CME DIGEST – December 2013


Holiday Heart Syndrome—real or myth?

proactive approach with risk stratification

By Ramon F. Abarquez, Jr. MD, EFACC, FAsCC, FPCP, FPCC, CSPSH
Academician, National Academy of Science and Technology Professor Emeritus, College of Medicine, University of the Philippines Chair, Philippine Medical Association Continuing Medical Education Commission

EACH HOLIDAY SEASON, particularly during the Yuletide long vacation, solicited or not, the health advisory is usually moderation rather than ‘binge’ activities. However, should everyone celebrating the ‘Birth of the Lord’ be over-cautious? Or is there a ‘limited-few’ who are at greater adverse risk? The challenge for physicians is to identify these individuals who are at risk so they could be properly forewarned and adequately treated.

The coming holidays maybe a solemn ceremonial to some or a festive reunion to the majority. But more importantly, reflective opportunities should be primordial. Why? The season may translate into clinically preventable morbidity and mortality consequences.

The “Holiday Heart” syndrome was coined in 1978, to describe patients who had atrial fibrillation following ‘binge alcohol’ drinking. (Glatter, Curr Treat Options Cardiovasc Med. 2012;14(5):529-35)

Is ‘binge drinking’ also prone to an episode of ventricular fibrillation leading to sudden death that may be a random occurrence or weather-related? In a mortality review in Australia, (January 1, 2008 to December 31, 2009) most cases had holiday-related deaths. (Bierton, Forensic Sci Med Pathol. 2012; Oct 12) Usually the ‘at-risk-individual’ is more prone to be the victim. Thus, considerable options for risk stratification with positive action plans can result into opportunities for a progressive quality of life improvement that should be incorporated in any New Year’s ‘must-do’ resolution.

Assessing risk profile

Poor prognosis is related to target organ damage and not to the mere presence of high BP, dyslipidemia, DM, obesity or smoking.”Heart burns” or reflux esophagitis caes, even with medical therapy, are also at risk of sudden death in a retrospective Finnish study. (Rantanen, Am J Gastroenterols.2007;102(2):246-53); and especially among those patients taking domperidone (Prescrire Int. 2012;21(129):183)

CME DIGEST - Holiday Heart Syndrome

Cases with post-prandial bradycardia (Mizumaki,J Cardiovasc Electrophysiol. 2007;18(8):839-44) or hyperglycemia related AF are also at higher risk. (Kato, J Cardiol. 2006;48(5):269-720) particularly among cases with ‘full-stomach’ (Ikeda, J Cardiovasc Electrophysiol. 2006;17(6):602-7)

Diabetic cases with post-prandial reactive hypoglycemia (Brun, Diabetes Metab.2000;26(5):337-51.) can develop AV blocks. (Okamoto, Intern Med. 1997;36(8):579-81) A year after diagnosis of ‘unspecified chest pain’ attributable to cardiac, gastrointestinal, respiratory, psychological or musculoskeletal etiologies and after adjustment for age, sex and number of primary consultations, the odds of an eventual diagnosis of heart failure or coronary heart disease were 4.7 and 14.9 times greater, respectively compared to control, Similarly, the odds of a diagnosis of gastro-esophageal reflux disease (GERD), hiatus hernia or peptic ulcer disease were associated with at least threefold risk more than those with psychological, respiratory and musculoskeletal impression.

More importantly, mortality rate was increased among patients with “unspecified chest pain” during a mean follow-up period of 4 years with 842 of 13 740 (6.12 percent) patients dead in the unspecified chest pain cohort, compared with 710 of 20 000 (3.55 percent) patients in the control cohort. (Ruigomez, Family Practice 2006;23 (2):167-174)

The role of cigarette smoking on cardiac arrhythmia is less clearly defined wherein pro-fibrotic effect of nicotine on myocardial tissue with consequent increased susceptibility to catecholamine could be the mechanism. (D’Alessandro, Eur J Prev Cardiol. 2012;19(3):297-305) More importantly however, after the ‘no-smoking law’ in restaurants and work-place was enforced in Olmstead County, Minnesota, the incidence of acute MI and sudden cardiac death decreased by 33 percent and 17 percent respectively in 18 months despite the persistent prevalence of hypertension, DM, dyslipidemia and obesity. (Hurt, Arch Intern Med.2012;29:1-7) Furthermore, mothers smoking 1-10 and > 10 sticks of cigarettes daily give a 2.93 and 4.36 times more infant sudden death, respectively.

Binge eating, drinking

During holidays with festive moods, binge eating and drinking are widely hypothesized to be related to idiopathic tachyarrhythmias that can lead to sudden death.(Fuenmayor, Int J Cardiol. 1997 ;59(1):101-3.) Dysrrhythmias are considered to be frequently alcohol-related and confirmed by positive screening test for alcoholism. Among 289 patients (aged < 65 years) admitted for supraventricular tachyarrhythmias, 35.3 percent had idiopathic arrhythmia with a known drink related onsettime, specifi cally more often among chronic alcohol abusers. Arrhythmia, independent of the most recent ethanol use, occurred during weekends (47 percent), during weekdays (22 percent; p = 0.040) compared to out-of-hospital population (12 percent; p = 0.002). However, the increased frequency of problem drinkers among patients with weekend-onset idiopathic arrhythmias was only relative since the number of abstainers and non-problem drinkers have decreased. (Kupari, Am J Cardiol. 1991;67(8):718-22) However, even among those with no known cardiac disease, the most frequent tachyarrhythmia is atrial fi brillation and less frequently, but with worse prognosis, is ‘torsades de pointes’ polymorphic ventricular tachycardia. (Treibal, Vnitr Lek.2008;54(4):410-4)

By healthandlifestylemagazine Posted in CME Digest

LAST CALL – December 2013


javier-pic22Three Disasters and a Country

BY SATURNINO P. JAVIER, MD, FPCP, FPCC, FACC

The second half of 2013 may well go down in Philippine history with a record three disasters in a row. While other nations confront a calamity for several or more years, the Philippines unfortunately had to grapple with three disasters in just a few months – two natural and one man-made.

