The Philippine Medical Women’s Association is an organization of medical women to foster closer relationships and fellowship among all medical graduates to enrich, encourage, and empower one another in their chosen fields of practice or specialties and subspecialties so that they may be beter equipped to serve the community and the underprivileged and take an active part in national affairs speciallyy in problems that affect women, children, and the family.
Since then, the association has grown to more than 4,000 members nationwide in 45 various chapters in Metro Manila and the provinces.

It is with great pride and honor to introduce the First International Symposium on Neurocritical Care of St. Luke’s Medical Center which will be held on January 14 and 15, 2010 in Manila, Philippines.   The symposium will provide participants a unique opportunity to get an update on the remarkable developments in neurocritical care. Leading scientists and clinical experts will present the state of the art in basic and clinical research in neurocritical care and patient management.

We look forward to welcoming you to the symposium. We hope that this meeting will be a memorable experience for all of you, where you will be able to further friendships and strengthen scientific collaboration.

Yours sincerely,

Lina C. Laxamana, MD, Program Director

With the country’s most advanced and most comprehensive diagnostic and treatment facilities, our team of neurologists and neurosurgeons offer diagnostic evaluation, consultation and management to a wide range of pediatric and adult neurological diseases of the brain, spinal cord and peripheral nerves or muscles.

Patients can avail of the Institute’s facilities like the Neurocritical Care Unit, Clinical Neurophysiology Laboratory, Comprehensive Epilepsy Program, Acute Stroke Unit, Neuro-Ophthalmology Service, and Hearing and Balance Disorders Laboratory. The country’s first Comprehensive Stroke Services offers Brain Attack Prevention and an Acute Brain Attack Program specially designed to meet the needs of patients.

The Institute’s Neurosurgery Section pioneered in minimally invasive neurosurgery in the country. It is the country’s leading and most experienced team performing Stereotactic Radio Surgery, Endoscopic and Keyhole Neurosurgery as well as Cerebrovascular, Epilepsy and Spine Surgery, Image-Guided Surgery, and Pediatric and Functional Neurosurgery.

The Neurocritical Care Unit provides monitoring for potential deterioration, administration of emergency medications and intensive care of critically-ill neurologically-impaired patients. Similarly, a special Acute Stroke Unit is a specialized unit for the comprehensive treatment of patients with acute stroke.

Epileptics can now look forward to a multi-disciplinary service dedicated solely to their care through the Institute’s Comprehensive Epilepsy Program. This program offers a wide range of diagnostic and therapeutic services which includes an Epilepsy Monitoring Unit, also the first of its kind in the country which accurately diagnoses seizure types, a very important step in determining treatment strategy. Other diagnostic and ancillary procedures available are equipment for video-EEG monitoring, portable teledigital EEG, anti-epileptic drug level determination, epilepsy surgery, ketogenic diet treatment program, and Vagus Nerve Stimulation.

In partnership with the Research and Biotechnology Division, the St. Luke’s International Institute of Neurosciences established the Stroke Data Bank to fully understand and effectively fight stroke or “brain attack”, one of the leading causes of disability and mortality worldwide. At St. Luke’s Medical Center alone, more than 600 strokes are admitted annually. The Stroke Data Bank aims to determine the epidemiology of the stroke and its subtypes in the hospital-based population, analyze the effect of established and less established risk factors in the development of stroke, determine the short and long-term prognosis after a stroke including risk of recurrence, compare efficacy of different treatment modalities for acute and non-acute stroke, estimate enrollment of stroke patients in future clinical trials, and disseminate information about stroke prevention to the public, as well as report the results of the study to the local and international medical community.

As the country’s leader in the field of Neurosciences, the Institute is also home to five highly specialized centers manned by experts trained locally and abroad. One of these is the Comprehensive Brain Tumor Center which provides a comprehensive and coordinated multidisciplinary approach to the care of adult and pediatric patients with brain and spinal cord tumors, and systemic cancer. The Center is manned by the Brain Tumor Board which is composed of specialists from neurology, neurosurgery, medical oncology, radiation oncology, neuroradiology, nuclear medicine, neuropathology, psychiatry, pain management, and nursing.

Another center of excellence under the Institute is the Comprehensive Sleep Disorders Center which offers a multi-disciplinary team approach to sleep disorders using the combined expertise and experience of neurologists, pulmonologists (adult and pediatric), psychiatrists, and otorhinolaryngologists, all of whom are board certified in their fields of specialty with a common subspecialty in Sleep Medicine. The center boasts of a computerized sleep monitoring system as well as a six-week Insomnia Treatment Program which is a comprehensive approach using a broad range of treatment modalities with proven efficacy.

St. Luke’s Memory Center is a hospital-based multi-disciplinary service providing a range of detailed assessment, management and advisory services for individuals with memory complaints and dementia. The Memory Center handles patients, young or old, with memory disorders or in various stages of dementia. It is part of treatment continuum in collaboration with the hospital’s geriatric, neurologic and psychiatric services.

The Memory Enhancement Program (MEP), a hospital-based out-patient plan, provides detailed diagnosis and Cognitive Rehabilitation Therapy for individuals with memory and associated cognitive difficulties. Experts in charge of the program include neurologists, psychologists, nurse clinicians, an occupational therapist, and a data manager.

The Movement Disorders Center is a facility for the clinical assessment and management of various movement disorders with particular emphasis on Parkinson’s Disease, tremor disorders, myoclonus, chorea, dystonia, tic disorders, and tardive syndromes. The Center has state-of-the-art neurophysiological equipment which greatly fosters the detailed study of various movement disorders. Effective management of various movement disorders is stressed, utilizing the latest knowledge in pharmacotherapy, physical and occupational therapy, psychotherapy and, when applicable, surgery.

