BACKGROUND: This is a rare case of two large urinary bladder stones causing severe infection of the urinary tract affecting the bone marrow due to chronic immune stimulation in a patient with recurrent anemia. Urinary bladder calculi are hard masses of minerals. They develop when the minerals in concentrated urine crystallize. This often happens when the bladder cannot be emptied. Signs and symptoms can vary from severe abdominal pain to blood in the urine. Sometimes, bladder stones don't cause any symptoms. If left untreated, bladder stones may lead to infections and other complications such as hepatic abscess via a hematogenous route. CASE: This is a case of a seventy-eight-year-old man with a history of multiple blood transfusions secondary to anemia of unknown cause. He came into our institution for a second opinion. We worked up the patient, which showed hepatic abscess and two large urinary bladder calculi. Further investigation of the anemia later led to a diagnosis of primary myelofibrosis. DIAGNOSTICS: Ultrasound showed a complex mass on the left hepatic lobe measuring 7.5 cm x 6.0 cm x 2.1 cm consistent with a hepatic abscess. The culture of the abscess was positive for E. coli. Computed Tomography (CT) scan of the lower abdomen showed heterogeneous mass measuring 8.6 cm x 8.7 cm x 9.2 cm within the urinary bladder (see Figure 2). Urinalysis was consistent with a urinary tract infection. Urine culture showed E. coli. Video-assisted cystoscopy showed two urinary bladder calculi, measuring 1.5 cm x 3.2 cm x 4.2 cm weighing 30 grams each (see Figure 3). The calculi were composed of 100% Calcium Oxalate. He underwent a series of diagnostic examinations for anemia including gastroscopy to rule out a bleeding ulcer. Complete blood count showed hemoglobin of 77 g/L and a hematocrit of 0.23. Finally, bone marrow core biopsy was done which is consistent with primary myelofibrosis. CONCLUSION: Urinary bladder stones can be asymptomatic and may present only with vague abdominal pain. It should be one of the considerations in asymptomatic patients with long-standing prostatitis or benign prostatic hyperplasia. Detailed history, thorough physical examinations, and cautious diagnostic tests are mandatory to confirm the diagnosis. A hepatic abscess may arise from infections in the urinary tract such as prostatitis through hematogenous extension. Therefore, it is important to address the origin of the infection to prevent such complications. This is a rare case of an elderly man who presented with chronic anemia and later found out to have large urinary bladder stones that caused severe infection leading to immune stimulation of the bone marrow, hence the diagnosis of primary myelofibrosis by bone marrow biopsy. Such a rare case must be thought of holistically and analytically.
Male ; Prostatitis ; Prostatic Hyperplasia ; Urinary Bladder Calculi ; Liver Abscess ; Anemia

BACKGROUND: Congenital heart diseases (CHD) pose a major global concern due to its increasing survival trend in the adult stage; but data in our country is lacking. Despite improvement in management, formal assessment for anxiety and depression in patients with adult CHD is not routinely done. The Hospital Anxiety and Depression Scale (HADS) is a popular and simple self-administered instrument highly reliable for detecting states of anxiety and depression for use in medical practice. Identifying the prevalence of anxiety and depression through a simple screening tool that may lead to a proper psychiatric referral may help health-care providers consider the contribution of these components of the disease and identify additional points of holistic care for our patients.

OBJECTIVES: We aim to determine the prevalence of anxiety and depression in adult CHD Filipino patients using the HADS-P questionnaire (validated Tagalog version of the HADS). We also aim to determine association between depression & anxiety and disease characteristics.

METHODS: This is a cross-sectional study using nonprobability sampling of adult Filipinos with CHD in the Philippine General Hospital (UP-PGH). The HADS-P is a 14-item, self-administered rating scale with independent subscales for anxiety and depression (seven items each) was administered to both the study and control groups after securing consent.

A cut-off score of > 8.0 points on either of the depression and anxiety subscale of the HADS was used to determine their respective prevalence. Logistic regression analysis was used to determine the association of clinical variables with anxiety or depression.

RESULTS: A total of 92 patients with CHD with a mean age of 33 years old were recruited. The prevalence of anxiety and depression was higher among those with CHD compared to local literature (61% and 34% respectively). Majority had an atrial septal defect, ventricular septal defect, and patent ductus arteriosus. On the basis of a HADS-P score of >8.0 per category, 56 patients had anxiety and 31 patients had depression. Simple logistic regression identified employment status, a higher NYFC, low distance six-minute walk test, uncorrected defects, and heart failure as predictors of anxiety; whereas lower educational achievement, higher functional class, right-to-left shunt or Eisenmenger physiology, low distance six-minute walk test, and heart failure were predictors of depression. Multiple logistic regression identified only employment status (ie. being unemployed) as a significant predictor of anxiety [OR 4.54, 95% CI 1.38 - 14.28, p 0.012]; while having a rightto-left shunt or Eisenmenger physiology was a significant predictor of depression [OR 6.44, 95% CI 1.82-22.76, p 0.004].

CONCLUSION: This cohort of adult Filipinos with CHD has higher HADS-P scores, suggestive of a higher prevalence of anxiety and depression compared to available data. Factors associated with anxiety and/or depression were related to their underlying CHD and sociodemographic profile. Screening for emotional disorders is of paramount importance to provide holistic care for this vulnerable population. Health care professionals should be alert for the possible need for psychological intervention for adult survivors of CHD, even among those that are seemingly emotionally well-adjusted.

Human ; Male ; Female ; Middle Aged ; Adult ; Depression ; Heart Septal Defects, Ventricular ; Ductus Arteriosus, Patent ; Vulnerable Populations ; Anxiety ; Heart Septal Defects, Atrial ; Heart Failure

OBJECTIVE: The objective of this study was to determine the safety, tolerability, and efficacy of valsartan (Diovan?) 80 mg tablet in the treatment of mild to moderate, uncomplicated essential hypertension in Filipino patients.
METHODS: Patients who were 18-80 years of age, male or female diagnosed with essential hypertension with mean sitting diastolic blood pressure (SDBP)> 90mmHg to 115mmHg were given valsartan? 80mg tablet daily for a minimum of 2 weeks to a maximum of 8 weeks of treatment.
RESULTS: A total of 3224 evaluable patients were included in the study. Almost forty percent (39.6%) of patients are newly-diagnosed hypertensives, 25.8% have been hypertensives for 1 to 2 years,17% for 3-5 years, and 17.6% for more than 5 years. The mean systolic blood pressure (SBP) at baseline was 156.9 mmHg ± 15.4 mmHg while the mean diastolic blood pressure (DBP) at baseline was 98.7 mmHg ± 6.4 mmHg. The SBP decreased at visit 2 to a mean of 135.3 mmHg ± 12.6 mmHg which reduction was very highly significant (paired t-test= 9.13, p<0.0001). On the other hand, the mean DBP decreased to 85.3 mmHg ± 7.2 mmHg at visit 2 which reduction from baseline to visit 2 was also very highly significant (paired t-test= 94.2, p<0.0001). Adverse events in patients had been mild. Over-all the drug had demonstrated its relative safety in this population of subjects.



Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Adolescent ; Valsartan ; Blood Pressure ; Essential Hypertension ; Hypertension ; Systole ; Blood Pressure Determination ; Diastole ; Tablets