1.The implications of randomized, controlled clinical trials in glaucoma on clinical practice
Khu Patricia M. ; Tumbocon Joseph Anthony J. ; Martinez Jose Ma. G. ; Altuna Jesus
Philippine Journal of Ophthalmology 2004;29(2):99-106
Human
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Male
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Female
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INTRAOCULAR PRESSURE
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GLAUCOMA
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OCULAR HYPERTENSION
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2.Tuberculous abscess of the thyroid.
Uyking-Naranjo May ; Dela Cruz Arik Paolo C ; Jasul Gabriel V ; Aranas Joseph Anthony
Journal of the ASEAN Federation of Endocrine Societies 2012;27(1):119-122
Tuberculosis (TB) of the thyroid gland is rare, with acute abscess formation being the least common form of presentation. As such, TB of the thyroid may be overlooked as an initial clinical impression. A careful approach by history, physical examination, laboratory testing and radiologic imaging may aid in defining the etiology of the thyroid abscess, but these remain nonspecific. An accurate diagnosis may only be made by histologic examination. We present a case of a tuberculous abscess of the thyroid gland in a 37-year-old female. TB of the thyroid should also be considered when evaluating patients presenting with a painful thyroid nodule.
Human ; Female ; Adult ; Abscess ; Physical Examination ; Thyroid Nodule ; Tuberculosis ; Viscera ; Thyroid Nodule
3.Biphasic tricalcium phosphate spheres with muscle resection in primary enucleation
Bernabe-Ko Jennifer ; Duran Ma Perla E ; Catipon Marissa Gay ; Tumbocon Joseph Anthony ; Abano Jessica Marie ; Cruz Chris Ryan R
Philippine Journal of Ophthalmology 2003;28(2):69-79
Purpose: To combine the advantage of porosity and biocompatibility of Biphasic Tricalcium Phosphate implant with Muscle Resection Methodology: Non-randomized, uncontrolled clinical case series Results: No migration or extrusion was observed. With improved muscle resection, socket and prosthesis mobility were noted. (Author)
Human
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Young Adult
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Adolescent
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EYE ENUCLEATION
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PROSTHESIS
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IMPLANTS
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ORBITAL IMPLANTS
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ARTIFICIAL IMPLANTS
4.Understanding structure and function in glaucoma
Khu Patricia M ; Aquino Norman M ; Tumbocon Joseph Anthony ; Lat-Luna Ma Margarita ; Martinez Jose Maria ; de Leon John Mark S ; Chung Alejandro N
Philippine Journal of Ophthalmology 2006;31(2):84-91
OBJECTIVE: Glaucomatous optic neuropathy (GON), defined as definitive damage to the optic-nerve head (ONH) and retinal-nerve-fiber layer (RNFL), involves structural changes in the ONH and RNFL and functional losses in the central visual field. Due to the unique anatomic distribution of the nerve fibers as they enter the ONH, there are specific changes in the ONH correlated with specific findings in the visual-field characteristic of GON. The evaluation of these changes is discussed.
METHODS: There are qualitative and quantitative methods in the structural examination of the ONH and RNFL, and quantitative techniques in the functional assessment of the central visual field. They are correlated to one another their strengths and limitations are discussed.
RESULTS: Clinical evaluation of the ONH and RNFL consists of five basic rules: (1) identify the limits of the optic disc and determine its size, (2) identify the s of the neuroretinal rim, (3) examine the RNFL, (4) examine the region for parapapillary atrophy, and (5) look for retinal and optic-disc hemorrhages. These steps are simple to use and comprise a portion of the comprehensive eye evaluation. Without proper documentation of the changes in glaucoma progression may be missed. Computer-based digital-imaging technology exemplified by the HRT II, GDx, OCT, provides fast, reproducible, objective measurements of the ONH and RNFL, allowing for more precise diagnosis and monitoring of glaucoma. These changes have good correlation to functional assessments exemplified by the standard automated perimetry (SAP) and the selective perimetry (FDT, SWAP). Typical glaucomatous visu field defects include nasal step, paracentral scotoma, and arcuate defects which follow the RNFL pattern. Progression of these defects is monitored over time and needs to be differentiated from long-term fluctuation.
CONCLUSION: The clinician should perform both structural and functional assessments to diagnose and monitor glaucoma. Both examinations provide complimentary information and each has its own place in the clinical care of glaucoma patients. The newer imaging devices and selective perimetry augment the diagnostic armamentarium of the clinician and should, therefore, be used appropriately.
