A case report on SMART-EST action plan with lifestyle medicine approach in the non-pharmacologic management of the metabolic syndrome

@#Obesity and overweight are considered health risks for non-communicable diseases. Most clinical practice guidelines suggest lifestyle modification as the primary management and as an adjunct to pharmacologic treatment. Using the SMART-EST goaloriented action plan and lifestyle medicine may improve weight reduction outcomes. The case presented had clinical criteria (3/5) for metabolic syndrome, diagnosed previously as obese stage II, asthma moderately uncontrolled, prediabetes, and mild dyslipidemia. Baseline weight and waist-to-hip ratio were taken and interpreted as obese stage II with a very severe risk for comorbidity. The diagnostics used were fasting plasma glucose, lipid profile, HbA1c, and 2-D echocardiography on the eight months of intervention only. Using the SMART-EST action plan plus Lifestyle medicine approaches as non-pharmacologic management for metabolic syndrome. There was an 11.4 % reduction in weight, improved fasting glucose, lipid profile, and 2-D echocardiography within the eight months of intervention.

Implementing lifestyle changes and diet- tracking APP in an obese male: A case report

@#Obesity is an epidemic and a major public health concern, with 800 million obese people worldwide and 27 million in the Philippines. Several guidelines have recommended that all adults be screened for obesity and that obese patients be offered intensive, multi-component behavioral interventions. Barriers to addressing obesity include insufficient time during visits, a lack of available referral services, the perception that patients will not be willing or able to make lifestyle changes, poor reimbursement for nutrition and weight-management counseling, a reluctance to discuss weight among physicians, and uncertainty about whether interventions will have a positive impact. Lifestyle medicine interventions and smartphone diet-tracking apps may help individuals lose weight, manage chronic conditions, and understand dietary patterns. This is a case report of a 31-year-old obese Filipino male who sought consultation at the Health and Lifestyle Institute with a complaint of 11 kg of weight gain over the past 4 years. He had previously been diagnosed with Hodgkin’s lymphoma and had previously undergone chemotherapy and radiation therapy. He was currently working as a resident physician at a private institution. He considered himself physically active and was thus concerned with his gradual weight gain and the resultant decrease in body image, as well as his overall health. A detailed history and physical examination were done, as were the examinations of the six pillars of lifestyle medicine, namely, diet, exercise, sleep, stress, relationships, and substance use. The GAD 7 and PHQ 9 screening questionnaires were given. Lifestyle prescription and setting of goals were then done, and the patient was followed up at a 4-month interval. On all visits, body fat analysis using a Karada scan was done, and the results were discussed with the patient. On the second follow-up consult, the patient reported the usefulness of a diet-tracking application he found called Lifesum. The patient lost a total of 13 kg and improved his overall sense of well-being.

“Lifestyle Redo” managing dyslipidemia as risk factor for cardiovascular disease in adults through lifestyle intervention

Background@#Cardiovascular disease (CVD) is a leading cause of death around the world including the Philippines. Dyslipidemia and lifestyle have been considered as important modifiable risk factors. Experts in the Philippines have recommended that among individuals with dyslipidemia, lifestyle modification should be advised regardless of their present condition or risk profile. However, a key limitation of the most recent guidelines is the lack of studies on lifestyle interventions involving Filipinos.@*Objective@#This study aimed to provide preliminary evidence for the use of a lifestyle medicine intervention program in the management of dyslipidemia as risk factor for cardiovascular disease.@*Methods@#This study employed a mixed method of quantitative and qualitative research designs. The tools used were selfadministered questionnaires, collecting and examining documents. Measures to improve validity in qualitative studies have also been employed such as respondent validation and rival explanation. Triangulation with the findings from the other qualitative methodologies was also employed. Ethical approval was granted.@*Results@#The first part of the study has a total of 66 participants who underwent a lifestyle intervention program in a single clinic, comprising of 26 male and 40 female subjects were selected through convenient sampling method. Around 50% of the participants were 40-59 years old, 42.4% were 30-39 years old, and only 7.6% were 60-89 years old. The knowledge of the respondents had an overall mean of 7.73 (SD=1.16) which is interpreted as high knowledge. The attitude of the respondents had a mean of 3.58 (SD=0.50) which is interpreted as very positive. The respondents also had a good lifestyle practice with overall mean of 2.76 (SD=0.49). The second part of the study consisted of eight participants with 3 males and 5 females who were chosen through purposive sampling. All participants experienced reduction of their LDL-C and total cholesterol levels after the 12-week lifestyle intervention. Two participants had increased triglyceride levels. The select group also showed reduction in the blood glucose levels and body mass index.@*Conclusion@#This study revealed that participants had good knowledge and attitude regarding cardiovascular diseases and its risk factors. Yet, there is still a high number of those who do not efficiently practice healthy lifestyle and diet. Additional information should be extracted to establish the dietary intake of participants which contributed to the increase in triglyceride levels of some select participants.

