Objective: To fabricate an inexpensive, reproducible and portable ringlight with flexible, quick-release mount for use with point-and-shoot consumer digital cameras in intraoral photodocumentation. Methods: Design: Instrumentation Setting: Tertiary Care Hospital Procedure: A commercially-available battery-powered mountaineer’s LED (Light Emitting Diode) headlight was converted into a portable ringlight with a flexible, quick-releasemount for intraoral photodocumentation. Results: The Flexmount Ringlight delivered an even and white illumination of the oral cavity and oropharynx at a working distance of more than 5cm from the subject in focus. It resulted in sharper pictures due to its constant illumination that assisted the camera’s autofocus system in getting accurate focusing intraorally. It also allowed the camera to use smaller apertures that have put more elements in focus and faster shutter speeds that have markedly reduced motion blur. Conclusion: The Flexmount Ringlight is an inexpensive, easy-to-assemble and portable ringlight that can be used in point-and-shoot consumer digital cameras. Its constant and even illumination resulted in reproducible, sharp, shadowless photographs of the oral cavity and oropharynx.

Objective: To describe the clinical and demographic profile of patients who underwent pediatric Endoscopic Sinus Surgery (ESS) and the indications for which the procedure was performed. Methods: Design: Cross-sectional Study Setting: Tertiary Government Hospital Subjects: Using the medical record registry, all patients below 18 years of age who underwent ESS under the Department of Otorhinolaryngology – Head and Neck Surgery of a tertiary government hospital in Metro Manila between December 31, 1999 and January 1, 2008 were reviewed. The age, sex, clinical presentation indications for doing ESS and extent of surgery done were described. The Lund MacKay Grading for nasal polyposis and Scoring for sinusitis were also applied and cross-referenced. Results: Twenty-seven children aged 7 to 17 years underwent ESS. The mean age was 12.9 years with most (15 patients) belonging to the adolescent age group (13-17 years). Male to female ratio was 1.45:1. The mean interval from onset of symptoms to the first outpatient consultation was 1.5 years; the most common presenting symptoms were nasal obstruction (85.2%) and discharge (59.3%). All of the patients who underwent pediatric ESS had chronic rhinosinusitis: either with nasal polyposis (85.2%), an antrochoanal polyp (11.1%) or both (3.7%). The Lund Mackay Grading for nasal polyps and sinusitis scores were cross-referenced: patients with larger, grade III nasal polyps tended to have more extensive sinus disease than those with grade II polyps. On their first consultation, the patients tended to present with extensive nasal polyp and sinus disease indicating the need for surgery. All patients with CRS and nasal polyposis underwent polypectomy with ethmoidectomy, uncinectomy and maxillary antrostomy, with additional frontal sinusotomy for a 17-year-old male and a 17-year-old female, both with grade 3 polyposis. The three patients who had antrochoanal polyps underwent polypectomy with uncinectomy and maxillary antrostomy. There were no operative complications such as cerebrospinal fluid leak and orbital injury reported.

Objective: To report successful marsupialization of a large Tornwaldt cyst using combined transnasal and transoral endoscopic surgery in a 7-year-old girl who presented with nasal obstruction. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Result: A 7-year-old girl presented with an 11-month history of recurrent yellowish nasal discharge gradually associated with nasal obstruction. Examination revealed a large, well encapsulated, broad-based cystic mass in the nasopharynx immediately adjacent to the posterior choanae, continuing posterior to the soft palate (pushing the uvula anteriorly) and extending inferiorly to the epiglottic area. Computerized Tomography (CT) demonstrated a well-circumscribed, midline hypodense mass with fluid attenuation obstructing the nasopharyngeal area extending inferiorly to the oropharyngeal area. Endoscopic marsupialization via transnasal and transoral approach was successful, and a respiratory epithelium-lined cyst consistent with a Tornwaldt cyst was confirmed by histopathologic examination Conclusion: Combined transnasal and transoral endoscopic marsupialization is possible a for a large symptomatic Tornwaldt cyst in a pediatric patient with relatively smaller and complex nasal cavities.
endoscopy ; cyst ; Nasopharynx ;

