Glycemic gap as a predictor of adverse outcomes in patients with Type 2 Diabetes Diagnosed with COVID-19 in a tertiary hospital in Metro Manila: A retrospective cohort study

Background@#Although elevated glucose levels are associated with adverse outcomes in the critically ill, HbA1c-based adjusted glycemic variables have not been extensively utilized as a tool to evaluate patients in the acute critical condition.@*Objective@#This study aims to determine whether glycemic gap can predict adverse outcomes in patients with type 2 diabetes diagnosed with COVID-19.@*Methodology@# A single center and retrospective study of adult patients with type 2 diabetes diagnosed with COVID- 19. Glycemic gap was calculated as the difference between the admission blood glucose and A1c‐derived average glucose. Logistic regression was used to determine association of glycemic gap and several adverse clinical outcomes. A decision curve analysis was used to determine the clinical utility of a clinical decision model based on this cut-off.@*Results@#A total of 150 diabetic patients with COVID-19 were analyzed. Median baseline HbA1c was 7.5% (range 4.79–18.42), while median admitting blood glucose was 196 (range 71–506) mg/dL. From these, computed glycemic gaps ranged from -180.5 to 312.8 mg/dL, with a median of 13.75 mg/dL. On univariate analysis, for every unit increase in glycemic gap, odds of developing ARDS increased five times (cOR 4.798, 95% CI 2.08 to 11.09); odds of developing shock increased four times (cOR 4.48, 95% CI 1.48 to 13.44). No single cut-off value for glycemic gap was able to discriminate patients with favorable outcome from those with adverse outcome. The decision curve analysis graphically shows that glycemic gap has a positive net benefit for threshold risk of 50% or higher.@*Conclusion@#Higher glycemic gaps were significantly associated with increased risk for poor outcomes in diabetic patients with COVID-19. Glycemic gap should be correlated with clinical status and other laboratory parameters to make it a more powerful discriminant among COVID-19 infected patients.

Post-operative complications of Trans-Sphenoidal surgery in a local tertiary hospital during hospital stay

Introduction@#Endoscopic trans-sphenoidal surgeries are mainly the procedure of choice in pituitary adenomas with favorable results and varied outcomes arise from these techniques. The study aims to report the postoperative complications, and if these complications may have an impact on hospital stay.@*Methods@#This is a retrospective cross-sectional study. 47 patients were involved ages 19 years old and above who had trans-sphenoidal surgery (TSS) from January 2011 to December 2016. Data collected were focused on preoperative diagnosis and post-operative complications (prolonged intubation, post-operative vomiting, CSF leak, post-operative bleeding, adrenal insufficiency, diabetes insipidus, electrolyte imbalance). Chi-square and independent T-tests were used in this study.@*Results@#Most of the cases reported were nonfunctioning pituitary macroadenoma, prolactinoma and acromegaly. The study showed that the average length of stay of a patient who had undergone TSS is about seven days. Mean age of patients was 47 years old and 59% are males. The five most common complications while at hospital stay were headache (46%), throat irritation (38%), electrolyte imbalance (27%), SIRS (25%), and diabetes insipidus (10%). No sufficient evidence was appreciated with these complications comparing to the length of hospital stay.@*Conclusion@#Headache is the most common complication of post TSS. Comparing post-operative complications, it did not dictate the length of hospital stay.

Prevalence of elevated TSH and its association with dyslipidemia and NAFLD among Filipino adult executive check-up patients in a tertiary hospital

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> The study examined the prevalence of elevated thyroid stimulating hormone (TSH) and its association with dyslipidemia and non-alcoholic fatty liver disease (NAFLD) among Filipino adults undergoing executive check-up.</p><p style="text-align: justify;"><strong>METHODS:</strong> Clinical characteristics such as age, vital signs, anthropometrics, FBS, lipid profile, liver function tests, TSH and hepatobiliary ultrasound were reviewed from the charts of 580 patients to determine the prevalence of elevated TSH, NAFLD, and dyslipidemia. Binary logistic regression analysis was performed to determine association between TSH levels, NAFLD, and dyslipidemia.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The prevalence of elevated TSH was 3.10%. Patients with increased total cholesterol was approximately 4.18 times as likely (95% CI 1.20 to 14.61%, p = 0.025) to have elevated TSH. However, after adjusting for age and sex, we had insufficient evidence to demonstrate an association between NAFLD and lipid levels with elevated TSH levels.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The prevalence of elevated TSH in this group of patients from a highly urbanized area was 3.1%. We had insufficient evidence to demonstrate an association between NAFLD, lipid levels, and elevated TSH levels after adjusting for age and sex.</p>

Prevalence of elevated TSH and its association with dyslipidemia and NAFLD among Filipino adult executive check-up patients in a tertiary hospital

