OBJECTIVE: To discuss a case of pituitary abscess presenting with amenorrhea and diabetes insipidus, and to enumerate the differential diagnosis for this condition
SIGNIFICANCE: By presenting this case, the author aims to increase awareness regarding the possibility of infectious causes of pituitary masses, thereby prompting early recognition and treatment of similar cases
CASE REPORT: This is the case of a 42-year old woman admitted due to severe generalized headache, amenorrhea and polyuria of three months duration, preceded by a one-month history of remittent fever. Physical examination was normal except for bitemporal hemianopsia
LABORATORY TEST RESULTS: On admission, she had mild anemia, hypernatremia with elevated serum osmolality, and failure to concentrate urine. Hormonal examinations showed normal thyroxine and growth hormone levels, low basal serum cortisol, and elevated prolactin levels. Cranial CT scan showed widening of the sella turcica with a homogenous, isodense, slightly enhancing focus in the sellar and suprasellar area.
COURSE: Initial considerations were chiasmatic glioma versus a pituitary adenoma. Transphenoidal surgery was done and intraoperatively, purulent fluid was noted. Aspirate gram stain showed 1-2 white blood cells per high power field but with no growth on culture. Subsequently, vision was fully restored but prolactin levels continued to be slightly elevated. Basal cortisol and urine specific gravity were persistently low. Repeat CT scan showed disappearance of the pituitary mass. Six months after the operation, the patient was able to go back to work but continues to take steroids and carbamazepine for the diabetes insipidus.
REVIEW OF LITERATURE: There are about 100 cases of pituitary abscess in literature mimicking pituitary adenoma and presenting with headaches, amenorrhea, visual field cuts, hypopituitarism, fever and meningitis. As in this case, the abscess is frequently sterile. Pituitary abscess should be considered in patients with a primary diagnosis of pituitary adenoma with accompanying signs and symptoms suggestive of an infection. (Author)

Human ; Female ; Adult ; Pituitary Neoplasms ; Sella Turcica ; Hemianopsia ; Hydrocortisone ; Carbamazepine ; Hypernatremia ; Diabetes Insipidus

BACKGROUND: Studies have shown a high prevalence of OSA among the middle-aged group, the male gender and among the obese population. The last two years has likewise shown that OSA is a risk factor for hypertension
OBJECTIVE:To determine the association of age, gender, obesity and hypertension with OSA among Filipino OSA patients
MATERIALS AND METHODS:Cross-sectional study from previous records of polysomnography at St. Lukes Medical Center. Chi-square test of association analysis was performed with the level of significance set at 0.05.
RESULTS: A significant association between age, male gender, obesity and OSA is observed (p value: 0.001). This study showed that hypertension is prevalent among OSA patients (41.3 percent) than those without OSA (33.3 percent), however no statistical significance is noted (p value: 0.132).
CONCLUSION: The male gender, middle-age group and obesity are strongly associated with OSA in Filipino patients.

Human ; Male ; Aged ; Middle Aged ; Adult ; Adolescent ; Polysomnography ; Prevalence ; Hypertension ; Obesity

BACKGROUND: Coronary Artery Disease (CAD) is closely associated with several major risk factors including many that can be modified or eliminated. Hypertension, diabetes mellitus, dyslipidemia, smoking and obesity are among these. Early identification of these risk factors gives the physician opportunities for primary and secondary prevention of CAD.
OBJECTIVE: To assess the practice of physicians with regards identification and management of risk factors of patients with CAD at the Makati Medical Center.
METHODOLOGY: Two hundred and one (201) patients admitted at the Makati Medical Center from July 2001 up to December 2001 with symptomatic or objective evidence of myocardial ischemia during treadmill exercise and angiographic findings of CAD were assessed. Identification and management of the different risk factors by the physicians were reviewed.
RESULTS: Of the 201 patients 167 (83 percent) were male, 65 (32 percent) were over 65 years old and 7 (3 percent) had strong family history of CAD. One hundred twenty seven (63 percent) had hypertension, 77 (38 percent) had diabetes mellitus, 96 (47 percent) had dyslipidemia, 113 (63 percent) were obese and 103 (51 percent) were smokers. Active management was done for the hypertension, diabetes and dyslipidemia. Only 39 percent of the smokers were off the habit for more than a year and only 19 percent of the obese received counseling for weight loss and exercise.
CONCLUSION: All patients identified with hypertension, dyslipidemia and diabetes mellitus were placed on appropriate diet and medications, patients with smoking problems and obesity were less consistently managed with smoking cessation approaches and weight losing manipulation through diet and exercise.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Coronary Artery Disease ; Weight Loss ; Risk Factors ; Smoking Cessation ; Smokers ; Obesity ; Diabetes Mellitus ; Dyslipidemias ; Hypertension ; Smoking ; Diet

OBJECTIVES: Among relatively healthy Filipinos undergoing executive check-ups (periodic health examinations), the study aims 1.) To determine the correlation of hypertension and serum uric acid, 2.) To determine the association between serum uric acid and age, sex, obesity or relative weight, cigarette smoking, alcohol intake, diabetes mellitus, anti-hypertensive drug intake, cholesterol, and serum triglyceride, and 3.) To determine prevalence of hyperuricemia.