Created for the interdisciplinary evaluation and management of children and adolescents up to 18 years of age who manifest developmental or behavioral problems in the cognitive, motor, communicative and/or academic realms is the Neurodevelopmental Center. Some indications of developmental disabilities are poor head control at three months of age, failure to sit alone at 10 months, tantrums, hyperactive/uncooperative or oppositional behavior, poor eye contact, short attention span, and repetitive/unusual behavior not found in other kids of the same age.

St. Luke’s Neurodevelopmental team of physicians, child neurologists, neurophychologists, speech-language pathologists, clinical psychologists, occupational therapists, educational specialists, social workers and nurses provide such services as: neurodevelopmental screening/surveillance of high risk neonates, infants and young children; neurodevelopmental evaluation of infants and young children; child psychiatric evaluation and counseling; neurophysiological evaluation; speech-language evaluation and therapy; occupational therapy; and music and play therapy.

The Mood Clinic was created to provide a comprehensive treatment approach to patients with mood disorders. With people leading very stressful lives, more cases of depression have been reported. Not too many people know that depression is a treatable illness involving an imbalance of brain chemicals called neuro-transmitters. It is not a character flaw or a sign of personal weakness. The Clinic also serves as a liaison with other mood programs locally and internationally. It also aims to generate research studies involving mood disorders.

Incretin-Based Therapy in Type 2 Diabetes Mellitus
Advancing Treatment, Improving Outcomes

Gabriel V. Jasul Jr., MD, FPCP, FPSEM
Clinical Associate Professor, UP College of Medicine
Endocrinology Training Officer, St. Luke’s Medical Center

Albert Lim Rafanan, MD
Pulmonary, Critical Care and Sleep Medicine
Chong Hua Hospital, Cebu City, Visayas, Philippines

WHAT IS OBSTRUCTIVE SLEEP APNEA(OSA)?
Loud snoring which is interrupted by respiratory arrest (apnea) of more than 10 secs in duration is obstructive sleep apnea. This is usually accompanied by a reduction in blood oxygen saturation followed by a microawakening to breath. In severe cases, hundreds of breathing pauses can occur every night.
In obstructive apnea, the throat closes during inhalation due to excessive relaxation of the pharynx muscles and the floor of the mouth, accompanied by increased tissue pressure from outside. This prevents air from entering the lungs, and the patient is threatened with suffocation.

IS OSA DANGEROUS? WHAT ARE THE EFFECTS?
OSA has been associated with an increased mortality ratio of 3.33. Sleep apnea has been associated with an up to 23-fold increased risk of heart attack. A number of studies have now documented sleep apnea in over two-thirds of male stroke victims. In the las JNC-7 Guidelines of hypertension, OSA was the most common etiology for secondary hypertension. In fact, in some series, almost half of subjects with hypertension demonstrated sleep apnea. In many patients, treating sleep apnea can bring blood pressure readings under control: often with less medication.

In some cases, OSA may be fatal. In many instances, the idea that someone died peacefully during sleep clearly must have amounted to wishful thinking, since instead, the deceased was probably fighting violently for breath up to the very end.

The most frequent symptom of sleep apnea is tiredness during the day. The continual lack of quality sleep can affect one’s life in many ways including depression, irritability, loss of memory, lack of energy, sexual dysfunction, a high risk of auto and workplace accidents, and many other problems.

Other common complications of sleep apnea include heart failure, cardiac arrhythmias, and increased levels of fasting blood glucose, insulin, and glycosylated hemoglobin, independent of body weight.

IS OSA COMMON?
Yes, extremely common! Sleep apneaoccurs in all age groups and both sexes but is more common in men. Four percent of middle-aged men and 2 percent of middle0aged women have sleep apnea.

WHO GETS OSA?
People most likely to have or develop sleep apnea include those who snore loudly and also are overweight, or have high blood pressure, or have some physical abnormality in the nose, throat, or other parts of the upper airway. Sleep apnea seems to run in some families, suggesting a possible genetic basis.

HOW WILL I KNOW IF MY PATIENT HAS OSA?
The only definite way to diagnose is to spend a night in a sleep laboratory to have a polysomnogram. The Chong Hua Hospital Center for Sleep Disorders is the first and only complete sleep laboratory outside Manila. During the sleep study, 16 recordings (including Electroencephalogram, EKG, Electromyogram, electrooculogram, sleep position, pulse oximetry, airflow measurements by oronasal thermistor and nasal pressure transducer, thoracic and abdominal efforts, real time video recording, snoriing sensors and limb movement monitor) will be analyzed to make a definitive diagnosis and initiate treatment. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep.

Maria Arleen G. Atilano-Obsioma, MD
Infectious Disease Consultant
Capitol University Medical City, Cagayan de Oro City

Severe sepsis and septic shock are major healthcare problems affecting millions of individuals around the world each year. In 2004, an international group of experts in the diagnosis and management of infection and sepsis published the first internationally accepted guidelines that the clinicians could use to improve outcomes in severe sepsis and septic shock. The 2008 guideline is an update to the previous guideline.

The key recommendations include: early goal-directed resuscitation of the septic patient during the first 6 hours after recognition; blood cultures prior to antibiotic therapy; imaging studies performed promply; administration of broad-spectrum antibiotic therapy within 1 hour of diagnosis; reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate; a usual 7-10 days of antibiotic therapy guided by clinical response; source control; administration of either crystalloid or colloid resuscitation; fluid challenge to restore mean circulating filling pressure; reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfussion.