In 2009, a 52-year-old man presented with a two year history of intermittent right-sided pulse-synchronous tinnitus. He noted that the tinnitus worsened when his blood pressure was elevated. Otologic exam was unremarkable, with no obvious middle ear fluid or mass. There was no neck bruit, and the tinnitus diminished on manual compression of the ipsilateral internal  jugular vein. In keeping with the recommendations for clinical imaging at that time, a non-contrast CT of the temporal bone was performed. This was to evaluate for conditions such as : a middle ear glomus, an aberrant internal carotid artery, a jugular bulb variant (e.g. a high-riding jugular bulb), otosclerosis, superior semicircular canal dehiscence syndrome, a persistent stapedial artery, or a hemangioma of the temporal bone.1 No evidence of these conditions was found. An MRI of the brain, with MR angiography and venography of the intracranial vasculature also performed to evaluate for conditions such as:  idiopathic intracranial hypertension, a dural arteriovenous fistula, an arteriovenous malformation, vascular loop syndrome, and dural sinus stenosis or thrombosis.2 All of these conditions were excluded. As no definite pathology was identified, no firm treatment reommendations were initiallly made.

In 2011, Eisenman reported on a series of 13 patients with pulsatile tinnitus due to a sigmoid sinus diverticulum and/or dehiscence who were successfully treated surgically via an extraluminal transmastoid approach.3 This was the first relatively large series published in the otologic literature. This publication likewise reported on the subtle radiologic signs that signify the presence of a sigmoid sinus diverticulum and/or dehiscence, such as an irregularity of the normal semicircular contour of the bony sinus wall, focal thinning of the calvarial cortex overlying the adjacent sinus wall, absence of the normal thin layer of cortical bone overlying the sinus, and the "air-on-sinus" sign, where mastoid air cells directly contact the sinus wall, without overlying bone.3

In light of this new information, the patient's imaging studies were re-evaluated, and evidence of a right-sided sigmoid sinus diverticulum and/or dehiscence was identified. The images below show the findings on an axial slice of the patient's temporal bone CT study.

How significant is this condition ? Sigmoid sinus diverticulum and/or dehiscence is being increasingly recognized as a common cause of pulsatile tinnitus. In fact, a recent study by Schoeff et al. found its prevalence to be 23% in patients with pulsatile tinnitus.4 As such, the identification of this condition is highly relevant, particularly because effective surgical management is available for its alleviation.

Introduction This study aimed to determine the effectiveness of mustard green leaf decoction as an adjunct to drug treatment in controlling blood glucose among Filipinos with type 2 diabetes mellitus.

Methods Participants were randomly assigned to receive mustard decoction or a placebo solution for eight weeks on top of their oral anti-hyperglycemic medication. Fasting blood sugar and complete blood counts were determined at baseline, Week 4 and Week 8, and compared within and across the two groups. 

Results There was a decreasing trend in the blood sugar in the mustard green group while the opposite was noted in the placebo group. The mean FBS levels of the mustard green group were significantly lower than that of the placebo group at the Week 8 determination (6.10 vs 8.69 mmol/L, p=0.0004). The decrease in blood sugar level on the eight week in the mustard green group was significant compared with the baseline level (p=0.008).

Conclusion This study had demonstrated that the intake of Brassica juncea decoction can significantly decrease blood sugar level among type 2 diabetics compared to metformin alone. 

The paper looked into dynamics and variances of the manifestation of gratitude towards the older persons utilizing qualitative survey design. A total of 300 study participants, which include the young millennials, mid-lifers and older generation groups, were interviewed. The tool used was a simple interview guide for a freewheeling interview with storytelling style. Three-level classification of qualitative survey analysis was used. The findings revealed how family, work and societal changes have contributed to the changes in the manifestation of gratitude. The changes in the social structure and the demand to cope with these changes have caused the gap between the desire of the older persons to be respected and how the younger generations have shown this to them. Gratitude, which is manifestation of respect, has evolved and is now shown differently across intergenerational groups and seems to be experienced similarly across nations. The younger generations have a different view on respect in comparison with the older generations.

BACKGROUND. Metabolic Syndrome (MetS) is common in Chronic Obstructive Pulmonary Disease (COPD) patients but their association is still an unsettled issue. The aim of this study was to determine the association of MetS with the severity of airflow obstruction.

METHODOLOGY. This was a cross-sectional analytic study of 157 patients with COPD. They were classified using the Global Initiative for Chronic Obstructive Lung Diseases (GOLD). MetS was assessed using two well-recognized criteria. Demographics, clinical data, lifestyle-related characteristics, fasting blood sugar (FBS) and lipid profile were obtained. Multiple logistic regression was used to determine the association of MetS with the severity of airflow obstruction.

RESULTS. 40.13% and 17.20% of patients had MetS using the NCEP/ATP III-AHA/NHBLI and IDF criteria, respectively. MetS was not associated with severity of airflow obstruction. Of the MetS components, only elevated blood pressure (BP) was significantly associated with severity of airflow obstruction (GOLD II: OR=3.28, p<0.001; GOLD III: OR=4.04, p=0.2; GOLD IV: OR=6.21, p=0.04). Elevated FBS was also associated with GOLD IV (OR=16.09, p=0.02). Significant factors associated with MetS in COPD patients were body mass index, inhaled steroid, number of pack-years, and GOLD II.