In October, a magnitude 7.2 earthquake struck the Visayas, with the epicenter in Bohol, and affecting the neighboring cities of Cebu and Davao. The quake, which was the deadliest to hit the Philippines in more than 20 years, is said to have released the energy equivalent to more than 32 Hiroshima bombs. It killed more than 200 people and displaced nearly a million people.

Less than a month later, while the dust had just begun to settle in the Visayas, a monster super typhoon – Yolanda (international code name Haiyan) hit the island province of Leyte, badly affecting Tacloban and Eastern Samar, killing more than 5,000 people and causing unimaginable and unspeakable destruction of lives, limbs and properties. Touted as a Category 5 storm and given an unprecedented Signal 4 which is the highest storm signal issued by the Philippine weather bureau, the typhoon was labeled as the strongest ever recorded and reported to make landfall. Yolanda undeniably lived up to all weather forecasters’ hype.

Just hours before the super typhoon struck, the Philippines reeled from another super storm – the man-made calamity of a national scandal woven by Janet Napoles. As she sat on the witness stand during the Senate Blue Ribbon Committee hearing on the pork barrel scandal, she unleashed powerful torrents of “I don’t know, I cannot recall and I invoke my right against self incrimination”. In the end, she wrought havoc on the collective psyche of a nation which tried to make sense of how this Basilan undergraduate was able to dupe the Filipino people of ten billion pesos allegedly.

Last Call

Napoles’s dumbfounding silence on the stand provided the eerie calm before the storm Yolanda. She essentially was the front-act for the super typhoon.

With two natural calamities and one man-made disaster, the world once again witnessed the much vaunted Filipino resilience. The entire humanity saw the indomitable Filipino spirit that goads all Filipinos – calamity survivors or not – through their daily lives.

The interaction of these three calamities cannot be lost on any intrepid observer. While the relief operations for the quake victims had yet to be completed, the super typhoon derailed all these efforts and mobilized the most massive relief operations ever to be staged for a Philippine disaster – engaging the services of governments and countries around the world.

Ironically, it takes Mother Nature to come to seemingly protect a man-made disaster whipped by Napoles as Yolanda takes the nation’s attention away from that which Nature has nothing to do about – although one wonders how much of human nature propels and fuels greed and avarice among Napoles and her accomplices. As she gets sidelined and shielded from public fury in the aftermath of Yolanda’s devastation in the Visayas, Napoles gets a break from media headlines and national attention. Yet, she and the ‘monster’ of all scams that she is involved with is an economic disaster where the alleged amount behind the large scale pillage of the national economy would certainly bring about a huge impact on the rehabilitation of the quake and typhoon-ravaged areas of the Philippines.

With massive local and international aid pouring in, the relief operations will slowly but certainly bring back the damaged cities and provinces back on their feet, and shall once again prove to all and sundry the grit and strength that Filipinos are made of. Call them imperturbable, sturdy and iron-clad. (As CNN reporters repeatedly emphasized, they do not and cannot fathom where Filipinos draw their strength from.)

One wonders – when will we, as a nation get the relief (and closure) from Napoles, her coddlers and benefactors? This country has had disasters far too many. We need the collective respite from any other disaster. Heavens spare us from typhoon “Tanda”, “Sexy” or “Pogi”.

For comments, spjavier2958@yahoo.com

A DOSE OF FAITH – December 2013


pastor-mendozaGod’s Creation

BY RICHARD G. MENDOZA, MPH, PHD

At the turn of the nineteenth century, Napoleon and his army were on their way across the Mediterranean Sea to conquer the Egyptians. One starlit night, a number of Napoleon’s soldiers, products of the French Revolution and its rejection of God, were trying to outdo each other in giving reasons why they knew there was no God.

Napoleon, in his characteristic manner, was pacing back and forth on the deck listening to their reasoning, when one of them asked him what he thought of what they had said. He thoughtfully responded, “Very good, but if there is no God, then who made and sustains all of those?” And he pointed upward at the stars looking down on them.

That is a good question. Who made this world and the billions of stars, and who charts their course and keeps them in that course? Many gods have been worshiped by people throughout the ages. And people worship many different gods today: Buddha, Shinto, Satan, the gods of the Hindus, and others. Their followers each claim that their god is the only true and supreme God in the world. And many have been taught that God is not the Creator of all that we see.

They believe instead in what Darwin taught: a theory called evolution, which teaches our children that the world and the cosmos came into being through a series of changes that took place over billions of years. This theory of origins teaches that once the first cell was formed, it went through many biological and geological changes, and the marvelous universe came about. Blind chance and miraculous changes account for the intricate universe that we see about us. Can all of this miraculous universe be simply a product of changes in nature, not guided by any supreme intelligence but just happening randomly here and there?

As we examine the intricate design of almost everything we see on this earth and in this universe, we must conclude that there is an intelligence at work in the creation and sustaining of life on this earth. The whole world was excited to see the amazing feat of the first space shuttle flight. They saw the rocket ignite, and then the supporting mechanism fall away as the mighty power of the engine lifted the vehicle heavenward. We listened with keen anticipation to regular reports on the capsule’s progress as it separated from the shuttle and continued on its way through space.

