OBJECTIVE: To determine the efficacy and safety of sodium bicarbonate, citric acid, sodium citrate, and tartaric acid (compound drug) in comparison to potassium citrate in the treatment of kidney stones.

METHODS: Prospective randomized controlled trial of patients with kidney stones recruited from February to October 2011 at Out-patient Department was conducted. Ninety subjects, consented and eligible, were enrolled in this study. Random allocation of subjects into two groups was done using computer generated randomization. Subjects assigned to group I were treated with the compound drug(12 grams/day); while group II subjects were given potassium citrate(60mEq/day) for 6 weeks. Urinary pH levels were examined weekly and the effect of medical treatment on stone size changes was evaluated by ultrasonography every two weeks in the six-week treatment period. Intention to treat analysis was done with 95% confidence level(CI). Statistical analysis of results was determined using analysis of variance (ANOVA) with multiple repeated measures for between group urinary pH changes and chi square for between groups difference in stone size changes.

RESULTS: A total of 74 subjects completed the study with a dropout rate of 18%, which was mainly due to geographic and financial reasons. Demographic and baseline stone characteristics of both groups were not significantly different. Treatment outcome between the two groups based on stone size changes (in general and both radiolucent and radioopaque stones subgroups) did not show any significant statistic difference. The pH level changes over six-week treatment period between the two groups showed a total mean pH difference of 0.445, (95% CI: 0.213, 0.677), which was statistically significant (P<0.001) in favor of Group I. Both treatment regimens were well-tolerated with very few non-serious medication adverse effects.

CONCLUSION:  Urinary alkalinization with sodium bicarbonate, citric acid, sodium citrate, and tartaric acid is a well-tolerated and highly effective treatment resulting in dissolution of non-obstructing kidney stones and is comparable to the gold standard potassium citrate.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; KIDNEY CALCULI ; NEPHROLITHIASIS ; UROLOGIC DISEASES ; KIDNEY DISEASES ; SODIUM BICARBONATE ; CITRIC ACID ; SODIUM CITRATE ; TARTARIC ACID ; POTASSIUM CITRATE ; INORGANIC CHEMICALS ; ORGANIC CHEMICALS ; TREATMENT OUTCOME ; SAFETY

OBJECTIVE: To determine the relationship between dietary omega-3 fatty acid(n-3PUFA) and omega-6 fatty acids (n-6PUFA) with prostate cancer risk from a meta-analysis of prospective cohort studies.

DESIGN: Cohort studies that investigated the relationship of dietary omega fatty acids and prostate cancer risk were retrieved from MEDLINE, Unbound MEDLINE, EMBASE, OVID, Cochrane Library and Science direct up to June 2011, and were critically appraised using Newcastle-Ottawa Quality Assessment for cohorts. General variance-based method was used to the pool the effect estimates at 95% confidence interval. Heterogeneity was assessed by chi square and quantified by I2.

RESULTS: Eight cohort studies were included for meta-analysis. n-3PUFA, n-6PUFA and their derivatives were not significantly associated with risk of prostate cancer in general. A significant heterogeneity (P=0.023,I2=63%) between studies was noted. After inter-study variability adjustment was done, repeat analysis showed a significant negative association between high dietary intake of alpha-linolenic acid(ALA) and prostate cancer risk (pooled RR:0.915;95% CL:0.849, 0.985;P=0.019) Likewise, a slightly positive association was noted on dietary long chain omega-3 fatty acids (EPA+DHA) and prostate cancer risk (pooled RR: 1.135; 95% CI:1.008, 1.278 P=0.036), however when two other cohort studies with data of EPA and DHA both analyzed separately was included into the pool, the association became not significant (RR=1.034;95%CI:0.973,1.096;P=0.2780).

CONCLUSION: The intake of n-3PUFA and n-6PUFA does not significantly affect the risk of prostate cancer. High intake of ALA may reduce risk of prostate cancer, while intake of long-chain omega-3 fatty acids does not have a significant effect.

