Transcriptional profiles associated with coronary artery disease in type 2 diabetes mellitus.

Background: Coronary artery disease (CAD) is a common complication of Type 2 diabetes mellitus (T2DM). Understanding the pathogenesis of this complication is essential in both diagnosis and management. Thus, this study aimed to characterize the presence of CAD in T2DM using molecular markers and pathway analyses. Methods: The study is a sex- and age-frequency matched case-control design comparing 23 unrelated adult Filipinos with T2DM-CAD to 23 controls (DM with CAD). Healthy controls served as a reference. Total RNA from peripheral blood mononuclear cells (PBMCs) underwent whole transcriptomic profiling using the Illumina HumanHT-12 v4.0 expression beadchip. Differential gene expression with gene ontogeny analyses was performed, with supporting correlational analyses using weighted correlation network analysis (WGCNA). Results: The study observed that 458 genes were differentially expressed between T2DM with and without CAD (FDR<0.05). The 5 top genes the transcription factor 3 (TCF3), allograft inflammatory factor 1 (AIF1), nuclear factor, interleukin 3 regulated (NFIL3), paired immunoglobulin-like type 2 receptor alpha (PILRA), and cytoskeleton-associated protein 4 (CKAP4) with AUCs >89%. Pathway analyses show differences in innate immunity activity, which centers on the myelocytic (neutrophilic/monocytic) theme. SNP-module analyses point to a possible causal dysfunction in innate immunity that triggers the CAD injury in T2DM. Conclusion: The study findings indicate the involvement of innate immunity in the development of T2DM-CAD, and potential immunity markers can reflect the occurrence of this injury. Further studies can verify the mechanistic hypothesis and use of the markers.

Glucagonoma-induced Dilated Cardiomyopathy in a Young Woman.

A 27-year-old woman presented with an epigastric mass, accompanied by emesis and weight loss. An abdominal computed tomography (CT) scan showed a pancreatic head-body mass and liver metastasis. Biopsy revealed well-differentiated pancreatic neuroendocrine tumor, grade 3. Chromogranin and synaptophysin stains were positive, with a Ki-67 index of 33.6%. Increased frequency of episodic emesis with incomprehensible speech and right-sided weakness prompted admission. A cranial magnetic resonance imaging (MRI) scan showed a subacute cerebrovascular infarct. Serum glucagon was markedly elevated. On the third hospital day, neurologic symptoms progressed, with repeat cranial MRI demonstrating acute lacunar infarcts. Two-dimensional echocardiography was consistent with dilated cardiomyopathy. Because of her fragile condition, she was not a candidate for surgery and chemotherapy. She was treated with long-acting octreotide every 4 weeks for a total of 10 doses. Posttreatment, a 2-dimensional echocardiogram and an abdominal CT scan showed no significant change. We report a rare case of glucagonoma with associated prominently dilated cardiomyopathy and ischemic stroke.

Genetic Variants Associated with Poor Responsiveness to Sulfonylureas in Filipinos with Type 2 Diabetes Mellitus.

Introduction: Sulfonylureas (SUs) are commonly used drugs for type 2 diabetes mellitus (T2DM) in the Philippines. This study aimed to associate genetic variants with poor response to gliclazide and glimepiride among Filipinos. Methodology: Two independent, dichotomous longitudinal substudies enrolled 139 and 113 participants in the gliclazide and glimepiride substudies, respectively. DNA from blood samples underwent customized genotyping for candidate genes using microarray. Allelic and genotypic features and clinical associations were determined using exact statistical methods. Results: Three months after sulfonylurea monotherapy, 18 (13%) were found to be poorly responsive to gliclazide, while 7 (6%) had poor response to glimepiride. Seven genetic variants were nominally associated (p<0.05) with poor gliclazide response, while three variants were nominally associated with poor glimepiride response. For gliclazide response, 3 carboxypeptidase-associated variants (rs319952 and rs393994 of AGBL4 and rs2229437 of PRCP) had the highest genotypic association; other variants include rs9806699, rs7119, rs6465084 and rs1234315. For glimepiride response, 2 variants were nominally associated: CLCN6-NPPA-MTHFR gene cluster - rs5063 and rs17367504 - and rs2299267 from the PON2 loci. Conclusion: Genetic variants were found to have a nominal association with sulfonylurea response among Filipinos. These findings can guide for future study directions on pharmacotherapeutic applications for sulfonylurea treatment in this population.

