Background. The Surviving Sepsis Campaign guideline recommends the use of norepinephrine or dopamine as vasopressor therapy in septic shock. Epinephrine is suggested as an alternative agent. However, mortality and morbidity data on the use of epinephrine versus other vasopressors remains controversial. Objective. To evaluate the benefits of epinephrine versus standard treatment (norepinephrine/dopamine) in patients with septic shock using 28-day mortality as the primary outcome. Methods. PUBMED, Cochrane Library, clinical trial registries and reference lists were searched for randomized controlled trials (RCTs) comparing epinephrine with standard treatment in adult septic shock patients. Trial authors were contacted for further information. Two reviewers independently evaluated methodological quality and extracted data. Conflicts were resolved by consensus. A random-effects model was used to estimate the relative risk (RR). Results. No significant difference in 28-day mortality (RR = 0.99) and 90-day mortality (RR = 0.99) was found between patients that received epinephrine versus those that received standard treatment. Post-hoc analysis of overall mortality also showed no significant difference between groups. Noted adverse effects include tachycardia and lactic acidosis within the first 24 hours. Beyond that period, no difference was noted between epinephrine and standard treatment. Conclusion. Epinephrine as vasopressor therapy in adult septic shock patients may be as effective as standard treatment in reducing 28-day mortality. However, lack of high quality studies precludes drawing of definite clinical guidelines. Further investigation is warranted.
SHOCK ; SEPSIS ; BACTERIAL INFECTIONS AND MYCOSES ; INFECTION ;

OBJECTIVES: To assess the validity of the Filipino-translated version of the Michigan Neuropathy Screening Instrument(MNSI) in screening for diabetic neuropathy among Filipino patients with diabetes mellitus using nerve conduction velocity(NCV) as gold standard and to determine the most accurate cut-off score for the diagnosis of neuropathy using MNSI.
METHODOLOGY: A cross-sectional analytic study was done among adult diabetic patients. The original MNSI Questionnaire was translated and back-translated to the Filipino language. Each patient answered the Filipino version of MNSI Questionnaire followed by a lower extremity examination done by the investigator. All patients underwent NCV as reference standard. Sensitivity and specificity of MNSI were determined.
RESULTS: We studied a total of 150 subjects. Eighty-seven (58%) were diagnosed to have diabetic neuropathy based on NCV. The sensitivity and specificity of the MNSI Questionnaire improved to 73.6% and 52.4% respectively when the cut off was reduced to ?4, whereas for the MNSI Examination, the sensitivity and specificity improved to 86.2% and 55.6% respectively when the cut off was reduced to ?1. Combining both MNSI Questionnaire and MNSI Examination further improves the sensitivity to 95.4% whereas specificity is at 39.7%.
CONCLUSION: The analyses in 150 subjects confirm that the Filipino-version of MNSI is a valid screening tool for diabetic neuropathy when compared with NCV as gold standard.

Human ; Male ; Female ; Adult ; Questionnaires ; Diabetes Mellitus ; Philippines ; Patients

Pituitary abscess is a rare condition. It can present with hormonal deficiencies and may affect reproductive health. We present a case of a 43-year-old female presenting with bitemporal hemianopsia and amenorrhea. Imaging of the pituitary showed a sellar-suprasellar mass 2.6 x 2.4 x 1.8 cm with an enhancing nodular component. Pre-operative diagnosis was pituitary adenoma with panhypopituitarism and compression of the optic chiasm. The patient underwent transsphenoidal excision of the tumor. Intraoperative findings revealed purulent fluid consistent with pituitary abscess. There was immediate improvement of vision post operatively. She did not develop diabetes insipidus. Gram stain showed polymorphonuclear (PMN) cells 0-1 per oil immersion field (OIF) and Gram-positive cocci 0-1 per OFI, however there was no growth on culture. The abscess was also negative for acid-fast bacilli and was negative on polymerase chain reaction. Histopathologic evaluation showed benign cyst contents. The patient was treated with ceftriaxone 2 grams every 12 hours for 14 days and was eventually discharged with prednisone and levothyroxine. Pituitary abscess is an important differential diagnosis for sellar and suprasellar masses. There are no specific clinical and radiologic features that will enable a preoperative diagnosis of pituitary abscess.
Amenorrhea

Objective: This study seeks to determine the association between vitamin D and testosterone in healthy, adult Filipino males. Methodology: This cross-sectional study included 110 healthy, non-obese, male volunteers aged 21–40. History and physical exam were taken, and blood was drawn for vitamin D, total testosterone (TT), sex hormone binding globulin (SHBG), albumin, insulin, fasting plasma glucose, and total cholesterol. Free testosterone (FT) was calculated. Vitamin D data were classified by status and TT, FT, and SHBG levels were compared using the Kruskal–Wallis’s test. The associations of vitamin D levels with TT, FT, and SHBG were explored using multiple regression analysis. Results: Vitamin D levels were sufficient in 3 (2.7%), insufficient in 17 (15.45%), and deficient in 90 (81.8%) of the sample. There were no significant differences in the mean TT (p=0.7981), FT (p=0.8768), nor SHBG (p=0.1838) across vitamin D status. Vitamin D was not associated with TT nor FT before or after adjustment for age and age plus body mass index (BMI). Vitamin D was associated with SHBG before and after the aforementioned adjustments, but this became insignificant on sensitivity analysis. Conclusion There is no association between vitamin D and TT, FT nor SHBG in our cohort with deficient Vit D levels.
Vitamin D ; Sex Hormone-Binding Globulin