OBJECTIVE: Measurement of kidney size by ultrasonography is an important parameter in the renal evaluation of patients. This study aims to establish the average size of kidneys of healthy adult Filipinos and examine the factors that influence it.
DESIGN: Cross-sectional, observational study
SETTING: Section of Nephrology, Department of Medicine and Department of Radiology, UP-PGH Medical Center, a tertiary government hospital
PARTICIPANTS: 264 healthy Filipino adults underwent kidney ultrasound after preliminary screening by history, physical examination, urinalysis, and serum creatinine
RESULTS: Renal sizes and volume were measured by ultrasound in 105 males and 159 females, with ages ranging from 18 to 75 years old. The left kidney was significantly larger than the right for mean length but not for width or thickness. Except for cortical thickness, renal length (L=98 mm, R=96mm vs. L=95mm, R=93mm), width (L=48mm, R=49mmvs. L=46mm,R=46mm), and thickness (L=43mm, R=42 mm vs. L=39 mm, R=39 mm) were significantly larger in males compared to females. While the gender differences persisted when corrected for age and body mass index, this disappeared when corrected for total body area. With advancing age, there was minimal shortening but significant increases in width and thickness (renal shape index)
CONCLUSION: Our study provides estimates of the average kidney size for normal adult Filipinos. The average kidney size of Filipinos is smaller than that of Caucasians for length (L=96mm vs. 112 mm, R=94mm vs. 109mm) and for width (L=47mm vs. 58mm, R=48mm vs. 57mm). Males have larger kidneys than females but the gender difference disappeared when corrected for total body area. Height but not weight has a significant influence on kidney size. With advancing age, kidneys tend to increase in width and thickness with no significant decrease in length or volume.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Kidney ; Radiology ; Adult ; Ultrasonography ; Patients

To establish reference values for lung function test in Filipinos, 283 (130 males and 153 females) normal non-smoking (< 0.5 pack years), adults were studied using a body plethysmograph (Jaeger, West Germany). Spirometric indices were integrated from a pneumotachograph (linear at flows between 0-20 1/sec with ± 2% error). Spirometric performance and measurements followed the ATS Snowbird Workshop recommendations. Lung volumes and airway resistance (Raw) were taken from the average of three plethysmographic determinations.

Multiple linear regressions with backward elimination was done. The data obtained was regressed against independent variables of age height, weight, and body surface area for each sex.

Analysis of variance (ANOVA) of the regression equations for most parameters were significant at = 0.01. In a few parameters were significance was = 0.05. Only in Raw was the regression model not significant. The coefficient of determination (R) of our regression equations were low (<0.50). However, such low R have been observed in other predictions equations which have gained widespread acceptance, attesting to their clinical usefulness. Ninety five percent confidence interval was used to determine the lower limit of normal for FEV1 and FVC. Since the other parameters showed greater individual variability, cumulative percentiles of % of predicted were determine instead (Knudson 1977). For performance test, the 5th percentiles of % of predicted was computed. For lung volumes, the 5th and 95th percentiles were determined. For Raw, the 95th percentiles of the actual values was used. Since there were fewer subjects above the age of 60 years, the use of these equations is subject to this limitation.

Human ; Male ; Female ; Smoking ; Lung ; Analysis Of Variance ; Population

Normal values and upper limits (95th percentile and 95% confidence interval of liver, spleen and portal vein size, as well as liver extensions below the costal margin were determined prospectively with ultrasound in 224 healthy subjects (renal donors). Correlation with sex, age, weight, height, and body surface area were assessed. Some correlation values were significant (r ? 0.30). The highest correlation (r=0.65 was liver AP diameter with weight. A formula to predict normal liver AP diameter was derived. Another set of subjects with established liver disease was compared with the normal means. All abnormal diameter means were at or above the 95th percentile, and the difference between the means of the normal and abnormal diameters were significant.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Liver ; Spleen ; Portal Vein ; Adult ; Veins ; Palpation ; Percussion ; Radiography

Hepatitis C virus (HCV) infection is a devastating disease that is increasingly being diagnosed among Filipinos, especially in at-risk populations. There are disease-specific nuances in the evaluation and management of this infection. Furthermore, advances in the field brought about by clinical research are rapidly moulding the way we evaluate and manage HCV patients. Evidently, consensus statements formulated by experts in the field are needed in order to serve as a guide to physicians who see HCV patients in the clinic. With this in mind, the Hepatology Society of the Philippines spearheaded the formation of these statements which aimed to address issues in the diagnosis, evaluation, treatment, and follow-up care of patients with HCV infection.
Recommendations on the specific tests to perform in the evaluation of HCV patients before, during and after treatment, and first-line treatment of patients with acute and chronic HCV infection were provided. Treatment algorithms for chronic HCV infection, divided according to viral genotype, were also devised. We acknowledge the limitations brought about by the local inavailability of some drugs/treatment regimens in the local setting at the time of the formulation of these statements. As such, these statements will be revised as soon as new data become locally applicable.

