September 2012

Experts debate Chinas healthcare reforms

FORUM Healthcare in China: Finding the right balance

NEWS Weight training lowers type 2 diabetes risk in men

CONFERENCE Recreational runners may strain heart too

IN PRACTICE Nerves can be a pressing problem

1,500 Academic Speakers 1,500 Sessions Speakers 340 Academic 340 Sessions 70 Special Topics 70 Special Topics
Date: Date: Venue: Venue:

Congress Language:
English and Mandarin Congress Language: English and Mandarin

11-14 October 2012 11-14 October 2012 China National Convention Center (CNCC), China National Beijing, China Convention Center (CNCC), Beijing, China

Organized by:

Organizing Committee of Asia Pacific Heart Congress (APHC) Organized by: Organizing Committee of Great Wall International Congress of Cardiology (GWICC) Organizing Committee of Asia Pacific Heart Congress (APHC) Organizing Committee of Great Wall International Congress of Cardiology (GWICC)

Congress Secretariat for Overseas Delegates:

Secretariat Secretariat for Overseas (Shanghai Office) Congress Office of GWICC & APHC Delegates: Tel: 86-21-6157 3888 ext. 3861/3862/3864/3865 Secretariat Office of GWICC & APHC (Shanghai Office) Fax: 86-21-6157 3888 ext. 3861/3862/3864/3865 Tel: 86-21-6157 3899 Email: secretariat@heartcongress.org Fax: 86-21-6157 3899 Email: secretariat@heartcongress.org Please visit www.heartcongress.org for further details

delegates already 10,000 confirmed! delegates already confirmed!

10,000

September 2012

Experts debate Chinas healthcare reforms

Elvira Manzano

he inaugural Healthcare in China summit held in Beijing recently served as a platform for experts to debate Chinas major health challenges, identify key issues that could derail implementation of its recent reforms, and formulate strategies to meet new targets. The forum brought together top government officials, policy makers, academics and experts within the country and from around the world. Mr. Lei Haichao, deputy director-general of the Beijing Health Bureau, said that although China has made significant headway towards system improvement (eg, the establishment of a nationwide health insurance system, a primary drug list and a centralized drug procurement system), some issues remain to be addressed including resource allocation. He said more than 85 percent of Chinas health budget was spent on diagnosis and treatment, with very little allocated for disease prevention. Our services are still treatment-focused and the burden of healthcare on patients is still very heavy, especially on rural residents, he added. In recent years, the government has approved several health laws and initiated more projects that are set to benefit public hospitals. However, more investments have to be poured into insurance and equipment, Lei said.

China has implemented major reforms to its healthcare system in recent years, but resource allocation remains a major issue.

Chinas healthcare system funding is a balance between public and private. No country has a purely public or purely private health system, and no country can provide solely public funding, said Lei. Like any country, China is trying to find a balance between the two forms. At the panel discussions convened during the conference, experts provided suggestions on how best to allocate resources, progress public hospital reforms, augment services and raise standards of care. Specific recommendations included removing physicians financial incentives to overprescribe drugs and tests, controlling investments and medical costs and refocusing efforts towards stemming the tide of chronic diseases which are responsible for a very high proportion (80 percent) of deaths in China.

September 2012

Forum

Healthcare in China: Finding the right balance

Based on an excerpt from a keynote address by Mr. Lei Haichao, deputy director-general, Beijing Health Bureau, during the Healthcare in China 2012 Economist Conference held recently in Beijing, China.

Elvira Manzano

ver that past 3 years, China has made commendable progress with respect to its healthcare reforms. Since 2009, the Chinese government has allocated more than RMB 1.5 trillion to improve the countrys healthcare system, with significant progress made in coverage of medical insurance and the establishment of a primary drug list and centralized drug procurement system. There remain deeply entrenched issues, however, particularly with the way in which resources are allocated. Our services are still very much treatment focused, with more than 85 percent of medical resources spent on diagnosis and treatment. Relatively little is spent on the prevention of diseases. Furthermore, the burden of healthcare on patients is still very heavy, especially on rural residents.

China is looking to find the right balance between public and private funding of its healthcare system.

With ongoing reforms,

we will see more financial resources allocated to hospitals, but personally

I dont think it is enough yet Overall however, the Chinese government has been quite successful in implementing

its recent healthcare reforms, playing a leading role in planning and showing high levels of commitment to building a better system. The government has already pushed through more than 10 new laws, as well as initiated many pilot projects. The results from these have been good and now they need to roll out to 10,000 public hospitals. Further areas that the government can do to improve Chinas healthcare system include the following: Invest more in insurance and equipment. Guarantee quality of service in all healthcare centers. Provide better service when it comes to

September 2012

Forum
of how to pay their staff and cover their daily costs. With ongoing reforms, we will see more financial resources allocated to hospitals, but personally I dont think it is enough yet. In the near future we will also see more government money and training going into generalist doctors and local facilities, with GPs and family doctors given more opportunities to train. In addition, in some places, people who go to local hospitals will be given more money back as an incentive to go to primary healthcare centers. We need to find the right balance between private and public. No country has a purely public or purely private system and no country can provide solely public funding. Like every country, China is trying to find its balance.

public disclosure, so everyone knows the state of the market. Better educate the general public in the prevention of diseases. While it is important for the government to maintain its role as the main provider of primary healthcare services, the private sector should also be involved in non-primary services. Indeed, the healthcare system needs to work closely together with the medical insurance system in order to help those with higher demands and who can afford more expensive and individualized services. The situation for hospitals throughout China has been that day-to-day hospital charges have not been financed by the government. In fact, hospital staff salaries have usually been covered by patients treatment fees. Hospitals have therefore faced the ongoing challenges

September 2012

Philippine Focus

APEC economies address threat of nosocomial infections

Dr. James Salisi

ealth-care associated infections (HAIs) pose a threat to APEC economies as these infections become more prevalent. HAIs increase the cost of health care and tip the balance towards increased expenditures in secondary care that affect a few rather than primary care that helps the majority of people. In the first APEC High-Level Workshop on Reducing the Economic Burden of Health-care Associated Infections representatives from academic institutions, hospitals, healthcare associations, patient organizations, and the medical technology industry were asked to examine cost reduction and improvement of health outcomes through public policy and best practices in prevention and control of HAIs. The secretary of the Department of Health, Dr. Enrique Ona said that the advancing stage of patients admitted to healthcare settings, the greater prevalence of chronic diseases among admitted patients, and the increased use of diagnostic and therapeutic procedures which affects the host defenses will provide continuing pressure on Healthcare-Associated Infections in the future. One in four patients admitted to hospitals acquire HAIs in some developing countries. In the US, Europe, and Japan nearly 6 million incidents are reported yearly. A significant burden both for the patient and for public health, Ona pointed to infections acquired in healthcare settings

as among the major causes of death and increased morbidity among hospitalized patients. He cited that healthcare-associated infections affect 8.7 percent of hospital patients, on average, and that the region has the highest frequency of people suffering from infectious complications acquired in healthcare facilities. Healthcare-associated infections add to the imbalance between resource allocations for primary or secondary healthcare by diverting scarce funds to the management of potentially preventable conditions, he elaborated. Collaboration among key players is essential to the success of new approaches agreed upon by the participants according to Dr. Benedetta Allegranzi, technical lead of the World Health Organizations Clean Care is Safer Care initiative and co-chair of the APEC workshop. The recommendations developed during the workshop included establishing suitable policies as well as adequate human and financial resources to address healthcareassociated infections prevention and control at local levels, and enhancing multi-sector efforts to share information on implementation and impact of policies and best practices in reducing the health and economic burden. Systematic approaches to surveillance and data collection, the APEC members agreed, are needed as well as development and implementation of policies and best practices to reduce the impact of HAIs.

