BACKGROUND

Hand grip strength (HGS) is a tool to measure muscle strength, which is an important component in sarcopenia and frailty. Grip strength (GS) in midlife can predict physical disability in senior years and help evaluate a patient's overall health.

The general purpose of this study is to validate the HGS using an aneroid sphygmomanometer and Jamar dynamometer as a diagnostic tool for sarcpenia. The specific aims of this study are (a) to determine the concurrent criterion validity, (b) to determine the reliability, and (c) to measure the inter-rater agreement of the aneroid sphygmomanometer against the Jamar dynamometer in measuring HGS.

This prospective validation study measures HGS using an aneroid sphygmomanometer and Jamar dynamometer obtained from seventy participants 50 years old and above. Statistical methods used in data analysis include Spearman Rho, univariate linear regression analyses, intra-class correlation, inter-rater reliability, intra-rater reliability, Bland-Altman plots, and Lin’s concordance.

There was a significant correlation of HGS with the Jamar dynamometer and aneroid sphygmomanometer regardless of the rater [Spearman Rho (rs=0.762 to 0.778, p=0.001)]. Jamar GS is comparable to GS using a sphygmomanometer with the formula of [Jamar = 0.54 x sphygmomanometer (mmHg) - 45.12].

Aneroid sphygmomanometer can be used as an option to measure GS and has a valid value to predict the Jamar GS value. Hence, it can be an alternate tool for diagnosing sarcopenia.

Systemic lupus erythematosus (SLE) is the most common form of lupus and a chronic autoimmune disorder that can affect multiple organ systems including the joints, skin, the cardiovascular system and even the central and peripheral nervous system. Although rare, these patients may present with neuropsychiatric symptoms. This patient presented initially with an SLE flare associated with sudden focal to generalized tonic-clonic seizures. Further rheumatologic workup was done which revealed that the patient also has scleroderma, an autoimmune connective tissue that causes inflammation of the skin and other key internal organs. Due to the seizure occurrence, cranial magnetic resonance imaging (MRI) was done which showed incidental mesial temporal sclerosis, which is the scarring of the medial part of the said lobe of the brain. Her overlap syndrome was managed with Hydrocortisone and she was given Valproic acid as her anti-epileptic drug with no recurrence of seizure afterwards.

BACKGROUND

This first clinical practice guideline (CPG) on osteoporosis prevention and management in the Philippines is the output of a shared undertaking by a multidisciplinary CPG development team spearheaded by the Osteoporosis Society of the Philippines Foundation, Inc. and joined by the Philippine Academy of Family Physicians; the Philippine College of Endocrinology, Diabetes, and Metabolism; the Philippine Orthopedic Association; the Philippine Obstetrics and Gynecological Society and the Philippine Rheumatology Association. This guideline seeks to augment and update the "Consensus statements on osteoporosis diagnosis, prevention and management in the Philippines," initially published in 2011, incorporating evidence-based practices developed in the last decade.

The steering committee formulated and prioritized clinical questions based on meetings and stakeholder consultations. A PICO (population, intervention, comparator, outcome) format was used to develop clinical questions and guide the systematic search for evidence. The development of guidelines followed the ADAPTE process. Once completed, panel discussions were done using the Evidence to Decision Framework. After the panel discussions, the final recommendations were revised.

Thirty-four recommendations were formulated to address 27 clinical questions related to screening, prevention, diagnosis, pharmacologic and nonpharmacologic treatment, surgical management, follow-up, and continuity of care. With these recommendations, the developers aim to establish a standard of care in the prevention, diagnosis and management of osteoporosis and fragility fractures in both in-patient and out-patient cases that are appropriate to the Philippine context. Specifically, the CPG development group aims to use these recommendations to define the standard of care for osteoporosis as part of universal healthcare services once the program is implemented nationally. Relevant stakeholders may also use the recommendations to inform public and private payor policies for patients with fragility fractures, as well as by local government units or private companies looking to establish orthogeriatric centers with fracture liaison services.

This guideline is helpful for physicians and other allied health personnel in screening, diagnosis, management and prevention of primary osteoporosis and fragility fractures among postmenopausal women and older men.

Osteoporosis is a major public health concern leading to significant morbidity and mortality, especially in the elderly population. However, this disease is underdiagnosed and, as a result, undertreated. This cross-sectional study aims to determine the knowledge, attitudes and practices (KAP) of physicians in the diagnosis and management of osteoporosis, which would help identify key areas of improvement in the care of patients with this disease. One hundred and nine physicians answered an online questionnaire looking at their KAP on the diagnosis and management of osteoporosis, and their answers were analyzed using descriptive statistics, Pearson’s correlation and the Chi-square test. More than half of the participants obtained satisfactory scores on knowledge, and majority had neutral to positive attitude regarding osteoporosis. A statistically significant correlation was seen between having low knowledge and negative attitudes on osteoporosis screening and management.

