Human ; Male ; Female ; Nursing ; Nursing Care ; Professional Practice

OBJECTIVE: To determine the presence or absence of gross laryngeal or vocal cord pathology during endoscopic examination and determine if there is a relationship between these findings, the number of years in teaching, and the presence of other risk factors among teachers in a public secondary school in Bacolod City.

DESIGN: Cross-sectional Study

SETTING: Secondary Public School in Bacolod City, Philippines.

PARTICIPANTS: A total of 50 school teachers participated in the study conducted from July 2016 to May 2017. They completed a questionnaire on demographic data, professional profile and lifestyle profile and underwent laryngoscopic examination.

RESULTS: The most common pathologic laryngoscopic findings were vocal fold nodule (12%), swollen arytenoids (10%), paretic vocal cords (6%) aqnd epiglottic mass (6%). There was no significant relationship between laryngoscopic findings and number of years teaching (X2 = 0.103, df = 1, p = .748). However, there was a significantrelationship between laryngoscopic, smoking (X2 = 6.419, df = 1, p = .011) and daily water intake (X2 = 10.208, df = 2, p = .006).

CONCLUSIONS: Results of this study suggest that in terms of voice care, public school teachers may benefit from avoidance of smoking and increased water intake.

Human ; Male ; Female ; School Teachers ; Hoarseness ; Voice ; Vocal Cords ; Laryngoscopy

Objective: To determine the presence or absence of gross laryngeal or vocal cord pathology during endoscopic examination and determine if there is a relationship between these findings, the number of years in teaching, and the presence of other risk factors among teachers in a public secondary school in Bacolod City.

 

Methods

Study Design:      Cross-sectional study

Setting:                 Secondary public school in Bacolod City, Philippines          

Participants:        A total of 50 school teachers participated in the study, conducted from July 2016 to May 2017. They completed a questionnaire on demographic data, professional profile, and lifestyle profile and underwent laryngoscopic examination.

 

Results: The most common pathologic laryngoscopic findings were vocal fold nodule (12%), swollen arytenoids (10%), paretic vocal cords (6%) and epiglottic mass (6%). There was no significant relationship between laryngoscopic findings and number of years teaching (X2 = 0.103, df = 1, p = .748. However, there was a significant relationship between laryngoscopic findings, smoking (X2 = 6.419, df = 1, p = .011) and daily water intake (X2 = 10.208, df = 2, p =.006).

 

Conclusions: Results of this study suggest that in terms of voice care, public school teachers may benefit from avoidance of smoking and increased water intake.

 

Keywords:  teachers, vocal cord, hoarseness, voice, laryngoscopy, videostroboscopy

 

Human ; Male ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Hoarseness ; Voice

A 16-year-old male-looking patient presented at the emergency room for severe abdominal pain. Physical examination revealed acute abdomen, ambiguous genitalia, empty rectal vault with watery discharge and right lower quadrant palpable mass. Ultrasound showed a uterus and right adnexal mass. General surgery evaluated urethral patency and noted presence of recto-urethral fistula. Surgical exploration, right salpingo-oophorectomy and suprapubic cystostomy were done. Immediate referral to a reproductive endocrinologist was done postoperatively. Retrograde urethrogram and cystogram revealed neurogenic bladder with fistula formation. On follow up, whole abdomen MRI revealed thickened endometrium with fluid levels, tortuous left fallopian tube, multiloculated left adnexal mass and left renal agenesis. Serum levels of 17-hydroxyprogesterone and cortisol were noted to be elevated and karyotyping revealed 46 XX. Patient then underwent psychiatric evaluation and assessment. Patient was readmitted for urology and pediatric surgery diagnostic work up. However, regardless of the findings, patient decided not to undergo further surgeries and opted to be female.
Hyperplasia ; Vagina, absence of

The surgical management in a case of vaginal agenesis is technically challenging and requires a strong demand for expertise. The objective of this report was to record the hospital's first experience in vaginal reconstruction using Bilateral Pudendal Thigh Fasciocutaneous Flap. Presented here is a case of 23-year old, female who consulted for primary amenorrhea who plans of getting married soon. Physical examination revealed normal secondary sexual characteristics with absent vagina. Imaging revealed an absent uterus with normal ovaries and distal vagina that ends in a blind pouch. Patient underwent vaginal reconstruction with no post-operative complications. Follow-up revealed incision site infection but eventually resolved with oral and topical antibiotics. Four weeks post-operatively, good wound healing was noted, vagina was 6 centimeters in length, admits two fingers on internal examination. Overall, the authors' first neovaginoplasty using Bilateral Pudendal Thigh Fasciocutaneous Flap was a technically safe procedure with good cosmetic outcome.