September 2012

Philippine Focus

Metro Manila Health Research and Development Consortium; July 20, 2012; S. Paul University Manila

Study profiles motorcycle accidents in Metro Manila

Gabriel Angelo Sembrano, RN

r. Mario Geronilla, an orthopedic surgeon at the Philippine General Hospital, presented a cross sectional descriptive study that aimed to determine the profile of motorcycle accidents in Metro Manila and the prevalence of musculoskeletal injuries resulting from such accidents. According to the Geronilla, motorcycle accidents top the list among the leading causes of injuries to motorists, both fatal and nonfatal. Fatal vehicular accidents commonly take place at 9PM while the nonfatal ones commonly occur at 4AM. Majority of these cases involved males belonging to the 21 to 35 age group. From 2007 to 2008, it was noted that there had been an increase of 16.3 percent in the incidence of motorcycle-related musculoskeletal injuries. Lower extremity injuries were the most common among the accidents. Injury to the tibia ranked first with 25 percent, followed by femur at 20 percent, forearm at 12.5 percent, while the rest involved spine and upper extremities injuries. The study was conducted in three major government institutions, namely the Philippine General Hospital, Philippine Orthopedic Hospital and East Avenue Medical Center. Charts and clinical records of patients involved in vehicular accidents were reviewed. Data on the incidence of musculoskeletal injuries were also gathered. Geronilla pointed out that there is a need to

enhance the level of education among motorists as well as the students as a form of prevention in order to improve road safety. He also added that determining primary trauma centers will facilitate in identifying centers that can adequately manage injured motorists. The study recommended the formulation of a motorcycle accident registry for a comprehensive national database. Road safety education among elementary and high school students should also be included in their curricula to effectively change behaviors at an early age and to build more awareness about existing laws. It also recommended motorcycle lanes to protect motorists and pedestrians alike. In addition, designated trauma centers are ideal to ensure immediate and proper care for road accident victims, and that the establishment of an effective referral network among hospitals is vital for the efficient transport and care for these patients. According to the study, road accidents are expected to become the second leading cause of death worldwide by 2020 from being the fourth cause of death in 2004 and sixth in 1995. The Metro Manila Development Authority (MMDA) Traffic Operations Center Metropolitan Road Safety Unit showed that from the period of January to December 2006 in Metro Manila, Philippines, motorcycles have had the highest fatality accident rate with 122 motorcycles involved, or 23.6 percent of the total fatal accidents, followed by cars with 113 or 21.9 percent.

September 2012

Philippine Focus

Metro Manila Health Research and Development Consortium; July 20, 2012; S. Paul University Manila

Faradism shows effectiveness in post-op swelling

Dr. Yves St. James Aquino

aradism under pressure (FUP) was comparable to intermittent pneumatic compression (IPC) in treating post-operative swelling due to anterior cruciate ligament reconstruction, according to an assessor-blinded, randomized, controlled Phase II trial done by physical therapy majors in the University of Sto. Tomas. The study, which was presented by Prof. Michael Jorge Peralta, involved nine participants from Moro Lorenzo Sports Clinic in Quezon City, aged 18 to 25 who had ACL reconstruction presenting with post-operative swelling. The participants were randomly assigned to either the experimental group (FUP, n=5) or the control (IPC, n=4). The treatment, with accompanying daily pre- and post-tests, was given for five consecutive days. The study used outcome measures that included visual analog scale (VAS), range of motion (ROM), and limb girth. Repeated measures ANOVA was used in comparing the outcomes within groups measured over five days of the study, while unpaired t-test was used to compare outcomes between groups. Results showed that improvements were seen in both FUP and IPC when it came to pain, range of motion and limb girth. Only

the limb girth measurements above the medial tibial plateau for those who received IPC were statistically significant, while there was no statistically significant difference found between FUP and IPC for all the other outcome measures. IPC, which uses air pumps and inflatable leggings for pressure, has been a common treatment for edema. Faradism under pressure is done through the application of electrical stimulation combined with compression or bandaging. Swelling or edema has various causes, ranging from serious conditions such as congestive heart failure and liver and kidney diseases to mild conditions such as prolonged position or high-salt diet. Post-surgical patients may experience edema in the extremities, resulting from having to sit or lie in one position for a long time. Severe edema may be treated with drugs (eg, diuretics) to help remove excess fluid via urine output. The research group included Eldrich Norwin Chua, Ma. Elaine de la Cruz, Paola Angela Esperanza, Angelie Fajardo, Brian Joseph Ginete, Romina Vanessa Ignacio, Russell Angelo Nogot, and Johleen Kaye Sacayan .

September 2012

Philippine Focus

Metro Manila Health Research and Development Consortium; July 20, 2012; S. Paul University Manila

Low-cost robotic arm helps Filipino stroke patients

Gabriel Angelo Sembrano, RN

study by Matthew Ang et al., assessed the use of an affordable robotic arm to improve the functionality of stroke patients. The robotic arm study was significant as the technology was created specifically to suit the needs and values of the Filipino patient. This new device aims to rehabilitate a patients arm by way of supporting lateral forearm movements. In effect, the patient would be able to perform self-feeding, brushing own teeth, buttoning own shirt, and other day to day activities. The device was tested on its various components, such as angle sensor, emergency button, and reporting system consistency, and was found to be fully functional and ready for further use or testing. Intended primarily for the Filipino clientele, the machine developed was low-cost and effective in its intended function, said the study. The study authors expressed awareness of incidents of failures in spite of todays rapid technological advancement and developments in robotic systems aimed at rehabilitating stroke patients. According to them, these were associated on the inability of the systems design to motivate the patients to voluntarily conduct different activities that

could stretch the impaired arm to its limit and help improve its condition. They articulated the need for a low-cost device that utilizes active-motion therapy along with biofeedback. The machine performs active motion therapy by augmenting the motion of patients arm while a biofeedback system helps the patient gain conscious control of arm movement, according to study authors. It is able to provide an evaluation of the patients condition which is sent to the respective doctor or therapist. This does not only allow the concerned healthcare professional to monitor the patients progress, but it also allows the patient to be actively engaged in his or her rehabilitation process. Aside from this, the robot has an easyto-use ergonomic mainframe to ensure optimum experience by the patient. Previous study by Huang et al., on biofeedback recommended integration of sufficient numbers and types of sensors to detect with accuracy the dynamic variables during movement. It also emphasized the importance of intensity of task training and patients active involvement in improving motor function. Huang et al., added that comparison of robot-aided therapy with task-oriented biofeedback to conventional therapy would be enlightening [JNER 2006, 3:11].