CONCLUSION. MetS is not associated with severity of airflow obstruction. Only certain components of MetS showed significant associations such as elevated BP with GOLD II-IV and elevated FBS with GOLD IV.

BACKGROUND: The dengue vaccine controversy in the Philippines caused significant public anxiety affecting childhood vaccines, as well as other healthcare programs. An assessment of parental perception and attitude on childhood immunization and other government healthcare programs after the dengue vaccine controversy is lacking

OBJECTIVE: To determine the perception and attitude of parents on childhood immunization and other government health care programs after the dengue vaccine controversy at a tertiary pediatric hospital.

METHODOLOGY: A hospital-based cross-sectional survey was done at a tertiary pediatric hospital. A total of 96 subjects participated in the study. Parents with children ages 9 to 18 years old whose child was either vaccinated or non-vaccinated with dengue vaccine seen in the dengue clinic, outpatient department and private clinics were invited to answer the structured questionnaire. Proportional stratified sampling was employed. Mann Whitney U-test compared the perception and attitude scores between parents of children who were recipients and non-recipients of dengue vaccine. A p-value of

RESULTS: The overall perception and attitude of parents on childhood immunization, deworming and vitamin A supplementation did not differ significantly between parents of non-dengue vaccinated children and dengue-vaccinated children. Sociodemographic factors such as gender, marital status, educational attainment, employment, and economic status did not differ significantly in their perception and attitude in terms of childhood immunization, deworming and vitamin A supplementation.

CONCLUSIONS: The overall perception and attitude of parents in both groups showed no significant difference toward childhood immunization, deworming and vitamin A supplementation. There is no association with the overall perception and attitude of parents on childhood immunization, deworming and vitamin A supplementation and their sociodemographic factors. RECOMMENDATIONS: Future similar studies may be conducted in other regions to determine parental perception and attitude towards the government's immunization program and other health care programs.

This study was conducted to: (1) determine the profile of nurses in various work settings based on available databases; (2) describe the current nursing education and programs in the Philippines; and (3) identify national key issues affecting the nursing workforce. The study utilized descriptive, cross-sectional research design; and employed institutional survey, Delphi survey, and round table discussions. Results showed that the Department of Health has the current number of nurses working in hospitals and communities in the different regions, including information on age and sex distribution, employment characteristics, and type of hospital affiliations. The Professional Regulations Commission Board of Nursing has the results of the national licensure examinations. Commission on Higher Education has information on BSN curriculum and schools. Priority key issues identified are: (1) nursing leadership and nursing role clarity, (2) workplace safety and violence, and (3) shortage of nurses, (4) unjust compensation, and (5) skills mix and geographic maldistribution. PNA is thought to have a big role in helping address these key issues. 

PURPOSE: Cancer constitutes a public health concern and has been an evident universal health problem for the past decade. New treatment options with the goal of finding an absolute cure for the disease are explored by the medical society. This study aims to examine the Health-Related Quality of Life and levels of hope among patients with cancer undergoing adjuvant therapy, and to determine the relationship of these variables, their domains and subscales.

METHODS: The study used a descriptive, cross-sectional, correlational research design. Ninety two respondents from Porac, Pampanga, aged 18 and above, diagnosed with cancer, and are undergoing adjuvant therapy were selected via consecutive sampling. Two instruments were utilized in the study: the EORTC QLQ-C30 and the Herth Hope Index. Pearson's r with a p-value set at

FINDINGS: Results revealed that over a half of the respondents (53.26%) have high HRQoL scores (mean of 68.5) in the EORTC QLQ- C30 questionnaire. On the other hand, the overall level of hope based on the Herth Hope Index was 33.32, which was generally acceptable, where 66.30% of the scores were considered high. Domains of HRQoL namely physical functioning, role functioning, emotional functioning, cognitive functioning and social functioning were all positively correlated with hope subscales specifically:
temporality and future, readiness and expectancy and interconnectedness at varying strengths.

CONCLUSIONS: A diagnosis of cancer does not equate to one's loss of hope. Hope may be anchored in Health-Related Quality of Life which involves different domains rather than in the form of treatments for cure. Further studies which focus on comparing outcomes of
patients who decline and those who willingly undergo adjuvant therapy, a repeated measures study to determine continuum levels and lastly, an intervention study focusing on symptom management may be done to gain more in-depth information regarding the effects of adjuvant therapy on the HRQoLand level of hope among these patients.

OBJECTIVE: To develop a locally adapted patient decision aid (PtDA) on treatment intensification among Filipino patients with Type 2 Diabetes Mellitus and to test the feasibility of using PtDAs in a low middle-income country.

