INTRODUCTION

Papillary thyroid cancer (PTC) is generally considered to be an indolent disease with relatively good prognosis. However, some studies have shown that the Filipino population has a higher risk for disease recurrence compared to non-Filipino patients and hence early identification and management during the follow-up period would be beneficial, especially those in whom risk factors for recurrence were identified.

OBJECTIVE

This study aims to identify determinants for disease recurrence of patients with papillary thyroid carcinoma (as defined by the American Thyroid Association (ATA) guidelines 2015) diagnosed from January 1, 2013-December 31, 2017, seen at the University of Santo Tomas Hospital (USTH) outpatient endocrine clinic and underwent total thyroidectomy with or without radioactive iodine ablation therapy.

METHODOLOGY

Retrospective review of outpatient medical records of 82 patients with PTC who underwent total thyroidectomy with or without radioactive iodine (RAI) therapy and achieved excellent response (ER) to therapy was performed. Baseline clinical profile such as age at diagnosis, sex, family history of thyroid cancer, family history of goiter, histopathology result, serial thyroglobulin (Tg), anti-thyroglobulin (anti-Tg) levels, whole body scan reports, neck ultrasound reports and RAI doses were collected. Logistic regression analysis was used to identify determinants to the development of worsening response.

RESULTS

Of the 82 patients, 18 (21.9%) developed worsening response to therapy. Predictors of poor outcomes identified from previous studies such as age, sex, extent of disease, size and multifocality of tumors, ATA risk classification and initial dynamic risk assessment, RAI therapy, level of thyroid-stimulating hormone (TSH) suppression were analyzed. After logistic regression analysis, there was no significant association between variables and progression to worsening response that were previously identified in other studies.

CONCLUSION

Even though no significant association between investigated variables and worsening response were identified in this study, previous studies with larger populations that had exhibited positive association should be considered and hence current Philippine guidelines for the management of PTC must still be applied.

Human ; Thyroid Cancer ; Thyroid Neoplasms ; Thyroid Cancer, Papillary

Objectives: Knowing the limited epidemiological studies on painful diabetic peripheral neuropathy (pDPN) in the Philippines, the present review aimed to map the prevalence of pDPN and identify the associated healthcare gaps. Materials and Methods: A systematic search of MEDLINE, Embase and BIOSIS was conducted using predefine inclusion criteria, and relevant studies published in English between 2004 and 2021 were identified. An unstructured literature search was also conducted on public and government websites with no date restriction. Data combined from all sources were synthesized and presented as a simple mean. Results: Three studies were considered for final analyses of the 26 articles retrieved from structured and unstructured searches. The sample sizes for the three studies were 103, 172, and 100, respectively. The simple mean prevalence of pDPN was estimated at 26.5%. Awareness of pDPN based on a published study was 89%. According to published studies, screening and diagnosis of pDPN were 65% and 76.7%, respectively. One-third of the patients with pDPN (75%) were treated. No literature is available for adherence and control. Conclusion Limited data exist on the different management stages of patients with pDPN in the Philippines. The study analysis will help address the knowledge gaps, improve patient care and pain management, and aid decisionmaking.
diabetes mellitus ; Philippines

Background: Unilateral adrenalectomy is indicated for patients with unilateral primary aldosteronism resulting in normalization of hypokalemia and resolution of hypertension. This study aims to determine the proportion of patients with cure of hypertension and improvement of hypokalemia after unilateral adrenalectomy among patients with aldosterone-producing adenoma and assess the association of preoperative factors with these outcomes. Methods: This is a retrospective cohort study among patients with aldosterone-producing adenoma who underwent unilateral adrenalectomy with at least one month follow-up after the operation. Patients were selected from admissions to the University of Santo Tomas Hospital from January 2008 to November 2018. The proportion of patients with cure of hypertension and resolution of hypokalemia were determined. Binary logistic regression was used to determine preoperative factors associated with these outcomes. Results: Twenty-one patients were included in this study. Cure of hypertension was noted in 47.62% and 42.86% of patients within 24 hours of adrenalectomy and on follow-up, respectively. Improvement of hypokalemia was noted in 61.90% of patients within 24 hours of operation while all patients had improvement of hypokalemia on follow-up. Patients without preoperative hypokalemia were more likely to have cure of hypertension within 24 hours of adrenalectomy (OR=0.0250, p=0.005) and on follow-up (OR=0.0571, p=0.010). Conclusion Unilateral adrenalectomy results in improvement of hypertension and hypokalemia in the majority of patients with aldosterone-producing adenoma. Shorter duration of hypertension and absence of preoperative hypokalemia were significantly associated with cure of hypertension after unilateral adrenalectomy.
Hyperaldosteronism ; Adrenalectomy