10 September 2012 Philippine Focus

Advocacy campaign for universal health care launched

Dr. James Salisi

he Department of Health (DOH) recently launched the Secretarys Cup, an advocacy campaign that aims to increase awareness among Filipinos on the thrust and impact of universal health care (UHC). This campaign includes talks by former DOH secretaries on the challenges of Philippine health system, intercollegiate debates on controversial health policy issues, and town hall meetings throughout the country on universal health care. A series of talks by former DOH secretaries on the six pillars of health systems development will commence in August 2012 and end in January 2013. Dr. Alberto Romualdez Jr. is slated to talk about governance in August followed by Dr. Alfredo Bengzon on health regulation in September, Dr. Francisco Duque on health financing in October, Dr. Esperanza Cabral on health service delivery in November, Dr. Jaime Galvez Tan on health information technology in December, and Dr. Manuel Dayrit on human resources in January next year. Secretary Enrique Ona will sum up the discussion in February 2013. [UHC] builds on the efforts of the Department of Health in the past five decades, during which programs like primary health care, health sector reform, an integrated referral system, and the National Health Insurance Program (PhilHealth) were developed and implemented, Said Ona in a press release. Universal health care is all about providing health care whenever and wherever it is needed, while at the same time protecting the

hard-earned money of patients and their families through universal PhilHealth coverage, he added. The Secretarys Cup will provide opportunities to dispel the fears about universal health care, discuss issues about Philippine health system, and provide critical information to the people. To lead the discourse on controversial health policy issues in colleges and universities in the country, an intercollegiate debate tournament starting in August and ending in national championships in February next year will pit at least 50 teams. With universal health care as the overarching theme, topics to be debated on include the corporatization of government hospitals, private hospitals and the no balance billing policy, and the DOHs role in public and private hospitals. Other topics include health professional fees, advertisements on health products, removal of salary caps for PhilHealth premiums, mandatory social insurance coverage, medical tourism, access to medical records, and the production and deployment of health professionals To understand the needs and demands of the people on health care services delivery and policies, town hall meetings will be held throughout the country. These meetings will engage patient groups, peoples organizations, health workers and professional groups. The DOH hopes that the Secretarys Cup will result in a better understanding and appreciation for Universal Health Care and bring the DOH closer to the people.

11 September 2012 Philippine Focus

BEYOND CLINIC

Community doctor bridges economic gaps

Dr. James Salisi

r. Gene Nisperos traces his love for community medicine to the years of experience in the field not practicing clinical medicine. I wanted to spend 2 to 3 years in the community just to see it for myself and to discover what it had in store for me. I had always considered coming back and taking up residency at the [Philippine General Hospital]. But as I spent more time in the community, the more I loved it and the less I thought of going back to become a clinician, he shares. Nisperos has a deep understanding of how poverty results in poor health. He was born in Manila to a poor family, with seven siblings, a father who was a government employee, and a mother who tended to their

needs at home. His family survived on the meager salary of his father and there were days that there would be no food on the table or not enough money for jeepney fare to school. Despite the poverty, Nisperos became a scholar at the International School Manila and his education there afforded him a different perspective on life. He also credits his experience there for his resilience later on. Going to a school for the richest Filipinos and coming home to a family that could barely manage their financial needs highlighted for him the disparities between the rich and the poor Filipinos, the contrast between his studying with the privileged class and living in poverty at home. Imagine hobnobbing with the privileged and ultra-rich, and be surrounded by luxury

12 September 2012 Philippine Focus

and a system where everything you need is at your fingertips; and then going home by public transport, being elbowed by the riding public all rushing to go their way, and arriving home where we could barely make ends meet. It was difficult. There were instances when I could not attend certain activities because I did not have the money to do so, he added. I wanted to be a doctor because whenever we got sick, my parents had a hard time bringing us to the doctor because we had no money. Then my mother almost died of PTB (pulmonary tuberculosis). So I thought I should be a physician to be able to help my parents in their old age. I think it would have brought me some stability financially but I never thought it would make me rich, he related. Although he had opportunities to study abroad because of his international school education, in 1986 he decided to go to the University of the Philippines (UP) where his parents could afford to send him. However, getting into UP through the INTARMED program (a seven-year integrated liberal arts and medicine program for high-performing high school graduates) was not as affordable as his parents hoped. The tuition fee for an INTARMED student was thrice as expensive as that of a regular UP student. Nisperos related: I immediately felt the limitations imposed by my familys economic situation. My father did not want me to proceed because he could not sustain the requisites. So I worked during my first two years in college to support myself. Because of the demands of going through medicine proper, he had to stop working. He sustained himself by getting scholarships and student loans, and even joining contests. An activist in his student days, he became involved in fighting for human rights and working for the welfare of the people. Nisperos spent many years in Mindanao after obtaining his license to practice as a physician in 1993 up to 2004. His work brought him closer to farmers and peasant communities. When I was in Mindanao, I actually stopped being a doctor and worked as a paralegal and training officer of a farmer organization, he noted. He found helping farmers and peasant communities in their legal cases, mainly involving the loss of land to landowners, more exciting than clinical medicine. And even more so when they won cases and the farmers actually got their lands back. He returned to being a doctor when he went back to Manila. Nisperos teaches community medicine now at the UP Manila College of Medicine. He also works at the National Telehealth Center, managing policy advocacy, research and implementation of the National Telehealth Service Program which aims to increase access to health services through information and communication technology in remote areas in the country. He considers what he is doing now as not much different from what he loved about being in community medicine which was working for the welfare of those who are being exploited by the system and mired in unrelenting poverty the farmers and workers. While he used to work closely with the people in the community, in contrast he now works at a different level policy. Asked about his decision to pursue public health or policy advocacy as a career he responded: I guess my personal experience with my familys struggle to survive, plus my schizophrenic experience at ISM (where people can live in the lap of luxury in a sort of bubble existence). I also wanted to have some relevance in my life.

13 September 2012 Philippine Focus

Conference Calender September
13th Philippine Society of Allergy, Asthma and Immunology Biennial Convention September 3-4, 2012 Info: Philippine Society of Allergy, Asthma and Immunology Telephone: (02) 712 9432 Email: pasaai_1972@yahoo.com Venue: Sofitel Philippine Plaza, Pasay City 7th Biennial convention, Society of Adolescent Medicine of the Philippines September 3-4, 2012 Venue: Manila Diamond Hotel, Manila Info: Society of Adolescent Medicine of the Philippines Telephone: (63947) 844-4218 Email: secretariat@samphilippines.com Website: www.samphilippines.com 21st Annual Convention & 22nd Anniversary Celebration, Perinatal Association of the Philippines September 30-October 1, 2012 Venue: Crowne Plaza Hotel, Mandaluyong City Info: Perinatal Association of the Philippines Telefax: (632) 925-3538 Email: pap_inc@yahoo.com Website: www.perinatphil.org 1st Annual Convention Philippine College of Geriatric Medicine October 8-9, 2012 Venue: Century Park Hotel Info: Philippine College of Geriatric Medicine Telephone: (632) 394-3066 Website: http://www.geriatricsphilippines.org/ 21st Philippine College of Physicians Midyear |Convention October 11-13, 2012 Venue: Mimosa Holiday Inn, Clark Field, Pampanga Info: Philippine College of Physicians Telephone: (632) 910 2250 Website: www.pcp.org.ph 12th Philippine Society of Pathologists Midyear Convention October 25-26, 2012 Venue: Davao Insular Waterfront Hotel, Davao City Info: Philippine Society of Pathologists Telephone: (632) 738-6814, (082) 301-7008 Fax: (082) 300-3098 Email: pspinc1950@yahoo.com, zegenmanagementgroup@gmail.com Website: www.philippinepathology.org