METHODOLOGY: A qualitative approach and an iterative process of development of a PtDA were employed for this study. We describe the process of developing a Filipino version of the Diabetes Medication Decision Aid. This PtDA was designed to help the patient choose the appropriate treatment intensification based on his own values and preferences, in consultation with his physician. The process involved decisional needs assessment through focus group discussions and key informant interviews, systematic literature review, iterative process of the development of a PtDA with clinical encounters (pilot testing), and preliminary field testing.

RESULTS: Decisional needs assessment revealed that Filipino patients are open to participate in shared decision-making if given the opportunity, including those with low socioeconomic status who likely have low health literacy. Physicians prefer to have visual aid tools to help them support their patient's decision-making. A PtDA prototype of a set of flash cards in Filipino was created and revised in an iterative method. We developed a more visually appealing tool after inputs from the expert panel and patient advisory group. Its use during clinical encounters provided additional insights from patients and clinicians on how to improve the PtDA. Preliminary field testing showed that its use is feasible in the target patient population.

CONCLUSION: Filipino patients, clinicians, and diabetes nurse educators have contributed to the creation of the first Filipino PtDA for diabetes treatment intensification.

Background and Objective: Cadavers are the main teaching and learning tools utilized by faculty and students of Gross Anatomy. The conventional procedure of using formalin to preserve cadavers has its limited benefit due to its obnoxious odor, darkened color, indistinguishable small structures, rigid joints, with friable organs and tissues. Using the Thiel Method, cadavers are known to have: life-like presentation, a high degree of suppleness, natural mobilization of various body parts with tolerable odor, natural color, and antimicrobial and antifungal efficacy. The aim of this study was to compare the Thiel soft-embalmed cadaver and the formalin-preserved cadaver for use in Gross Anatomy dissection.

Materials and Method: Six formalin-preserved cadavers were compared with six Thiel soft-embalmed ones and were evaluated by 160 first year medical students and 10 faculty members of Gross Anatomy from the University of the Philippines College of Medicine using a visual analogue scale that evaluated the cadaver's presenting color. A Likert scale was utilized to assess the skin and muscle texture, blood vessel integrity, odor, joint flexibility, and state of cadaver preservation. Their perceptions on the ease of the dissection process, distensibility, and differentiation of structures were also elicited through a questionnaire checklist.

Results: Results show that the Thiel Method-preserved cadavers were rated higher compared to the formalinpreserved cadavers in terms of: 1) presenting color; 2) tolerable odor; 3) skin and muscle texture; 4) blood vessel integrity; 5) joint flexibility; and 6) state of cadaver preservation after 1 year. However, the ease of the dissection process, the distensibility of structures, and the differentiation of the various structures were easily managed in the formalin-preserved cadavers while the feasibility of practicing laparoscopy, endoscopy, and intubation were seen in the Thiel soft-embalmed cadavers. Results validate the claims of previous studies on the advantages presented in using the Thiel Method.

Conclusion: Cadavers preserved utilizing the Thiel Method are life-like and can be used for Gross Anatomy dissection. The data gathered support the feasibility of using them also in research and training.

BACKGROUND AND OBJECTIVES: Acoustic analysis is an objective instrumental method that makes more accurate and reliable assessments of vocal characteristics possible. The aim of the current study was to describe the vocal characteristics of Filipinos with perceptually normal voices in terms of (1) fundamental frequency, (2) intensity, (3) frequency and intensity perturbations, (4) speaking fundamental frequency range, and (5) nasalance.

METHODOLOGY: A total of 142 healthy adults aged 18 - 53 years participated in this study. The group was composed of 73 men (26.9 ± 6.4 years old) and 69 women (26.1 ± 6.5 years old). Voice samples were collected using Computerized Speech Laboratory™ (CSL; Model 4300B) during sustained phonation of vowel /a/ and spontaneous speech. Nasometer™ (Model 6200-3) was used to assess nasality while participants read plosive- and sibilant-loaded sentences.

RESULTS AND CONCLUSION: The average acoustic values for males were F0 = 125.8 ± 23.4 Hz, SF0 = 122.6 ± 15.6 Hz, SF0 range = 85.8-269 Hz, SPL (speech) = 58.6 ± 5.3 dB, SPL (vowel) = 66.6 ± 6.2 dB, jitter = 0.92 ± 0.48%, shimmer = 2.21 ± 0.73%, nasalance = 12.5-17.1%; for females, F0 = 196.3 ± 23.0 Hz, SF0 = 194.8 ± 19.0 Hz, SF0 range = 97.1- 309.6Hz, SPL (speech) = 57.6 ± 4.3 dB, SPL (vowel) = 65.3 ± 4.5 dB, jitter = 1.12 ± 0.34%, shimmer = 2.7 ± 0.64%, nasalance = 13.1-19.1%. Significant differences were found between male and female subjects for F0, SF0, perturbation measures, and SPL during sustained phonation (p< 0.05). Acoustic data obtained also appear to be consistent with the results of local and international studies. While these can be used as tentative normative data for Filipinos, it is recommended that future studies be completed with more systematic analysis procedures and stringent participant selection to ensure balance for age, sex, and vocal history among subgroups.