Philippine journal of internal medicine最新文献

{"title":"Perceived Negligence: Why Patients Sue?","authors":"Capule, Fpcp, V. Rodel","doi":"10.3860/PJIM.V48I3.2661","DOIUrl":"https://doi.org/10.3860/PJIM.V48I3.2661","url":null,"abstract":"Let me share with you my thoughts on why patients sue despite rendering your best professional care to them. My past 10 years in law practice, dealing mainly with medical malpractice cases, have been a professional journey for me both as a lawyer and a physician. The opportunity to hear first hand patients and family members alike articulate their opinions, observations and feelings as to why they are filing a complaint or has filed a complaint has heightened my awareness on the unique nature of medical practice. I am pretty sure that as actively practicing physicians, and for an alleged medical negligence, you have already confronted peer reviews, disciplinary proceedings, complaints and actual medical malpractice suits. Perhaps, it is true that complaints are badges of burgeoning practice – more patients, more complaints. In my experience one observation remains the same and certain; if you commit negligence you will be sued. If the patient or family members did not sue, then your case is the exception. Do not take comfort that you did not intend to harm a patient or commit negligence. Understand that it is the very nature of negligence, there is no malice or intent involved; otherwise it is no longer negligence but physical injuries or homicide or maybe murder. What I want to address specifically is why do patients sue in the absence of negligence? Why did the patient or family member perceive your conduct as negligent in the absence of actual negligence? Remember that majority of medical malpractice cases are based only on “perceived negligence” and eventually will be dismissed. However, what matters is not in winning cases but in avoiding cases based on perceived negligence. It is best to remember that once you are sued, you have already lost. It is useless to taste your victory because the public nature of the case and the protracted course of litigation have already robbed you of your appetite to celebrate not to mention the adverse financial impact of facing a lawsuit. The first question to ask is “Why was it perceived as negligence in the first place?” In the absence of good communications with the patient or family members, any sudden occurrence of adverse events or complications can be interpreted by some as “physician-made.” The unfair expectation “to guarantee good results” has further expose physicians as “fair game” for lawsuits once something bad happens to a patient. In this scenario, I believed that the main culprit is “failed communications.” The often cited maxim “Physician’s communication skills are as important as clinical skills” should always be underscored every time a physician attends to a patient. All the more that this maxim gains significance if you are dealing with in-patients (admitted patients). Take note that majority of medical negligence cases are filed by in-patients. Ask yourself – Do I spend enough time, in a 24-hour period, explaining all aspects of the disease to a patient? Do I have the patience to answer","PeriodicalId":85270,"journal":{"name":"Philippine journal of internal medicine","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70066957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Virgin Coconut Oil on Lipid Profile and Fasting Blood Sugar: A Phase I Clinical Trial","authors":"Cecille R Dela Paz, C. Jimeno, R. Sy, F. Punzalan, P. D. Pena","doi":"10.3860/PJIM.V48I2.2632","DOIUrl":"https://doi.org/10.3860/PJIM.V48I2.2632","url":null,"abstract":"Background: Virgin coconut oil (VCO) is promoted as a dietary supplement for people with various ailments. However, there have been few formal scientific studies to validate its health benefits. Objective: To determine the effect of VCO on lipid profile, FBS, weight and body mass index (BMI) of healthy humans and evaluate its safety profile by determining effect on creatinine, potassium, AST, ALT and CBC Methods: Weight and height were obtained from 30 healthy males and BMI was computed on first visit. Baseline laboratories were taken: FBS, 2-hour glucose after 75 gram oral glucose, total cholesterol, triglyceride, LDL, HDL, creatinine, potassium, AST