October
12th Asian Oceanic Society of Paediatric Radiology (AOSPR) Congress and the 9th Joint Convention of CT-MRI and Ultrasound Societies of the Philippines October 4-6, 2012 Venue: SMX Convention Center, Pasay City Info: Asian Oceanic Society of Paediatric Radiology Telephone: (632) 373 8462 Email: aospr1@gmail.com Website: www.aospr.com

Upcoming
34th Philippine Neurological Association Annual Convention November 7-10, 2012 Venue: The Manor, Baguio City Info: Philippine Neurological Association Email: secretariat@pna.org.ph Telephone: (632) 723-3337 Fax: (632) 723-2102 Website: www.pna.org.ph

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14 September 2012 Philippine Focus

NOTES ON LEADERSHIP
The Medical Tribunes Dr. Yves Saint James Aquino talks to presidents of specialty societies to discuss their roles in promoting their respective fields

Collaboration needed to prevent infection

s the global community celebrated the World Hepatitis Day last July 28, one society president takes the opportunity to promote healthier liver for the Filipinos. Dr. Diana Payawal, president of the Hepatology Society of the Philippines, discussed how the celebration was marked by focusing on viral hepatitis and the diseases that it cause. Specifically focusing on hepatitis B and C infections, the society aims to promote prevention, screening and control of the disease. The vaccination program is one of the leading parts of our advocacy, said Dr. Payawal. This why were on our way with partnering with the Rotary Club. Rotary Club is one of the leading civic organizations in the Philippines. Payawal recognized the need for collaboration with different organizations, including those under the government. For the hepatitis B and C, just like any disease, wed like the government to answer their own share. Alam mo naman ang stakeholders hindi lang pwede hep B and hep C sa aming area, said Payawal. At present, the government actually answers for the first dose of the vaccine. That is why its important to come up with the second and the third dose. She added that the second and third dose is where they need the support from organizations like the Rotary Club. The president also intends to further

Dr. Diana Payawal

President Hepatology Society of the Philippines

strengthen the societys relationship with the Asian Pacific Association for the Study of the Liver, which is one of the leading organizations that promote the latest scientific advancement and education in the field of hepatology. Now, ang ginawa ko is nagla-lobby ako sa Asia Pacific for them to help us, for support, financially, added Payawal. The support would enable the society to implement programs that would health the community in improving the status of hepatitis in the country. Payawal said that shes proud to continue the achievements and programs done by the previous society officers, specifically the ones that help hepatitis B-positive employees in the work place. In the past, it is common for employers to deny employment to applicants who

15 September 2012 Philippine Focus

have tested positive for hepatitis, which is a clear form of discrimination. In 2009, the society published the HSP Guidelines for the Evaluation of the HBsAg+ Worker for Employment. With such guidelines, an advisory coming from the Department of Labor and Employment, entitled the Hepatitis B Policy in the Workplace, was implemented in January 1, 2011. Other projects initiated by the society include educational programs and workshops, establishment of liver clinics in Cebu and Davao, and continuing medical education for specialist and general practitioners. The next is we will aim for the eradication or decrease the prevalence of hepatitis B by advocating good vaccination program, said Payawal.

ADVERTORIAL

Healthy eyesight for adults 50 and over

Once we reach the fourth decade, physiological changes in the eye can cause vision problems that may require corrections. As we age, the pupils begin to decrease in size, decreasing the response to light. This means that older people require more illumination in order to see compared to a younger person.1 This also affects an aging persons ability to focus, which takes much longer with increased nearsightedness. Presbyopia, or loss of visual accommodation, also occurs. Thickening and yellowing of the lens of the eye can cause increased sensitivity to glare, decreased depth perception and, in certain cases, color blindness.1 It is important to have a regular comprehensive eye examination, which is the only way to really be certain that your eyes are healthy. A number of common serious eye problems, such as glaucoma, diabetic retinopathy and macular degeneration, often begin without symptoms. It is best to catch these conditions before they get worse.2 You can prevent eye problems by following these simple tips and let your eyesight stay healthy as you reach the golden years.2 - Know your familys eye health history. Many eye diseases are he reditary, and regular check-up can help prevent or minimize the risk of acquiring the disease. - Quit smoking or never start the habit. Research has demonstrated that the habit increases the risk of age-related macular degeneration. - Clean your hands and contact lenses properly. Proper hygiene helps prevent infection that can cause eye complications. - Maintain a balanced diet. A diet rich in fruits and dark green, leafy vegetables promote healthy eyes. - Wear protective eyewear and practice eye safety. - Give your eyes a break. Try the 20-20-20 rule and give your eyes a rest. Every 20 minutes, look away about 20 feet in front of you for 20 seconds to avoid eye strain.
References:
1. Lata, H and Alia, L. JK Science 2007;(9)3:111-116. 2. National Eye Institute National Institutes of Health. Simple Tips for Healthy Eyes. Article accessed from http://www.nei.nih.gov/healthyeyes last November 22, 2011.

16 September 2012 Philippine Focus

LGU empowerment for the management of DM kidney complications

Dr. Yves St. James Aquino

n exploratory-qualitative study by Dr. Frances Soliven-Quebec assessed the importance of the local government unit (LGU), along with other sectors, in promoting health education to avoid kidney complications in patients with type 2 diabetes mellitus (T2DM) in Paraaque City. Profiles of respondents in Barangay BF Homes, San Antonio and La Huerto were over 40 years old, overweight or obese, with family history of diabetes, history of cardiovascular disease, high triglycerides, among others. Out of the 250 questionnaires distributed in health centers, clinics and offices, only 222 were returned. This included patients with high-risk T2DM, government officials, medical personnel of local health centers and church and local civic leaders. Questionnaires were composed of four parts to identify basic demographic data, knowledge and attitude on T2DM and general health, and health practices in the prevention of kidney complication in T2DM. Data showed that in the surveyed 16 barangays in Paraaque City, which included 122,457 families, there are still no diabetes health care projects provided by the local health centers during the study period. In applying the X2 statistical tool to test for significant relationships, data revealed that age was not related to knowledge and practices, while family income significantly relate to practices. Based on survey responses, majority of the local leaders agree that the status of health care delivery, particularly in preventing kidney

complications of diabetes, has to be improved (59%). Local leaders also agreed that there has to be an institutionalized health-promoting lifestyle intervention, diabetes education campaign, and inclusion of prevention and early detection for PhilHealth coverage. Majority of the respondents identified lack of political will as the main barrier in delivering sustainable health programs. Based on the results, the research author recommended collaboration among local government units and other social sectors, including civic, religious, business, academic and other private and governmental organizations. Partnerships can provide expertise and financial assistance that could support health programs for healthcare delivery. The author also recommended the institutionalization of health programs that promote healthy lifestyle, aiming at risk factors such as obesity, hypertension and smoking. This should involve schools and health institutions conducting diabetes education campaigns aimed to increase health literacy and awareness and improve attitude and health practices. There should also be a regular dissemination of diabetes information translated in Filipino to help prevent kidney complications and to promote general well-being, according to the study. Lastly, the study emphasized the importance of safe drinking water, uncontaminated supply of food, reduced pollution, and better waste management. In other words, all policies of the government should always consider the consequences on the health of the people particularly kidney health, concluded the study.

