A feasibility study on re-establishing the Bioavailability/Bioequivalence unit of the Department of Pharmacology and Toxicology, College of Medicine-University of the Philippines Manila

Objectives@#The Bioavailability/Bioequivalence Unit (BA/BE Unit) of the Department of Pharmacology and Toxicology, College of Medicine, University of the Philippines Manila which has not been operational since 2012, is due for renewal of its accreditation. To date, there are only three Philippine Food and Drug Administration-accredited laboratories that perform bioequivalence studies in the Philippines. One of the prerequisites of registering specific generic medicines is the conduct of Bioequivalence (BE) studies which are performed to ensure that the generic drug is at par with the innovator drug. Thus, this study aimed to determine the feasibility of re-establishing the BA/BE Unit as a bioequivalence testing center. @*Methods@#The feasibility study done is a qualitative descriptive analysis based on expansive literature review and performance of SWOT analysis within the BA/BE unit. Literatures were selected based on its assessed relevance to the study. The databases checked were PubMed and Google Scholar. The terms used were from the Medical Subject Heading (MeSH) including feasibility studies, therapeutic equivalency, and generic drugs. Literature review was performed on the factors affecting the four types of feasibility studies (market, technical, financial, and organizational). A SWOT analysis of the BA/BE Unit was done through the review of records and documents of previous BE studies and focus group discussion among the BA/BE Unit team members. @*Results@#The BA/BE Unit conducted 24 bioequivalence studies from 2006-2009 and still receives inquiries from drug companies. It implements its QMS throughout the pre-analytical, analytical, and post-analytical stages of the workflow. Its organizational structure consists of qualified professionals with updated GCP and GLP certificates. Because of the adequately equipped facility, lower honoraria for government-employed personnel, and lower expenses for laboratories and in-patient admissions, the cost of conducting a bioequivalence study in the BA/BE Unit will be lower than in other BE centers. @*Conclusion@#Based on the SWOT analysis and market, technical, financial, and organizational considerations, reestablishing the BA/BE Unit as a bioequivalence testing center is feasible.

The prevalence of metabolic syndrome among adult Filipinos with hypothyroidism: A retrospective cohort study

Background and Objective@#Dyslipidemia in hypothyroidism results from the effects of thyroid hormones on lipid metabolism. These, in combination with hypothyroidism-induced hemodynamic changes, are risk factors for cardiometabolic diseases. We determined the prevalence of metabolic syndrome (MS) among adult Filipinos with hypothyroidism and compared clinical and laboratory characteristics of those with versus without MS. @*Methods@#This is a retrospective study of 105 patients with biochemically confirmed hypothyroidism. A review of records obtained anthropometric measurements, blood pressure, fasting blood glucose, lipid profile, and thyroid hormones. Clinical and laboratory characteristics were then compared between MS and those without. Significant differences were determined by two-way ANOVA, while heterogeneity of categorical variables was determined by chi-square or Fisher exact test. All data analyses were performed using Stata version 17.0 with a significance level of p<0.05.@*Results@#The prevalence of MS is 36.19% (95%CI: 27.04%,46.15%). Body mass index (BMI) peaks at obese class I among those with MS. There is a significantly higher proportion of patients diagnosed to have diabetes (28.95% vs. 7.46%; p=0.003) and hypertension (52.63% vs. 14.93%; p<0.001) in the MS group. No significant differences were noted between groups regarding age, sex, etiology of hypothyroidism, blood pressure, fasting glucose, lipid profile, and thyroid hormone levels.@*Conclusion@#Our study showed that the prevalence of MS in adult Filipinos with hypothyroidism is increased at 36.19%. Only BMI, presence of diabetes, and hypertension were shown to be significantly higher. Emphasis must be placed on early screening among hypothyroid patients at high risk of developing MS. A prospective study using waist circumference and clinical and metabolic parameters is needed to validate these findings.

