INTRODUCTION

Hyperthyroidism was thought to lower thyroid cancer risk due to TSH suppression, potentially leading to overlooked diagnoses. This study examines clinical factors linked to thyroid cancer in hyperthyroid patients who have undergone thyroidectomy.

This study determined the clinical factors associated with malignancy among patients with hyperthyroidism who underwent thyroidectomy in a tertiary hospital.

This analytical cross-sectional study reviewed electronic biopsy results of adult patients who underwent thyroidectomy from January 2009 to December 2019 for hyperthyroidism secondary to Graves’ Disease, Solitary Toxic Adenoma or Multinodular Toxic Goiter. It considered factors linked to thyroid cancer, its prevalence, and clinical features associated with aggressive tumor behavior.

Sixty hyperthyroid patients who underwent thyroidectomy were included, 12 of whom have thyroid cancer. Each increase in the initial free thyroxine (FT4) leads to increased likelihood of thyroid cancer by 1.02 times (95% CI 1.001-1.03, p=0.044). The presence of thyroid nodule is associated with 24 times (95% CI 2.67-3275.62, p=0.002) higher risk of thyroid cancer, while every unit increase in mm for nodule diameter increases thyroid cancer odds by 1.04 times (95% CI 1.01-1.07, p=0.022). An FNAB pre-op diagnosis of malignancy is associated with having histopathologic diagnosis of thyroid cancer increased by 40 times (95% CI 2.42-6668.98, p=0.007). Although aggressive tumor behavior was noted among those with a younger age on average (36.35 vs 46.75 years), higher initial FT4 (95.97 vs 23.55 pmol/L), and those with sizeable diameter of multinodular goiter (95 mm vs 20 mm), only the high FT4 was statistically significant.

Initial FT4, thyroid nodules, nodule size, and pre-operative FNAB finding of a malignancy were the factors associated with thyroid cancer in hyperthyroid patients who underwent thyroidectomy. Furthermore, those with aggressive tumor behavior had higher initial FT4 levels.

Introduction: Obesity remains to be a public health concern across the globe. Studies have established that obesity plays an important role in the pathogenesis and progression of cardiovascular diseases such as hypertension and coronary artery disease. Evidence suggesting the link between obesity and decompensation of heart failure is only just emerging. General Objective: Determine the associations between body mass index (BMI) outcomes of severity and mortality among adult Filipino patients admitted with decompensated heart failure. Study Design: Retrospective Cohort study design. Study Setting: Chong Hua Hospital, a tertiary hospital in Cebu City, Philippines Study Population: All adult patients with a diagnosis of Decompensated heart failure who were admitted in the hospital from 2015 to 2019. Main Outcome Measure: Determine association of BMI using Asian cut-offs and Outcomes of patients admitted for decompensated heart failure. Results: A total of 356 patients were admitted for acute decompensated heart failure from year 2015-2019. Majority of the patients were in the obese category 1 (28.93%) and predominantly were classified as NYHA Class III heart failure. There was no significant association between BMI and outcomes among patients with decompensated heart failure. Furthermore, it was noted that the pro-BNP values were higher in patients with lower BMI categories than in the overweight and obese categories. Conclusion Obesity, while increasing the chance of developing heart failure (HF), appears to protect people who have already been diagnosed with HF (the "obesity paradox"). This study, although not reaching statistical significance, showed that patients with lower BMI admitted for heart failure decompensation had increased use of positive pressure ventilation and higher mortality rates compared to obese patients. A larger sample size may be needed to show such association. Furthermore, patients in lower BMI category had higher pro-BNP values than their counterparts consistent with previous literature.

Objectives: This study aims to determine the role of HbA1c level during first trimester in predicting gestational diabetes mellitus in Filipino non-diabetic women. Hence, to identify those will be at increased risk of its adverse maternal and perinatal outcomes, and who will benefit from early intervention. This will aid in preventing maternal and perinatal morbidity and mortality and reducing health care cost by avoiding strategies which can result in false positive cases. Methodology: A cross-sectional study conducted in a tertiary hospital in the Philippines. Seventy-one Filipino pregnant women were included in the final analysis. HbA1c levels were taken during the first trimester and routine screening of gestational diabetes mellitus (GDM) utilizing 75 grams OGTT during 24th-28th weeks age of gestation. Binary logistic regression modeling was performed to determine if HbA1c was a predictor of gestational diabetes mellitus. The calculated median for Hba1c was then utilized as a threshold value to predict GDM. Odds ratio, relative risk and corresponding 95% confidence intervals from binary logistic regression were computed to determine the association of variables. Results: In this study the prevalence rate of GDM is 38%. It showed that first-trimester HbA1c level is not a predictor of GDM and adverse maternal and perinatal outcomes. However, in utilizing an HbA1c threshold of ≥ 5.2%, there is a two-fold increase risk of developing hypertensive disorders, requiring insulin during pregnancy, and macrosomic newborns and a four-fold increase risk of having large for gestational age newborns. It has a positive predictive value (PPV) of only 16%. However, it has a high negative predictive value (NPV) of 88% therefore it can be used to rule out risk of GDM as early as in the first trimester. Conclusion The association of HbA1c level and the occurrence of GDM was not observed in this study. However, by using an HbA1c threshold of ≥ 5.2%, as opposed to the standard reference range for diagnosing type 2 diabetes mellitus and gestational diabetes mellitus in Caucasians, the relative risk of developing GDM in 24th-28th weeks AOG is 1.26 (0.6865, 2.3242).
Diabetes, Gestational ; Pregnancy ; Insulin

