PHA Warns Against Unhealthy Lifestyle The media got another well-deserved earful on the perils of smoking, drinking heavily, and unhealthy diet.
Through a media forum held February 18, the Philippine Heart Association (PHA), in cooperation with the National Press Club (NPC), told the public to put a check on any bad habits they might have that might increase their risk for heart disease, hypertension, stroke, and diabetes mellitus.
Drs. Romeo Santos, Eugene Reyes, and Eddison Ty warned that the prevalence of these diseases has risen to alarming levels, placing undue burden on the country's health-care delivery system and the personal resources of those afflicted.
They stressed the importance of prevention and education. They also said that healthy lifestyle advocacy should begin while young, since this is when unhealthy habits start to take root.
They explained the havoc caused by the increased consumption of junk food and fast food on children's health. Diabetes mellitus could no longer be considered an adult onset disease, since obesity in schoolchildren has made them vulnerable to it.
The cardiologists also disclosed that tobacco companies do really target young people to patronize their products. They sardonically pointed out that so many adults are already hooked on smoking, so the tobacco companies have now shifted their attention to a group with a greater-and renewable-number of potential customers.
The vitamin-fortification of junk foods, they also declared, is more a marketing device than anything else, and does not really help children become more aware of and interested in proper nutrition.
The PHA also held a free clinic for the media at the NPC building. A medical team from Pfizer, Bayer, and Roche did lipid testing, sugar screening, blood pressure monitoring, body mass index check, and fat analysis.
Many of the members of the media found out that they themselves needed to advocate a healthier lifestyle as they were already at risk for these killer diseases.
New Challenges for PSNM in 2003
The Philippine Society of Nuclear Medicine (PSNM) held its annual convention January 31 with the theme New Challenges in Nuclear Oncology. PSNM president Dr. Jerry M. Obaldo formally opened the one-day affair that featured lectures on the latest developments in nuclear medicine.
Dr. Teofilo San Luis, chair of the department of nuclear medicine at St. Luke's Medical Center (SLMC), was the main speaker. He discussed new challenges in thyroid malignancy, the seventh most common type of cancer in the Philippines occurring in both sexes.
San Luis introduced new ways of diagnosis, treatment, and monitoring of thyroid malignancy. Thyroid cancer imaging detects the residual functioning of the thyroid tissue and the differentiated thyroid cancer. Whole body scintigraphy enables proper evaluation of thyroid cancer and gives ample preparation before the removal procedure. San Luis said tetrofosmin imaging is used for follow-up of high-risk patients and those with negative I-131 (iodine) scans. In monitoring the recurrence of malignant tumors, Serum ThyroGlobulin is used nowadays. The sodium iodide symporter catalyzes the active accumulation of iodide from the interstitium into the cell.
In terms of therapy and treatment, some therapeutic modalities like the Recombinant Human TSH is costly but safe and effective. San Luis said further research is now being conducted in developing gene therapy, involving production of suicide cells to kill the malignant cells and the introduction of the genes responsible for the transport of iodine. Endoscopic thyroid surgery is preferred for patients requiring surgery.
Dr. Gerald Goco of SLMC spoke about applications of positron emission tomography (PET) in oncology. PET is now made available in the Philippines and is used in detecting hidden malignant tumors. PET works in various stages from disease diagnosis to tumor staging to treatment, planning, and monitoring and detection of recurrence. He said PET greatly helps in the management of cancer patients.
Jacqueline San Pedro
Overcoming Thyroid Disorders
The Philippine Thyroid Association's (PTA) 19th annual convention last month focused on current issues in thyroid disorders, among them, interpretation of thyroid function tests, unconventional use of iodine 131 in nontoxic goiter, medical and surgical options for thyroid cysts, use of postsurgical ablation therapy, thyroid and infertility, goiter in children, and preemployment screening.
