OBJECTIVE: We determined the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy and compared its cost-effectiveness with percutaneous nephrolithotomy (PCNL) for the management of lower pole renal calculi with a size of 1.0cm to 2.0cm in widest dimension.

MATERIALS AND METHODS: Using the cost estimate data available locally from patient billing charges and average professional fee, efficacy and complication rates data from the literature, the cost-effectiveness for the percutaneous nephrolithotomy and shock wave lithotripsy as primary therapy for lower pole stones were evaluated. We developed a decision analysis model in which a patient in whom primary therapy (either ESWL or PCNL failed was rendered stone-free with secondary ESWL using a trial version add-in software for Microsoft Excel from www.TreePlan.com with some modifications.

RESULTS: The average cost over all outcomes from the decision to perform ESWL in patients with lower pole stones 1.0 to 2.0 cm is Php 53,801.07 and Php 127,019.27 for PCNL. For PCNL to be as cost effective, cost incurred should be lowered to Php 47,746.38

CONCLUSIONS: Extracoporeal shock wave lithotripsy, despite its considerable low efficacy as compared to PCNL as a primary treatment for lower pole stones 1.0 to 2.0 cm, is still more cost-effective.

Human ; Male ; Female ; NEPHROLITHIASIS ; UROLOGIC DISEASES ; KIDNEY DISEASES ; COST-BENEFIT ANALYSIS ; TREATMENT OUTCOME ; LITHOTRIPSY ; NEPHROSTOMY, PERCUTANEOUS ; THERAPEUTICS ; THERAPY

OBJECTIVE: To compare the efficacy of Clarithromycin versus Methylprednisolone in the treatment of non-eosinophilic nasal polyposis.

DESIGN: Randomized Controlled Trial

SETTING: Tertiary Government Training Hospital

PARTICIPANTS: Forty  two (42) patients with Chronic Rhinosinusitis with determination of eosinophil count.  Both groups were further randomized into a treatment arm given Clarithromycin (CLA) 500mg/ day and another arm given Methylprednisolone (METH) 32 mg/ day tampering to 8 mg/ day for 15 days. All participants underwent pre- and post-treatment evaluation via anterior rhinoscopy, Sino-Nasal Outcome Test (SNOT-22) and Endoscopic Appearance (EA) Scoring. Date were encoded and subjected to statistical analysis using Mann-Whitney U test.

RESULTS: For the 9 participants in the non-eosinophilic group, 4 were given CLA and 5 were given METH. The CLA arm showed significant improvement in SNOT-22 scores by the 15th day (p= .007). The METH arm did not demonstrate significant improvement by the 7th (p= .44) or 15th day (p= .22). Comparison in the improvement in SNOT-22 scores between the two arms showed that on both 7th and 15th days, CLA outperformed METH (p= 0.26 and p= .004, respectively). For the EA scoring, both the CLA and METH groups significantly improved by the 7th (p= .27 and p= 0.017, respectively) and 15th day (p= .013 and p= .027, respectively). Comparison in the improvement of EA scores between the two arms showed significant difference on the 15th day (p= .01) with the CLA performing better than METH. Overall, the results suggest that the CLA arm performed significantly better than METH arm in the treatment of non-eosinophilic patients.

Of the 33 eosinophilic patients, 17 were given CLA and 16 were given METH. The CLA arm showed significant improvement in SNOT-22 scores by the 15th day (p< .001) while the METH arm both on 7th (p= .033) and 15th day (p< .001). Comparison of the improvement in SNOT-22 results between the two arms showed no significant difference (7th day p= .494; 15th day p= .587). For the EA scoring, both treatment groups showed significant improvement by the 7th and 15th day (p< .001). Comparison on the improvement in EA scores between the two arms showed significant difference (p< .001) on both 7th and 15th day, suggesting that METH was more effective than CLA. Overall, the results showed that both CLA and METH were effective in the treatment of eosinophilic nasal polyps. However, METH was significantly better than CLA in terms of superior EA scores.

CONCLUSION: In terms of improving symptoms and well-being, as well as decreasing nasal polyp size and reducing discharge and edema as reflected in superios SNOT 22 and EA scores, Clarithromycin was significantly more effective than Methylprednisolone in the treatment of non-eosinophilic nasal polyps. While both Clarithromycin and Methylprednisolone were shown to be effective in the treatment of eosinophilic nasal polyps, Methylprednisolone was significantly better in that Clarithromycin in terms of EA scores. A biopsy for tissue eosinophilic cell count prior to treatment is recommended to establish the predominant inflammatory cell in nasal polyps in order to provide appropriate targeted treatment, i.e. Clarithromycin for non-eosinophilic nasal polyps and Methylprednisolone for eosinophilic polyps.