GLAUCOMA
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OPTIC NERVE
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VISUAL FIELDS
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VISUAL FIELD TESTS
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OPTIC DISK
5.Trans-sphenoidal Approach to the Supraclinoid Internal Carotid Artery for Endovascular Access in a Cadaver.
Andrew Kelly JOHNSON ; Hunter Kegan HOLT ; Anthony Joseph SERICI ; Roham MOFTAKHAR
Neurointervention 2013;8(1):29-33
PURPOSE: Sometimes, intracranial pathology in the distal vasculature cannot be accessed by standard endovascular techniques because of occlusion or insurmountable tortuosity of theinternal carotid artery (ICA). A trans-sphenoidal surgical approach can follow a similar trajectory to the course of the supraclinoid ICA. This study evaluates the feasibility of a trans-sphenoidal approach to the supraclinoid ICA for endovascular access. MATERIALS AND METHODS: In a fresh cadaver head, the sphenoid sinus was dissected through a trans-sphenoidal route. Bone over the carotid prominence was removed to expose the ICA. The artery was catheterized using the Seldinger technique, and three-dimensional digital subtraction angiography was performed to evaluate the procedure. RESULTS: The catheter was successfully inserted into the supraclinoid ICA via the trans-sphenoidal route. Three-dimensional radiographic reconstruction confirmed placement of the catheter and the trajectory of the sheath into the supraclinoid ICA. CONCLUSION: While the trans-sphenoidal route has innumerable disadvantages over the standard endovascular access techniques, this route could be considered when other treatment options are too risky or impractical.
Angiography, Digital Subtraction
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Arteries
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Cadaver
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Carotid Arteries
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Carotid Artery, Internal
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Catheters
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Endovascular Procedures
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Head
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Sphenoid Sinus
6.Diagnostic accuracy of the optical coherence tomography in assessing glaucoma among Filipinos. Part 1: Categorical outcomes based on a normative database
Noel de Jesus Atienza ; Joseph Anthony Tumbocon
Philippine Journal of Ophthalmology 2012;37(1):3-10
Objective:
To determine the accuracy of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL)
parameters using the Stratus OCT in diagnosing glaucoma among Filipino patients and to determine the validity of
the OCT measurements compared with a reference standard.
Methods:
Glaucoma suspects were recruited consecutively from patients undergoing diagnostic tests. The results
of the Stratus OCT fast RNFL protocol were analyzed against the independent assessment by glaucoma experts
who were blinded. Outcomes included RNFL thickness values of ≤5 percentile and ≤1 percentile of the normative
database for each RNFL sector, quadrant, and for the average RNFL thickness. Estimates of diagnostic accuracy
with 95% confidence intervals were calculated.
Results:
A total of 119 subjects assessed as glaucoma and 397 subjects assessed as normal were included in the
analysis. Using the best categorical criterion for abnormality (average RNFL thickness of ≤1 percentile of the
normative database), the OCT had a specificity of 98% (95% CI 96 - 99) and a sensitivity of 37% (95% CI 28 - 46).
The criterion with the highest sensitivity was the presence of at least one sector with thickness at ≤5 percentile.
Conclusion
The Stratus OCT demonstrated a specificity of 98% and a sensitivity of 37% for the diagnosis of
glaucoma using as a criterion an average RNFL thickness of ≤1 percentile of the normative database. It was a poor
screening test for glaucoma suspects, although it showed some promise as a confirmatory test.
Glaucoma
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Tomography, Optical Coherence
7.Diagnostic accuracy of the optical coherence tomography in assessing glaucoma among Filipinos. Part 2: Optic nerve head and retinal nerve fiber layer parameters
Noel de Jesus Atienza ; Joseph Anthony Tumbocon
Philippine Journal of Ophthalmology 2012;37(1):11-18
Objective:
To determine the accuracy of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters
using the Stratus OCT in the diagnosis of glaucoma and to determine the validity of these measurements.
Methods:
Glaucoma suspects undergoing glaucoma diagnostic tests were recruited consecutively. The numerical
results of the Stratus OCT fast optic disc and fast RNFL protocols were analyzed against an independent assessment
by glaucoma experts who were blinded as to the results of the OCT. An ROC curve analysis was applied to derive
estimates of diagnostic accuracy and multi-level likelihood ratios.