"Thyroid disorders are issues that have to be overcome," said PTA founding member Dr. Virgilio L. Gonzales in an opening message. Calling attention to the declining level of public awareness on the prevalence of thyroid disorders, Gonzales called on the PTA to do its share in raising public consciousness, as well as in promoting use of iodine-fortified salt and other food products. He said the PTA could help the Department of Health carry out the iodine fortification program to overcome iodine deficiency problems.
Dr. Gil C. Fernandez, Philippine Medical Association president, lauded the PTA for having "established a foothold in community service," and urged the association to focus its efforts on the less fortunate to give them access to your services."
Thyroid diseases are three to four times more common in women than in men. Discussing its impact on fertility, Dr. Leisa Magboo-Gaviola said that although it is presumed that estrogens play a role, no clear evidence has yet emerged. It may relate to the closely intertwined relationship between thyroid function and the female reproductive axis. She noted that patients with either hyperthyroidism or hypothyroidism tend to be infertile, although it is certainly possible to have these diseases and still get pregnant. But once properly treated, fertility is quickly restored, and one can have a safe, uneventful pregnancy and delivery, Gaviola said.
Concerning goiters in children, Dr. Sioksoan Chan-Cua, pediatric endocrinologist at the University of the Philippines-Philippine General Hospital, said that in general severe defects in thyroid gland development or inborn errors of thyroid hormonogenesis may be detected early in infancy. On the other hand, less severe defects or acquired abnormalities, particularly autoimmune disease, present later in childhood and in adolescence.
A panel discussion zeroed in on the role of physicians in screening applicants for employment. The discussants-doctors Vincent C. Santos, Susan Yu-Gan, Oscar Tinio, Mercedes Palma of DoH, and Fe Bacungan-agreed that preemployment screening for thyroid problems and other disorders is important both for the prospective employee and the employer. It helps ensure that companies would be hiring healthy workers. On the other hand, it serves as a tool for detecting health problems that a job applicant might have, and therefore offer them the opportunity for early treatment. The panel stressed that physicians who screen job applicants don't have the responsibility to accept or reject applicants, but they can recommend qualified individuals based on their health condition and the requirements of the job.
The PTA's officers for 2002-2003 are doctors Lourdes Paulino, president; Benigno L. Ong, vice president; Leilani B. Mercado-Asis, secretary; Consolacion O. Obmerga, treasurer; and Vincent Santos, public relations officer.
Band Performs Less the Fanfare
Like donating an organ, conducting medical missions is hopefully an altruistic endeavor. They are done not for the image of charity an individual or organization will get from them-not even as a kind of investment from which one could get returns in the future-but for the full benefit of someone in need, without wanting anything in return, something that almost aims for the full effacement of the giver.
For 65 years the Philippine Band of Mercy has worked quietly for the benefit of indigent patients. Despite many of its officers and members being celebrities in their respective fields, one will rarely find them taking out an ad in the papers announcing their good deeds. And yet their work is unflagging. Their job, after all, does not depend on whether the media are there to document their activities.
Unlike the run-of-the-mill medical mission, which usually involves a lot of fanfare for about a full day's work that takes an entire year, if at all, to get followed up, the PBM extends help almost daily.
Although for the past 65 years the primary service the PBM offers has been in cleft lip and palate-and this does not only cover the surgery, but the orthodontic and dental care and speech therapy as well-it has branched into other services. At present it is actively involved in helping kids with hydrocephalus and meningocele, orthopedic impairments, eye problems, and severe burns.
The PBM serves an average of 90 surgical patients every month; in 2002 alone 769 patients benefited from cleft lip and palate surgery, comprising 72 percent of all patients served.
Aside from these regular services, the PBM also hooks up with other organizations and local communities in holding missions that "[provide] health care services with long-term results." But knowing that seasonal medical missions are not enough, PBM is now working on training local doctors and "making medical intervention available on a permanent basis in all local hospitals."
And now, the PBM is doing work on going beyond medical and surgical help. The organization says: "After the surgical correction of any form of physical disfigurement, the child still comes home to the reality of poverty." That is why in 2000, the PBM started an educational assistance program that aims to ensure the child beneficiaries' education, which "will boost their chances of becoming self sufficient members of society."