Risk factors associated with prolonged nasopharyngeal carriage of SARS-CoV-2 and length of stay among patients admitted to a COVID-19 referral center in Manila, Philippines

Objective@#Prolonged nasopharyngeal carriage of SARS-CoV-2 has been linked to prolonged hospital stay and delayed radiologic recovery. To determine if clinical risk factors are associated with prolonged nasopharyngeal carriage or longer hospital stay, we performed a descriptive analysis of 169 moderate to severe COVID-19 patients admitted at the Philippine General Hospital from March to June 2020.@*Methods@#Length of nasopharyngeal RT-PCR positivity and clinical demographic data were extracted from existing patient records. Chi-square test, Mann-Whitney U test, and regression analysis were performed to describe the association of clinical risk factors with prolonged nasopharyngeal carriage and length of hospital stay.@*Results@#The median duration of carriage was 19 days (IQR 12.0-30.0 days). No comorbidities or inflammatory markers had a statistically significant association with prolonged nasopharyngeal carriage defined as >24 days of nasopharyngeal RT-PCR positivity. Characteristics associated with a statistically significant longer hospital stay included chronic kidney disease stages 3-5, severe disease, and use of empiric antibiotics on admission. Prolonged carriage >24 days, hsCRP, and D-dimer at admission, also had a statistically significant but weak correlation with length of stay.@*Conclusion@#Among patients with moderate disease, comorbidities and inflammatory markers were not associated with prolonged COVID-19 nasopharyngeal carriage. Prolonged nasopharyngeal carriage >24 days was associated with longer hospital stay, while D-dimer and hsCRP levels at admission, also had statistically significant but small effects on increasing the hospital length of stay.

Prevalence of Metabolic Syndrome and specific cardiovascular risk factors among older persons in the Philippines: Results from the 8th Philippine National Nutrition Survey

Background@#Cardiovascular diseases are the leading causes of deaths among adults in the Philippines, and this is true also among older persons aged 60 years and above. Identification of risk factors and diseases that lead to cardiovascular mortality among the elderly is important to have an impact on longevity.@*Objective@#This study aimed to determine the prevalence of metabolic syndrome and specific cardiovascular risk factors among older persons in the Philippines.@*Methods@#A cross sectional design was used, with data taken from the results of the 8th Philippine National Nutrition Survey (NNS) Clinical and Health Survey done in 2013. Although there is a more recent survey, only the 2013 data is complete and available for secondary analyses.@*Results@#There were 1,835 older persons who were participants in the 8th Philippine NNS who had complete clinical data. The prevalence of Metabolic Syndrome was 52.6% in this population with the distribution of the components as follows: 33.5% have elevated waist circumference; 59.25 had elevated BP >130/85 mm Hg; 30.1% had fasting blood glucose ≥100 mg/dL (includes prediabetes and diabetes); 63% have low HDL, and 39% have elevated triglycerides ≥150 mg/dL. The results for other cardiovascular diseases and risk factors are as follows: 44% had hypertension using the criterion of the JNC VII report (BP ≥140/90 mm Hg); 85% had LDL cholesterol ≥100 mg/dL; 31% are current alcohol drinkers; 22% are current smokers; 53.7% have low physical activity; and 82% have an unhealthy diet.@*Conclusions@#Fifty-two percent (52%) of older Filipinos have metabolic syndrome and have a high prevalence of cardiovascular risk factors, foremost of which are elevated LDL-cholesterol at 85%, hypertension at 44% based on JNC VII, approximately 10% with diabetes mellitus, but with a double burden of overweight/obesity and undernutrition. This data can help plan for public health approaches to improve quality of life and increase longevity of Filipinos.

Critical Illness-Related Corticosteroid Insufficiency (CIRCI) among patients with refractory shock at a tertiary hospital: A look into clinical practices and patient outcomes

