OBJECTIVES

In the past decade, the prevalence of diabetes in the Philippines has been increasing. The prevalence of diabetes is 7.1% and it is the sixth leading cause of death among adults. Preventive measures to address the incidence of diabetes, as well as diabetes-related complications, have been in place. However, knowledge of the risk factors for developing cardiovascular or renal-related Type 2 Diabetes Mellitus (T2DM) complications has numerous benefits for T2DM patients. This study aimed to describe common risk factors among Filipino T2D patients which increase their risk of developing cardiorenal complications including Heart Failure and CKD. Furthermore, the study aimed to assess the
awareness of T2DM patients regarding these risk factors

METHODS

A clinic-based cross-sectional survey among Filipinos with T2DM Philippines was conducted in the different regions in the Philippines from April 2021 to January 2022. The study participants were 16,268 patients of various ages and sex, however, only 11,578 of them answered the form completely. The patients and their corresponding physicians answered a validated self-assessment form on whether they had 8 identified risk factors for T2DM.

RESULTS

This survey identified Hypertension as the most common risk factor present in 96.49% of T2DM patients followed by Dyslipidemia (82.56%), Family History of CVD (77.11%), Obesity (59.66%), Kidney Disease (38.08%), Personal History of CVD (36.22%), Smoking (35.49%) and Family History of Kidney Disease (33.05%). Most patients were aware of the presence of these risk factors. However, there were some identified by the physician but unknown to the patient. In decreasing order of frequency, these were personal history of heart and blood vessel diseases (7.19%), followed by family history of kidney disease (5.44%) and smoking (5.1%).

CONCLUSION

This survey was able to identify crucial risk factors in developing T2DM complications that are most common among T2DM patients in the Philippines. Furthermore, for the first time, the study was able to show the level of awareness of T2DM patients regarding the risk factors that they have in developing these complications. These data show the importance of determining and addressing the common risk factors in preventing T2DM complications. Moreover, identification of these risk factors is an important step in prevention of cardiorenal complications.

Identification (psychology) ; Cross-sectional Studies ; Diabetes Mellitus, Type 2 ; Diabetes Complications ; Kidney Diseases

OBJECTIVES

This study aimed at determining the association of the clinical profile of patients with GDM to maternal and neonatal outcomes

METHODS

This single-center, retrospective, descriptive, cross-sectional chart review was conducted in a tertiary hospital in Cebu City to 229 patients with GDM admitted from January 2021 to December 2022.

RESULTS

The study revealed several significant associations. Hypertension was strongly linked with primary cesarean section (OR: 4.32, P-value 0.004); and severe pre-eclampsia (OR: 16.97, P-value: 0.000). Gravidity showed significant correlations with Ballard’s score (P-value: 0.013), birthweight (P-value: 0.045) and 5-minute APGAR score (P-value: 0.001). Parity was associated with birthweight (P-value: 0.011) and 5-minute APGAR score (P-value: 0.001). Weight gain during pregnancy was linked to birthweight (P-value: 0.004) and occurrence of congenital anomalies (OR: 1.26, P-Value: 0.032). Additionally, prenatal smoking was associated with 5-minute APGAR score (P-value: 0.006). Moreover, having a Small for Gestational Age (SGA) fetal growth status is associated with insulin-requiring mothers, (OR: 4.79, P-Value: 0.049); and a family history of diabetes was significantly associated with insulin therapy (OR: 5.38, P-value: 0.021).

CONCLUSION

Patients' clinical profile affect maternal and neonatal outcomes among patients with GDM. Careful consideration of these factors during the perinatal period may help reduce maternal and fetal risks

Tertiary Care Centers ; Smoking ; Pregnancy ; Diabetes, Gestational ; Hypertension ; Apgar Score

OBJECTIVES

 

METHODS

We included all SLE cases reported between January 2021 and December 2022 based on our Rheumatology Section census in this retrospective chart review. We evaluated the changes in the prednisone dosage and the lupus disease activity before, during and after completion of tuberculosis (TB) treatment. The characteristics of the patients were also described.

