Laryngosternopexy is a suturing method between the thyroid lamina and sternal ligament in order to relieve tension from the anastomosis when performing segmental resection of the airway.  A thick absorbable monofilament suture is passed through thyroid lamina and the interclavicular ligament of the sternum in a figure of eight fashion as described by Castellanos.1,2 In laryngosternopexy, the suture support is ventral to the anastomotic site in the midline. However, this places the "pexy" sutures in the way, making a tracheotomy and second stage decannulation difficult. We describe a modified laryngosternopexy (laryngoclaviculopexy) that can be performed with the "pexy" sutures out of the way to allow access to the trachea, and our initial experience with three patients.

OBJECTIVE: This paper aims to describe an unconventional surgical procedure performed in a case of penetrating neck injury involving the larynx.

METHODS:

Design: Case Report

Setting: Tertiary Government Hospital

Population:          One

RESULTS: A 38-year-old man sustained a hacking laceration to the anterior neck that extended into the hypopharyngeal area, transecting the thyroid cartilage. After pre-emptive tracheostomy, the patient was referred to otorhinolaryngology - head and neck surgery due to the extensive hypopharyngeal injury. Neck exploration performed to control bleeders confirmed a Schaefer-Fuhrman Classification Group 3 penetrating neck injury. Anastomotic reconstruction of the hypopharynx, transected thyroid cartilage and strap muscles was attempted using absorbable sutures with post-operative re-establishment of structural continuity and documentation of full bilateral vocal fold mobility. The patient was about to be discharged home with a tracheotomy and nasogastric tube when he suddenly deteriorated and expired on the eighth post-operative day.

CONCLUSION:  Our technique might be utilized in cases where urgent reconstruction of laryngeal structures is considered despite serious damage to the laryngeal skeleton, and may provide a temporary surgical option for similar cases in an emergent setting. However, we cannot recommend it as a routine standard on the basis of one case.

KEYWORDS:  larynx; penetrating neck injury; vocal cord; reconstruction, neck exploration

A 41-year-old man presented with an 8-year history of recurrent mouth ulcers, previously treated with unrecalled antibiotics and vitamins but with no relief. Examination showed a 2.0 x 1.0 cm hard, immovable ulcer at the right lateral tongue. On further interview, a history of repeated biting trauma on the site of the lesion was elicited. The clinical impression was a non-healing tongue ulcer. Incision biopsy of the lesion was performed and the specimen sent for histopathologic evaluation.

The specimen consisted of three, cream-tan, irregularly-shaped soft tissues measuring up to 0.9 cm in widest diameter. The cut sections of the tissues showed a tan-pink to cream-white soft cut surface. Microscopic examination showed a squamous epithelium-lined tissue with a dense polymorphic infiltrate of inflammatory cells rich in neutrophils, eosinophils, plasma cells and large atypical mononuclear cells, and accompanying granulation tissue formation. (Figure 1 and 2) Immunohistochemical studies showed CD20 expression of B-cells in the lymphoid follicles, with CD3 and CD5 highlighting the surrounding T-cells. The plasma cells are staining for both kappa and lambda, with kappa-lambda ratio of 3:1. The Ki-67 showed a high proliferation index within the reactive germinal centers, and scattered low proliferative activity within the interfollicular areas. (Figure 3) Given the morphologic and immunohistochemical profile of the lesion, we diagnosed it as traumatic ulcerative granuloma with stromal eosinophilia.

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is considered a rare lesion of the oral mucosa. First described in 1881 by Riga then defined histologically in 1890 by Fede,1,2 it has since been called by a variety of terms including traumatic ulcerative granuloma, ulcerative eosinophilic granuloma, and Riga-Fede disease in infants and neonates. The term TUGSE was first coined by Elzay in 1983 to delineate it from more aggressive conditions such as eosinophilic granuloma, eosinophilic fasciitis and carcinoma with stromal eosinophilia.3 It is a benign, chronic, self-limiting lesion of the oral mucosa.1,2

TUGSE typically manifests as an isolated ulcer with elevated margins or an indurated submucosal mass, most commonly affecting the dorsal or lateral surfaces of the tongue but can be found in other locations in the oral mucosa such as the lip, palate, and gingiva. 2,4 The lesions can also be multifocal and recurrent, and can persist from several weeks to months, but will heal without treatment; a wide age range of patients can be affected, with a peak incidence in the sixth and seventh decades of life, with only a slight female predominance.1,4 Due to its clinical manifestation, it can often be mistaken for malignancy or an infection; however, its microscopic and immunohistochemical features, self-limiting nature and spontaneous resolution indicate a benign reactive process.1,2

