Functional disability of Filipino patients with hand Osteoarthritis seen at a Rheumatology outpatient clinic of a Tertiary Government Hospital

Introduction@#Osteoarthritis (OA) is a common joint disease which may cause functional limitation in daily activities. The aim of this study is to determine disability of patients with hand osteoarthritis (HOA) using the Disability of Arm, Shoulder and Hand (DASH) questionnaire and to determine association of risk factors to the development of HOA. @*Methods@#This is a cross-sectional study done in a tertiary government hospital. Patients seen at the rheumatology outpatient clinic aged 40 years and above, diagnosed with primary OA of hands, knees, hips and spine based on American College of Rheumatology criteria and who gave written informed consent, were included. Patient characteristics were extracted. Descriptive statistics were used. Those with HOA were compared to those without HOA, as to biomechanical stress, menopause, body mass index (BMI) and family history. They were made to complete the DASH questionnaire. Data was analyzed using chi-square and logistics regression analysis to determine association of risk factors for HOA. @*Results@#One hundred fifty patients with primary OA were included; 61.3% were between 60-79 years, 92% were female. Forty-one percent were obese, 55.3% had family history of OA. There were 88 cases of HOA (59%). Mean age at onset is 58.2±8.8 years, mean age at diagnosis is 61.8±9.6 years. The most common complaints were stiffness and pain (60.3%), stiffness only (29.5%) and pain only (10.2%). The average DASH is 28.7±15.6 (mild disability), seen in 59.1%, moderate disability in 37.5% and severe in 3.4%. Among the risk factors for the development of HOA, there was a trend for menopause, BMI and biomechanical stress to increase risk of HOA. Among the biomechanical factors, cooking, laundry and cleaning showed a trend toward increasing risk two-fold.@*Conclusion@#This study showed that half of patients with primary OA in the study had HOA that was mildly disabling in a majority, and moderately disabling in 1/3 of cases. There may be correlation with biomechanical factors in its development. Other important risk factors for its development need to be further studied in a larger cohort of patients.

Chronic Tophaceous Gout in a patient with Cyanotic Congenital Heart Disease

Introduction@#Gout is a clinical syndrome resulting from deposition of urate crystals in joints causing inflammation, intense pain and even disability. In 2003 National Nutrition and Health Survey (NNHeS), the overall prevalence of gout was 1.6% and the prevalence of hyperuricemia was 28.4% of the 4498 adults >20 years old. Gout complicating cyanotic congenital heart disease (CCHD) was infrequently recognized in early reports with Somerville referring only nine patients over a period of five years in the registry of two hospitals. Recent studies have shown increased recognition, with Yamamura identifying 16% of the 92 patients with CCHD to have gouty arthritis. There is no local data on the frequency of gout among patients with CCHD @*Case Presentation@#26-year-old male previously diagnosed with Transposition of Great Arteries presented with a mass on the 5th digit of left hand with pathologic bone destruction on radiograph underwent disarticulation of the same finger. Intraoperative findings revealed chalky substances that led to the referral to rheumatology section. A diagnosis of chronic tophaceous gout was considered after review of history. He had a three year history of intermittent polyarticular arthritis involving the elbows, knees and ankle joints and later developed tophi in the helices of the ears and the DIP joint of the fifth digit of the left hand. There is increasing level of hyperuricemia as the severity of arthritis progressed. He had a polyarticular gout flare post operatively. The gout attack resolved after treatment with colchicine. Allopurinol was initiated after control of gout flare with resulting decrease in uric acid level.@*Discussion@#This case described a young male patient with transposition of great vessels with acute intermittent polyarthritis and tophi formation. The occurrence of gout and the complexity of the congenital heart disease have caused a considerable financial, functional and emotional instability on the patient, his parents and extended family. In patients with cyanotic congenital heart disease, the prevalence of hyperuricemia ranges from 16 to 43%. Several factors identified to be associated with hyperuricemia in CCHD in our case which include hypoxemia, polycythemia and impaired renal function. Nonetheless, management of gout in patient with CCHD is similar to the primary and secondary gout.@*Conclusion@#Gouty arthritis should be a differential in a patient with a cyanotic congenital heart disease complaining of joint swelling and tenderness. Early and prompt diagnosis will relieve symptoms and prevent complications that may lead to physical inactivity of patients.

