Purpose: Cardiovascular disease (CVD) is more prevalent in men than women, but the mechanisms responsible for this are not fully understood. We aimed to evaluate differences in trimethylamine (TMA), a microbial metabolite and its oxidized form, trimethylamine N-oxide (TMAO), which is thought to promote atherosclerosis, between men and women with coronary heart disease (CHD), using as a reference a non-CVD population. Materials and Methods: This study was carried out within the framework of the CORDIOPREV study (NCT00924937; June 19, 2009), a clinical trial which included 827 men and 175 women with CHD, with a non-CVD population of 375 individuals (270 men and 105 women) as a reference group. Plasma TMA and TMAO were measured by HPLC-MS/MS. The carotid study was ultrasonically assessed bilaterally by the quantification of intima-media thickness of both common carotid arteries (IMT-CC). Results: We found higher TMAO levels and TMAO/TMA ratio in CHD men than CHD women (p=0.034 and p=0.026, respectively). No TMA sex differences were found in CHD patients. The TMA and TMAO levels and TMAO/TMA ratio were lower, and no differences between sexes were found in the non-CVD population. TMAO levels in CHD patients were consistent with higher IMT-CC and more carotid plaques (p=0.032 and p=0.037, respectively) and lower cholesterol efflux in CHD men than CHD women (p<0.001). Conclusions Our results suggest that CHD men have augmented TMAO levels compared with CHD women, presumably as a consequence of higher rate of TMA to TMAO oxidation, which could be associated with CVD, as these sex differences are not observed in a non-CVD population.

Purpose: Cardiovascular disease (CVD) is more prevalent in men than women, but the mechanisms responsible for this are not fully understood. We aimed to evaluate differences in trimethylamine (TMA), a microbial metabolite and its oxidized form, trimethylamine N-oxide (TMAO), which is thought to promote atherosclerosis, between men and women with coronary heart disease (CHD), using as a reference a non-CVD population. Materials and Methods: This study was carried out within the framework of the CORDIOPREV study (NCT00924937; June 19, 2009), a clinical trial which included 827 men and 175 women with CHD, with a non-CVD population of 375 individuals (270 men and 105 women) as a reference group. Plasma TMA and TMAO were measured by HPLC-MS/MS. The carotid study was ultrasonically assessed bilaterally by the quantification of intima-media thickness of both common carotid arteries (IMT-CC). Results: We found higher TMAO levels and TMAO/TMA ratio in CHD men than CHD women (p=0.034 and p=0.026, respectively). No TMA sex differences were found in CHD patients. The TMA and TMAO levels and TMAO/TMA ratio were lower, and no differences between sexes were found in the non-CVD population. TMAO levels in CHD patients were consistent with higher IMT-CC and more carotid plaques (p=0.032 and p=0.037, respectively) and lower cholesterol efflux in CHD men than CHD women (p<0.001). Conclusions Our results suggest that CHD men have augmented TMAO levels compared with CHD women, presumably as a consequence of higher rate of TMA to TMAO oxidation, which could be associated with CVD, as these sex differences are not observed in a non-CVD population.

Purpose: Cardiovascular disease (CVD) is more prevalent in men than women, but the mechanisms responsible for this are not fully understood. We aimed to evaluate differences in trimethylamine (TMA), a microbial metabolite and its oxidized form, trimethylamine N-oxide (TMAO), which is thought to promote atherosclerosis, between men and women with coronary heart disease (CHD), using as a reference a non-CVD population. Materials and Methods: This study was carried out within the framework of the CORDIOPREV study (NCT00924937; June 19, 2009), a clinical trial which included 827 men and 175 women with CHD, with a non-CVD population of 375 individuals (270 men and 105 women) as a reference group. Plasma TMA and TMAO were measured by HPLC-MS/MS. The carotid study was ultrasonically assessed bilaterally by the quantification of intima-media thickness of both common carotid arteries (IMT-CC). Results: We found higher TMAO levels and TMAO/TMA ratio in CHD men than CHD women (p=0.034 and p=0.026, respectively). No TMA sex differences were found in CHD patients. The TMA and TMAO levels and TMAO/TMA ratio were lower, and no differences between sexes were found in the non-CVD population. TMAO levels in CHD patients were consistent with higher IMT-CC and more carotid plaques (p=0.032 and p=0.037, respectively) and lower cholesterol efflux in CHD men than CHD women (p<0.001). Conclusions Our results suggest that CHD men have augmented TMAO levels compared with CHD women, presumably as a consequence of higher rate of TMA to TMAO oxidation, which could be associated with CVD, as these sex differences are not observed in a non-CVD population.