Cysteine-rich secretory protein-1 (CRISP-1) is a glycoprotein secreted by the epididymal epithelium. It is a member of a large family of proteins characterized by two conserved domains and a set of 16 conserved cysteine residues. In mammals, CRISP-1 inhibits sperm-egg fusion and can suppress sperm capacitation. The molecular mechanism of action of the mammalian CRISP proteins remains unknown, but certain non-mammalian CRISP proteins can block ion channels. In the rat, CRISP-1 comprises two forms referred to as Proteins D and E. Recent work in our laboratory demonstrates that the D form of CRISP-1 associates transiently with the sperm surface, whereas the E form binds tightly. When the spermatozoa are washed, the E form of CRISP-1 persists on the sperm surface after all D form has dissociated. Cross-linking studies demonstrate different protein-protein interaction patterns for D and E, although no binding partners for either protein have yet been identified. Mass spectrometric analyses revealed a potential post-translational modification on the E form that is not present on the D form. This is the only discernable difference between Proteins D and E, and presumably is responsible for the difference in behavior of these two forms of rat CRISP-1. These studies demonstrate that the more abundant D form interacts with spermatozoa transiently, possibly with a specific receptor on the sperm surface, consistent with a capacitation-suppressing function during sperm transit and storage in the epididymis, and also confirm a tightly bound population of the E form that could act in the female reproductive tract.
Amino Acid Sequence ; Animals ; Conserved Sequence ; Humans ; Male ; Mammals ; Membrane Glycoproteins ; genetics ; metabolism ; Molecular Sequence Data ; Rats ; Spermatozoa ; physiology

BACKGROUND: Implantable cardioverter-defibrillator (ICD) is the therapy of choice in the prevention of SCD. The ICD has been proven to improve survival among survivors of cardiac arrest, patients who are at risk of having one because of myocardial scarring and low left ventricular ejection fraction, and those with primary inherited arrhythmia syndromes. The insertion of an ICD is indicated for survivors of cardiac arrest due to ventricular fibrillation or hemodynamically unstable sustained ventricular tachycardia after the exclusion of any reversible cause. At present, there are no nationwide data regarding the prevalence of ventricular tachyarrhythmias requiring an ICD. OBJECTIVES: The aim of this study was to determine the (1) total hospitalization claims per year (2017 and 2018) for arrhythmias requiring an ICD, (2) total number of cardioverter-defibrillator insertions done for patients mentioned in (1), (3) prevalence of hospitalization for cardiac arrhythmias requiring insertion of ICD among patients admitted for medical conditions for 2017 and 2018, (4) the demographic profile of patients who were hospitalized for cardiac arrhythmias requiring insertion of ICD, (5) type of facilities (primary, secondary, or tertiary; government or private) where the patients were confined, and (6) duration of hospitalization and mortality rate of patients admitted for the above conditions. METHODS: This is a descriptive study using the database of Philippine Health Insurance Corporation (PhilHealth) on hospital claims of admitted patients 19 years or older in PhilHealth-accredited hospitals from January 1, 2017, to December 31, 2018. Anonymized records were reviewed using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) of the World Health Organization. The codes relevant to the study question were chosen and used. The PhilHealth Relative Value Scale (RVS) codes were used to determine the procedures that the patients underwent for their cardiac arrhythmias. Patients’ demographic profile, diagnosis, region, hospitalization stay and status on discharge, and type of facility of admission were collected. Descriptive statistics using median value and interquartile range for quantitative data and frequency and percentage for categorical data were reported. RESULTS: In 2017 and 2018, among patients 19 years or older, there were 1282 and 1480 claims of cases of cardiac arrhythmias requiring an ICD (based on ICD-10 codes), whereas those who underwent placement of an ICD (based on RVS codes) numbered 50 and 45, respectively. The prevalence of hospitalization for cardiac arrhythmias related to ICD among patients who were admitted for medical conditions was 0.05% and 0.06%, for the same years. The overall in-hospital mortality rates were 10.84% and 9.46% in each year for those who were admitted for cardiac arrhythmias that required an ICD; however, there were no recorded mortalities for those who underwent implantation of a cardioverter-defibrillator. For patients with arrhythmias requiring an ICD (based on ICD-10 and RVS codes), the median (first quartile [Q1], third quartile [Q3]) age was 59 (43, 72) years. In 2018, the median (Q1, Q3) age was 57 (38, 71) years. There were similar proportions of males (53%) and females (47%) in both years. The majority of cases based on ICD-10 codes of cardiac arrhythmias requiring an ICD were confined in government hospitals, whereas most of the claims for procedures based on RVS codes were in private hospitals. Most of the procedures were done in the National Capital Region. The duration of hospitalization was 3 to 4 days. CONCLUSION Based on PhilHealth claims, the admission due to cardiac arrhythmias requiring ICD is common in both private and government hospitals. Cardioverter-defibrillator implantation is being done mostly in the National Capital Region and private hospitals. There is a wide gap between the prevalence of cardiac arrhythmias requiring an ICD and the frequency of implantation of the lifesaving device.
implantable cardioverter-defibrillator ; Defibrillators, Implantable ; Death, Sudden, Cardiac ; Brugada Syndrome