@#<p style="text-align: justify;"><strong>Introduction.</strong> A significant number of critically ill patients, as high as 60% among patients with septic shock, suffer from critical illness-related corticosteroid insufficiency (CIRCI), which refers to an inadequate corticosteroid response to the level of stress.</p><p style="text-align: justify;"><strong>Objectives.</strong> This study aimed to determine the strategies employed in managing patients with critical illness-related corticosteroid insufficiency and the outcomes of these patients at a tertiary hospital.</p><p style="text-align: justify;"><strong>Methods.</strong> This was a single-center, mixed-methods study which consisted of a review of charts of patients 19 years old and above admitted for shock or developed refractory hypotension from January 2017-December 2019, and key informant interviews and focus group discussion among clinicians who have experience in managing CIRCI.</p><p style="text-align: justify;"><strong>Results.</strong> A total number of 362 patient charts reviewed showed a relatively low rate of initiation of corticosteroids for patients with refractory shock, at just 28.57% of the entire population. After corticosteroids were initiated, patients were in shock for a median of just one day and the median blood pressure improved to 100/60 mm Hg. In this cohort, patients who were started on steroids had more severe illness, as measured by the Mortality Probability Model (MPM) score, which had a median of 43.65% for the group on steroids and just 25.0% for the non-steroid group (p ? 0.0001). Patients who were started on steroids had a statistically significant longer median days on a ventilator, 5 days vs. 3 days for the non-steroid group (p = 0.0297); longer median length of intensive care unit (ICU) stay, 8 days vs. 5 days for the non-steroid group (p = 0.0410), and a higher morbidity and mortality rate. The need for steroids, the presence of septic shock, and a higher MPM score were significant predictors of mortality.</p><p style="text-align: justify;">Discussions among clinicians revealed significant variability in practices in the management of CIRCI.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The presence of clinical features of CIRCI is a poor prognostic factor. Timely recognition, work-up, and interventions to address CIRCI are paramount in critical care.</p>

Quality of nutritional care assessment among critically-ill patients in a tertiary government hospital

@#<p style="text-align: justify;"><strong>Background and Objectives:</strong> Malnutrition is prevalent both at baseline admission and because of hospitalization. It is aggravated by adverse hospital practices and results in poor outcomes, reduced quality of life, and higher treatment costs. Improving quality of care involves nutritional intervention as a low-risk, cost-effective strategy which guides providers in improving practices systems-wise. This study aims to assess the quality of nutritional care and the nutritional status of critically- ill patients admitted in a low-resource setting.</p><p style="text-align: justify;"><strong>Materials and Methods:</strong> This is a mixed methods study among adults admitted in intensive care units (ICUs) of a tertiary government hospital. Anthropometric and biochemical indicators were obtained through chart review. The degree of malnutrition was assessed using the Subjective Global Assessment. Quality indicators under Donabedian domains were assessed and compared to current standards. The length of ICU stay and mortality rate were recorded. Dietary prescription and provision practices of healthcare providers were supplemented by a focus group discussion (FGD). Factors causing provision interruptions were also identified.</p><p style="text-align: justify;"><strong>Results and Discussion:</strong> Sixty-four ICU admissions were included. Staff-to-patient ratio was not ideal. Under process-related factors, out of 49% with actual anthropometric documentations (rest were estimates), 24% had normal body mass indices (BMI), 17% were underweight, and the rest were either overweight or obese. The baseline ICU malnutrition rate was 69%. Malnutrition screening, and assessment of risk and biochemical indicators were not done routinely. Majority (92%) had baseline dietary prescription but only 69% had specific energy and macronutrient breakdown, all done through predictive weight-based equations. Nutritional supplies arrived within 8 hours in 65% of patients. Feeding was initiated within 24-28 hours in 94% of patients. Commercial formula was the preferred type of enteral nutrition (EN). Total duration on nothing-by-mouth (NPO) (hours) throughout ICU stay was significant. Supportive measures to improve gastro-intestinal (GI) tolerance were not standardized. Common factors in delaying feeding initiation were hemodynamic instability, fasting for procedures and GI bleeding. Throughout the ICU stay, fasting for procedures, hemodynamic instability and mechanical ventilation (MV)-related factors were common. ICU mortality rate was 19% and average length of ICU stay was 5 days.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Malnutrition is still prevalent in our ICUs and is affected by suboptimal healthcare practices. Staff - to-patient ratios, malnutrition risk screening and assessment, dietary referrals, documentation and minimizing interruptions in nutritional care provision needs improvement. A system review and establishment of a nutrition team is imperative.</p>

Approach to lower the cardiovascular risk of individuals with Type 2 Diabetes Mellitus: Evidence-based consensus statements of the Philippine Heart Association and Philippine Society of Endocrinology Diabetes and Metabolism