Diabetes remains as the 6th leading cause of death in the Philippines, with more than 33,000 deaths in 2016. Given this alarming prevalence, it is imperative that this public health concern be prioritized in the country and to answer such concern, a group of cardiologists and endocrinologists who are in active clinical practice and research, formed a technical working group composed of five members. Their primary objective was to develop an evidence-based consensus document for Filipino healthcare practitioners and people in the academe that would serve as a guideline on the approach to lower the CV risk of individuals with T2DM. The TWG agreed on focusing with the pharmacological approach to treatment of lowering CV risk for T2DM patients using the ADAPTE model which is a more systematic approach to guideline adaptation. The recommendations were developed using the ADAPTE framework appraising all international practice guidelines and recommendations through to 2013. The technical working group’s overall objective of guideline adaptation is to take advantage of the existing guidelines to enhance the efficient production and use of high-quality adapted guidelines specially in the local Philippine setting. Each of these articles was then assessed using the AGREE instrument. Based on the key questions that the technical working group had identified regarding the approach to lower the risk of individuals with type 2 diabetes, 9 recommendations concerning the antidiabetic drug of choice for persons with type 2 diabetes with or without established ASCVD and management of type 2 diabetes mellitus patients with hypertension and dyslipidemia were drafted and are presented in this report.
Diabetes Mellitus, Type 2 ; Heart Disease Risk Factors

The prevalence of obesity in Asia is of epidemic proportions, with an estimated 1 billion overweight/obese individuals in the region. The majority of patients with type 2 diabetes mellitus (T2DM) are overweight/obese, which increases the risk of cardiorenal outcomes in these patients; hence, sustained reductions in body weight and visceral adiposity are important management goals. However, most of the glucose-lowering therapies such as insulin, sulfonylureas, glinides, and thiazolidinediones induce weight gain, which makes the management of overweight/obese T2DM patients challenging. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are the only oral glucose-lowering agents that have been shown to reduce body weight and visceral adiposity. In addition, SGLT-2 inhibitors therapy reduces ectopic fat deposition and improves adipose tissue function and weight-related quality of life. In this article, we aim to consolidate the existing literature on the effects of SGLT-2 inhibitors in Asian patients with T2DM and to produce clinical recommendations on their use in overweight or obese patients with T2DM. Recommendations from international and regional guidelines, as well as published data from clinical trials in Asian populations and cardiovascular outcomes trials are reviewed. Based on the available data, SGLT-2 inhibitors represent an evidence-based therapeutic option for the management of overweight/obese patients with T2DM.

Introduction: 131Iodine therapy is effective in nodular nontoxic goiter with enhanced effects using recombinant thyroid stimulating hormone (rTSH). The eventual fibrosis of the thyroid tissue and blood vessels ligates the vascular supply of the nodule. The study aims to show the successful reduction of thyroid and nodule volumes in large solitary and multinodular goiters using serial low dose 131iodine therapy (10mCi) at three to six months interval. Methods: A retrospective analytical study was done from January 2010 to December 2012 and included twenty three patients with enlarged solitary and multinodular (nodule/s ≥2cm) non-toxic goiter (females: age range 35-65yrs) given serial 131iodine therapy (eight to10mCi) at three to six-month interval. Before each course, serum thyroid stimulating hormone (TSH) was done to document hypothyroidism while thyroid gland and nodule sizes were monitored by ultrasonographic measurements serially with each 131iodine therapy. Relief of compressive symptoms was monitored on follow-up at clinic. Results: Thyroid size reduced by 38-40% from baseline after first radioactive iodine (RAI) and by 33-39% after the second RAI. Thyroid nodules reduced by 63-69% and 11-25% serially. Significant reduction was noted after the first RAI. One subject underwent third RAI with 80-85% overall reduction in nodule size. All patients developed post-RAI hypothyroidism and overall had greater than 50% increase in levothyroxine replacement dose after the last RAI. Significant relief of compressive symptoms was noted by 91% post-therapy. Four thyroid nodules disappeared which resulted in reduced total number of thyroid nodules from 29 to 25 nodules post serial RAI. Conclusion Serial 131iodine therapy proved to have thyroid and nodule size reduction by more than 70% in this study. Among patients who do not consent or have contraindications to surgery, serial 131iodine therapy may be considered a safe and effective non-surgical alternative.
Goiter

