bluuebunny/crossref_metadata_2025 huggingface dataset:
Calcifications in Thyroid Ultrasonography and Thyroid Carcinoma
Authors: Sio Maria Christina D. , Uy Jacqueline Austine U. , Soriano Ronaldo G.
Published: April 2019

Background: Thyroid nodules are a common disease entity occurring in 5-10% of the general population and increasing with age. Their detection on ultrasonography ranges from 13% to 67%.  Calcifications on ultrasound may occur in both benign and malignant diseases, but have been cited for increased risk of thyroid carcinoma.  

Objective: To determine the association of calcifications found on thyroid ultrasonography and the different types of calcifications with thyroid carcinoma.

Method:

Study Design: Retrospective Study

Setting: Tertiary Private Hospital

Participants:  126 patients with pre-operative thyroid or neck ultrasonography who subsequently underwent thyroidectomy (total or subtotal, with or without frozen section) were selected from a database covering a one-year period from January to December 2012. The presence and type of calcification on ultrasonography was correlated with the final histopathologic report for a diagnosis of thyroid carcinoma. Sensitivity, specificity, positive and negative predictive values were obtained.

Results: 51 out of 126 studies (40%) were observed to have calcifications of any description, in both histologically benign (41%) and malignant (59%) nodules. Calcifications seen in malignancy arose from papillary carcinoma (86%). Follicular carcinoma and others (Plasmacytoma and Lymphoma) accounted for 7% each. The peripheral type of calcification was most prevalent accounting for 37% (11 out of 30).  The sensitivity of detecting calcifications on ultrasonography is 58.82%, specificity 81.33%, positive predictive value 68.18% and negative predictive value 74.38%. Chi square test computed was 21.54 (P <0.05).

Conclusion: There was an association between calcification found on ultrasonography and thyroid carcinoma and 86% of the calcifications were peripheral patterns, mostly found in papillary thyroid carcinomas. Ultrasonography alone is not sufficient in diagnosing thyroid carcinoma, but may increase the suspicion of malignancy depending on the type of calcification.

Keywords: Thyroid carcinoma, papillary carcinoma, calcifications, ultrasonography
Sensorineural Hearing Loss: What Lies Beneath? Neurovascular Conflict Secondary to a Dural Arteriovenous Malformation
Authors: Bickle Ian C.
Published: April 2019

This middle-aged gentleman with no previous medical history presented to the local ENT outpatient clinic complaining of right-sided hearing loss.  No history of trauma or previous head and neck surgery was elicited.

Following clinical and auditory assessment a right sensorineural hearing loss was confirmed.  A right-sided facial palsy was additionally identified on examination.

A MRI of the internal auditory meati was performed (Figure 1a & 1b).  Following radiologist review, MRI and MRA of the brain was undertaken.

 

DISCUSSION

 

Auditory impairment is a condition with a legion of potential causes. One of the routine aspects of the assessment process for those with sensorineural hearing loss is MR imaging (MRI) of the internal auditory meati (IAMS).

 

The vast majority of MRI studies are normal, however one of the more commonly identified pathologies are cerebrovascular abnormalities. The most well recognised is neurovascular conflict of the vestibulocochlear nerve by a vascular loop at the root entry zone (REZ), however a broader range of potential responsible structural abnormalities are known. A wide range of processes for auditory dysfunction have been outlined.1 These include; cerebral ischaemia events, subarachnoid haemorrhage, cerebrovascular malformations and rarely dural arteriovenous fistulas (dAVFs).

 

Dural AVF's are abnormal vascular communications between the dural venous sinuses and an arter(ies) - most frequently branches of the external carotid artery. Sensorineural hearing impairment is one of the rarer presenting symptoms. The mechanism for hearing impairment is believed to result from either direct vascular compression on the vestibulocochlear nerve from an enlarged aberrant draining vein or from a vascular steal phenomenon (Figures 2a & 2b). An engorged draining vein from the dAVF causing mechanical compression on the nerve is the most well recognized.2 A single prior case has been reported of compression from an intraossesous dAVF of the skull base.3

 

The arteriovenous fistula may be directed identified (Figure 3) along with the associated signs of enlarged cerebral cortical veins and white matter change of venous hypertension (Figure 4).
Pterygopalatine Fossa Infiltration: A Radio-Anatomic Study among Adult Patients in a Tertiary Private Hospital
Authors: Apale Neil Louis L. , Romualdez Joel A. , Rivera Rodolfo E. , Lu Joseph Benjamin M.
Published: April 2019

Objective: As a guide to the clinical practice of infiltration of local anesthesia into the pterygopalatine fossa via the greater palatine canal, this study sought to determine and record the mean CT scan measurements of the following: 1) palatal mucosal thickness, 2) length and width of greater palatine canal, and 3) length and width of pterygopalatine fossa, among adult patients in a private tertiary hospital in Quezon City.

Method:

Study Design:            Retrospective, Descriptive Study

Setting:                       Tertiary Private Hospital

Participants:              Paranasal Sinus (PNS) CT Scans of 113 adult patients from January 2014 to May 2014 were reviewed and evaluated. Excluded were images with pathology that distorted the anatomy of the sinuses and surrounding structures.