Alcohol, coronary artery disease with myocardial infraction, lifestyle medicine: A case study

@#This 63 year old, heavy drinker, previous smoker man, was physically active, a community leader and with good sleeping habits. His diet: processed foods and drinks, meat, poultry products; minimal fruits and vegetables added about a year earlier. Two weeks prior, after drinking alcohol, he experienced progressive difficulty of breathing on physical exertion, relieved by rest. The night before the incident he had a drinking spree. Early morning, he had severe shortness of breath, difficulty of breathing and chest heaviness. He was rushed to the nearby hospital, was admitted at the ICU with the diagnosis of Ischemic Heart Disease with Myocardial Infarction, and, Type 2 Diabetes. The diagnosis was sustained and the management continued upon transfer to a better-equipped hospital. Strict nutritional prescription was introduced and early ambulation started while still in the hospital. His medications were steeply tapered off while lifestyle modification intensified. His progress was extraordinary. This case exemplified the havoc of heavy alcohol drinking, and, its uneventful cold turkey abstinence; favored early ambulation post myocardial infarction, and showed the independence of each CVD risk factor. Is intensive Lifestyle Modification safe and beneficial even in morbid situations?

Cultural stress: The undiagnosed epidemic of our time / 中西医结合学报

Global technologies that have made the world more interconnected have also, inadvertently, amplified the forces of stress that are now with us 24 hours a day, 7 days a week. The accumulated impact of this stress I call cultural stress anxiety syndrome and call on integrative medicine practitioners to recognize that it is exacerbating whatever acute stressors are also present in our patients' lives. In this Commentary, I outline seven major components of cultural stress (time pressure, digital intrusion, digital dependency, isolation, sedentary lifestyle, poor sleep and uncertainty), describe their health consequences, and finally, offer cultural stress-specific remedies I have utilized in my own practice, along with studies that affirm their efficacy. My hope is that we, as integrative medicine practitioners who are cognizant of the role that stress plays in disease development, will more fully appreciate the added impact of cultural stress, and advise our patients on the importance of proactive stress management. Please cite this article as: Murad H. Cultural stress: the undiagnosed epidemic of our time. J Integr Med. 2023; 21(3): 221-225.

Pico de Massa Óssea e Níveis de Exercício Físico em Estudantes Universitários / Peak Bone Mass and Exercise Levels: Comparison between Physical Education and Medical Students