@#Diabetes remains as the 6th leading cause of death in the Philippines, with more than 33,000 deaths in 2016. Given this alarming prevalence, it is imperative that this public health concern be prioritized in the country and to answer such concern, a group of cardiologists and endocrinologists who are in active clinical practice and research, formed a technical working group composed of five members. Their primary objective was to develop an evidence-based consensus document for Filipino healthcare practitioners and people in the academe that would serve as a guideline on the approach to lower the CV risk of individuals with T2DM. The TWG agreed on focusing with the pharmacological approach to treatment of lowering CV risk for T2DM patients using the ADAPTE model which is a more systematic approach to guideline adaptation. The recommendations were developed using the ADAPTE framework appraising all international practice guidelines and recommendations through to 2013. The technical working group’s overall objective of guideline adaptation is to take advantage of the existing guidelines to enhance the efficient production and use of high-quality adapted guidelines specially in the local Philippine setting. Each of these articles was then assessed using the AGREE instrument. Based on the key questions that the technical working group had identified regarding the approach to lower the risk of individuals with type 2 diabetes, 9 recommendations concerning the antidiabetic drug of choice for persons with type 2 diabetes with or without established ASCVD and management of type 2 diabetes mellitus patients with hypertension and dyslipidemia were drafted and are presented in this report.

Knowledge, Attitudes and Practices of Health Care Providers in the Philippine General Hospital towards In-Patient Hypoglycemia and its Management

@#Objectives. To determine the knowledge, attitudes and practices (KAP) of health care providers at the Philippine General Hospital towards hypoglycemia among non-critically ill patients using a validated, self-administered survey tool. Methods. This study covered two phases out of a three-phased project: (1) development and validation of a 43- item KAP survey tool and (2) assessment of KAP among nurses and residents using the tool. Phases 1 and 2 are analytic cross-sectional studies. Data for the KAP survey was collected using the developed tool and focused group discussions (FGDs). Results of this study will be the framework for Phase 3, which is the development of an in-patient hypoglycemia protocol. Results. The validated KAP survey tool yielded a low overall mean score of 12.56 ± 2.11 in the knowledge domain although high scores (4.88 ± 1) were noted for knowledge on management of hypoglycemia. In terms of attitude, majority (99.31%) of respondents believed that fewer hypoglycemia events correlates to better clinical outcomes and are willing to adopt a nurse-driven protocol. Most respondents (52.8%) employed correct practices in hypoglycemia management. The FGDs identified the perceived facilitators and barriers to hypoglycemia management. Conclusion. There is a gap in knowledge and practices in managing hypoglycemia among health care providers which needs to be addressed further with education and training. Nevertheless, health care providers have a positive attitude towards having a standard hypoglycemia protocol that will contribute greatly to its implementation in the clinical area.

Prevalence of metabolic syndrome and specific cardiovascular risk factors among older persons in the Philippines: Results from the 8th Philippine National Nutrition Survey

Background@#Cardiovascular diseases are the leading causes of deaths among adults in the Philippines, and this is true also among older persons aged 60 years and above. Identification of risk factors and diseases that lead to cardiovascular mortality among the elderly is important to have an impact on longevity. @*Objective@#This study aimed to determine the prevalence of metabolic syndrome and specific cardiovascular risk factors among older persons in the Philippines. @*Methods@#A cross sectional design was used, with data taken from the results of the 8th Philippine National Nutrition Survey (NNS) Clinical and Health Survey done in 2013. Although there is a more recent survey, only the 2013 data is complete and available for secondary analyses. @*Results@#There were 1,835 older persons who were participants in the 8th Philippine NNS who had complete clinical data. The prevalence of Metabolic Syndrome was 52.6% in this population with the distribution of the components as follows: 33.5% have elevated waist circumference; 59.25 had elevated BP >130/85 mm Hg; 30.1% had fasting blood glucose ≥100 mg/dL (includes prediabetes and diabetes); 63% have low HDL, and 39% have elevated triglycerides ≥150 mg/dL. The results for other cardiovascular diseases and risk factors are as follows: 44% had hypertension using the criterion of the JNC VII report (BP ≥140/90 mm Hg); 85% had LDL cholesterol ≥100 mg/dL; 31% are current alcohol drinkers; 22% are current smokers; 53.7% have low physical activity; and 82% have an unhealthy diet. @*Conclusions@#Fifty-two percent (52%) of older Filipinos have metabolic syndrome and have a high prevalence of cardiovascular risk factors, foremost of which are elevated LDL-cholesterol at 85%, hypertension at 44% based on JNC VII, approximately 10% with diabetes mellitus, but with a double burden of overweight/obesity and undernutrition. This data can help plan for public health approaches to improve quality of life and increase longevity of Filipinos.