Results: Our study showed average CT scan measurements of 5.98 mm palatal mucosal thickness, 16.99 mm greater palatine canal length, 18.75 mm pterygopalatine fossa length, 2.37 mm greater palatine canal width, and 2.58 mm pterygopalatine fossa width. Comparison of average measurements by sex was not statistically significant. There was statistical significance when comparing the right palatal mucosal thickness of 5.86 mm with the left which was 6.11 mm, with p-value of 0.001. Comparison between the length of the right pterygopalatine fossa of 18.48 mm with the  left side at 19.01 mm, showed statistical significance with p-value of 0.01.

Conclusion: As the average measurement of the mucosal palatal thickness combined with the length of the greater palatine canal was 22.97 mm, we recommend bending the needle 23 mm from the tip in a 45 degree angle, for adult patients who will undergo sinus surgery, control of posterior epistaxis, trigeminal nerve block, and minor oral cavity surgeries.

Keywords: pterygopalatine fossa infiltration, greater palatine canal, greater palatine foramen, regional anesthesia blocks
Augmentation Rhinoplasty with Rib Cartilage Graft
Authors: Lagura Elaine Marie A. , Yap Eduardo C. , Garcia Anna Victoria G.
Published: April 2019

Objective: To investigate the outcome and complications of augmentation rhinoplasty with rib cartilage grafts

 

Methods:

Study Design:            Retrospective study

Setting:                       Tertiary Government Hospital

Participants:              Patients who underwent dorsal nasal augmentation with autologous rib cartilage grafts between June 2008 and October 2012.

 

Results: A total of 12 patients (3 male, 9 female) were included in the study. Mean age was 29 years. Seven were cases of primary simple rhinoplasty with 4 cases of revision (previously using alloplastic materials) and one case of trauma. Indications for the procedure were all cosmetic. There was no incidence of infection, both in the donor and recipient sites, warping of the graft, graft extrusion, resorption, pneumothorax, chest wall deformity or prolonged edema. Post-operative pain in the donor site was relieved by oral pain medications. No revision surgery was required.

 

Conclusion: Costal cartilage is a good option for structural support of the nose. In our experience patients have become wary of the complication of allografts and have opted to use autografts. The surgeon’s knowledge of the nasal anatomy as well as his or her experience with autologous grafts plays a major role in avoiding post-operative morbidity.

Keywords: Rhinoplasty, rib graft, costal cartilage graft, Southeast Asian nose
Hyalinizing Trabecular Tumor of the Thyroid Gland
Authors: Te Vincent G. , Carnate Jose M.
Published: April 2019

A 34-year-old woman with a 4-year history of a slowly enlarging thyroid gland underwent a total thyroidectomy. Histologic sections showed multinodular colloid goiter. In addition, a 1.2 centimeter diameter discrete mass with a solid white cut surface was noted within the left lobe.

Sections from the left lobe mass show a well-demarcated tumor whose cells are arranged in trabecular and nested growth patterns. (Figure 1) The cells are polygonal to spindly and have ample eosinophilic, slightly granular cytoplasm and oval to angular nuclei that are often grooved. (Figure 2) Hyaline material and a delicate fibrovascular stroma surround the nests and trabeculae, and occasional psammoma bodies are seen. (Figure 3) These features led us to a diagnosis of hyalinizing trabecular tumor.

Hyalinizing trabecular tumor (HTT) is a rare thyroid neoplasm of follicular cell derivation.1, 2 The tumor occurs in adults with a wide age range (4th – 7th decades) and a mean age of 47 years. It is more common in females.1 The classic histologic findings are of a solid circumscribed epithelial neoplasm with or without a thin capsule composed of medium to large-sized polygonal to fusiform cells that are arranged in alveolar, trabecular and nested groups. The cells have finely granular, acidophilic, amphophilic or clear cytoplasm. Nuclei often have prominent grooves and small nucleoli. Calcospherites (psammoma bodies) may be present. Colloid is scant or absent. 1, 2, 3

 

Because of overlapping nuclear features, a follicular variant of papillary thyroid carcinoma is a differential diagnosis. Histologic features are usually sufficient to distinguish the entities as a nested-alveolar architecture is rarely a prominent feature of a papillary carcinoma.2 Immunohistochemistry may be of aid in this distinction especially in difficult cases with limited material. Cytokeratin 19 and HBME1 are negative in HTT and are usually positive in papillary thyroid carcinomas.4, 5, 6 Neuroendocrine markers are also negative in HTT and are positive in medullary thyroid carcinomas and paragangliomas.2

 

HTT is of uncertain malignant potential, and a 2008 review of 119 HTTs has shown only one case progressing to malignancy.3 The majority of cases have behaved in a benign fashion and thus may be treated conservatively.1
Descending Necrotizing Mediastinitis, a Dreaded Complication of Acute Tonsillitis
Authors: Go Ma. Stephanie C. , Cruz Emmanuel Tadeus S.
Published: April 2019

Objective: To report a case of acute tonsillitis that subsequently developed descending necrotizing mediastinitis, and to discuss the signs and symptoms, differential diagnosis, pathophysiology, diagnostic criteria, ancillary procedures and management.

 

Methods:

            Design: Case Report

            Setting: Tertiary private and government hospital

            Patient: One

 

Results:  A 36-year-old woman was admitted with a 2-day history of sore throat and a diagnosis of acute exudative tonsillitis. She complained of sore throat accompanied by dyspnea, neck and chest pain which rapidly progressed to mediastinitis. She was transferred to a tertiary government hospital where video assisted thoracoscopic surgery with bilateral deloculation, mediastinoscopy and bronchoscopy revealed purulent discharge from the right main stem bronchus with multiloculated effusion in the left lung and posterolateral loculated effusion in the right lung. Her condition improved and she was discharged after a month of antibiotic therapy.