Variants of SLC2A10 may be Linked to Poor Response to Metformin.

Purpose: A study among Filipinos revealed that only 15% of patients with diabetes achieved glycemic control, and poor response to metformin could be one of the possible reasons. Recent studies demonstrate how genetic variations influence response to metformin. Hence, the present study aimed to determine genetic variants associated with poor response to metformin. Methods: Using a candidate variant approach, 195 adult Filipino participants with newly diagnosed type 2 diabetes mellitus (T2DM) were enrolled in a case-control study. Genomic DNA from blood samples were collected. Allelic and genotypic associations of variants with poor response to metformin were determined using exact statistical methods. Results: Several polymorphisms were nominally associated with poor response to metformin (P uncorr < 0.05). The most notable is the association of multiple variants in the SLC2A10 gene-rs2425911, rs3092412, and rs2425904-with common additive genetic mode of inheritance. Other variants that have possible associations with poor drug response include rs340874 (PROX-AS1), rs815815 (CALM2), rs1333049 (CDKN2B-AS1), rs2010963 (VEGFA), rs1535435 and rs9494266 (AHI1), rs11128347 (PDZRN3), rs1805081 (NPC1), and rs13266634 (SLC30A8). Conclusion: In Filipinos, a trend for the association for several variants was noted, with further observation that several mechanisms may be involved. The results may serve as pilot data for further validation of candidate variants for T2DM pharmacotherapy.

Executive summary of the 2020 clinical practice guidelines for the management of hypertension in the Philippines.

Hypertension is the most common cause of death and disability worldwide with its prevalence rising in low to middle income countries. It remains to be an important cause of morbidity and mortality in the Philippines with poor BP control as one of the main causes. Different societies and groups worked and collaborated together to develop the 2020 Philippine Clinical Practice Guidelines of hypertension arising for the need to come up with a comprehensive local practice guideline for the diagnosis, treatment, and follow up of persons with hypertension. A technical working group was organized into six clusters that analyzed the 30 clinical questions commonly asked in practice, looking into the definition of hypertension, treatment thresholds, blood pressure targets, and appropriate medications to reach targets. This guideline also includes recommendations for the specific management of hypertension among individuals with uncomplicated hypertension, hypertension among those with diabetes, stroke, chronic kidney disease, as well as hypertension among pregnant women and pediatric populations. It also looked into the appropriate screening and monitoring of patients when managing hypertension, and identification of groups who are at high risk for cardiovascular (CV) events. The ADAPTE process was used in developing the statements and recommendations which were then presented to a panel of experts for discussion and approval to come up with the final statements. This guideline aims to aid Filipino healthcare professionals to provide evidence-based care for persons with hypertension and help those with hypertension adequately control their blood pressure and reduce their CV risk.

AFES A.S.-O.N.E.: ASEAN Survey Of Needs in Endocrinology in the Time of the COVID-19 Pandemic.

OBJECTIVES: The COVID-19 pandemic has made a major impact on hospital services globally, including the care of persons with diabetes and endocrine disorders. The aim of this study is to describe the epidemiology of COVID-19 in the ASEAN Federation of Endocrine Societies (AFES) member countries; to describe challenges, changes and opportunities in caring for patients with endocrine diseases, as well as in fellowship training programs, and endocrinerelated research in the AFES countries. METHODOLOGY: The AFES ASEAN Survey Of Needs in Endocrinology (AFES A.S.-O.N.E.) was an open-ended questionnaire that was sent to the presidents and representatives of the AFES member countries by email. Responses from Societies were collated and synthesized to obtain perspectives on the emergent issues in endocrinology in the Southeast Asian region during this pandemic. RESULTS: The burden of COVID-19 cases varied widely across the AFES member countries, with the least number of cases in Vietnam and Myanmar, and the greatest number of cases in either the most populous countries (Indonesia and the Philippines), or a country with the highest capability for testing (Singapore). The case fatality rate was also the highest for Indonesia and the Philippines at around 6%, and lowest for Vietnam at no fatalities. The percentage with diabetes among patients with COVID-19 ranged from 5% in Indonesia to 20% in Singapore, approximating the reported percentages in China and the United States. The major challenges in managing patients with endocrine diseases involved inaccessibility of health care providers, clinics and hospitals due to the implementation of lockdowns, community quarantines or movement control among the member countries. This led to disruptions in the continuity of care, testing and monitoring, and for some, provision of both preventive care and active management including surgery for thyroid cancer or pituitary and adrenal tumors, and radioactive iodine therapy. Major disruptions in the endocrine fellowship training programs were also noted across the region, so that some countries have had to freeze hiring of new trainees or to revise both program requirements and approaches to training due to the closure of outpatient endocrine clinics. The same observations are seen for endocrine-related researches, as most research papers have focused on the pandemic. Finally, the report ends by describing innovative approaches to fill in the gap in training and in improving patient access to endocrine services by Telemedicine. CONCLUSION: The burden of COVID-19 cases and its case fatality rate varies across the AFES member countries but its impact is almost uniform: it has disrupted the provision of care for patients with endocrine diseases, and has also disrupted endocrine fellowship training and endocrine-related research across the region. Telemedicine and innovations in training have been operationalized across the AFES countries in an attempt to cope with the disruptions from COVID-19, but its over-all impact on the practice of endocrinology across the region will only become apparent once we conquer this pandemic.