and ALT, and CBC. Each subject took VCO 15 mL t.i.d. before meals. After 6 weeks, repeat laboratory examinations were done. Weight was taken and BMI recomputed. Adverse events were reported. Results: There was significant increase in mean FBS (76.03, 6.62 mg/dl to 80.11, 9.04 mg/dl, p=0.024), significant decrease in HDL (47.58, 7.54 to 44.09, 7.10, p=0.028), significant increase in creatinine (76.44, 9.88 umol/L to 82.99, 11.29 umol/L, p = 0.0002) and platelet count (281.03, 52.6 x 109/L to 295.1, 58.06 x 109/L, p = 0.040) and significant decrease in WBC count (7.63, 1.74 x 109/L to 6.85, 1.5 x 109/L, p = 0.012). There was no effect on the rest of the laboratory examinations done. Twenty participants reported mild gastrointestinal (GI) complaints, including diarrhea (8), abdominal pain (3), diarrhea and abdominal pain (5), and diarrhea and vomiting (4). Conclusion: VCO significantly increases FBS and decreases HDL. VCO also increases creatinine and platelet count and decreases WBC count. Mild GI complaints were the most commonly reported adverse events. Further studies may be needed in order to validate the results of this exploratory study and elucidate the metabolic effects of VCO. Keywords: virgin coconut oil; metabolic effect; lipid profile Philippine Journal of Internal Medicine, Vol. 48 No. 2: Jul-Sep 2010, pp 1-6","PeriodicalId":85270,"journal":{"name":"Philippine journal of internal medicine","volume":"48 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2012-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70066901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Escitalopram in Philippine Clinical Practice: Result of an Open-label, Observational Study in 2920 Outpatients with Depression","authors":"Benjamin Ong, G. Lan","doi":"10.3860/PJIM.V49I2.2455","DOIUrl":"https://doi.org/10.3860/PJIM.V49I2.2455","url":null,"abstract":"Aim: To evaluate the effectiveness and tolerability of escitalopram under naturalistic conditions inadult outpatients in the Philippines suffering from depression. Methods : A 4-week, open-label, multi-centre, observational study was conducted in the Philippines enrolling 3005 patients. Clinical effectiveness was evaluated with the Clinical Global Impression scales. Results: 91% of patients who received escitalopram completed 4 weeks of treatment. The mean CGI-S score decreased from 4.6±1.0 at baseline to 2.4±1.0 at Week 4. The percentage of patients achieving remission of depressive symptoms (CGI-S≤2) increased from baseline to Week 4, so that at Week 4, 54.3% of patients achieved remission. The percentage of patients with much or very much improvement in depression (CGI-I score≤2) increased from 17.2% at Week 1 to 78.4% at Week 4. The incidence of adverse events (<10%) and the incidence of patients who withdrew due to adverse events (<1%) was low. The most frequently reported adverse event was nausea (1.8%), followed by headache (0.9%). There were no deaths or otherserious adverse events, nor were there any attempted or completed suicides during the study. Conclusion: In patients in the Philippines with depression, treatment with escitalopram was welltolerated and associated with improvements in the patient’s severity of illness, and an increased proportion of patients achieving remission of depressive symptoms. No new safety findings with escitalopram were observed in the treatment of these patients. Keywords: Clinical Global Impression; escitalopram; depression; SSRI; observational study Philippine Journal of Internal Medicine, Vol. 49 No. 2: Apr-Jun 2011, pp 100-104","PeriodicalId":85270,"journal":{"name":"Philippine journal of internal medicine","volume":"49 1","pages":"100-104"},"PeriodicalIF":0.0,"publicationDate":"2012-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70066773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Treatment of Chronic Pain in the Philippines","authors":"H. Lu, Francis O Javier","doi":"10.3860/PJIM.V49I2.2449","DOIUrl":"https://doi.org/10.3860/PJIM.V49I2.2449","url":null,"abstract":"Background: There are currently no data on the prevalence and incidence of chronic pain in the Philippines. Objective: This study was undertaken to determine the incidence and prevalence of chronic pain in the general adult population of the Philippines. It also aimed to establish the demographic