Introdução: Promover um adequado pico de massa óssea (PMO) é uma estratégia de prevenção para a osteoporose. Os estudantes universitários estão em idade de aquisição de massa óssea suscetível à influência dos hábitos do estilo de vida, incluindo a prática de exercícios físicos. Assim sendo, este estudo objetivou avaliar a massa óssea em universitários com diferentes estilos de vida. Métodos: Foram avaliados 142 estudantes, sendo 74 de Medicina (MED) e 68 de Educação Física (EF), com idade média de 22 anos. As variáveis do estudo foram obtidas por meio de anamnese densitométrica. A densidade mineral óssea (DMO) da coluna lombar, corpo inteiro, colo do fêmur e fêmur total foi medida por absorciometria de dupla emissão de raios X. Resultados: Não houve diferenças em relação à idade, sexo, IMC e ingestão de cálcio entre os grupos. Os estudantes de EF praticam mais exercícios que os de MED (481 vs. 128 min/semana). A frequência de exercício físico suficiente (> 150 min/semana) foi maior no grupo EF (91,2% vs. 40,5%; p <0,01). Exercícios que influenciam a DMO foram mais frequentes entre os estudantes de EF (91,2% vs. 63,5%; p <0,01). Baixo PMO foi mais frequente no grupo MED (52,7 vs. 14,7; p<0,01). Observou-se correlação positiva entre a quantidade semanal de exercício físico e DMO. Conclusão: Maiores taxas de prática de exercícios físicos foram associadas com melhor PMO em estudantes do curso de Educação Física.

Introduction: Promoting adequate peak bone mass (PBM) is a prevention strategy for osteoporosis. College students are at the age of bone mass acquisition susceptible to the influence of lifestyle habits, including exercise. Therefore, this study aimed to evaluate bone mass in college students with different lifestyles. Methods: We evaluated 142 students, 74 from Medicine (MED) and 68 from Physical Education (PE), with a mean age of 22 years. The study variables were obtained by densitometric anamnesis. Bone mineral density (BMD) of the lumbar spine, whole body, femoral neck, and total femur was measured by dual emission X-ray absorptiometry. Results: There were no differences in age, gender, BMI, and calcium intake between the groups. PE students exercised more than MED students (481 vs. 128 min/week). The frequency of sufficient exercise (> 150 min/week) was higher in the EF group (91.2% vs. 40.5%; p <0.01). Exercise influencing BMD was more frequent among EF students (91.2% vs. 63.5%; p <0.01). Low PBM was more frequent in the MED group (52.7 vs. 14.7; p<0.01). The study showed a positive correlation between the weekly amount of exercise and BMD. Conclusion: Higher exercise rates were associated with better PBM in physical education students.

Perfil clínico de pacientes atendidos con diabetes mellitus tipo 2 en un programa de reversión / Clinical Profile Trial Of Patients Cared With Diabetes Mellitus Type 2 In A Reversion Program

La diabetes es una enfermedad crónica que aparece cuando el páncreas no produce insulina suficiente o cuando el organismo no utiliza eficazmente la insulina que produce. La insulina es una hormona que regula el azúcar en la sangre. El efecto de la diabetes no controlada es la hiperglucemia (aumento del azúcar en la sangre), que con el tiempo daña gravemente muchos órganos y sistemas, especialmente los nervios y los vasos sanguíneos.

Diabetes is a chronic disease that appears when the pancreas does not produce enough insulin or when the body does not use the insulin it produces effectively. Insulin is a hormone that regulates blood sugar. The effect of uncontrolled diabetes is hyperglycemia (increased blood sugar), which over time severely damages many organs and systems, especially nerves and blood vessels.

Consumo de tabaco y Neoplasia Intraepitelial Cervical / Tobacco Use And Cervical Intraepithelial Neoplasia

Objetivo: Determinar el efecto del consumo de tabaco en el desarrollo de neoplasia intraepitelial cervical en mujeres. Métodos: Se realizó una revisión sistemática. Se realizó la búsqueda electrónica, utilizando la pregunta de investigación: ¿Cuál es la asociación entre el tabaquismo y el desarrollo de neoplasia intraepitelial cervical? cuya pregunta PEO fue: Población: Mujeres. Exposición: Uso de tabaco. Resultado: Neoplasia intraepitelial cervical. Se seleccionaron los artículos publicados desde el 1 de enero de 2014 hasta diciembre de 2019. Resultados: Se encontraron 71 artículos, de los cuales 55 fueron excluidos por no cumplir con los criterios de selección, quedando 16 artículos para el análisis de este artículo. Aquellas mujeres que consumían tabaco tenían una asociación significativa para el desarrollo de neoplasia intraepitelial de alto grado (OR = 1,43, IC del 95% = 1,14-1,80). Asimismo, se observó asociación entre el tabaquismo severo y el uso de anticonceptivos orales, con mayor riesgo de neoplasia intraepitelial grado II y III (OR = 11,5; IC 95%, 1,88-70,40). Conclusión: La evidencia disponible sugiere la asociación entre el consumo de tabaco y el desarrollo de neoplasia intraepitelial cervical, particularmente lesiones intraepiteliales cervicales de alto grado.

