Background: Airway inflammation is considered to be important in asthma but is relatively inaccessible to study. Less invasive methods of obtaining sputum from patients unable to produce it spontaneously should provide a useful investigational tool in asthma.Objective: To evaluate the value of eosinophil count in induced sputum and blood count of asthmatic patients and normal subjects.Specific Objectives: (I) to determine the influence of asthma exacerbation with sputum and peripheral eosinophilia, and (2) to determine differences in peripheral and sputum eosinophil count between normal and asthmatic subjects.Study Design : Prospective-Cohort StudySetting: The study was conducted at the Iloilo Mission Hospital, a tertiary private hospital in Iloilo City, Philippines.Methodology: Twenty eight subjects were included in the study. Fifteen asthmatic patients underwent pulmonary function test, sputum induction and blood sampling. Thirteen normal subjects were evaluated using sputum induction and blood sampling.Results: Sputum and peripheral eosinophilia between asthmatic patients with and without chest findings of rales and wheeze do not significantly differ. The significant and positive correlation between forced vital capacity and peripheral eosinophilia may suggest other inflammation or conditions related to asthma such as allergy. Post bronchodilator FEV, significantly and negatively correlated with sputum eosinophilia. Comparison between eosinophilia markers in induced sputum and blood in asthmatic patients and normal subjects revealed that asthmatic tend to have relatively higher and significant sputum eosinophilia than normal subjects.Conclusions: FEVj and forced vital capacity were found to correlate with bronchial inflammation. Sputum eosinophilia were relatively higher among asthmatic patients than normal subjects. Hence, induced sputum could be used as a marker for airway inflammation.
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OBJECTIVE: To evaluate the usefulness and sensitivity of bronchoalveolar lavage (BAL) as compared to sputum culture for the isolation of specific microorganism among adult patients seen at Iloilo Mission Hospital, tertiary hospital in Iloilo City, Philippines.METHODS: This is a retrospective comparative evaluation of culture isolates obtained from sputum and BAL taken from 34 adult patients who underwent bronchoscopy at the Iloilo Mission Hospital from January 2006- September 2007.RESULTS: Pseudomonas Aeruginosa are the most frequent isolated organism in bronchoalveolar lavage. Majority of the sputum culture reVealed no growth of microorganism on final report. Sputum specimens are frequently contaminated by upper respiratory tract bacteria such as Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, enteric gram negative bacteria, and Candida organisms, which are potential lower respiratory tract pathogens. This study shows that there is a significant increase in the number of patients who were found positive with microbial growth culture isolate using BAL. It was noted that 32 out of 34 patients had positive growth culture on BAL as compared with only 23 out of 34 patients had growth of isolate on sputum culture.CONCLUSION: BAL collection provides more definite culture isolate information for characterizing Pseudomonas Aeruginosa infection and growth isolates in which the sputum culture failed to report. This suggests that bronchoscopy specimens are preferable over sputum for the accurate diagnosis of pulmonary infections.
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BACKGROUND: Over the past century, the physicians' view on pneumonia that is inflammatory disease of the lungs with alveolar involvement has undergone several major changes. Emphasis was placed on anatomic location, histopathology and pathogenesis. Recent evidence suggests that cytokine response may be a useful adjunct in diagnosing pneumonia. Acute tissue injury from virtually any cause including infectious diseases will result in rapid increase in the concentrations of several proteins in the serum including C-Reactive Protein (CRP). Several studies have corroborated the role of CRP in the diagnosis of bacterial versus viral meningitis in children and suspected septicemia in neonates. However, its role in the etiological diagnosis of respiratory infections is not well established.

OBJECTIVES: This study sought to (1) determine CRP as a diagnosis marker among patients with community acquired pneumonia (CAP), (2) evaluate the CRP levels among patients with CAP, (3) determine the correlation between CRP, WBC count and segmenters, and (4) determine if bacterial isolate significantly influence the level of CRP.

RESEARCH DESIGN: Prospective Cohort Study

SETTING: Iloilo Mission Hospital, a private tertiary hospital in Iloilo City, Philippines

SUBJECTS: A total of forty one patients 18 years old and above admitted with the diagnosis of CAP from May 1 to November 15, 2004 were included in the study. Expectorated sputum samples were examined and determined suitable for culture if the squamous cells < 5-10/hpf and polymorphonuclear cells > 20-25/hpf. Serum samples for CRP, WBC and segmenters were obtained within the first 24 hours of admission. Descriptive statistics were utilized. The statistical tools employed were means, frequency counts, standard deviation; Pearson's r and serum analysis all set at .05 alpha level of significance.