profile of chronic pain sufferers, identify the causes and intensity of chronic pain, and understand the impact of chronic pain on daily living and quality of life. This study also explored current treatment practices for patients with chronic pain, their levels of satisfaction with treatment, and barriers to obtaining appropriate treatment. Methodology: The study was conducted in the Philippines via a quantitative sample survey that involved face-to-face interviews using a two-phase structured questionnaire. Results: The survey showed an overall prevalence of moderate-to-severe chronic pain (chronic pain M+S) of 10.4% of the general adult population, with an annual incidence rate of 3.4%. Chronic pain M+S was more commonly reported by women and the elderly. The most common locations of pain were the knees, back and lower back. Daily routine was affected in about half of the sufferers, but they had rational attitudes to pain and positive views of medical treatment. High consultation fees discouraged nearly twothirds of sufferers from seeking medical advice for their pain. Despite the availability of effective pain treatments, a large proportion of patients taking prescription painkillers reported that the medication was less than effective, indicating alarge gap between achievable pain relief targets and patients’ expectations of pain medications. Conclusion: The Philippines has a relatively high prevalence of chronic pain M+S. There is a need for improved pain management to ensure that patients with chronic pain receive appropriate and effective treatment. Keywords: Asia; chronic pain; incidence; prevalence; quantitative survey; the Philippines; treatment Philippine Journal of Internal Medicine, Vol. 49 No. 2: Apr-Jun 2011, pp 61-69","PeriodicalId":85270,"journal":{"name":"Philippine journal of internal medicine","volume":"49 1","pages":"61-69"},"PeriodicalIF":0.0,"publicationDate":"2012-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70066624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling the Enigma of Bangungut: Is Sudden Unexplained Nocturnal Death Syndrome (SUNDS) in the Philippines a Disease Allelic to the Brugada Syndrome?","authors":"Albert C Gaw, Byron Lee, Giselle Gervacio-Domingo, Charles Antzelevitch, Romeo Divinagracia, Felipe Jocano","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>BACKGROUND: Sudden unexplained nocturnal death syndrome (SUNDS) has been reported worldwide. SUNDS is endemic in Southeast Asia and is colloquially known as Bangungut in the Philippines, Lai Tai in Thailand, and Pokkuri in Japan. Although SUNDS in Thailand and Japan have been determined to be phenotypically, genetically and functionally identical to the Brugada syndrome, the relationship between Bangungut/SUNDS in the Philippines and the Brugada syndrome has not been clarified. This paper explores the concordance between Bangungut/SUNDS and the Brugada syndrome. METHODS: We summarized autopsy studies on Bangungut retrieved from PubMed since 1917 and current epidemiological data on Philippine SUNDS to clarify its diagnostic features. We also reviewed current hypotheses of the pathophysiological mechanism of the Brugada syndrome to explore its applicability to Bangungut/SUNDS. RESULTS: The use of the term Bangungut is confusing as it includes many diseases that may cause SUNDS. However, our review reveals a notable subset of Bangungut, identified as Bangungut/SUNDS with no gross cardiac pathology that conforms to the clinical picture of the folk-belief of Bangungut and of the Brugada syndrome, namely: predominance among male in the 20-40 age range; sudden death during sleep or at rest, usually following ingestion of a large meal at night; and victims were in apparent good health prior to their demise. Current pathophysiological mechanisms of Brugada syndrome seemed plausible explanations for a majority of this subset of Bangungut/SUNDS. CONCLUSION: Bangungut/SUNDS and the Brugada syndrome appear closely related. Pathophysiological mechanisms of the Brugada syndrome may explain the enigma of Bangungut/SUND. Whether Bangungut/SUNDS is phenotypically, genetically and functionally an allele of the Brugada syndrome remains inconclusive due to lack of research data. We therefore proposed a research agenda including genetic testing and pharmacological challenge of probands and their family members suspected of SUNDS to conclusively establish the relationship between these two syndromes.