Insulin Resistance and ß-Cell Function of Lean versus Overweight or Obese Filipino Patients with Newly Diagnosed Type 2 Diabetes Mellitus.

OBJECTIVES: To compare the level of insulin resistance and ß-cell function between lean and overweight/obese Filipino patients with newly diagnosed type 2 diabetes mellitus (T2DM). METHODOLOGY: This was a cross-sectional analytical study including newly diagnosed T2DM Filipino patients from St. Luke's Medical Center - Quezon City. The patients were classified as either lean or overweight/obese. Age, sex, smoking history, anthropometric measures and blood pressure were obtained. Insulin resistance and ß-cell function were determined using the homeostasis model assessment (HOMA). The original model (HOMA1) and the updated model (HOMA2) were used. RESULTS: A total of 80 subjects were included. There were 40 subjects in each group. The overweight/obese subjects had significantly higher mean insulin resistance (HOMA1-IR 9.8±11.7, HOMA2-IR 3.0±2.0) compared to the lean group (HOMA1-IR 2.9±1.5, HOMA2-IR 1.3±0.5). This was consistent in both HOMA1 and HOMA2 (p-values=0.001 and <0.001, respectively). The mean ß-cell function of the overweight/obese patients was significantly higher than the lean subjects when using HOMA1 (lean=57.8±35.5, overweight/obese=93.6±66.4, p-value=0.003), but not in HOMA2 (lean=57.6±30.5, overweight/obese=74.8±45.7, p-value=0.051). Overweight/obesity increased HOMA1-IR by 4.0 and HOMA1-B by 46.1 (p-values= 0.002 and <0.001, respectively). Through the use of HOMA2, overweight/obesity increased HOMA2-IR by 1.4 and HOMA2-B by 29.1 (p-values<0.001). Being overweight/obese was also associated with significantly higher odds for developing greater insulin resistance (HOMA1-IR adjOR = 5.6, 95%CI= 1.7-19.2, p-value=0.005; HOMA2-IR adjOR=10.9, 95%CI=3.4-34.9, p-value<0.001) and lower odds for a decreased ß-cell function (HOMA1-B adjOR = 0.2, 95%CI = 0.05-0.9, p-value=0.033; HOMA2-B adjOR=0.2, 95%CI=0.04-0.9, p-value=0.043) compared to being lean. CONCLUSION: Newly diagnosed overweight/obese T2DM had higher mean insulin resistance and ß-cell function compared to lean T2DM. Overweight/obesity was also associated with higher odds of developing insulin resistance and lower odds for a decreased ß-cell function compared to being lean. The overweight/obese T2DM group also had worse metabolic profile manifested by higher FPG, HbA1c, SGPT and blood pressures compared to the lean T2DM group.

