OBJECTIVES: To determine the effect of malunggay leaf capsules on LDL (primary efficacy outcome measure); weight, BMI, FBS, serum glucose 2 hours after a 75 g oral glucose load, cholesterol, HDL and triglycerides (secondary efficacy outcome measures); creatinine, ALT and CBC (secondary safety outcome measures); and to determine if these are associated with adverse events.

STUDY DESIGN: randomized controlled trial

PARTICIPANTS: Seventy nine Filipinos, 18-55 years old with LDL>2.6 mmol/L (100 mg/dL) but of low cardiovascular risk were randomized into malunggay and placebo groups.

INTERVENTION: Malunggay capsules for 30 days versus placebo

RESULTS: 33 and 35 participants in the malunggay and placebo groups, respectively, completed the treatment. There was a reduction of 13.76 mg/dL in the LDL of the malunggay group, compared to a 19.28 mg/dL reduction in the placebo group (p=0.564).

CONCLUSION: Malunggay leaf capsules given for 30 days among adults with serum LDL >2.6 mmol/L (100 mg/dL) but with low cardiovascular risk decreased LDL levels to the same degree as placebo. There were no significant differences in the change in the secondary efficacy and safety outcome measures, and in the occurence of adverse events.

Human ; Male ; Female ; Middle Aged ; Adult ; Adolescent ; Triglycerides ; Creatinine ; Capsules ; Cardiovascular Diseases ; Body Mass Index ; Risk Factors ; Cholesterol, Hdl ; Body Weight ; Lipoproteins, Ldl ; Glucose

Background: A rare case of Mayer-Rokitansky-Kuster-Hauser syndrome is reported here. A 26 year old Filipina with primary amenorrhea consults for inability to consummate sexual intercourse with a male partner. She is phenotypically female - has female secondary sexual characteristics, and has normal female external genitalia. There is a shallow vaginal dimple. Absence of the upper vagina and uterus has been demonstrated by transrectal ultrasound. Ultrasound and intravenous pyelography have documented the absence of the left kidney. Chromosomal analysis reveals a normal female karyotype (46, XX). Endocrine evaluation shows normal levels of estradiol, follicle-stimulating hormone and luteinizing hormone. Radiographs did not reveal any associated skeletal abnormalities. Aside from this being a rare case of a disorder of sexual development, this is worth reporting because it illustrates the diagnostic work-up of a patient presenting with primary amenorrhea.

We report a case of a Filipino male diagnosed with Noonan syndrome on the basis of facial dysmorphism, chest deformity, short stature, mental and skeletal retardation, pulmonic stenosis and hypogonadism. In addition, he has three clinical features which are not known to be associated with the syndrome and are perhaps being reported for the first time:structurally normal kidneys with nephrotic syndrome, pituitary macroadenoma and pes varus.

Human ; Male ; Adolescent ; Noonan Syndrome ; Nephrotic Syndrome ; Dwarfism ; Pulmonary Valve Stenosis ; Hypogonadism ; Musculoskeletal System

INTRODUCTION: Physical activity is an important factor in reducing morbidity from type 2 diabetes mellitus and maintaining quality of life. There is no available data on physical activity among Filipino patients with type 2 diabetes mellitus.
OBJECTIVES: The objectives are to assess the physical activity level of patients with type 2 diabetes mellitus at the UP-PGH Diabetes Clinic using Global Physical Activity Questionnaire and to determine the relationship between physical activity, health profiles and socio-demographic characteristics.
METHODOLOGY: A cross-sectional study was conducted to assess the physical activity levels of 151 patients with type 2 diabetes mellitus (46 men and 105 women) using GPAQ. Anthropometric measurements, socio-demographic profiles and HbA1c were also taken.
RESULTS: Majority of subjects had moderate to high physical activity (68.9%) and most of the patients had poor glycemic control based on HbA1c of ?7% (68.2%). Subjects aged 60 years and above (68.1%; p=0.022) and with poor glycemic control (89.4%; p=<0.001) had low physical activity level. There is no significant statistical correlation between physical activity, anthropometric profile and other socio-demographic characteristics.
CONCLUSION: Majority of the patients with type 2 diabetes mellitus at the UP-PGH Diabetes Clinic had moderate to high physical activity level. Subjects with poor glycemic control and older age group were associated with low physical activity.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Anthropometry ; Cross-sectional Studies ; Diabetes Mellitus, Type 2 ; Diabetes Mellitus ; Exercise ; Hyperglycemia ; Quality Of Life ; Surveys And Questionnaires

OBJECTIVE: To develop a locally adapted patient decision aid (PtDA) on treatment intensification among Filipino patients with Type 2 Diabetes Mellitus and to test the feasibility of using PtDAs in a low middle-income country.