 

Conclusion:  Acute tonsillitis seldom leads to a life-threatening complication such as mediastinitis. Descending necrotizing mediastinitis develops when acute tonsillar infection progresses and descends to the mediastinum. It is a surgical emergency which requires mediastinal drainage, thoracotomy and long-term antimicrobials. Clinicians who manage oropharyngeal infections should be aware of this rare but lethal complication which may occur even in non-immunocompromised individuals.

 

Keywords: Acute tonsillophraryngitis, tonsillitis, mediastinitis, descending necrotizing mediastinitis.
Primary Laryngeal Aspergillosis in a Postpartum Patient
Authors: Villanueva Jose Carlo R. , Opulencia Alejandro P. , Calavera Kenneth Z. , Lim William L.
Published: April 2019

Objective:  To present a rare case of primary laryngeal aspergillosis manifesting with hoarseness in a seemingly healthy, immunocompetent, postpartum patient and discuss the probable contributing factors leading to this unusual disease process.

Methods:

Study Design: Case Report

Setting: Tertiary Private University Hospital

Subjects:  One (1)

Results: A 28-year-old previously healthy post-partum woman presented with hoarseness of a few weeks duration and recent intake of antibiotics and steroids. Videolaryngoscopy revealed a creamy, exophytic mass overlying both vocal folds. Microscopic examination revealed septated, dichotomously branching hyphae with acute angles characteristic of Aspergillus sp. The patient recovered with anti fungal medications.

Conclusion: The clinical presentation of laryngeal aspergillosis can be very non-specific and should not be disregarded merely on the basis of immune competence. It should be considered, together with other host and environmental factors when a patient responds poorly to conventional treatment. There is a need for quick and accurate diagnosis as the disease responds quite rapidly with appropriate anti fungal medications.

 

Keywords: Aspergillosis, hoarseness, larynx, postpartum, immunosupression
A Myringotomy and Ventilating Tube Applicator: New Look at a Five-Century-Old Procedure
Authors: Amable Jay Pee M. , Sia-Vargas Lily L.
Published: April 2019

Objective: To fabricate a single instrument that can be used to perform myringotomy and insert a pressure equalizing tube at almost the same time.

 

Methods:

Study Design: Surgical Instrumentation

Setting: Tertiary Private Hospital

Subject: A chicken egg membrane was used as a tympanic membrane model

 

Result: The fabricated instrument was able to perforate the egg membrane and apply the modified polyethylene pressure equalizing tube in less than one minute without complications.

 

Conclusion: The prototype applicator can facilitate myringotomy and pressure equalizing (PE) tube insertion at only a fraction of the time it usually takes to do the standard myringotomy and subsequent ventilating tube insertion.

 

Keywords: Myringotomy, pressure equalizing tube, ventilating tube, acute otitis media, otitis media with effusion, polyethylene tube
Effects of Dexamethasone versus Saline-Impregnated Nasal Packing on the Postoperative Outcome of Patients with Chronic Rhinosinusitis and Nasal Polyps after Endoscopic Sinus Surgery: A Randomized Controlled Trial
Authors: Promentilla Shella May A.
Published: April 2019

Objective: To evaluate the effects of Dexamethasone-impregnated absorbable nasal pack versus saline-impregnated nasal packing on postoperative outcome of nasal cavities after endoscopic sinus surgery using the Perioperative Sinus Evaluation Scoring System (POSE) and Lund and Kennedy Endoscopic Scoring System.

Methods:

Study Design: Prospective, randomized, double blinded, placebo-controlled trial

Setting: Single Center Tertiary Government Hospital

Population: Nineteen patients aged 15 years old and above, diagnosed with chronic rhinosinusitis, with nasal polyposis grade 3, who underwent endoscopic sinus surgery from January 2015 to August 2015

Results: Nasal cavities that received postoperative dexamethasone-impregnated nasal packs showed significantly lower POSE scores than placebo on post-op Days 14 (p value 0.0022; 95% CI: -2.113 to -0.5116) as well as lower Lund-Kennedy Scores on post-op day 14 (p value of 0.0180; 95% CI: -2.493 to – 0.2571) and day 28 (p value of 0.007; 95% CI: -1.56275 to -0.2832)

Conclusion: Dexamethasone-impregnated absorbable nasal packing affords better postoperative outcomes: less edema, crusting, secretions, and synechiae, than saline-impregnated absorbable packing in later postoperative days.

Keywords: Dexamethasone, endoscopy, nasal polyp, nasal cavity, intranasal absorption
Congenital Oval Window Aplasia: An Unusual Cause of Conductive Hearing Loss in an Adult
Authors: Chiong Charlotte M. , Mercado-Evasco Rachel T. , Chiong Alessandra E. , Perez Mary Ellen C. , Abes Franco Louie L. , Chan Abner L.
Published: April 2019

Objective: To report a case of congenital oval window aplasia (COWA) in a Filipino adult presenting with  unilateral maximal conductive hearing loss and discuss the diagnostic considerations, pathophysiology and management.

Methods:

            Study Design:  Case report

            Subjects: One (1)

            Setting:  Tertiary Public Referral Center

Results: Audiometric evaluation showed a maximal unilateral left conductive hearing loss. High resolution temporal bone CT showed absence of the oval window on the left along with facial and stapes abnormalities.  Exploratory tympanotomy showed an aberrant facial nerve, monopodal and abnormally located stapes and absent oval window.  Postoperative hearing gain achieved after a neo-oval window and Schuknecht piston wire prosthesis remained stable over two years.