Risk factors associated with prolonged Nasopharyngeal carriage of SARS-CoV-2 and length of stay among patients admitted to a COVID-19 referral center in Manila, Philippines

Objective@#Prolonged nasopharyngeal carriage of SARS-CoV-2 has been linked to prolonged hospital stay and delayed radiologic recovery. To determine if clinical risk factors are associated with prolonged nasopharyngeal carriage or longer hospital stay, we performed a descriptive analysis of 169 moderate to severe COVID-19 patients admitted at the Philippine General Hospital from March to June 2020. @*Methods@#Length of nasopharyngeal RT-PCR positivity and clinical demographic data were extracted from existing patient records. Chi-square test, Mann-Whitney U test, and regression analysis were performed to describe the association of clinical risk factors with prolonged nasopharyngeal carriage and length of hospital stay. @*Results@#The median duration of carriage was 19 days (IQR 12.0-30.0 days). No comorbidities or inflammatory markers had a statistically significant association with prolonged nasopharyngeal carriage defined as >24 days of nasopharyngeal RT-PCR positivity. Characteristics associated with a statistically significant longer hospital stay included chronic kidney disease stages 3-5, severe disease, and use of empiric antibiotics on admission. Prolonged carriage >24 days, hsCRP, and D-dimer at admission, also had a statistically significant but weak correlation with length of stay. @*Conclusion@#Among patients with moderate disease, comorbidities and inflammatory markers were not associated with prolonged COVID-19 nasopharyngeal carriage. Prolonged nasopharyngeal carriage >24 days was associated with longer hospital stay, while D-dimer and hsCRP levels at admission, also had statistically significant but small effects on increasing the hospital length of stay

Present Working Impression: Perspectives of Internal Medicine Resident Physicians in a COVID-19 Referral Hospital in Manila, Philippines

@#As the new batch of physicians in the Department of Medicine of the Philippine General Hospital, University of the Philippines Manila (UP-PGH) started their residency in January 2020, COVID-19 was only a disease that was heard of in the news, as it was spreading in China. When the first few patients with coughs and colds would ask us whether it was nCOV (as it was known then), we would not even consider it; we just gently reassured them. Then, the first patient in the country with COVID-19 was admitted on the last week of January 2020,1 prompting various local and national efforts to try to prevent its further spread. Even then, hospital operations and training activities went on as usual except that more people wore masks and practiced social distancing. When the government declared community quarantine for the whole of Luzon mid-March due to the rise in confirmed cases, hospital operations slowed down as the outpatient department (OPD) was closed and workforce was minimized. Before the month ended, the hospital would be designated to be one of the COVID-19 referral centers.

Association of sunlight exposure with 25-hydroxyvitamin D levels among working urban adult Filipinos

Objectives@#To determine the association of different levels of sunlight exposure, measured using the Filipino sunlight exposure questionnaire (SEQ) with 25-hydroxyvitamin D (25-OHD) levels among working urban adult Filipinos. @*Methods@#Seventy-five adult participants, living and working in Metro Manila, for at least 1 year, were grouped according to their perceived sunlight exposure pattern: low sunlight exposure (mostly indoor work); moderate sunlight exposure (both indoor and outdoor work); and high sunlight exposure (mostly outdoor work). After completion of the self-administered Filipino SEQ, they underwent serum 25-OHD level determination. Strength of correlation between the SEQ scores and 25-OHD levels was computed. @*Results@#Serum 25-OHD levels generally increased with increasing sunlight exposure levels. The overall Pearson’s correlation between the SEQ scores and 25-OHD levels of the participants was 0.396 (P ¼ 0.001). The correlation for the individual domains was 0.342 for intensity of sunlight exposure (P ¼ 0.003), 0.321 for factors affecting sunlight exposure (P ¼ 0.005), and 0.256 for sun protection practices (P ¼ 0.027). @*Conclusions@#The sunlight exposure of working urban adult Filipinos, as measured by the Filipino SEQ, has an overall significant, direct and moderate association with serum 25-OHD levels. This Filipino SEQ can serve as a valuable clinical tool for sunlight exposure assessment to identify individuals at risk for vitamin D deficiency.