RESULTS

All the subjects in the study were females with a mean age of 35.85 years. The pulmonary site (50 %) is the most common area of involvement in tuberculosis infection. Prior to anti-TB treatment, the mean MEX-SLEDAI score was 5.45 (SD ± 4.20) within 1 year prior to the TB diagnosis with prednisone dosage mean of 14 mg (SD ± 17.0). Three months after anti-tuberculosis medication initiation, the prednisone dosages and the MEX-SLEDAI increased however, the changes were not statistically significant. Within 1 month of completion of anti-TB treatment, there was decrease in the MEX-SLEDAI with mean of 3 (SD ± 3.68) and dosages of prednisone with mean of 4.38 mg (SD 3.13). The changes were statistically significant with p-values of

CONCLUSION

There were no significant changes in the MEX-SLEDAI and prednisone dosage within 3 months of starting antiTB medications. However, completion of treatment results to better SLE disease scores and lower prednisone requirements.

Human ; Female ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Tuberculosis ; Therapeutics ; Rheumatology ; Diagnosis ; Censuses ; Prednisone

BACKGROUND

This study was inspired by the increasing cases of Diabetes Mellitus II (DM II) and the drive to strengthen early detection and intervention. The study specifically examined the American Diabetes Association (ADA) Risk Screening Form to detect DM and its potential as a cost-effective alternative to the standard screening criteria using Fasting Plasma Glucose (FPG) and 2-hour Oral Glucose Tolerance Test (OGTT).

METHODOLOGY

It utilized observational, cross sectional, descriptive, comparative design conducted among 269 hospital employees in a tertiary hospital. All participants were examined using the ADA Risk Screening Form and underwent standard test of FPG and 2-hour OGTT. Mean and standard deviation, frequency and percentage, and Mann-Whitney test were used in the treatment of data.

RESULTS

The clinicodemographic profile of the employees showed that most of the personnel belonged to age old (66.5%). Among the employees, 159 were females (66.5%) and 110 were males (59.1%). Additionally, most of the
personnel do not have hypertension (73.2%) and are physically active (56.1%) however most were noted to be overweight
(48.3%) and have family history of diabetes (45%). Furthermore, majority of the females did not have a history of gestational
diabetes mellitus (37.2%). The results revealed that most of the personnel were identified under decreased risk using the
ADA screening form and are non-diabetic (79.18%) using the laboratory test, whereas those pre-diabetic and diabetic
accounted 13.38% and 7.43% respectively. The results showed sensitivity of ADA Risk Screening Tool for DM Type 2
alongside the results of FPG and OGTT 30.4 and 25.7 respectively, specificity (87.3, 87.7), positive predictive value (38.6,
44.2), negative predictive value (82.7, 75.7), and accuracy (75.5, 70.6). Lastly, the results revealed that the use of ADA
screening tool showed no difference with the use of FPG with p-value of 0.095 and OGTT with p-value of 0.118.

Human ; Male ; Female ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Association ; Form ; Government ; Hospitals ; Mass Screening ; Occupational Groups ; Risk

BACKGROUND

Diabetic retinopathy (DR) remains to be the leading cause of blindness worldwide. Traditionally, risk factors such as diabetes duration, HbA1c levels, hypertension and dyslipidemia have been closely linked to the development of this condition. However, recent research suggests that these factors account for only a portion of DR cases. Emerging studies highlight additional potential risk factors including diabetic nephropathy, insulin use, and body mass index -though data on these factors remain limited and at times contradictory. While there have been a few local studies exploring some of these variables, none have comprehensively examined how these factors collectively influence the occurrence and severity of diabetic retinopathy. This study aims to asses both the factors associated with presence and occurrence of diabetic retinopathy.

