Sex: Male
Education:

• Interventional Bronchoscopy (transbronchial needle aspiration biopsy), Hospital Torette, Ancona Italy, 2005
• Postgraduate Research Training, Kyoto School of Medicine, Kyoto University, 2004
• Fellowship Training Pulmonary Medicine, Veterans Memorial Medical Center, 2001
• Residency, Iloilo Mission Hospital, 1999
• Doctor of Medicine, West Visayas State University, 1994
• Bachelor of Science in Medical Technology, Southwestern University, 1989

Field of Specialization
Internal Medicine
Pulmonary Medicine
Interventional Bronchoscopy

Researches:

Article title: Emergence of Candida famata Fungemia in an Immunocompromised Patient: A Case Report Highlighting Clinical Presentation, Diagnosis, and Therapeutic Strategy
Authors: Rollin P Tabuena, Shaira S. Arinzol, Ma. Daisy P. Tabuena,  Lysa Lynn U. Libanan
Publication title: Philippine Journal of Chest Diseases 22(2), 2024

Abstract:

Candida famata, once regarded as benign, is now being recognized as an opportunistic pathogen. This case presents an 88-year-old male with multiple comorbidities who developed C. famata bloodstream infection during treatment for healthcare-associated pneumonia complicated by prolonged catheter use and hospital stay. Antifungal therapy with voriconazole led to clinical improvement and eventual discharge of the patient in stable condition. The rarity of C. famata infection presents diagnostic and therapeutic challenges. This case highlights the importance of timely antifungal therapy and a multidisciplinary approach in managing invasive candidiasis, particularly in immunocompromised patients. Further research is needed to optimize treatment.

Article title: Evaluation of loop-mediated isothermal amplification test kit (TB Lamp) for the diagnosis of pulmonary tuberculosis in a tertiary hospital in Iloilo City: Retrospective Study
Authors: Rollin P Tabuena, Jiggy Leonard F. Landong, Ma. Daisy P. Tabuena, Earl Joshua G. Alcantara and Ma. Theresa Crisanta L. Anayan
Publication title: Chest Infections 164(4), Supplement October 2023

Article title: Ataxia with vitamin E deficiency in the Philippines : A case report of two siblings
Authors: Ma Daisy Tabuena, Ryoma Morigaki, Ryosuke Miyamoto, Hideo Mure, Nobuaki Yamamoto, Kazuhisa Miyake, Taku Matsuda, Yuishin Izumi, Yasushi Takagi, Rollin P Tabuena, Toshitaka Kawarai
Publication title: The Journal of Medical Investigation 68(3.4):400-403, 2021

Abstract:

Article title: Cough triggers and their Pathophysiology in patients with prolonged or chronic cough.
Authors: Hisako Matsumoto, Rollin P Tabuena, Akio Niimi, Hideki Inoue, Isao Ito, Masafumi Yamaguchi, Kojiro Otsuka, Tomoshi Takeda, Tsuyoshi Oguma, Hitoshi Nakaji, Tomoko Tajiri, Toshiyuki Iwata, Tadao Nagasaki, Makiko Jinnai, Hirofumi Matsuoka, Michiaki Mishima
Publication title: Allergology International 61(1):123-32, 2012

Abstract:
Background: The character or timing of chronic cough is considered to be unpredictable for diagnosing its cause. However, the associations of cough triggers with cough pathophysiology remains unknown.

Methods: We developed a closed questionnaire listing 18 triggers that were reported by ≥1% of 213 patients in a retrospective survey. Using this questionnaire, patients with cough-predominant or cough-variant asthma (n = 140) and those with non-asthmatic cough (54) were asked whether their cough was induced by the listed triggers. Associations of triggers with causes of cough, airway sensitivity to inhaled methacholine, exhaled nitric oxide (NO) levels, number of sensitizing allergens, and scores from gastroesophageal reflux (GER) questionnaires were examined. Factor analysis was used to categorize variables, including the 12 most common cough triggers, diagnosis of asthmatic cough, airway sensitivity, and exhaled NO levels.

Results: "Cold air" and "fatigue/stress" induced cough more often in asthmatic coughers than in non-asthmatic coughers. "Spices" and "meals" induced cough more frequently in GER-coughers (n = 19). Patients who marked "cold air" as the trigger were more sensitive to inhaled methacholine and showed higher exhaled NO levels than those who did not mark this trigger. The "post-nasal drip" trigger was associated with elevated exhaled NO levels, and this association was mainly exhibited by patients with cough-predominant asthma. The triggers "pollen" and "mold smell" were associated with a number of sensitizing allergens. The number of triggers was weakly associated with GER scores. By factor analysis, "cold air," "fatigue/stress," asthmatic cough, airway hypersensitivity, and elevated NO levels were categorized into the same factor.

Conclusions: Several cough triggers may reflect the pathophysiology of prolonged or chronic cough.
Full text available upon request to the author

Article title: An Unusual Iatrogenic Foreign Body (Surgical Gauze) in the Trachea.
Authors: Rollin P Tabuena, Lina Zuccatosta, Alberto Tubaldi, Stefano Gasparini
Publication title: Respiration 75(1):105-8, 2008

Abstract:
We report the case of a 60-year-old male with history of surgery for tracheal stenosis 21 years prior to the onset of difficult asthma-like symptoms. Upon exploring the tracheobronchial tree using the fiberoptic bronchoscope, a surgical gauze was found. The foreign body migrated transluminally from the mediastinum into the trachea and its removal was possible with rigid bronchoscopy leading to a rapid recovery of his symptoms.
Full text available upon request to the author

Article title: The relationship of D-Dimer levels with pulmonary thromboembolism
Authors: Navarro III F.J., Tabuena R., Tabuena M.D.
Publication title: Philippine Journal of Internal Medicine 46:7-13, 2008

Abstract:
Background: Pulmonary thromboembolism (PTE) is frequently evaluated in acute care settings. Despite this the clinical diagnosis of PTE is difficult. Results of ventilation-perfusion (V/Q) scans may be inconclusive, pulmonary angiograms (PAGs) are cumbersome, involve risk, and expensive. Therefore, it must be emphasized that in order to improve the diagnostic work-up of patients with suspected PTE, the use of clinical score assessment (wells criteria) and D-dimer testing in routine daily practice could be used as an alternative.
Objectives: This study aims to (1) determine the relationship between D-dimer levels and Well’s criteria its relationship to different risk factors for developing pulmonary thromboembolism and to correlate the d-dimer to patient’s outcomes.
Study Design:
Setting: Iloilo Mission Hospital, a private tertiary hospital in Iloilo City, Philippines
Methodology: Hemodynamically stable patients who are at risk developing pulmonary thromboembolism are requested for D-dimer assay. Rior to the testing physicians completed for the pretest probability of PTE using Well’s Clinical Model, score ,2 points low probability, 2-6 points intermediate probability and >6 points – high probability. Associated co-existing conditions and risk factors were taken into consideration.
Results: A total of 62 patients (mean age of 55 years old, 1:1 male: female ratio) were enrolled. Subjects were then classified as to low, intermediate and high risk for developing pulmonary thromboembolism based on Well’s criteria.
Conclusions: This study showed that the Well’s criteria have a highly significant relationship with D-dimer levels. This means that the higher the Wells criteria and D-dimer level, the higher risk it is for the patient to have pulmonary thromboembolism. This study also showed that high D-dimer levels were associated with increased hospital mortality. The combination of physician’s pretest probability and D-dimer level results in a significant correlation to mortality.
Full text available upon request to the author

Article title: The role of Perilesional Edema on the Outcome of Hypertensive Intracerebral Hemorrhage
Authors: Baylosis, E.J., Tabuena M.D., Tabuena R.
Publication title: Philippine Journal of Internal Medicine 46:1-6, 2008

Abstract:
Background: Intracerebral hemorrhage (ICH) is more than twice as common as subarachnoid hemorrhage (SAH) and is more likely to result in death or major disability than cerebral infarction or SAH, having an advance age and hypertension are the most important risk factors for ICH. ICH occurs more frequently among men than women and is significantly more common among young and middle-aged blacks than whites of similar ages. Though this is the current scenario Asian’s ICH incidence is reported higher than those reported for whites in the United States and Europe.
Objectives Aimed at determining the relationship of perilesional edema’s role on the outcome of hypertensive patients with intracerebral hemorrhage.
Specific Objective: (1) Seeks to determine the difference in the perilesional edema volume and the Glasgow Coma Scale (GCS) score of patients at the emergency room (ER) when grouped according to location of hemorrhage brain. (2) to determine the difference in the edema volume when they are grouped according to deterioration and medical outcome, (3) determine the degree of relationship between edema volume and GCS scores as well as edema volume and ICH volume.
Setting: Iloilo Mission Hospital, a private tertiary hospital in Iloilo City, Philippines
Results: For the difference in edema size and ER GCS scores the results showed no significant difference in the edema size and the GCS score of patients at the ER when they are grouped according to location of bleeding.
Conclusions: This study was able to show that the patients with smaller edema size or volume have a good medical outcome since they have no deterioration compared to those who have a higher edema size or volume which developed early deterioration compared to those who have a higher edema size or volume which developed early deterioration. It also showed that those who have died have significantly bigger edema size/volume that those who have the same neurologic deficits or has developed additional neurologic deficits.
Full text available upon request to the author