Profile of the Adult Filipino with High Blood Sugar in the 8th National Nutrition Survey: Validation of the Philippine Guidelines for Screening

@#AIMS: Practice guidelines on diabetes in the Philippines have recommendations for screening using risk factors with thresholds based on international data. This paper investigated whether there is a basis to support these screening recommendations using data from the 8 th Philippine National Nutrition Survey (NNS). METHODOLOGY: This is a cross-sectional analytic study of data from the results of the 8 th Philippine NNS that was conducted across the country from June 2013 to April 2014. Crude odds ratios were obtained for each variable to determine their association with diabetes, and multivariate logistic regression analysis was performed to assess the independent association of demographic and clinical characteristics with diabetes. RESULTS: These variables were found to be significantly associated with diabetes and impaired fasting glucose: male gender; age > 40 years; hypertension with BP > 140/90 mm Hg; triglyceride levels > 150 mg/dL; overweight with BMI > 23 kg/m2 ; and abdominal obesity with waist circumference ≥ 90 cm in male and ≥ 80 cm in female adults. CONCLUSION: The risk factors associated with diabetes mellitus among adult Filipinos are similar to other countries but the development of diabetes is associated with relatively younger age, and lower BMI and waist circumference.

Association between perceived family functionality and teenage pregnancies

Background@#Teenage pregnancy is a public health concern because of its increasing incidence and its dire consequences. Numerous studies document the role of family in initiating sexual activity and teenage pregnancy, but there is a lack of studies that assess the effects of families and peers on teenage sexual behavior in the Philippines.@*Objective@#To determine the association between perceived family functionality as measured by the Family APGAR and teenage pregnancy in selected barangays in District 2, Quezon City, Philippines@*Methodology@#The study enrolled 233 women who are residents of Barangays Commonwealth and Payatas in Quezon City. Cases consisted of 133 women aged 18 to 24 years at the time of the interview who have become pregnant in 2011-2016, while they were 13 to 19 years old, while controls (N=100) were similar but had never been pregnant before age 20. Consecutive respondents who consented to participate in the study were enrolled and interviewed using the Filipino version of the Family APGAR. Respondents were then classified as having functional or dysfunctional families. Odds ratio was computed to determine the relationship between family functionality and teenage pregnancy.@*Results@#Family dysfunction based on the Family APGAR score was significantly associated with increased risk of teenage pregnancy with an OR 16.69, 1.93-144 (p=0.010) along with having both parents as caregivers with an OR of 29.69, 2.46-345, and teenage pregnancy in the mother with an OR of 15.87, 2.006-125.@*Conclusion@#Perception of dysfunction in the family based on the Family APGAR score, having both parents as caregivers and teenage pregnancy in the mother are associated with teenage pregnancy. Future researches should investigate the interactions of these factors but targeting family functionality may be key to curbing teenage pregnancies.

Blood pressure lowering effects of Sodium Glucose Transporter 2 Inhibitors among adult patients with Type 2 Diabetes Mellitus: A meta-analysis