Results:
A total of 119 subjects assessed as glaucoma and 397 subjects assessed as normal were included. All ONH
and RNFL OCT parameters showed statistically significant differences in mean values between the 2 groups. The
ROC curve identified the vertical integrated rim area (AUC: 0.822), the cup-disc area ratio (AUC: 0.816), and the
horizontal integrated rim width (AUC: 0.794) as the best optic disc parameters; and the RNFL average thickness
(AUC: 0.827), the superior quadrant (AUC: 0.807), and the inferior quadrant (AUC: 0.804) as the best RNFL
parameters. Multi-level likelihood ratios for ONH and RNFL parameters were calibrated using a projected posttest
probability of 70% for a positive test result (therapeutic threshold) and a 10% posttest probability for a negative
result (diagnostic threshold).
Conclusion
The results showed that statistically significant mean differences in ONH and RNFL parameters
did not translate into a high predictive ability for each individual parameter. Single cut-off value for each OCT
parameter based on the best sensitivity and specificity combination did not result in high predictive values for any
single parameter. Multi-level likelihood ratios for the best ONH and RNFL parameters were derived to increase the
diagnostic capability of the Stratus OCT.
Tomography, Optical Coherence
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Glaucoma
;
Optic Disk
8.Oxidative stress markers and lipid profiles of patients with polycystic ovary syndrome in a Nigerian tertiary hospital
Chukwunonso Isaiah ENECHUKWU ; Anaelechi Jude ONUEGBU ; Madu Japheth OLISEKODIAKA ; George Uchenna ELEJE ; Joseph Ifeanyichukwu IKECHEBELU ; Joseph Odirichukwu UGBOAJA ; Ubuo Kalu AMAH ; John Ekenedirichukwu OKWARA ; Anthony Osita IGWEGBE
Obstetrics & Gynecology Science 2019;62(5):335-343
OBJECTIVE: To determine the activities of oxidative stress markers and lipid profiles of patients with polycystic ovary syndrome (PCOS) in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. METHODS: This was a nested case-control study consisting of 50 PCOS patients and 50 healthy women of the same age range without any evidence of PCOS. The study measured the levels of malondialdehyde (MDA), activity of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), total antioxidant capacity (TAC); concentrations of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C), as well as high-density lipoprotein cholesterol (HDL-C) using standard spectrophotometric methods. Anthropometric indices were also assessed. P-values of <0.05 were taken to be statistically significant. RESULTS: There were significantly higher levels of MDA (P=0.002), lower activity of SOD (P<0.001), and lower TAC (P=0.001) in PCOS patients when compared with the controls. There were higher concentrations of TC (P=0.017) and LDL-C P=0.012) in PCOS patients than in controls. Significant differences were not observed between the 2 groups in terms of the activity of GSH-Px, as well as the concentrations of HDL-C and TG. The body mass index, waist circumference, and waist-hip ratio were all significantly higher in PCOS patients. CONCLUSION: This study revealed higher levels of MDA, as well as lower activity of SOD and TAC, among PCOS patients. Furthermore, there were higher levels of TC and LDL-C among the PCOS patients. Hence, monitoring these parameters may improve the clinical management of PCOS.
Body Mass Index
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Case-Control Studies
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Cholesterol
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Female
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Glutathione Peroxidase
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Hospitals, Teaching
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Humans
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Lipoproteins
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Malondialdehyde
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Nigeria
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Obesity
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Oxidative Stress
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Polycystic Ovary Syndrome
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Superoxide Dismutase
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Tertiary Care Centers
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Triglycerides
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Waist Circumference
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Waist-Hip Ratio
9.Dietary Compliance, Dietary Supplementation and Traditional Remedy Usage of Type 2 Diabetic Patients With and Without Cardiovascular Disease.
