BACKGROUND

The COVID-19 pandemic has had a significant impact on the world leading to significant morbidity and mortality. The disease was caused by the SARS-CoV-2 virus and can caused severe respiratory illness, as well as a range of other complications depending on presence of cardiometabolic risks. These factors included a range of conditions such as obesity, high blood pressure, high cholesterol, and states of insulin resistance. People with these risk factors are hypothesized to more likely experience severe COVID-19 symptoms and have worse clinical outcomes.

To determine the association between cardiometabolic risk factors and the development of severe COVID-19 patients in rural tertiary hospital in Bayombong, Nueva Vizcaya.

We reviewed the medical records of patients aged 19 years or older with a real-time polymerase chain reaction (RT-PCR)-confirmed COVID-19 hospitalized at the Region II Trauma and Medical Center in Bayombong, Nueva Vizcaya. A retrospective correlation design was utilized for the study, using a review of the medical records of patients from March 2020 to December 2022. Fasting plasma glucose (FPG), Low Density LipoproteinCholesterol (LDL -c) levels, Hypertension, BMI, Waist to hip ratio and demographic characteristics of the patients were recorded. A simple and multiple ordinal logistic regression was done to checked the association between COVID-19 and different independent variables. All analyses were performed using STAT A SE 18.0, with a p-value of less than 0.05 as the cut-off to determine statistical significance.

We enrolled 1,582 participants; most were 50 to 59 years old (24.3%), Male (57.7%) and unvaccinated. When we compared our patients' Hyperlipidemia, FBS and Hypertension directly correlate with length of stay while Myocardial Infarction, Atrial Fibrillation and waist to hip ratio inversely correlate with length of stay measured during the pandemic and the pre-pandemic period, we found a statically significant increased (CONCLUSION

This study demonstrates the consequences of Diabetes Mellitus, Hypertension, Hyperlipidemia and Cardiovascular Disease showed significant associations with mortality and Clinical Severity of patients. Moreover, Age, Male, and Co-morbidities were significant confounders for the associations of Cardiometabolic Risk Factors on COVID-19 mortality and clinical severity.

Sheehan’s syndrome is characterized by hypopituitarism following ischemic necrosis of the pituitary gland caused by postpartum hemorrhage and impaired blood supply to the enlarged pituitary gland during pregnancy. The worldwide prevalence has since decreased due to improvements in obstetric care. Behavioral change is a rare presentation and is often misdiagnosed and managed as psychosis. We report a 42-year-old woman presenting with behavioral changes associated with postpartum failure of lactation and amenorrhea. Hormonal work-up revealed panhypopituitarism; serum cortisol, 98.93 (NV: 138–690 nmol/L); free T4, less than 5.15 (NV: 11.5–23.00 pmol/L); free T3, less than 2.30 (NV: 2.89–4.88 pmol/L); FSH, 3.63 (NV: 30–135 mIU/mL); LH, 3.88 (NV: 13–80 mIU/mL); serum estradiol, 3.89 (NV: 10.41–35.0 pg/mL); IGF-1, 13.13 (NV: 56–194 ng/mL); and serum prolactin, 1.8 (NV: 2.6–24.8 ng/mL). Cranial MRI with contrast revealed an atrophic pituitary gland consistent with Sheehan's syndrome. The symptoms improved substantially upon replacement with steroids and thyroid hormones and she was able to resume her routine activities. The psychiatric features of hypopituitarism can be attributed to a combination of hypothyroidism, hypoglycemia, and hypocortisolism and have been shown to reverse with adequate hormone replacement.
Hypopituitarism ; Psychotic Disorders ; Hypopituitarism