Introduction: Hormone-producing adrenal tumors, adrenal carcinomas and other adrenal diseases can be potentially cured with adrenalectomy. In the local setting, studies are often limited by a small sample size and inadequate patient data. This study aimed to determine the clinical and histopathologic characteristics and perioperative outcomes of patients who underwent adrenalectomy. Methods: This is a retrospective chart review study from January 2007 to June 2017 in a tertiary hospital in Cebu City, Philippines. Clinical profiles, type of surgery, and operative outcomes were determined. Comparative analysis of clinical profile, histopathologic features, and surgical outcome was done. Descriptive as well as appropriate inferential statistical methods were used to analyze the data. Results: A total of 31 patients who underwent adrenalectomy were included with the mean age of 45.7 [SD=17.1] years old and a 1:3 male to female distribution. The distribution of tumors was as follows: hormone-producing adrenal tumor (74.2%), malignant adrenal tumors (12.9%), and other benign lesions (12.9%). Among patients with hormoneproducing tumors, 39.1% had catecholamine excess, 34.8% had aldosterone excess, and 26.1% had cortisol excess. Hormone-producing adrenal tumors were common at age 20 to 40 years old while malignant tumors were more common among those above 40 years old (p-value=0.023). Stage 3 hypertension (p-value=0.010) and improvement of hypertension postoperatively (p-value=0.046) were more common among hormone-producing tumors. On the other hand, large tumor size (>4cm) (p-value=0.011), blood loss needing blood transfusion (p-value=0.001), prolonged operation (p-value=0.046), and longer hospital stay (p-value=0.002) were common among those with malignant tumors. Open adrenalectomy was associated with significant blood loss needing transfusion (p-value=0.001) and prolonged hospital stay (p-value=0.024). Conclusion Hormone-producing adrenal tumors with secondary hypertension are the most common pathology among patients who underwent adrenalectomy. They are usually seen among patients less than 40 years old, with smaller tumor size, and frequently present with higher blood pressures that improve following adrenalectomy. In contrast, adrenal carcinomas are more common among patients above 40 years old and have larger tumor size. More often they have prolonged operation time, greater blood loss, and longer hospital stay. Patients who underwent open adrenalectomy had more blood loss and had a longer hospital stay than those who underwent laparoscopic surgery.
Adrenalectomy

OBJECTIVES: To determine the predictive utility of admission random blood sugar (RBS) as a screening tool for undiagnosed diabetes and pre-diabetes among hospitalized patients, and to determine its optimal cutoff value that will best predict the presence of diabetes and pre-diabetes. Secondarily, we also determined the predictive utility as well as the optimal cut-off value for hemoglobin Ale (HBAlc) in screening for diabetes and pre-diabetes.

METHOD: This is a cross-sectional criterion-reference study, including all patients aged 20 to 75 years old, with no known history of diabetes, who were admitted to the general medical ward. Patients who were pregnant , on chronic corticosteroid therapy, or had renal insufficiency and hematological problems were excluded. Glycemic classification was based on the discharge diagnosis of diabetes, or results of FBS and 75 grams OGTT done 6 weeks after, among those not discharged with any anti-diabetic medications. Operating characteristics of each cutoff value were determined and the optimal cutoff value for admission RBS and HBAlc were derived through an ROC curve.

RESULTS: Based on the standard screening criteria, 84 (35 percent) out of the 240 subjects were diagnosed to have diabetes, while 29 subjects (12.1 percent) had pre-diabetes. The best cut-off value for admission RBS in the detection of unrecognized DM was derived at 150 mg/dl with a resultant sensitivity of 85% (as compared to 46% with the conventional cut-off value of 200mg%) and specificity of area under the curve shows excellent predictive ability (AUC=0.92). Glycosylated hemolobin at cut off value of 6.2 showed comparable predictive ability (AUC=0.94), with sensitivity of 90% and specificity of 86%. Both admissions RBS and HBA 1c however showed poor predictive ability for pre-diabetes. To our knowledge, this is the first study reporting on the role of admission RBS for diabetes and pre-diabetes case finding in a hospital setting.

CONCLUSIONS: Admission RBS was found to be an excellent screening tool for undiagnosed diabetes but not pre-diabetes among hospitalized patients. Lowering down the cuttoff value from the conventional 200mg% to 150mg%, greatly improves the sensitivity and still with adequate specificity for screening of diabetes. (Author)