Radio messages from the astronauts and their detailed descriptions reminded us of the years of research and planning that had been necessary to build and launch the Columbia, thrusting it into space and safely returning it to earth. Had anyone watching the Columbia during her flight declared that the whole project was the result of blind chance, he would have been labeled insane.

As we look at the heavens and realize that the numberless stars above are guided in their assigned orbits with such precision that astronomers can predict the exact location of each heavenly body years into the future, we begin to realize that a Master Intelligence obviously has been involved with the design, creation, and control of the complex universe in which we live.

A Dose Of Faith

That Master Designer is God!

Let’s find our more about Him. Where should we start in this search for the handiwork of God? Let’s see what the Psalmist had to say about the way man was created: “I will praise You, for I am fearfully and wonderfully made; Marvelous are Your works.” (Psalm 139:14).

The design of the human body demands the existence of a Designer. Have you ever wondered about all that is involved in the simple act of seeing? Scientists tell us that the delicate engineering of the eye’s cornea and lens make the most advanced camera seem like child’s toy by comparison. The tiny rods and cones in the eye change light into electro-chemical impulses through processes even the most sophisticated laboratory can’t reproduce.

Brain cells transform these electrical impulses into the miracle of seeing-something no high-tech computer can come close to doing. Darwin once stated that the thought of the eye, and how it could possibly be produced by natural selection, made him ill. And here’s why: The human eye could not have evolved over long periods of time, because it is absolutely useless unless complete.

The lens, which focuses light, would be useless without the retina, which senses light. Vision involves a complete system of organs, all interrelated, all thoroughly designed. That’s the way the human body is.

All parts perform incredibly complicated tasks. No wonder the Psalmist said we are fear-fully and wonderfully made! You probably remember what God had to say about the origin of man: “… Let Us make man in Our image, according to Our likeness.” (Genesis 1:26). It was an all-wise, caring God who gave man those two eyes to help him in seeing the wonders of His Creator. Adam and Eve did not just evolve or just happen. The Bible states that God designed our bodies in His image. He is the Great Engineering Intelligence who designed us and then brought us into being!

Man is very complicated and could only have been designed by a very wise Designer.

Please follow this series and be filled with more wisdom about creation. This will strengthen your faith in God, the creator. May the Lord bless you!

For comments, write me at chardgrace@yahoo.com

CME NUGGETS – December 2013


ED SUSMANPharmacists Help Keep Patients on Medication

BY ED SUSMAN

DALLAS, TEXAS – Empowering pharmacists to take an active role in maintaining adherence to prescribed medicine appears to improve the likelihood that patients will take more that 80 percent of the drugs the doctor orders.

Researchers here at the annual Scientific Sessions of the American Heart Association reported that of 122 patients assigned to enhanced intervention, 89.3 percent were adherent compared with 73.9 percent of the 119 patients in the usual care group (P =0.003).

P. Michael Ho, MD, PhD, assistant professor of medicine at the University of Colorado/ VA Medical Center, Denver, also reported that patients on the interventional study were: –More adherent to clopidogrel: 86.8 percent versus 70.7 percent in the usual care group (P=0.03).

–More adherent to statins: 93.2 percent versus 71.3 percent in the usual care group (P <0.001).

–More adherent to angiotensin converting enzyme inhibitors (ACE) of angiotensin receptor blockers: 93.1 percent versus 81.7 percent for those in usual care.

–But no differences were seen in adherence to beta blockers, with 88.1 percent of those in the intervention taking more than 80 percent of their medication over the course of a year, compared with 84.8 percent (P =0.59) of those on usual care.

–There were no statistically significant differences in the proportion of patients who achieved blood pressure goals or low density lipoprotein cholesterol goals, the researchers said.

The intervention comprised pharmacist-led medication reconciliation and tailoring, patient education, collaborative care involving pharmacists, and automated telephone voice messaging calls which offered education and refill reminders, Dr. Ho said.

The researchers sought to determine the proportion of patients who would be adherent to medication regimens based on a mean proportion of days covered greater 80 percent in the year after hospital discharge using pharmacy refill data.

Ho and colleagues conducted the study at Veterans Affairs medical centers in Denver; Little Rock, Ark.; Seattle and Durham, N.C. They were recruited from Sept. 1, 2010 through July 1, 2011. All the patients were admitted to the hospitals with acute coronary syndrome events, and visited VA hospitals for their usual treatment care.

CME NUGGETS 1

In the intervention group, a pharmacist met with patients within 10 days of discharge at an in-person clinic visit or via telephone call to address medication problems or adverse effects and reconciled differences in medications between the pre-hospital and post-discharge regimens. The pharmacist also provided patients with a pill box and instructed the patient on how to fill the pill box. One month later, the pharmacist called the patient to assess any interim new medications as well as adverse effects to medications and/or adherence issues.

Patients also received education about medications at the point of hospital discharge but also continued to receive education by the study pharmacist following hospital discharge to ensure retention of the information. This education session was performed at the 1-week and 1-month visit following discharge.

Additionally, the pharmacist notified the patient’s primary care clinician and/or cardiologist that the patient was enrolled in the adherence intervention by having them cosign the pharmacists’ initial enrolment note in the computerized medical record.

The voice messaging system contacted patients at regularly scheduled intervals. The medication reminder calls and medical refill calls for the first 6 months of the intervention. They received refill reminders for the last 6 months.

“We demonstrated an improvement in adherence to cardioprotective medications after acute coronary syndrome hospital discharge with use of a multifaceted intervention but not a change in low density lipoprotein cholesterol of blood pressure levels,” Ho wrote in the journal paper.

“Additional studies are needed to understand the impact of the magnitude of adherence improvement shown in our study on clinical outcomes prior to broader dissemination of such an adherence program.”

