OBJECTIVES

To compare the effectiveness of different exercise interventions on improving adiposity-related inflammatory markers of metabolically healthy obese (MHO) adults.

METHODS

This is a systematic review with meta-analysis of randomized controlled trials (RCTs) and quasi-experimental studies on the effects of exercise interventions in the inflammatory markers of sedentary adults with MHO phenotype. Systematic searches were performed in PubMed, Cochrane, CINAHL, and OVID from January 2021 to January 2022. The included studies were from 2000 to 2021. The inclusion criteria included: a) adults with obese phenotype, b) has physical activity or exercise as intervention, and c) inflammatory markers as outcome measure. Exclusion criteria included: a) pregnant women, b) adults with cardiovascular conditions or taking medications, c) participants having central obesity. The review was registered on PROSPERO (CRD42021249661). Risk of bias (RoB) assessment was performed using Revised Cochrane RoB tool for RCTs, and ROBINS-I tool for quasi-experimental studies. A metaanalysis was performed for inflammatory markers and body composition measurements using random effects model with forest plots presenting mean differences (MD) of outcome measures with 95% CI.

RESULTS

Twenty-one RCTs and seven quasi-experimental studies with 1,117 participants were included in the review. For short-term intervention, aerobic exercises showed an increased trend in IL-6 levels, and both resistance and aerobic exercises reduced TNF-alpha and CRP levels, respectively. For long-term exercises, aerobic exercises showed a significant reduction in CRP (MD= -0.33, 95%CI, -0.57 to -0.09, p=0.006). Long-term concurrent training also showed a significant reduction in TNF-alpha (MD= -2.65, 95%CI, -4.13 to -1.18; p=0.0004). Meta-regression also found no direct association between body weight and fat mass, and changes in inflammatory markers.

CONCLUSION

Concurrent and aerobic exercises were both effective in reducing pro-inflammatory markers. Concurrent training was more effective in reducing BMI, body fat composition, and CRP compared to aerobic and resistance exercises. Furthermore, middle-aged women benefited from aerobic exercises to reduce IL-6 levels. These results indicate the need for both resistance and aerobic exercise in improving inflammatory levels of the body. This review has limitations in terms of degree of heterogeneity brought by different exercise protocol and assessment of inflammatory markers. More research is needed to identify possible outcome measures that can predict chronic inflammation in MHO people.

Aerobic Exercise ; Exercise

Objective: This study seeks to determine the association between vitamin D and testosterone in healthy, adult Filipino males. Methodology: This cross-sectional study included 110 healthy, non-obese, male volunteers aged 21–40. History and physical exam were taken, and blood was drawn for vitamin D, total testosterone (TT), sex hormone binding globulin (SHBG), albumin, insulin, fasting plasma glucose, and total cholesterol. Free testosterone (FT) was calculated. Vitamin D data were classified by status and TT, FT, and SHBG levels were compared using the Kruskal–Wallis’s test. The associations of vitamin D levels with TT, FT, and SHBG were explored using multiple regression analysis. Results: Vitamin D levels were sufficient in 3 (2.7%), insufficient in 17 (15.45%), and deficient in 90 (81.8%) of the sample. There were no significant differences in the mean TT (p=0.7981), FT (p=0.8768), nor SHBG (p=0.1838) across vitamin D status. Vitamin D was not associated with TT nor FT before or after adjustment for age and age plus body mass index (BMI). Vitamin D was associated with SHBG before and after the aforementioned adjustments, but this became insignificant on sensitivity analysis. Conclusion There is no association between vitamin D and TT, FT nor SHBG in our cohort with deficient Vit D levels.
Vitamin D ; Sex Hormone-Binding Globulin

OBJECTIVE: To determine the factors associated with in-hospital mortality among diabetic patients admitted for lower extremity infection.

METHODOLOGY: This is a retrospective analysis of diabetic patients with lower extremity infection admitted at the UP-Philippine General Hospital. Data was analyzed through multiple logistic regression after multiple imputation was performed for missing data.

RESULTS: 441 patients with diabetes were included in the analysis, of which 98.1% have Type 2 diabetes mellitus; 58.1% were males and the mean age of the cohort was 56.7 ±11.1 years. The mortality rate was 11.1% over the 3-year period from 2015 to 2017, of which 46% died from myocardial infarction (MI). Multivariate logistic regression showed the following were associated with increased likelihood of in-hospital mortality: non-performance of surgery (OR=4.22, 95%CI 1.10-16.27, p=0.036), elevated BUN (OR=1.06, 95%CI 1.01-1.11, p=0.016), MI (OR=27.19, 95%CI 6.38-115.94, p=0.000), respiratory failure requiring mechanical ventilation (OR=26.14, 95%CI 6.28-108.80, p=0.000), gastrointestinal bleeding (OR=10.08, 95%CI 1.87-54.38, p=0.007), hospital-acquired pneumonia (OR=9.46, 95%CI 2.52-35.51, p=0.001) and shock (OR=7.09, 95%CI 2.17-23.22, p=0.001).

CONCLUSION: In the in-patient setting, morbidity and mortality is high among diabetic patients with lower extremity infection. Non-performance of surgery, elevated BUN, MI, respiratory failure requiring mechanical ventilation, gastrointestinal bleeding, hospital acquired pneumonia and shock are associated with in-hospital death.

Human ; Male ; Female ; Mortality ; Hospitalization

BACKGROUND: The management of papillary thyroid carcinoma (PTC) in high-risk patients is well-standardized. However, this is not the case for low-risk patients. Filipinos show a high incidence of recurrence of thyroid cancer. Thus, the identification of risk factors for recurrence in this population could potentially identify individuals for whom radioactive iodine (RAI) therapy might be beneficial. METHODS: We reviewed the medical records of adult Filipinos with low-risk PTC who underwent near-total or total thyroidectomy at the University of the Philippines-Philippine General Hospital. Multivariate logistic regression analysis was used to determine risk factors for recurrence. RESULTS: Recurrence was documented in 51/145 of patients (35.17%) included in this study. Possible risk factors such as age, sex, family history, smoking history, tumor size, multifocality, prophylactic lymph node dissection, initial thyroglobulin (Tg) level, initial anti-thyroglobulin (anti-Tg) antibody concentration, suppression of thyroid stimulating hormone production, and RAI therapy were analyzed. Multivariate analysis revealed that a tumor diameter 2 to 4 cm (odds ratio [OR], 9.17; 95% confidence interval [CI], 1.62 to 51.88; P=0.012), a tumor diameter >4 cm (OR, 16.46; 95% CI, 1.14 to 237.31; P=0.04), and a family history of PTC (OR, 67.27; 95% CI, 2.03 to 2228.96; P=0.018) were significant predictors of recurrence. In addition, RAI therapy (OR, 0.026; 95% CI, 0.01 to 0.023; P≤0.005), an initial Tg level ≤2 ng/mL (OR, 0.049; 95% CI, 0.01 to 0.23; P≤0.005), and an anti-Tg antibody level ≤50 U/mL (OR, 0.087; 95% CI, 0.011 to 0.67; P=0.019) were significant protective factors. CONCLUSION: A tumor diameter ≥2 cm and a family history of PTC are significant predictors of recurrence. RAI therapy and low initial titers of Tg and anti-Tg antibody are significant protective factors against disease recurrence among low-risk PTC patients.
Adult ; Hospitals, General* ; Humans ; Incidence ; Iodine ; Logistic Models ; Lymph Node Excision ; Medical Records ; Multivariate Analysis ; Recurrence* ; Risk Factors* ; Smoke ; Smoking ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin

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

OBJECTIVE: To determine an association between iodine deficiency and the incidence of thyroid carcinoma among adult Filipino patients consulting at the Philippine General Hospital.