Article title: Diagnostic Yield isolate from Bronchoalveolar lavage versus sputum culture: The Iloilo Mission Hospital experience
Authors: Bullas M.B., Capacio M.A., Tabuena R., Tabuena M.D.
Publication title: Philippine Journal of Internal Medicine 46: 63-68, 2008

Abstract:
Objectives To evaluate the usefulness and sensitivity of bronchoalveolar lavage (BAL) as compared to sputum culture for the isolation of specific microorganism among adult patients seen at Iloilo Mission Hospital tertiary hospital in Iloilo City, Philippines.
Setting: Iloilo Mission Hospital, a private tertiary
hospital in Iloilo City, Philippines
This is a retrospective comparative evaluation of culture isolates obtained from sputum and BAL taken from 34 adult patients who underwent bronchoscopy at the Iloilo Mission Hospital from January 2006- September 2007.
Results: Pseudomonas Aeruginosa are the most frequent isolated organism in bronchoalveolar lavage. Majority of the sputum culture revealed no growth of microorganism on final report. Sputum specimens are frequently contaminated by upper respiratory tract bacteria such as Staphylococcus aureus, streptococcus pneumoniae, Haemophilus influenzae, enteric gram-negative bacteria and Candida organisms, which are potential lower respiratory tract pathogens. This study shows that there is a significant increase in the number of patients who were found positive with microbial growth culture isolate using BAL. It was noted that 32 out of 34 patients had positive growth culture on BAL as compared with only 23 out of 34 patients and growth of isolate on sputum culture.
Conclusions: BAL collection provides more definite culture isolate information for characterizing Pseudomonas Aeruginosa infection and growth isolates in which the sputum culture failed to report. This suggests that bronchoscopy specimens are preferable over sputum for the accurate diagnosis of pulmonary infections.
Full text available upon request to the author

Article title: Use of Eosinophil Count In induced Sputum and Blood in Evaluating Airway Inflammation in asthmatic and normal subjects.
Authors: Sarbues M.L., Tabuena R., Tabuena M.D.
Publication title: Philippine Journal of Internal Medicine 46:63-68, 2008

Abstract:

Background: Airway inflammation is considered to be important in asthma but is relatively inaccessible to study. Less invasive methods of obtaining sputum from patients unable to produce it spontaneously should provide a useful investigational tool in asthma.

Objective: To evaluate the value of eosinophil count in induced sputum and blood count of asthmatic patients and normal subjects.

Specific Objectives: (1) to determine the influence of asthma exacerbation with sputum and peripheral eosinophilia, and (2) to determine differences in peripheral and sputum eosinophil count between normal and asthmatic subjects.

Study Design: Prospective-Cohort Study

Setting: The study was conducted at the Iloilo Mission Hospital, a tertiary private hospital in Iloilo City, Philippines.

Methodology: Twenty-eight subjects were included in the study. Fifteen asthmatic patients underwent pulmonary function test, sputum induction and blood sampling. Thirteen normal subjects were evaluated using sputum induction and blood sampling.

Results: Sputum and peripheral eosinophilia between asthmatic patients with and without chest findings of rales and wheeze do not significantly differ. The significant and positive correlation between forced vital capacity and peripheral eosinophilia may suggest
other inflammation or conditions related to asthma such as allergy. Post bronchodilator FEV1 significantly and negatively correlated with sputum eosinophilia. Comparison between eosinophilia markers in induced sputum and blood in asthmatic patients and normal subjects revealed that asthmatic tend to have relatively higher and significant sputum eosinophilia than normal
Conclusions: FEV1 and forced vital capacity were found to correlate with bronchial inflammation. Sputum eosinophilia was relatively higher among asthmatic patients than normal subjects. Hence, induced sputum could be used as a marker for airway inflammation.
Full text available upon request to the author

Article title: C-reaction Protein as a Diagnostic Marker for Community acquired Pneumonia.
Authors: Belosillo-Lindero J. Tabuena R., Tabuena M.D.
Publication title: Philippine Journal of Internal Medicine 46:69-73, 2008

Abstract:

Background:
Over the past century, the physicians view on pneumonia that is inflammatory disease of the lungs with alveolar involvement has undergone several major changes. Emphasis was placed on anatomic location, histopathology and pathogenesis. Recent evidence suggests that cytokine response may be a useful adjunct in diagnosing pneumonia. Acute tissue injury from virtually any cause including infectious diseases will result in rapid increase in the concentrations of several proteins in the serum including C-Reactive Protein (CRP). Several studies have corroborated the role of CRP in the diagnosis of bacterial versus viral meningitis in children and suspected septicemia in neonates. However, its role in the etiological diagnosis of respiratory infections is not well established.

Objectives: This study sought to (1) determine CRP as a diagnosis marker among patients with community acquired pneumonia (CAP), (2) evaluate the CRP levels among patients with CAP, (3) determine the correlation between CRP, WBC count and segmenters, and (4) determine if bacterial isolate significantly influence the level of CRP.
Research Design: Prospective Cohort Study
Setting: Iloilo Mission Hospital, a private tertiary
hospital in Iloilo City, Philippines

Subjects:
A total of forty-one patients 18 years old and above admitted with the diagnosis of CAP from May 1 to November 15, 2004 were included in the study. Expectorated sputum samples were examined and determined suitable for culture if the squamous cells < 5-10/hpf and polymorphonuclear cells > 20- 25/hpf. Serum samples for CRP, WBC and segmenters were obtained within the first 24 hours of admission.
Descriptive statistics were utilized. The statistical tools employed were means, frequency counts, standard deviation; Pearson’s r and serum analysis all set at .05 alpha level of significance.
Results: Fifty eight percent (58%) of these patients were classified as CAP moderate risk. Most were males (68%) and in their middle adult (56%) with mean age of 61. Patients classified as high-risk pneumonia had the highest elevated mean CRP level of 18.87 as compared to patients who were classified as low and moderate risk. Pearsonses r was utilized to determine the relationship between CRP, WBC and segmenters. The p-value of 0.05 showed a positive correlation between CRP and segmenters.

Conclusions: Analysis of the means revealed that Klebsiella pneumonia had the highest CRP mean (89.67). Comparisons of mean CRP by type of bacteria were found not to be significantly different from each other. Hence bacterial isolate does not influence variability of CRP levels.
Full text available upon request to the author

Article title: Cranial CT findings among patients with Transient Ischemic attack (TIA) at Iloilo Mission Hospital.
Authors: Baylosis, E.J., Baria S.M., Tabuena R., Tabuena M.D.
Publication title: Philippine Journal of Internal Medicine 45:7-10, 2007

Abstract:

Background:
Transient ischemic attack is no longer considered a benign event but rather a critical harbinger of impending stroke. Failure to quickly recognize and evaluate this warning sign could mean missing an opportunity to prevent permanent disability or death. There is no reliable way to determine if the abrupt onset of neurologic deficits represents reversible ischemia without subsequent brain damage or if ischemia will result in permanent damage to the brain. Rapid advance in compute tomography (CT) and magnetic resonance imaging (MRI) technology in the last 25 years have contributed significantly to our understanding of the pathophysiology of clinically defined TIAs.

Specific Objective:
This study aims to (1) determine the cranial CT scan finding among TIA patients admitted at Iloilo Mission Hospital for the period of November 2003 – November 2005; (2) determine the common clinical features of patients admitted for TIA;(3) determine the most common risk factors in patients with TIA; (4) to determine the proportion of TIA patients admitted who underwent cranial CT scan

Study Design:
Setting: Iloilo Mission Hospital, a private tertiary hospital in Iloilo City, Philippines

Methodology:
This is a retrospective study of patients admitted with the diagnosis of TIA from November 2003-November 2005. The clinical history and physical examination as well as cranial CT scan findings were noted. Other pertinent data collected include age, gender and co-morbid factors.

Results:
Thirty-seven patients were included in the study, 72.9% of who, were above 60 years old. There were 12 (13.4%) men and 25 (67.6%) women (M:F=1:2:1) Known risk factors that were seen in this series included hypertension (HTN0+ hypercholesterolemia + diabetes mellitus (24.3%) hypercholesterolemia alone (5.4%) no risk factors (5.4%). The most common presenting symptoms were slurred speech, dizziness and hemiparesis. The duration of symptoms noted in patients with TIA were: 6 hours or less in 54.1%, followed by 7-12 hours in 16.2%, 13-18 hours in 13.5% and 19-24 hours in 16.2%. Cranial CT scanned showed abnormalities in 94.1% of TIA patients. There were cerebral and basal ganglia infractions (32.4%) taken with the duration of 6 hours (52.9%). Other findings include cerebellar infarct/ multiple infarct (11.8%) and lacunar infarcts/bifrontal subdural effusion (2%). Two patients had a normal CT scan.
Conclusions:
Cranial Ct scan is advantageous in the diagnosis of TIA because it is easily available and it provides evidence that other substantiates the diagnosis of cerebral/ischemia or suggests an alternative diagnosis. Early CT studies demonstrated non-ischemic etiologies. Most of the TIA occur in less than 6 hours from the onset of symptoms
Full text available upon request to the author

Article title: Efficacy of Tranexamic acid in Reducing the Hematoma size volume with Hypertensive Intracerebral Hemorrhage
Authors: A. Ojacastro, M.D. Tabuena, R. Tabuena
Publication title: International Journal of Stroke 3(Supp): 1i97-198

Abstract:

Background: Intracerebral hemorrhage accounts for 10 to I5% of all strokes. It is the type of stroke with the highest mortality, with a 1-year survival rate of less than 50%. Hematoma volume is a critical determinant of outcome in intracerebral hemorrhage, especially if measured early after the onset of symptoms. Tranexamic acid is a synthetic derivative of the amino acid lysine that exerts its antifibrinolytic effect through the reversible blockade of lysine binding sites on plasminogen molecules.
Objective: This study aims to determine the effect of Tranexamic acid on intracerebral hematoma volume in patients with Hypertensive intracerebral hemorrhage admitted in Iloilo Mission Hospital from January 20 12 to December 20 14. Specifically, it aims to determine and compare the size reduction in hematoma volume and determine if there is a significant difference in the mean hematoma volume among patients with Hypertensive Cerebral Hemorrhage treated with Tranexamic Acid and Standard therapy and standard management alone.