Background: An accurate, quantifiable assessment of hand grip strength (HGS) can predict overall strength and health with a good predictor for identifying populations at higher risk for any medical conditions like rheumatoid arthritis, neuromuscular diseases and stroke that helps clinicians establish realistic treatment goals and provides treatment outcome data. The purpose of the study is to determine the percentile scores of HGS of healthy adult individuals of various age groups using Jamar dynamometer and modified sphygmomanometer. Methods: This descriptive study measures HGS using Jamar dynamometer and modified sphygmomanometer obtained from one hundred twenty healthy participants 20 years old and above. Comparative analyses of the 2 apparatuses were conducted using One-Way ANOVA. The reference intervals at different percentiles were calculated using the Clinical and Laboratory Standard Institute (CLSI) guidelines. Results: Grip strength (GS) using Jamar dynamometer (JD) and modified sphygmomanometer (MS) among younger (20- 29 years old) participants, the 50th percentile (Q2) JD score was 28.29 kg with an equivalent MS score of 161.38 mmHg, were significantly higher compared to those across older age groups especially among the ≥70 years old with a JD Q2 score of 16.74 kg and MS Q2 score of 101.33 mmHg. These findings suggest that HGS decreases with increasing age. Conclusion Scores obtained from this study can serve as preliminary baseline values or guide for interpreting GS measurements.
Hand Strength ; Sphygmomanometers

Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

Objective: Musculoskeletal ultrasound has gained recognition in early identification of crystal deposits in the joints and soft tissues. This study aims to validate the sonographic features of 1st metatarsophalangeal joints (MTPJs) in gout and asymptomatic hyperuricemia (AH). Methods Patients with gout (n=20) and AH (n=16) underwent a gray-scale ultrasound assessment of both 1st MTPJs on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 blinded trained sonologists for the presence of double contour sign (DCS), erosions, and tophi.
Gout ; Validation Study

Background: The COVID-19 pandemic has caused a global public health emergency. High levels of fear and limited access to cancer treatment may jeopardize the delivery of optimal oncologic care, potentially influencing treatment outcomes. This study aimed to identify patients’ and their caregivers’ perception of safety and accessibility of cancer care during the COVID-19 pandemic. Methods: A cross-sectional survey of patients and caregivers at the Benavides Cancer Institute, University of Santo Tomas Hospital was performed from August to October 2020 using a 20-item investigator-developed questionnaire. Results: A total of 207 participants answered the survey. Frequency of hospital visits varied from none to more than ten times in the previous month; but having multiple postponements were uncommon. Eighty-two percent, 77%, 62%, and 55% of participants reported being afraid of contracting COVID-19 from other patients, hospital surroundings, hospital staff, and doctors, respectively. Twenty-six percent and 12% had difficulty finding transportation and passing through checkpoints, respectively. Twenty-eight percent strongly expressed financial limitations in prioritizing cancer care. Participants were amenable to the use of telemedicine and stringent protocols to reduce in-hospital transmission risk, but had some reluctance to spend out of their pockets for screening tests. Conclusion The perceived safety of cancer care was influenced by fears of contracting COVID-19; and accessibility was influenced by limited transportation and financial constraints. Despite these, multiple postponements and cancelled hospital visits were uncommon. Institutional approaches targeting these concerns will be crucial to ensure safe and timely delivery of cancer care during the COVID-19 pandemic and further mitigate its impact on oncologic outcomes.
COVID-19 ; Pandemics ; Safety

Objectives: Despite the public-health significance of both malnutrition and crises, little has been done to explore the convergence of the two domains and develop ways to improve policies and practices, especially in rural communities. This article remedies that knowledge gap by focusing on nutrition-related changes, responses, and practices during crisis situations in Siargao Island, Philippines, using the COVID-19 pandemic as a backdrop. Methods: Forty-six (46) semi-structured interviews were conducted among parents, caregivers, local health workers, and local officials of Del Carmen, Siargao Island. Principles of thematic analysis were applied to data analysis using NVivo 12. Afterwards, the preliminary data were presented in a virtual validation session with the local community and stakeholders. Results: Despite the high prevalence of malnutrition amid a backdrop of economic and nutritional difficulties, the community members generally viewed their children as healthy. Rice remained (disproportionately) central to people’s diets; possible alternatives like root crops were considered emergency foods only and not culturally acceptable as staples, in spite of their cheap and ubiquitous nature. Lastly, the economic and financial repercussions of the COVID-19 pandemic have also negatively affected the community members’ overall nutrition and food sources. Conclusion More efforts should be directed toward encouraging the consumption of root vegetables and fruits as rice alternatives in everyday diet—a costeffective strategy that would also promote dietary diversification. More importantly, nutrition responses should consider local food systems in terms of specific local economies and geographies, while health promotion efforts should engage with local notions of ‘health’ and ‘nutrition’ and encourage community participation in (re)designing policy interventions.
Nutrition ; public health ; rice ; COVID-19

Objective: The project aims to develop a community kitchen manual for public health emergencies.

Participants: The officers and members of the Samahan ng Nagkakaisang Kababaihan ng BASECO served as community respondents for this project. These eight women were in charge of the community kitchen operations, particularly the feeding program during the COVID-19 pandemic.

Implementation: The whole project comes in three phases. The design stage was executed in phase one of this project. The phase one also focused on the development of manual content based on available literatures and considered the interviews conducted with respondents.

Discussion: The manual contains guidelines on food safety and meal preparations. Based on the interview, the proponents identified specific contents that must be included in the guidelines, as compared with the need to improve current operations of the group's community kitchen. Looking at the activities of the community, the proponents indicated the food flow guidelines to ensure a safe, nourishing and accessible community kitchen (S.N.A.C.K).

Conclusion: The designed community kitchen manual may be of use to lay groups putting up community kitchens, since there is no existing manual in the Philippines. However, phases two and three must be conducted to validate its usefulness and accuracy in the field.