INTRODUCTION: Diabetes mellitus is rapidly increasing worldwide but the greatest increase is expected in developing countries including the Philippines. It is of public health concern to monitor countrywide prevalence of diabetes as it leads to significant cardiovascular-related mortality as well as significant complications such end stage renal disease, blindness, lower leg amputations and blindness.
METHODOLOGY: This is a national survey to estimate the prevalence of diabetes and pre-diabetes using the criteria of the World Health Organization through a stratified multi-stage sampling design representing each of the 17 regions in the country.
RESULTS AND DISCUSSION: The national prevalence of diabetes in the year 2008 was 7.2% (6.5-7.9); impaired glucose tolerance 7.0% (6.1-7.8) and impaired fasting glucose was 2.2% (2.2-3.1). There was a greater prevalence of individuals with diabetes in the urban areas at 8.5% (7.5-9.5) compared to the rural areas at 5.7% (4.6-6.8). Diabetes is slightly more preponderant among females at 7.4% (6.4-8.3) compared to males at 7.0% (6.1-8.0).
CONCLUSION: The prevalence of diabetes mellitus in the Philippines is rising with the prevalence in 2008 at 7.2%. The prevalence of pre-diabetes exceeds that of diabetes mellitus at approximately 10.2%.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Glucose Intolerance ; Fasting ; Prediabetic State ; Diabetes Mellitus ; Amputation ; Kidney Failure, Chronic ; Blindness ; Glucose

Objective: To determine the accuracy of the chloride-phosphate ratio in the screening for primary hyperparathyroidism in calcium stone formers.Methods: Forty six subjects with nephrolithiasis were included in the study. Clinical and biochemical profiles of each patient were reviewed. Non-fasting blood was extracted for serum chloride and phosphate and compared with ionized calcium and intact parathyroid hormone (PTH) as the reference standard. The sensitivity, specificity, and likelihood ratios of the test against reference standard for the diagnosis of primary hyperparathyroidism (PHPT) were computed, as well as the receivers' operator curves.Results: Among the 46 subjects, 17 were recognized as positive biochemically for PHPT. Among calcium stone formers, the ratio of chloride and phosphate of greater than or equal to 33 has a sensitivity of 70.6% and specificity of 62.1% when compared with ionized calcium and PTH in the screening of PHPT in calcium stone formers. Using the ROC analysis, the best cut-off is at 32.4 while a cut-off of 27.98 has the best sensitivity of 94.12% (95% CI, 71.3-99.9).Conclusion: Among calcium stone formers, the chloride-phosphate ratio greater than or equal to 28 may be used for screening for PHPT with a sensitivity of 94%. It may be considered in the selection of patients for PTH assay or situations where PTH assay is not available.
Hyperparathyroidism, Primary ; Nephrolithiasis

OBJECTIVES: To describe the outcome of treatment of pituitary tumors at the University of Santo Tomas Hospital (USTH) in 2004-2008 in terms of achieving clinical improvement, hormonal control, and radiological cure and to determine the mortality and morbidity of patients during the immediate postoperative period.

METHODOLOGY: This is a retrospective cohort study. Clinical, ophthalmological, hormonal and neuroradiological findings were evaluated at baseline and after treatment. Hormonal control was defined as normalization of excess hormone production while radiological cure was defined as complete eradication of the tumor.

RESULTS: Data of forty one patients (23 males, 18 females; mean age: 42 years, range: 19-68) were reviewed. Majority have clinically non functioning tumors (n=17), followed by prolactinoma (n=12) and acromegaly (n=7). Eighty six percent were macroadenomas. Transphenoidal surgery (TSS) was the main treatment in 70% of patients (n=28) while dopamine agonist was used in another 28% (n=11). Diabetes insipidus occurred in 24% of cases. One patient died of hospital acquired pneumonia. Thirty one patients were evaluated after a mean of 1.4 years (range: 0.25 ???? 3.9 years). There was a decrease in visual disturbances (73 to 23%), headache (63 to 6%),signs and symptoms of hypogonadism (38 to 19%) and hypopituitarism (60 to 52%) before and after treatment, respectively. Hormonal control was achieved in 71% while radiological cure was achieved in 35%.

CONCLUSION: Improvement in clinical parameters and hypopituitarism were achieved after treatment. Hormonal control was achieved in majority of cases despite residual tumors. Surgery was carried out safely in most cases.

Pituitary Tumors

CASE SUMMARY: A 41-year-old female, presented with a four-week history of blurring of vision with progressive bilateral visual failure accompanied by headache.Cranial MRI showed a sellar/suprasellar tumoral mass lesion measuring 6.2 x 5.3 x 6.8 cm extending to the basal frontal lobes, sphenoid sinus, planum sphenoidale, midbrain, pons, left cerebellar hemisphere, left side of vermis with extrinsic compression on the optic chiasm and 3rd ventricle producing obstructive hydrocephalus. Her serum prolactin was markedly elevated at 46,520 mg/mL. Treatment was started withbromocriptine 2.5 mg/tab at bedtime, increasing to 2.5 mg/tab every 8 hours.One week after discharge, patient was admitted because of cerebrospinal fluid (CSF) rhinorrhea and bacterial meningitis. She was treated with antibiotics and underwent packing of the sphenoid sinus. There was a recurrence of the CSF leak one week after packing, which then resolved spontaneously. The MRI scan performed after four months of bromocriptine therapy revealed a decrease in size of the sellar/suprasellar mass now measuring 4.3 x 3.7 x 5.2 cm and a significant drop in the prolactin level at 6.55 ng/mL.
None