Thyroid storm is a life-threatening condition with mortality rates reaching up to 20 to 30%. First-line treatment includes inhibition of thyroid hormone synthesis, prevention of release of preformed hormones, blocking of peripheral FT4 to FT3 conversion, enhancing hormone clearance, and definitive radioactive iodine ablation. However, in the presence of life-threatening adverse effects (e.g., agranulocytosis) and contraindications (e.g., fulminant hepatic failure), therapeutic plasma exchange (TPE) can be used to rapidly remove circulating thyroid hormones, antibodies, and cytokines in plasma; this is recommended by the American Society of Apheresis (ASFA) and the American Thyroid Association (ATA) as second-line treatment for thyroid storm. Here, we report a 49-year-old female with Graves' disease admitted in our emergency room for a 6-week history of fever, weight loss, jaundice, exertional dyspnea, palpitations, and diarrhea. Her initial thyroid hormone levels were: FT4 64.35 (NV 9.01-19.05 pmol/L), FT3 23.91 (NV: 2.89-4.88 pmol/L), and TSH 0.00000 (NV: 0.35-4.94 mIU/L) and we managed her as a case of thyroid storm (Burch-Wartofsky score 70) by initiating high dose propylthiouracil. However, her sensorium deteriorated and serum bilirubin continued to rise from 307.2 on admission to 561.6 umol/L on the 5th hospital day (NV: 3 - 22 umol/L). TPE was performed after consultation with the Division of Hematology. Over the treatment course, her thyroid hormones normalized: FT4 13.18 pmol/L, FT3 2.30 pmol/L. However, despite TPE, her symptoms worsened and she became comatose, had hypotension despite vasopressors and developed new-onset atrial fibrillation. She expired on her 7th hospital day from multiorgan failure. TPE is effective in decreasing circulating thyroid hormone levels. However, it had no effect on clinically important outcomes as our patient still deteriorated and eventually succumbed. We still wrote and submitted this case report since if only successful cases were reported, the true effectiveness rate of TPE could not be determined.Thyroid storm is a life-threatening condition with mortality rates reaching up to 20 to 30%. First-line treatment includes inhibition of thyroid hormone synthesis, prevention of release of preformed hormones, blocking of peripheral FT4 to FT3 conversion, enhancing hormone clearance, and definitive radioactive iodine ablation. However, in the presence of life-threatening adverse effects (e.g., agranulocytosis) and contraindications (e.g., fulminant hepatic failure), therapeutic plasma exchange (TPE) can be used to rapidly remove circulating thyroid hormones, antibodies, and cytokines in plasma; this is recommended by the American Society of Apheresis (ASFA) and the American Thyroid Association (ATA) as second-line treatment for thyroid storm. Here, we report a 49-year-old female with Graves' disease admitted in our emergency room for a 6-week history of fever, weight loss, jaundice, exertional dyspnea, palpitations, and diarrhea. Her initial thyroid hormone levels were: FT4 64.35 (NV 9.01-19.05 pmol/L), FT3 23.91 (NV: 2.89-4.88 pmol/L), and TSH 0.00000 (NV: 0.35-4.94 mIU/L) and we managed her as a case of thyroid storm (Burch-Wartofsky score 70) by initiating high dose propylthiouracil. However, her sensorium deteriorated and serum bilirubin continued to rise from 307.2 on admission to 561.6 umol/L on the 5th hospital day (NV: 3 - 22 umol/L). TPE was performed after consultation with the Division of Hematology. Over the treatment course, her thyroid hormones normalized: FT4 13.18 pmol/L, FT3 2.30 pmol/L. However, despite TPE, her symptoms worsened and she became comatose, had hypotension despite vasopressors and developed new-onset atrial fibrillation. She expired on her 7th hospital day from multiorgan failure. TPE is effective in decreasing circulating thyroid hormone levels. However, it had no effect on clinically important outcomes as our patient still deteriorated and eventually succumbed. We still wrote and submitted this case report since if only successful cases were reported, the true effectiveness rate of TPE could not be determined.

Objectives: This study looked into the prevalence of diabetes mellitus (DM) and risks for cardiovascular and metabolic diseases among young adults with diabetes (age 20-44 years old, YOD) and late-onset DM (≥45 years old, LOD) in Filipinos. Methodology: Weighted data from 546,580 adults with DM from the 8th Philippine National Nutrition and Health Survey (NNHeS) were utilized. Differences in sociodemographic, anthropometric, clinical profiles and metabolic risks were compared between YOD and LOD. Results: The aggregated prevalence of DM is 5.43% (95%CI, 5.10–5.79), YOD were 2.64% (95% CI, 2.32–3.00) and LOD 9.85% (95%CI, 9.18–10.56). Mean age of YOD was 37,6 years, LOD 59,9 years. The YOD were mostly males (56%), with higher BMI (26.24 kg/m2 vs 25 kg/m2, p=0.002), lower mean SBP (122.41±19.17 mmHg vs 135.45±22.47 mmHg, p<0.001), more daily smokers (23% vs 14%), and alcoholic beverage drinkers (39% vs 31%). Physical activity was similar between groups (44% vs 51%, p=0.078). However, average total caloric intake (1776.78±758.38 kcal vs 1596.88±639.16 kcal, p=0.023) and carbohydrate intake (306.13±142.16 grams vs 270.53±104.74 g, p=0.014) were higher in YOD. Dietary carbohydrate proportions were higher than recommended (69% vs 68%) for both groups. Young Filipinos had higher risk to develop diabetes when they are obese II (22% vs 12%), current drinker (56% vs 37%), and current smoker (28% vs 18%). Eighty percent of YOD and LOD had metabolic syndrome (MetS). With every unit increase in age and fat intake, the odds of having MetS were raised by 5.4% (95%CI 1%–10%, p=0.029) and 1.6% (95%CI 0.04%-3%, p=0.044), respectively. Conclusion Early-onset diabetes mellitus appears to be driven by obesity, MetS and social behaviors. Modifiable risk factors can be improved early to decrease hazards to develop cardiometabolic complications.
Metabolic Syndrome ; Cardiovascular Diseases