Social networks

In another study, researchers detailed how harnessing the power of social networks – group of 2-6 people called “microclinic” – in resource poor settings can improve overall health.

In rural Kentucky, people engaged in the microclinics reduced their weight an average of 6.89 pounds over the course of a 45 week program compared with an decrease of 0.69 pounds in the control group (P<0.001), reported Eric Ding, Sc.D., research scientist at the Harvard School of Public Health, Boston.

In his late-breaker presentation, Dr. Ding also reported that the weight loss was maintained out to 16 months – an average 5.87 pound decrease compared to a 1.24 pound decrease among controls (P<0.001) – even after interventions had ceased.

“The Microclinic Social Network Behavioral Health Program lifestyle intervention may be effective for obesity, waist circumference, blood pressure and glycemic control in resource limited settings,” Ding reported. “As the first randomized trial designed to harness social network effects, results support the promise of leveraging social networks to propagate health.”

In the trial, researchers randomized 301 individuals who were member of existing family or social networks and provided them with health related classes and activities; a second group of 193 individuals were given standard health department information on improving lifestyle. Eventually 297 people in 121 microclinic units participated in the interventional group and 192 people in 93 microclinic units were counted in the control group.

The participants were almost all women – 91.5 percent and were about 51 years of age. The participants had a mean body mass index of 36.2 kg/m2. Participants had to have been overweight or had at least one metabolic risk factor for eligibility.

While the intervention group received specialist sessions with various health care providers, they and other community members were also able to attend cooking classes, family fitness fair, health holiday planning and other activities, Dr. Ding said. The classes for the intervention group were conducted once a week for the first month and then biweekly through the end of the 10 month intervention period.

CME NUGGETS 2

In addition to the weight loss, he said that the interventional group also did well in other areas:

Waist circumference was reduced 3.19 inches among the intervention group compared with 1.87 inches in the controls (P<0.001) after 45 weeks. The difference after 16 months was muted, a reduction of 1.27 inches from baseline among those who had the intervention and a reduction of 0.13 inches in the controls (P=ns).

Systolic blood pressure was reduced an average of 5.29 mm Hg after 45 weeks in the intervention groups compared with a reduction of 0.97 mm Hg in the control (P<0.001), and that significant difference was maintained out to 16 months even though interventions had been discontinued, with the intervention group still showing a drop in blood pressure of 3.75 mmHg, while controls had an increase of systolic blood pressure of 6.78 mmHg.

Proportional HbA1c decreased 0.99 percent at 30-34 weeks in the intervention group compared with an increase of 0.89 percent in the controls (P=0.03), although by 45 weeks the difference was not significant – a reduction of 1.21 percent in the intervention group and an increase of 0.09 percent in the controls.

After 16 months, the HBA1c in the intervention groups was decreased an average of 2.34% and the control group recorded a decrease of 1.40 percent — that difference was not significant.

No significant differences were observed between the two groups for increases in high density lipoprotein – the so-called ‘good’ – cholesterol.

Drug fails to help

Finding ways to get people to take proven medication and positively change their lifestyle remains an important treatment paradigm because numerous attempts to find medications at this year’s meeting often failed.

For example, treatment with intravenous sodium nitrite just prior to heart attack therapy did not reduce the size of the infarct by reducing reperfusion injury, researchers said here.

The eff ect size of the infarct at 6-8 days as measured by cardiac magnetic resonance imaging was -0.7 percent (95% CI -2.2 to 0.7, P=0.34) among patients treated with sodium nitrite compared with patients receiving placebo, reported Nishat Siddiqi, MD, clinical research fellow at the University of Aberdeen, Scotland, in her late-breaker press briefing.

“We found no differences between the group in the secondary endpoint – infarct size at 6 months, or in several pre-specified and ad hoc endpoints,” she said. “The treatment outcome curves virtually overlapped.”

“We know that prompt reperfusion during a heart attack saves cardiac muscle,” Dr. Siddiqi said. “However, we also know that, paradoxically, the restoration of blood fl ow to the ischemic myocardium causes further damage. This reperfusion injury can account to up to 50% of your final infarct size.”

Noting that sodium nitrite appeared to reduce reperfusion injury in animal models, she and colleagues randomized 280 patients into two groups – one receiving a dose of 70 micromoles of sodium nitrite in a 5-mol saline solution just before reperfusion attempts and one group who did not receive the drug.

But the drug failed to live up to its promise when used in human subjects, she said.

December 2013


H&L June FINAL cover.indd

The Season of Giving, Sharing and Sacrificing

With the recent series of natural calamities affecting millions of our countrymen, the real spirit of Christmas has come to the fore, with everyone trying to do his or her share to alleviate the sufferings of our fellow Filipinos, whose future has been made uncertain with the devastation they had experienced. All over the city, we see instances of this culture of giving, sharing and sacrificing especially as Christmas approaches—doctors and nurses joining medical missions, establishments giving a portion of their profits to the relief efforts in Visayas; companies foregoing their annual Christmas parties to donate to the earthquake victims in Bohol and the typhoon survivors in Tacloban and other areas. The international community has also shown the genuine spirit of ‘brotherhood among nations’, showing how it is to be our ‘brother’s keeper’.

All of these happening at this time of the year are probably just coincidental. But it is, in no small part, a true Christmas miracle.

Cover photo courtesy of Jose Martin Punzalan

November 2013


H&L June FINAL cover.indd

Typhoon Yolanda: The Aftermath

A few weeks have passed and Filipinos are still reeling from the devastation wrought by Typhoon Yolanda. It’s heartening to note that generosity knows no bounds in times of need—evident in the outpouring of sympathy and support—with the national government, the private sector, and the international community doing what they can to help our countrymen in dire need of assistance in the Visayas and other places ravaged by the super typhoon.