METHODOLOGY: A qualitative approach and an iterative process of development of a PtDA were employed for this study. We describe the process of developing a Filipino version of the Diabetes Medication Decision Aid. This PtDA was designed to help the patient choose the appropriate treatment intensification based on his own values and preferences, in consultation with his physician. The process involved decisional needs assessment through focus group discussions and key informant interviews, systematic literature review, iterative process of the development of a PtDA with clinical encounters (pilot testing), and preliminary field testing.

RESULTS: Decisional needs assessment revealed that Filipino patients are open to participate in shared decision-making if given the opportunity, including those with low socioeconomic status who likely have low health literacy. Physicians prefer to have visual aid tools to help them support their patient's decision-making. A PtDA prototype of a set of flash cards in Filipino was created and revised in an iterative method. We developed a more visually appealing tool after inputs from the expert panel and patient advisory group. Its use during clinical encounters provided additional insights from patients and clinicians on how to improve the PtDA. Preliminary field testing showed that its use is feasible in the target patient population.

CONCLUSION: Filipino patients, clinicians, and diabetes nurse educators have contributed to the creation of the first Filipino PtDA for diabetes treatment intensification.

Human ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Decision Making

Background: Teachers in medicine do not only teach scientific facts about health and disease to their learners but they are also looked up to as role models. Little is known about the qualities of consultant-faculty members who are regarded as role models by Filipino internal medicine residents. Objective: This study aimed to determine the reasons why consultant-faculty members are considered role models by Filipino internal medicine residents. Methods: A cross-sectional survey was conducted among internal medicine residents at a tertiary national university hospital in the Philippines. Participants were asked to give the reasons for citing consultant-faculty members who they consider as role models. Results: There were 81 residents who participated (93% response rate) who gave a total of 332 qualities as reasons for citing them as role models. The most commonly cited quality category was those of personal qualities (35.84% of all responses). This was followed by academic, clinical, teaching, leadership and research qualities. Physical qualities were the least cited (0.30% of all responses). Across the four batches of residents, personal qualities were consistently cited the most number of times, while physical qualities were consistently cited the least. Conclusion Filipino internal medicine residents identified personal qualities as the most frequent reason for considering their consultant-faculty as role models.
Internal Medicine

Background: Management of type 2 diabetes mellitus requires the maintenance of self-care behaviors, which include proper nutrition. However, diabetic patients often find that following a healthy diet is the most difficult component of self-care. It is important to assess the eating behaviors of diabetic individuals in order to customize a dietary plan but locally clinicians are hampered by the lack of a culturally adapted or validated tool. Objective: The goal of this study is to develop and validate a Filipino eating behavior questionnaire for adults with type 2 diabetes mellitus. Methodology: Literature review, expert interviews and focus group discussions among type 2 diabetic patients were done. All inputs, including pooled items from existing eating behavior questionnaires, were reviewed and categorized into corresponding eating behavior domains as determined by expert panel consensus. After translation into Filipino and pre-testing, the questionnaire was administered twice to 197 adults with type 2 diabetes. Questionnaire reliability was determined using Cronbach’s α and Spearman’s rank correlation coefficient. Results: A 29-item, self-administered, Filipino eating behavior questionnaire answerable by a 4-point Likert scale was initially developed. This questionnaire featured three known eating behaviors namely: uncontrolled, restrained, and emotional eating; and included two newly identified eating behaviors: social and pro-active eating. In both first and second tests, only the items in the uncontrolled (Cronbach’s α 0.739 & 0.816), social (Cronbach’s α 0.641 & 0.707), and pro-active (Cronbach’s α 0.622 & 0.665), eating domains were found to be internally consistent. One item under the restrained eating domain was deleted to improve the consistency of the items. For the test-retest reliability, moderate to high positive correlation (coefficients ranging from 0.530 to 0.744) between scale scores in the two test runs was achieved. This indicated stable responses to the items. Conclusion An eating behavior questionnaire for type 2 diabetic individuals that was developed to be culturally appropriate is a generally reliable, reproducible and valid instrument to assess eating behaviors. This study identified social and pro-active eating as behaviors among Filipinos with type 2 diabetes mellitus that were not previously described in foreign literature. The instrument may provide benefit in evaluating eating behaviors and formulating more individualized nutrition management plans.
Eating ; Behavior ; Surveys and Questionnaires

