Background and objectivesThe loss of muscle or fat free mass (FFM) as a result of systemic inflammation and poor nutrition in Chronic Obstructive Pulmonary Disease (COPD), is recognized as an important factor that influences symptoms and disease-related outcomes. To date, there are no data on body composition among Filipino COPD patients and how it impacts COPD disease severity. This paper examined the relationship of Fat Free Mass Index (FFMI = FFM/height) and sarcopenia with COPD disease severity variables.MethodsThis was a cross-sectional analytic study comparing low and normal FFMI, sarcopenic and nonsarcopenic COPD patients, in terms of lung function, exercise capacity, and quality of life score. Filipino COPD patients older than 40 years were included. Patients performed six minute walking distance (6MWD), handgrip strength (HGS), and quality of life status evaluation using Filipino version of COPD Assessment Test (CAT). Body composition was measured using bioelectrical impedance analysis (BIA).ResultsA total of 41 patients were included. The mean age was 69.22 years. The prevalence of being underweight and having sarcopenia was 32% and 46%, respectively. Point biserial correlation showed that COPD patients with low FFMI had a statistically significant reduction in peak inspiratory flow (r= −0.5791, P value 0.0002), peak expiratory flow (r= −0.4475, P value 0.0055), and handgrip strength (r= −0.4560, P value 0.0027); and lower CAT score (r= −0.3422, P value 0.0285). Similar findings were observed among sarcopenic COPD patients.ConclusionThe prevalence of being underweight and having sarcopenia was high. Low FFMI results in reduction of lung function and upper limb muscle strength among Filipino COPD patients.

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Haemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of pathological immune activation characterised by extreme inflammation. We present a case of a young Filipino man consulting for non-specific symptoms of fever, body malaise and weight loss. Prominent physical examination findings included gross pallor, cachexia and hepatosplenomegaly. Laboratory results revealed pancytopaenia, while bone marrow examination revealed haemophagocytosis. Further workup for HLH showed hypertriglyceridaemia, hypofibrinogenaemia and hyperferritinaemia (fulfilling 6 of 8 diagnostic criteria). Exhaustive serological and haematological examinations showed chronic hepatitis B virus infection and past evidence of Epstein-Barr virus infection as possible triggers. The patient was started on antiviral therapy, high-dose steroids and chemotherapy. He initially improved, but eventually succumbed to severe fungal sepsis and pulmonary haemorrhage. An autopsy confirmed the diagnosis of HLH.

To determine the prevalence of the risk of Obstructive Sleep Apnea among patients with uncontrolled Hypertension (HTN) seen at the OutPatient Department of the University of the Philippines-Philippine General Hospital METHODS: This is a cross-sectional study that enrolled 325 adult Filipino HTN patients seen at the outpatient department (OPD) of UP-PGH from January 2019 to July 2019. Participants also answered Berlin Questionnaire (BQ), Epworth Sleepiness Scale (ESS) and the St. Lukes Medical Center-Obstructive Sleep Apnea Clinical Score (SLMC-OSACS) for their OSA risk. Descriptive statistics were used to summarize the clinical characteristics of the patients. A chi-square test was used to analyze categorical data univariately. Logistics regression analysis was used to determine the association of the different independent variables with the outcome (dependent) variable. RESULTS: The risk of OSA was significantly high among uncontrolled HTN patients: 106 (60.7%) based on BQ (p<0.0001) and 68 (69.4%) based on SLMC-OSACS (p<0.0001). OSA risk among uncontrolled HTN was 6x higher (OR¼5.69; 95% CI¼3.49-9.28;p<0.0001) using the BQ and 4x higher (OR¼3.70; 95% CI¼2.19-6.26;p¼<0.0001) using the SLMC-OSACS than those with controlled HTN. Daytime excessive sleepiness was not significantly associated. Other variables significantly associated with high risk OSA were BMI and other comorbidities. CONCLUSIONS: Among patients with hypertension, the risk of OSA based on the Berlin Questionnaire and SLMC-OSACS was significantly high among uncontrolled hypertension patients than those with controlled hypertension. Daytime excessive sleepiness noted with the ESS was not significantly associated with uncontrolled hypertension. Other demographic and clinical profile that were significantly associated with high risk OSA were BMI and other comorbidities (such as bronchial asthma, congestive heart failure) based on the SLMC-OSACS. CLINICAL IMPLICATIONS: Utilizing these sleep questionnaires and determining the risk for OSA among patients with uncontrolled hypertension will lead to early evaluation of OSA and complications. Locally this will aid in improving detection and provide more strategic management of uncontrolled hypertension to decrease associated cardiovascular events. This will guide our clinicians to prioritize patients who would benefit referral to sleep specialists DISCLOSURES: No relevant relationships by Jamie Chua, source¼Web Response No relevant relationships by Angelica cruz, source¼Web Response No relevant relationships by Maria Lowella De Leon, source¼Web Response no disclosure on file for Manuel Jorge; No relevant relationships by Anna Katrina Tojino, source¼Web Response