RESULTS: Fifty eight percent (58 percent) of these patients were classified as CAP moderate risk. Most were males (68 percent) and in their middle adult (56 percent) with mean age of 61. Patients classified as high-risk pneumonia had the highest elevated mean CRP level of 18.87 as compared to patients who were classified as low and moderate risk. Pearson's r was utilized to determine the relationship between CRP, WBC and segmenters. The p-value of 0.05 showed a positive correlation between CRP and segmenters.

CONCLUSIONS: Analysis of the means revealed that Klebsiella pneumonia had the highest CRP mean (89.67). Comparisons of mean CRP by .type of bacteria were found not to be significantly different from each other. Hence bacterial isolate do not influence variability of CRP levels.

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.
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Objective: Metabloc Syndrome has been implicated in several diseases including heart attack and stroke. At the 29th International Stroke Conference, it was emphasized that metabolic syndrome may almost double the risk of stroke and steps should be done towards its prevention. We, therefore, investigated the prevalence of metabolic syndrome among Filipino stroke patients and compared two definitions of metabolic syndrome: the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation consensus (IDF).Methodology: This is a prevalence study involving stroke patients admitted at our institution from November 2005 to November 2006 using condition-specific cut points for metabolic syndrome as defined by NCEP-ATP III and IDF consensus. Counts, frequencies and means were used. Differences inicharacteristics were tested for statistical significance using chi square test and Mann-Whitney (I test.Results: Metabolic syndrome using the IDF consensus was fulfilled by 72 (40.7 percent) patients, all of which are included in the 108 patients (61 percent) that fulfilled the NCEP-ATP III criteria. Of the 177 patients, 40.7 percent fulfilled both criteria. There was concordance between the two definitions (Cohen kappa coefficient - 0.6092; p < 0.0001)Conclusion: There is higher prevalence estimate of metabolic syndrome in Filipino stroke patients when using the NCEP-ATP III criteria compared to the IDF criteria. There is, however, good concordance between the two definitions.
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Objectives: Primary objective: 1) To compare the outcome one year after between subtotal thyroidectomy and radioactive therapy based on the 1-year failure rate.Secondary objectives: 1) To determine the thyroid function status of patients a year after each treatment modality; 2) To know the risk factors associated with treatment failure; 3) To determine the rate of complications for each treatment modality.Methods: Retrospective Cohort StudyInclusion Criteria: 1) Adults (> 18 years old) patients seen at the PGH-OPD thyroid Clinic from 1990 to 2004 diagnosed to have Graves' disease who underwent either thyroidectomy or radioiodine therapy.Exclusion Criteria: 1) patients with concomitant thyroid CA; 2) Patients who underwent both treatment modalities. Statistical analysis used were means, standard deviation, Pearson chi2 and logistic regression analysis.Results: Of the 182 patients, 60 belonged to the thyroidectomy group and 122 in the radioiodine group. There were more females than male with the ratio of M:F in both groups 1:6. There is a higher 1-year failure rate seen in patients who underwent radioiodine (20 percent) compared to those who underwent thyroidectomy (3 percent). There were more patients who became hypothyroid in the thyroidectomy group (73 percent) compared to the radioiodine group (56 percent). The percentage of patients becoming euthyroid is comparable for both treatment modalities. There were more patients still persistently hyperthyroid one year after radioiodine therapy. The onset of hypothyroidism for the thyroidectomy group in majority of patients is on the 2nd month after the intervention while it is 3-4 months after radioiodine therapy. There was no complication present following radioiodine therapy but in those who underwent thyroidectomy, one had recurrent laryngeal nerve palsy and two had permanent hypoparathyroidism. Overall, there is a complication rate of 5 percent for patients who had subtotal thyroidectomy.Conclusions: Radioiodine therapy has a higher failure rate (20 percent) compared to thyroidectomy (3 percent) but there is a higher risk for hypothyroidism in subtotal thyroidectomy (73 percent) than in radioiodine therapy (56 percent). Although radioactive iodine has a higher failure rate it can still be an option as a definitive therapy in Graves' disease because of its lower rate of hypothyroidism as compared to thyroidectomy.Complication rate was higher in the subtotal thyroidectomy group (5 percent) and none in the radioiodine group. Over-all success of surgery is not impressive because of the high rate of hypothyroidism and the presence of complications.
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OBJECTIVE: Gout is the most prevalent form of arthritis afflicting Filipinos. The diagnosis and overall management need further improvement especially among medical practitioners. Our study aims to develop evidence-based guidelines for general medical practitioners on the management of uncomplicated gout with the overall goal of improving the standard of care of patients with gouty arthritis.