METHODS: Retrospective chart review of 2188 adult Filipinos undergoing executive medical check-ups in 6 major hospitals Results: Hyperuricemia was present in 37.9 percent (adjusted prevalence, 95 percentCI 36.0-39.9) (n=845). The mean uric acid was 0.38 mmol/L (95 percent CI 0.37-0.39). It was significantly associated with hypertension at adjusted Odds Ratio 1.27 (95 percent CI 1.05-1.53, p=0.013). The risk factors for hyperuricemia were age, male, weight, smoking, alcohol intake, hypertension, normoglycemia, triglycerides, and cholesterol. After adjustment in a step-wise logistic regression, the independent predictors identified were hypertension, hypercholesterolemia, age, males and non-diabetics.

CONCLUSIONS: Hypertension was significantly associated with hyperuricemia among adult Filipinos undergoing periodic health check-ups. The major predictors of elevated serum uric acid were hypertension, male sex, hypercholesterolemia, age and absence of diabetes mellitus. The prevalence of hyperuricemia at 37.9 percent was much higher compared to a previous local study (21 percent) and prevalence studies from other countries (8.4-27.6 percent).

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Adolescent ; Uric Acid ; Hyperuricemia ; Antihypertensive Agents ; Triglycerides ; Hypercholesterolemia ; Cigarette Smoking ; Obesity ; Body Weight ; Hypertension ; Cholesterol ; Diabetes Mellitus ; Smoking

OBJECTIVES: To determine the effect of the timing of nephrology referral, whether early (ER) or late (LR), on morbidity and mortality of dialysis patients Study Design: Cohort, retrospective

MATERIALS AND METHODS: We retrospectively reviewed all patients with CRF who were dialyzed for the first time in the Center for Kidney Diseases of the University of Santo Tomas Hospital from January 1 to December 31, 2000. Included cases were classified as either early referral or late referral patients. Excluded in this study were patients with severe acute renal failure (ARF), those who had undergone acute peritoneal dialysis for whatever cause, those with malignancies, those who transferred to another dialysis unit and those who were lost to follow-up.

RESULTS: Among 104 patients, 45 (43.3 percent) were included in the study. Sixteen cases (35.6 percent) were timed as ER and 29 (64.4 percent) as LR. There was no difference in the age, sex, comorbid illness and type of renal diseases in both groups. The mean values of BUN, serum creatinine were higher in the LR group. Majority (50 percent) of the ER group had creation of AV fistula at the onset of the first dialysis. The initial morbity was longer in the LR group (mean, 20.48 +/- 11.55 days). The need for emergent dialysis was similar in both groups. There was no difference in the mortality rate in both groups (ER 75 percent, LR 62 percent). Likewise, survival analysis showed no difference in the two groups at twelve months.

CONCLUSION: To our knowledge, this is the first study in the Philippines that focused on CRF patients early or late referral status, and its effects on morbidity and mortality. Further studies are needed to determine whether these results are linked with dialysis modalities, psychosocial conditions and socioeconomic factors. Widespread dissemination of clear guidelines for general practitioners and non-nephrologists, interventions to promote early diagnosis and adequate pre-dialysis follow-up and development of educational programs for the patients need to be evaluated since they appear to be important in improving the survival of CRF patients.

Human ; Male ; Female ; Nephrology ; Renal Dialysis ; Creatinine ; Blood Urea Nitrogen ; Peritoneal Dialysis ; Morbidity ; Survival Analysis ; Acute Kidney Injury ; Socioeconomic Factors ; Neoplasms ; Fistula

OBJECTIVES: 1. To report cases of "normal", asymptomatic, young, pre-employment males without significant cardiovascular risk factors but with electrocar diographic (ECG) T-wave inversion in multiple leads; and 2. To emphasize the importance of overall clinical correlation in interpretation of the ECG and in overall diagnostic and management decisions.
SETTING: Outpatient urban pre-employment clinic
CASE SUMMARY: Seven young (44 years of age), pre-employment, asymptomatic, male cases with resting ECG findings of T-wave inversion in multiple leads but with normal physical, radiographic, and cardiosonographic cardiac anatomy are herein reported. All cases did not have significant cardiovascular risk factors and were able to uneventfully hurdle at least 9 METs of monitored treadmill exercise. All cases were eventually cleared for employment and presumably enjoying a productive life; nobody among them was repatriated.
CONCLUSION: Clinical presentation is the more important arbiter of cardiovascular/physical fitness than any isolated ECG finding.