Human ; Male ; Recommended Dietary Allowances ; Nutritional Requirements ; Diet ; Fatty Acids, Omega-3 ; Fatty Acids, Omega-6 ; alpha-Linolenic Acid ; Fatty Acids ; Prostatic Neoplasms ; Neoplasms ; Genital Neoplasms, Male ; Risk ; probability

OBJECTIVE: To investigate the efficacy of terpene compound drug (pinene, camphene, borneol, anethole, fenchone and cineol in olive oil) in facilitating spontaneous passage of ureteral calculi

METHODS: Systematic literature search of the MEDLINE, EMBASE, OVID, Science Direct, Proquest, Google scholar, Cochrane Library databases and rference lists of related literature was done without language restriction. Trials on ureterolithiasis medical expulsive therapy (MET) that compare terpene compound drug versus placebo/control group or alpha-blockers were identified. Articles retrieved were critically appraised by two independent reviewers according to Cochrane Collaboration recommendations. Data from included studies were extracted for calculation of risk ratio (RR) and 95% confidence interval (CI). Effect estimates were pooled using Mantel-Haenszel method with random effect model. Inter-study heterogeneity and publication bias were assessed. The PRISMA guidelines for meta-analysis reporting were followed.

RESULTS: Five trials (total of 344 subjects) of adequate methodological quality were included. Pooled effect estimates from homogenous studies showed that compared to placebo/ control group, patients treated with terpene compound drug had significantly higher ureteral calculi expulsion rate (pooled RR: 1.34; 95% CI 1.12, 1.61). Analysis of studies that compare terpene compound drug with alpha-blockers showed no significant difference (pooled RR: 0.79; 95% CI 0.59, 1.06), although significant inter-study heterogeneity was noted. Only minor gastrointestinal adverse effect was reported on terpene compound drug use.

CONCLUSIONS: The results suggest that terpene compound drug as MET is effective in promoting passage of ureterolithiasis. High quality large-scale RCTs comparing alpha-blockers and terpene compound drug are warranted to make a more definitive conclusion.

Human ; Male ; Female ; TERPENES-adverse effects,therapy,TREATMENT OUTCOME ; UROLOGIC DISEASES ; URETERAL DISEASES ; Ureteral Calculi

Permanent visual loss is a well established major sequela of idiopathic intracranial hypertension (IIH). It is often insidious and frequently unnoticed by patients with IIH. It is vital to monitor these patients with serial perimetric and visual acuity tests because visual loss can be halted and occasionally reversed if treatment is begun early. We report a case of IIH with an empty sella turcica and polycystic ovary syndrome who developed visual field loss over ten years. This report illustrates the importance of close ophthalmic monitoring and detailed neurological and endocrinological evaluation to prevent complications in such patients.
Adult ; Chronic Disease ; Empty Sella Syndrome ; complications ; diagnosis ; Female ; Humans ; Polycystic Ovary Syndrome ; complications ; diagnosis ; Pseudotumor Cerebri ; complications ; diagnosis ; Vision Disorders ; diagnosis ; etiology

INTRODUCTIONOrthodeoxia is a rare clinical syndrome characterised by dyspnoea and arterial deoxygenation that accompanies a change from a supine to erect position.

CLINICAL PICTUREWe describe an unusual case of "paradoxical orthodeoxia" in a 70-year-old man with a thoracic aortic aneurysm: arterial desaturation when supine that improved when erect.

TREATMENT AND OUTCOMENon-invasive imaging revealed compression of the left pulmonary artery by the aneurysm (thoracic computed tomography) and patent foramen ovale (transesophageal echocardiography). Nuclear studies show decreased relative left lung perfusion attributable to the former, and right-to-left atrial shunt attributable to the latter. The degree of right-to-left shunt increases in the supine position: nuclear pulmonary shunt study shows shunt extent of 21% when supine versus 10% erect.

CONCLUSIONA physioanatomical explanation is proposed.

Aged ; Aortic Aneurysm, Thoracic ; epidemiology ; Dyspnea ; etiology ; Echocardiography, Transesophageal ; Female ; Heart Septal Defects, Atrial ; epidemiology ; Humans ; Oxygen ; blood ; Posture ; physiology ; Supine Position ; physiology