METHODOLOGY: The Technical Review Committee (TRC) of the Philippine Rheumatology Association (PRA) Gout Special Interest Group (S1G) conducted a literature search relating to management issues on all phases of gout from years 1980 to 2007 using databases including Medline, Ovid, Lilacs, Cochrane Central Register of Controlled Trials (CENTRAL). The GRADE system in rating quality of evidence and strength of recommendation was used. A multidisciplinary panel voted and approved the final recommendations during an en bane meeting.

RESULTS: Nine recommendations for the management of uncomplicated gouty arthritis were developed based on evidence from the literature and consensus among experts and key stakeholders. Concerns regarding the initiation and maintainance of urate lowering therapy, target serum uric acid levels, treatment of acute gout, lifestyle and dietary modifications, comorbidities associated with gout such as cardiovascular disease were addressed.

Background: B cell depletion with rituximab, a genetically engineered chimeric anti-CD20 monoclonal antibody has been shown to be effective in certain chronic immunological diseases including rheumatoid arthritis, systemic lupus erythematosus, and antineutrophil cytoplasmic antibody (ANCA) associated vasculitis. Several published reports have shown its effectiveness in Churg-Strauss Syndrome. Case report: We report a case of a 56 year old Filipino male, with a prior history of asthma and sinus abnormalities, who presented with peripheral eosinophilia, leukocytoclastic vasculitis, and severe axonal distal symmetrical sensorimotor polyneuropathy. Sural nerve biopsy revealed vasculitic neuropathy. He had received intravenous immunoglobulin, methylprednisolone pulses and high dose oral steroids but without clinical improvement. He was then given 2 doses of rituximab 500 mg combined with 500 mg cyclophosphamide, administered 2 weeks apart, without adverse events. A month later, his neurologic functions had significantly improved with increasing ambulation, and prednisone was effectively tapered to 10 mg daily. Conclusion: Rituximab is an important option in the management of systemic vasculitis including Churg-Strauss syndrome refractory to the usual immunosuppressive agents.

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Objective: The objective of the study was to evaluate the safety and tolerability, and efficacy of olmesartan medoxomil (olmesartan) 20 mg and 40 mg tablets in a wide population of Filipino patients with mild to moderate hypertension.Methods: Three thousand twenty nine (3029) Filipino out-patients (mean age for all = 53.8 years; number of females = 1609 or 53.1 percent) with mild to moderate hypertension were enrolled in this 8-week, open-label, dose-titration post-marketing surveillance study. All subjects initially received 20 mg olmesartan once daily for 4 weeks. Patients who attained the blood pressure (BP) goal of systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg were maintained on 20 mg olmesartan; dose was up-titrated to 40 mg once daily for those who did not attain the BP goal. Safety and tolerability was assessed by incidence of adverse events and Discontinuation of medication in subjects who took at least one dose of the medicine (n = 2988). Efficacy was assessed as the mean change in blood pressure and attainment of BP goal in subjects who had baseline and post-baseline BP determination (n=2978).Results: Of the 2988 patients, there was a total of 116 reported adverse events. The more commonly reported adverse events were dizziness (n=34, 1.1 percent), headache (n=17, 0.6 percent), and cough (n = 9, 0.3 percent). The adverse events were mostly mild in nature and necessitated discontinuation of the medication in 43 patients (1.4 percent). As compared with baseline BP determination, there was significant change of both mean systolic and mean diastolic blood pressure during Week 4 (mean SBP change, -22.2 +/- 13.784 mmHg, mean DBP change, -12.1 +/- 9.019 mmHg, p
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