17 September 2012 Philippine Focus

Helminth reinfection after drug treatment seen in Bukidnon

Gabriel Angelo Sembrano, RN

study by Ian Abordo et al., conducted last August 2010 in a community in Valencia City, Bukidnon, showed that three weeks after a de-worming activity done, a proportion of the participants were found to still have parasitic infections. This suggests resistant infection or rapid reinfection after the deworming process, the authors suggest. Abordo et al., further pointed out that children playing barefoot in contaminated watery areas together with pets that are not leashed or kept in cages may have contributed to this outcome. According to the authors, the main objective of this study was to describe the prevalence of intestinal parasitism, environmental sanitation, and hygienic practices of the schoolchildren and the communitys residents after de-worming. This study employed several methods in obtaining data. Gathering of data from children 6 to 12 years and their parents involved the use of Environmental Sanitation Questionnaire, Hygienic Practices Questionnaire, fecalysis, and semi-structured interviews. The results showed that three weeks after the deworming activity, 13 of the 203 pupils still had intestinal parasites, with hookworms and pinworms being the most prevalent. Five children were still infected with hookworm, four with Trichuris trichiura, one with Ascaris lumbricoides, one with tapeworm, and two with Schistosoma. However, there were

no double infestations found among the 13 schoolchildren. Upon physical assessments, these children manifested pallor, cough and colds. Eight children experienced abdominal pain; nine suffered body weakness; five had loss of appetite; and four had body mass index (BMI) below normal range based on the Philippine BMI standards. The presence of intestinal parasites and Schistosoma may either be due to rapid reinfection or resistant infection as 11 of the infected children received and took deworming drugsmebendazole/albendazole for other types of intestinal parasites and praziquantel for schistosomias, the authors suggested. During the conduct of the interviews among the parents, it was revealed that these infected children had been fond of bathing in rivers, playing on dirty ponds and playing on dirty ground barefoot. Based on a study conducted by the University of the Philippines National Institutes of Health and the Department of Health (DoH) in 2005, the prevalence of soil-transmitted helminthiasis in the Philippines reached to 66 percent while ascariasis alone reached to 70 percent. Under the DoHs Soil Transmitted Helminth Control Program, done in partnership with the Department of Education, a nationwide biannual deworming activity is conducted yearly in all public elementary schools for children aged 6 to 12 years. This is done by teachers under the supervision of school nurses or any health personnel.

18 September 2012 Philippine Focus

MARKET WATCH
Invida launches dual-action beta blocker

nvida Philippines, the local subsidiary of Menarini, has launched nebivolol, a highly cardioselective beta blocker that effectively treats hypertension and congestive heart failure. We are pleased to provide Filipino patients with a proven effective treatment for both hypertension and CHF, said Dr. Maaliddin Biruar, Director for Medical and Scientific Affairs, Invida Philippines, Inc. Nebivolol selectively blocks b-1 receptors and has a nitric oxide-potentiating vascular dilatory effect. Guests of the press conference, held in Crowne Plaza Galleria last August 15, 2012 included experts Dr. Dante Morales, president of the Philippine Society of Hypertension; Dr. Romeo Dvinagracia, founder and past president of the Heart Failure Society of the Philippines; and Prof. Andrew Coats, MD, professor-at-large and CEO of Norwich Research Park in the United Kingdom. Dr. Coats discussed SENIORS study, which demonstrated the effectiveness of nebivolol in reducing blood pressure, as well as decreasing the combined risk of death and cardiovascular hospital admissions in elderly patients with CHF.

Novartis BioCamp promotes scientific progress through youth

peakers from different government and private industries, along with science students, attended the Novartis BioCamp held last July 30, 2012 at the Asian Institute of Management Conference Center in Makati. Based on academic excellence and professional experience, two students from six shortlisted candidates will be selected to represent the country in the prestigious International BioCamp scheduled on August 26-29, 2012 at the Novartis International Headquarters in Basel, Switzerland. Since 2006, as part of its Kaagapay Program and in partnership with the DOST, Novartis Healthcare Philippines has organized the Local BioCamp, one of the countrys biggest annual biotech workshops that brings together promising young Filipino scientists and respected Filipino biotech experts and entrepreneurs. Other Local BioCamp partners are the PCHRD, Intellectual Property Philippines (IPP), and the countrys first biotech consulting firm Hybridigm Consulting, Inc.

19 September 2012 Philippine Focus

MARKET WATCH
Biotne fights dry mouth

he World Health Organization reports an estimated 2.6 million Filipinos suffer from dry mouth, which results from decreased or minimal saliva flow. Dry mouth has been linked to severe dental problems and complications. Global brand Biotne has a wide range of dental hygiene products created specially to fight dry mouth. Biotne has patented salivary LP3 enzyme system that helps relieve symptoms of dry mouth. The formulation helps supplement salivas natural defenses that include a mixture of lactoperoxidase, lysozyme and lactoferrin, each having specific roles in maintaining oral health. The Biotne range is formulated for the sensitive mucosa as it is free of alcohol and sodium lauryl sulfate. The Biotne range includes toothpaste, moisturizing gel, mouth spray and mouth wash. Available in drugstores nationwide.

IPNAP promotes Nutrition Month in a roundtable discussion

he Infant and Pediatric Nutrition Association of the Philippines (IPNAP), composed of Abbott, Fonterra, Mead Johnson, Nestle, and Wyeth, hosted a roundtable discussion that focused on efforts to combat malnutrition. The event was participated by Dr. Mario Capanzana of the Department of Science and Technology, Dr. Leonara Panlasigui with the School of Nutrition of the Philippine Womens University, and Ms. Victoria Wieneke of the organization Kabisig ng Lahi. Dr. Capanzana, director of the Food and Nutrition Research Institute, gave an assessment of the latest National Nutrition Survey among Filipinos, with updates on malnutrition rates in the country. IPNAPs executive director Alex Castro and programs administrator Joey Montalvo discussed the associations perspective and efforts done to fight the countrys malnutrition problem among young children. The association also presented achievements of the renowned Oh My Gulay project of the Department of Education.

20 September 2012 Philippine Focus

MARKET WATCH
Roche celebrates World Hepatitis Day

n partnership with the Hepatology Society of the Philippines, Roche celebrated the World Hepatitis Day as a global response to viral hepatitis. We are very excited to celebrate World Hepatitis Day, Dr. Jane Ricaforte-Campos, chair of the World Hepatitis Day celebrations, said. Our goal is to inform everyone that they should be tested because hepatitis can be asymptomatic. People need to know if they are infected. Additionally, we strive to educate everyone that those with the disease should not be stigmatized or discriminated against. Aldrich Talledo and Sam Digma, two patients infected with hepatitis, were invited to share their personal experiences after being diagnosed with the disease. The personal testimonials of the two brave souls who shared their struggles and triumph with hepatitis give us a lot of inspiration and affirmation to believe in our vision as a company. In the end, its all about giving the best for the patient, says Butch Lopez, Roche business unit head.