Objectives: Effective communication has been correlated with improved outcomes in diabetes mellitus. Patient comprehension bears an effect on understanding, improving healthcare access and utilization, interaction with healthcare providers, caring for one’s own health, and shared decision making. Currently, there is a gamut of information on diabetes-related terms from various sources. However, no material has yet been available for clinical use in the third world setting. Hence, we explored the most common themes discussed during an outpatient diabetes consult in our hospital. Methodology: Consultation audio recordings (N = 96) and focus group discussions (N = 32) were conducted among adults with diabetes. Transcribed results underwent qualitative content and thematic analyses to develop the conceptual framework. Results: The study generated the following themes: diabetes mellitus diagnosis, lifestyle modification, treatment targets, hypoglycemia precautions, diabetes complications, and medication safety. There was a good understanding of these themes among patients with a higher educational attainment, however, among those with lower educational attainment, the attitude of patients toward diabetes care is paternalistic. Conclusion The themes discussed in outpatient diabetes consult reflects the dimensions of diabetes care mainly influenced by socio-cultural factors, patient-doctor relationships and adaptability to limitations of resources. The results will be used to develop and validate a culturally appropriate diabetes health literacy tool.
Diabetes Mellitus ; Health Literacy

Objectives: Daily levothyroxine is the treatment of choice and standard of care in hypothyroidism, sufficient to restore thyroid stimulating hormone (TSH) to normal range. For many patients, daily lifelong therapy is required, making adherence a major issue. In such cases, weekly replacement may be a suitable alternative to improve adherence. In this study, we aimed to determine the efficacy and safety of weekly levothyroxine replacement among adults with hypothyroidism. Methodology: Electronic databases were searched. Two reviewers (HCC and RBL) independently screened the abstracts, reviewed full-text papers, critically appraised the quality of included studies using PRISMA guidelines. Meta-analysis was performed using the random-effects model. The primary outcome is the difference in serum TSH levels between weekly and daily administration, while secondary outcomes included adverse events and symptoms of hypothyroidism. Results: The primary outcome is the difference in serum TSH levels between weekly and daily administration. Secondary outcomes included adverse events and clinical symptoms. The study included two randomized trials (n=109) in the primary analysis. The difference in TSH levels was 1.78 mIU/mL higher [(95% confidence interval (CI): 1.28 to 2.28, p<0.00001] at 6 weeks and 1.22 mIU/mL higher (95% CI: 0.76 to 1.67, p<0.00001) at 12 weeks for the weekly regimen. There was no significant heterogeneity between the two groups. There was no significant difference in hypothyroid symptoms and adverse events before and after levothyroxine treatment within each group. Conclusions Weekly levothyroxine resulted in less suppression and higher mean serum TSH levels, while still remaining within the normal reference range. It may be a suitable alternative for non-adherent patients. However, larger randomized trials with longer duration of follow-up are needed to firmly establish its role.
Hypothyroidism ; Thyroxine ; Thyroid Hormones

Diabetes mellitus (DM) is a known risk factor for morbidity and mortality among patients with COVID-19 based on recent studies. While there are many local and international guidelines on inpatient management of diabetes, the complicated pathology of the virus, the use of glucose-elevating drugs such as glucocorticoids, antivirals and even inotropes, and various other unique problems has made the management of in-hospital hyperglycemia among patients with COVID-19 much more difficult than in other infections. The objective of this guidance is to collate and integrate the best available evidence that has been published regarding in-patient management of diabetes among patients with COVID-19. A comprehensive review of literature was done and recommendations have been made through a consensus of expert endocrinologists from the University of the Philippines-Philippine General Hospital (UP-PGH) Division of Endocrinology, Diabetes and Metabolism. These recommendations are evolving as we continue to understand the pathology of the disease and how persons with diabetes are affected by this virus.
COVID-19 ; SARS-COV-2