Surgical Flaps ; Vagina

OBJECTIVE: This study aimed to evaluate the timing of tracheostomy and relationship to outcomes (length of hospital stay, length of mechanical ventilation, morbidity and mortality rate) in adults with moderate and severe tetanus. 

METHODS:

            Design:           Cross-Sectional Study

            Setting:           Tertiary Government Training Hospital

            Patients:         All adult patients (19 years old and above) diagnosed with moderate and    severe stage tetanus from January 2015 to January 2018 were considered for inclusion.

RESULTS: There were 109 patients included in this study, majority were males (n=95) with a male to female ratio of 7:1. Most belonged to the 51-60 years age group (mean: 53.7 SD: +/-16.1). Based on Cole Tetanus staging, the majority presented with severe stage tetanus (67.9%; n=74). Only 35.8% (n=39) were admitted at the Intensive Care Unit. Early tracheostomy was performed in 56.0% (n=61) of the patients (mean 6.3 hours SD: +/- 4.61). Mortality rate was noted to be 52.3% (n=57). Overall, early tracheostomy among moderate to severe stage tetanus patients showed shorter length of hospital stay and length of mechanical ventilation than  late tracheostomy (tracheostomy >24 hours) (p-value < .05). However, no significant difference was noted for timing of tracheostomy in terms of morbidity and mortality rate (p-value > .05).

CONCLUSION: Early tracheostomy within less than 24 hours from time of admission for moderate and severe tetanus is associated with shorter length of hospital stay and mechanical ventilation than late tracheostomy, and may play a role in tetanus management.

KEYWORDS: tracheostomy; tetanus; hospital stay; mechanical ventilation; morbidity; mortality

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Tetanus ; Length Of Stay ; Morbidity ; Mortality

Objective: To investigate the distribution and aerosolized particle counts generated during mastoidectomy, we utilized low-cost and locally available material and developed a plastic tent creating a barrier between the health care workers (HCW) and patient. Methods: The barrier tent is a clear plastic bag attached to the microscope lens. The tent is draped and tucked underneath the patient’s head and upper torso with surgeon’s arms also passed underneath and secured with clamps. We demonstrated the area of greater contamination by spread of droplet particles and bone dust after drilling using fluorescent dye. Particle counts inside and outside the barrier was determined and then comparison with and without the tent after drilling of cadaveric temporal bone were also done. Results: The area with highest concentration of contamination (“hot zone”) was noted opposite the surgeon’s hand drill which is dependent on the operator’s handedness. Other hot zones noted were opposite the operator and on the operator’s side. Particle determination of aerosol size 0.3 and 2.5µm inside the barrier tent were at peak levels after bone drilling procedure. Then a significant drop of particle counts was noted at 2 minutes after drilling was stopped with flattening observed at 8 minutes. Conclusion Our experimental results suggest that the improvised barrier tent can be effective in mitigating aerosols generated during mastoid surgery and may serve as an added protection for the operating room team.
SARS-CoV-2 ; Mastoid ; COVID-19