OBJECTIVES: This study aimed to develop and validate a simple questionnaire for chronic neuropathic pain that can be administered as a screening tool by general practitioners and internists in order to help them identify patients with probable neuropathic pain.
METHODS: Following a development phase and a pilot study, the revised version of the screening tool which included eleven descriptors associated with neuropathic pain both in English and Filipino languages was validated on 120 consecutive patients with any type of pain except psychogenic pain, recruited in the out-patient clinics of six hospitals. The questionnaire was validated by assessing the sensitivity, specificity, positive and negative predictive value of each item and the overall questionnaire. The internal consistency of the questionnaire items was assessed using the Kuder-Richardson formula 20.
RESULTS: Overall, the internal consistency of the SigN-PQ using the Kuder-Richardson formula 20 was 0.7837; the sensitivity was 91.89% with specificity of 80.22%, PV (+) was 65.38% and PV(-) was 96.0%. For the English version, the descriptors with the highest scores were burning (Sensitivity: 100%, Specificity: 93%) and electricity-like (Sensitivity: 100%, Specificity: 93%). For the Filipino version, mainit (burning) has the highest sensitivity of 88% with specificity of 82.6%, followed by gumagapang (tingling) with sensitivity of 86.96% and specificity of 85.42%. The sensation of saksak (stabbing) and hiwa (lancinating) have the lowest sensitivity, 60% and 54% respectively, although their specificity scores are high. Since this study is a validation of a screening tool for neuropathic pain, the investigators decided to choose descriptors with higher sensitivity. Thus, in the final version of the SignN-PQ, the descriptors saksak and hiwa were removed.
CONCLUSION: The SigN-PQ Neuropathic Pain Questionnaire has a high overall sensitivity of 91.89% and specificity of 80.22%. The pain descriptors in the questionnaire are consistent with the descriptors cited in the literature. It is a valid screening instrument for neuropathic pain that can be easily incorporated in the daily practice of general practitioners and internists.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Neuralgia ; Pain ; Diagnosis ; General Practitioners ; Outpatients ; Research Personnel ; Sensitivity And Specificity ; Surveys And Questionnaires

BAome III criteria. METHODS: After EAR3Q was developed by Asian experts by cCKGROUND/AIMS: The development-processes by regional socio-cultural adaptation of an Enhanced Asian Rome III questionnaire (EAR3Q), a cultural adaptation of the Rome III diagnostic questionnaire (R3DQ), and its translation-validation in Asian languages are presented. As English is not the first language for most Asians, translation-validation of EAR3Q is essential. Hence, we aimed to culturally adapt the R3DQ to develop EAR3Q and linguistically validate it to show that the EAR3Q is able to allocate diagnosis according to Ronsensus, it was translated into Chinese, Hindi-Telugu, Indonesian, Korean, and Thai, following Rome Foundation guidelines; these were then validated on native subjects (healthy [n = 60], and patients with irritable bowel syndrome [n = 59], functional dyspepsia [n = 53] and functional constipation [n = 61]) diagnosed by clinicians using Rome III criteria, negative alarm features and investigations. RESULTS: Experts noted words for constipation, bloating, fullness and heartburn, posed difficulty. The English back-translated questionnaires demonstrated concordance with the original EAR3Q. Sensitivity and specificity of the questionnaires were high enough to diagnose respective functional gastrointestinal disorders (gold standard: clinical diagnoses) in most except Korean and Indonesian languages. Questionnaires often uncovered overlapping functional gastrointestinal disorders. Test-retest agreement (kappa) values of the translated questionnaires were high (0.700-1.000) except in Korean (0.300-0.500) and Indonesian (0.100-0.400) languages at the initial and 2-week follow-up visit. CONCLUSIONS: Though Chinese, Hindi and Telugu translations were performed well, Korean and Indonesian versions were not. Questionnaires often uncovered overlapping FGIDs, which were quite common.
Asia ; Asian Continental Ancestry Group* ; Constipation ; Diagnosis* ; Dyspepsia ; Follow-Up Studies ; Gastrointestinal Diseases ; Heartburn ; Humans ; Irritable Bowel Syndrome ; Surveys and Questionnaires* ; Sensitivity and Specificity ; Translations

In the last two decades gastroesophageal reflux disease (GERD), initially thought to be a disease only common  in the West, is described  increasingly in Asia, including the Philippines. A recent local report indicated that the prevalence of erosive esophagitis (EE), a common complication of GERD, has more than doubled, i.e., 2.9% to  6.3%,  between the two time periods of 1994-1997 and 2000-2003, respectively. GERD causes recurrent annoying symptoms which are common  reasons  for  clinic  visits  and consultations thus, it is the objective of these guidelines to provide both primary care physicians  (PCPs) and specialists a current, evidence-based, country-specific recommendations for the optimal management  of  GERD.  These  guidelines  are  intended   to   empower   PCPs   to   make   a   clinic-based diagnosis of GERD, to start an empiric acid-suppressive therapy in the appropriate patient,and direct them to select which GERD patient may need to undergo investigations to ascertain further the diagnosis of GERD or to assess outcomes of therapy. We acknowledge that studies published in the future may influence the impact on our confidence on the recommendations enumerated in  these guidelines thus, we commit to update this document when it is deemed appropriate.