 

Hepatitis C ; Diagnosis ; Infection ; Consensus ; Carcinoma, Hepatocellular ; Liver Cirrhosis

BACKGROUND: One under-explored area in chronic obstructive pulmonary disease (COPD) patients is anxiety and/or depression, which may have negative impact in the patients' condition. This is possibly the first study to possibly assess the burden of anxiety and depression in COPD patients in the Philippines.

STUDY DESIGN: This is a prospective descriptive survey in three tertiary care hospitals in Manila, Philippines.

PARTICIPANTS: A total of 204 patients were enrolled in the study with the following inclusion criteria: Filipino patients who are aged more than or equal to 40 years with a diagnosis of COPD (documented post-bronchodilator FEV1/FVC ratio less than 0.7) by a physician seen at the outpatient clinics of three tertiary care hospitals with no primary diagnosis of asthma, no previous lung volume reduction surgery, lung transplantation or pneumonectomy and at least finished Grade 2 education.

Exclusion criteria include pregnant patients and patients previously diagnosed to have an anxiety, depression, or on any anti-depressant medications.

METHODS: Descriptive statistics was obtained with frequency and percentages of the demographic and physiologic variables in the study by tabulation and graph. The prevalence of anxiety and depression was determined by calculating the percentage of each patient with a score of 8 or higher on the Hospital Anxiety and Depression Scale (HADS) with validated Tagalog version, respectively.

RESULTS: The prevalence of anxiety in Filipino COPD patients is 47.55%. The prevalence of depression in Filipino COPD patients is 31.37%.

CONCLUSION: The prevalence of depression in Filipino COPD patients is comparable to the prevalence of depression from other general medical conditions nationwide according to the study of Batar (31.37% vs. 31%). Anxiety is slightly more prevalent in COPD from other general medical conditions (47.55% vs. 36%). A study on the risk factors of anxiety and depression among Filipino COPD patients is recommended.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Anxiety ; Depression ; Pulmonary Disease, Chronic Obstructive ; Patients ; Depression

Chorinic hepatitis B virus (CHB) infection is a serious problem that affects over 300 million people worldwide and is highly prevalent in the Asia Pacific region. In the Philippines an estimate 7.3 million Filipinos or 16.7% of adults are chronically infected with HBV, more than twice the average prevalence in the Western Pacific region.

In view of the above, the Hepatology Society of the Philippines (HSP) embarked on the development of consensus statements on the management of hepatitis B with the primary objectives of standardizing approach to management, empowering other physicians involved in the management of hepatitis B and advancing treatment subsidy by the Philippine Health Insurance Corporation (PhilHealth).

The local guidelines include screening and vaccination general management, indications for assessment of fibrosis in those who did not meet treatment criteria. indications for treatment, on-treatment and post-treatment monitoring and duration of antiviral treatment. Recommendations on the management of antiviral drug resistance, management of special populations including patients with concurrent HIV or hepatitis C infection, women of child-bearing age (pregnancy and breastfeeding), patients with decompensated liver disease, patients receiving immunosuppressive medications or chemotherapy and patients in the setting of hepatocellular carcinoma are also included. However, the guidelines did not include management for patients with liver and other solid organ transplantation, patients on renal replacement therapy, and children.

The consensus statements will be amended accordingly as new therapies become available.

Hepatitis B ; Consensus ; Hepatitis B, Chronic ; Hepatitis B Virus ; Fibrosis ; Drug Therapy ; Carcinoma, Hepatocellular ; Liver Cirrhosis ; Hepatitis Delta Virus ; Hiv

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is considered a rare disease. In the Philippines, there are currently no local registry for such rare disease thus clinical features that may be unique to the country is difficult to characterize.
OBJECTIVE: To characterize the TTP patients seen in our institution based on the demographic, clinical and laboratory profile of these patients.
RESULTS: A total of eight patients were described in this report. Median age was 38 years (range, 20-63) with a female predominance. All patients had neurologic  symptoms and microangiopathic hemolytic anemia. Minor neurologic symptoms (confusion, headache and dizziness) were more frequently observed. Renal dysfunction (serum creatinine >1.4mg/dL), fever (>38.0°C), and thrombocytopenia were observed in four patients (50%), seven patients (87.5%) and six patients (75%) respectively. Patients underwent median of three sessions of Plasma Exchange (range, two to 38). Of the six patients who received therapeutic plasma exchange, five were discharged alive.
CONCLUSION: Fifty percent of the patients in this report presented with the classic pentad. This feature should be kept in mind as TTP is a true hematopologic emergency. A high index of suspicion, prompt evaluation and treatment of patients are necessary because multi-organ thrombosis may not be reversible. If treatment is not urgently administered, Therapeutic Plasma Exchange is the management of choice and should be done immediately once TTP is recognized.