‘Yolanda’ was indeed an unparalleled disaster. But there are important lessons that could be learned. And as we empathize with the typhoon victims, it would be good to know and feel what it was like to be smack-dab in the eye of the storm (considered as one of the worst in recent decades) and be grateful one came out of it alive to tell the story.

There are no more piles of anonymous dead bodies along the highway, relief efforts are well in place, and sights are now set on the road to recovery for victims of the typhoon. We dedicate H&L to that battle, as a tribute to the resiliency and strength of the Filipino spirit.

Cover photo courtesy of Jose Martin Punzalan

LAST CALL – November 2013


javier-pic22Fates and Faiths

By Saturnino P. Javier, MD, FPcP, FPcc, Facc

There is a certain unease that creeps over me in the aftermath of the 7.2 Magnitude earthquake that hit Bohol and nearby provinces and destroyed lives, limbs and properties. Something just does not seem right when there is a pervasive sense of relief and gratitude that engulfs many of those living in Metro Manila as they heave a collective sigh —“What a relief it did not happen in Manila!” Or something like—“Thank God, it spared Metro Manila!”

The remarks may seem selfish, or even un-Christian. Yet, realistically though ironically, it must be a common reaction among us in the city.

I certainly understand the reason where the sense of gratefulness is coming from. However, it does not seem right that we thank God that the quake hit Bohol and it spared us and the city. Or that it killed Boholanos and spared Metro Manilans. Or that it was all right for a quake to hit any city elsewhere, just not ours. When we thank God, it seems like God is a punitive and mer-By Saturnino P. Javier, MD, FPcP, FPcc, Faccciless Being who selectively imposes devastation and death on some places and people.

When the dust settled down after the quake, hundreds died and damage ran up to billions. In the aftermath, Bohol and nearby provinces dealt with personal losses. Many must have been traumatized and scarred – mentally, emotionally and physically.

Equally painful, if not worse, the province suffered indescribable cultural and historical losses. Many historical landmarks – especially places of worship in Loboc, Baclayon, Maribojoc, Loay, Dauis and Loon – were either levelled to the ground or destroyed beyond recognition. The full glory and magnificence of those centuries-old churches were lost. For many Boholanos and the others who had the privilege of seeing those churches up close and personal, the grandeur and stature of those places would just be etched in the collective imagination of all those blessed with seeing them before.

Countless poignant images surfaced after the quake. There was an iconic Madonna and Child statue standing tall as a mute witness amid the pile of rubble from the 180-year-old Our Lady of Light Parish Church in Loon, Bohol. Another statue of the Virgin Mary stood unscathed at the Santa Cruz Parish Church in Maribojoc, also in Bohol. On television, there was the repeated showing of the Santo Nino in the Cebu Cathedral where the bell tower collapsed.

Likewise, there were the many images of earthquake survivors leaving behind all their belongings and just holding on to their Santo Nino’s, Nazareno’s and Virgin Mary’s, clutching their crucifi xes, embracing their faiths and clinging on to what seemed like their last vestiges of hope.

Amidst the wreckage, the chaos and the devastation, the devoutly Catholic Filipino communities stood strong and unperturbed, turning (or returning) to their faith, showing all the world that the indomitable Filipino spirit will triumph and prevail – with God’s merciful assistance and divine intervention.

Alas, something seemed to have been lost in the media reporting, or downplayed in the chronicling of events even if a few have alluded to it. The fact is that what saved a lot of lives was that the day was a national holiday – where most students and employees were not in the schools or offi ces respectively.

What needs to be underscored is that quite interestingly, it was a Moslem holiday—the Eid al-Adha—that seemingly spared a number of Christian lives. In the interweaving of lives, fates and faiths, an important and significant day of the Moslem faith kept a number of Catholic lives from being lost in the powerful quake.

Last CallHow do we put all these therefore– without being sacrilegious or blasphemous? Worship for Allah spared the lives of many worshippers of Christ? A day of sacrifice in the Moslem faith ushered unspeakable sacrifices and hardships among the Catholics?

When fates and faiths intertwine, there are rich symbolisms, deep connections or undefined ironies that may be fully hard to comprehend, or even accept. It leaves us all with the singular appreciation that when all else is lost or gone, we turn to Someone to pull us through.

For comments, spjavier2958@yahoo.com

A Dose of Faith – November 2013


pastor-mendozaWhen A Man Dies

By Richard G. Mendoza, MPH, PhD

Those who came back to life told stories about what happened when they were dead. But they did not really die! They went through what is called a “Near Death Experience”.

An online encyclopedia explains that “a near-death experience (NDE) refers to personal experiences associated with impending death, encompassing multiple possible sensations including detachment from the body, feelings of levitation, total serenity, security, warmth, the experience of absolute dissolution, and the presence of a light. These phenomena are usually reported after an individual has been pronounced clinically dead or very close to death.”

What happens when a man dies? Does he go straight to heaven, to hell or to some other place? In the Bible, God told Adam after the fall in Genesis 3:18,19: “In the sweat of your face you shall eat bread till you return to the ground, for out of it you were taken; For dust you are, and to dust you shall return.”

A Dose of Faith

Here is the key to understanding what death is all about and what God intends to do to save us from eternal separation from Him. The Bible says that man would return to the dust from which he was taken. Notice how Adam was created by God: “And the Lord God formed man from the dust of the ground, and breathed into his nostrils the breath of life; and man became a living beHere is the key to understanding what death is all about and what God intends to do to save us from eternal separation from Him. The Bible says that man would return to the dust from which he was taken. Notice how Adam was created by God: “And the Lord God formed man from the dust of the ground, and breathed into his nostrils the breath of life; and man became a living being.” (Genesis 2:7)

God took the elements of the earth and made a body for man. But man, at that point was only a corpse. It took something more to make him a living being. It says here that God breathed into Adam’s nostrils the breath of life and man became a living soul.