METHODOLOGY

This analytical cross-sectional study included patients with diabetes (n=201, aged 18 years and older) who underwent fundus photography at The Medical City Ortigas between January 1, 2022, and December 31, 2022. Data collection involved a thorough review of patient records, which provided demographic information and details on potential risk factors. The presence and severity of diabetic retinopathy (DR) were assessed based on fundus photography results, as interpreted by ophthalmologists. To evaluate the statistical significance of the association between risk factors and DR status, logistic regression analysis was done

RESULTS

Duration of diabetes (odds ratio [OR] 1.07; 95% CI, 1.01-1.13 per year increase), HBA1c (OR 1.4; 95% CI, 1.1-1.86),
fasting blood sugar (OR 1.4; 95% CI, 0.977-0.998), hypercholesterolemia (OR 5.02; 95% CI 1.67-16.44) and presence of
nephropathy (OR 3.39; 95% CI 1.49-8) were correlated with diabetic retinopathy.

CONCLUSION

The presence of diabetic retinopathy was significantly associated with several clinical factors. Each additional year of diabetes mellitus duration was associated with a 1.07-fold increase in the likelihood of DR. Additionally, each 1% increase in HbA1c was linked to a 1.40-fold increase in DR risk. The presence of diabetic nephropathy and hypercholesterolemia were also strong predictors, associated with a 3.39-fold and 5-fold increase in the likelihood of DR, respectively. Glycemic control, dyslipidemia and nephropathy appear to be associated with more severe forms of diabetic retinopathy. Clinicians handling diabetes patients with this patient profile should be wary of this diabetes complication.

Human ; Male ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Diabetic Retinopathy ; Hospitals ; Risk ; Risk Factors ; Tertiary Care Centers

BACKGROUND

Determination of serum bicarbonate (HCO3 - ) using arterial blood gas analysis in patients with diabetic ketoacidosis allows for the evaluation of the severity of the condition, determines whether HCO3 - therapy is required, and tracks the progression and resolution of the disease. Serum carbon dioxide combining power (CO2CP) from venous chemistry analysis has often been used as an indicator of metabolic acidosis. This study investigated the relationship between HCO3 - and CO2CP and developed an approximation formula for serum bicarbonate concentration using its predictor variables, as this may lessen the need to repeat arterial blood gas analysis or be used in settings in which blood gas analyzers are unavailable.

METHODOLOGY

This single-center, retrospective, cross-sectional study investigated a total of 77 patients diagnosed with diabetic ketoacidosis. Assessment of the bivariate correlations between serum HCO3 - and serum CO2CP as well as other potential predictor variables was done via Pearson’s correlation coefficient. Predictor variables that were significantly correlated with serum HCO3 - were identified and an approximation formula was developed by regression analysis. Evaluation of the correlation between the approximated HCO3 - value and the actual serum HCO3 - concentration was performed using correlation coefficient and residual statistics to assess agreement.

RESULTS

Serum CO2CP had significant correlation with serum HCO3 - (r = 0.768, p < 0.05). By multiple regression analysis, the following approximation formula was therefore expressed: HCO3 - = 12.682 + (0.612 x CO2CP) – [ketones] + (0.085 x BUN) - (0.026 x SGPT) – (1.23 x Creatinine) - (0.067 x Chloride). Examination of residuals revealed a mean of zero (0), indicating no significant difference between the actual and approximated levels of serum HCO3 -

CONCLUSION

The predictor variables included in the formula collectively contribute significantly to the approximation of serum HCO3 - . The approximated serum HCO3 - values also showed significant correlation with actual serum HCO3 - concentration; thus, the formula may be utilized to derive an approximation of serum bicarbonate concentration in patients with diabetic ketoacidosis.

Human ; Male ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Attention ; Bicarbonates ; Carbon Dioxide ; Diabetic Ketoacidosis ; Ketosis ; Patients ; Carbon ; Power (psychology) ; Power, Psychological ; Serum

BACKGROUND

Tuberculosis (TB) has long been a recognized infectious disease contributory to worldwide mortalities. Most cases are from low- to middle-income countries, including the Philippines. Hepatobiliary TB comprises only a small portion of extrapulmonary TB. Tuberculous liver abscess (TLA) usually presents with nonspecific findings causing delay in the diagnosis. Due to this, further reports are needed for early detection along with timely treatment for future courses.