Objective: The sources of diabetes distress, defined as hidden negative emotions from the demands of daily self-management, are unknown to Filipinos with type 2 diabetes mellitus in the outpatient department. Therefore, we aimed to 1) explore the sources of distress in the perspective of Filipinos with type 2 diabetes mellitus and 2) create a conceptual framework of diabetes distress for Filipinos with T2DM.

Methods: Focus group discussions were done and audiotaped among Filipinos with type 2 diabetes (n=17). The transcript underwent content analysis to generate themes and subthemes. Relationships were determined between codes, categories, and themes elicited in the study to create a conceptual framework unique to Filipinos.

Results: The content analysis revealed five themes of diabetes distress: caregiver factor, socio-economic factor, psycho-emotional factor, medication-related factor, and health care service delivery factor. The socio-economic factor was a distinct theme missing in the prevailing validated questionnaires. Therefore, an adapted conceptual framework was created, as approved by the expert panel.

Conclusion: In conclusion, Filipinos with type 2 diabetes mellitus in the outpatient department have multiple sources of diabetes distress, namely, caregiver factor, socio-economic factor, psycho-emotional factor, medication-related factor, and health care service delivery factor. The socio-economic factor is a unique theme identified among Filipinos. Recognizing the sources of diabetes distress is vital to accurately screen Filipinos with type 2 diabetes mellitus and optimize management outcomes. The study findings will help develop and validate the questionnaire to screen diabetes distress unique to Filipinos.

Outpatients ; Diabetes Mellitus, Type 2

We report the case of a patient with hypoglycemic symptoms and weight gain. Biochemical investigations revealed endogenous hyperinsulinemic hypoglycemia. A CT scan and MRI of the abdomen were initially not successful in localizing a pancreatic mass. However, an endoscopic ultrasound was able to demonstrate a pancreatic head mass. Enucleation of the mass resulted in clinical and biochemical improvement. This report also demonstrates the pattern of weight loss after surgery, showing an initial phase of gradual weight loss followed by a rapid loss of weight. This pattern of weight loss after successful removal of an insulin-producing pancreatic neuroendocrine tumor is a novel addition to the existing knowledge we have about this condition.
Hypoglycemia ; Insulinoma ; Weight Loss

OBJECTIVES: To determine cut-off levels of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) for overweight/obesity associated with cardiometabolic diseases (CMDs) among adult Filipinos in a rural community.
METHODOLOGY: This community-based cross-sectional observational study utilized data from our Phase II of Diabetes Self-Management Education Program in San Juan, Batangas, Philippines. It included 332 Filipino adults with no known illnesses and residing for at least 6 months in the rural communities. Optimal cut-offs were determined by the intersection of sensitivity and specificity curves of having at least 1 or 2 CMDs.
RESULTS: The study population included 332 participants (72.3% females). Mean BMI, WC and WHR were 23.5 kg/m2, 79.5 cm and 0.87 respectively. Twenty eight percent, 11.1%, 78.3% and 85.8% of the participants have hypertension, diabetes, dyslipidemia, and at least 1 CMD respectively. The optimal cut-off for overweight/obesity and central obesity in males and females are BMI of 24 and 23 kg/m2, WC of 84 and 77 cm, and WHR 0.91 and 0.85 respectively.
CONCLUSION: Similar to other Asian countries, cut-off levels for overweight, obesity, and central obesity associated with CMDs are lower than the currently recommended cut-offs among Filipino adults in rural communities, particularly for WC in both sexes.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Body Mass Index ; Obesity ; Overweight ; Waist Circumference ; Adult ; Hypertension ; Diabetes Mellitus ; Dyslipidemias