The Acne Board of the Philippines develops local acne treatment guidelines

cne vulgaris is one of the most common skin disorders for which patients seek consult. It is chronic, multifactorial and may lead to significant scarring both physically and psychologically. Recognizing the need for a local protocol, the members of the Acne Board of the Philippines headed by chairperson Dr. Ma. Flordeliz Abad-Casintahan, recently met to set in motion the publication of the clinical practice guidelines for acne management, one of the boards major activities for 2012. The treatment recommendations are the result of the collaborative efforts, expertise and research of the dermatologists that make up the board as well as clinicians belonging to other medical specialties. Formed in 2005, the Acne Board of the Philippines is comprised of 10 dermatologists from different regions of the country with a shared interest in acne. The group conducts educational activities annually. The Multidisciplinary Treatment Guidelines for Acne is part of their objective to disseminate information to dermatologists and residents-in-training and more importantly, to improve the outcome of acne vulgaris in Filipino patients.

21 September 2012 Conference Coverage

ASEAN Federation of Cardiology Congress, 13-15 July, Singapore

Recreational runners may strain heart too

Rajesh Kumar

igh levels of endurance exercise in recreational runners may result in transient but significant ventricular stunning, release of cardiac biomarkers and acute kidney injury, according to a Singapore study. Previous studies involving elite long distance runners have linked high-level endurance exercise with elevated cardiac biomarkers, right ventricular dysfunction as well as a decrease in glomerular filtration rate. However, it has been suggested that such findings may not apply to the majority of recreational runners participating in moderate endurance events. In the present pilot study, the researchers recruited 10 healthy subjects (mean age 36.5 years) to complete a 21km treadmill run. Before and after the run, echocardiograms and peripheral blood samples were taken from the participants to confirm the hypothesis that changes in cardiac biomarkers may reflect RV dysfunction after moderate endurance activity. Highly sensitive troponin T (hsTnT), Nterminal pro brain natriuretic peptide (NTProBNP) and the novel renal biomarker neutrophil gelatinase-associated lipocalin (NGAL) were analysed prior to, within 1 hour of run completion, and 24 hours after the run. The hsTnT in five out of 10 subjects ranged from 15 to 33 pg/mL within 1 hour post-exercise, which was above the 99th percentile (14 pg/mL) of the upper reference limit. These

A pilot study conducted in Singapore showed that recreational runners can strain their hearts or damage their kidneys while performing heavy amounts of endurance exercise.

fell below the cut-off in all but one subject at 24 hours. NTProBNP levels were below the established cut-off value for detection of heart failure. There was no direct correlation between changes in strain and hsTnT or NTProBNP. While the findings support the concept of cardio-renal coupling in endurance exercise, the researchers acknowledge that the number of subjects in this study is small, and validation with a larger study is required. Whether these individuals are more prone to chronic myocardial and/or kidney injury is unknown. The findings warrant further investigation in larger populations of recreational runners and the general population should not be unnecessarily alarmed at this point, said study researcher Dr. Yeo Tee Joo of the cardiac department at National University Heart Centre, Singapore. Yeo said that physicians should reassure any of their patients who are recreational runners that the benefits of regular exercise far outweigh any potential risks.

22 September 2012 Conference Coverage

In a healthy person with no history of cardiovascular disease, he said some key points they need to be reminded of, are: Always keep well hydrated. Slow down or stop if there are any unusual symptoms including: chest pain/uneasiness, giddiness and/or palpitations. Avoid strenuous activity when unwell (eg, during fever or flu). Engage in exercise in a progressive manner. [The latter] is in particular for weekend warriors who lead a sedentary lifestyle and feel compelled to over-strain once or twice a week rather than exercise regularly at a manageable intensity, more frequently, said Yeo.

Measure BP on both arms

Rajesh Kumar

hysicians are being reminded to take routine blood pressure (BP) measurements from both arms of their patients following research that showed a difference of just 10 mmHg in inter-arm systolic BP is closely linked to peripheral artery disease, especially in non-obese and nonhypertensive patients. We as physicians neglect to evaluate BP from both arms. Its a simple procedure which can reveal so much information on other vascular diseases and correlation with surrogate marker such as ankle brachial index (ABI), said author Dr. Erwin Mulia of the department of cardiology and vascular medicine, faculty of medicine at Universitas Indonesia, Jakarta, Indonesia. The cross-sectional study evaluated 80 patients who followed elective coronary angiography from March to May 2011. The mean difference in inter-arm systolic BP was 34.6 mmHg and mean ABI was 1.3 (0.7-1.8). A difference of 10 mmHg in systolic BP was found in 85 percent of subjects. The correlation between inter-arm BP difference and ABI in coronary artery disease patients was 0.337 (P=0.001). In non-overweight/ obese and non-hypertensive patients, the correlation was 0.450 (P=0.001) and 0.501 (P=0.043), respectively.

Some also say that [inter-arm difference in systolic BP] has correlation with severity of coronary stenosis, though my previous research didnt show its correlation with Gensini score, said Mulia. In primary care services or in rural areas where availability of diagnostic tools is limited, Mulia said such a simple procedure could prevent delays in the diagnosis of vascular diseases. He pointed out that the textbook of cardiovascular medicine Braunwalds Heart Disease recommends blood pressure measurement on both arms, while earlier research had linked a difference of just 15 mm Hg or more in inter-arm SBP to the risk of vascular disease or death. An earlier meta-analysis concluded that a difference in systolic BP of 10 mm Hg or morebetween arms might help to identify patients who need further vascular assessment [while] a difference of 15 mmHg or more could be a useful indicator of risk of vascular disease and death. [Lancet 2012; 379:905-914] Therefore, a patient with an inter-arm sytstolic BP difference of 10 mmHg would benefit from further investigation for vascular disease and ought to be targeted with aggressive management of their cardiovascular risk factors, said Mulia.

Please visit www.isrd.org for further details

Chinese Alliance Against Lung Cancer (CAALC)

Nearly 100 Academic Speakers, 15 Sessions and 6 Special Topics

English Sessions Highlights
Mechanical Ventilation Sleep Apnea Update Biomarkers and Therapeutic Strategies in Airway Diseases State-of-the-art Ventilation Strategy Highlight on COPD Management ALI Forum - Mechanism and New Drug Target Plenary Session - Message from ATS Infection and Immunity ALI Forum - Mechanism and New Drug Target Translational Respiratory Medicine

ISRD 2012
The very first joint scientific sessions with the American Thoracic Society

24 September 2012 News

Calcium supplements linked to MI, kidney stones

Yen Yen Yip
he safety of calcium supplements has come under further scrutiny as recent reports suggest they may be linked with higher risks of myocardial infarction (MI) and kidney stones. Calcium supplements have been widely embraced by doctors and the public on the grounds that they are a natural and therefore safe way of preventing osteoporotic fractures, wrote Professor Ian Reid and Dr. Mark Bolland from the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, in an editorial in a recent issue of Heart journal. [Heart 2012;98:895-896] The editorial accompanied a study linking calcium supplements to an increased risk of heart attacks. [Heart 2012;98:920-925] The European Prospectiv Investigation into Cancer and Nutrition (EPIC) study, led by researchers based in Heidelberg, Germany, assessed calcium intake through the diet and supplements of close to 24,000 subjects for about 11 years. The results showed that subjects who took calcium supplements regularly were 86 percent more likely to have a heart attack than those who did not take any supplements. Calcium supplements, which might raise MI risk, should be taken with caution, concluded lead author Dr. Kuanrong Li from the Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany, and colleagues. The study also evaluated subjects whose

Calcium supplementation appears less safe when compared with normal dietary intake of calcium.

calcium intake came from dietary sources. Those who took a moderate amount of calcium through their diet (820 mg per day), instead of supplementation, were about 30 percent less likely to suffer a heart attack compared with those who took less dietary calcium (513 mg per day). Interestingly, those who included more than 1,100 mg of calcium in their daily diet did not observe a lowered risk of heart attack.