Human ; Male ; Female ; Adult ; Purpura, Thrombotic Thrombocytopenic ; Patients ; Thrombocytopenia ; Plasma Exchange

BACKGROUND: Differentiated thyroid cancer is a common endocrine malignancy with an indolent course and high overall survival rate. With more cases diagnosed early, survivors of this cancer live longer and hence are at risk of second primary cancers. In patients with known primary malignancy, work-up often focuses on the primary disease, so that coexistence of another primary malignant lesion can be missed.
CASE PRESENTATION: We report a case of a 78 year-old Filipino male diagnosed to have papillary thyroid cancer with nodal metastases presenting with an incidental rectosigmoid cancer on pre-operative workup.
TREATMENT AND OUTCOME: Patient eventually underwent complete surgical removal of both malignancies. He is currently on levothyroxine suppression therapy with no evidence of tumor recurrence for both malignancy and is on close follow-up for cancer recurrence surveillance.
CONCLUSION: Clinical vigilance for cancer screening and surveillance is mandatory for patients diagnosed with any type of primary malignancy to reduce the rate of missing secondary primary malignancy simultaneously present in the same patient , Early cancer detection might improve cancer patient's overall prognosis and eventually proved to be life-saving.

Human ; Male ; Aged ; Neoplasms ; Patients ; Prognosis ; Thyroxine

BACKGROUND: Dengue Hemorrhagic Fever/Dengue Shock Syndrome (DHF/DSS) occurs only in a small number of dengue fever (DF).This condition,when coupled with a form of congenital hemolytic nemia called Hereditary Spherocytosis (HS), will turn a relatively manageable case of DF into a complicated condition with very poor prognosis.

CASE PRESENTATION: Here we report a case of a 19-year-old male student from Manila who came in with fever,jaundice, and dengue warning signs. He was also diagnosed with HS. This compounding infection initiated a hemolytic crisis of his HS, causing severe bleeding and multiple organ failure on top of DHF/DSS. The progression of the disease started with bleeding, and later on with altered sensorium (encephalopathy), respiratory failure, and ultimately, demise.

CONCLUSION: DHF/DSS together with HS may cause a hemolytic crisis. High RBC turnover and heightened erythroid marrow activity in HS makes a patient vulnerable to develop aplastic crisis due to dengue virus infection. Erythroid marrow failure may result in profound anemia, heart failure, hypoxia, cardiovascular collapse, and death.

Human ; Male ; Adult ; Severe Dengue ; Patients ; Dengue ; Death

OBJECTIVE: To establish a normal range of values for thyroid volume among adult Filipinos and to correlate thyroid dimensions with age, sex, weight, height, and urinary iodine.
METHODS: This is a cross-sectional study conducted at the University of the Philippines-Philippine General Hospital. Out of 212 health personnel screened, 169 were included based on the following exclusion criteria: goiter stage Ib to III as defined by WHO, hyperthyroid or hypothyroid, hospitalization within the past month, chronic renal disease, chronic alcohol intake, more than 4 pack years of smoking, and abnormal laboratory profile. Laboratory parameters included FT3, FT4, TSH, creatinine, anti-thyroglobulin, anti-thyroid peroxidase, 24-hr urinary iodine , and thyroid ultrasonography. There were 55 males and 114 females with a mean age of 38.98 +/- 11.21 years old, mean weight of 59.84 +/- 11.91 kg.
RESULTS: The size of the right lobe ranged from 3.58-5.09 x 1.15-1.89 x 1.01-1.90 cm (LxWxD) while the left lobe ranged from 3.62-5.01 x 1.15-1.93 x 1.03-1.84, comparable with established values in literature. Using Hotelling's T-squared, male sex was associated with a larger thyroid dimension, (p-value <0.01) There was no statistically significant relationship between thyroid dimension and urinary iodide level. (Pillai's Trace p=0.88, Wilk's Lambda p=0.88, Hotteling's Trace p=0.88, Roy's Largest Root p=0.57). In general, thyroid dimensions were significantly correlated with the demographic variables using canonical correlation (0.5431, p=0.0232).
CONCLUSIONS: The normative thyroid dimensions established among Filipino adults were comparable with the accepted reference values. Thyroid dimensions were significantly correlated with weight, height, and sex but not with urinary iodide levels.

Thyroid Gland ; Body Weight ; Body Height ; Gender Identity ; Reference Values ; Cross-sectional Studies ; Iodine ; Urine ; Creatinine ; Ultrasonography