Methodology: This is a retrospective, cross-sectional study conducted among patients admitted to Iloilo Mission Hospital from January 2012 to December 2014 with a diagnosis of intracerebral hemorrhage through a Cranial CT scan. Medical charts of patients 18 years old and above admitted in the said period were reviewed by the Researcher using the exclusion and inclusion criteria. Patients were grouped as those patients given with Tranexamic Acid in addition to the standard therapy and those patients given with the standard management alone.

Results: The data showed the predominance of the male patients, the proportion of which is almost double that of the female patients. The age range is wide from as young as 29 years old to as old as 87 years old. Comparing the difference in pre- and post-treatment hematoma volume within each of the two treatments was done and it can be seen from the data that there is a reduction in the hematoma volume before and after Tranexamic and standard therapy treatment. The difference in the volume is significant as supported by the paired t-test t value of 3.36 1 at p=.005<.0 1 at df 13.

Conclusions: Tranexamic Acid, when added to the standard therapy showed a highly significant reduction in hematoma volume in patients with intracerebral hemorrhage.
Full text available upon request to the author

Article title: Lung Care Foundation of Iloilo Inc. and PCCP Iloilo Chapter, Iloilo City, Philippines. Smoking Prevalence among Grade 4-6 Public elementary Pupils in Iloilo City, Philippines
Authors: R P. Tabuena, D.T. Isidro, S.T. Suresca
Publication title: American Journal of Respiratory and Critical Care Medicine 175:232, 2007

Abstract:
Background: Cigarette smoking continues to be the single most important preventable cause of cancer, heart disease and premature death in many countries and is responsible for approximately five million deaths annually worldwide. The prevalence of adolescent smoking in developing countries is still unacceptably high on the clinical level thus school-based prevention program play an important role in the early prevention of smoking in children and adolescents. To date there are no published studies regarding the smoking prevalence of elementary school pupils in Iloilo City hence this study was conducted.
Materials and Methods: The main participants of this study were the 4974 grades 4-6 elementary pupils from the Iloilo Central School, Jaro Elementary School II, La Paz Elementary School I, Mandurriao Elementary School, Molo 1 Elementary School and Jalandoni Memorial School of the Division of City Schools, City of Iloilo. The Teen smoking survey was translated to Ilonggo version (the native tongue) and was purposedly constructed, validated and reliability tested. Chi-square was used t determine the correlation of demographic variables and risk factors with smoking behavior. A p value of <0.05 was considered significant.
Result: A tool of 500 questionnaires were distributed and 465 were retrieved statistic analysis. The overall smoking prevalence in this study is 3% ( 95%C.I. 1.46.56) among the 465 public elementary school students there were 14 students who were smokers, 4 were current smokers. There was a preponderance of male smokers and all of them were enrolled in the 6th grade level.
Conclusions: the overall prevalence of smoking is 3% there is strong association between smoking behavior ad the male gender, age of 12 years and above, a grade level of students and exposure to smoking parents.
Full text available upon request to the author

Article title: Transbronchial needle aspiration (TBNA) in additional to conventional diagnostic bronchoscopy (CDB) in the diagnosis of submucosal and peri bronchial lesions- Iloilo City
Authors: Tabuena R., Tabuena M.D., Basco J., Navarro F. III
Publication title: European Respiratory Journal 2007

Abstract:

Background: As a method that obtains diagnostic samples from a parabronchial or submucosal lesion, the Transbronchial Needle Aspiration (TBNA) uses needles attached to a catheter and is introduced through a rigid or flexible bronchoscope.

Objectives and Methods:
This prospective study of 42 patients from various tertiary hospital in Iloilo City, Philippines was conducted from January 2004 up to November 2006, aims in determining TBNA’s diagnostic utility using Olympus Gauge 21 Cytology Needle (Olympus NA – 1C-1) in Submucosal and Peribronchial Lesions. Specifically, it compares Conventional Diagnostic Bronchoscopy’s (CDB) (bronchial washing, bronchial brushing and endobronchial forceps biopsy) yield with that obtained from CDB combination and Transbronchial Needle Aspiration (CDB + TBNA) in submucosal and peri bronchial lesions. Transbronchial Needle Aspiration (TBNA) was performed to all patients with a 21-gauge Olympus Cytology Needle (Olympus NA-1C-1) using fiberoptic bronchoscopy. All patients had bronchial washing (BW), bronchial brushing (BB) and endobronchial forceps biopsy (EBB). The statistical tool used was McNemar’s Test using SPSS v 10.0 and set at 0.05 alpha.

Result: The study revealed that there was a significant increase in diagnostic yield with the additional; of TBNA to CDB (CDB=52%; CDB + TBNA = 93%; p value = 0.000). A statistical significance was noted from Submucosal Lesion (SL), (CDB + TBNA = 95%; p value =0.008), as well as in the Peri bronchial Lesion (PL), (CDB= 48%, CDB + TBNA= 90%; = value=0.004).
There was a statistical advantage in performing TBNA in the upper lobes (CDB= 64%; CDB+TBNA= 96%; p value 0.008) compared with other lobes (CDB=53%, CDB+TBNA = 59%; p value = 1.000)

Conclusions: The study’s obtained diagnostic yields affirmed that indeed TBNA is a safe procedure. It increased diagnostic yield in patients with submucosal and per bronchial lesions if performed in addition to CDB compared to CDB alone. Diagnostic utility on the upper lobes significantly increased with the addition of TBNA to Conventional Diagnostic Bronchoscopy (CDB. TBNA as a diagnostic procedure of choice for patients with submucosal and peri bronchial lesions is highly recommended.
Full text available upon request to the author

Article title: Airway wall thickening in Patients with Cough variant asthma and non-asthmatic chronic cough.
Authors: Hisako Matsumoto, Akio Niimi, Rollin P Tabuena, Masaya Takemura, Tetsuya Ueda, Masafumi Yamaguchi, Hirofumi Matsuoka, Makiko Jinnai, Kazuo Chin, Michiaki Mishima
Publication title: Chest 131(4):1042-9, 2007

Abstract:
Background: Chronic cough, which may be of asthmatic or nonasthmatic origin, is an important clinical issue. Airway inflammation, and remodeling demonstrated by subbasement membrane thickening has been associated with cough variant asthma (CVA) as well as with nonasthmatic chronic cough (NAC). CT studies have shown airway wall thickening in patients with asthma who wheeze. We examined airway wall thickness by CT in adult patients with chronic cough and examined its pathophysiologic implication.

Methods: Nonsmoking, steroid-naïve patients with CVA (n = 27), NAC (n = 26), and healthy control subjects (n = 15) were studied. Airway dimensions were assessed by a validated CT technique, in which we measured airway wall area (WA) corrected by body surface area (BSA), the ratio of WA to outer wall area (percentage of wall area [WA%]), absolute wall thickness (T)/ square root BSA, and airway luminal area/BSA of a segmental bronchus. Correlations between CT parameters and clinical indexes such as disease duration and cough sensitivity were examined.

Results: In patients with CVA, WA/BSA, WA%, and T/ square root BSA were all significantly greater than those in control subjects. In patients with NAC, WA/BSA and T/ square root BSA were significantly greater than in control subjects. The increase of WA/BSA and T/ square root BSA of NAC patients was less than that of CVA patients. In a subset of patients with NAC, WA% correlated with capsaicin cough sensitivity (n = 9, r = 0.75, p = 0.034).

Conclusions: Walls of central airways are thickened in patients with CVA, and also to a lesser degree in patients with NAC. Airway wall thickening in NAC may be associated with cough hypersensitivity.
Full text available upon request to the author

Article title: Weaning outcome of Neurological Patients at the ICU of West Visayas State University Medical Center.
Authors: Buyco M., Tabuena R., Tabuena Ma. Daisy
Publication title: European Respiratory Journal 2006

Abstract:
Background: One of the major challenges for the clinician in mechanical ventilation is deciding on the best time to wean the patient because 25-30% of patients failed on the initial attempts at discontinuing mechanical ventilation. This accounted for a disproportionate consumption of health care resources.