Conclusion: A congenital minor ear anomaly classified as Cremers Class 4a in which a congenital oval window aplasia was associated with an aberrant facial nerve anomaly and a monopodal stapes is reported. Recent literature supported the view that congenital oval window aplasia can in selected cases be amenable to various surgical approaches and a stable postoperative hearing gain is achievable in the long term.

Keywords: oval window absence,  Cremers classification, congenital middle ear
Recurrent Epistaxis from a Post-Traumatic Infraorbital Artery Pseudoaneurysm
Authors: Pascual Ma. Victoria P. , Alonzo Daniel M.
Published: April 2019

Objective: To present a rare case of post-traumatic recurrent epistaxis in an elderly woman.

Methods

Design:            Case Report

Setting:            Tertiary Private Hospital

Participants:    One

Results: A 93-year-old woman had multiple admissions for recurrent life threatening nose-bleeding that was not controlled until a post-traumatic pseudoaneurysm of the infraorbital artery was diagnosed and embolized. 

Conclusion: The diagnosis of pseudoaneurysm should be considered in such cases, and treatment involving surgeons and interventional radiologists should be initiated to minimize morbidity and mortality.

 

Keywords: recurrent epistaxis, post-traumatic pseudoaneurysm, right infraorbital artery, right internal maxillary artery, embolization
Association of the Laterality of Chronic Suppurative Otitis Media with the Laterality of Sinonasal Disease Based on Temporal Bone CT - Scan Results and Lund Mackay Scoring System
Authors: Adan Walfrido C. , Cruz Emmanuel Tadeus S.
Published: April 2019

Objective: To determine the association between the laterality of chronic suppurative otitis media (CSOM) and the laterality of sinonasal disease, based on temporal bone ct-scan results and Lund-Mackay Scoring system, among patients admitted for ear surgery in a tertiary government hospital in Metro Manila.

Method:

Design:            Retrospective review of records

Setting:           Tertiary Government Hospital

Patients:         Ninety-eight patients diagnosed with chronic suppurative otitis media admitted for otologic surgery in the Department of Otorhinolaryngology – Head and Neck Surgery from January 2011 to June 2014 were considered for inclusion. Hospital charts and temporal bone ct-scan results were retrieved and analyzed for ear and sinonasal radiographic abnormalities and laterality. Excluded were those without CT-scan plates, who underwent temporal bone surgery for reasons other than chronic suppurative otitis media, and those with incomplete records. The Lund-Mackay Scoring System was used to grade sinonasal findings which were compared to CSOM complications. Data was analyzed using t-test, ANOVA for homogenous numerical data, Kruskal-Wallis for heterogenous numerical data, and chi-square test for nominal type of data. 

 Results: Of the 64 patients included in the study, 12 or 18.75% had radiographic sinonasal abnormalities.  There was no significant association between the laterality of ear disease and the laterality of sinonasal pathology as there was no significant difference in the proportion of subjects with sinonasal disease according to laterality of CSOM (p=.32). When site of nose pathology was compared to Lund-Mackay graded scores, it was found that bilateral nose pathology generally had a higher Lund-Mackay score of 8.60 ± 5.60. However, there was no significant difference in the Lund-Mackay score according to the nose pathology site (p=.20).   An association was seen between total LMS and patients with ear pathologies, but no significant difference was noted (p=.44).  Although patients with ear complications had higher LM scores, this was not statistically significant.

Conclusion: Laterality of ear disease was not associated with the laterality of sinonasal disease, although CSOM complications were associated with high Lund-Mackay scores. Future, better-designed studies may shed more light on these associations.

Keywords: chronic suppurative otitis media, sinonasal disease, Lund-Mackay, Temporal Bone CT-Scan
Relapsing Polychondritis Initially Presenting with Hoarseness and Difficulty Breathing in a 21-Year-Old Male
Authors: Padua Paula Francezca , Lim William L.
Published: April 2019

Objective:       To present a case of relapsing polychondritis initially presenting with hoarseness and difficulty breathing and to discuss the diagnostic criteria and typical CT scan findings of relapsing polychondritis.

Design:                       Case Report

Setting:                       Tertiary Private Hospital in Metro Manila

Case Report:              A 21-year-old man who was initially managed as a case of bronchial asthma for persistent hoarseness and recurrent difficulty breathing was found to have severe laryngeal edema on endoscopy, and soft tissue expansion of the cricoid cartilage with calcifications and irregular first tracheal ring on CT scan.  He also had recurrent eye redness and developed bilateral aural inflammation, and was subsequently diagnosed to have relapsing polychondritis.

Conclusion:                Relapsing polychondritis is a rare autoimmune disease characterized by recurrent inflammation and eventual destruction of cartilage throughout the body. Typical manifestations may not always be present, causing a delay in diagnosis.  It should be considered in patients with intractable respiratory symptoms not responsive to treatment for upper respiratory tract infections or asthma. A CT scan may reveal signs of cartilage destruction and help in diagnosis.      

Keywords:     Polychondritis, Relapsing; airway involvement; imaging
Traumatic Perforation of the Tympanic Membrane: Etiologies and Risk Factors for Healing and Intervention
Authors: Sannigrahi Rajarshi , Ghosh Debangshu , Saha Jayanta , Basu Sumit Kumar
Published: April 2019

Objective: To study various etiologies of traumatic tympanic membrane perforation; evaluate the factors involved in healing of traumatic tympanic membrane perforation; and identify patients with perforations unlikely to benefit from conservative management.

