Coexisting non-functioning pituitary macroadenoma and sellar-suprasellar lipoma: A case report and literature review

@#Intracranial lipomas are benign tumors that may occasionally be found in the suprasellar cistern while pituitary adenomas are far more common brain tumors. Pituitary adenomas may rarely coexist with other intracranial tumors in the sellar-suprasellar region. We share a unique case of a patient with coexisting non-functioning pituitary adenoma and sellar-suprasellar lipoma presenting with blurring of vision. We report a 55-year-old male presenting with a two-year history of blurring of vision with findings of a 2.7 x 3.0 x 3.2 cm homogeneously enhancing lobulated isointense mass on the sellar-suprasellar region. Hormonal workups revealed low cortisol and mildly elevated prolactin. He initially underwent endonasal transsphenoidal excision of the tumor which revealed to be a lipoma on histopathology. Due to minimal improvement of vision from the subtotal excision, he underwent repeat surgery through the transcranial approach which in turn showed a pituitary adenoma. The co-occurrence of two sellar-suprasellar tumors with different histology is rare, as most of the evidence is based on only a handful of case series. Intracranial lipomas result from persistence and abnormal differentiation of the meninx primitiva during the development of the subarachnoid cisterns. On the other hand, pituitary tumorigenesis is still largely unclear but appears to involve multiple tumor suppressor genes, oncogenes, cell cycle deregulation factors, and miRNAs. Given the differing pathogenesis of each tumor type, the coexistence may only be coincidental. The best surgical approach in this situation is unknown but the focus is on complete excision of the adenoma.

Does Adopting a Multidisciplinary Approach in the Management of Acute Hip Fractures in Orthopedic Geriatric Patients Lead to Better Outcomes? A Preliminary Report of the University of the Philippines - Philippine General Hospital (UP-PGH) Orthogeriat

@#OBJECTIVES: This study is a retrospective cohort that aims to describe the profile of orthopedic geriatric patients aged 60 years old and above with acute hip fractures occurring within one month of admission in the Philippine General Hospital managed by a multidisciplinary team approach. METHODS: Data collection from the database was done to gather information regarding the patient profile, time to surgery, causes for delay in consultation, length of hospital stay, and follow-up rate, since this model was implemented. RESULTS: Overall, we saw a decrease in the time from admission to surgery and a decrease in the length of hospital stay, when compared to previous data. Follow-up rates and compliance to maintenance medication are at 96% and 72% respectively. CONCLUSION: The implementation of a multidisciplinary approach and fracture liaison service presents us with favorable results in addressing hip fractures and osteoporosis.

Diabetes distress sources among Filipinos with type 2 diabetes mellitus in the outpatient department of a tertiary government hospital

@#<p style="text-align: justify;"><strong>Objective:</strong> The sources of diabetes distress, defined as hidden negative emotions from the demands of daily self-management, are unknown to Filipinos with type 2 diabetes mellitus in the outpatient department. Therefore, we aimed to 1) explore the sources of distress in the perspective of Filipinos with type 2 diabetes mellitus and 2) create a conceptual framework of diabetes distress for Filipinos with T2DM.</p><p style="text-align: justify;"><strong>Methods:</strong> Focus group discussions were done and audiotaped among Filipinos with type 2 diabetes (n=17). The transcript underwent content analysis to generate themes and subthemes. Relationships were determined between codes, categories, and themes elicited in the study to create a conceptual framework unique to Filipinos.</p><p style="text-align: justify;"><strong>Results:</strong> The content analysis revealed five themes of diabetes distress: caregiver factor, socio-economic factor, psycho-emotional factor, medication-related factor, and health care service delivery factor. The socio-economic factor was a distinct theme missing in the prevailing validated questionnaires. Therefore, an adapted conceptual framework was created, as approved by the expert panel.</p><p style="text-align: justify;"><strong>Conclusion:</strong> In conclusion, Filipinos with type 2 diabetes mellitus in the outpatient department have multiple sources of diabetes distress, namely, caregiver factor, socio-economic factor, psycho-emotional factor, medication-related factor, and health care service delivery factor. The socio-economic factor is a unique theme identified among Filipinos. Recognizing the sources of diabetes distress is vital to accurately screen Filipinos with type 2 diabetes mellitus and optimize management outcomes. The study findings will help develop and validate the questionnaire to screen diabetes distress unique to Filipinos.</p>

Association of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with diabetic kidney disease among adult patients with type 2 diabetes mellitus: A meta-analysis of observational studies