Consider an equation like this:[Body + Breath = A Living Soul] or in death we might write

[Body - Breath = Corpse]. That is what the Wise man said in Ecclesiastes,

“Then the dust will return to the earth as it was, and the spirit will return to God who gave it,” (Ecclesiastes 12:7). Job also adds: “As long as my breath is in me, and the breath of God in my nostrils, my lips will not speak wickedness.” (Job 27: 3)

It is clear that in death, the body returns to dust and the spirit, also translated as breath of life, returns to God. Note that the word spirit is in small letter and is therefore not referring to the Holy Spirit, the third person of the Godhead. This spirit refers to what was breathed by God to the dust, to make it a living person. The breath of life is different from the oxygen given to patients in hospitals that won’t give life to a dead man; it only comes from God, the source of life.

Let’s take a look at another text.“Do not put your trust in princes, nor in a son of man, in whom there is no help. His spirit departs, he returns to his earth; in that very day his plans perish,” (Psalm 146:3,4). King David introduces something new here. He says that when the breath leaves the body and it returns to the earth that the conscience part of man or his thoughts perish! This harmonizes with what Solomon said: “For the living know that they will die; but the dead know nothing, and they have no more reward , also their love, their hatred, and their envy have now perished.” (Ecclesiastes 9:5,6) He knows nothing! This is in keeping with what the psalmist wrote, that the dead are not in heaven praising God.

Then where are they, you will ask. David makes it quite clear: “The dead do not praise the Lord, nor any who go down into silence.” (Psalm 15:17) “But man dies and is laid away; indeed he breathes his last and where is he? So man lies down and does not rise, till the heavens are no more, they will not awake nor be roused from their sleep. For the memory of them is forgotten.” Here we have it from God’s own Word that man dies and lies down in the grave and does not rise until the resurrection day. The dead do not roam around as ghosts either, they are there at the cemetery! The breath of life also returns to God, does not roam around and it’s not a personality that is able to speak and think.

You will notice that Job used the term sleep in talking about death. That’s the same thing that other Bible writers say. David wrote: “Consider and hear me, O Lord my God; enlighten my eyes, lest I sleep the sleep of death.” (Psalm 13:3) David was afraid of sleeping the sleep of death, he wanted to live! Daniel tells about the dead who will be raised just before the coming of Christ: “And, many of those who sleep in the dust of the earth shall awake, some to everlasting life, some to shame and everlasting contempt.” (Daniel 12: 2)

One of the most comforting truths in God’s Word is that when a person dies he or she rest quietly, undisturbed by the problems of life until the call of the Life giver. Is it any wonder that the Bible likens death to a sleep? The prophet Nathan told King David what would happen to him his time to die would come.“When thy days be fulfilled,… thou shalt sleep with thy fathers.” (2 Samuel 7:12) Jesus Himself called death a sleep. He used the same descriptive term to describe the death of His dear friend, Lazarus (read the story in John 11).

This is the message of comfort that the apostle Paul shared with the early Christians: “But I do not want you to be ignorant, brethren, concerning those who have fallen asleep, lest you sorrow as others who have no hope!” (1 Thessalonians 4:13)

Paul tells us what Jesus will do when He comes the second time: “For the Lord Himself will descend from heaven with a shout, with the voice of an archangel, and with the trumpet of God. And the dead in Christ will rise first.” (1 Thessalonians 4:16)

Paul describes in detail the events that will occur when Jesus comes:

“Behold, I tell you a mystery: We shall not all sleep, but we shall all be changed —in a moment, in the twinkling of an eye, at the last trumpet. For the trumpet will sound and the dead will be raised incorruptible, and we shall be changed.” (1 Corinthians 15:51,52)

Jesus had told the disciples that all would be raised from the grave.“Do not marvel at this; for the hour is coming in which all who are in the graves will hear his voice and come forth —-those who have done good, to the resurrection of life, and those who have done evil, to the resurrection of condemnation.” (John 5:28,29)

What about those who are still alive? “Then we who are alive and remain shall be caught up together with them in the clouds to meet the Lord in the air. And thus we shall always be with the Lord.” (1 Thessalonians 4:17)

Try to analyze, if people went to either heaven or hell at death, why would there be any need for the resurrection of either the righteous or unrighteous?

Why would Jesus make this statement as He comes back the second time?

Stories told by those who went through near death experiences and were revived are therefore untrue. Science and medicine attributed those experiences as products of hallucinations when the dying lacks oxygen (hypoxia) on the brain or when there were surges of electrical impulses on the brain during NDE, but this is another subject matter to be discussed.

Remember we will die in this sinful world, but our hope lies in Jesus who says: “I am the resurrection and the life. He who believes in Me, though he may die, he shall live.” (John 11:25)

For comments, write me at chardgrace@yahoo.com

CME NUGGETS – November 2013


ED SUSMANGains Made in Treating Hepatitis C Virus

BY ED SUSMAN

WASHINGTON, DC – More than 10,000 doctors and allied health care professionals gathered here to learn about new advances – especially in the treatment of Hepatitis C Virus — at the 64th meeting of the American Association for the Study of Liver Diseases.

An investigational three drug oral combination that avoids the use of both interferon and ribavirin – two treatments associated with intolerable side effects in many people – appears to allow a high percentage of hepatitis C virus infected patients to achieve a sustained virologic response.