Methods

Study Design:  Prospective observational study

Setting:            Tertiary Government Medical College and Hospital

Subjects:          64 consecutive cases of traumatic tympanic membrane perforation seen over one year were followed for 3 months. Perforations were assessed in terms of size, etiology, condition of edge and other associated factors or combinations of factors with regards to spontaneous healing, using descriptive statistics and chi-square tests.

 Results: Of the 64 cases, 51 perforations healed while 13 did not. There were significant associations between tympanic membrane condition after 3 months and explosive mode of injury (χ2 = 23.30; p=.00001) as well as with size of perforation ((χ2 = 25.75; p=.00001). The risk of persistence of a tympanic membrane perforation was 34.57 times more among patients with a perforation size >50% compared to those with perforation size ≤50%  [OR-34.57 (6.28, 190.14); p= .00001]. Combined, explosive etiology and perforation size >50% were significantly associated with non-healing ((χ2 = 37.60; p = .00001). There were no significant associations with the condition of the edge of the perforation and upper respiratory tract infection.

Conclusions: An explosive etiology and tympanic membrane perforation size >50% may be significant risk factors predicting non-healing of the perforation. Risk stratification of patients having one or both of these risk factors, with early intervention for those with both, and close monitoring for those with any one of these may lessen unnecessary morbidity. Bigger multicenter future studies are necessary to confirm these initial findings.

Keywords: tympanic membrane perforation, tympanic membrane, risk factors, wound healing, early intervention
Optical Myringotomy Knife
Authors: De Leon Rozelle O. , Amable Jay Pee M.
Published: April 2019

Objective: To describe an improvised optical myringotomy knife essential in creation of an incision in a myringotomy simulator.

Methods:

Study Design: Instrumental Innovation

Setting:           Tertiary Private Hospital

Subject:          None

Results: The optical myringotomy knife was able to create incisions on mock membranes made up of polyethylene film (Cling Wrap) in a myringotomy simulator. The incisions measured approximately 2 mm with sharp edges indicating that the myringotomy knife was able to penetrate the mock membrane with ease. It provided good control in performing myringotomy incisions under endoscopic visualization of the tympanic membrane.  

Conclusion: Our initial experience with this optical myringotomy knife for tympanostomy tube insertion suggests that it may greatly improve the performance of myringotomy especially among less experienced surgeons. Further studies may establish its accuracy and replicability in vitro, after which formal in vivo trials can be attempted.

 

Keywords: tympanostomy, middle ear ventilation, endoscopy, instrumentation
Ehretia Microphylla (Tsaang Gubat) versus Loratadine as Treatment for Allergic Rhinitis: A Randomized Controlled Trial
Authors: Umali Fatima Angela C. , Chua Antonio H.
Published: April 2019

Objective:  To determine if Ehretia microphylla (Tsaang Gubat) decoction tea and placebo can improve the symptoms of mild intermittent allergic rhinitis in comparison to loratadine and control tea.

 

Methods:

Study Design:            Double blind, Randomized Controlled Trial

Setting:                       Tertiary Government Training Hospital

Subjects:                    Twenty-four patients diagnosed with mild intermittent allergic rhinitis from October 2015 to July 2016 were randomly divided into a treatment group given Ehretia microphylla (Tsaang Gubat) decoction tea and placebo, and a control group given control tea and loratadine, both taken for 7 days. Patients underwent pre–  and post–intervention evaluation by anterior rhinoscopy, Sino-nasal Outcome Test 22 (SNOT 22) Questionnaire and 10-point Visual Analog Scale (VAS). Data were encoded and subjected to statistical analysis using Mann Whitney U test, and Wilcoxon Signed Rank test.

 

Results: Age and gender of the treatment and control group participants were comparable. Prior to intervention, no differences in symptoms were noted between both groups on SNOT 22 and VAS scores. After intervention, no differences in symptoms were noted between the 2 groups on SNOT 22 and VAS scores either. Comparison of pre- (30.4 ± 17.3) and post- (7.2 ± 6.5) intervention mean SNOT 22 scores of the loratadine control group with pre- (32.5 ± 23.7) and post- (7.8 ± 10.4) intervention mean SNOT 22 scores of the Ehretia Microphylla treatment group showed significant improvement of symptoms in both groups. Likewise, comparison of pre- and post-intervention mean VAS scores of the loratadine control group and pre- and post-intervention mean VAS scores of the Ehretia Microphylla treatment group based on symptoms of sneezing, rhinorrhea, nasal congestion and pruritus showed significant improvement of symptoms in both groups (p-values of < .001).

                       

Conclusion: Ehretia microphylla (Tsaang Gubat) decoction tea may improve symptoms of allergic rhinitis (sneezing, rhinorrhea, pruritus, and nasal congestion) and be taken as an alternative to loratadine in patients with mild intermittent allergic rhinitis. Further clinical trials with more participants may provide stronger evidence for this conclusion.