Introduction@#Sodium glucose transporter 2 (SGLT2) inhibitors are a new class of anti-diabetic agents that not only lower down blood sugar but can potentially cause weight loss and decrease in blood pressure. The aim of this meta-analysis is to evaluate the magnitude of changes in blood pressure and safety parameters with the use of SGLT2 inhibitors among adult patients with type 2 diabetes mellitus (DM).@*Methods@#Randomized controlled trials (RCTs) were retrieved from electronic databases. We used the method recommend by the Cochrane Collaboration to perform a meta-analysis of RCTs of SGLT2 inhibitor for type 2 DM.@*Results@#Of 137 studies retrieved in the literature search, 28 were eligible for inclusion. A total of 23,728 patients with average age of 50-63 years old, when SGLT2 inhibitor were compared with placebo or active comparators there were statistically significant reduction in systolic (MD: -4.01, 95% CI -4.03 to -3.99) and diastolic blood pressure (MD: -1.48, 95% CI -1.49 to -1.46). There were no significant differences in the incidence of hypoglycemia (RR: 0.94, 95% CI 0.90 to 0.99, P<0.00001) between SGLT2 inhibitors and control groups. The incidence of urinary tract infections was similar between the SGLT2 inhibitors and the control groups (RR: 1.12, 95% CI 1.01 to 1.25, P=1.00). There was statistically greater incidence of orthostatic hypotension among patients given SGLT2 inhibitors than the control group (RR: 1.41, 95% CI 1.14 to 1.75, P=0.99).@*Conclusion@#Treatment with SGLT2 inhibitor provided statistically significant reductions in systolic and diastolic blood pressure in patients with type 2 DM compared with placebo or other anti-diabetic agents.

Factors Associated with Postoperative Diabetes Insipidus after Pituitary Surgery

BACKGROUND: Determining risk factors for diabetes insipidus (DI) after pituitary surgery is important in improving patient care. Our objective is to determine the factors associated with DI after pituitary surgery. METHODS: We reviewed records of patients who underwent pituitary surgery from 2011 to 2015 at Philippine General Hospital. Patients with preoperative DI were excluded. Multiple logistic regression analysis was performed and a predictive model was generated. The discrimination abilities of the predictive model and individual variables were assessed using the receiving operator characteristic curve. RESULTS: A total of 230 patients were included. The rate of postoperative DI was 27.8%. Percent change in serum Na (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.15 to 1.69); preoperative serum Na (OR, 1.19; 95% CI, 1.02 to 1.40); and performance of craniotomy (OR, 5.48; 95% CI, 1.60 to 18.80) remained significantly associated with an increased incidence of postoperative DI, while percent change in urine specific gravity (USG) (OR, 0.53; 95% CI, 0.33 to 0.87) and meningioma on histopathology (OR, 0.05; 95% CI, 0.04 to 0.70) were significantly associated with a decreased incidence. The predictive model generated has good diagnostic accuracy in predicting postoperative DI with an area under curve of 0.83. CONCLUSION: Greater percent change in serum Na, preoperative serum Na, and performance of craniotomy significantly increased the likelihood of postoperative DI while percent change in USG and meningioma on histopathology were significantly associated with a decreased incidence. The predictive model can be used to generate a scoring system in estimating the risk of postoperative DI.

Comparison of Fixed versus Calculated Activity of Radioiodine for the Treatment of Graves Disease in Adults

BACKGROUND: Radioactive iodine as a treatment modality has been shown in several studies to be a safe and effective therapy for Graves disease. However, there is still no uniformity regarding optimal dosing method. The aim of this study is to compare the efficacy of calculated and fixed dosing of radioiodine for the treatment of Graves disease. METHODS: A hundred twenty-two patients diagnosed with Graves disease were randomized to receive either fixed or calculated dose of radioiodine. Those randomized to fixed activity received either low fixed activity at 9.9 mCi for thyroid gland size <40 g or high fixed activity at 14.9 mCi for thyroid gland size 40 to 80 g, and those grouped to calculated activity received 160 µCi/g of thyroid tissue adjusted for 24 hours radioiodine uptake. Thyroid function tests (free thyroxine [T4] and thyroid stimulating hormone [TSH]) were monitored at 10, 16, and 24 weeks after radioactive iodine therapy. The primary outcome, treatment failure was defined as persistently elevated free T4 and low TSH. RESULTS: Of the 122 patients randomized, 56 in the fixed dose group and 56 in the calculated dose group completed the follow-up. At the end of 6 months, the percentage of treatment failure was 37.50% in the calculated dose group versus 19.64% in the fixed dose group with a relative risk of 0.53 (95% confidence interval, 0.28 to 0.98) favoring the fixed dose group. CONCLUSION: Fixed dose radioiodine has a significantly lower incidence of persistent hyperthyroidism at 6 months post-radioactive therapy.