INTRODUCTION: Radiofrequency catheter ablation (RFA) is an interventional cardiac electrophysiologic procedure that uses heat energy for definitive management of supraventricular tachycardias. It is a class I recommendation for chronic management of most supraventricular arrhythmias. No local data exist in the incidence hospitalization for SVT and utilization of RFA for this condition. The study aimed to obtain the prevalence of hospitalization of patients with supraventricular tachycardias where RFA is utilized, including the patients’ demographic profile, length of hospitalization, and mortality rate. METHODOLOGY: Philippine Health Insurance Corporation claims for hospitalization from January 1, 2017, to December 31, 2018, were reviewed. Data analysis was done using median and interquartile range for continuous data, and frequency and percentage distribution for categorical data. RESULTS: There were 1121 and 1149 claims for hospitalization for SVTs (atrial paroxysmal tachycardia, atrioventricular paroxysmal tachycardia, nodal paroxysmal tachycardia, and junctional tachycardia) in 2017 and 2018, respectively. This represents four hospitalization claims for SVT per 10,000 of the total PHIC claims. The majority of patients were female with median age of 52 years. Only 25 and 19 patients underwent radiofrequency ablation in 2017 and 2018, respectively. The majority of these patients were male and younger with a median age of 31 years. No mortality was recorded among patients admitted for catheter ablation. CONCLUSION In 2017 and 2018, hospitalization claims for SVT requiring catheter ablation were 0.04% (four hospitalization claims for SVT per 10,000 of the total claims) in both years. The majority of patients were admitted with pharmacologic therapy on discharge with very low utilization of radiofrequency ablation for long-term management.
Arrhythmias, Cardiac ; Tachycardia, Supraventricular ; Radiofrequency Ablation ; prevalence ; Hospitalization