Histologically, TUGSE is characterized by a diffuse polymorphic infiltrate of inflammatory cells that can extend deep into the submucosa and skeletal muscle; it is predominantly composed of eosinophils, B and T lymphocytes, macrophages, with atypical large mononuclear cells.1,2,4 These atypical cells have abundant pale cytoplasm, irregular nuclear contours, small nucleoli and fine chromatin.1,2,4 The origin of these large mononuclear cells are still disputed and have been reported to originate from lineages such as histiocytes (CD68), dendritic cells (factor XIII), myofibroblasts (vimentin) and T-lymphocytes due to their variable immunohistochemical characteristics.1,2,4 The immunostains performed in our case showed intact B-cell compartment highlighted using CD20, and intact T-cell compartment using CD3 and CD5. The plasma cells are polyclonal to kappa and lambda. The proliferation index using Ki-67 is high within the reactive germinal centers, and low in the interfollicular area. The immunohistomorphologic features are compatible with a reactive process.

The etiology and pathogenesis of TUGSE have not been completely established but is postulated to be associated the with trauma, although obvious trauma could only be demonstrated in 50% of the cases.1,4 Traumatic disruption of the mucosa facilitates a cell-mediated immune response due to the action of a non-identified etiologic factor such as microorganisms, toxins and/or foreign proteins; this induces an eosinophilic and mast cell reaction, including a release of cytotoxic T-cells ultimately leading to local tissue destruction.1,5 It has also been suggested that it may be a CD30+ lymphoproliferative disorder.1,4-6 A CD30 positivity can be seen in lymphomas, lymphoproliferative diseases, Reed-Sternberg (RS) cells, and activated T and B cells, but also occur in benign cutaneous disorders such as drug reaction, atopic dermatitis and molluscum contagiosum; however, involvement of the oral mucosa with lymphoproliferative diseases is rare.1,4,5

The pathogenesis and etiology of the entity remains unclear, and can mimic malignant conditions due to its clinical, histological, and immunohistochemical features thus the diagnosis of TUGSE should be made by the combination of clinical data, histopathologic, and immunohistochemical features.1 The condition has a benign course and is characteristically self-healing.1,2

BACKGROUND AND OBJECTIVE: The study presented and compared the level of marital satisfaction of male and female Business Process Outsourcing (BPO) night shift workers. Prior to this study, there were researches that looked into the effect of night shift or nonstandard work schedule on the workers' marital life. There were also studies that tried to connect shift work to the quality of married life of BPO workers in the Philippines but they were conducted using the perspectives of the wives only. Thus, this study offered a holistic view on marital satisfaction because it took into consideration the views of both husbands and wives.

METHODS AND RESEARCH PARTICIPANTS: Sixty-six males and females in Metro Manila were purposefully selected and surveyed, of whom 11 were interviewed face to face. Data from the survey were analyzed using Mann Whitney U Test of Significance. Information from the qualitative interview was used to validate quantitative data.

RESULTS: Results showed that male and female BPO night shift workers were satisfied with their marriage. There is no significant difference in the level of marital satisfaction of males and females.

CONCLUSION: It is very evident from the study findings that economic and financial capacity affects marital satisfaction. This study can also help practitioners of pre-marital counseling. It was found in the study that compatibility of the couples' expectations in the marriage and with each other influenced marital satisfaction. 

Promoting positive birth experiences may help create circumstances amenable to enhancing the quality of obstetric care and improving outcomes for mothers and infants. This study aims to examine the relationship between childbirth satisfaction and maternal confidence during early postpartum period in mothers from maternity units of San Jose, Occidental Mindoro. This is a descriptive cross-sectional study utilizing Women's Views of Birth Labour Satisfaction Questionnaire (WOMBLSQ) and Maternal Confidence Questionnaire (MCQ). To correlate the level of childbirth satisfaction and maternal role confidence of early postpartum mothers, Pearson's R correlation was used. A p value of 0.05 was taken for statistical significance. It revealed that the early postpartum mother respondents in the study were satisfied with their childbirth experience and confident with their maternal role. Moreover, the childbirth satisfaction was positively correlated with maternal role confidence. It is implicated in the practice of healthcare professionals to provide better understanding of the factors that influence maternal role within their particular social contexts.