Objective: To determine the success rate of weaning among neurological patients on the basis of their Glasgow-Coma-Scale-Score (GCS) and their readiness for discontinuation of ventilatory support. Methodology: This was a prospective cohort study done in WVSUMC, Iloilo, Philippines from January-October 2004. Fifty-three patients were included, twenty-five met the necessary criteria. They were subdivided into: stroke-14 (56%), traumatic brain injury-3 (12%), encephalitis/meningitis-3 (12%), aneurysmal hemorrhage – 3 (12%), global cerebral ischemia – 2 (8%). GCS of >9 had 58.3% weaning success while GCS of <9 had 46.2% (p=0.695). Weaning success is independent of etiology of neurologic deterioration.

Results: Weaning outcome based on age group disclosed no significant difference (p=1.00). As to co-morbidities, 92 % had Pneumonia /PTB 3 (p=0.15) 52% had hypertension (p=0.593); had 12% DM (p=0.48); 8% had hypercholesterolemia (p=1.0); 4% had hyperthyroidism (p=1.0) , 4% had malnutrition (p=0.48) showing no significant outcome difference of weaning based on co-morbidities.

Conclusions: Based on the etiological factors of neurological deterioration, data revealed significant difference (p=0.045) in weaning outcome in patients with encephalitis and GCS 9. However, based on the GCS score alone it was noted that patients with GCS < 9 can be weaned successfully irregardless of the low GCS score.
Full text available upon request to the author

Article title: Prognosis of cough Variant asthma; a retrospective analysis.
Authors: Hisako Matsumoto, Akio Niimi, Masaya Takemura, Tetsuya Ueda, Rollin Tabuena, Masafumi Yamaguchi, Hirofumi Matsuoka, Toyohiro Hirai, Shigeo Muro, Yutaka Ito, Tadashi Mio, Kazuo Chin, Hideki Nishiyama, Michiaki Mishima
Publication title: The Journal of Asthma 43(2):131-5, 2006

Abstract:
Patients with cough variant asthma, a common cause of chronic cough, may develop wheezing. We examined the determinants of this phenomenon and achievement of remission in 42 patients. During 4 years after diagnosis, wheezing developed in 13 of the patients. Early inhaled corticosteroid treatment was inhibitory against the development of wheezing by univariate analysis and by multivariate analysis with an odds ratio of 0.12 (95% confidence interval, 0.02 to 0.87, p = 0.037). Remission was achieved in 7 patients, who were younger than those without remission by univariate analysis (p = 0.048). Early treatment with inhaled corticosteroid may prevent the progression of cough variant asthma to classic asthma.
Full text available upon request to the author

Article title: Peripheral Arterial Disease’s Prevalence using Ankle Brachial Index (ABI): Its association to stroke
Authors: Dianco F., Tabuena M.D., Tabuena R.
Publication title: Philippine Journal of Internal Medicine 44:219-223, 2006

Abstract:
Background: Peripheral arterial Disease (PAD) due to atherosclerosis is the leading cause of occlusive arterial disease of the extremities and Ankle Brachial Index (ABI) by doppler is used to objectively assess these patients.

Objective: To determine the prevalence of peripheral arterial occlusive disease and its association to cerebrovascular disease.

Methodology: The study is a cross-sectional descriptive study which includes patients with a single or multiple atherosclerotic risk factors consulted as out-patient and subjected to ABI determination. There were seventy subjects included in the study and data were subjected to Chi-Square Analysis (x2) at 0.05 alpha level of significance. Results: The prevalence of PAD was noted to be at 54%. Risk factors to PAD is prevalent among out patients with single or more atherosclerotic risk factors. Age and presence of multiple risk factors are significantly associated with PAD and the presence of multiple risk factors and PAD are significantly associated with stroke.

Conclusions: The study showed that PAD is prevalent among patients with single or more atherosclerotic risk factors. There was significant association between age, and the number associated risk factors to the development of peripheral arterial occlusive disease. The older the age group and the more risk factors there is, the more prevalent is the PAD. The study also showed that there is a significant association of the presence of stroke in patients with peripheral arterial occlusive disease.
Full text available upon request to the author

Article title: Hemicraniectomy in the middle cerebral artery infarction: A case report.
Authors: Minerva I.T., Tabuena M.D., Tabuena R.
Publication title: Philippine Journal of Internal Medicine 44:209-212, 2006

Abstract:
Objective: This case report aimed to describe the outcome of the patient who was diagnosed to have massive middle cerebral infarction that underwent hemicraniectomy which emphasized the value of hemicraniectomy in the management of massive middle cerebral infarction.

Case Summary: This is a case report of a 64- year-old hypertensive Filipino male of four years admitted for the first time due to right -sided weakness. He was aphasic, disoriented to person, place and time with a Glasgow Coma Scale of 11 (Eye =4, Verbal= 2, Motor =5). Cranial Ct Scan showed a subacute infarct that involves left cerebral hemisphere at the middle cerebral artery territory. An anti-hypertensive drug, osmotic diuretic and anti-platelet agents controlled the patient’s blood pressure. He was referred to a neurosurgeon for evaluation and management. On the third day, patient’s neurologic status deteriorated and was found to have anisocoria and GCS score of 7 (v=1, E=1, M= 5) thus he underwent an emergency craniectomy and duraplasty. Intra-operative procedures revealed a taut dura and edematous brain parenchyma. The patient developed pneumonia as a result of a postoperative complication and was treated with antibiotics and underwent tracheostomy after 2 weeks postoperatively and subsequently weaned form respirator. After one month of hospitalization with an improved condition and having a GCS of 9 (V=1, E=4, M=4) the patient was discharged. 
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Article title: Prognostic factors affecting mortality of adult patients with hypertensive hemorrhage of the basal ganglia admitted at West Visayas State University Medical Center
Authors: Lee C.L., Tabuena M.D., Tabuena R.
Publication title: Philippine Journal of Internal Medicine 44: 191-195, 2006

Abstract:
Background: Stroke is one of the leading causes of mortality and its impact in the society is alarming as its sequel may result to disability among surviving patients. Intracerebral hemorrhage, which commonly involves the basal ganglia, is the third most common cause of stroke but is notably devastating form which a fatality rate approaching 50%.

Objective: To determine the factors associated with survival and mortality among patients with hypertensive basal ganglia hemorrhage. Methodology: Included were all adult patients (19 years old) admitted at WVSU Medical Center from March 2001 to February 2002 with a diagnosis of hypertensive hemorrhage of the basal ganglia documented by cranial CT scan. Excluded were those not to confirm by CT scan, intracerebral hemorrhage involving other area and intracerebral hemorrhage following trauma or septic embolization Chi-Square test was used to determine the significance of the difference in the characteristics of the two large groups (survived and died) relative risk ratio and logistics regression analysis were used to determine significant factors affecting survival or death. Significant p value was set at 0.05 alpha.

Results: A total of 30 cases were included (50% survived and 50% died). Patients who survived had lower mean arterial pressure, lower blood pressure on admission, higher Glasgow Coma Scale (GCS) score and smaller volume of the bleed compared to those who died. The presence of interventricular extension, poor blood pressure control, increasing age, history of previous stroke or transient ischemic attack and the presence of comorbid factors (smoking, diabetes and hypercholesterolemia) were found to be associated with mortality. However, none was found to be a significant predicator of survival or mortality.

Conclusions: The outcome of basal ganglia hemorrhage is highly variable. Death may occur rapidly despite prompt medical treatment. Primary prevention of the modifiable risk factors is still of utmost importance.
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Article title: Effects of dexamethasone in hypertensive intracerebral hemorrhage if the basal ganglia.
Authors: Sumagpao N., Tabuena M.D., Tabuena R.
Publication title: Philippine Journal of Internal Medicine 44:185-189, 2006

Abstract:
Background: Corticosteroids particularly dexamethasone are known to be effective in reducing vasogenic cerebral edema associated with both primary and metastatic brain tumor or brain abscess. A controversy over the benefit of corticosteroids in treating hypertensive intracerebral hemorrhage (ICH) remains unresolved. Standard textbooks of neurology as well as several monographs in cerebrovascular disease (CVD), still recommend corticosteroids in the management of cerebral edema accompanying ICH despite the lack of evidence.

Objective: This study aims to evaluate the effects of dexamethasone for the treatment of hypertensive ICH of the basal ganglia with edema. Specifically it sought to: determine the outcome of dexamethasone in the improvement of the level of consciousness in patients with hypertensive basal ganglia hematoma, to ascertain complications associated with the use of dexamethasone in the treatment of patients with hypertensive ICH of the basal ganglia. Subjects:There were 32 patients with ICH included in the study. Subjects were admitted from October 2003 to October 2004 at the Iloilo Mission Hospital (IMH) and found to have suffered a hypertensive ICH of the basal ganglia that amount to more than 10ml with edema as confirmed by the cranial CT scan result. Excluded from the study were patients whose hematomas were caused by head trauma, brain tumor, saccular arterial aneurysm, arteriovenous malformation, with blood dyscrasia and those who have infection on the day of admission. The subjects were stratified according to their level of consciousness using the Glasgow coma scale and were randomly assigned to group either with or without dexamethasone.