CASE

Presenting a 17-year-old male who came in with right upper quadrant abdominal pain associated with intermittent fever. The symptoms persisted and eventually progressed to abdominal distention, weight loss and jaundice. Initial laboratories were taken including an ultrasound finding of a complex lesion in the hepatic lobe. He was initially managed with empiric antibiotic therapy – Ciprofloxacin and Metronidazole, however, despite it, there was persistence of right upper quadrant pain, abdominal distention and jaundice. Due to this, further work-up was done with drainage of the abscess. Cultures were taken revealing tubercle bacilli along with other microbial growth. Antibiotics and antituberculosis medications sensitive to the microorganisms were started. With the noted improvement of jaundice and abdominal distention and resolution of pain and fever, he was discharged.

CONCLUSION

 Tuberculous liver abscess is an uncommon presentation of extrapulmonary tuberculosis in an
immunocompetent male with right upper quadrant abdominal pain and jaundice. Although TB is endemic in the
Philippines, this gastrointestinal involvement is often not immediately recognized. Thus, with any suspicion of liver abscess,
tuberculous (TLA) type should be included in the differentials for early diagnosis and management. 

Human ; Male ; Adolescent: 13-18 Yrs Old ; Abscess ; Liver ; Liver Abscess ; Research Report

BACKGROUND

Enteric duplication cyst is a rare congenital anomaly of the digestive tract, affecting 0.2% of children and 5- 6% of adults, occurring in 1 in 4,500 births. Intussusception is uncommon in adults, accounting for less than 5% of cases, and is found in 1% of bowel obstruction patients. Clinical symptoms in adults can differ from the typical pediatric presentation.

CASE

A 40-year-old female was hospitalized with epigastric pain and vomiting, which began 12 hours prior to admission. She experienced crampy pain, escalating to severe pain radiating to the right upper quadrant, along with 12 episodes of non-bilious vomiting. She had a previous history of acute cholecystitis and no known comorbidities. Upon admission, her blood pressure was elevated, and she had icteric sclerae and a tender right upper quadrant with a mass in the epigastrium. Laboratory findings showed leukocytosis, hypokalemia, hypoalbuminemia, and hyperbilirubinemia. A computed tomography of the whole abdomen with contrast revealed duodenojejunal intussusception with biliary obstruction, along with a duodenal duplication cyst measuring 4.2 x 5.8 cm, acting as the lead point, with invagination of part of the pancreatic head into the intussusception. She was managed with decompression, medications, and intravenous antibiotics. After three days, she underwent exploratory laparotomy, pancreatoduodenectomy, segmental resection of the jejunum, and anastomosis procedures. Histopathology confirmed the duodenal duplication cyst, showing intestinal-type mucosa lining exhibiting ischemic necrosis with no atypia or malignant tumor cells. The patient tolerated the procedure well, and her symptoms resolved. She was discharged on the 14th hospital day in stable condition.

CONCLUSION

Adult duodenojejunal intussusception is a rare disease that is difficult to diagnose due to its nonspecific symptoms and is possible in cases of duplication cysts which can act as a lead point, such as in our patient. Therefore, a high index of suspicion and imaging plays an important role in the diagnosis of a duplication cyst with intussusception in adults especially those presenting with abdominal pain, vomiting, and jaundice. A correct and timely diagnosis is needed to prevent various complications including bowel infarction and sepsis.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdominal Pain ; Cysts ; Female ; Intussusception ; Jaundice ; Jaundice, Obstructive ; Pain ; Research Report

BACKGROUND

Pulmonary aspergilloma is the most common pulmonary involvement due to Aspergillus. It usually develops in a pre-existing cavity in the lung, most often due to tuberculosis. Hemoptysis occurs secondary to local invasion of the blood vessels lining the cavity. Recurrence of which, is an indication to do surgery, lobectomy in particular. Antifungals like amphotecin B given intravenously and itraconazole given orally, have been the traditional management. But with the emergence of newer antifungals, Echinocandins in particular, which functions to inhibit the β-(1,3) p-glucan synthase, an enzyme necessary for the synthesis of an essential component of the cell wall of fungi, one may need not undergo surgery. The most common antifungal medication for Aspergillus is voriconazole, a second-generation triazole. This case demonstrates the efficient utilization of Voriconazole along with Anidulafungin, which is necessary for the fungal cell wall integrity. For immunocompromised patients with pulmonary aspergilloma, this dual therapy presents a viable substitute for surgical intervention and an efficient treatment approach.

