INTRODUCTION

Papillary thyroid cancer (PTC) is generally considered to be an indolent disease with relatively good prognosis. However, some studies have shown that the Filipino population has a higher risk for disease recurrence compared to non-Filipino patients and hence early identification and management during the follow-up period would be beneficial, especially those in whom risk factors for recurrence were identified.

This study aims to identify determinants for disease recurrence of patients with papillary thyroid carcinoma (as defined by the American Thyroid Association (ATA) guidelines 2015) diagnosed from January 1, 2013-December 31, 2017, seen at the University of Santo Tomas Hospital (USTH) outpatient endocrine clinic and underwent total thyroidectomy with or without radioactive iodine ablation therapy.

Retrospective review of outpatient medical records of 82 patients with PTC who underwent total thyroidectomy with or without radioactive iodine (RAI) therapy and achieved excellent response (ER) to therapy was performed. Baseline clinical profile such as age at diagnosis, sex, family history of thyroid cancer, family history of goiter, histopathology result, serial thyroglobulin (Tg), anti-thyroglobulin (anti-Tg) levels, whole body scan reports, neck ultrasound reports and RAI doses were collected. Logistic regression analysis was used to identify determinants to the development of worsening response.

Of the 82 patients, 18 (21.9%) developed worsening response to therapy. Predictors of poor outcomes identified from previous studies such as age, sex, extent of disease, size and multifocality of tumors, ATA risk classification and initial dynamic risk assessment, RAI therapy, level of thyroid-stimulating hormone (TSH) suppression were analyzed. After logistic regression analysis, there was no significant association between variables and progression to worsening response that were previously identified in other studies.

Even though no significant association between investigated variables and worsening response were identified in this study, previous studies with larger populations that had exhibited positive association should be considered and hence current Philippine guidelines for the management of PTC must still be applied.

Introduction: Patients with diabetes require regular follow-ups to achieve optimal glycemic targets. The coronavirus- 19 (COVID-19) pandemic resulted in interruptions in healthcare delivery placing greater importance on patient’s self-management of their condition. Telemedicine bridged the gap between the physician and patient that was created by community quarantines. Objective: To determine if there is a difference in patient’s self-care activities before and after using telemedicine using the Diabetes Self-Management Questionnaire (DSMQ). Methodology: A descriptive repeated cross-sectional study of patients with type 2 diabetes mellitus at the University of Santo Tomas Hospital who consulted via telemedicine using different available platforms were included. Self-care was measured using the DSMQ. Patient satisfaction with telemedicine was also assessed using a patient satisfaction survey. Results: An improvement in self-care practices was seen as significantly higher mean DSMQ scores after telemedicine consultations (6.79 ± 1.33 to 7.32 ± 1.21, p = 0.0015), with the highest scores on dietary control and physical activity. There was a statistically significant reduction in HbA1c on follow up (8.37 ± 2.31 to 7.31 ± 1.36; p<0.00001). Those with well-controlled diabetes (n = 14) at baseline remained to have good control while the proportion of those with poorly controlled diabetes (n = 34) showed improved glycemic control on follow up (p = 0.0045). Most patients were highly satisfied with telemedicine. Conclusion The use of telemedicine by patients with diabetes showed numerical improvement in both self-care practices and glycemic control. These findings imply that telemedicine may be mainstreamed as part of diabetes care among Filipinos.
COVID-19 ; Telemedicine

BACKGROUND

Patients with diabetes are vulnerable and highly susceptible to contracting COVID-19. Stress hyperglycemia ratio (SHR) may provide prognostic information in hospitalized patients. It is debatable whether stress hyperglycemia directly leads to poor outcomes, or is simply a marker of increased stress and inflammation.

This study investigates whether high SHR is associated with poor clinical outcomes among patients with type 2 diabetes mellitus (T2DM) and moderate to critical COVID-19 infection. Moreover, this study aims to compare high SHR versus absolute hyperglycemia as a predictor of poor outcomes.

A chart review was conducted on 146 COVID-19 patients with T2DM from March 2020 to December 2021. The area under the receiver operating curve was conducted to categorize SHR into low and high levels. The association of high SHR levels and absolute hyperglycemia with outcomes was analyzed using the regression analysis. Survival analysis was also utilized to allow differences in the time when in-hospital mortality occurred.

Patients with high SHR had a significantly higher proportion of mortality and invasive ventilation compared to those with low SHR. High SHR significantly increased the likelihood of invasive ventilation by 16.49 times and mortality hazards by 5.70 times compared to low SHR. Kaplan-Meier survival curves showed that those with high SHR had significantly lower survival rates than those with low SHR. In contrast, the survival estimates between those with and without absolute hyperglycemia were not statistically significant.

High SHR (>1.082) was associated with poorer outcomes, increased invasive mechanical ventilatory support and increased mortality.