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. 

BACKGROUND: In 2017, there were sixty people who identified themselves as lesbian, gay, bisexual and transgender/ transsexual (LGBT) people in Sememi Public Health Center, and seven of them were known to be people living with HIV/AIDS (PLWHA). People who are at high risk for HIV infection, especially the LGBT people and Female Sex Workers, are at even greater risk of developing a number of severe periodontal diseases. Periodontal problems, such as periodontitis, in HIV patients, are more severe and occur more frequently than uninfected patients. However, data on dental visit in Sememi Public Health Center as the primary health center in Sememi district is still limited, and there is still no data regarding periodontal health status among HIV patients.

OBJECTIVE: The aim of this study is to investigate the relationship between HIV/AIDS and periodontal health status among the population who are at high risk of HIV/AIDS in Sememi Public Health Center area.

METHOD: This study was conducted with a cross-sectional design. The sample size was determined using a total sampling technique and came up with 30 participants.

CONCLUSION: Population with a high risk of HIV/AIDS in Sememi Health Center area in Surabaya City has poor periodontal status, due to a large number of bleeding on probing (BOP), periodontal pocket depth, and loss of attachment (LOA). There is no significant difference between BOP results and pocket depth between the HIV and non-HIV groups. But a significant difference was found between LOA in the HIV and non-HIV groups. On the contrary, we found that there is no significant relationship between HIV/AIDS and xerostomia in this study.

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

Objective: To describe a prototype improvised hand held device for alaryngeal speech. Methods: Design: Instrument Innovation. Setting: Tertiary Private Hospital. Participants: Four listeners with normal hearing, were native Tagalog-speakers and had no previous experience with alaryngeal speech types participated in initial trials. Results: The prototype PHONETOVOX was fabricated using a soundproofed cellphone casing with an intra-oral sound port attachment and a cellphone was loaded with Pocket Talkbox v. 1.4.0 software. The device was tested for its ability to produce intelligible speech by using the cellphone as a substitute for the larynx using oral cavity resonators and articulators, producing a synthesized sound mimicking the human voice. The PHONETOVOX produced intelligible words. Initial testing using a C-V-C Tagalog Word List had 4 listeners identify 34, 35, 47, and 54 out of 93 words (37 to 58%), with an overall average intelligibility of 46%. Conclusion Despite its restrictions in articulation and the wide range of results from the four listeners, our initial results may suggest the potential of PHONETOVOX as another modality for alaryngeal speech comparable to the 36 – 38 % intelligibility of commercially-available devices. Further trials with actual laryngectomees are needed to further establish intelligibility and acceptability.
Human ; Male ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Laryngectomy

OBJECTIVE: To describe the incidence, pattern, and severity of maxillofacial trauma among patients who sustained gunshot and blast injuries of the maxillofacial region in a tertiary military hospital.

METHODS:

            Design:            Retrospective Case Series

            Setting:            Tertiary Military General Hospital

            Participants:  All patients admitted under the otorhinolaryngology service with

                                    gunshot and blast injuries to the face

RESULTS: A total of 108 patients were admitted due to gunshot and blast injuries to the face from January 2010 to December 2015. Most sustained gunshot injuries (73, 67.6%) compared to blast injuries (35, 32.4%). Of 108 patients, 71 had maxillofacial fractures (65.7%) while the remaining 37 only had soft tissue injuries (34.3%). Majority of those with maxillofacial fractures had single bone involvement (52, 72.2%); the rest had two or more bones affected (19, 27.8%) The most common bone injured was the mandible (77.5%), followed by the maxilla (35.2%), zygoma (12.7%), and others (frontal, nasal, and temporal bones) at 5.6%.

CONCLUSION:       Gunshot injuries had a higher incidence than blast injuries among military personnel with projectile injuries to the face seen during the study period. There were more fractures and combinations of fractured bones affected in gunshot injuries, although the breakdown of soft tissue injuries was similar among those with gunshot and blast injuries. However, the relation of injury patterns and severity to gunshot or blast etiology, or to other factors such as protective gear, cannot be established in this present study.

KEYWORDS: gunshot injuries; blast injuries; maxillofacial; projectile