</p>","PeriodicalId":85270,"journal":{"name":"Philippine journal of internal medicine","volume":"49 3","pages":"165-176"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404490/pdf/nihms-355783.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30797541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness, usage and perception of food supplements among adult residents in Metro Manila","authors":"A. J. Cruz, C. Orense, C. Celeste","doi":"10.3860/PJIM.V49I1.2441","DOIUrl":"https://doi.org/10.3860/PJIM.V49I1.2441","url":null,"abstract":"This study was conducted to determine current awareness, extent of usage and perception of food supplements among adults from households in randomly selected barangays of Metro Manila included in the 7th National Nutrition Survey (NNS) and to compare current data with the 1998 survey data. The multistagesampling design employed in the 7th NNS with the household as the ultimate sampling unit was used. The respondents’ awareness, usage, reasons for using food supplements, presence of illness or disease conditions, and perceived health status after using supplements were obtained by self-administered pretested questionnaires. Descriptive statistics were used to describe subjects’ profile. Test of proportions were computed to compare and determine any difference between the 1998 and 2008 survey data. A total of 1,809 adults from 148 sampled households were selected as respondents, 55.8% were females and 44.2% males. Majority of respondents, 85.6%, were aware of food supplements, compared with as only 37.5% in 1998. By gender, women were more aware and were users of food supplements than men in 1998 and 2008. Among food supplements, the single nutrient category had the highest consumption, (64.7%) by regular users, followed by combined nutrients 60.4% by regular and 36.9% sporadic users. Herbal supplements had 51.4% regularand 48.6% sporadic users. Some important reasons cited for using food supplements were: “they make me healthy,” and “they give me energy” and “they are doctor-recommended.” About 48% of users perceived themselves as “slightly improved,” 45% as “very much improved” and 6.7% perceived “no change.” Majority of respondents agreed that “health supplements are needed if a person feels tired and run-down” and that “health supplements make one feel better physically.”The same proportion (53%) of respondents in both survey periods, agreed that “health supplements usually improve a person’s physical appearance.” For both survey periods, majority strongly disagreed that “one can skip meals and just take health supplements.” The level of awareness and usage of food supplements among adults in Metro Manila is significantly higher in 2008 than in 1998. For both survey periods, there is a strong belief on the positive effects of foodsupplements on one’s health status. Keywords: National Nutrition Survey (NNS); food supplements Philippine Journal of Internal Medicine , Vol. 49 No. 1: Jan-Mar 2011, pp pp 30-37","PeriodicalId":85270,"journal":{"name":"Philippine journal of internal medicine","volume":"49 1","pages":"30-37"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70067010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and outcomes of unrecognized diabetes mellitus and prediabetes among acute stroke patients with admission hyperglycemia at the Philippine General Hospital: DASH study","authors":"M. J. Cardino, C. V. Josol, Guillermo G. Manalo, C. Jimeno","doi":"10.3860/PJIM.V49I2.2452","DOIUrl":"https://doi.org/10.3860/PJIM.V49I2.2452","url":null,"abstract":"Background: Hyperglycemia occurs in 60% of acute stroke patients, 12-52% of which maybe previously undiagnosed with diabetes. A retrospective study by Gacutan showed21% admission hyperglycemia at the Philippine General Hospital. Screening for glucose disorders among hyperglycemic stroke patients provides a venue for secondary prevention. There are no current guidelines on screening for post-stroke hyperglycemia by the Stroke Society of the Philippines. Objective: To determine the prevalence and outcomes of unrecognized diabetes and prediabetes among acute stroke patients. Secondarily, we aim to determine the clinical and biochemical