@#<p style="text-align: justify;"><strong>Objective:</strong> This meta-analysis aimed to evaluate the association of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) with the presence of diabetic kidney disease (DKD) among adult patients with Type 2 diabetes mellitus (T2DM).</p><p style="text-align: justify;"><strong>Methods:</strong> A systematic search of articles was performed in various databases. Studies must have fulfilled the following criteria for inclusion: 1) Randomized controlled trial or observational study; 2) Included adults diagnosed with T2DM; 3) Reported data associating NLR or PLR with the presence of DKD; and 4) Controlled for confounders using logistic regression. Data analysis was performed using Review Manager 5.4 software. The estimates were derived using the generic inverse variance method and pooled using the random effects model. Results were presented as odds ratios (OR) and standard errors (SE) with 95% confidence intervals (CI), and graphically shown as forest plots. The I2 value and Chi-square test were used to assess heterogeneity across studies.</p><p style="text-align: justify;"><strong>Results:</strong> Seven studies were included in the review, totaling 1,486 patients. All were cross-sectional studies and had satisfactory methodological quality as evaluated using the Newcastle-Ottawa Quality Assessment Scale. Pooled analysis from six studies showed a statistically significant association between increased NLR and the presence of DKD, defined as either the presence of albuminuria (95% CI, OR 1.68 [1.28, 2.19], p<0.01); or an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 (95% CI, OR 1.56 [1.09, 2.23], p=0.01). In both analyses, there was no significant heterogeneity across studies (I2=0%, Chi2=3.54; and I2=28%, Chi2=2.76 respectively). On the other hand, pooled analysis from two studies did not show a statistically significant association between PLR and albuminuria (95% CI, OR 1.75 [0.85, 3.60], p=0.13), although both studies were homogeneous (I2=0%, Chi2=0.57).</p><p style="text-align: justify;"><strong>Conclusion:</strong> We found a statistically significant association between increased NLR and the presence of DKD. However, a similar association was not found with PLR. Larger studies with more robust designs are recommended.</p>

Spleen Factor: The Spleen’s Role as a Respiratory Organ

@#The Bajaus’ ability to free dive for prolonged periods is attributed to their exceptional physiologic response and large spleens. The spleen has been traditionally viewed as a hematologic and immunologic organ. Unconventionally, this review explores the spleen’s role as a respiratory organ and how apnea training can enhance the spleen’s form and function. Eligible articles obtained from Pubmed were discussed. The selected studies have shown that an 8-week home-based apnea training regimen can enhance the spleen volume by as much as 24% and that prolonged apnea training can increase both splenic contraction and baseline serum hemoglobin levels. However, the sample size and heterogeneity of these studies largely limit the generalizability of these findings. Thus, several future studies are needed to further explore the spleen’s respiratory function in humans.

Relationship of average daily glycemic index and glycemic load with body mass Index among Filipinos in the rural setting

Introduction@#While the relationship between obesity and caloric intake is widely accepted, the role of glycemic index (GI) and glycemic load (GL) to body mass index (BMI) remains equivocal. This study seeks to determine the daily glycemic index (GI) and glycemic load (GL) of usual diet of rural-dwelling Filipinos, and their relationship with body mass index (BMI). @*Methods@#This is a cross-sectional study reviewing the data of 139 adults from San Juan, Batangas. Average daily GI and GL were calculated from two-day food recall questionnaires. Spearman’s rank test was used to determine correlation of daily GI and GL with BMI; the mean BMI was compared among GI and GL tertiles using one-way ANOVA. Partial least squares regression was used to determine the contribution of food items to daily GI and GL.@*Results@#No overall correlation was observed between daily GI or GL and BMI using Spearman’s rank. However, BMI was higher with increasing GI tertiles (p<0.0001) and GL tertiles (p=0.0108) among the males, but not females. Bread, coffeemix and sweets were major contributors to daily GI, while rice, bread/pastries and sweetened beverages were to daily GL. Leafy vegetables negatively contributed to both.@*Conclusion@#There is a positive relationship observed between daily GI and BMI, and daily GL and BMI among the men, but not women, in this population. Staple food with high GI like bread/pastries and sweetened beverages contributed most to both daily GI and GL, with the addition of rice for daily GL. Among Filipinos with marginal daily caloric intake, optimizing carbohydrate quality (low GI or GL) rather than limiting its quantity may be more appropriate. Future studies of prospective design and using objective methods of food intake reporting are recommended.

Cause of primary amenorrhea in a Filipina: The mayer-rokitansky-kuster-hauser syndrome (mullerian agenesis, congenital absence of the uterus and vagina)

Background: A rare case of Mayer-Rokitansky-Kuster-Hauser syndrome is reported here. A 26 year old Filipina with primary amenorrhea consults for inability to consummate sexual intercourse with a male partner. She is phenotypically female - has female secondary sexual characteristics, and has normal female external genitalia. There is a shallow vaginal dimple. Absence of the upper vagina and uterus has been demonstrated by transrectal ultrasound. Ultrasound and intravenous pyelography have documented the absence of the left kidney. Chromosomal analysis reveals a normal female karyotype (46, XX). Endocrine evaluation shows normal levels of estradiol, follicle-stimulating hormone and luteinizing hormone. Radiographs did not reveal any associated skeletal abnormalities. Aside from this being a rare case of a disorder of sexual development, this is worth reporting because it illustrates the diagnostic work-up of a patient presenting with primary amenorrhea.