The 12-week sustained virologic response – akin to remission from the infection – was reached by 92.2 percent of patients treated with daclatasvir plus asunaprevir and a 75 mg twice daily dose of BMS-791325, a new nonnucleoside agent, said Gregory Everson, MD, professor of medicine at the University of Colorado Anschutz Medical Campus, Aurora.

He also said that a 12-week sustained virologic response was achieved by 91.7 percent of patients on the regimen that used a 150 mg twice daily dose of BMS- 791325.

In his late-breaker oral presentation, Dr. Everson said the efficacy of the treatment was observed in cirrhotic patients and in non-cirrhotic patients; in patients with Genotype 1a and in Genotype 1b and in patients with favorable and unfavorable genetics.

“This was a well-tolerated regimen with low rates of adverse events and treatment discontinuation, regardless of the dose of BMS-791325,” he said. There were three serious adverse events – one among the 80 patients on the low dose regimen; two among the 86 patients on the high dose, he said.

The treatment course was 12 weeks, followed by a 12 week observation period to determine if a sustained virologic response had been achieved.

In the Phase 2b trial, researchers enrolled treatment naïve patients, stratified by genotype 1a of genotype 1b and by presence of biopsy confirmed cirrhosis. About10 percent of cirrhotics were assigned to each group. The primary endpoint was sustained virologic response at 12 weeks by achieving the lower limit of assay quantification.

“The results in this trial look promising,” said Michael Fried, MD, director of the University of North Carolina Liver Center, Chapel Hill. “But this was a Phase 2b trial. We have to see what happens in the Phase 3 studies.”

In the study, researchers enrolled a predominantly male cohort (67 percent) who had a median age of 54 years. About 83 percent of the cohort was white; black or African Americans accounted for 16 percent of the group. About 82 percent of the patients were infected with hepatitis C virus genotype 1a. About 9 percent of the patients – 15 individuals – were diagnosed with cirrhosis.

HIV co-infection

In another study, researchers said that combination therapy to treat patients co-infected with HIV and Hepatitis C Virus can achieve a high percentage of virological end-of-treatment response to the hepatitis infection without aff ecting control of the HIV, the virus that causes AIDS.

At 48 weeks, 83 percent of patients had a sustained response to hepatitis infection with the combination of telaprevir plus pegylated interferon and ribavirin, and maintained suppression of HIV to less than 50 copies/ml, said Laurent Cotte, MD, coordinator of the study for the French National Agency for Research (ANRS), and a physician at Centre Hospitalier Universitaire de Lyon.

Dr. Cotte said more than half the patients with HIV in France are co-infected with Hepatitis C Virus making this population of patients difficult to treat.

“Despite a high discontinuation rate related to toxicity (20.3 percent), a very high virological response rate was achieved at Week 48 with the combination therapy in patients who were already experienced with pegylatedribavirin HIV co-infected patients,” Dr. Cotte said at his poster presentation.

The researchers began dosing a cohort of 69 patients. He said 8 patients discontinued treatment before 16 weeks due to adverse events; 10 patients discontinued between 16 weeks and the end of the study. At Week 16, 88 percent of the patients in the intention-to-treat analysis had achieved a virologic response to the telaprevir-based combination. By the end of the study, 83 percent of the intention-to-treat population had maintained that virological response, he said. Dr. Cotte noted that the patients are being followed to determine if they can sustain that response and, in effect, cure the patient of the hepatitis C infection.

All the patients were treated with highly active anti-retroviral therapy and had controlled their HIV to undetectable levels using the 50-copies/ml assay.

CME NUGGETS - Gains Made in Treating Hepatitis C Virus

Dr. Cotta acknowledged the sweeping advances being made in treatment for Hepatitis C Virus, noting that pegylated interferon and ribavirin may soon be obsolete drugs. “When we started this study, this was the standard of care treatment,” he said. “But even with these newer regimens, this study will be the set point that shows what we will need for this population. It shows that these patients can be treated effectively.”

“We had a very good sustained virological response – 83 percent of the patients achieving that by week 48. We also had significant adverse events, notable anemia, the need for erythropoietin, the need for blood transfusion and reduction in ribavirin dosing. Over the course of 48 weeks, about 70 percent of patients experienced those Grade 3 or Grade 4 events.

Babies fine with tenofovir

Pregnant women being treated for Hepatitis B Virus infections with the nucleotide inhibitor tenofovir appear to avoid mother-to-child transmission of the pathogen to their children. Of the 14 pregnancies followed through to delivery, no birth defects were observed even among the 12 women who took tenofovir throughout the pregnancy – including the first trimester, said Christiane Stern, MD, senior medical scientist for Gilead Sciences, Boulogne, France, who presented the poster on behalf of a consortium of French doctors and hospitals who participated in the VIREAL study.

“In a Hepatitis B Virus real-life cohort, tenofovir treatment during pregnancy was well tolerated, including in patients treated from the first trimester,” Dr. Stern said. “No safety issues were reported for breast-feeding while on tenofovir up to 1 year.” She said five women reported breast-feeding, including three women taking tenofovir.

The researchers from three dozen hospitals in France recruited 441 chronic hepatitis B patients who were treated with tenofovir from June 2008 to April 2010. There were 16 pregnancies in the study cohort, 14 of which there was enough follow-up data for analysis. In 11 of the 14 cases women were on tenofovir throughout the pregnancy; in one case treatment with tenofovir was commenced at four weeks of gestation. The other two cases involved women whose high level of hepatitis B status was discovered late in pregnancy were given tenofovir after 20 weeks and 30 weeks to prevent mother-to-child transmission.