Physicians, Primary Care ; Prevalence ; Specialization ; Gastroesophageal Reflux ; Ambulatory Care ; Esophagitis ;

Background. Subacute sclerosing panencephalitis (SSPE) is a fatal neurodegenerative disease caused by prolonged persistent infection of the central nervous system with a measles virus mutant. Though various treatment modalities have been tried, there is no effective treatment to completely cure SSPE and new therapeutic strategies are needed.

Objective. This is a prospective uncontrolled observational open label trial to describe the short-term outcomes and safety of intraventricular ribavirin in combination with oral isoprinosine in Filipino SSPE patients.

Methods. Sixteen (16) unrelated SSPE patients between ages 3-26 years and in various clinical stages were included in this study. Demographic data were described. Intraventricular instillation of ribavirin (1-3 mg/kg/dose) through an Ommaya reservoir was given for a duration of 3-6 months in 13 patients. The duration of follow-up was 48 weeks. The clinical outcome was assessed before, during, and after treatment using the Neurological Disability Index (NDI), Brief Assessment Examination (BAE), and clinical staging using the Jabbour Classification. Adverse side effects from intraventricular ribavirin were enumerated.

Results. Six of 13 (46.15%) patients mostly in Stage III illness had clinical improvement showing decreasing NDI and BAE scores during treatment and the clinical improvement was maintained or improved further during the 48-week follow-up period. Clinical improvement manifested as improved mental alertness, decrease in spasticity and reduction of seizures. The clinical staging of those who improved remained stable during and after treatment was discontinued. Five (38.46%) patients in Stage II disease worsened and progressed to Stage III despite ribavirin therapy including 1 (7.6%) patient who died after the treatment phase due to pneumonia and brainstem failure. The clinical course of two (15.38%) patients remained unchanged. Minor adverse side effects of ribavirin included transient fever, rash, oral sores, seizure episodes, drowsiness, bladder retention and mild increase in transaminases. Ommaya reservoir infection was a serious adverse event in 5 (31.25%) patients.

Conclusion. There is still no definitive cure for SSPE. Although ribavirin may help alleviate some of the symptoms of SSPE and prolong life, it may not reverse or halt the progression of the disease. Long term follow-up of these patients and continuous use of intraventricular ribavirin will better clarify its role in modifying the fatal course of SSPE. The role of ribavirin in Stage I patients and a controlled clinical trial in Stage II SSPE needs further studies.

Subacute Sclerosing Panencephalitis ; Ribavirin ; Measles virus

Background: The benefits of infant massage in hospital and community settings have been documented in literature: better weight gain of preterm and low birthweight infants, shortened hospital stay, slightly better scores on developmental tests, fewer postnatal complications, and effects on physical and mental health. Objectives: This study described the perceptions and experiences of infant massage among caregivers of infants 2-6 months old consulting in two public health centers in Quezon City before and after infant massage training. Methods: This qualitative study assessed perceptions and experiences at baseline and after infant massage training of mothers and caregivers taking care of infants 2-6 months old. Pre-training interviews were conducted, as well as immediately after, and seven days after training on infant massage delivered by the Philippine League of Government and Private Midwives, Inc. (PLGPMI). Training consisted of lectures and demonstrations, after which mothers/caregivers gave their babies the massage under the trainer's supervision. Post-training interviews were conducted immediately after the training and seven days after. Responses to the interviews were transcribed. The transcripts and interview notes were analyzed independently by two research team members. Qualitative Content Analysis (QCA) was done. Disagreements were settled by discussion. Results: The infant’s mother was identified as the best person to perform infant massage. Infant massage was a new concept to many participants before the training. In general, the perception was positive. It was believed to promote the baby's physical development and bonding with the mother/caregiver. These same benefits were reported after the training. Post-training, all 11 participants who returned for follow-up interviews reported having massaged their babies at home. They were also able to describe the process and timing of massage as taught to them. The participants’ responses centered on seven (7) identified themes, identified at baseline and after training: 1) general concepts of infant massage, 2) benefits of infant massage, 3) methodologies, materials, and considerations, 4) persons credible to perform infant massage, 5) application/performance of infant massage, 6) intentions and 7) infant massage as a public health measure. Conclusion There was a positive perception of infant massage among mothers and caregivers of infants 2-6 months old, whether or not they had prior knowledge. The sharing of information and the training given enhanced this. Participants showed good reception and retention of infant massage's basic concepts and process and improved their confidence in handling their babies and massaging them.
Mother-Child Relations ; Caregivers ; Health Education ; Community Health Centers