Taking [calcium] in one or two daily [doses] is not natural

In contrast to past research, the EPIC study did not show an association between higher calcium intake and reduced CV and stroke risk, or overall CV mortality. The safety of calcium supplements has come into question, said Reid and Bolland. It is now becoming clear that taking this

25 September 2012 News

micronutrient in one or two daily [doses] is not natural, in that it does not reproduce the same metabolic effects as calcium in food. We should return to seeing calcium as an important component of a balanced diet, and not as a low cost panacea to the universal problem of postmenopausal bone loss. In a separate study, high doses of calcium and vitamin D supplements were shown to cause higher rates of hypercalciuria and hypercalcemia in 163 postmenopausal women with vitamin D insufficiency. The study, presented at the 2012 Annual Meeting of The Endocrine Society in Houston, US, randomized the women to vitamin D doses ranging from 400 IU to 4,800 IU per day, and calcium from 1,200 mg to 1,400 mg daily, over a year. Blood and urinary calcium levels were measured at baseline and every 3 months during the year-long study period. The investigators found that about one in three subjects (33 percent) experienced hypercalciuria, defined as urinary calcium levels greater than 300 mg in a 24-hour urine calcium test. Hypercalcemia was also identified in about one in 10 subjects (10 percent). Given that both events are known to contribute to the risk of kidney stones, lead study investigator Professor Christopher Gallagher, director of the Bone Metabolism Unit at Creighton University Medical Center, Nebraska, US, has suggested that clinicians should monitor the blood and urine calcium levels of patients who take calcium and vitamin D supplements on a longterm basis.

26 September 2012 News

Weight training lowers type 2 diabetes risk in men

Alexandra Kirsten

en who do regular weight training may be able to reduce their risk of type 2 diabetes (T2D), according to the findings of a new study by researchers based in the US and Denmark. Until now, previous studies have reported that aerobic exercise is of major importance for type 2 diabetes prevention, said lead author Mr. Anders Grntved, visiting researcher in the department of nutrition at Harvard School of Public Health, Boston, Massachusetts, US. This is the first trial to examine the role of weight training in the prevention of T2D. In their study, data from a prospective cohort study involving 32,002 men enrolled into the Health Professionals Follow-up Study conducted in the US from 1990 to 2008 were analyzed. Participants recorded how much time they spent each week on weight training and aerobic exercise (including jogging, running, cycling and swimming) on questionnaires they filled out every 2 years. During 18 years of follow-up, 2,278 new cases of T2D were documented. [Arch Intern Med 2012; DOI:10.1001/archinternmed.2012.3138] What the researchers found was a doseresponse relationship between an increasing amount of time spent on weight training and lower risk of T2D (P=0.001 for the trend). To examine the association of weight training with the risk of T2D and to assess the influence of combining weight training with

Men who engaged in both aerobic and weight training for more than 150 minutes per week had the greatest reduction in T2D risk.

aerobic exercise, the men were categorized according to how much weight training they did per week: up to 59 minutes, between 60 and 149 minutes, and 150 minutes or more. Depending on the training amount, they reduced their T2D risk by 12 percent, 25 percent and 34 percent, respectively, compared with no weight training. Men who engaged in aerobic exercise and weight training for at least 150 minutes per week had the greatest risk reduction of 59 percent. This study provides clear evidence that weight training has beneficial effects on diabetes risk over and above aerobic exercise, which are likely to be mediated through increased muscle mass and improved insulin sensitivity, the researchers stated. The authors added however that further research is needed to confirm the results of the study as well as to analyze whether the findings can be generalized to women. Furthermore, the effect of duration, type and intensity of weight training on T2D risk should be examined in greater detail.

HIMSS AsiaPac12 will link people and information in new ways that increase patient care and safety, reduce healthcare costs and improve quality of care across the continuum of care in Asia Pacific. FOur HeAltHcAre It cONFereNces IN ONe sYMpOsIA prOGrAM Clinicians IT Leadership Symposium nursing Informatics Symposium

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lINKING PeoPle, Potential and Progress

register today and you stand a chance to win Formula 1 tickets!* Please visit himssasiapac.org/12 for more information. *Terms and conditions apply.

Opening address by Guest-of-Honour Mr GAN Kim Yong Minister for Health, Republic of Singapore

Opening Keynote by Dr Blackford MIDDletON Corporate Director, Clinical Informatics Research & Development, Partners HealthCare System, Harvard Medical School, Brigham & Womens Hospital

closing Keynote by Dr charles sAWYer MD, FACP Associate Chief Health Information Officer Geisinger Health System

Diamond sponsors

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transforming healthcare through IT

28 September 2012 Calendar

September
9th International Exhibition on Hospital, Diagnostic, Pharmaceutical, Medical and Rehabilitation Equipment Supplies
12/9/2012 to 14/9/2012 Location: Singapore Info: Messe Dsseldorf Asia Tel: (65) 6332 9626 Email: shirley@mda.com.sg Website: www.medicalfair-asia.com

8th World Stroke Congress

10/10/2012 to 13/10/2012 Location: Brasilia, Brazil Info: World Stroke Organization Tel: (41) 22 908 0488 Email: stroke@kenes.com Website: www1.kenes.com/wsc

23rd Great Wall International Congress of Cardiology (GW-ICC) Asia Pacific Heart Congress (APHC) 2012
11/10/2012 to 14/10/2012 Location: Beijing, China Info: Secretariat Office of GW-ICC & APHC (Shanghai Office) Tel: (86) 21-6157 3888 Extn: 3861/62/64/65 Fax: (86) 21-6157 3899 Email: secretariat@heartcongress.org Website: www.heartcongress.org

Hospital Management Asia 2012

13/9/2012 to 14/9/2012 Location: Hanoi, Vietnam Info: Ms. Sheila Pepito Tel: (632) 846 8339 Email: sheilapepito@exedraevents.com Website: hospitalmanagementasia.com

London College of Clinical Hypnosis (LCCH-Asia) Certificate in Clinical Hypnosis

22/9/2012 to 23/9/2012 Location: University of Malaya, Kuala Lumpur, Malaysia Info: LCCH Secretariat Tel: (60) 3-7960 6439 / 7960 6449 Email: info@hypnosis-malaysia.com Website: www.hypnosis-malaysia.com

42nd Annual Meeting of the International Continence Society

15/10/2012 to 19/10/2012 Location: Beijing, China Tel: (41) 22 908 0488 Fax: (41) 22 906 9140 Email: ics@kenes.com Website: www.kenes.com/ics

October
48th Annual Meeting of the European Association for the Study of Diabetes
1/10/2012 to 5/10/2012 Location: Berlin, Germany Info: EASD Secretariat Email: secretariat@easd.org Website: www.easd2012.com

8th Asian-Pacific Society of Atherosclerosis and Vascular Diseases Meeting

20/10/2012 to 22/10/2012 Location: Phuket, Thailand Info: Asian-Pacific Society of Atherosclerosis and Vascular Diseases Tel: (66) 2940 2483 Email: apsavd@lawson-marsh.com Website: www.apsavd2012.com