Results: The result showed that dexamethasone effect was not significant in regard to patients’ level of consciousness or its presence or absence in person with infection.

Conclusions: In this study it showed that giving or not giving dexamethasone was not significant factor in the improvement of the level of consciousness of the patient. Presence or absence of complication such as infection was not dependent on giving or not giving dexamethasone.
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Article title: Polymorphisms of B7 (CD80 and CD86) genes do not affect disease susceptibility to sarcoidosis.
Authors: Tomohiro Handa, Sonoko Nagai, Isao Ito, Rollin Tabuena, Michio Shigematsu, Kunio Hamada, Masanori Kitaichi, Takateru Izumi, Tomoki Aoyama, Junya Toguchida, Michiaki Mishima
Publication title: Respiration 72(3):243-8, 2005

Abstract:
Background: B7 proteins (CD80, CD86) are costimulatory molecules expressed on antigen-presenting cells and are essential factors for T cell activation.

Objectives: The aim of this study is to investigate the relationship of B7 gene polymorphisms either to disease susceptibility or to cell profile of bronchoalveolar lavage (BAL) fluid in Japanese sarcoidosis patients.

Methods: Gene polymorphisms located in CD80 promoter, CD80 exon 3 and exon 8 of CD86 were examined in 146 Japanese sarcoidosis patients and 157 healthy controls using single-strand conformation polymorphism and direct sequencing. The distribution of genotypes was compared between the two groups. BAL fluid cell profiles were compared for the various genotypes of the different polymorphisms for the 62 patients who underwent BAL.

Results: There were no significant differences in the distribution of genotypes or allele frequencies for all polymorphisms between sarcoidosis and controls. There were no significant differences in BAL fluid cell profiles among the different genotype groups of the various polymorphisms studied.

Conclusions: There was no relationship between the B7 gene polymorphisms studied and disease susceptibility or BAL fluid cell profiles in Japanese sarcoidosis patients.
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Article title: Patients characteristics and clinical features of Japanese Sarcoidosis patients with low bronchoalveolar lavage CD4/CD8 ratios.
Authors: Handa T., Nagai S., Shigematsu M., Tabuena R., Takeuchi M., Mikuniya T., Hamada K., Izumi T., Mishima M.
Publication title: Sarcoidosis, Vasculitis and Diffuse Lung Disease 22(22): 154-60, 2005

Abstract:
Previous studies have shown that there is an association between low BALF (bronchoalveolar lavage fluid) CD4/CD8 ratio and lower remission rates in sarcoidosis patients. To investigate the patient characteristics and clinical features of Japanese sarcoidosis patients with low BALF CD4/CD8 ratios. 322 Japanese sarcoidosis patients were retrospectively analyzed, and 3 groups were selected according to BALF CD4/CD8 ratios as follows: patients with the BALF CD4/CD8 ratio in the lowest 5 percentile (Group 1: 0.43-1.41), median 5 percentile (Group II: 4.68-5.47), and top 5 percentile (Group III: 12.6-60.1). Each group consisted of 16 patients (5% of 322 patients). The patient characteristics, clinical features, and the short-term prognosis for at least 2 years (average 116 months) were compared among the groups. Multivariate analysis was performed for 322 patients to investigate the determinants of BALF CD4/CD8 ratios. The number of BALF CD8+ cells were greater in Group I than in the other two groups. In Group I, there were higher incidences of younger age, male gender, and lower number of extrathoracic lesions compared with Group III. Multivariate analysis showed that younger age and male gender were independently associated with low BALF CD4/CD8 ratios. The frequency of treatment with corticosteroid and progression to pulmonary fibrosis tended to be higher in Group I. Low BALF CD4/CD8 ratios were due to increased number of BALF CD8+ cells. Younger age and male gender were independently associated with low BALF CD4/CD8 ratios in sarcoidosis patients.
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Article title: Relationship of airway wall thickening to an imbalance between matrix metalloproteinase-9 and its inhibitor in asthma
Authors: H Matsumoto, A Niimi, M Takemura, T Ueda, M Minakuchi, R Tabuena, K Chin, T Mio, Y Ito, S Muro, T Hirai, S Morita, S Fukuhara, M Mishima
Publication title: Thorax 60(4):277-81, 2005

Abstract:
Background: The balance between matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) may be critical in extracellular matrix remodelling, a characteristic of asthmatic airways. An excess of TIMP-1 over MMP-9 has been associated with chronic airflow obstruction but the mechanisms underlying this association remain unknown. Recent computed tomographic (CT) studies indicate that airway wall thickening is associated with chronic airflow obstruction.

Methods: Sputum levels of MMP-9, TIMP-1, and their molar ratio were examined in 26 patients with stable asthma and their relationship with pulmonary function and airway wall thickness, assessed by a validated CT technique which measured wall area corrected by body surface area (WA/BSA), the ratio of WA to outer wall area (WA%), and the absolute wall thickness corrected by radicalBSA of a segmental bronchus (T/ radicalBSA), was examined.

Results: Sputum MMP-9 levels were inversely correlated with WA% and TIMP-1 levels were positively correlated with WA/BSA and T/ radicalBSA. The MMP-9/TIMP-1 molar ratio was inversely correlated with WA% and T/ radicalBSA and positively correlated with post-bronchodilator values of mid-forced expiratory flow and maximum expiratory flow at the quartile of lung volume.

Conclusion: Excess TIMP-1 may have a pathogenetic role in airway wall thickening in asthmatic patients which may result in chronic airflow obstruction.
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Article title: Cell profiles of Bronchoalveolar Lavage Fluid as Prognosticators of Idiopathic Pulmonary Fibrosis/Usual Interstitial Pneumonia among Japanese Patients.
Authors: Rollin P Tabuena, Sonoko Nagai, Takeo Tsutsumi, Tomohiro Handa, Takeuchi Minoru, Takeshi Mikuniya, Michio Shigematsu, Kunio Hamada, Takateru Izumi, Michiaki Mishima
Publication title: Respiration 72(5):490-8., 2005

Abstract:
Background: The role of bronchoalveolar lavage fluid (BALF) cell profiles in predicting the clinical outcome of idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP) is still under discussion.

Objective: To determine whether BALF cell profiles affect the survival of patients with UIP diagnosed by surgical lung biopsy/autopsy at the early stage of IPF.

Methods: This hospital-based retrospective cohort study used 81 Japanese patients with histologically proven IPF/UIP who underwent BAL examination. The BALF samples were obtained from non-current smokers: NCS (n = 41) and current smokers: CS (n = 40). The Kaplan-Meier and Cox's proportional hazard methods were used to estimate the survival and evaluate the risk ratio for death in the two groups. To detect the multicollinearity, a stepwise regression was employed.

Results: A slight increase in the absolute numbers of BALF neutrophils tended to relate to a decrease in the relative risk for death in NCS patients and CS patients in the univariate analysis. In stepwise regression, the increase in percent vital capacity and the increase in the BALF CD4/CD8 ratio in NCS was detected as a favorable predictor, while increased BALF cells affected the results due to chronic smoking in CS.

Conclusions: Based on the study bias of the biopsy-proven IPF/UIP patients at stable stages, an independent variable indicating a favorable outcome was an increased BALF CD4/CD8 ratio in NCS patients, while it was difficult to identify definite prognosticators in CS patients.
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Article title: Diurnal variation and serial changes of peak expiratory flow in adult patients with cough variant asthma
Authors: Matsumoto H., Niimi A., Takemura T., Ueda T., Tabuena R., Chin M., Mishima
Publication title: European Respiratory Journal 48:588, 2004

Abstract:
No abstract available
Full text available upon request to the author

Article title: The significance of bronchoalveolar lavage (BAL) CD4/CD8 ratio in Japanese patients with Sarcoidosis
Authors: Tabuena R., Nagai S., Handa T., Shigematsu M., Hamada K., Izumo T., Mishima M.
Publication title: American Journal of Respiratory and Critical Care Medicine 169:35, 2004

Abstract:
No abstract available
Full text available upon request to the author

Article title: Diabetes Insipidus in Neurosarcoidosis, a long term follow up of more than eight years.
Authors: Rollin P Tabuena, Sonoko Nagai, Tomohiro Handa, Michio Shigematsu, Kunio Hamada, Isao Ito, Takateru Izumi, Michiaki Mishima, Om P Sharma
Publication title: American Journal of Respiratory and Critical Care Medicine 169:35, 2004

Abstract:
Four patients with sarcoidosis presented as hypothalamic-hypophyseal syndrome including diabetes insipidus (DI) were followed up for more than 8 years from the onset of clinical manifestation. The mean age was 26 years, male : female ratio was 3 : 1 and the mean disease duration of 10 years. All patients had hypogonadism, hyperprolactinemia. Pituitary enlargement with thickening of the pituitary stalk were detected by magnetic resonance imaging (MRI) with gadolinium enhancement and attenuation in the intensity of the posterior lobe of the pituitary was detected without enhancement. Corticosteroid therapy resulted in the initial improvement of symptoms and gradual decrease in the tumor size but failed to cure polyuria due to DI. The use of desmopressin was necessary for a long period. None of these patients died from DI or central neurosarcoidosis.
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Article title: Metastatic tumor in the right atrium.
Authors: Tabuena R., Matsumoto H., Mio T., Nagata Y., Mishima M.
Publication title: Internal Medicine 43 (5):445-6, 2004