Purpose: Cardiovascular disease (CVD) is more prevalent in men than women, but the mechanisms responsible for this are not fully understood. We aimed to evaluate differences in trimethylamine (TMA), a microbial metabolite and its oxidized form, trimethylamine N-oxide (TMAO), which is thought to promote atherosclerosis, between men and women with coronary heart disease (CHD), using as a reference a non-CVD population. Materials and Methods: This study was carried out within the framework of the CORDIOPREV study (NCT00924937; June 19, 2009), a clinical trial which included 827 men and 175 women with CHD, with a non-CVD population of 375 individuals (270 men and 105 women) as a reference group. Plasma TMA and TMAO were measured by HPLC-MS/MS. The carotid study was ultrasonically assessed bilaterally by the quantification of intima-media thickness of both common carotid arteries (IMT-CC). Results: We found higher TMAO levels and TMAO/TMA ratio in CHD men than CHD women (p=0.034 and p=0.026, respectively). No TMA sex differences were found in CHD patients. The TMA and TMAO levels and TMAO/TMA ratio were lower, and no differences between sexes were found in the non-CVD population. TMAO levels in CHD patients were consistent with higher IMT-CC and more carotid plaques (p=0.032 and p=0.037, respectively) and lower cholesterol efflux in CHD men than CHD women (p<0.001). Conclusions Our results suggest that CHD men have augmented TMAO levels compared with CHD women, presumably as a consequence of higher rate of TMA to TMAO oxidation, which could be associated with CVD, as these sex differences are not observed in a non-CVD population.

Purpose: Cardiovascular disease (CVD) is more prevalent in men than women, but the mechanisms responsible for this are not fully understood. We aimed to evaluate differences in trimethylamine (TMA), a microbial metabolite and its oxidized form, trimethylamine N-oxide (TMAO), which is thought to promote atherosclerosis, between men and women with coronary heart disease (CHD), using as a reference a non-CVD population. Materials and Methods: This study was carried out within the framework of the CORDIOPREV study (NCT00924937; June 19, 2009), a clinical trial which included 827 men and 175 women with CHD, with a non-CVD population of 375 individuals (270 men and 105 women) as a reference group. Plasma TMA and TMAO were measured by HPLC-MS/MS. The carotid study was ultrasonically assessed bilaterally by the quantification of intima-media thickness of both common carotid arteries (IMT-CC). Results: We found higher TMAO levels and TMAO/TMA ratio in CHD men than CHD women (p=0.034 and p=0.026, respectively). No TMA sex differences were found in CHD patients. The TMA and TMAO levels and TMAO/TMA ratio were lower, and no differences between sexes were found in the non-CVD population. TMAO levels in CHD patients were consistent with higher IMT-CC and more carotid plaques (p=0.032 and p=0.037, respectively) and lower cholesterol efflux in CHD men than CHD women (p<0.001). Conclusions Our results suggest that CHD men have augmented TMAO levels compared with CHD women, presumably as a consequence of higher rate of TMA to TMAO oxidation, which could be associated with CVD, as these sex differences are not observed in a non-CVD population.

Background: There is an increasing trend of obesity in the Philippines with approximately 28.8% of adults considered overweight and 9.6% obese. This is presumably due to a shift in eating patterns towards dining out in restaurants and fast food chains for their convenience. Excess fast food consumption results in diets that are calorie dense yet nutritionally deficient due to their high levels of fat, sugar, and salt leading to increased prevalence of associated diseases such as Type 2 diabetes and cardiovascular diseases. Objective: The researchers determined the effect of presenting the caloric information of fast food items on the total calories ordered among college students in private and public higher education institutions in Quezon City. Methodology: A double-blind experimental research was performed with 179 students by convenience sampling. The participants were randomly assigned to a control group (without caloric labels) and an experimental group (with caloric labels). An online questionnaire was sent to each subject containing their menu and order form along with questions on their demographical data (age, sex, food allowance, BMI, physical activity). Results: Using single linear regression, none of the demographic characteristics were found to be confounding variables. Using multiple linear regression analysis, it was found that the experimental group ordered significantly less calories (p-value = 0.013). Conclusion The results of the study conclude that those presented with calorie labels ordered less calories than the control.
Fast Foods