Osteoporosis is a major public health concern leading to significant morbidity and mortality, especially in the elderly population. However, this disease is underdiagnosed and, as a result, undertreated. This cross-sectional study aims to determine the knowledge, attitudes and practices (KAP) of physicians in the diagnosis and management of osteoporosis, which would help identify key areas of improvement in the care of patients with this disease. One hundred and nine physicians answered an online questionnaire looking at their KAP on the diagnosis and management of osteoporosis, and their answers were analyzed using descriptive statistics, Pearson’s correlation and the Chi-square test. More than half of the participants obtained satisfactory scores on knowledge, and majority had neutral to positive attitude regarding osteoporosis. A statistically significant correlation was seen between having low knowledge and negative attitudes on osteoporosis screening and management.

Introduction: The bacille Calmette-Guerin (BCG) vaccine is used for the prevention of tuberculosis (TB) worldwide. Evidence reports a much lower incidence of COVID-19 in TB-endemic areas implying a possible protective mechanism of BCG in countries with mandated BCG policies. The objective of the study is to synthesize and critically evaluate the effectiveness of national BCG vaccination policies in reducing infection and severity of COVID-19 in their native population.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search using pre-identified keywords will be done in PubMed, Cochrane, HERDIN Plus, WPRIM, Web of Science and EBSCO databases. After the initial selection of studies based on eligibility criteria, methodological appraisal will be conducted using the Joanna Briggs Institute appraisal instruments and an adapted quality assessment checklist for ecologic studies. Relevant data will be extracted and synthesized including reporting descriptive and inferential statistics to interpret results.

Results: The study will generate a systematic review synthesizing evidence regarding the effects of BCG in curtailing the spread of the COVID-19 pandemic.

Discussion: The battle against the COVID-19 pandemic is far from over, and as such, further studies must be undertaken to verify the evidence behind initial strategies in battling it. This includes the use of BCG in decreasing COVID-19 incidence and mortality. The results of the review can ultimately guide health authorities and policy makers create evidence-based decisions regarding BCG vaccination policies and clinical trials related to COVID-19 control and prevention.

Systematic Review Registration: PROSPERO, CRD42021244060

Background: Diabetes will remain a threat to global health. No longer just a disorder of mature age, there is now a well-recognized trend towards the young. Early diagnosis leads to early intervention and prevention of complications in this susceptible but vital portion of the population. Objective: To compare the risk factors predisposing adults to early-onset (<40 years old) versus late-onset (≥40 years old) type 2 diabetes at the University of Santo Tomas Hospital from January 2015-December 2017. Methods: This is a retrospective review of medical records. All adult patients who fulfilled the inclusion criteria from January 2015 to December 2017 were included in the study. Data from charts were reviewed and analyzed. Results: The early-onset group had a mean age of 34 years, while the late-onset group had a mean age of 51 years. The early-onset diabetics were mostly obese, had higher HbA1c, worse lipid profiles, and had a positive family history of diabetes. Only a BMI of >27.50 kg/m2 was found to be a significant risk factor contributing to early-onset of diabetes. Myocardial infarction and nephropathy were more frequent in the late-onset group while retinopathy was more common in the early-onset group. Lastly, only retinopathy and neuropathy were significantly associated with longer duration of diabetes. Conclusion The mean age of Filipinos was at least 5 years younger than the studies done on Caucasians. Most patients in the early-onset group were obese and had worse metabolic profiles. Retinopathy was more common in the early-onset group, while myocardial infarction and neuropathy were more common in the latter.
Risk Factors|philippines|early Diagnosis

Objective: Antenatal steroids have shown to decrease the rate of neonatal complications and morbidity; however, neonates are predisposed to significant hypoglycemia resulting in invasive interventions and prolonged nursery admissions. The risk of hypoglycemia in the preterm has been well studied, but the association of antenatal steroids and hypoglycemia in preterm neonates has not been well explored. Thus, we sought to determine the association of antenatal steroids given to mothers who delivered prematurely and the development of neonatal hypoglycemia.

Methods: A cross-sectional study using chart review was done on mother-preterm neonate pairs admitted in the charity obstetrical ward of The University of Santo Tomas Hospital from January 1, 2018 to December 31, 2019. The subjects were mothers either given or not given antenatal steroids before preterm delivery and their respective neonates. The provision of antenatal steroids was the primary exposure, while neonatal hypoglycemia was the primary outcome. Measurement of association was done using odds ratios. Univariate and multivariate logistic regression analyses were done.

Results: Of the 69 preterm neonates included in the study, hypoglycemia was observed in 14 neonates, among which 8 neonates were exposed to antenatal steroids. After examining the association using Fisher's exact formula and controlling for potential confounders, neonatal hypoglycemia was not significantly higher among neonates exposed to antenatal steroids.