METHODS: This is a comparative cross-sectional study of all patients referred to the Section of Endocrinology with nodular goiter who underwent thyroidectomy from May 2006 to Jan 2007 at the PGH. One hundred sixty four patients were included. After giving their informed consent, each patient was interviewed and examined. Urine was collected and urine iodine measured using the rapid urinary iodine colometeric test kit by Merck Laboratory.

RESULTS: The overall prevalence of iodine deficiency among patients with thyroid nodules is high at 63.4%. The prevalence of malignant thyroid nodules among patients with iodine deficiency is not significantly different compared to patients who are iodine sufficient (55.8% vs 40%, p=0.052). Among patients with malignant nodules, 39.7% had follicular or follicular variant papillary Ca in the iodine deficient group compared to 29.2% in the iodine sufficient group. These proportions were not statistically significant (p=0.37). Lastly, in terms of extent of malignant lesion, among patients with iodine deficiency, 46.6% of patients had extensive lesions versus 25% in the iodine sufficient group. Again, the difference between the two groups was not statistically significant (p=0.07).

CONCLUSION: Despite the government efforts to eliminate iodine deficiency in our country, this remains as a significant health problem among adult Filipinos with thyroid nodules. It may be a risk factor for nodular thyroid disease and these results show that it may also play a crucial role in promoting the development of thyroid carcinoma, although more patients are needed to accurately evaluate the association between iodine exposure and risk of thyroid carcinoma.

Human ; Iodine Deficiency Disorder ; Thyroid Carcinoma ; Thyroidectomy

SYNOPSIS: In a rare case of thyrotoxicosis, transitioning in less than a month post-thyroidectomy from subclinical hyperthyroidism into frank hyperthyroidism, active thyroid hormone production was documented as coming from a metastatic focus in the occiput of the patient.CLINICAL PRESENTATION: A 63-year-old Filipino woman came in for a 4-year-duration left occipital mass measuring 9 cm x 8 cm, along with thyroid nodules which were 3-cm in the right lobe and 2-cm in the left lobe. Suspected to have metastatic thyroid carcinoma, she underwent total thyroidectomy. From a pre-operative subclinical hyperthyroid state, she developed overt symptoms and signs of thyrotoxicosis within one month post-operatively.PHYSICAL FINDINGS: One month post-thyroidectomy, the patient lost 5 percent of immediate post-op weight, was ambulatory, with a heart rate of 118 beats/min. Skin was warm and moist. On her left occiput was a 9 cm x 8 cm superficial mass. A 10-cm horizontal scar was seen on the anterior base of the neck, with no masses. There were fine finger tremors and + + + deep tendon reflexes.LABORATORY WORK-UP: Thyroid FNAB was suspicious for follicular tumor. Total thyroidectomy specimen showed follicular carcinoma, widely invasive, right and left lobes. Whole body 1-131 scintigraphy revealed functioning metastatic thyroid tissue in the head, corresponding to the palpated mass. Head CT scan revealed occipital calvarial metastasis with intracranial/ extradural extensions. From a pre-operative subclinical hyperthyroid state (FT4=22.2 pmol/L [NV 12-24 pmol/L], TSH=0.07 mm/L [NV 0.4-4 mIU/L]), patient became frankly hyperthyroid 1 month post-op (FT4=49.4 pmol/L, FT3= 30.4 pmol/L, TSH=0.06 mlU/L).Diagnosis: Follicular Thyroid Carcinoma Stage IVC S/P Total Thyroidectomy; Thyrotoxicosis (T4 type) secondary to Hyperfunctioning Occipital Bone Metastasis.TREATMENT/OUTCOME: The patient was given carbimazole and propranolol with resolution of thyrotoxic signs and symptoms. Still of good functional capacity, she now awaits palliative external beam radiotherapy and subsequent radioiodine therapy.SIGNIFICANCE: This is one of the less than 100 reported cases around the world, of thyrotoxicosis caused by hyperfunctioning thyroid carcinoma, since the first reported case in 1948.
Thyroid Cancer ; Thyrotoxicosis ; Metastatic Follicular Thyroid Carcinoma