Association of Metabolic Syndrome with the Severity of Airflow Obstruction in Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Metabolic Syndrome (MetS) is common in Chronic Obstructive Pulmonary Disease (COPD) patients but their association is still an unsettled issue. The aim of this study was to determine the association of MetS with the severity of airflow obstruction. METHODOLOGY: This was a cross-sectional analytic study of 157 patients with COPD. They were classified using the Global Initiative for Chronic Obstructive Lung Diseases (GOLD). MetS was assessed using two well-recognized criteria. Demographics, clinical data, lifestyle-related characteristics, fasting blood sugar (FBS) and lipid profile were obtained. Multiple logistic regression was used to determine the association of MetS with the severity of airflow obstruction. RESULTS: 40.13% and 17.20% of patients had MetS using the NCEP/ATP III-AHA/NHBLI and IDF criteria, respectively. MetS was not associated with severity of airflow obstruction. Of the MetS components, only elevated blood pressure (BP) was significantly associated with severity of airflow obstruction (GOLD II: OR=3.28, p<0.001; GOLD III: OR=4.04, p=0.2; GOLD IV: OR=6.21, p=0.04). Elevated FBS was also associated with GOLD IV (OR=16.09, p=0.02). Significant factors associated with MetS in COPD patients were body mass index, inhaled steroid, number of pack-years, and GOLD II. CONCLUSION: MetS is not associated with severity of airflow obstruction. Only certain components of MetS showed significant associations such as elevated BP with GOLD II-IV and elevated FBS with GOLD IV.

Prevalence of Metabolic Syndrome and its Individual Features Across Different (Normal, Overweight, Pre-Obese and Obese) Body Mass Index (BMI) Categories in a Tertiary Hospital in the Philippines.

OBJECTIVE: This study aims to determine the prevalence of metabolic syndrome and its individual components across different BMI categories among patients seen at Wellness Center and Obesity and Weight Management Center, St. Luke's Medical Center Quezon City. METHODOLOGY: This was a 3-year retrospective study of patients seen at the institution from 2013 to 2016. The patients were divided according to Asia-Pacific BMI categories and presence of metabolic syndrome was determined as defined by NCEP/ATP III-AHA/NHLBI (2005). RESULTS: This study included a total of 1367 adult patients with the mean age of 53 (SD=12.4). The overall prevalence of metabolic syndrome is 51.0%. Its prevalence across the different BMI categories are as follows: 29.6 % with Normal BMI (BMI 18.5-22.9 kg/m2), 38.9% in overweight (BMI 23-24.9 kg/m2), 56.9% in Pre-Obese (BMI 25-29.9 kg/m2) and 62.4% in Obese (BMI ≥30 kg/m2) subgroup. Presence of central obesity using the Asian cut-off has the highest prevalence among patients with metabolic syndrome across all categories. In the group with normal BMI, hypertension and elevated blood glucose were highest with central obesity being the least common but still with 7.3% of individuals meeting the criteria for central obesity. CONCLUSION: There is high prevalence of metabolic syndrome even in patients with normal BMI. Diagnosis and screening for its individual components should not only be confined to individuals with higher BMI.

Validation of the oral health screening questionnaire in predicting serious periodontitis among adult Filipinos with type 2 diabetes mellitus / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Periodontitis affects more than half of patients with diabetes. In resource poor areas in the Philippines, access to routine dental visits may be difficult and thus, a selective approach might be needed to identify those who need dental evaluation and management. An easy-to-administer oral health self-report questionnaire was developed in order to predict serious (moderate to severe) periodontitis.<br /><strong>OBJECTIVE:</strong> The study aims to determine the validity of the Oral Health Screening Questionnaire for Persons with Diabetes (OHSQPD) in estimating the prevalence of serious periodontitis.<br /><strong>METHODOLOGY:</strong> A cross-sectional criterion-referenced study of 175 participants with T2DM were included in the study. They were asked to answer the questionnaire and then made to undergo a full dental examination to identify the presence and severity of periodontitis. The validity of the questionnaire was assessed by determining the sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver-operating curve (AUROC) with the dental examination as the gold standard.<br /><strong>RESULTS:</strong> Using the questionnaire, the prevalence of serious periodontitis was 61% (106) based on an optimal cut-off score of ?12. At this score, the questionnaire yielded a sensitivity of 80.4% and a specificity of 70.6%, with an AUROC of 0.83.<br /><strong>CONCLUSION:</strong> The OHSQPD is a valid tool in detecting serious periodontitis</p>

Prevalence of diabetes mellitus and pre-diabetes in the Philippines: A sub-study of the 7th National Nutrition and Health Survey (2008)