And the work is nowhere near done: in the future the PBM aims to offer microfinancing service to beneficiary families who wish to have a source of livelihood. They are also at work, among others, in establishing a protocol for the handling of medical missions with the Philippine Association of Plastic, Reconstructive, and Aesthetic Surgeons, with whom they are organizing the 12th ASEAN Congress in Plastic Surgery slated February 2004.
Asian Microcirculation Confab Braves Terror Threats
Terrorism problems notwithstanding, the Philippines proudly hosted the fifth Asian Microcirculation Congress February 22 to 24 at the Westin-Philippine Plaza Hotel.
Medical practitioners, bioengineers, and medical scientists from all over the world and with varying medical backgrounds took part to rediscover their own fields of expertise from the microcirculation viewpoint.
The study of the microcirculation (composed of microscopic blood vessels) answers numerous long-standing questions about pathological processes and diseases because the behavior of the "macro" circulation is not necessarily the same as that of its smaller counterparts. Since these tiny vessels supply vital nutrients to practically all the parts of the body, a microcirculation congress assures relevant topics for anyone in medicine.
"I was a voice crying out in the wilderness.
Cardiologists were still looking only at the heart transplant, surgeons only at
the big vessels, and the oncologists only at therapeutics. Microvessels seemed
to be too trivial for anyone to pay attention to."
-Dr. Tigno
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"I was a voice crying out in the wilderness," congress president Dr. Xenia Tigno said of her attempts to introduce microcirculation studies in the Philippines in the 1980s. "Cardiologists were still looking only at the heart transplant, surgeons only at the big vessels, and the oncologists only at therapeutics. Microvessels seemed to be too trivial for anyone to pay attention to."
Hopefully after the 86 lectures on such topics as developments in microcirculation and their application in cardiovascular diseases, diabetes, rheology, dermatology, bioengineering, neurology, and even traditional and alternative medicine, a greater awareness of the benefits of focusing on the microcirculation could be expected.
Dr. Hideyuki Niimi of Japan talked about "Cerebral angiogenesis induced by growth factors: Intravital microscopic studies using models." This dealt with microcirculation in cerebral neocapillaries of mice induced by growth factors such as fibroblast growth factor (bFGF) and platelet-derived growth factors (PDGF). Using fluorescence video microscopy, he showed the audience how these induced neocapillaries were functional and how controlled stimulation of angiogenesis may be useful for reconstruction of cerebral tissue flow.
Dr. Axel Pries of the Free University of Berlin explained how rheology, the study of blood flow in the vessels, become increasingly complex as the vessels get smaller and smaller. Taking off from an in vitro point of view, Pries discussed expected figures of blood flow viscosity and hematocrit. However, in vivo situations are affected by several other factors, which would yield heterogeneous behavior of the blood.
Said Pries: "Hematocrit is by no means the only heterogeneous parameter in micro vessels. You can turn it around and say that heterogeneity in possibly every parameter is a hallmark of microcirculation so it is by no means adequate to say that a critical capillary is 5 microns has a blood flow of 0.5 mm/s and a diameter of 0.3. The reality is that all these parameters show a large heterogeneity."
University of Maryland's Dr. Marc Simmard discussed "Early pathophysiological changes in cerebral vessel predisposing to stroke." He showed a study of the response of lenticulostriate arterioles in rats in three models of human conditions associated with stroke. Chronic angiotensin II hypertension, chronic nicotine administration, and oxidative endothelial injury showed that abnormal regulation of L-type calcium channels is directly responsible for abnormal proliferative responses in vascular smooth muscles in various forms of cerebral arteriolar injury associated with endothelial dysfunction, such as the three models mentioned.
The role of microcirculation in different medical specializations was seen in several plenary and parallel sessions. Here are some:
"Wound Healing," co-sponsored by the Philippine Society of Cutaneous Medicine, and "Skin Microcirculation in Health and Disease" covered topics on diagnosis of leg ulcerations, pathophysiological theories behind chronic venous ulcers, biological wound dressing, and skin microcirculation in burn wounds to name a few.