Abstract:
A 59 year-old woman was evaluated because of an elevated carcino-embryonic antigen (CEA). Six years previously, she underwent right upper lobe lobectomy for poorly differentiated adenocarcinoma. A metastatic cervical lymphadenopathy was resected two years after surgery leading to a decrease in the CEA level. However on subsequent follow-up, a gradual elevation of CEA was noted. Radiological examinations including fluoro-deoxy -D-glucose positron emission tomography failed to determine the site of recurrence. Finally, an enhanced computed tomography of the chest revealed a tumor in the right atrium as confirmed by magnetic resonance imaging. Although she had been well except for a small amount of ascites, she refused the contemplated operation for the removal of the tumor and thus radiotherapy was employed. Her initial clinical course was complicated with disseminated intravascular coagulopathy but eventually recovered and she underwent radiation treatment of 50 Gy. Keywords: metastatic tumor, right atrium, carcino-embryonic antigen, magnetic resonance imaging, radiotherapy
Full text available upon request to the author

Article title: Diabetes Insipidus from Neurosarcoidosis: long-term follow up for more than eight years.
Authors: Rollin P Tabuena, Sonoko Nagai, Tomohiro Handa, Michio Shigematsu, Kunio Hamada, Isao Ito, Takateru Izumi, Michiaki Mishima, Om P Sharma
Publication title: Internal Medicine 43(10):960-6., 2004

Abstract:
Four patients with sarcoidosis presented as hypothalamic-hypophyseal syndrome including diabetes insipidus (DI) were followed up for more than 8 years from the onset of clinical manifestation. The mean age was 26 years, male : female ratio was 3 : 1 and the mean disease duration of 10 years. All patients had hypogonadism, hyperprolactinemia. Pituitary enlargement with thickening of the pituitary stalk were detected by magnetic resonance imaging (MRI) with gadolinium enhancement and attenuation in the intensity of the posterior lobe of the pituitary was detected without enhancement. Corticosteroid therapy resulted in the initial improvement of symptoms and gradual decrease in the tumor size but failed to cure polyuria due to DI. The use of desmopressin was necessary for a long period. None of these patients died from DI or central neurosarcoidosis.
Full text available upon request to the author

Article title: Successful weaning using non-invasive positive pressure ventilation in a Patient with status Asthmaticus.
Authors: Tetsuya Ueda, Rollin Tabuena, Hisako Matsumoto, Masaya Takemura, Akio Niimi, Kazuo Chin, Michiaki Mishima
Publication title: Internal Medicine 43(11):1060-2, 2004

Abstract:
In the treatment of severe asthma attack, acute application of non-invasive positive pressure ventilation is shown to be beneficial in some selected patients, while endotracheal intubation and mechanical ventilation is required in the remaining cases. Management with invasive ventilation in status asthmaticus is often associated with complications such as excessive mucus production and atelectasis, which may lead to prolonged hypoxemia and may increase mortality. We present a case of status asthmaticus who developed refractory atelectasis during invasive mechanical ventilation but had a dramatic resolution as well as successful weaning when non-invasive positive pressure ventilation was instituted.
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Article title: Validation of Bayesian Approach in estimating the probability of malignancy for Solitary Pulmonary Nodules.
Authors: Tabuena R, Dela Cruz MT.
Publication title: Philippine Journal of Internal Medicine 40: 319-32, 2004

Abstract:
Objective: An infectious process and malignancy can both present as Solitary Pulmonary Nodule (SPN) dilemma. In the proposed Bayesian approach of Cummings et al, they came up with a formula for the computation of the probability of malignancy in patients with SPN. This formula is validated in this study. Study Population: Patients aged more than 18 years old diagnosed to have SPN as defined by Veterans Administrative Cooperative Study ( VACS ) were included in the study. The diameter of the pulmonary nodule patient’s age, smoking history, likelihood ratios of each factor were multiplied and odds of malignancy were computed. All subjects with SPN who consented were biopsied either by computed tomography, bronchoscopy open lung or thoracotomy to confirm whether the lesion is benign or malignant. The accuracy rate of the Bayesian approach was determined using the histopathologic diagnosis as gold standard.

Results: Included in the analysis were seventy -seven patients admitted for SPN from January to December 2000- 2001. Thirty-two patients were diagnosed to have bronchogenic carcinoma and one severe dysplasia. There were thirty-three patients with benign findings, nine with tuberculoma, one with bronchogenic cyst and arterial – venous (AV) malformation. The mean age of the patients was 70+ 10.77 years. There were 56 males (72.7%) and 21 females (27.3%). Age was found to be associated with malignancy (p value 0.003). The gender was not associated with malignancy (p value 0.438) while smoking showed a significant association (p value 0.021). The probability score of malignant group (Bayesian score 93.4) is significantly higher than the benign (Bayesian score 52.3) with a p value of 0.000. The best cut off value for the probability of malignancy was computed at > 79%, with a sensitivity of 97% and specificity of 84%. The overall accuracy rate of this cut was 90%.

Conclusions:The Bayesian approach was safe and effective in estimating the probability of malignancy in patients with SPN. The best cut-off value for the probability of malignancy was computed at >79%. Determining the probability of malignancy will help the clinician in managing patients by not subjecting low risk patients to unnecessary thoracotomy and being aggressive in working up high risk patients for a more definite diagnosis.

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Article title: Antikoch’s induced hepatitis, a Veterans Memorial Medical Center Experience
Authors: . Tabuena R., Dalisay C., Bringas B.
Publication title: Philippine Journal of Chest Diseases 10:104-108, 2003

Abstract:
Background:The increasing incidence of tuberculosis exposes a greater number of patients to the risks of three potentially hepatotoxic drugs, isoniazid, rifamcipin and pyrazinamide. This study is designed to determine the incidence of drug-induced hepatitis among patients with anti- tuberculosis medications and the various factors related to the development of drug-induced hepatitis. Methods:This is a prospective cohort study of patients more than 18 years of age, admitted with a diagnosis of PTB class III admitted at the Veterans Memorial Medical Center from June 2000 to October 2001. Patients who developed drug-induced hepatitis were regarded as cases and the controls ere those who did not develop drug-induced hepatitis. Excluded were alcoholics, history of jaundice, hepatitis in the past, patients with right-sided heart failure and those with intake of hepatotoxic medications. The characteristics of both groups were compared. Paired t-test and Chi-square test were used to determine the significance of the difference between the two groups and a p value of <0.05 was considered to be significant.

Results:Three hundred forty-two patients were diagnosed to have PTB class III based on the symptoms, chest radiograph, sputum for AFB smear and PPD testing. Fifty-one patients developed drug induced hepatitis and the majority belonged to 65 and below age group. Triple therapy with Rifampicin, Isoniazid and Pyrazinamide had a greater chance of developing drug induced hepatitis after 16 days of therapy.

Conclusions: Drug induced hepatitis is not uncommon with the incidence of 14.9% in this study. There seems to be a noticeable relationship with the use of triple anti-kochs regimen and the development of hepatitis. 
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Article title: Smoke Inhalational injury.
Authors: Tabuena R., Nazal A., Bringas B.
Publication title: Philippine Journal of Internal Medicine 41:91-93, 2003

Abstract:
No abstract available
Full text available upon request to the author

Article title: Cytomegalovirus Pneumonia in a renal transplant patient, a case report.
Authors: Tabuena R., Dalisay C., Leyson M.
Publication title: Philippine Journal of Internal Medicine 41:39-41, 2003

Abstract:
Objective: To know the commitment infections after kidney transplantation and to have knowledge on the approach in prevent and treat these infections as an immunocompromised patient.

Case Summary: A case of a 54 year-old female married who was admitted because of fever and cough. Six months prior to admission she underwent kidney transplantation due to end stage renal disease (ESRD) secondary to Chronic Glomerulonephritis. She was found to be positive for anti- cytomegalovirus IgG prior to the transplant procedure. She is being maintained on Prednisone, Cyclosporine, Mycophenolate, Amlodipine, Telmisartan, and Isosorbide mononitrate. Pertinent findings on admission were cushingoid facies, pale conjunctivae, with truncal obesity, Chest x-ray showed pneumonia on the left and cardiomegaly. She was initially treated as a case of Pneumonia in the immunocompromised host using a third-generation cephalosporin (Ceftazidime), Clarithromycin and clindamycin, Fluconazole was also started due to the presence of moderate growth of Candida on the sputum culture. There was persistence of fever despite of the medications, which prompted the service to check for Cytomegalovirus (CMV) antigenemia on the sixteenth hospital day. The test revealed a positive result. However, the patient refused bronchoscopy. Ganciclovir was started with dose adjusted to creatinine level and a dramatic response was noted with the lysis of fever two days after the antiviral therapy was instituted. She was discharged improved on the 34th hospital day. After three months follow-up a repeat chest radiograph showed a complete resolution of the pneumonic the infiltrates.

