Objective: This is a health systems research conducted with the goal of evaluating the quality of care (QoC) in diabetic emergencies, specifically Diabetic Ketoacidosis (DKA) and Hyperglycemic hyperosmolar state (HHS), at the Philippine General Hospital (PGH) in terms of structures, processes and outcomes, and determining facilitators and barriers to effective delivery of care from the healthcare providers’ point of view. Methods: The first phase of this study is a retrospective chart review involving an audit of the quality of services rendered to patients diagnosed to have DKA/HHS at the PGH. The second phase is a series of focus group discussions (FGDs) among physicians and nurses involved in the care of DKA/HHS patients. Facilitators and barriers to delivery of care were identified in these FGDs, as well as recommendations on how to improve delivery of care. Results: The recognition of DKA/HHS as a possible diagnosis at first encounter was observed in only 67% of cases. Timely initiation of hydration was met in 40% of cases and only 10% of the patients underwent adequate laboratory monitoring. Correction of at least half of the estimated water deficit in the first 24 hours of admission was achieved in 84% of the cases. Despite this, mortality rate was still high at 23%. Among those who died, thirty-seven percent (37%), seventy-five percent (75%) and over thirty percent (31%) had delayed initiation of hydration, at least one episode of hypokalemia or hypoglycemia, respectively. Barriers to good quality of care for DKA/HHS were mostly attributed to delays. These delays were due to lack of resources, limited bed-capacity and challenges experienced in the handling of specimen from the ER clerk to the laboratory and release of results. Conclusion Failure to follow guidelines and delays in the delivery of care are possible reasons for the high mortality rates noted and could be a reflection of poor quality of care among DM emergency patients in PGH. Proper documentation in the medical charts is also important. Clinical pathways and DM emergency kits are a few of the suggested approach to address the barriers to good quality care.
Diabetic Ketoacidosis ; Quality of Health Care

Objective: This study aims to identify factors associated with mild cognitive impairment (MCI) among elderly Filipinos with Type 2 diabetes mellitus. Methodology: This is an analytic cross-sectional study involving 133 elderly (≥60 years old) with Type 2 diabetes mellitus consecutively sampled from the General Medicine and Diabetes Clinics of the Philippine General Hospital. Eligible subjects were interviewed to gather demographic and clinical data. Body mass index, waist-hip ratio and mean blood pressure were computed. HBA1c, lipid profile, creatinine and urine proteinuria were tested or recorded if done recently. Dilated fundus examination via indirect ophthalmoscopy and 10-gram monofilament test were performed to detect retinopathy and neuropathy. The Montreal Cognitive Assessment-Philippines tool was administered to detect patients with probable MCI using a cutoff score of ≤21. Multivariate logistic regression analysis was performed to determine the associated factors. Results: Using MoCA-P tool, MCI has a rate of 45% among elderly Filipino diabetics. Having more than 12 years of education is significantly associated with lower odds of MCI. (OR 0.38 CI 0.18, 0.80, p value 0.010). Conclusion The rate of MCI among Filipino elderly diabetics is high. Higher education is associated with lower odds of having MCI. Case-control or prospective cohort studies involving larger sample and non-diabetic population are recommended.
Cognitive Dysfunction ; Diabetes Mellitus, Type 2

The traditional binary classification of gender is repeatedly challenged throughout history with the presence of transgenders. Under the umbrella of transgenderism is transsexualism which pertains to individuals who identify with or desire to become the opposite sex. Transsexualism or Gender Dysphoria is classified as a medical condition under ICD 10 and DSM-5. The proposed treatment is sex reassignment that includes all treatments carried out to adapt to the desired sex. Sex reassignment involves a multidisciplinary approach wherein the psychiatrist or mental health practitioner, endocrinologist and surgeon play active roles. Certain legal and ethical issues exist in the treatment of transsexualism. This article provides a review of psychological, medical and surgical issues in the evaluation and treatment of Transgender individuals, with an Asian perspective, and in the context of an actual case.
Gender Dysphoria ; Transsexualism ; Transgender Persons