predictors of unrecognized/newly diagnosed diabetes mellitus among the acute stroke patients. Methodology: Cross-sectional prospective study. Acute stroke patients admitted from January to December, 2008 with admission hyperglycemia were included. Random blood sugar, glycosylated hemoglobin & the National Institute of Health Stroke Scale (NIHSS) were done on admission. All were followed up six weeks post-discharge for an FBS and 75-grams OGTT except those discharged with anti-diabetes medications who were considered newly-diagnosed diabetes. Outcomes: Glucose disorders were classified at six weeks post-discharge. Mortality was measured at six weeks and 12 weeks. Functional outcomes using the Modified Rankin Score & the Barthel’s Index were measured at the OPD 6-weeks postdischarge. Results: There were 504 stroke patients of which 178(35%) had admission hyperglycemia. Majority were newly diagnosed diabetes 32.7%, stress hyperglycemia 29.56%, impaired glucosetolerance, (IGT) 13.8%, impaired fasting blood sugar, (IFG) 8.8%, combined IGT and IFG 3.7%, previous diabetes 11.32%. Age, body mass index, alcohol abuse, smoking, hypertension, nosocomial infections, acute coronary syndromewere associated with diabetes. No association was noted with diabetes and atrial fibrillation. By Kruskal-Wallis test, admission RBS and HbA1c were higher among diabetics compared to prediabetics and stress hyperglycemics. Triglycerides was higher and HDL was lower among diabeticversus the stress hyperglycemia. No trends were noted for total cholesterol and LDL cholesterol across groups. On multiple logistic regression, age (OR: 1.06, p0.07), smoking (OR: 9.81, p0.05) & Hba1c (OR:11.39, p<0.01) were the predictors for newly diagnosed diabetes classification among the acute stroke patients. Higher Modified Rankin and lower Barthel’s index were seen among diabetics compared to the other groups measured on follow-up. Mortality at six weeks was higher among diabetics (OR: 2.34, p<0.01) compared to non-diabetics. A trend towards higher mortality at 12 weeks was also noted among diabetics (OR:1.81, p0.063) compared to other groups. Conclusion: Admission hyperglycemia was seen in 35% of admitted stroke patients, majority of which were unrecognized diabetes. By screening for post-stroke hyperglycemia, we identified 59.1% (32.7% unrecognized diabetes; 26","PeriodicalId":85270,"journal":{"name":"Philippine journal of internal medicine","volume":"58 10 1","pages":"79-87"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70066707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac tamponade as a complication of hypothyroidism: A case report","authors":"Karen Lazaro, Frederick Ogbac, M. Las, M. D. F. M. T. Adajar-Tolentino, M. Sy","doi":"10.3860/PJIM.V49I1.2444","DOIUrl":"https://doi.org/10.3860/PJIM.V49I1.2444","url":null,"abstract":"Case Summary: A 52-year old male was admitted at the Intensive Care Unit of Ospital ng Makati due to difficulty of breathing. The patient is a diagnosed case of papillary thyroid carcinoma, S/P total thyroidectomy and radioactive iodine treatment (1997) maintained on levothyroxine 100 mcg OD with poor compliance. On admission, the patient had neck vein engorgement, bibasal crackles, muffled heart sounds, abdomen had shifting dullness and (+) fluid wave test, and grade 3 bipedal edema. 12-L ECG showed electrical alternans and chest x-ray revealed an enlarged heart with water bottle configuration. Echocardiography showed compressed right ventricle and right atrium, right atrium systolic indentation, and a large echo free space which signified cardiac tamponade. The patient was tachypneic and became hypotensive. Subxiphoid pleuropericardial window with pericardiocentesis was done draining a total of 1.8 liters serosanguinous fluid. Thyroid function tests showed elevated TSH (>40uIU/L), decreased F T4 (0.00ng/dL ) and F T3 (0.72pg/mL ) . levothyroxine 25 mcg OD was started and increased to 50 mcg after three days. Pericardial fluid showed predominance of lymphocytes and had high proteincontent. The dyspnea was relieved and patient had increased urine output and decreased edema afterthe pericardiocentesis. Repeat 12-L ECG four hours after pericardiocentesis showed resolution of the electrical alternans. Repeat 2D-Echo with Doppler after several days showed mild pericardial