BACKGROUND: Symptomatic bradycardia, commonly attributed to sinus node dysfunction/ sick sinus syndrome, or atrioventricular (AV) blocks or conduction disorders from chronic fascicular blocks, is treated by implantation of a permanent pacemaker. Despite it being a class 1 recommendation, there is a perception based on informal surveys that permanent pacemaker implantation (PPI) is underutilized. The Philippines showed slow growth in the volume of implantation from 1049 in 2015 to 1225 in 2016. The Philippine pacemaker data after 2016 are incomplete and unreliable because of the lack of a national registry. It is the aim of this study to ascertain the prevalence of cardiac arrhythmias requiring PPI and the volume of its utilization in the Philippines. OBJECTIVES: The aims of this study were to (1) to determine the prevalence of hospitalization claims in 2017 and 2018 for cardiac arrhythmias requiring PPI, (2) to determine the regional distribution of arrhythmias requiring PPI, (3) to determine the regional distribution of hospitalization claims for PPI, (4) to determine the number of hospitalization claims for specific cases requiring PPI and the corresponding mortality rate, (5) to determine the number of hospitalization claims for PPI and the corresponding mortality rate, and (6) to describe the demographic profile of patients with indications and with claims for PPI, as well as the duration of hospitalization and type of facilities where the hospital claims were filed. METHODS: This is a descriptive study of Filipino patients 19 years or older, admitted for cardiac arrhythmias requiring PPI in the Philippine Health Insurance Corporation (PhilHealth)–accredited hospitals in 2017 and 2018. The data for disease prevalence were gathered from the database of PhilHealth using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) of the World Health Organization. The procedures that the patients underwent were determined using the latest PhilHealth Relative Value Scale (RVS) codes. Other variables gathered were the demographic data, diagnosis, region, duration of hospital stay, type of facility on admission, and the status on discharge. Qualitative data were tabulated and presented as frequency and percent distribution. Quantitative data were reported as median with corresponding quartiles (Q1 and Q3). RESULTS: Based on the 2017 and 2018 database of PhilHealth, out of the nationwide total medical admissions, there were 958 total claims for arrhythmias requiring pacemaker implantation in 2017 and 1144 total claims in 2018. The prevalence in both years was similar (0.04%). There were 549 and 683 total claims for PPI, in 2017 and 2018, respectively, and preponderantly done in the National Capital Region. Sick sinus syndrome/tachycardia–bradycardia syndrome had the greatest number of total claims for both years. More than half of the patients who had PPI were females. The median age was similar (67 and 68 years old for both years and 73 and 75 years old in 2017 and 2018, based on ICD-10 and RVS codes, respectively). The duration of hospitalization was a median of 4 days (ICD-10 codes) and 5 to 6 days (RVS codes). Most of the hospital claims for cardiac arrhythmias (76%–79%) requiring PPI were filed in private facilities. Mortality among those diagnosed was 3.6% for complete atrioventricular block and 0.3% for sick sinus syndrome but was low among those who underwent PPI (0.8%–2.2%). CONCLUSION The prevalence of hospitalization claims for arrhythmias requiring PPI was 0.04%, both in 2017 and 2018. There is a big gap between the number of cases requiring a permanent pacemaker and the number that underwent the procedure. Hospitalization claims, based on ICD-10 codes and RVS codes, were centralized in the National Capital Region and private hospitals. The mortality rate among those who had the procedure was low.
Arrhythmias, Cardiac ; prevalence ; Hospitalization

BACKGROUND: Radiofrequency ablation (RFA) is the recommended treatment of choice for supraventricular tachycardia (SVT), whereas implantable cardioverter-defibrillator (ICD) is recommended for patients at high risk for sudden death due to ventricular tachycardia/fibrillation. Radiofrequency ablation has been proven to improve the quality of life of patients with SVT, whereas an ICD has been shown to reduce mortality among patients at risk for sudden cardiac death. Both procedures are expensive and usually beyond the reach of the average Filipino patient. OBJECTIVES: The objectives are to (1) determine the cost of hospitalization for cardiac arrhythmias that require RFA and cardioverter-defibrillator implantation in the Philippines, (2) propose revised Philippine Health Insurance Corporation (PhilHealth) benefit packages for both procedures, and (3) determine the budget impact of the proposed revised packages. METHODS: Hospitalization costs were obtained for both RFA and cardioverter-defibrillator implantation from two government tertiary care hospitals. A range of hospitalization costs involving possible lower and higher cost scenarios was estimated. Based on these estimates and the yearly number of arrhythmias that require these procedures, revised benefit packages for both RFA and cardioverter-defibrillator implantation were proposed to PhilHealth. The budget impact analysis for the first 3 and 5 years of implementation of these revised packages was subsequently calculated. RESULTS: The estimated hospitalization costs for RFA ranged from Philippine pesos (PHP) 248,485 to 310,480, whereas for cardioverter-defibrillator implantation, the costs ranged from PHP 509,122 to 581,940. These amounts are greatly disparate from the present PhilHealth coverages, which are PHP 9700 and 18,000 for RFA and cardioverter-defibrillator implantation, respectively. Based on these hospitalization costs, the proposed RFA benefit package is PHP 275,000 to 310,000, whereas for an ICD benefit package, PHP 513,000 to 576,000 is proposed. The incremental cost of more than PHP 300 million for RFA and more than PHP 700 million for an ICD is distributed for the next 3 or 5 years of implementation for these benefit packages, respectively. CONCLUSION The present PhilHealth case rates for both RFA and cardioverter-defibrillator implantation are greatly underestimated, which probably is the reason for their underutilization. There is a need to revise these case rates with due consideration of their actual hospitalization costs to lessen inequity in accessing these procedures.
Radiofrequency Ablation ; Defibrillators, Implantable