Mun Chieng TAN ; Ooi Chuan NG ; Teck Wee WONG ; Anthony JOSEPH ; Abdul Rahman HEJAR ; Abdul Aziz RUSHDAN
Clinical Nutrition Research 2015;4(1):18-31
This analytical cross-sectional study examined the nutrient intakes, dietary compliance, dietary supplementation and traditional remedy usage in type 2 diabetes mellitus (T2DM) patients from selected tertiary hospitals in multi-racial Malaysia. We compared the different characteristics of T2DM patients with and without cardiovascular disease (CVD). Socio-demographic status, dietary intakes, dietary supplementation, traditional remedy use, medical history, anthropometric measurements and clinical characteristics were obtained from face-to-face interviews. A total of 313 patients who were treated for T2DM participated in this study, in which 36.1% of them had CVD. The mean age of study subjects was 55.7 +/- 9.2 years; mean diabetes duration was 10.1 +/- 8.1 years; 52.1% were females; and 47.0% were Malays. The mean total energy intake of the subjects was 1674 +/- 694 kcal/day, and patients with CVD consumed higher total calories (p = 0.001). Likewise, the mean carbohydrate, protein and total fat intake of CVD patients were significantly higher than non-CVD patients (p < 0.05), while mean intakes of cholesterol, fibre, minerals and all vitamins were comparable between CVD and non-CVD patients. Regardless of CVD status, a notably high proportion of the subjects did not meet the recommendations of the Medical Nutrition Therapy Guidelines for Type 2 Diabetes for total energy, carbohydrate, protein, total fat, and fibre intakes. Meanwhile, 52.4% used at least one dietary supplement and 12.1% took single traditional remedy or in various combinations. Traditional remedies and supplement intake did not differ between CVD and non-CVD subjects. It is suggested that T2DM patients should be educated based on their personalized dietary intake, dietary supplementation and traditional remedy usage. The recommendations for T2DM patients shall be met to achieve the optimal metabolic goals and minimize the potential diabetic complications.
Cardiovascular Diseases*
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Cholesterol
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Compliance*
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Cross-Sectional Studies
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Diabetes Complications
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Diabetes Mellitus, Type 2
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Dietary Supplements*
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Energy Intake
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Female
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Humans
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Malaysia
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Minerals
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Nutrition Therapy
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Tertiary Care Centers
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Vitamins
10.The association of cardiovascular disease with impaired health-related quality of life among patients with type 2 diabetes mellitus.
Mun Chieng TAN ; Ooi Chuan NG ; Teck Wee WONG ; Abdul Rahman HEJAR ; Joseph ANTHONY ; Harri SINTONEN
Singapore medical journal 2014;55(4):209-216
INTRODUCTIONThe aim of this study was to evaluate the health-related quality of life (HRQoL) of Malaysian patients with type 2 diabetes mellitus (T2DM) who have cardiovascular disease (CVD), as well as identify the determinants of HRQoL among this cohort of patients.
METHODSThis study was an analytical cross-sectional study involving 313 patients aged 30-78 years (150 men, 163 women; mean age 55.7 ± 9.2 years) who were diagnosed with T2DM (mean duration of T2DM 10.1 ± 8.1 years) at two tertiary Malaysian government hospitals. The patients' sociodemographic, lifestyle, clinical and laboratory data were collected prospectively from medical records and via face-to-face interviews. HRQoL was assessed using the 15D instrument - a generic, 15-dimensional and standardised measure of HRQoL that can be used as both a profile and a single index score measure.
RESULTST2DM patients with CVD were found to have significantly lower 15D HRQoL scores than their nonCVD counterparts (p < 0.001). The HRQoL of T2DM patients with CVD was significantly lower than those without CVD (p < 0.05) in all of the 15 dimensions of the 15D instrument. Multinomial logistic regression analysis using backward stepwise method revealed a significant association between CVD and impaired HRQoL (odds ratio [OR] 11.746, 95% confidence interval [CI] 4.898-28.167). Age (OR 1.095, 95% CI 1.054-1.137), duration of T2DM (OR 1.085, 95% CI 1.032-1.140), ethnicity (OR 0.411, 95% CI 0.187-0.903), body mass index (OR 1.074, 95% CI 1.006-1.148), and physical activity level (OR 3.506, 95% CI 1.415-8.689) were also significant predictors of HRQoL.
CONCLUSIONIn T2DM patients, the presence of CVD was significantly associated with a lower HRQoL. Therefore, the importance of tertiary prevention to minimise the potential deterioration of the HRQoL of T2DM patients with CVD should be highly emphasised.
Adult ; Aged ; Cardiovascular Diseases ; complications ; psychology ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; complications ; psychology ; Female ; Humans ; Malaysia ; Male ; Middle Aged ; Quality of Life ; Social Class ; Surveys and Questionnaires ; Tertiary Care Centers