Primary Aldosteronism among adult Filipinos with resistant Hypertension: A pilot study

Background@#Primary aldosteronism (PA) was previously thought to be uncommon. With the utilization of plasma aldosterone concentration and plasma renin activity ratio (PAC/PRA) as a mode of screening, the frequency of its detection increased significantly. Among the population with an indication for PA screening, resistant hypertension has the highest prevalence. Detection of PA in this group is essential since it is associated with increased cardiovascular and cerebrovascular complications.@*Objective@#To determine the prevalence of PA among adult Filipinos at Capitol University Medical Center, Cagayan de Oro City, Misamis Oriental.@*Methods@#Adult Filipino patients with resistant hypertension underwent PA screening using the PAC/PRA. Patients with positive results were confirmed for PA either through IV saline infusion or using the following criteria: history of spontaneous hypokalemia or documented hypokalemia prior to screening, undetectable PRA (< 1 ng/ml/hour), and a PAC of > 15 ng/dl.@*Results@#Twenty-one patients were recruited, but only fourteen participated in the study. Thirty five percent of those who participated screened positive for PA. Among those who screened positive, three patients were confirmed of having PA.@*Conclusion@#The prevalence of PA in adult Filipinos with resistant hypertension in Capitol University Medical Center, Cagayan de Oro City, Misamis Oriental is estimated to be 21.43%.

Public health and public health ethics

Spectacular achievements in the health of individuals have not been matched by equivalent improvement in the health of whole populations. Indeed it is against the background of deterioration in levels of population health in some parts of the world and the emergence and re-emergence of infectious diseases in association with powerful globalizing forces that there has been a recrudescence of interest in ÔPublic HealthÕ. Here attention is drawn to the dominant values that have shaped our world, to the differences between broad and narrow definitions of public health, to some values that need to be promoted, and to an ethic of public health that considers both human rights and human needs.

Global health ethics: the rationale for mutual caring

Despite spectacular twentieth century scientific and technological progress, the world is more inequitable than it was fifty years ago. This is evident both in terms of access to health care for individuals, and in relation to the health of whole populations. Disparities in wealth and health within and between nations are widening inexorably and the rapidly expanding global economy has failed to reduce poverty among those with little if any access to health care. In this context the Universal Declaration of Human Rights remains an unrealized aspiration for the majority of the world's people. Given these realities, no single discipline, or body of knowledge is likely to make much difference. For example, approaches based only on neo­liberal economics, as exemplified by the structural adjustment programmes of the World Bank, have not been successful in promoting health equity. The authors believe that an interdisciplinary approach is required, and that bioethics, an interdisciplinary field, can make a contribution towards improving health globally. To do this, the scope of bioethics should be expanded towards a results­oriented global health ethics, based upon widely shared and foundational values that could be carried forward through five transformational approaches.

Randomized controlled trial of once vs. twice daily gentamicin therapy in newborn.

OBJECTIVE: To compare the efficacy of once daily gentamicin administration to the conventional twice daily dosage schedule by estimation of serum gentamicin concentrations (SGC) in neonates. DESIGN: Randomized controlled trial. SETTING: Medical college hospital. SUBJECTS: Seventy three neonates of gestational age>32 weeks at risk or with clinical features of sepsis. METHODS: The subjects were divided into preterm and term groups. Babies in each of these groups were randomized to receive a single daily dose (4 mg/kg) or a twice daily dose (2.5 mg/kg) of injection gentamicin intravenously. Trough and peak SGC were estimated half an hour prior and one hour after the second dose. Statistical analysis was done using the equivalence method. RESULTS: In preterm as well as term babies, the mean peak and trough gentamicin levels were comparable in the two regimens. There is statistically significant evidence to show that the effect of once daily and twice daily dosage is similar. CONCLUSION: Once daily gentamicin administration is as effective as twice daily therapy and would be more cost effective.