Relationship between healthy diet and risk of cardiovascular disease among patients on drug therapies for secondary prevention a prospective cohort study of 31 546 high-risk individuals from 40 countries
Dehghan M.,Hamilton General Hospital |
Mente A.,Hamilton General Hospital |
Mente A.,McMaster University |
Teo K.K.,Hamilton General Hospital |
And 7 more authors.
Circulation | Year: 2012
Background: Diet quality is strongly related to cardiovascular disease (CVD) incidence, but little is known about its impact on CVD events in older people at high risk of CVD and receiving effective drugs for secondary prevention. This study assessed the association between diet quality and CVD events in a large population of subjects from 40 countries with CVD or diabetes mellitus with end-organ damage receiving proven medications. Methods and Results: Overall, 31 546 women and men 66.5±6.2 years of age enrolled in 2 randomized trials, the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET) and the Telmisartan Randomized Assessment Study in ACEI Intolerant Subjects With Cardiovascular Disease (TRANSCEND), were studied. We used 2 dietary indexes: the modified Alternative Healthy Eating Index and the Diet Risk Score. The association between diet quality and the primary composite outcome of CV death, myocardial infarction, stroke, or congestive heart failure was assessed with Cox proportional hazard regression with adjustment for age, sex, trial enrollment allocation, region, and other known confounders. During the 56-month follow-up, there were 5190 events. Patients in the healthier quintiles of modified Alternative Healthy Eating Index scores had a significantly lower risk of CVD (hazard ratio, 0.78; 95% confidence interval, 0.71-0.87, top versus lowest quintile of modified Alternative Healthy Eating Index). The reductions in risk for CV death, myocardial infarction, and stroke were 35%, 14%, and 19%, respectively. The protective association was consistent regardless of whether patients were receiving proven drugs. Conclusions: A higher-quality diet was associated with a lower risk of recurrent CVD events among people ≥55 years of age with CVD or diabetes mellitus. Highlighting the importance of healthy eating by health professionals would substantially reduce CVD recurrence and save lives globally. © 2012 American Heart Association, Inc.
Lewin J.,Peter MacCallum Cancer Center |
Puri A.,Tata Memorial Center |
Quek R.,National Cancer Center |
Ngan R.,Queen Elizabeth Hospital |
And 3 more authors.
The Lancet Oncology | Year: 2013
Sarcomas are a rare and diverse set of cancers that disproportionately affect young people. The best possible outcome depends on access to highly specialised, multidisciplinary care. Although advances have been made in therapeutic techniques, access to some treatments might be limited by cost implications. This Review proposes an evidence-based, consensus recommendation for optimum management of bone and soft-tissue sarcoma across the Asia-Pacific region, taking into account variation in health-care resources, stratified according to the Breast Health Global Initiative resource levels. A web-based survey of 89 clinicians involved in the care of patients with sarcoma from 18 Asia-Pacific countries generated the recommendations for diagnosis, staging, and management, including supportive and palliative care, and research. © 2013 Elsevier Ltd.
Lapitan M.C.M.,Philippine General Hospital |
Lapitan M.C.M.,University of the Philippines at Manila |
Buckley B.S.,Philippine General Hospital |
Buckley B.S.,National University of Ireland
Journal of Obstetrics and Gynaecology Research | Year: 2011
Aim: Obstructive uropathy is a recognized complication in advanced cervical cancer. Urinary diversion is commonly used to bypass the obstruction and improve renal function. The degree of survival benefit that diversion offers is not well established and its impact on quality of life (QoL) is uncertain. This study considered these factors in order to inform treatment decisions. Methods: This study examined a prospective cohort of patients with advanced cervical cancer and obstructive uropathy in Manila, Philippines. Age, cancer treatment status, comorbidities, serum creatinine level, degree of obstructive uropathy and QoL were recorded at baseline. Patients with creatinine values >150 mmol/L, or who were being considered for radiotherapy or nephrotoxic chemotherapy or manifesting uncontrolled or recurrent uropathy-related urinary tract infection, were offered diversion. Follow-up data collection was at 3, 6, 9 and 12 months from cohort entry. Results: Of the 230 patients invited, 205 patients joined the cohort. Complete data were available for 198, of whom 93 underwent diversion, 56 required diversion but elected not to receive it, and 49 did not require it. Although survival at 12 months among those who underwent diversion was no greater than among those who required but elected not to receive the procedure, diversion was associated with significantly improved chance of survival in the shorter term. There was no significant difference in the QoL between the groups throughout the study. Conclusion: With no evidence of an impact on QoL, the decision to offer diversionary surgery might be based solely on a survival benefit, which is modest but potentially important to patients. © 2011 The Authors.
