"Normal but Catastrophic" Euglycemic Diabetic Ketoacidosis Precipitated by Sodium-Glucose Cotransporter-2 Inhibitor Use: A Case Report.

Euglycemic diabetic ketoacidosis (EuDKA) is an uncommon diabetic complication. Just like diabetic ketoacidosis (DKA), EuDKA is a medical emergency. EuDKA is primarily related to the imbalance between insulin and counter-regulatory hormones, with an elevated insulin/glucagon ratio, and is characterized by blood glucose near normal (blood glucose less than 250 mg/dL) in the background of DKA. There are many factors associated with EuDKA, but the overall mechanism is based on a relative state of carbohydrate deficit, resulting in ketosis while maintaining near-normal glucose levels. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new oral antidiabetic medication category that can precipitate EuDKA. EuDKA is more common in patients with diabetes mellitus on SGLT2 inhibitors with lower mass index and decreased glycogen store which can be triggered by surgery, infection, trauma, a major illness or reduced food intake and persistent vomiting, gastroparesis, dehydration, and reduced insulin dosages. This is a case of a 34-year-old male, Filipino, diagnosed with type 2 diabetes mellitus, who was maintained on dapagliflozin + metformin 5mg/1000mg taken twice a day with good compliance and was admitted with EuDKA precipitated by decreased food intake and managed with intravenous insulin. Throughout admission, the blood glucose levels did not exceed 250mg/dL. His clinical condition improved through insulin therapy, administration of sodium bicarbonate, and intravenous hydration. EuDKA is an uncommon diabetic complication. High clinical suspicion is required to avoid delay in diagnosis and management since normal blood sugar levels masquerade the underlying DKA. Nevertheless, the cornerstone for the management of DKA and EuDKA remains the same: intravenous hydration and insulin therapy.

Barriers to Antiretroviral Medication Adherence in People Living with HIV (PLHIV) at the Time of the COVID-19 Pandemic in the Philippines.

Background: During the COVID-19 pandemic, the HIV crisis in the Philippines worsened and triggered a chain reaction that disrupted the provision and utilization of HIV services. This study aims to fill in the gap in knowledge by exploring the possible association between sociodemographic characteristics and the barriers to ART adherence for PLHIV in the Philippines at the time of the COVID-19 pandemic. Methods: A cross-sectional study was performed by using a survey questionnaire, which was distributed via online social media (Twitter). Data were analyzed using the Stata software. Results: There is a significant association between the following treatment barriers and sociodemographic characteristics: the location of treatment hubs and respondents who finished college/graduate studies; checkpoints and crossing borders; and (1) respondents from Northern Luzon Region, (2) unemployed respondents and financial assistance-1. respondents 18 to 25 years old; 2. unemployed respondents-(3) respondents who finished elementary/high school and psychosocial support-(1) respondents from the NCR; (2) respondents 26 to 30 years old, stocks of ARVs and other medicines, and employed respondents. Conclusions: The results suggest a necessity for innovative approaches to make HIV care services, particularly ART, more accessible to PLHIV during the COVID-19 pandemic. Future large-scale studies exploring the association between sociodemographic characteristics and barriers to medication adherence of PLHIV during the COVID-19 pandemic are recommended.

Clinical profile and outcomes of adult patients with echocardiographic evidence of cardiac tamponade at the Philippine General Hospital: A 5-year study (the captive-heart study)

BACKGROUND: Cardiac tamponade is a life-threatening hemodynamic condition from pericardial effusions that increase intrapericardial pressure suffeciently to externally compress and restrict cardiac chamber filling, constrain cardiac output, and induce backward failure. The number of pericardial effusions arising from cardiothoracic post-surgical and catheter-based procedures accounts for 70% of all the cases in one series. In the Philippines, tuberculous infection remains as one of the most common etiologies of pericarditis, and accounts for 25.1% of the 438 cases of pericardial effusion in a local review. METHODS: This is a retrospective cross-sectional study. The inpatient adult echocardiograhy database of the Philippine General Hospital-Section of Cardiology from June 2007 to June 2012 was reviewed, and all confirmed studies with evidence of cardiac tamponade on echocardiography were included. RESULTS: A total of 58 patients were included in this review. The age ranged from 18-75 years, with mean of 43±15 years. Thirty-eight (66%) patients were diagnosed cases of malignancy, with lung cancer as the most common type. The other concomitant conditions included pulmonary tuberculosis (12%), presence of pulmonary mass of undetermined etiology (7%), systemic lupus erythematosus (3%), endocrine disorder (3%), renal failure (3%), and post cardiac surgery status (2%). The most common clinical findings were tachycardia (84%) and elevated jugular venous pressure (57%). Hemodynamic compromise was seen in 8 patients (14%), and Beck's triad was present in only 5 (9%) of the cases. The pericardial effusions were moderate to large in size in 95% of the cases. All effusions were circumferencial, and 100% had right-sided chamber collapse, 38 (66%) of which had both right atrial and right ventricular diastolic collapse. CONCLUSIONS: Malignancy and TB pericarditis account for most cases of cardiac tamponade in our setting. There should be a high index of suspicion for cardiac tamponade among patients presenting with difficulty of breathing and tachycardia, especially on a background of malignancy of TB infection. Cardiac tamponade carries a high in-hospital mortality rate and prompt recognition and intervention is warranted. There was a higher rate of intervention among those who survived their hospitalization, a finding that is similarly reflected by a previous study.

Prevalence of coronary artery disease among adult patients with congenital heart disease who underwent coronary angiogram at the University of the Philippines-Philippine General Hospital from September 1998 to November 2011

OBJECTIVES: To determine prevalence of coronary artery disease (CAD) among adult patients with congenital heart disease (CHD), who underwent Coronary Angiography (CA) at the UP-PGH. Secondary: to determine severity of CAD lesions among these patients. METHODS: This is a descriptive study of adult patients with Congenital Heart Disease who underwent selective coronary angiography from September 1998 to December 2010 at the Philippine General Hospital. RESULTS: 52 adult patients with CHD underwent CA, Ten (19%) had angiographic evidence of coronary atherosclerosis visually. Significant CAD was found in 11.5% (n=6), all patients being ≥ 40 years old (mean age 54 ± 7.9 years; range 47 -61); 4 (66%) are female; Five (83%) have documented traditional CVD risk factors, mostly hypertensive (33%). None with significant CAD had cyanosis, 4 patients (66%) have typical chest pain. Majority of CHD's were simple (61%), mostly atrial septal defects (36%). Four (n=4)(70%) patients with Simple CHD, 2 (30%) patients with Intermediate CHD and none of those with Complex CHD had significant CAD. CONCLUSION: Prevalence of CAD among ACHD patients using CA in this study is 11.5%. This study supports the notion of routine CA among patients with ACHD ≥ 35 years old with traditional CV risk factors. Need for primary prevention of CAD and modification of traditional CV risk factors among these patients is emphasized, as important with the general population.