 

Keywords: Allergic rhinitis, tsaang gubat, ehretia microphylla, loratadine
Hungry Bone Syndrome (HBS) in Patients Operated for Primary Hyperparathyroidism (PHPT): A Six-Year Experience
Authors: Padilla-Baraoidan Rhoda Zyra M. , Capuli-Isidro Maria Jocelyn , Cudal Beinjerinck Ivan B. , Embestro-Pontillas Ayezl A.
Published: April 2019

Objective:      To review cases of adult patients who develop Hungry Bone Syndrome (HBS) after parathyroidectomy for Primary Hyperparathyroidism (PHPT) in a tertiary care center in the Philippines and describe the clinical features, pre-operative preventive measures done, and risk factors for HBS.

Methods:

Study Design:            Retrospective case note review

Setting:                       Tertiary Private Hospital

Participants:              Chart review of adult Filipino patients who underwent parathyroidectomy for PHPT at Makati Medical Center from January 2011 to December 2016 was conducted and evaluated according to the inclusion and exclusion criteria. Medical information obtained included clinical parameters, biochemical results, operation performed, pathology, length of hospital stay and complications if with any.

Results:          From among 20 adult Filipino patients (mean age 55 years; 13, 65% female) who underwent parathyroidectomy for PHPT, HBS was found in 7 (35%). Most common pre-operative symptoms of hypercalcemia were musculoskeletal complaints. To prevent HBS, all were hydrated prior to surgery, while some were given bisphosphonates and diuretics. The most common parathyroid gland imaging used for pre-procedure localization was Tc 99m Sestamibi scan with single photon emission computed tomography (SPECT) and 19 (95%) had parathyroid adenoma on post-operative histopathologic report. Among biochemical and clinical factors that may be risk factors for HBS, those with HBS had significantly lower pre-operative 25-hydroxyvitamin D, higher BUN, phosphate and alkaline phosphatase (ALP) than those without HBS. Of these, only ALP showed significant association with HBS (OR = 107.17, p = <0.0001). Length of hospital stay was longer among those with HBS, although not statistically significant.

Conclusion:    Knowledge on post-parathyroidectomy HBS for PHPT may aid clinicians on pre-operative prevention and post-operative monitoring. Thirty-five percent (7) of our patients presented with HBS post-parathyroidectomy for PHPT from 2011 to 2016. An abnormal ALP level pre-operatively may be a risk factor in developing HBS post-parathyroidectomy for PHPT.

Keywords: primary hyperparathyroidism, hungry bone syndrome, Philippines
Risk Factors for Recurrent Papillary Thyroid Carcinoma
Authors: Gloria Jonel Donn Leo S. , Pontejos Alfredo Quintin Y. , Grullo Precious Eunice R.
Published: April 2019

Objective:  To identify risk factors associated with disease recurrence among Filipinos with papillary thyroid carcinoma (PTC).

Methods:

Design:           Retrospective cohort study

Setting:           Tertiary National University Hospital

Participants: 76 patients diagnosed with papillary thyroid carcinoma, classified as low and low-to-intermediate risk (2015 ATA classification) that underwent total thyroidectomy with or without neck dissection from 2010-2014 and were followed up from 10 months to 5 years. Log rank and Cox regression analyses were used to determine significant risk factors for recurrence.

Results:  29 (38.15%) had recurrence.  On univariate analysis, age, tumor size, multifocality, extrathyroidal extension, presence of lateral neck nodes and RAI therapy were statistically associated with recurrence.  However, on multivariate analysis, no clinicopathologic factor was statistically associated with recurrence.

Conclusion: Age of >45 years, female sex, tumor size of >2 cm, multifocality, presence of microscopic extrathyroidal extension, and lymph node metastasis might contribute to the recurrence of papillary thyroid cancer while post-operative radioactive ablation may have some protective effect.  However, this study suggests that other factors must be included in the model to better understand the relationship between these factors and recurrence.

 

Keywords: papillary thyroid cancer, thyroid neoplasm, recurrence
Joseph Anthony R. Rivera, MD (1980-2016)
Authors: Gelera January E.
Published: April 2019

It is an honor to write this tribute to honor Dr. Joseph Anthony ‘Otep’ Rivera (1980-2016) – a friend, colleague, teacher, brother, uncle and son.

How do you describe a person, a friend, who led an extraordinary life, that the loss of his companionship and example defies measurement?

Can his life be measured by his accomplishments in his field of work, patients’ illnesses dispelled, and injuries healed? Perhaps. As important as his labor was though, as certain and measurable his accomplishments are, what remains of Otep in our memories will be his warmth and humanity.

Otep and I were batch mates, and anyone familiar with the circumstances of this unique relationship knows there can be no small degree of friction and quarreling on occasion. We had our share, but he would drop any issue of contention to help me in times of need.

Otep had a relaxed approach to problem solving, displaying initiative and ingenuity in organizing the resources needed to solve any challenge. His passion for community service was recognized by his colleagues, and deeply appreciated by the people he helped.

He had a charismatic personality that drew people to him. People listened to him, followed him.    What made him special was his love for people, all people.  This was apparent by the work he chose.  Yes, he was a doctor.  Yes, he trained to be an ear, nose and throat specialist.  However, this was not enough for him. He devoted his extra time working as an emergency medical technician, responding to emergency calls.  He also found time to be a firefighter during his days off. I don’t know how he found the time. Given his other responsibilities, it simply defies the laws of physics. After residency, aside from establishing his private practice, he taught clinical ENT to medical students at Our Lady of Fatima Medical University.   He also worked as the Chief Medical Officer of the Municipality of Apalit, Pampanga.  His work as a rural health provider left the people of Apalit not only with better medical care, but also with the awareness they now had a new friend.

