccups and reflux disease has not been previously documented by objective methods. This report describes the case of a 23-year-old female who presented with protracted hiccups; all other organic pathologies were ruled out, and endoscopy and conventional pH-metry confirmed a diagnosis of non-erosive reflux disease as the unique cause.
2-Pyridinylmethylsulfinylbenzimidazoles ; Electric Impedance ; Endoscopy ; Female ; Gastroesophageal Reflux ; Hiccup ; Humans ; Proton Pump Inhibitors ; Young Adult

No abstract available.
Observer Variation ; Humans

PURPOSE: Immunoglobulin (Ig) E autoantibodies against thyroid antigens such as thyroid peroxidase (TPO) have been demonstrated in chronic spontaneous urticaria (CSU) patients in higher frequency than healthy subjects. However, if these IgE autoantibodies can trigger urticaria is still a matter of study. The aim of this study was to investigate the relationship between concomitant IgE autoantibodies against thyroid antigens in CSU. METHODS: Patients with CSU, healthy subjects and patients with autoimmune thyroid disease (ATD) were recruited. Total IgE and specific anti-TPO IgE and IgG were assessed in all subjects. The basophil activation test and skin tests with TPO were performed to demonstrate whether this antigen could selectively induce urticaria reaction in subjects with positive anti-TPO IgE. RESULTS: Anti-TPO IgE was present in all 3 groups (CSU: 34.0%, ATD: 16.6%, healthy subjects: 8.1%). Anti-TPO IgE levels were higher in CSU patients, whereas anti-TPO IgG were higher in ATD patients. After exposure to TPO, CD203c expression from patients with CSU and anti-TPO IgE significantly increased in comparison to the other groups; 33.0% vs. 14.0% in ATD patients and 9.0% in control subjects (P < 0.05). Skin reactions with TPO were higher in patients with CSU according to the intradermal (CSU: 18.0%, ATD: 3.3%, control: 8.0%) and skin prick tests (12.0%, 0%, 0%, respectively). Passive transfer of anti-TPO IgE from a CSU patient to the skin of control subjects without anti-TPO IgE induced a positive skin reaction. CONCLUSIONS: Anti-TPO IgE is not a specific biomarker for CSU. However, IgE against TPO plays a pathogenic role in inducing effector cell activation and skin exacerbation in some patients with CSU.
Autoantibodies ; Autoimmunity ; Basophils ; Healthy Volunteers ; Humans ; Hypothyroidism ; Immunoglobulin E* ; Immunoglobulin G ; Immunoglobulins ; In Vitro Techniques* ; Iodide Peroxidase ; Skin ; Skin Tests ; Thyroid Diseases ; Thyroid Gland ; Urticaria*

A retrospective study was undertaken on 103 diabetic patients with foot ulcers who were confined at the UERM Memorial Medical Center from January 1988 to June 1991 with the aim of determining clinical and laboratory criteria which are useful in predicting the need for amputation. Patients were divided into two groups according to treatment modality: Group A, debridement (58 patients) and Group B, amputation (45 patients). Nineteen variables chosen from the patients demographic characteristics, clinical histories and evaluation, and laboratory work-up were reviewed, evaluated, and processed using the normal approximation statistics and logistic regression to obtain a resulting set of predictors. Osteomyelitis, leukocytosis, decreased or absent peripheral pulses, systolic hypertension and smoking history were the five variables found to be significantly associated with the need for an ablative surgical procedure. These quantitated variables are entered into the computed logistic equation to obtain a score which will enable us to determine the appropriate therapeutic intervention tailored to the individuals risk status. If the computed value is greater than or equal to 7, amputation should be the course of action. If the computed value is less than or equal to 3, conservative treatment is advocated. If the value obtained is between 3 and 7, the patient is considered a borderline case and proper management will have to depend on the judgment of the surgeon. With this scoring system as a guide, a definitive operation can be performed at an early stage to prevent the burden of multiple operations and the accompanying high morbidity and post-operative mortality rates.

Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging new technology with considerable potential to treat various neurological diseases. With refinement of ultrasound transducer technology and integration with magnetic resonance imaging guidance, transcranial sonication of precise cerebral targets has become a therapeutic option. Intensity is a key determinant of ultrasound effects. High-intensity focused ultrasound can produce targeted lesions via thermal ablation of tissue. MRgFUS-mediated stereotactic ablation is non-invasive, incision-free, and confers immediate therapeutic effects. Since the US Food and Drug Administration approval of MRgFUS in 2016 for unilateral thalamotomy in medication-refractory essential tremor, studies on novel indications such as Parkinson's disease, psychiatric disease, and brain tumors are underway. MRgFUS is also used in the context of blood-brain barrier (BBB) opening at low intensities, in combination with intravenously-administered microbubbles. Preclinical studies show that MRgFUS-mediated BBB opening safely enhances the delivery of targeted chemotherapeutic agents to the brain and improves tumor control as well as survival. In addition, BBB opening has been shown to activate the innate immune system in animal models of Alzheimer’s disease. Amyloid plaque clearance and promotion of neurogenesis in these studies suggest that MRgFUS-mediated BBB opening may be a new paradigm for neurodegenerative disease treatment in the future. Here, we review the current status of preclinical and clinical trials of MRgFUS-mediated thermal ablation and BBB opening, described their mechanisms of action, and discuss future prospects.
Alzheimer Disease ; Blood-Brain Barrier ; Brain ; Brain Neoplasms ; Essential Tremor ; High-Intensity Focused Ultrasound Ablation ; Immune System ; Magnetic Resonance Imaging ; Microbubbles ; Models, Animal ; Neurodegenerative Diseases ; Neurogenesis ; Parkinson Disease ; Plaque, Amyloid ; Sonication ; Therapeutic Uses ; Transducers ; Ultrasonography ; United States Food and Drug Administration