Abes G.T.,Philippine National Ear Institute |
Abes G.T.,University of the Philippines |
Abes F.L.L.B.,Philippine General Hospital |
Jamir J.C.,University of the Philippines
Otology and Neurotology | Year: 2011
Background: Tuberculosis (TB) is a rare cause of otitis media. This study aims to increase awareness on the clinical presentation of TB otitis media and illustrate how early detection affects treatment outcome. Methods: Chart review of 12 patients (13 ears) from a tertiary hospital in Manila, Philippines, seen from 2004 to 2009. Clinical predictors of the disease were summarized. Clinical, radiologic, and audiometric outcomes after treatment were compared between treatment groups. Results: The 5 otoscopic presentations were multiple perforations, single perforation with refractory otorrhea and exuberant granulation tissue formation, single perforation with minimal otorrhea and no granulation tissue formation, intact tympanic membrane with middle ear effusion, and intact tympanic membrane with tumorlike tissue in the middle ear. Clinical predictors of the disease were history of pulmonary TB, work-related contamination of the infection, positive purified protein derivative test, positive chest radiographic finding and intraoperative granulation tissue with cheesy material, and temporal bone computed tomographic scan findings. Patients who had no middle ear surgery showed significantly better clinical, radiologic, and audiometric outcomes than those who were diagnosed late and had more complicated surgical procedure. Conclusion: The clinical presentation of TB otitis media is variable. Early detection of the early forms entail less surgical intervention and favors better treatment results. Copyright © 2011 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
Oliva R.V.,Philippine General Hospital |
Bakris G.L.,University of Chicago
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2012
Hypertension is common in people aged 65 and older. African Americans and women have a higher prevalence of hypertension than white individuals, and in those aged 70 and older, the hypertension was more poorly controlled than in those aged 60-69. The number of trials available in the elderly population compared with the general population are limited; hence, the database for strong recommendations as to goal blood pressure (BP) are limited. The American College of Cardiology with the American Heart Association has recently published a consensus report of management of hypertension in the elderly population. This review presents an overview of this consensus report and reviews specific studies that provide some novel findings regarding goal BP and progression of nephropathy. In general, the evidence strongly supports a BP goal of less than 150/80 mmHg. The evidence review for the consensus report supports a goal of <150/80 mmHg for the elderly with scant data in those over age 80. However, it was decided to set the goal to less than 140/90 mmHg unless the patient cannot tolerate it and then try for 140-145 mmHg. The data are scant at best for those over age 80 mmHg but some evidence exists for <150/80 mmHg. Diuretics and calcium antagonists are the most efficacious single agents for treatment; however, most patients will require two or more drugs to achieve such goals. © The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
Lo T.E.N.,Philippine General Hospital
BMJ Case Reports | Year: 2013
Presented in this paper is a case of a 36-year-old Filipino man presenting with a chronic history of intermittent proximal muscle weakness and paralysis which was associated with failure to thrive, severe bony deformities, muscle wasting and multiple electrolyte abnormalities (hypokalaemia, hypocalcaemia, hypomagnesaemia). Severe skeletal deformities led to a pathological fracture of the femoral bone and restrictive chest wall expansion during inspiration necessitating admission and consult at our institution. Correction of multiple electrolyte abnormalities was the mainstay of treatment for this case and resulted into full reversal of paralytic symptoms but skeletal and osseous abnormalities persisted. This case highlights the insidious course and subtle signs of Fanconi's syndrome leading to disfiguring skeletal deformities and abnormalities if not diagnosed early. Early suspicion and eventual diagnosis might be the key for these patients to have normal productive life devoid of crippling complications. Copyright 2013 BMJ Publishing Group. All rights reserved.
Lo T.E.,Philippine General Hospital
BMJ case reports | Year: 2013
Presented in this paper is a case of a young Filipino man presenting with recurrent acute gouty flares leading to chronic tophaceous gout and unusual cutaneous manifestations (miliary gout, panniculitis, ulcerations). Unusual sites within the body (torso, shoulder, forearms, thigh) revealed multiple urate dermal deposition. Self-medication with steroids eventually led to secondary Cushing's syndrome and eventual emergence of metabolic complications.