Objective: To determine the effect of tobacco consumption with the development in women of cervical intraepithelial neoplasia. Methods: A systematic review was conducted. The electronic search was carried out, using the research question: What is the association between smoking and the development of cervical intraepithelial neoplasia? whose PEO question was: Population: Women. Exposure: Tobacco use. Outcome: Cervical intraepithelial neoplasia. Articles published from January 1, 2014 to December 2019 were selected. Results: 71 articles were found, 55 being excluded because they did not meet the selection criteria, leaving 16 articles for this paper analysis. Those women who smoked tobacco had a significant association for the development of high-grade intraepithelial neoplasia (OR = 1.43, 95% CI = 1.14-1.80). Likewise, synergy was observed between severe smoking and the use of oral contraceptives, with a greater risk of grade II and III intraepithelial neoplasia (OR = 11.5; 95% CI, 1.88-70.40). Conclusion: The available evidence suggests the association between tobacco use and the development of cervical intraepithelial neoplasia, particularly high-grade cervical intraepithelial lesions.

Estudio de Factibilidad para Evaluar la Proporción de Cáncer Atribuible a Factores de Riesgo Modificables en el Perú y Latinoamérica / Feasibility Study To Evaluate The Proportion Of Cancer Attributable To Modifiable Factors Of Risk In Peru And Latin America

Objetivo: Evaluar la factibilidad y validar de la propuesta metodológica para estimar la incidencia y mortalidad por cáncer atribuible a factores de riesgo modificables para el Perú y Latinoamérica. Métodos: Estudio piloto, ecológico a partir de fuentes secundarias. Se buscó y seleccionó los factores de riesgo modificables, prevalencia de exposicion, los riesgos relativos de dichos factores (RR) o una aproximación mediante la razón de posibilidades (OR). La información fue consignada en una ficha de recolección de datos la cual fue validada mediante juicio de expertos. Para el cálculo de la Fracción Atribuible Poblacional (FAP) se ensayó la fórmula planteada por Parkin y se desarrolló un modelo de simulación estadística con el software R. Studio V. 3.6.1. Resultados: En el Perú se cuenta con estudios de prevalencia para la mayoría de factores de riesgo modificables; asimismo, se dispone en Latinoamérica de estudios con estimaciones de OR para varios de los factores; sin embargo hubo que utilizar estudios de los Estados Unidos para los factores restantes. No hallamos estudios nacionales de radiaciones ionizantes ni ultravioleta. Se ensayó la sintaxis del modelo de simulación estadística la cual mostró ser válida y consistente con los resultados de estudios internacionales de FAP encontrándose dentro de los rangos de los estudios publicados. Conclusión: Es factible y viable realizar estudios de FAP de factores de riesgo modificables para cáncer en países de Latinoamérica, particularmente en el Perú, donde se cuenta con la información requerida para su estimación.