Conclusions: The diagnosis of CMV Pneumonia is challenging and cannot be reliably made on clinical grounds alone, it should be based on clinical features, quantitative blood cultures and bronchoalveolar lavage specimen, transbronchial or open lung biopsy and serologic studies such as CMV DNA polymerase chai reaction, CMV antigenemia or viral culture. Although the definitive diagnosis of CMV Pneumonia must be base on histologic examination of invasive disease in tissue biopsy specimen, the diagnosis in this patient was based on CMB antigenemia. The response to treatment in CMV Pneumonia is poor but survival rates of 60% have been reported in patients whose treatment were given early thus, a high index of suspicion and management is a must.

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Article title: “Daily Screen” as a weaning parameter in mechanically Ventilated Patients.
Authors: Tabuena R., Atienza Dalisay C.
Publication title: Philippine Journal of Internal Medicine 41:27-31, 2003

Abstract:
Introduction: Weaning from mechanical ventilation is a period of transition from total ventilatory support to spontaneous breathing. It represents a clinical problem because as many as 25% of intubated and mechanically ventilated patients will need a progressive withdrawal from the artificial ventilatory support. Daily Screen is a set of simple weaning criteria needed before typing to wean a patient from mechanical ventilation which includes PF ratio > 200, PEEP <5cm. H20, MIP,-20cm , f/VT ratio < 105 and absence of vasopressor agents or sedatives.

Objective: The objective of this study is to validate daily screen as a simple weaning criteria for patients with mechanical ventilation confined at pulmonary intensive care unit as well as to compare the rate of successful versus failed weaning, mean length of intensive coronary unit (ICU) stay of in-hospital mortality between 2 groups. Materials and Methods: This is a prospective cohort study conducted between February to October 2000 in a pulmonary ICU setting at Veterans Memorial Medical Center. This included patients over 18 years old, who were or mechanical ventilation of less than 2 weeks were enrolled after a written informed consent. They were also assessed clinically for weaning by their attending physicians. Excluded were patients with tracheostomy, dependence on mechanical ventilation for more than 2 weeks and a previous trial weaning failure. Patients will be classified under Group A if they fulfilled all of the 5 criteria and Group B if they lacked at least one of the daily screen criteria. The investigator followed up the patients until discharge to determine the occurrence of the primary outcome of interest, which was defined as the successful weaning.

Results: One hundred twenty-three patients were recruited and classified as either Group A if they fulfilled all of the five criteria and Grouped B if they lacked at least one. Patients who fulfilled the criteria set for daily screen have a higher success rate (p=0.000) shorter length of ICU stay and lower mortality rate (p=0.000).

Conclusions: The “daily screen” may be a reliable set of weaning parameter, which can be used to predict successful weaning outcome prior to initiation of weaning in the intensive care unit. Patients who met the five criteria had a successful weaning (96%), a shorter length of ICU stay and a low in-hospital mortality rate.

Full text available upon request to the author

Article title: Cushing’s syndrome from Exogenous Corticosteroids: A case series.
Authors: Tabuena R. and Bringas B.
Publication title: Philippine Journal of Internal Medicine 40: 319-32., 2002

Abstract:
Introduction: Cushing’s syndrome is a condition that results from an excess cortisol, a hormone produced by the adrenal glands. The majority of the case are due to exogenous glucocorticoids.

Objective: This paper aims to present five cases of Cushing’s syndrome secondary to intake of prolonged steroids and the misconceptions of patients regarding this drug. Methodology: Five cases with a diagnosis of Cushing’s syndrome from exogenous corticosteroids admitted for respiratory problems at the pulmonary service from January 2000 to December 2001 were reviewed.

Results: Five cases were included in the series and the mean age of subjects were 64 years. There were three females and two males. Common clinical features were Cushingold facies, truncal obesity, abdominal striae and hypertension. The serum cortisol levels of the subjects were normal to slightly elevated.
Full text available upon request to the author

Article title: Onset of a second stroke in patients maintained on low dose and medium dose aspirin.
Authors: Pedroso M.D., Punzalan R., Tabuena R.
Publication title: Philippine Journal of Internal Medicine 40:101-104, 2002

Abstract:
Ischemic stroke accounts for approximately 85% of all stroke in Europe and North America. Prevention of stroke is a crucial health care issue because it is major cause of disability in developed countries. The objective of this study is to determine and compare the onset of a second ischemic stroke between patients taking aspirin at 100mg/day and 300-325 mg/day prior to the onset of a second stroke.

Study Population: The records of all patients taking aspirin for secondary stroke prevention admitted for and or diagnosed with recurrent ischemic strokes at the University of the East Ramon Magsaysay Memorial Hospital from January 1993 to August 1998 were reviewed. They were included in the study if the initial stroke was documented by cranial computed tomography. These patients were classified into two groups- one group using 100 mg aspirin/day and the other group using 300-325 mg/day of aspirin for secondary prevention of stroke. The interval between the initial stroke and the second stroke was compared between the two groups. All patients underwent cranial CT scan to document the presence of a new ischemic stroke. The significance of the difference in the onset of a second stroke between the two groups was analyzed using the t-test. A p value of < 0.05 are considered statistically significant. Results: Thirty-nine patients were already on aspirin prior to the onset of the second stroke and the previous strokes were documented by cranial computed tomography. Both groups did not differ in terms of mean age, sex ratio and risk factors for stroke. There was a difference of 5.5 months in the onset of the second stroke between the two groups and this finding is in favor of the higher dose of aspirin used but the differences is not statistically significant with a p value of 0.2

Conclusions: There is no significant difference in the onset of a second stroke between patients previously maintained on low dose aspirin (100md/day) and medium dose aspirin (3oo mg to 325 mg/day) prior to the onset of a second stroke. Full text available upon request to the author Article title: The effect of Cilostazol on fibrinogen level in Type 2 Diabetes Mellitus patients with concomitant cardiovascular events and risk factors. Authors: Tabuena R., Apistar M., Dañucop M., Jalbuena L. Publication title: Philippine Journal of Internal Medicine 40:44-49, 2002 Abstract:

Objective: Fibrinogen plays a part in atherothrombosis via several mechanisms by promoting atherosclerosis, an essential component of platelet aggregation and increasing plasma viscosity. Elevated plasma fibrinogen is an important predictor of cardiovascular risk and indicator of thrombotic tendency. Which can be reduced by antiplatelet therapy. This study aims to determine the effectiveness of cilostazol as an antiplatelet in lowering high level of fibrinogen of patients with diabetes mellitus type 2 with commitment cardiovascular risk factors or events. Participants: Thirty patients admitted at Iloilo Mission Hospital (IMH) and Iloilo Doctors Hospital (IDH) from March 1997 to November 1999 were used as cases. These patients were diagnosed with Diabetes Mellitus type 2, had concomitant cardiovascular risk factors or events and were used as the study group. The baseline fibrinogen levels were elevated. Excluded from the study were patients previously maintained on anti- platelets, pentoxifylline and fibrates. Alcoholics patients with blood dyscrasias, as well as pregnant women were likewise not included in the study. The significance of the difference between pre-treatment and post – cilostazol treatment was analyzed using the paired t test and a p value of < 0.05 was considered statistically significant. Intervention: The cases were given cilostazol 50 mg. two times a day soon after the fibrinogen levels were determined and noted to be elevated. Fibrinogen levels were measured within one month, using clotting assay in citrated plasma.

Results: Mean baseline fibrinogen levels of the study group were recorded at 522 mg/dl. Post treatment data of patients (study group) who received cilostazol showed a significant difference with plasma fibrinogen levels markedly lowered (327 mg/dl) after 2 to 4 weeks of treatment using the paired t-test (p < 0.000). Conclusions: Cilostazol effectively decreased the fibrinogen level 2 to 4 weeks after initiation of treatment in patients with Diabetes Mellitus type 2 with cardiovascular risk factors and cardiovascular events.
Full text available upon request to the author

Article title: The effect of Cilostazol on fibrinogen level in Type 2 Diabetes Mellitus patients with concomitant cardiovascular events and risk factors.
Authors: Tabuena R., Apistar M., Dañucop M., Jalbuena L.
Publication title: Philippine Journal of Internal Medicine 40:44-49, 2002

Abstract:
Objective: There is an increasing awareness that raised plasma fibrinogen is an important predictor of cardiovascular risk and indicator of thrombotic tendency, which can be reduced by anti-platelet therapy. Thrombosis contributes to atherogenesis. It is for this reason that haemostatic variables have been included in the studies of cardiovascular risk. Fibrinogen plays a part in atherothrombosis via several mechanisms by promoting atherosclerosis, as an essential component of platelet aggregation and increasing plasma viscosity. The objective of this study is to determine the effectiveness of anti-platelets in lowering high level of fibrinogen of patients with diabetes mellitus type 2 with concomitant cardiovascular risk factors or events.

Methods:This is a clinical investigation with external control on the effect of anti-platelets of fibrinogen level in Diabetes Mellitus Type 2 with concomitant cardiovascular risk factors or cardiovascular risk events. Fifty patients admitted at Iloilo Mission Hospital (IMH) and Iloilo Doctors Hospital (IDH) from March 1997 to October 1998 were used as cases. Twenty-five patients were diagnosed with Diabetes Mellitus type 2 (DM 2) with concomitant risk factors or events were used as the study group and twenty-five were non-diabetic patients with the other diseases and no cardiovascular risk factors were used as the external group. All patients had baseline fibrinogen levels. The study groups were given anti-platelets and the fibrinogen levels were measured within one month after using clotting assay in citrated plasma. Excluded from the study were patients previously maintained on anti-platelets, pentoxifylline and fibrates. Alcoholics, patients with blood dyscrasias as well as pregnant women ere likewise excluded. The data was analyzed using the t test and correlation analysis, p value of < 0.05 was considered statistically significant.