Small bowel obstructions are commonly caused by bowel adhesions from previous intra-abdominal surgeries.1 Bowel obstructions in adults that are caused by the presence of vestigial embryonic structures are unusual.2 Omphalomesenteric duct and urachus are primitive embryonic structures, which normally involute between the 5th and 12th week of gestation.3 4 Failure to involute leads to anomalies such as patent ducts and omphalomesenteric cysts.2 5 6 7 Omphalomesenteric duct remnants are present in at least 2% of the population.2 Among the urachal remnants, a patent urachus is less common, only accounting for 15% of the cases.8 Simultaneous occurrence of both remnants is rare.5 Diagnostic imaging, such as ultrasonography, is usually performed to facilitate planning for subsequent management of patients who present with chronic symptoms related to the persistence of these remnants.9 Computed tomography may also be done to determine the location, size and patency of ducts and cysts, while voiding cystourethrograms can be used to determine bladder wall involvement.8 However, among undiagnosed patients who present with acute bowel obstruction, the presence of these remnants is usually established intraoperatively during exploratory laparotomy. The approach to treatment involves excision of the remnants and appropriate surgical management of the bowel obstruction.1 2 5 6 10 11 Prognosis is often good with uneventful postoperative recovery.1 2 5 A 29-year-old male came to our emergency room complaining of generalized, vague abdominal pain, gradual abdominal distension, post-prandial vomiting of previously eaten food, obstipation, and fever within 48 hours before consultation. The patient did not report any history of weight loss or gastrointestinal symptoms prior to the onset of the present problem. On physical examination, the patient was tachycardic and showed signs of an acute abdomen. Digital rectal examination showed an empty rectal vault, with no masses or bleeding noted. Laboratory findings revealed leukocytosis at 18.3 x 103/µL and normal serum electrolyte levels. Upright and supine abdominal x-rays showed dilated bowel loops with thickened serosa and multiple air-fluid levels (Figure 1A, 1B). We did an exploratory laparotomy with a working diagnosis of complete intestinal obstruction. Intraoperatively, we noted torsion of the ileum (Figure 1C) around a band, which runs from the ileum approximately 80 cm from the ileocecal valve, to the umbilicus. The band, an omphalomesenteric remnant, contains a cyst measuring 10 x 4.7 x 3 cm. (Figure 1D). We also noted a patent urachus inferior to the omphalomesenteric remnant, connecting the bladder to the umbilicus (Figure 1E). We detorted the bowels manually, resected the portion of the ileum where the omphalomesenteric remnant was attached, and did a double-barrel ileostomy. We excised the urachal remnant and performed cystorrhaphy and umbilicoplasty. The patient had an unremarkable postoperative recovery. Ileal anastomosis was planned to take place around 6 weeks postoperatively. Given the unexpected intraoperative findings of persistent embryonic structures, we asked the patient postoperatively about history of related symptoms. The patient denied of recurrent urinary tract infections in the past, but he claimed to have intermittent umbilical wetness with non-foul-smelling discharge, which spontaneously resolved after a few years, when he was a teenager. Omphalomesenteric remnants can be a cause of intestinal obstruction in adults with no previous history of surgery. A history of symptoms related to the presence of the remnants is rarely elicited preoperatively. Excision of the remnants with appropriate repair of affected structures and adequate management of the intestinal obstruction usually resolves the problem.
Intestinal Obstruction ; Urinary Bladder Diseases

BACKGROUND: In the Philippines, screening for ear problems especially in children at entry to school is usually undertaken by school nurses and teachers who typically do not have specialized instrumentation. The penlight has recently been employed as screening method in determing the possibilities of ear problems in public school communities. This study attempts to determine the accuracy of the penlight as an alternative method for screening to assess the common external ear abnormalities among Grade 1 students in an elementary school. OBJECTIVES: 1. To compare the result of otologic examination using the penlight versus otoscopy in determining of common pediatric ear problems. 2. To determine the sensitivity, specificity and predictive values of penlight examination in the screening of ear canal and tympanic membrane for abnormal conditions among Grade 1 students. METHODS: Otologic examination with the use of a penlight was carried out by the tranined nurse in ears of Grade 1 students and the results compared with those obtained from otoscopy done by an otolaryngologist. Presence of ear conditions such as cerumen, discharge, foreign body, tympanic membrane visualization, and an overall assessment were recorded in an Excel file. The examiners were both blinded with the findings. RESULTS: Ninety-four students (188 test ears) with a median age of 6 years, ranging from 5 to 10 years, and a 1:1 sex distribution were included in the study. The result showed an excellent agreement (P<.001) between the penlight and otoscopic examination. The sensitivity and specificity were of 98.6% and 100%, respectively. The PPV is nearly 100% and NPV of 95.2% and and overall accuracy of 98.94%. CONCLUSIONS There is an excellent agreement between the nurse‘s findings and otolaryngologist‘s findings in examining the ear canal and tympanic membrane. The penlight has on overall accuracy of 98.94%, in identifying cerumen, discharge, foreign body and visualizing the tympanic membrane. Thus, this study shows that with trained nurse in otologic examination, the penlight is an effective screening in identifying common ear problem among children.
Tympanic Membrane