Conclusion: Antenatal steroids given to mothers who delivered preterm were not associated with the development of neonatal hypoglycemia. A prospective study model, larger population size and longer study coverage should be made to strengthen the outcome of the study.

BACKGROUND AND OBJECTIVES. Several reports have shown that coexistence of diabetes mellitus and COVID-19 is one of the risk factors for poor outcome and increased mortality. Rapid metabolic deterioration with development of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS) may result due to the acute insulin secretory capacity loss, stress condition and the cytokine storm. In this review, we aim to describe the prevalence of hyperglycemic crises(DKA/HHS) in patients with COVID-19 infection as well as their clinical outcomes. METHODS. An intensive search was done using the WebMD, PubMed, Medline and Google Scholar databases for articles published between December 2019 to October 2020 that identified the number of patients who developed DKA and/or HHS among those who were admitted for COVID-19. Their clinical outcomes were likewise described. RESULTS. This review included 4 articles in which individual quality was assessed. A total of 1282 patients were admitted for COVID-19 and the prevalence of DKA was 1.32%. HHS was not reported in any of the studies. Five (29.4%) of the patients with DKA and COVID-19 died and 12 (70.6%) recovered. CONCLUSIONS. A significant number of COVID-19 patients developed DKA and it is associated with a high mortality rate. This reimposes the need for an appropriate algorithm for the optimal management of concomitant COVID 19 and hyperglycemic crises to avoid morbidity and mortality. Additionally, there is paucity of large-scale studies describing the prevalence of DKA/HHS in patients with COVID-19.
Diabetic Ketoacidosis ; COVID-19 ; Water-Electrolyte Imbalance ; Acid-Base Imbalance ; Coma

Background: The overall increase in the number of people with diabetes mellitus has a major impact on the increasing number of patients with diabetic kidney disease (DKD). Hypoglycemia that is brought about by altered glucose homeostasis and the hemodialysis process in patients with DKD poses a great challenge to clinicians in achieving blood glucose control. This study has been undertaken to evaluate the prevalence of hypoglycemia among diabetics undergoing hemodialysis and determine the clinical factors predicting the development of hypoglycemia. Methods: We conducted a prospective, cross-sectional study that included 75 patients with diabetes mellitus undergoing maintenance hemodialysis at the University of Santo Tomas Hospital, Center for Kidney Disease. The patients’ predialysis and hourly intradialytic serum glucose levels were measured until the end of the session. Hypoglycemia was considered as a blood glucose ≤70 mg/dL with/without symptoms. Results: Elderly patients and in-hospital patients tend to develop hypoglycemia with a p-value of 0.0028 and 0.001, respectively. Old age (p-value 0.0093), female sex (p-value 0.0224), hypertension (p-value 0.0301), CAD (p-value 0.0058), frequency of hemodialysis (p-value 0.0000), no caloric intake during the dialysis session (p-value 0.0022) and admission (p-value 0.0007) predicted hypoglycemia in our study Conclusions In conclusion, the prevalence of hypoglycemia among patients with type 2 diabetes mellitus undergoing maintenance hemodialysis in our setting is 12%. There is an increased rate of hypoglycemia amongst the elderly as well as admitted patients. Our results identifi ed old age, presence of CAD, increased frequency of hemodialysis and hospital admission as the predictors of hypoglycemia.
Renal Dialysis ; Hypoglycemia ; Kidney Failure, Chronic

Objective: Games promoting nutrition education are helpful tools to improve nutrition knowledge. Healthy Foodie is an interactive web-based nutrition game for Filipino children. This study aimed to determine the effectiveness of Healthy Foodie on the nutrition knowledge of children aged 7 to 10 years old. Methodology: This study had 2 phases. In Phase 1, we developed and validated the Healthy Foodie nutrition game application and Nutrition Knowledge Questionnaire involving 46 participants. The Nutrition Knowledge Questionnaire was divided into 2 15-item questionnaires: Part 1 pertained to Food Group Knowledge and Part 2 on Food Frequency Knowledge. Phase 2 was the implementation of the game and questionnaire. This was a randomized controlled trial conducted in two elementary schools in Manila, involving 360 participants divided equally into control and experimental groups. Results: For Phase 1, internal consistency of the questionnaire using the Kuder-Richardson Formula 20 was 0.75 for part 1 and 0.70 for Part 2. In Phase 2, comparing the adjusted posttest mean Food Group Knowledge scores, there was statistically higher score (F=111.84, p=0.0001) in the experimental group (11.57±0.20) compared to the control (8.51±0.20). In the adjusted posttest mean Food Frequency Knowledge scores, there was a statistically higher score (F=56.12, p=0.0001) in the experimental group (10.70±0.15) compared to the control (9.07±0.15). Conclusion A nutrition game-based intervention such as Healthy Foodie is effective as a reinforcement intervention to previous standard nutrition education of school-aged children
Health Education ; Video Games