15th Biennial Meeting of the European Society for Immunodeficiencies (ESID 2012)
3/10/2012 to 6/10/2012 Location: Florence, Italy Tel: (41) 22 908 0488 Fax: (41) 22 732 2850 Email: esid@kenes.com Website: www.kenes.com/esid

Upcoming
2012 Scientific Sessions of the American Heart Association
3/11/2012 to 7/11/2012 Location: Los Angeles, California, US Info: American Heart Association Tel: (1) 214 570 5935 Email: sessionsadmin@heart.org Website: www.scientificsessions.org

29 September 2012 Calendar

8th International Symposium on Respiratory Diseases & ATS in China Forum 2012
9/11/2012 to 11/11/2012 Location: Shanghai, China Info: UBM Medica Shanghai Ltd. Tel: (86) 21-6157 3888 Extn: 3861/62/64/65 Fax: (86) 21-6157 3899 Email: secretariat@isrd.org Website: www.isrd.org

63rd Annual Meeting of the American Association for the Study of Liver Diseases
9/11/2012 to 13/11/2012 Location: Boston, Massachusetts, US Info: American Association for the Study of Liver Diseases Tel: (1) 703 299 9766 Website: www.aasld.org

National Diagnostic Imaging Symposium

2/12/2012 to 6/12/2012 Location: Orlando, Florida, US Info: World Class CME Tel: (980) 819 5095 Email: office@worldclaswscme.com Website: www.cvent.com/events/national-diagnostic-imaging-symposium-2012/event-summaryd9ca77152935404ebf0404a0898e13e9.aspx

Asian Pacific Digestive Week 2012

5/12/2012 to 8/12/2012 Location: Bangkok, Thailand Tel: (66) 2 748 7881 ext. 111 Fax: (66) 2 748 7880 E-mail: secretariat@apdw2012.org Website: www.apdw2012.org

World Allergy Organization International Scientific Conference (WISC 2012)

6/12/2012 to 9/12/2012 Location: Hyderabad, India Info: World Allergy Organization Tel: (1) 414 276 1791 Fax: (1) 414 276 3349 E-mail: WISC@worldallergy.org Website: www.worldallergy.org

30 September 2012 In Practice

Nerves can be a pressing problem

Adjunct Associate Professor Hee Hwan Tak
M.B.B.S. (Singapore), F.R.C.S. (Glasgow)

Singaporean patient who had undergone a kidney transplant complained of unsteadiness in 2009 and developed a tendency to fall. The kidney specialist was concerned enough to admit him for an MRI scan of the spine to see if there was anything compressing the nerves of his spinal column, which could cause such symptoms. The scan revealed significant compression of the nerves in the neck. We all know that the spinal column houses, protects and nourishes our nerves. Control of all our major body systems and organs is via our nervous systems, which are akin to electrical wires branching out from a central grid. The nerves in the neck belong to the upper motor nerves, which are more critical. Injury or damage to these nerves will result in greater damage and consequences than lower motor nerves. There was little chance that this patients compressed nerves would get better by themselves. I advised him to undergo spinal surgery to free the compressed nerves and, at the same time, undergo a fusion of the affected level of the spine. Fusion as the first surgical option Fusion involves linking the affected segments, or vertebrae, of the spine, by stimulating bone growth between the segments and by attaching them with rods, screws

and plates. This stops further movement between the segments and prevents them from compressing the nerves. The patient was not keen and said that some form of transplant surgery might be made available to him should his nerves deteriorate further. I told him that nerve and stem-cell transplant was still in the animal experiment stage and the only option at the time was to release the nerves from further compression before his condition worsened. By making more room for the nerves in such cases, we hope that there will be more blood supply bringing nutrients to the nerves. The eventual result may be gradual recovery of the function of the nerves. When patients see a spine specialist regarding a spine problem, their main concerns usually are: whether their condition is serious, whether they will be paralysed and whether surgery is needed now or in the future. Ruling out the red flags Our medical undergraduates have been taught to rule out red-flags or serious spinal conditions, which may be life- or limbthreatening. Examples of such red-flag conditions include cancer, infections, unstable fractures of the spine and compression of the upper motor nerves. These symptoms include weakness of the arms or legs, fever, urinary incontinence and loss of appetite or weight. Fortunately, most complaints of neck and back pain are due to muscular strain, poor posture and wear and tear of the spine. The vertebrae in the spine are cushioned and separated by spongy intervertebral discs, which are each made of a fibrous out-

31 September 2012 In Practice

er shell containing a gel-like material. When the spine degenerates, the shells of the intervertebral discs can weaken and tear. When this happens, the inner material bulges out and compresses the spinal nerves. Chemicals called prostaglandins are also released from the discs. These can result in intermittent attacks of pain, punctuated with good symptom-free days. When the nerves within the spinal column are pinched, the pain may radiate or spread to the extremities. The patient may complain of numbness, tingling or weakness of the affected extremities. The good thing is that most of these symptoms are resolved in most patients, usually after two to three months of simple treatment measures such as anti-inflammatory medication, back or neck exercises and lifestyle modification. As they feel better, patients often ask if the extent of their nerve compression has been reduced. A patient gets better not because the degree of nerve compression has lessened but because the chemical irritation of the nerves has become less acute. Anti-inflammatory medication inhibits the effects of the chemicals that leak from the damaged intervertebral discs. However, about 10 to 15 per cent of patients do not feel significantly better after two to three months. It usually means that their nerves are unable to cope with the compression around them. This is when the possibility of surgery is discussed. In general, the aim of all types of spinal About the Author:
Adjunct Associate Professor Hee Hwan Tak, a specialist in spinal disorders and deformities, is the medical director of the Centre for Spine and Scoliosis Surgery, Singapore Medical Group, and a lecturer at Singapores National University of Singapore Yong Loo Lin School of Medicine.

surgery is the same, regardless of the condition of the spine decompression or freeing of the nerves. Sometimes, the segment of the spine may be potentially unstable or painful and may need to be stabilized to some degree. Treatment options abound About 10 to 20 years ago, fusion of the segment was the only option. Nowadays, we have the luxury of more treatment methods at our disposal. These include disc replacement, which means replacing the damaged intervertebral disc with an artificial one made of metal and plastic; and dynamic stabilization, which involves implanting a metal device to reinforce the damaged part of the spine. Determining whether to stabilize or not and the type of stabilization to be used is often a joint decision by the spine specialist and the patient. We take into account the age, lifestyle, job demands and expectations of the patient in the decision-making process. Progress has been made in the treatment that he wanted, although it remains experimental. In October 2010, the worlds first clinical trial using human embryonic stem cells to treat spinal cord injuries began. The aim is to convert stem cells into cells similar to our nerve cells. Only time will tell if this method will improve the outcome for patients. Scientific research may not always produce the results that we want. But there is no going back in our quest for improvement in the treatment of spinal conditions.

32 September 2012 Humor

Ive been Dr. Lamonts patient for over 12 years and Ive never seen his face!

Lucy, I think we should Go ahead and take those, Im curious get a divorce! to see what they will do to you!

Whats halitosis?

Do you know what gets me? You put on a white coat and right away everyone thinks you are a doctor!

Do you have to go on and on about how gross the whole thing is?

It was just a joke!

Glad you could make it!

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