Introduction: The incidence of diabetes mellitus (DM) is increasing globally and it is associated with significant morbidity and mortality. The importance of a better quality of diabetes care is increasingly acknowledged. Objective: This clinical audit was conducted to assess the quality of care given to type 2 DM patients in public primary care clinics. Methods: A clinical audit was conducted in two selected urban public primary care clinics, between April and June of 2005. The indicators and criteria of quality care were based on the current Malaysian clinical practice guidelines for type 2 DM. A structured pro forma was used to collect data. Results: A total of 396 medical records of patients with type 2 DM were included in this audit. Most of the patients had measurements of fasting blood glucose and blood pressure recorded in more than 90% of the visits over the previous one year.Twenty-seven percent of the patients had glycosylated haemoglobin (HbA1c) done every 6 months with a mean of 8.3%. Only 15.6% had HbA1c values less than 6.5%. Fifty percent had blood pressure controlled at 130/80 mmHg and below; and 13.0% had low density lipoprotein cholesterol values of 2.6mmol/L or less. The majority of the patients were overweight or obese. Conclusions: The quality of diabetes care in this study was found to be suboptimal. There is a gap between guidelines and clinical practice. Certain measures to improve the quality of diabetes care need to be implemented with more rigour

Seven Malaysian medicinal plants were screened for their antiplasmodial activities in vitro. These plants were selected based on their traditional claims for treatment or to relieve fever. The plant extracts were obtained from Forest Research Institute Malaysia (FRIM). The antiplasmodial activities were carried out using the pLDH assay to Plasmodium falciparum D10 strain (sensitive strain) while the cytotoxic activities were carried out towards Madin- Darby bovine kidney (MDBK) cells using MTT assay. The concentration of extracts used for both screening assays were from the highest concentration 64 microg/ml, two fold dilution to the lowest concentration 0.03 microg/ml. Goniothalamus macrophyllus (stem extract) showed more than 60% growth inhibition while Goniothalamus scortechinii root and stem extract showed a 90% and more than 80% growth inhibition at the last concentration tested, 0.03 microg/ml. The G. scortechini (leaves extract) showed an IC50 (50% growth inhibition) at 8.53 microg/ml, Ardisia crispa (leaves extract) demonstrated an IC50 at 5.90 +/- 0.14 microg/ml while Croton argyratus (leaves extract) showed a percentage inhibition of more than 60% at the tested concentration. Blumea balsamifera root and stem showed an IC50 at 26.25 +/- 2.47 microg/ml and 7.75 +/- 0.35 microg/ ml respectively. Agathis borneensis (leaves extract) demonstrated a 50% growth inhibition at 11.00 +/- 1.41 microg/ml. The study gives preliminary scientific evidence of these plant extracts in line with their traditional claims.
ug ; /mL ; seconds ; Concentration ; Psychological inhibition

Chorinic hepatitis B virus (CHB) infection is a serious problem that affects over 300 million people worldwide and is highly prevalent in the Asia Pacific region. In the Philippines an estimate 7.3 million Filipinos or 16.7% of adults are chronically infected with HBV, more than twice the average prevalence in the Western Pacific region.

In view of the above, the Hepatology Society of the Philippines (HSP) embarked on the development of consensus statements on the management of hepatitis B with the primary objectives of standardizing approach to management, empowering other physicians involved in the management of hepatitis B and advancing treatment subsidy by the Philippine Health Insurance Corporation (PhilHealth).

The local guidelines include screening and vaccination general management, indications for assessment of fibrosis in those who did not meet treatment criteria. indications for treatment, on-treatment and post-treatment monitoring and duration of antiviral treatment. Recommendations on the management of antiviral drug resistance, management of special populations including patients with concurrent HIV or hepatitis C infection, women of child-bearing age (pregnancy and breastfeeding), patients with decompensated liver disease, patients receiving immunosuppressive medications or chemotherapy and patients in the setting of hepatocellular carcinoma are also included. However, the guidelines did not include management for patients with liver and other solid organ transplantation, patients on renal replacement therapy, and children.

The consensus statements will be amended accordingly as new therapies become available.

Hepatitis B ; Consensus ; Hepatitis B, Chronic ; Hepatitis B Virus ; Fibrosis ; Drug Therapy ; Carcinoma, Hepatocellular ; Liver Cirrhosis ; Hepatitis Delta Virus ; Hiv

INTRODUCTIONTranscranial Doppler (TCD) is an established tool for the non-invasive assessment of cerebral blood flow. Since TCD results vary with the skills and experience of the sonographer, it requires validation against contrast angiography. We evaluated the diagnostic accuracy of TCD against computed tomography angiography (CTA) and the feasibility of the latter as an additional screening tool in our acute ischaemic stroke patients.

MATERIALS AND METHODSOur stroke unit manages about 700 patients annually. Acute stroke patients undergo TCD for vascular assessment of major arteries of the circle of Willis. Randomly selected acute stroke patients with significant stenosis on TCD underwent high-resolution cranial CTA with multidetector helical scanner. CTA was performed within 24 hours of TCD and images were interpreted by a neuroradiologist blinded to TCD findings. An independent neurosonologist reevaluated TCD if CTA findings were contradictory. Additional information by either modality was also noted.

RESULTSFifteen patients (12 men, mean age 61 +/- 15years) with cerebral ischaemia and moderate (>50%) stenosis in > or =1 large intracranial arterial segment on routine TCD were evaluated by CTA. Compared with 21 segments of significant stenosis on CTA, TCD showed 16 true-positive, 3 false-positive and 5 false-negative results (sensitivity: 76.2%, positive predictive value: 84.2%). In 3 cases, TCD showed findings complementary to CTA (real-time embolisation, collateral flow patterns, evidence of distal M2 branch occlusion).