CASE

We present a case of a 54-year-old married patient, who presented with massive hemoptysis four days before consulting a private physician. She had ten episodes of hemoptysis four hours before admission and was rushed to the hospital. The patient had multiple comorbidities, including diabetes, hypertension, and asthma, contributing to an immunocompromised state. She had a history of anti-tuberculosis treatment in 2000, which was discontinued due to an allergic reaction. During her hospital stay, she experienced febrile episodes, and capillary glucose monitoring was beyond acceptable levels, prompting antibiotic initiation. A chest CT scan revealed pulmonary tuberculosis with cicatricial atelectasis of the lingular segment and infected cavitary formation. A bronchoscopy and biopsy of the cavitary lesion were scheduled. Surgical intervention, particularly lobectomy, was not pursued due to multiple factors, including the patient's immunocompromised status, her underlying comorbidities, and the response to antifungal therapy. After eight to 14 fourteen (8-14) hospital days, no episodes of hemoptysis were noted, and the biopsy result revealed fungal colonization consistent with Aspergillus species. The patient was discharged with oral Voriconazole and other maintenance medications. A repeat chest CT scan after five months of antifungal therapy showed regression of the fungus ball.

CONCLUSION

In this case, pulmonary aspergilloma in an immunocompromised patient was successfully treated with a combination antifungal therapy utilizing anidulafungin and voriconazole. The favorable clinical response to dual antifungal therapy provides a feasible non-surgical alternative to surgical intervention, which has historically been the preferred option for treating recurrent hemoptysis, particularly in high-risk patients. The fungus ball's regression and the fungal infection's resolution support the growing role of more recent antifungal medications in the treatment of complicated pulmonary infections. This case suggests that echinocandins combined with triazole therapy are a viable less invasive treatment option for pulmonary aspergilloma than surgery.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Anidulafungin ; Immunocompromised Host ; Patients ; Therapeutics ; Voriconazole

The spleen is a very hostile environment for tumor cells due to its anatomic location, blood supply, and rich immunological property – which makes it one of the most unique organ to be involved in metastatic diseases.15 Splenic metastases from non-hematologic malignancies are rare ranging from 0.6 to 7.1% base on autopsy reports of cancer patients, and 1.1 to 3.4% base on review of splenectomy cases.14 Moreover, isolated splenic metastases are more infrequent with only 31 cases reported from 1969 to October 2015.16 A splenic abscess is an unusual formation and is usually caused by hematogenous spread from an infection. Such expected frequency varies in different autopsy studies between 0.14% and 0.7%.1 Albeit rare, abscess can also result from migration of gut flora brought about by direct invasion of tumor cells from a neighboring neoplasm.17 This is a case of a 36-year-old female who came in with a history of abdominal pain, chills and fever for seven months. CT scan of the whole abdomen revealed splenic abscess with suspicion of a splenic rupture. The patient underwent exploratory laparotomy with abscess evacuation, splenectomy and double barrel colostomy and given with intravenous antibiotics. Histopathology results showed metastatic adenocarcinoma in the spleen. Thorough deliberation of her case was done and she was eventually managed as a case of Colon Cancer Stage IV and underwent chemotherapy. Splenic abscess developing from splenic metastasis from a colonic adenocarcinoma is rare and with concomitant high mortality rate. More often than not, splenic metastasis is discovered in advanced stage together with metastatic tumor in other organs while isolated splenic metastasis is even more uncommon. A splenic abscess as an initial demonstration of a colon cancer is not a common daily encounter of physicians hence a high index of suspicion coupled with sensitive and specific imaging is necessary in order to provide prompt medical and surgical intervention.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdomen ; Adenocarcinoma ; Autopsy ; Colostomy ; Gastrointestinal Microbiome ; Pain ; Research Report ; Infections ; History ; Splenic Rupture ; World Health Organization ; Neoplasms ; Disease ; Fever ; Hematologic Neoplasms