INTRODUCTION: Diabetes mellitus is rapidly increasing worldwide but the greatest increase is expected in developing countries including the Philippines. It is of public health concern to monitor countrywide prevalence of diabetes as it leads to significant cardiovascular-related mortality as well as significant complications such end stage renal disease, blindness, lower leg amputations and blindness.METHODOLOGY: This is a national survey to estimate the prevalence of diabetes and pre-diabetes using the criteria of the World Health Organization through a stratified multi-stage sampling design representing each of the 17 regions in the country.RESULTS AND DISCUSSION: The national prevalence of diabetes in the year 2008 was 7.2% (6.5-7.9); impaired glucose tolerance 7.0% (6.1-7.8) and impaired fasting glucose was 2.2% (2.2-3.1). There was a greater prevalence of individuals with diabetes in the urban areas at 8.5% (7.5-9.5) compared to the rural areas at 5.7% (4.6-6.8). Diabetes is slightly more preponderant among females at 7.4% (6.4-8.3) compared to males at 7.0% (6.1-8.0).CONCLUSION: The prevalence of diabetes mellitus in the Philippines is rising with the prevalence in 2008 at 7.2%. The prevalence of pre-diabetes exceeds that of diabetes mellitus at approximately 10.2%.

Tuberculous abscess of the thyroid / Journal of the ASEAN Federation of Endocrine Societies

Tuberculosis (TB) of the thyroid gland is rare, with acute abscess formation being the least common form of presentation. As such, TB of the thyroid may be overlooked as an initial clinical impression. A careful approach by history, physical examination, laboratory testing and radiologic imaging may aid in defining the etiology of the thyroid abscess, but these remain nonspecific. An accurate diagnosis may only be made by histologic examination. We present a case of a tuberculous abscess of the thyroid gland in a 37-year-old female. TB of the thyroid should also be considered when evaluating patients presenting with a painful thyroid nodule.

Angiotensin I-converting enzyme gene polymorphism and diabetic nephropathy in Filipino type 2 diabetes mellitus patients / Journal of the ASEAN Federation of Endocrine Societies

Objective. Previous studies have demonstrated the role of genetic susceptibility in the pathogenesis of diabetic nephropathy. The study aimed to determine the frequencies of angiotensin I-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism in a pilot population of Filipino type 2 diabetic patients and normal controls. Methods. An analysis of the ACE gene polymorphism was performed in 42 diabetic patients with and without nephropathy, and 24 normal controls. The analysis was done using polymerase chain reaction, restriction enzyme digestion, and gel electrophoresis techniques to determine the polymorphism (II, DD or ID). Independent T-tests and chi-square tests were used to compare clinical characteristics, and logistic regression analysis was done to determine odds ratio for development of nephropathy. Results. The ID polymorphism of the ACE gene was more frequent (52.4%) in patients with diabetic nephropathy (n=21). In those without nephropathy (n=21), II was more common (61.9%). ID was the more frequent genotype in the normal controls (n=24) (58.3%). The odds of developing diabetic nephropathy were increased by 4.8 times in those with ID polymorphism, and 2.9 times in those with DD. Conclusion. The D allele was more common in patients with diabetic nephropathy, similar to the observation in South Indian patients. Since the study involved only a small pilot group, studies on a larger population is needed to establish the hypothesized role of the D allele in susceptibility to diabetic nephropathy in Filipinos.

Changes in ovarian function after radioactive iodine among patients with differentiated thyroid carcinoma at St. Luke's Medical Center / Journal of the ASEAN Federation of Endocrine Societies

OBJECTIVE: To determine the prevalence of menstrual and reproductive dysfunction among subjects who have undergone radioiodine treatment for thyroid carcinoma.METHODOLOGY: This study enrolled adult women with Differentiated Thyroid Carcinoma who received the treatment at age 40 years and below. Data was processed using SAS program and evaluated using Fischer's test and Wilcoxon test.RESULTS: The study enrolled 46 women. Three reported cycle irregularities, 4 reported changes in amount of bleeding and 1 had amenorrhea. The prevalence rate of menstrual abnormalities was 15.2%. These women received a significantly higher dose of radioactive iodine (RAI) (120 vs. 110 mCi, p = 0.0064). Eleven women tried to conceive and there were 5 births to 5 different subjects after radiation. There were no congenital anomalies and 1 miscarriage. Four women were menopausal with an average age of 44.4 years old.CONCLUSION: This study showed that the prevalence of menstrual disturbances after high dose radioactive iodine treatment among thyroid cancer patients is 15.2%. The affected group received a significantly higher dose of radioactive iodine compared to the unaffected group.