Introduction: Adiponectin is an adipocytokine known to have anti-inflammatory and anti-atherogenic effects. It appears to impact insulin resistance and the subsequent development of type 2 diabetes mellitus (T2D). The gene encoding adiponectin ADIPOQ, has single nucleotide polymorphisms (SNPs) that can be useful biomarkers to predict development of T2D; with the T/G polymorphism of SNP +45 in exon 2 being the most common. Objective: This study was conducted to evaluate the association of T45G adiponectin gene polymorphism with hyperglycemia among adult Filipinos seen at the outpatient department of the Philippine General Hospital. Methods: This is a matched case-control study, with duration of 12 months. DNA was extracted using the QIAGEN MIDI Blood Extraction Kit. The genomic DNA obtained was then subjected to real time PCR for SNP detection. Results: One hundred (100) adults were enrolled; forty-three (43) had normoglycemia, while fifty seven (57) had hyperglycemia, after a 75-g oral glucose tolerance test. Hyperglycemic subjects were older (44±15.6 years vs. 52±8.3 years, p-value 0.002), and had lower HDL levels (58.5±16.0 mg/dLvs. 47.8+11.8 mg/dL, p-value 0.000). Among thirty-nine (39) participants found to have the T45G adiponectin gene polymorphism, 22 or 56.4% were hyperglycemic while 17 or 43.6% were normoglycemic. Conclusion There was no significant association observed between the T45G SNP and presence of hyperglycemia.
Adiponectin ; Hyperglycemia

Objective: To explore the attitudes, behaviors, and beliefs of urban adult Filipinos on sunlight exposure as an initial step in the development and validation of a culturally-appropriate questionnaire. Methodology: Focus groups were conducted among urban Filipinos 19 years old and above (n=38). The transcribedresults underwent qualitative content and thematic analyses and were used to develop a conceptual framework. Results: Qualitative analysis revealed four main themes of sunlight exposure: internal influences, external influences,perceived benefits, and perceived risks. Both internal and external influences lead to perceived risks and benefits.Consequently, the perceived benefits (or lack) of sunlight exposure influence an individual’s attitude towards vitamin D supplementation; whereas the perceived risks of sunlight exposure influence an individual’s attitude towards the needfor sun protection Conclusion The attitudes, behaviors and beliefs of urban adult Filipinos on sunlight exposure are influenced by bothinternal and external factors, that in turn lead to perceived risks and benefits. An increased awareness of these factorsis necessary to establish future recommendations on proper sunlight exposure in this population. The study results willbe used to develop and validate a culturally-appropriate sunlight exposure questionnaire.
Urban Health ; Public Health ; Qualitative Research

OBJECTIVES: To develop and validate a self-reported sunlight exposure questionnaire (SEQ) for urban adult Filipinos. METHODS: The study included adults (19–76 years old) in Metro Manila, Philippines, well-versed in the Filipino (Tagalog) language and had resided in Metro Manila for at least 1 year. Exclusion criteria included pregnancy, active skin disorders, and immunocompromised states. An expert panel created a questionnaire in Likert-scale format based on a conceptual framework and 4 existing instruments. The study proceeded in 4 phases: questionnaire item development, translation and back-translation, pretesting, and construct validity and reliability testing using factor analysis, the Cronbach alpha coefficient, and the paired t-test. RESULTS: A 25-item, self-administered, Filipino (Tagalog) SEQ answerable using a 4-point Likert scale was created. The questionnaire was administered to 260 adult participants twice at a 2-week interval, with all participants completing both the first and second rounds of testing. All questionnaire items possessed adequate content validity indices of at least 0.86. After factor analysis, 3 questionnaire domains were identified: intensity of sunlight exposure, factors affecting sunlight exposure, and sun protection practices. Internal consistency was satisfactory for both the overall questionnaire (Cronbach alpha, 0.80) and for each of the domains (Cronbach alpha, 0.74, 0.71, and 0.72, respectively). No statistically significant differences were observed in the responses between the first and second rounds of testing, indicating good test-retest reliability. CONCLUSIONS We developed a culturally-appropriate SEQ with sufficient content validity, construct validity, and reliability to assess sunlight exposure among urban adult Filipinos in Metro Manila, Philippines.