CONCLUSIONTCD in our neurovascular laboratory shows a satisfactory agreement with cranial CTA in evaluating patients with cerebral ischaemia. TCD can provide additional real-time dynamic findings complementary to information provided by CTA.

Aged ; Brain Ischemia ; diagnosis ; Cerebral Angiography ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Singapore ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Transcranial

BACKGROUNDNasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary therapy. For those recurrent NPC (rNPC) patients, re-irradiation may cause some complications. In recent years, endoscopic endonasal nasopharyngectomy (EEN) has become a surgical option for rNPC patients. Here we introduce the concept of en bloc excision (EBE) technique for EEN, including the surgical technique and clinical outcomes.

METHODSA retrospective study was conducted covering September 2009 to May 2013, involving the collection of locoregional rNPC cases from two institutions (Kuang-Tien General Hospital (KTGH) in Taiwan and National University Health System (NUHS) in Singapore). These patients failed prior therapy and then underwent EEN. We reported the 2-year overall survival rate, the 2-year disease-free survival rate, and related complications.

RESULTSNine patients (five from KTGH and four from NUHS) completed this study, with five, two, and two patients of recurrence tumors (rT1), rT2, and rT3, respectively. The mean age was 46.4 years (range 32-63); the mean follow-up period was 24.9 months (range 10-45). The 2-year survival rate and the 2-year disease-free rate were 100% and 80%, respectively, in five patients. No significant complications or cases of mortality occurred.

CONCLUSIONSThe EBE concept of EEN is suitable for early rT1 and has relatively encouraging short-term outcomes. In selected rT2, careful EBE can be performed by expanding the surgical field. A clear view of the internal carotid artery-related anatomy is indispensable. In the future, more series may be needed to determine the role of EEN in rNPC patients.

Adult ; Carcinoma ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

Introduction: The coronavirus pandemic has affected millions worldwide. Better understanding of COVID-19 in pediatric hematology-oncology patients in a resource-limited setting is crucial to improve care as the pandemic ensues. Objectives: This study describes the clinical profile and outcomes of pediatric hematology oncology patients with COVID-19 seen at the Philippine General Hospital (PGH). Methods: A retrospective, descriptive review of pediatric hematology oncology patients with COVID-19 seen between March 2020 to March 2021 in PGH was done. Results: Forty patients were identified. Seventeen percent had non-malignant hematologic conditions, 40% had leukemias, and 42.5% had solid tumors. Fever and cough were the most common manifestations. Seventy-six percent were on treatment, 9% were newly diagnosed, and 7% were in relapse or disease progression. Fifty-five percent had mild COVID-19; 5% and 2.5% had severe and critical COVID-19, respectively. Thirty-seven percent were asymptomatic. Cancer-related therapy was placed on hold for most patients. There were two mortalities, none was due to COVID-19. Conclusion Results suggest that patients with hematologic and oncologic conditions have a mild course, with majority showing recovery from COVID-19. Delays in cancer-related therapy however, may contribute to disease progression and mortality.
COVID-19

Cleidocranial dysplasia (CCD) is an autosomal dominant skeletal dysplasia whose most common features include late closure of fontanelles, absent or hypoplastic clavicles, and dental abnormalities. This disorder is primarily due to mutations in RUNX2 (CBFA1) gene. Here we present a Filipino child with clinical and radiologic features of CCD who was also diagnosed with B-cell acute lymphoblastic leukemia (ALL). On history, the patient’s father and paternal grandfather also presented with short stature and similar facial features. Association of leukemia and CCD has been noted in the literature. Hence, this report adds to the potential role of RUNX2 gene in leukemogenesis. With the potential predisposition to developing leukemia, this provides implications in genetic counselling and possible recommendations for surveillance later on.
Cleidocranial Dysplasia ; Leukemia

Purinergic P2Y Receptor Antagonists ; Consensus ; Cardiovascular System ; Cardiology ; Asia

Background: COVID-19 caused educational institutions to transition online, necessitating tailored interventions in spreading factual information. Formal learning in the Philippines has yet to resume physically. Objectives: This methodological and formative research sought to develop a contextualized, home-based, and age-appropriate COVID-19 prevention curriculum for Filipinos within ages 5-8, 9-12, and 13-16. This articledescribes the process of co-developing the curriculum and identifying key themes in curriculum development which may be relevant to low-middle income countries (LMIC). Methodology: Preliminary curriculum materials were developed based on COVID-19 prevention literature and existing health promotion materials. A focus group discussion (FGD) with eight subject experts was conducted to explore the barriers and facilitators to knowledge and behavioral change. Results were analyzed thematically using predetermined themes: content, structure, delivery, and appropriateness to context. Results: The co-development provided insights through academic, professional, and cultural lenses. Subthemes were generated from content, delivery, structure, and appropriateness to context recommending the use of activities that are engaging and empowering to the child and providing support for carers. Curriculum key outcomes of this research include a clearer, comprehensive, accurate, and contextualized curriculum in relation to the target age groups. Conclusion Curriculum co-development may be improved by involving key persons in the community. To promote behavioral change and hygienic practices among Filipino children, active, constructive, and interactive learning methods, as well as a motivational approach, must be employed. Major findings for curriculum effectiveness highlighted the importance of the following: prevention-focused materials, accurate and updated information, summary provisions at the curriculum's end, availability of activity materials, household involvement, and open-ended activities. Future research may work on contextualizing other health literacy curricula to the local context and tailoring interventions at the community level.
COVID-19 ; Curriculum ; Hygiene ; Child