Impact of waist circumference measurement variation on the diagnosis of metabolic syndrome

INTRODUCTION: While waist circumference (WC) is widely used as an index for visceral fat accumulation and purportedly the primary pathology responsible for the metabolic syndrome (MS), its proposed cut-off value varies depending on the disparate diagnostic criteria used as well as on the gender, race and ethnic group being evaluated. Due to the strong association between MS and central obesity, waist circumference should be incorporated into the routine physical exam when assessing cardiovascular disease and diabetes risk. Currently however, there is no standard location for the measurement of WC. On literature review, we found no scientific rationale for preferring any one WC site to the others hence, this study.OBJECTIVE: This study aims to (1) determine waist circumference measurement var iat ions among MS patients, (2005 NCEP-ATP III/AHA/NHLB criteria), at three levels: (A) umbilical level, (B) midline level (between the inferior margin of the ribs and the superior border of the iliac crest) and (C) level of the superior border of the iliac crest.RESEARCH DESIGN AND METHODS: Across - sectional analytical study among adult patients, aged 40 to 69 years, diagnosed with MS using 2005 NCEP-ATP III/AHA/ NHLB criteria seen at the Philippine General Hospital, as part of the Asia-Oceania Survey on Metabolic Syndrome and Diabetes initiated by the Japan Diabetes Society.RESULTS: A total of 187 MS individuals were included in the study (56% females). Both males and females were obese stage 1 (25.5 kg/m2 and 26.7 kg/m2 respectively). The mean WC measurements at level A in men was 92.9 cm (81.36 - 104.44 cm) and 93.83 cm (83.4 - 104.26 cm) in women; at level B, the mean WC in men was 90.73 cm (75.49 - 105.97 cm) and 91.51 cm (80.62 - 102.4 cm) in women; and at level C, the mean WC in men was 93.5 cm (81.97 - 105.03 cm) and 95.12 cm (85.11 - 105.13 cm) in women. Results showed that WC measurements at three levels did not significantly differ among MS patients when stratified to age and sex. However, when waist circumference was measured at three levels among all patients with MS, there was significant difference in WC taken at level B and level C (Sig = 0.009). Waist circumference at level A was similar and less variable to WC level B than WC at levelC.CONCLUSIONS: Among patients with MS as defined by NCEPATP III/AHA/NHLB criteria, waist circumference at level B (midpoint level between the lower ribs and superior border of the iliac crest) was smaller than waist circumference at level A (umbilical level) and smaller than level C (superior border of the iliac crest) (WCB

Prevalence of thyroid dysfunction among patients taking glutathione supplementation: A cross-sectional study preliminary report

BACKGROUND: Glutathione due to its favorable side effect of skin whitening has been used by cosmetic centers and by individuals buying it as an over the counter supplementation. Because of this, this compound is prone to misuse. To date, there are limited studies on the adverse effects of exogenous supplementation of glutathione.OBJECTIVE: To determine the prevalence of thyroid dysfunction among individuals taking oral and intravenous glutathioneDESIGN: Cross-sectional studyMETHODS:Healthy Filipino subjects, 21 to 50 years of age, currently taking oral or intravenous glutathione, with no preexisting/ known thyroid disease and history of radiation exposure, and not taking medications with known effect on thyroid function were included in the study. Blood extraction for thyroid function test and thyroid ultrasound were conducted.RESULTS: A total of 36 subjects were analyzed with a mean age of 36.3±8 years, 86 percent were female. High dose glutathione (1000mg or more per day) was taken in by nine subjects (25%) while 27 subjects (75%) took doses below the recommended range (less than 1000ng per day). The prevalence of abnormal thyroid function was 5.56 percent (n=2). Both cases were taking low dose glutathione supplementation. No abnormal thyroid function was seen with higher doses of glutathione. No significant relationship was found between the duration of glutathione supplementation with thyroid function status. Thyroid stimulating hormone (TSH) levels were slightly higher among those taking high dose glutathione (mean=1.08 versus 1.04, p=.81). There was no significant differences in the duration and dose of supplementation with the size of the gland.RECOMMENDATION:The direct effect of L-glutathione supplements on thyroid function must be established using a longitudinal prospective study design. We also propose a group to serve as a negative control during the comparisons.