During residency, we remember Otep as a dependable, resourceful, committed friend, who loved life and all it offered.  His passion for cars was legendary.  If you had car trouble, you asked Otep. If you want to trade or buy cars, you asked Otep. You could ask Otep, even if you were stuck in traffic (he had a solution for everything). In addition, he was fun to work with, always ready to tell an anecdote or two to lift one’s spirit and make the workplace fun and enjoyable.

His life may have been cut short by an incurable illness, but to me, it was a life well lived.  Otep was a cherished friend to many, an awesome brother and uncle and a loving son—he will be missed, but never forgotten by those who are fortunate enough to have known him.
Reliability and Validity of the Filipino Sino-Nasal Outcome Test (SNOT) 22
Authors: Maningding Christine Anne C. , Roldan Rodante A.
Published: April 2019

Objective: To translate the Sino-Nasal Outcome Test (SNOT)  22 into Filipino, and establish the validity and reliability of the Filipino version of the Sino-Nasal Outcome Test (SNOT)  22.

 

Methods:

Design:           Prospective Cohort

Setting:           Tertiary Government Training Hospital

Participants: Twenty one (21) patients with rhinosinusitis with or without nasal polyposis were administered the Filipino SNOT 22 to determine reliability. Sixty three (63) patients with rhinosinusitis with or without nasal polyps and forty eight (48) controls were recruited for the validity study.

 

Results: The Filipino SNOT 22 had a Pearson correlation of 0.618 significant at the 0.01 level and a Cronbach’s alpha of 0.76. The calculated Z-Score was 7.21 with p-value < .00001 significant at p < .05. The value of U was 300 with a critical U value at 1512.

 

Conclusion: The self administered Filipino SNOT 22 is a reliable and valid tool for measuring QOL among Filipino patients with rhinosinusitis.

 

Keywords: sinusitis, reliability and validity, quality of life, sino-nasal outcome test 22
Crab Shell Impaction in the Larynx with Aphonia
Authors: Parekh Nayan M. , Kashyap Prashant R.
Published: April 2019

Objective:      To report a case of crab shell impaction at the glottic level presenting only as aphonia and cough.

Methods

Design:           Case Report

Setting:           Tertiary Government Hospital

Patient:           One (1)

 

Results:          A 36-year-old male, who presented in emergency with sudden aphonia after a meal, was found to have crab shell with leg spines impacted at the glottic level. Due to its large size, ragged edges and the sharp spines stuck in the tissue, endoscopic removal needed a prior tracheostomy. All pieces were extracted, with no bleeding, laceration or tissue damage. The patient completely recovered with normal vocal folds and a normal voice at follow up.

Conclusion:    Our experience suggests that an impacted foreign body may warrant a tracheostomy to secure the airway prior to extraction, and avoid any possible complications including laryngeal injury.

Keywords: foreign body, larynx, crab shell, loss of voice
Carlos F. Dumlao, MD (1950-2018)
Authors: Pontejos Alfredo Q.Y.
Published: April 2019

Carlos F. Dumlao, ‘Caloy’ as he is fondly called by friends, was born in Bayombong, Nueva Vizcaya on November 4, 1950. He studied in the Bayombong Central School for elementary, then the Nueva Vizcaya High School, graduating valedictorian from both schools.  He took his B.S. Pre-Med in the University of the Philippines (U.P.) Diliman, finishing in 1970. He then entered the U.P. College of Medicine and graduated in 1975. He is a brod in the Mu Sigma Phi Fraternity where I got to know him. He was one-year senior and he would always have a helping hand to anyone in need. He looked fearsome because of his bulk and stance but deep inside he had a soft heart and was very humble, for a guy who happened to be a son of a governor.

 

Faith would have that we would be together again in the Department of Otolaryngology in the Philippine General Hospital. He was my immediate senior and helped and taught me the rudiments of surgery. He was one of the "fastest guns alive" that he could finish a laryngectomy in an hour. 

 

Because of the prodding of Dr. Mariano B. Caparas, he took up the challenge of practicing in Baguio with the objective of establishing a training program there. The first few years were a challenge to him because he was not welcome there.  The senior surgeons frowned on the fact that he performed head and neck surgery, particularly thyroidectomy. But he persisted and even befriended them. He succeeded in forming a Department of Otolaryngology - Head and Neck Surgery in the Baguio General hospital. He gave much of his time and talent to that department and has produced a good number of diplomates and fellows.

 

He was unpretentious. What you see is what you get. He was also a true friend and a dedicated family man. He was faithful to Josie, his wife and his children Janie, Dessy, Biboy, Joboy and Popo.

 

One measure of success of a leader is the number of successors you have produced. He has done well in this. He has given much of himself to Baguio General Hospital, the Philippine Society of Otolaryngology – Head and Neck Surgery (PSO-HNS) Northern Luzon Chapter and to the PSO-HNS as a whole. His legacy will live on in his graduates in Baguio General Hospital and through his son Popo who just passed the Philippine Board of Otolaryngology – Head and Neck Surgery diplomate board examinations. Caloy, you have left you mark in Northern Luzon, particularly in Baguio City. May you rest in peace in God’s bosom.
WALKING WALKING TOUR ORGANIZER: AN INDONESIAN TRAVEL AGENT GOES INTERNATIONAL
Authors: Muhammad Maulana , Kusuma Fitri Anggreni , Apriliani Dewi , Elianne Inthe Ingrid Claudia , Rizqillah Hakim Mikhael Zulfikar , Diyanisa Santi , Alrashidi Hala Shaud
Published: April 2019

Walking Walking Tour Organizer is tour service located in Malang, East Java, Indonesia. So far Walking Wlaking Tour Organizer mostly serve consumer in Malang. Walking Walking Tour Organizer have commitment want to be a company could be worldwide.Asian country should be very good for target market because most of the total of tourist visiting Indonesia is from Asian country.
ENHANCE PROMOTION STRATEGIES CV UTERO GO INTERNATIONAL
Authors: Eka Albertus , Solis Roberto J Albuja , Voight Lea , Nuriah Nuriah , Win Swe Swe , Kawther Ashknani
Published: April 2019

With ongoing globalization, many business opportunities emerge all over the world. Operating business in one single country means to fail at exploiting additional profit from exporting one’s product or service globally.