Objective: To evaluate the feasibility of the methodological proposal to estimate the incidence and mortality due to cancer attributable to modifiable risk factors for Peru and Latin America. Methods: Pilot study, ecological from secondary sources. Modifiable risk factors, exposure prevalence, relative risks of these factors (RR) or an approximation by means of possibilities ratio (OR) were searched and selected. The information was recorded in a data collection form which was validated by expert judgment. For the calculation of the Population Attributable Fraction (FAP), the formula proposed by Parkin was tested and a statistical simulation model was developed with R. Studio V. 3.6.1 software. Results: In Peru there are prevalence studies for the majority of modifiable risk factors; Likewise, studies with OR estimates for several of the factors are available in Latin America; however, studies from the United States had to be used for the remaining factors. No national studies of ionizing or ultraviolet radiation were found. The syntax of the statistical simulation model was tested, which proved to be valid and consistent with the results of international FAP studies within the ranges of published studies. Conclusion: It is feasible and viable to carry out PAF studies of modifiable risk factors for cancer in Latin American countries, particularly in Peru, where the information required for its estimation is available.

Consumo de alcohol como factor asociado a la depresión en estudiantes varones de medicina humana de la universidad Ricardo Palma del año 2018 / Alcohol consumption as a factor associated with depression in students of human medicine of the Ricardo Palma university of the year 2018

Objetivo: Determinar si el consumo de alcohol es un factor asociado a la depresión en estudiantes de medicina varones de la Universidad Privada Ricardo Palma del Ciclo II (agosto-diciembre) del año 2018. Métodos: Estudio de tipo no experimental, analítico, transversal, descriptivo, correlacional en la Facultad de Medicina Humana de la Universidad Ricardo Palma, durante el año académico 2018. Una encuesta y un Test validado realizaron a 200 estudiantes varones luego de su consentimiento informado: El Test validado de auto-evaluación de rasgos depresivos de Zung. que consta de 20 preguntas que nos ayudan a determinar el estado depresivo según los criterios diagnósticos CIE-10 y DSM IV. Resultados: Se encuestaron a 200 estudiantes varones. El 67.5% de los estudiantes tienen entre 18 a 22 años. El 70% de los estudiantes rara vez consume alcohol, y el 9% de los estudiantes consume alcohol 2 a 6 veces por semana, el 48.5% de los estudiantes presenta depresión leve y el 3% de los estudiantes presenta depresión grave , en el grupo de estudiantes que tienen depresión grave el 50% consume alcohol 2 veces a la semana, en la prueba de Chi Cuadrado el valor p (p= 0.000), que permiten establecer que existe relación significativa entre el consumo de alcohol y la depresión en los estudiantes varones, Finalmente se encontró que el Odd Ratio (OR=9.4) para el Consumo de Alcohol establece que los estudiantes varones que consumen más de 1 vez por semana alcohol tienen 9.444 mayor riesgo de presentar Depresión que los estudiantes varones que consumen alcohol 1 vez a la semana o menos. Conclusión: El consumo de alcohol es un factor de riesgo asociado a la depresión en los estudiantes varones de la Facultad de Medicina de la Universidad Ricardo Palma.

Objective: To determine whether alcohol consumption is a factor associated with depression in male medicine students at the Ricardo Palma del Ciclo II Private University (August-December) in 2018. Methods: Non-experimental, analytical, transversal, descriptive, correlational in the Faculty of Human Medicine of the Ricardo Palma University, during the academic year 2018. A survey and a validated test carried out 200 male students after their informed consent: The validated test of self-evaluation of depressive features of Zung. which consists of 20 questions that help us determine the depressive state according to the diagnostic criteria ICD-10 and DSM IV. Results: 200 male students were surveyed. 67.5% of students are between 18 and 22 years old. 70% of students rarely consume alcohol, and 9% of students consume alcohol 2 to 6 times a week, 48.5% of students have mild depression and 3% of students have severe depression, in the group of students who have severe depression, 50% consume alcohol twice a week, in the Chi-square test the p-value (p = 0.000), which allows establishing that there is a significant relationship between alcohol consumption and depression in students Finally, it was found that the Odd Ratio (OR = 9.4) for Alcohol Consumption establishes that male students who consume alcohol more than once a week have 9,444 higher risk of developing depression than male students who consume alcohol 1 time a the week or less. Conclusion: Alcohol consumption is a risk factor associated with depression in male students of the Faculty of Medicine of the Ricardo Palma University.