Prevalence of periodontitis and its association with glycemic control among patients with type 2 diabetes mellitus seen at St. Luke's Medical Center

BACKGROUND: Studies have shown that diabetes increases the prevalence and severity of periodontitis. Furthermore, among patients with Type 2 Diabetes Mellitus (DM), poorer glycemic control was found to be associated with poorer periodontal health.OBJECTIVE: To determine the prevalence of periodontitis and its association with glycemic control among Filipino patients with Type 2 DM.DESIGN: Cross-sectional studyMATERIALS AND METHODS: Diagnosed Type 2 DM patients 35 years and above were recruited from the out-patient clinics of St. Luke's Medical Center from June-October 2009. Periodontitis was evidenced by the presence of ?3mm probing depth and ?3mm periodontal attachment loss at the same site. Periodontitis severity was classified based on probing depth and furcation involvement. Glycemic control was assessed by laboratory assay for HbA1c grouped into RESULTS: A total of 192 subjects were analyzed. Prevalence of periodontitis among the Type 2 DM population studied was 68.23%. In this study, we found out that for those whose length of time since last dental check-up was >1 year, the odds of having periodontitis is 3.8 times higher (95% CI 1.45-9.76, p-value 0.007) among subjects with HbA1c ?7% compared to those with HbA1c CONCLUSION: Our findings suggest that periodontitis is prevalent among the Filipino Type 2 DM population studied. In this study, it is the interaction of both HbA1c ?7% and length of time since last dental check-up >1 year that resulted in a statistically significant association with periodontitis.

Prevalence of secondary hyperparathyroidism among outpatient type 2 diabetic patients undergoing hemodialysis in a tertiary hospital

BACKGROUND: Secondary hyperparathyroidism (SHPT) can lead to significant morbidity, mortality, and additional healthcare resource ut i l i zat ion in chronic k idney disease. Baseline prevalence data is highly required. This study aims to determine the prevalence of secondary hyperparathyroidi sm (SPTH) in pat ient s wi th Type 2 diabetes undergoing hemodialysis.MATERIALS AND METHODS: We reviewed all medical records of patients whose chronic kidney disease (CKD) was due to Type 2 diabetes mellitus and are undergoing chronic hemodialysis from 2000 to 2009. Excluded were those who underwent hemodialysis due to acute renal failure or for chronic renal failure due to other causes other than diabetic nephropathy (e.g. hypertensive nephropathy, chronic glomerulonephritis, etc). Data collected include age, sex, body mass index, bone markers, intact PTH, and urea reduction rate.RESULTS: The age and sex adjusted period prevalence of secondary hyperparathyroidism was 28.9%, commonly seen in the 5th to the 6th decade of life. Patients with SPTH had higher serum intact PTH, higher total calcium level (mean 9.05 versus 8.6, p=.026) and a higher urea reduction rate (mean 54.1 versus 45.2, p=.045). There was a longer duration of hemodialysis sessions among those with secondary hyperparathyroidism (mean 2.4 years versus 1.78 years, p=.004). Dialysis was likewise more adequate.CONCLUSION: Prolonged diabet ic kidney di sease is associated with secondary hyperparathyroidism for which a more aggressive monitoring of calcium and phosphorus imbalance is required.

Adiponectin levels and its association with hyperglycaemia in adult Filipino participants in the 2003--04 National Nutrition and Health Survey.

Our objective was to determine the association of serum adiponectin levels with the presence of IFG or DM in Filipinos. This case control study used sera of adult participants in the Philippines' NNHeS: 2003-04. Subjects were divided into: normoglycaemic control, impaired fasting glucose, and type 2 diabetes mellitus. Seventy-seven prediabetic and 83 diabetic subjects were included in the prediabetic and diabetic groups, respectively. There was no significant difference in adiponectin values between control and prediabetic subjects. Diabetic subjects had significantly lower mean serum adiponectin levels (10.7 versus 14.2 microg/ml, p=0.0198) compared with age- and BMI-matched control subjects. Diabetic subjects were found most frequently (43.53%) in the lowest tertile (1.6-7.2 microg/ml) and least frequently (20%) in the highest tertile (14-84 microg/ml) of adiponectin values. We conclude that Filipinos with diabetes mellitus had significantly lower adiponectin levels compared with normoglycaemic subjects.