OBJECTIVES: The study examined the prevalence of elevated thyroid stimulating hormone (TSH) and its association with dyslipidemia and non-alcoholic fatty liver disease (NAFLD) among Filipino adults undergoing executive check-up.METHODS: Clinical characteristics such as age, vital signs, anthropometrics, FBS, lipid profile, liver function tests, TSH and hepatobiliary ultrasound were reviewed from the charts of 580 patients to determine the prevalence of elevated TSH, NAFLD, and dyslipidemia. Binary logistic regression analysis was performed to determine association between TSH levels, NAFLD, and dyslipidemia.RESULTS: The prevalence of elevated TSH was 3.10%. Patients with increased total cholesterol was approximately 4.18 times as likely (95% CI 1.20 to 14.61%, p = 0.025) to have elevated TSH. However, after adjusting for age and sex, we had insufficient evidence to demonstrate an association between NAFLD and lipid levels with elevated TSH levels.CONCLUSION: The prevalence of elevated TSH in this group of patients from a highly urbanized area was 3.1%. We had insufficient evidence to demonstrate an association between NAFLD, lipid levels, and elevated TSH levels after adjusting for age and sex.

Prevalence and risk factors for depression among Filipino adults with diabetes mellitus type 2 at the Makati Medical Center Outpatient Department

@#<p style="text-align: justify;"><strong>OBJECTIVE: </strong>To  determine  the  prevalence  of  depression  in  Filipino adult patients with type 2 diabetes mellitus (DM) and the risk factors associated in its development.<br /><strong>METHODS: </strong>This  is  a  prospective  cross-sectional  study.  Adult  patients (age 19 and above) with type 2 DM being seen at the outpatient department of the Makati Medical Center from  January  to  March  2015  were  included,  taking  into account  the  following:  age,  gender,  marital  status,  body  mass index, waist circumference, blood pressure, duration of  diabetes,  presence  of  other  co-morbid  illnesses,  pill  burden,  insulin  use,  educational  attainment,  employment  status,  family  income,  and  glycemic  status.    They  were  then screened for depression using the standardized PHQ-9 questionnaire. Bivariate analyses through Chi-square Test (for categorical variables) and Analysis of Variance (for interval/ratio variables) were used to determine which among the risk factors are significant for the development of depression.  Significant  risk  factors  were  treated  for  multivariate  and  univariate analyses through ordinal logistic regression.<br /><strong>RESULTS: </strong>A  total  of  110  adult  patients  with  type  2  DM  were  enrolled  in  this  study.  There  were  no  drop-outs.  Sixty-nine percent  of  the  patients  had  none  to  minimal  depression,  24% had mild depression, and 7% had moderate depression. None  of  the  patients  had  depression  that  warranted  anti-depressants  or  psychotherapy.   After  step-wise  analysis, increased  BMI,  elevated  diastolic  blood  pressure  and  uncontrolled blood sugar were found to be associated with higher  PHQ-9  scores  while  unemployment  was  associated with decreased PHQ-9 score.<br /><strong>CONCLUSION: </strong>The  prevalence  of  depression  among  Filipino type  2  diabetic  patients  is  higher  than  in  non-diabetic  patients. Being obese, having an elevated diastolic blood pressure, and the presence of uncontrolled blood sugar were significant predictors and were associated with an increased likelihood  of  developing  major  depressive  disorder. Being unemployed appears to have the opposite effect.</p>

Prevalence and risk factors for depression among Filipino adults with diabetes mellitus type 2 at the Makati Medical Center Outpatient Department

OBJECTIVE: To  determine  the  prevalence  of  depression  in  Filipino adult patients with type 2 diabetes mellitus (DM) and the risk factors associated in its development.METHODS: This  is  a  prospective  cross-sectional  study.  Adult  patients (age 19 and above) with type 2 DM being seen at the outpatient department of the Makati Medical Center from  January  to  March  2015  were  included,  taking  into account  the  following:  age,  gender,  marital  status,  body  mass index, waist circumference, blood pressure, duration of  diabetes,  presence  of  other  co-morbid  illnesses,  pill  burden,  insulin  use,  educational  attainment,  employment  status,  family  income,  and  glycemic  status.    They  were  then screened for depression using the standardized PHQ-9 questionnaire. Bivariate analyses through Chi-square Test (for categorical variables) and Analysis of Variance (for interval/ratio variables) were used to determine which among the risk factors are significant for the development of depression.  Significant  risk  factors  were  treated  for  multivariate  and  univariate analyses through ordinal logistic regression.RESULTS: A  total  of  110  adult  patients  with  type  2  DM  were  enrolled  in  this  study.  There  were  no  drop-outs.  Sixty-nine percent  of  the  patients  had  none  to  minimal  depression,  24% had mild depression, and 7% had moderate depression. None  of  the  patients  had  depression  that  warranted  anti-depressants  or  psychotherapy.   After  step-wise  analysis, increased  BMI,  elevated  diastolic  blood  pressure  and  uncontrolled blood sugar were found to be associated with higher  PHQ-9  scores  while  unemployment  was  associated with decreased PHQ-9 score.CONCLUSION: The  prevalence  of  depression  among  Filipino type  2  diabetic  patients  is  higher  than  in  non-diabetic  patients. Being obese, having an elevated diastolic blood pressure, and the presence of uncontrolled blood sugar were significant predictors and were associated with an increased likelihood  of  developing  major  depressive  disorder. Being unemployed appears to have the opposite effect.