The following report will analyst the business operations of the company Utero, a creative design agency, responsible for brand, design and consultant services and located in Indonesia. As the company is already very successful in their country of origin, they should start exporting their services to other countries, to grow and yield additional profit.

In order to do so, we will construct a marketing plan for Utero, based on a thorough analysis of the company’s background, its vision, mission and organizational structure. Also, we are going to assess the readiness of the company to do international marketing. Finally, we are going to give advice on how to successfully develop and implement international marketing, to enter markets all over the world.

We found, that Utero should implement different marketing strategies, such as publishing a video of the firm online to increase brand awareness and spread it on social media networks such as Facebook. Other possible ideas would be to create a company-based Facebook page or create advertisement that will be displayed on YouTube.

In general, our report aims at leading the company Utero on a successful path for further development and we believe that our proposed marketing plan will enable the company to significantly expand their business.
IMPROVE THE PROMOTION STRATEGY OF KAN JABUNG
Authors: Ummah Faiqotul , Iddo Charistantya , Hakimy Abdul Wahab , Amalia Shelma , Minggus Tommy , Cutrona Ludovica Fortunata
Published: April 2019

KAN Jabung is a cooperative established in 1979. KAN Jabung is a cooperatives that run several business. But, the main business for KAN Jabung is product from cow. Producing dairy milk for people is one of the core business. Lately, milk is become a vital need for people. Milk is the best way to maintain human good health. Delicious taste will never bored people who consume milk. In fact, milk consumption is raising year by year. But, people in the outskirt of the town still has a minimum consumption. So, team 22 think a strategy that suit in these facts. The strategy is going to take an advantage from minimal educating about milk. Milk nutrition isn’t just about the vitamin or calcium, but natural nutrition from milk still brought by the pasteruate ways. Because in UHT way, the nutrition is wasted because of heat and the company has to fill artificial nutrition and in people mindset natural is always better than artificial.

Our effort is based on KAN Jabung vision and mission. Being competitive agribusiness cooperatives, and grow sustainably is KAN Jabung vision. This vision means that KAN Jabung has to improving steadily and sustain the profit. Taking segment in family and kids, KAN Jabung hope is to penetrate this product until accepted by citizen in uptown and downtown.
The Influence of Semiotic Advertising Efficacy on Gen-Y Purchase Intent of Smart Phone
Authors: Oputa Elizabeth Adaobi , Ahmad Fakhrorazi
Published: April 2019

The paper presents an empirical analysis to demonstrate the influence of semiotic advertising efficacy on generation-y purchase intent of smart phone. Semiotic advertising is an effective, modern approach to advertising that focuses on the use of different signs, symbols, images and other visual aids for the purpose of marketing a given product or service. Since these signs tend to create an image of the brand in minds of consumers and also demonstrates the brand association with their cultural orientation, beliefs and values, semiotic advertising is said to have a significant impact on the brand equity as perceived by generation y customers. The study also confirms that since higher brand equity based on its components of perception, recognition, parity, loyalty and trust influences the purchase intentions and decisions of generation-y smart phone users positively, semiotic advertising must also have a positive influence on the purchase intent of the buyers.

The study has thus been based on the responses received from 620 generation-y smart phone users from a survey based on an instrument developed by the researcher to measure semiotic advertising efficacy, brand equity and purchase intentions as perceived towards advertisements of four smart phones shown to the respondents while undertaking the survey. The data obtained from the questions based on Likert scales has been analysed to prove the hypotheses as derived in the study. Outcomes as based on statistical path analysis establish that overall equity of a brand as perceived by generation y customers, increases with an increase in semiotic advertising efficacy and also the perceived brand equity has a positive and direct influence on purchase intentions. It is hence concluded from the discussions and findings that the purchase intentions of generation y smart phone users increase when the efficacy of semiotic advertising increases. The brands can be recommended to thus make sure that the visual elements and semiotics used in their advertisements align with cultural characteristics of buyers to enhance their overall efficacy.
Is Money the Biggest Motivator in the Workplace? What We Learn from Real-Life Facts.
Authors: Bhebhe Mqondisi
Published: April 2019

In response to Maslow’s (1943) hierarchy of needs, business executives today favour the use of non-financial rewards over money, resulting in a lot of dissatisfaction in the workplace. This paper analyses both the primary and secondary evidence, focusing on the causes of corruption, industrial strikes and the general behaviour towards money in an effort to guide employers on the best motivation technique. Findings suggest that most individuals can embark on violent and destructive behaviour if they are not paid in cash and are reluctant to fight for non-monetary rewards. However, to perfectly motivate the workforce, it concludes by recommending a mixture of both but with more emphasis on financial rewards, regardless of the individual’s corporate development level.