effusion. Repeat thyroid function tests showed normal FT4 and FT3 levels and increased TSH (34.5uIU/L). The patient was discharged improved maintained on levothyroxine 100 mcg OD and had no recurrence of the cardiac tamponade. Conclusion: Cardiac tamponade is a rare complication of hypothyroidism. A high index of suspicion is needed for prompt diagnos i s of cardiac tamponade and hypothyroidism followed by immediate intervention. Pericardiocentesis is necessary and hormonal treatment with levothyroxine is crucial as it produces satisfactory clinical outcome with reduction in recurrences of thecardiac tamponade after drainage is performed. Keywords: cardiac tamponade; hypothyroidism;  Pericardial effusion Philippine Journal of Internal Medicine, Vol. 49 No. 1: Jan-Mar 2011, pp 46-50","PeriodicalId":85270,"journal":{"name":"Philippine journal of internal medicine","volume":"49 1","pages":"46-50"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70066607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Major Amputation of Diabetic Foot Ulcers","authors":"M. John, T. Cardino, C. V. Josol, I. T. Isip-Tan, C. Jimeno","doi":"10.3860/PJIM.V49I2.2451","DOIUrl":"https://doi.org/10.3860/PJIM.V49I2.2451","url":null,"abstract":"Background: Diabetic foot ulcers are very common in the Philippines, accounting for 16-20% of the yearly emergency room admissions at the Philippine General Hospital. We look into the risk factors associated with major amputation of diabetic foot ulcers at the said institution. A multispecialty team, known as Diabetes Extremity Care Team (DECT), was created to address the concerns in the diabetic foot management. No data have been no reported from the Philippines. Objective: To compare the clinical and biochemical characteristics of diabetic foot ulcer patients who underwent major amputation and those who underwent minor and non-amputation and; to identify the risk factors associated with major limb amputation. Methods: Cross-sectional, analytical. A retrospective review of charts was done from 2004 to 2007 with the diagnosis of diabetic foot ulcer. There were 501 charts reviewed however nine wereexcluded due to lost pages. University of Texas was used in the classification of diabetic foot ulcers. Difference in means was tested using T-test and difference in proportions was tested using Chi Square test. Multiple logistic regression analysis was done to determine which variable was associated with major amputation. Results: Major amputation was done in 48.6% of patients which was significantly lower than the pre-DECT at 70% (p<0.001) however still above the ADA recommendation of <40%. Below knee amputation was done in 42.7%, above knee amputation at 4.7% and hip disarticulation in 1.2%. Presence of neuropathy (OR: 1.66, p0.04), peripheral vascular disease (OR: 1.27, p0.05) and ulcer severity using the University of Texas classification (OR: 2.16, p0.01) were associated with major amputation of diabetic foot ulcers. On multiple logistic regression, University of Texas 3D (OR: 2.2, p<0.01) and neuropathy (OR: 1.63, p0.02) were the predictors for major diabetic limb amputation. Conclusion: A significant proportion of diabetic foot ulcer patients at the Philippine General Hospital had major amputation. This study showed that patients with neuropathy and University ofTexas 3D classification were likely to undergo major amputation, thus the need for emphasis on adequate foot care among diabetic patients. Keywords: diabetic foot ulcers; major limb amputation Philippine Journal of Internal Medicine, Vol. 49 No. 2: Apr-Jun 2011, pp 74-78","PeriodicalId":85270,"journal":{"name":"Philippine journal of internal medicine","volume":"49 1","pages":"74-78"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70066666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life among Patients with Untreated Hepatocellular Carcinoma","authors":"A. Ong, P. Andrada, Frederick T Dy, Carmelita D. Dalupang, M. M. Chan, A. Ismael, R. Carpio, Celina S Tady, J. Sollano, Stephen N. Wong","doi":"10.3860/PJIM.V47I3.1652","DOIUrl":"https://doi.org/10.3860/PJIM.V47I3.1652","url":null,"abstract":"","PeriodicalId":85270,"journal":{"name":"Philippine journal of internal medicine","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70066593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}