Lapitan M.C.,Philippine General Hospital
Cochrane database of systematic reviews (Online) | Year: 2012
Urinary incontinence is a common and potentially debilitating problem. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure. To assess the effects of open retropubic colposuspension for the treatment of urinary incontinence. We searched the Cochrane Incontinence Group Specialised Register (searched 13 March 2012), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles. We contacted investigators to locate extra studies. Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group. Studies were evaluated for methodological quality or susceptibility to bias and appropriateness for inclusion and data extracted by two of the review authors. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated. This review included 53 trials involving a total of 5244 women.Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggested lower incontinence rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggested lower incontinence rates after open retropubic colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower incontinence rate after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (risk ratio (RR) for incontinence 0.51; 95% CI 0.34 to 0.76 before the first year, RR 0.43; 95% CI 0.32 to 0.57 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond five years).Evidence from 20 trials in comparison with suburethral slings (trans-vaginal tape or transobturator tape) found no significant difference in incontinence rates in all time periods assessed.In comparison with needle suspension, there was a lower incontinence rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.48; 95% CI 0.33 to 0.71), and beyond five years (RR 0.32; 95% CI 15 to 0.71).Patient-reported incontinence rates at short, medium and long-term follow-up showed no significant differences between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials incontinence was less common after the Burch (RR 0.38; 95% CI 0.18 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five year follow-up. There were few data at any other follow-up times.In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85% to 90%. After five years, approximately 70% of patients can expect to be dry. Newer minimal access procedures such as tension-free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known and closer monitoring of their adverse event profile must be carried out. Laparoscopic colposuspension should allow speedier recovery but its relative safety and long-term effectiveness is not known yet.
Espino-Strebel E.E.,Philippine General Hospital
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society | Year: 2010
Radical hysterectomy has been the treatment of choice for early-stage cervical cancer. Since its introduction in oncology, modifications to the original technique were made to enhance feasibility, improve cure rate, and decrease postoperative complications. Among these are the identification and preservation of pelvic autonomic nerves, known as the nerve-sparing radical hysterectomy (RH). This retrospective study was conducted to compare the nerve-sparing with the conventional RH in terms of feasibility and safety, including bladder dysfunction and perioperative and postoperative complications and morbidities. Patients with biopsy-proven early-stage cervical carcinoma, cervical carcinoma with central tumor recurrence or persistence after primary radiotherapy, and endometrial carcinoma with cervical involvement treated with RH with or without nerve-sparing technique were included. The perioperative and postoperative complications and bladder function of these patients were analyzed. Ninety-seven patients with early-stage cervical cancer and 24 patients with clinical stage II endometrial cancer underwent RH with or without nerve-sparing technique in a nonrandomized fashion. There was no statistically significant difference between the 2 procedures in terms of duration of surgery, intraoperative blood loss, duration of hospitalization, and morbidity. Patients who underwent the nerve-sparing approach had a statistically significant earlier return of bladder function, with a mean of 9.4 days for the cervical cancer cases (vs 21 days in the non-nerve-sparing group) and a mean of 8.5 days for the endometrial cancer cases (vs 22.6 days in the non-nerve-sparing group). The technique of sparing the pelvic autonomic nerves during RH for early-stage cervical cancer and clinical stage II endometrial cancer is comparable to the conventional method in terms of perioperative complications and morbidity, but is more favorable in terms of return of bladder function.
Oliva R.V.,Philippine General Hospital |
Bakris G.L.,University of Chicago
Journal of the American Society of Hypertension | Year: 2014
Management of hypertension in diabetes is critical for reduction of cardiovascular mortality and morbidity. While blood pressure (BP) control has improved over the past two decades, the control rate is still well below 50% in the general population of patients with type 2 diabetes mellitus (T2DM). A new class of oral glucose-lowering agents has recently been approved; the sodium-glucose co-transporter 2 (SGLT2) inhibitors, which act by eliminating large amounts of glucose in the urine. Two agents, dapagliflozin and canagliflozin, are currently approved in the United States and Europe, and empagliflozin and ipragliflozin have reported Phase 3 trials. In addition to glucose lowering, SGLT2 inhibitors are associated with weight loss and act as osmotic diuretics, resulting in a lowering of BP. While not approved for BP-lowering, they may potentially aid BP goal achievement in people within 7-10 mm Hg of goal. It should be noted that the currently approved agents have side effects that include an increased incidence of genital infections, predominantly in women. The approved SGLT2 inhibitors have limited use based on kidney function and should be used only in those with an estimated glomerular filtration rate (eGFR) > 60 mL/min/1.73 m2 for dapagliflozin and ≤ 45 mL/min/1.73 m2 for canagliflozin. Cardiovascular outcome trials are ongoing with these agents and will be completed within the next 4-5 years. © 2014 American Society of Hypertension. All rights reserved.