Results: Baseline fibrinogen levels of the study group showed elevated results compared to the external control. Pre and post treatment data of patients (study group) who received anti-platelets showed a significant difference with plasma fibrinogen levels markedly lowered after a month treatment using the t-test. Also, when sex and age was paired with fibrinogen level after treatment revealed no significant relationship.

Conclusions: Diabetes Mellitus Type 2 patients with cardiovascular risk factors and cardiovascular events have higher plasma fibrinogen levels. Anti-platelets effectively decrease the fibrinogen level one month after initiation of the treatment. However, there seems to be no significant preference in the use of the drug with regards to age and sex.
Full text available upon request to the author

Article title: Clinical Outcome of in-hospital patients with hypertensive hemorrhage of the basal Ganglia.
Authors: Tabuena R. and Sobrevega E.
Publication title: Philippine Journal of Internal Medicine 39:255-262, 2001

Abstract:
Objective: More than 60% of the hypertensive hemorrhage involves the basal ganglia and it is this group of patients from whom the optional management remains elusive. It was in this area of concern that this study was conducted. Primarily, it aimed to ascertain significant factors contributory to the survival rates of in-hospital patients diagnosed with Basal Ganglia hematoma.

Methods:This is a descriptive causal-comparative study (ex post facto design) to determine the survival rates of patients with basal ganglia hematoma. There were 60 patients admitted at 3 institutions namely Iloilo Mission Hospital (IMH), Iloilo Doctors Hospital (IDH) and St. Paul Hospital (SPH) with a diagnosed of hypertensive basal ganglia hematoma. To confirm the admission diagnosis the cranial CT scan was done for all the cases. The patients were categorized into 3 groups based on the size of the hematoma whether small – no more than 2 cm in largest diameter and no tightness of the Sylvian fissure, only slight shift midline structures and large – 5cm in diameter associated with tightness of the Sylvian fissure, only slight shift of midline structures and large – 5cm or more in diameter with definite shift of midline structures. Excluded from the study were patients whose hematomas were caused by head trauma, brain tumor, saccular arterial aneurysm and arteriovenous malformation and with blood dyscrasias. Admission and discharge grades were determined using the grading system for intracerebral hemorrhage – intracranial hemorrhage (ICH) proposed by the Japanese Ad Hoc Committee on Hypertensive Intracerebral Hemorrhage. This is a modified grading system derived from Glasgow Coma Scale (GCS) score. The statistical inference used was the Chi-square and interpreted at 5% level of significance. In some instances, the cells were collapse to obtain more meaningful data.

Results: Three factors were significantly contributory to the survival rate of patients with hypertensive basal ganglia hematoma. They were, namely the size of the hematoma, the intracerebral hemorrhage grade (ICH) and the presence of intraventricular extension. Medical or surgical intervention did not have any significant prognostic effect on survival rate of patients.

Conclusions: The clinical outcome of patients with hypertensive hemorrhage of the Basal Ganglia depends significantly on the size of the hematoma, ICH grade and the presence of intraventricular extension.
Full text available upon request to the author

Article title: The effect of anti-platelets on fibrinogen level in Type 2 Diabetes Mellitus patients with concomitant cardiovascular events and risks factors
Authors: Tabuena R., Dañucop M.
Publication title: Philippine Journal of Internal Medicine 39:150-154, 2001

Abstract:
There is an increasing awareness that raised plasma fibrinogen is an important predictor of cardiovascular risk and indicator of thrombotic tendency, which can be reduced by anti-platelet therapy. Thrombosis contributes to atherogenesis. It is for this reason that haemostatic variables have been included in the studies of cardiovascular risk. Fibrinogen plays a part in atherothrombosis via several mechanisms by promoting atherosclerosis, as an essential component of platelet aggregation and increasing plasma viscosity. The objective of this study is to determine the effectiveness of anti-platelets in lowering high level of fibrinogen of patients with diabetes mellitus type 2 with concomitant cardiovascular risk factors or events. Methods:This is a clinical investigation with external control on the effect of anti-platelets of fibrinogen level in Diabetes Mellitus Type 2 with concomitant cardiovascular risk factors or cardiovascular risk events. Fifty patients admitted at Iloilo Mission Hospital (IMH) and Iloilo Doctors Hospital (IDH) from March 1997 to October 1998 were used as cases. Twenty-five patients were diagnosed with Diabetes Mellitus type 2 (DM 2) with concomitant risk factors or events were used as the study group and twenty-five were non-diabetic patients with the other diseases and no cardiovascular risk factors were used as the external group. All patients had baseline fibrinogen levels. The study groups were given anti-platelets and the fibrinogen levels were measured within one month after using clotting assay in citrated plasma. Excluded from the study were patients previously maintained on anti-platelets, pentoxifylline and fibrates. Alcoholics, patients with blood dyscrasias as well as pregnant women ere likewise excluded. The data was analyzed using the t test and correlation analysis, p value of < 0.05 was considered statistically significant. Results: Baseline fibrinogen levels of the study group showed elevated results compared to the external control. Pre and post treatment data of patients (study group) who received anti-platelets showed a significant difference with plasma fibrinogen levels markedly lowered after a month treatment using the t-test. Also, when sex and age was paired with fibrinogen level after treatment revealed no significant relationship. Conclusions: Diabetes Mellitus Type 2 patients with cardiovascular risk factors and cardiovascular events have higher plasma fibrinogen levels. Anti-platelets effectively decrease the fibrinogen level one month after initiation of the treatment. However, there seems to be no significant preference in the use of the drug with regards to age and sex.
Full text available upon request to the author

Article title: Adrenal Carcinoma- A case report and review of related literature
Authors: Tabuena R., Tendencia M., Ariete G., Advincula J., Octaviano D., Legada B., Apistar M.
Publication title: Philippine Journal of Internal Medicine 37:200-203, 1999

Abstract:
This is a case of an adrenal cancer in a 42 year-old female who was admitted because of low back pain and numbness of extremities. During her confinement, she was noted to be hypertensive, hypokalemic with Cushingoid facies. Extensive work-up was done to determine the etiology of Cushing’s syndrome. Plasma cortisol revealed an elevated result of 60ug/dl. Abdominal CT scan of the abdomen showed a large retro-peritoneal mass with necrotic changes measuring 19x12x12 cm. Histopathologic report disclosed findings consistent with carcinoma. Full text available upon request to the author
Full text available upon request to the author

AWARDS

• Power Couple Awardee, Faaabvlous XII by Rupert Jacinto, Mariott Manila Grand Ballroom, November 20, 2024
• 21st Best Dressed Women of the Philippines and Men of Exemplary Influence at Shangri-La the Fort, September 20, 2024
• Asia's Influential Leader Awards of 2024 - in Medical Category, Grand Ballroom Okada Manila, February 16, 2024
• Awardee, Faabvolous Men of Faabvolous X1 by Rupert Jacinto, Mariott Hotel Manila, November 20, 2023
• Asia's Golden Icons Awards of 2023: Asia's Most Distinguished Doctor in Pulmonary Medicine, Mediterranean, Waterfront Hotel, Cebu City, June 2, 2023
• Asia's Modern Heroes of 2023: Heroes Renowned Medical Internist and Pulmonary Specialist of the Year, The Grand Ballroom, Okada Manila, February 17, 2023
• 2022 Regions Finest of Iloilo, March 12, 2022
• One of the Achievers Award, Municipality of Concepcion in the field of Medicine, February 23, 2017
• One of the Most Outstanding Men of Iloilo 2012, June 3, 2012
• Most Outstanding 100 Alumni Award, West Visayas State University, July 11, 2008
• European Respiratory Society Bursay Grantee in Smoking Cessation Programme, Rhodes Greece, September 20-22, 2006
• Most Outstanding Young Scientist Award, Department of Science and Technology, July 13-14, 2006
• European Respiratory Society Grantee Fellowship Training in Interventional Bronchoscopy, October 2004 - January 26, 2005
• Bursary Recipient, European Respiratory Society (ERS) School Course Interventional Bronchoscopy and Bronchoalveolar Lavage October 22-25, 2003
• Recipient of the Monbukagusho Fellowship Grant, a Japanese Government Scholarship, Kyoto University Department of Respiratory Medicine , Graduate School of Medicine, Kyoto, Japan, October 2002 to March 2004
• Best Poster Presenter, 32nd Annual Convention, Philippine College of Physicians Anti-Koch’s induced hepatitis (Rifampicin, Isoniazid, Pyrazinamide): A Veterans Memorial Medical Center (VMMC) Experience- EDSA Shangri-La Hotel, Manila, Philippines, May 14-17, 2002
• Most Outstanding Paper, 21st PCCP Annual Convention, “Daily Screen” as a weaning parameter in mechanically ventilated patients, March 5-8, 2002