Assessment of cognitive impairment in Systemic Lupus Erythematosus using the Mini-Mental Status Exam and the Montreal Cognitive Assessment Test-Filipino Version

Introduction@#Cognitive impairment (CI) in patients with systemic lupus erythematosus (SLE) presents with or without overt signs of central nervous involvement. The prevalence of CI is variable, ranging from 19-80%. It is often overlooked, leading to high healthcare costs and productivity loss. The usual tools for detection are expensive, time-consuming and not locally available. Detection of CI using the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Test (MoCA) is more clinically relevant and practical. The objectives of this study are to determine the prevalence of CI in SLE patients using MMSE/MoCA, to determine the degree of impairment in the different cognitive domains, and to characterize patients with CI in terms of disease activity, education, and employment.@*Methods@#This is a cross-sectional study of 62 SLE patients, 19 years or older, at a rheumatology clinic. Demographic and disease characteristics were collected. The validated Filipino versions of the MMSE/MoCA test were administered. Descriptive and non-parametric statistics were applied.@*Results@#Most patients are female (96.77%), below collegiate level of education (58.06%), and unemployed (70.97%). Mean disease duration is 8.92 (SD±7.03) years. Mean age at diagnosis is 28 (SD±10.30) years. Hypertension is the most common co-morbidity. Most have low lupus disease activity or are in remission (80.65%). Most are on prednisone (72.58%), with an average dose of 11.88mg/day (SD±10.66). The prevalence of CI is 38.71% (MMSE-P) and 77.42% (MoCA-P). The presence of CI is not related to educational level, employment, and disease activity.@*Conclusion@#Cognitive impairment (CI) is common in this cohort of SLE patients. Disease activity, level of education and employment do not seem to affect its occurrence. The MMSE-P and MoCA-P are rapid tools to assess the presence of CI and should be used in clinical practice to improve the quality of care for patients with lupus.

Medical education: Effectiveness of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks)

OBJECTIVE: To describe outcomes of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks).METHODS: Students were shown a 6-minute video on intubation. Students were exposed to video-assisted learning, video-assisted learning with instructor-guided simulation, and video-assisted learning with experiential learning. Each student was assessed by a non-graded 11 point objective structured clinical examination.RESULTS AND DISCUSSION: The three learning strategies: 1. Video-assisted learning, 2. Video-assisted learning with instructor-guided simulation, 3. Video-assisted learning with experiential learning (self-discovery learning) simulation showed OSCE mean scores (standard deviations) of 5.76 (2.16), 7.21 (2.35) and 7.60 (1.72), respectively. Failure of intubation was 21% (8/38), 2% (1/40) and 0% (0/36), respectively. There is an absolute risk reduction of 27-30% in failure of intubation when either VGL or VEL is used. Students recognized the contribution of the simulation-based activities to the development of their intubation skills. They appreciated the opportunity to actually perform intubation in a rehearsal setting before doing the procedure on real patients.CONCLUSION: Medical simulation enhanced student skills development. Experiential learning or self-discovery learning method may be as effective as instructor guided simulation.

Medical education: Effectiveness of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks)

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe outcomes of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks).<br /><strong>METHODS:</strong> Students were shown a 6-minute video on intubation. Students were exposed to video-assisted learning, video-assisted learning with instructor-guided simulation, and video-assisted learning with experiential learning. Each student was assessed by a non-graded 11 point objective structured clinical examination.<br /><strong>RESULTS AND DISCUSSION:</strong> The three learning strategies: 1. Video-assisted learning, 2. Video-assisted learning with instructor-guided simulation, 3. Video-assisted learning with experiential learning (self-discovery learning) simulation showed OSCE mean scores (standard deviations) of 5.76 (2.16), 7.21 (2.35) and 7.60 (1.72), respectively. Failure of intubation was 21% (8/38), 2% (1/40) and 0% (0/36), respectively. There is an absolute risk reduction of 27-30% in failure of intubation when either VGL or VEL is used. Students recognized the contribution of the simulation-based activities to the development of their intubation skills. They appreciated the opportunity to actually perform intubation in a rehearsal setting before doing the procedure on real patients.<br /><strong>CONCLUSION:</strong> Medical simulation enhanced student skills development. Experiential learning or self-discovery learning method may be as effective as instructor guided simulation.</p>