Human ; Male ; Adult ; Cardiovascular Diseases ; Risk Factors ; Physical Fitness ; Exercise Test ; Exercise ; Heart ; Electrocardiography ; Employment

OBJECTIVE: The objective of this study was to determine the safety, tolerability, and efficacy of valsartan (Diovan?) 80 mg tablet in the treatment of mild to moderate, uncomplicated essential hypertension in Filipino patients.
METHODS: Patients who were 18-80 years of age, male or female diagnosed with essential hypertension with mean sitting diastolic blood pressure (SDBP)> 90mmHg to 115mmHg were given valsartan? 80mg tablet daily for a minimum of 2 weeks to a maximum of 8 weeks of treatment.
RESULTS: A total of 3224 evaluable patients were included in the study. Almost forty percent (39.6%) of patients are newly-diagnosed hypertensives, 25.8% have been hypertensives for 1 to 2 years,17% for 3-5 years, and 17.6% for more than 5 years. The mean systolic blood pressure (SBP) at baseline was 156.9 mmHg ± 15.4 mmHg while the mean diastolic blood pressure (DBP) at baseline was 98.7 mmHg ± 6.4 mmHg. The SBP decreased at visit 2 to a mean of 135.3 mmHg ± 12.6 mmHg which reduction was very highly significant (paired t-test= 9.13, p<0.0001). On the other hand, the mean DBP decreased to 85.3 mmHg ± 7.2 mmHg at visit 2 which reduction from baseline to visit 2 was also very highly significant (paired t-test= 94.2, p<0.0001). Adverse events in patients had been mild. Over-all the drug had demonstrated its relative safety in this population of subjects.



Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Adolescent ; Valsartan ; Blood Pressure ; Essential Hypertension ; Hypertension ; Systole ; Blood Pressure Determination ; Diastole ; Tablets

BACKGROUND:?There is a critical relationship of time to treatment and myocardial salvage in the patient with acute myocardial infarction (AMI). As the proven beneficial management options for AMI have been extensively studied, the challenge lies in developing a process that minimizes pre-hospital delays, delays in assessment and initiation of reperfusion therapy. A greater emphasis on pre-hospital care has more potential in reducing mortality from acute MI than further development of hospital based treatments.

OBJECTIVE:?This study identifies the socio-demographic risk factors in patients with acute coronary syndrome and correlate them with pre-hospital delay. This response time to treatment is then correlated with the clinical outcome.

STUDY DESIGN:?Clinical Descriptive Study

METHODS:?Adult patients with diagnosis of acute coronary syndrome at the ICU setting of the USTH were sampled. Charts were reviewed and socio-demographic profiles identified. Pre-hospital delay from the onset of chest pain were correlated with these socio-demographic factors using multiple regression logistic regression. Chi square test was used to determine association between pre-hospital delay and clinical outcome.

RESULTS:?The study sample consisted of 220 patients with acute coronary disease. The sample population included 63% Non ST Elevation Myocardial Infarction (NSTEMI), 4% ST Elevation Myocardial Infarction (STEMI) and 33 percent with unstable angina. Male population accounted for 54% of the population. Thirty eight?percent(38%) of the population belonged to the 61.70 age group with mean age of 65 years old. The prevalence of hypertension (70%) and DM (41%) was high and about 30% of the population had prior history of coronary artery disease (CAD). About 35% reported family history of CAD and 41% had family history of DM. More than half of the population are smokers (55%). Majority of the patient population live within 10 kilometers from USTH (70%) while 28 patients (13%) came from the province. Thirty-eight percent (38%) sought consultation after two pain events, while only 4% came after more than 4 chest pain events. A significant number of population in the present series presented to the hospital delayed by more than four hours. Majority of the patients (40%), came in more than 6 hours. Twenty one percent (21%) came 2-4 hours while 30 percent came 4-6 hours from the onset of chest pain. The most common reason for the delay in seeking medical attention is financial limitation (36%), 31% had relief of chest pain by nitrates. Of the 220 included in the group, 50% had morbidity (such as development of acute renal failure, congestive heart failure), 41% had unremarkable outcome while there was 10% mortality noted. However in this study, we were not able to associate any socio-demographlc factors and the delay in time to treatment with the clinical outcome using available data and statistical.

CONCLUSION:?The results of this study demonstrate that patients with acute coronary event continue to exhibit prolonged delay in seeking medical care. This paper, Likewise, demonstrated that certain demographic and socioeconomic characteristics are associated with pre-hospital delay such as age, sex, history of CAD, hypertension and DM, proximity to the hospital, pain events prior to consultation and educational attainment. However, no correlation can be made between delay in time to treatment and clinical outcome.

Human ; Male ; Female ; St Elevation Myocardial Infarction ; Acute Coronary Syndrome ; Coronary Artery Disease ; Myocardial Infarction ; Hypertension ; Heart Failure

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