“As clinicians, this is information that we need to tell our patients,” Alexander Lalos, MD, a private practice gastroenterologist and a member of the adjunct faculty of Commonwealth Medical College, Scranton, Penn. “Many women want to know if it is safe to take certain medications while they are pregnant. Now we can say that there is a study which shows that it is safe.”

Dr. Lalos said that preventing mother-to-child transmission of Hepatitis B Virus is crucial in breaking the cycle in which women pass on infection to their children, creating chronic infection which can then be passed on to others. “About 10 percent of mothers with hepatitis B virus infection transmit the virus to their newborns if they are not treated,” he said.

Dr. Stern noted that the all but two of the babies were full term – 37 weeks of greater; One child was born at 34 weeks and one at 35 weeks. There were two Caesarean deliveries. In 11 cases where Apgar scores were recorded, all received scores of 10 at 10 minutes.

“Mother-to-child transmission is one of the main routes of Hepatitis B Virus transmission and the risk of transmission increases if the pregnant women has virus DNA greater than 6-7 log IU/ml at delivery,” she said. “Antiviral therapy given during the last trimester of pregnancy, in association with serovaccination of the newborn, can reduce the risk of mother-to-child transmission. However, tenofovir use from the first trimester had not been well-documented in patients with hepatitis B virus monoinfection.”

LIFE’s LESSON – November 2013


tacio-picAT YOUR SERVICE

By Henrylito D. Tacio

“The best way to find yourself is to lose yourself in the service of others,” said Mahatma Gandhi, the preeminent leader of Indian nationalism in British-ruled India. “The successful man doesn’t use others, other people use the successful man, for above all the success is of service,” noted American writer Mark Caine.

American poet Emily Dickinson has penned some lines about service: “If I can stop one heart from breaking, I shall not live in vain,” she wrote. “If I can ease one life the aching, or cool one pain, or help one fainting robin unto his nest again, I shall not live in vain.”

In 1908, Eugene V. Debs delivered one of the most eloquent speeches. “Now my friends,” he said, “I am opposed to the system of society in which we live today, not because I lack the natural equipment to do for myself but because I am not satisfied to make myself comfortable knowing that there are thousands of my fellow men who suffer for the barest necessities of life.

“We were taught under the old ethic that man’s business on this earth was to look out for himself. That was the ethic of the jungle; the ethic of the wild beast. Take care of yourself, no matter what may become of your fellow man.

“Thousands of years ago the question was asked; ‘Am I my brother’s keeper?’ That question has never yet been answered in a way that is satisfactory to civilized society.”

Life’s LessoNs

The American union leader, one of the founding members of the Industrial Workers of the World, continued his speech: “Yes, I am my brother’s keeper. I am under a moral obligation to him that is inspired, not by any maudlin sentimentality but by the higher duty I owe myself. What would you think me if I were capable of seating myself at a table and gorging myself with food and saw about me the children of my fellow beings starving to death.”

“Giving kids clothes and food is one thing but it’s much more important to teach them that other people besides themselves are important, and that the best thing they can do with their lives is to use them in the service of other people,” said Dolores Huerta, a labor leader and civil rights activist.

Hannah More, an English religious writer and philanthropist, says that even a smallest act you do is a great service to the person who receives it. “One kernel is felt in a hogshead; one drop of water helps to swell the ocean; a spark of fire help to give light to the world. None are too small, too feeble, too poor to be of service. Think of this and act,” she points out.

When you serve others, do it with open heart and gladness. A businesswoman stopped at a coffee shop and ordered a cup of coffee. The waitress grudgingly delivered it and asked, “Anything else?”

“Yes,” said the businesswoman. “I’d like some sugar, cream, a spoon, a napkin, and a saucer for the cup.”

“Well, aren’t you the demanding one,” snapped the waitress.

“Look at it from my point of view,” said the businesswoman. “You served a cup of coff ee and made fi ve mistakes.”

Just want kind of service did the waitress render?

Compare the above story with this one related by Fulton Oursler. This has been told many times so might have heard or read it somewhere. This illustrates that in some instances the service you may render to others may bring you to a higher position in life.

One stormy night, an elderly man and his wife entered the lobby of a small hotel in Philadelphia. The couple had no baggage.

“We know that all the places are filled up,” said the man. “But can you possibly give us a room here?”

The clerk replied that there were three conventions in town, and there are no more accommodations anywhere.

“Every guest room is taken,” he explained. “But still I simply can’t send a nice couple like you out into the rain at one o’clock in the morning. Would you perhaps be willing to sleep in my room? Oh, I’ll make out just fi ne; don’t worry about me.”

The next morning, as he paid his bill, the elderly man said to the clerk: “You are the kind of manager who should be the boss of the best hotel in the United States. Maybe someday I’ll build one for you!”

The clerk laughed. And he laughed again when, after two years had passed, he received a letter containing a round-trip ticket to New York and a request that he called upon his guest of that rainy night.

In the metropolis, the old man led the young clerk to the corner of Fifth Avenue and Thirty-Fourth Street and pointed to a vast new building there, a palace of reddish stone, with turrets and watchtowers, like a castle from fairyland cleaving the New York sky. “That,” the declared, “is the hotel I have just built for you to manage.”

As if hit by lightning, the young man, George C. Boldt, stood fixed to the ground. His benefactor was William Waldorf Astor and the hotel, the most famous of its day, the original Waldorf-Astoria.

Nathan C. Scheaffer asks: “At the close of life, the question will be not how much have you got but how much have you given? Not how much have you won but how much have you done? Not how much have you saved but how much have you sacrifi ced? It will be how much have you loved and served, not how much were you honored?”

For comments, write me at henrytacio@gmail.com