Odontogenic tumours are a heterogeneous group of lesions that develop in the oral cavity region and are characterized by the formation of tumoural structures that differentiate as teeth. Due to the diversity of their histopathological characteristics and clinical behaviour, the classification of these tumours is still under debate. Alterations in morphogenesis pathways such as the Hedgehog, MAPK and WNT/β-catenin pathways are implicated in the formation of odontogenic lesions, but the molecular bases of many of these lesions are still unknown. In this study, we used genetically modified mice to study the role of IKKβ (a fundamental regulator of NF-κB activity and many other proteins) in oral epithelial cells and odontogenic tissues. Transgenic mice overexpressing IKKβ in oral epithelial cells show a significant increase in immune cells in both the oral epithelia and oral submucosa. They also show changes in the expression of several proteins and miRNAs that are important for cancer development. Interestingly, we found that overactivity of IKKβ in oral epithelia and odontogenic tissues, in conjunction with the loss of tumour suppressor proteins (p53, or p16 and p19), leads to the appearance of odontogenic tumours that can be classified as ameloblastic odontomas, sometimes accompanied by foci of secondary ameloblastic carcinomas. These tumours show NF-κB activation and increased β-catenin activity. These findings may help to elucidate the molecular determinants of odontogenic tumourigenesis and the role of IKKβ in the homoeostasis and tumoural transformation of oral and odontogenic epithelia.

The diagnosis of lymphatic malformations can present problems with diagnosis and treatment. Non-response to a chosen procedure can magnify the initial problems or create new ones. We present such a case.

CASE REPORT

            A 9-year-old boy initially presented with a 3-year history of soft upper eyelid mass with red-violet discoloration after hitting his head on a wooden post. About 2 years before this presentation, progressive enlargement in size of the mass with extension to the left maxillary and left scalp region prompted an ophthalmologic consult, and Magnetic Resonance Imaging (MRI) of the orbit and Magnetic Resonance Angiography (MRA) of intracranial vessels revealed a venous-lymphatic malformation. (Figure 1) He was then referred to our institution for further management.

            The patient was noted to have a 4x2 cm reddish vascular mass over the left eyelid with no thrill or bruit and a surrounding 9x9 cm bluish left facial swelling in the periorbital region extending to the maxillary area corresponding to the MRI images. A repeat MRI/MRA showed a prominent branch of the left external carotid artery coursing towards the mass. (Figure 2)

An angiogram of the neck for possible coil insertion into the prominent vessel from the external carotid artery was performed by interventional radiology. However, the left common carotid, left external carotid, and left vertebral arteries showed no evidence of high- or low-flow arteriovenous malformation. (Figure 3) This favored a hypovascular, space-occupying lesion consistent with a cystic lymphatic malformation and the boy was referred back to our service for possible surgery.

Meanwhile, the mass continuously increased in size and by the time he was seen again in our clinic, the mass measured 15x15x20 cm occupying the left hemifacial area from the midportion of the parietal bone superiorly to the body of the mandible inferiorly, with violaceous skin discoloration and verrucous infraorbital lesions. (Figure 4) The patient was not considered a good candidate for surgical excision due to the size of the mass relative to his body, and initial sclerotherapy was planned to possibly decrease the size of the mass enough for excision of any residuals.

Percutaneous Sclerotherapy was performed using a guidewire-catheter replacement technique. An initial drainage of 800mL of non-clotting serosanguinous fluid was followed by infusion of 3% sodium tertradecyl sulfate, followed by 99% ethanol infusion. There was gross decrease in the size of the mass after the procedure. (Figure 5) A pigtail drainage catheter was maintained to continuously drain fluid from the lesion. On the 10th hospital day, the boy had febrile episodes associated with enlargement of the left hemifacial mass. Blood cultures showed no bacterial growth. Culture of the pigtail catheter tip grew Morganella morganii. Amikacin 170mg IV every 8 hours was started but fever was unrelenting. Wound cultures grew Methicillin Resistant Staphylococcus Aureus, and Co-trimoxazole 40mg/200mg per 5ml Pediatric Suspension, 10ml every 12 hours and Metronidazole 200mg/5mL oral suspension, 5mL every 8 hours were initiated.

During this month-long post-operative period, the mass continued to expand to its preoperative size. (Figure 6) Due to lack of funds, the antibiotics were given by mouth and the patient was discharged. On 3-month follow up, the mass had grown to even larger than the pre-embolization stage.

 DISCUSSION

            Lymphatic malformations (LM) are made up of variously dilated lymphatic channels or cysts, lined by endothelial cells with a lymphatic phenotype.1  Histologically, LM is classified into the macrocystic type, consisting of cysts larger than 2 cm with clear boundaries, and the microcystic type consisting of cysts smaller than 2 cm that appear diffuse and sprouted without clear boundaries. The two types coexist in the combined type.2  

            A 5-stage clinicoradiologic staging system has been devised by de Serres et al. based on cervical LM laterality and relationship to the hyoid bone predicting operative risk and surgical outcome.3 The higher the clinicoradiologic stage, the greater the potential risk of intraoperative and postoperative complications.  In general, bilateral microcystic suprahyoid LMs are more difficult to treat than infrahyoid LMs, especially when there are microcystic LMs involving the oral cavity, tongue, and/or pharynx. In this case, confirming whether it was a high-flow or a low-flow disease presented a dilemma early on. We relied on the initial MRI/MRA findings of a possible arterial feeding vessel, considering that MRI/MRI is more than 90% accurate in the diagnosis of high-flow vascular anomalies.4 However, during angiography for coil insertion, there were no feeding vessels found and a low-flow disease was considered. Thus, there were further delays in management associated with these procedures.

            In our case, the patient had a unilateral suprahyoid LM that has a complication rate of 41% with an average of 1.5 procedures to treat and cure the disease.3 The possible complications that were considered included facial nerve palsy, seroma, exsanguination and most importantly, functional compromise due to the projected large post-operative defect and location of the mass which could affect function of the left eye, feeding problems and long term facial disfigurement.5

            Considering these possible complications, we planned to attempt initial sclerotherapy before considering surgery. However, we encountered infection of the pigtail site and wound, and sclerotherapy failed to decrease the size of the mass. At the moment, subjecting the patient to repeat sclerotherapy may have a higher chance of failure.

            Noting that the treatment of lymphatic malformation should be directed towards preservation of functional and aesthetic integrity,5 we present our case for consideration.

Objective: The study aims to describe factors that contribute to the Length of Stay (LOS) in the Emergency Department (ED) patients of a Tertiary Private Hospital in Philippines. Methods: This is a retrospective descriptive study from September 1, 2015 to March 31, 2016 on the factors of ED consultations specifically on demographics (age and sex), payment schemes (Out of Pocket (OOP) and third party payer), shift times (morning, afternoon and night) and triage-levels were associated with LOS. Results: Our ED consultations with age (mean 40.75 years, SD 16.8, N 20,687, range 95) were dominated by females (56%), two age-range, 21-30 (28.4%) & 31-40 and third party payer (57%). LOS (mean of 4,40 hours, SD 3,89, N 18540, range 68) was significantly higher (p<0.001) on OOP patients, older age-range; 71-80, (3.5%) and 81-90, (2.3%). Emergent cases had higher incidence (X2= 30.2, p<0.001) on morning shift, urgent cases on afternoon shift and trauma cases on evening shift. Non-urgent cases were consistent on all time frames. LOS was significantly higher (X2=p<0.001) on urgent and emergent cases and on morning and afternoon shifts and significantly lowest, (p<0.001) on night shifts. Conclusion Higher LOS was associated on the following: urgent and emergent triage- levels, older age range, OOP, and morning and afternoon shifts.
Emergency Service, Hospital ; Length of Stay ; Triage

OBJECTIVE: The study aims to describe factors that contribute to the Length of Stay (LOS) in the Emergency Department (ED) patients of a Tertiary Private Hospital in Philippines.

METHODS: This is a retrospective descriptive study from September 1, 2015 to March 31, 2016 on the factors of ED consultations specifically on demographics (age and sex), payment schemes (Out of Pocket (OOP) and third party payer), shift times (morning, afternoon and night) and triage-levels were associated with LOS.

RESULTS: Our ED consultations with age (mean 40.75 years, SD 16.8, N 20,687, range 95) were dominated by females (56%), two age-range, 21-30 (28.4%) & 31-40 and third party payer (57%). LOS (mean of 4,40 hours, SD 3,89, N 18540, range 68) was significantly higher (p<0.001) on OOP patients, older age-range; 71-80, (3.5%) and 81-90, (2.3%). Emergent cases had higher incidence (X2= 30.2, p<0.001) on morning shift, urgent cases on afternoon shift and trauma cases on evening shift. Non-urgent cases were consistent on all time frames. LOS was significantly higher (X2=p<0.001) on urgent and emergent cases and on morning and afternoon shifts and significantly lowest, (p<0.001) on night shifts.

CONCLUSION: Higher LOS was associated on the following: urgent and emergent triage- levels, older age range, OOP, and morning and afternoon shifts.