"Radiation-Sterilized Human Amnion Membrane as Biological Wound" was an interesting topic on the use of fresh membranes taken from the placenta of newly delivered babies-processed, packed, irradiated, and used as sterilized dressings that prevent fluid loss, decrease pain, and lessen the need for antibiotics.
"Shock and Ischemia Reperfusion," a session co-sponsored by the Philippine Asian Vascular Society featured such topics as "Current concepts for fluid replacement for shock" and "Blood densitometry using digital image processing," a collaborative study with the UP Departments of Physiology and Electrical and Electronics Engineering.
"Microcirculation and Diabetes" discussed whether microvascular flow rate was related to ghrelin, leptin, and adiponectin levels. It also tackled the molecular basis of insulin resistance, endothelial dysfunctions in diabetes mellitus, and explained how the diabetic foot is a microcirculatory dysfunction.
What made this congress different was that it dealt not only with scientifically validated medical issues but debatable ones as well, such as traditional and herbal medicine.
A precongress lecture on "Microcirculation: Convergence of East and West" by Tigno took a closer look at the native
hilots and herbolario medical practices or what is also known as traditional medicine. According to Tigno, "much of the therapeutic body of traditional medical practices is based on purported improvement of the circulation."
"Several of these herbal concoctions have been verified to possess direct or indirect action on the microcirculation. However, some of the practices, including forms of diagnosis and esoteric discernment, of the herbolarios have obviously no scientific basis," she said.
On the other hand, alternative medicine includes iridology, reflexology, and nutritional supplementation, which represent a multibillion-dollar industry worldwide. Its importance is growing in recognition. In the United States, 75 percent of the medical schools include alternative medicine study in their curriculum.
"Through the application of its (microcirculation) methods we hope to validate or debunk traditional health practices many of whose therapeutic values are based on improvement of flow and circulation," said Tigno.
Congress sponsor Asian Union of Microcirculation (AUM) was organized in September 1991 during the World Congress for Microcirculation at Louisville, Kentucky. Since then, it has held congresses in Osaka, Beijing, Bangkok, Bandung, and Sydney participated in by scientists from Asia, Australia, Europe, and the Americas who had a common dream that of fostering microcirculation research in the Asia-Pacific region and to encourage collaboration across national boundaries and across continents. In the last ten years the AUM has witnessed not only a plethora of scientific output on microcirculation generated by Asian scientists but also the institution of various national societies dedicated to research on the area.
The Asian Union of Microcirculation-Philippine Chapter is presided by Dr.Tigno, with Drs. Camilo Roa as vice president and Ricardo Quintos as secretary general. Its trustees are doctors Ramon Abarquez, Nelson Abelardo, Bienvenido Aldenese, Avenilo Aventura, Dolores Bonzon, Ezperanza Cabral, Joven Cuanang, Ernesto Domingo, Augusto Litonjua, Enrique Ona, and Cecilia Tomas.
Nicole Tigno
PCPM Elects 2003 Officers
The Philippine College of Pharmaceutical Medicine (PCPM) recently elected its officers for 2003.
Dr. Rodolfo E. Joson was reelected president for a second term. The other officers are doctors Anthony Leachon, vice president; Luis Abola, secretary; Sonia Bongala, treasurer; and Nerissa Calimon, Beaver Tamesis, Jaime Montoya, Cynthia Valencia, Tomas Realiza, Mariano Lopez, Leandro Bongosia, and Eugene Ramos, directors.
The PCPM is a specialty society under the Philippine Medical Association and a member of the International Federation of Associations of Pharmaceutical Physicians. Membership is open to all physicians who want to know more about pharmaceutical medicine and the role of a physician working in a pharmaceutical company.
Doctors who wish to join PCPM or reactivate their membership may get in touch with Dr. Joson (+6 32 6334115,
JOSON_RODOLFO_E@Lilly.com) or Dr. Abola (+6 32 715-0795,
abolale@edsamail.com.ph).
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