Human ; Male ; Female ; Macrolides ; Clarithromycin ; Methylprednisolone ; Nasal Polyps ; Eosinophils

Objective: To compare the efficacy of Clarithromycin versus Methylprednisolone in the treatment of non-eosinophilic and eosinophilic nasal polyposis.

Methods:

            Study Design: Randomized controlled trial

            Setting:           Tertiary Government Training Hospital

Subjects:         Forty two patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) were grouped into non-eosinophilic and eosinophilic groups after biopsy determination of eosinophil count. Both groups were further randomized into a treatment arm given Clarithromycin (CLA) 500 mg/ day and another arm given Methylprednisolone (METH) 32 mg/ day tapering to 8 mg/ day for 15 days. All participants underwent pre- and post-treatment evaluation via anterior rhinoscopy, Sino-Nasal Outcome Test (SNOT-22) and Endoscopic Appearance (EA) Scoring. Data were encoded and subjected to statistical analysis using Mann-Whitney U test.

Results: For the 9 participants in the non-eosinophilic group, 4 were given CLA and 5 were given METH. The CLA arm showed significant improvement in SNOT-22 scores by the 15th day (p= .007). The METH arm did not demonstrate significant improvement by the 7th (p= .44) or 15th day (p= .22). Comparison of the improvement in SNOT-22 scores between the two arms showed that on both 7th and 15th days, CLA outperformed METH (p= .026 and p= .004, respectively). For the EA scoring, both the CLA and METH groups significantly improved by the 7th (p= .027 and p= 0.017, respectively), and 15th day (p= .013 and p= .027, respectively). Comparison of the improvement in EA scores between the two arms showed significant difference on the 15th day (p= .01), with the CLA performing better than METH. Overall, the results suggest that the CLA arm performed significantly better than the METH arm in the treatment of non-eosinophilic patients.

          Of the 33 eosinophilic patients, 17 were given CLA and 16 were given METH. The CLA arm showed significant improvement in SNOT-22 scores by the 15th day (p < .001), while the METH arm on both 7th (p= .033) and 15th day (p< .001). Comparison of the improvement in SNOT-22 results between the two arms showed no significant differences (7th day p= .494; 15th day p= .587). For the EA scoring, both treatment groups showed significant improvement by the 7th and 15th day (p< .001). Comparison of the improvement in EA scores between the two arms showed significant differences (p< .001) on both 7th and 15th day, suggesting that METH was more effective than CLA. Overall, the results showed that both CLA and METH were effective in the treatment of eosinophilic nasal polyps. However, METH was significantly better than CLA in terms of superior EA scores.

Conclusion: In terms of improving symptoms and well-being, as well as decreasing nasal polyp size and reducing discharge and edema as reflected in superior SNOT-22 and EA scores, Clarithromycin was significantly more effective than Methylprednisolone in the treatment of non-eosinophilic nasal polyps. While both Clarithromycin and Methylprednisolone were shown to be effective in the treatment of eosinophilic nasal polyps, Methylprednisolone was significantly better than Clarithromycin in terms of superior EA scores. A biopsy for tissue eosinophil cell count prior to treatment is recommended to establish the predominant inflammatory cell in nasal polyps in order to provide appropriate targeted treatment, i.e. Clarithromycin for non-eosinophilic nasal polyps and Methylprednisolone for eosinophilic polyps.

Keywords: macrolides, clarithromycin, methylprednisolone, nasal polyps, eosinophils

Human ; Male ; Female ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Clarithromycin ; Macrolides ; Methylprednisolone ; Nasal Polyps ; Eosinophils

p style=text-align: justify;strongOBJECTIVE:/strong To evaluate the necessity of placing a drain in post-thyroidectomy patients, we aimed to determine whether insertion of a passive drain as compared to no drain in post-thyroidectomy patients would significantly affect hematoma formation, wound infection, wound dehiscence and length of hospital stay.METHODS:br /Design:/strong Prospective randomized controlled trialbr /strongSetting:/strong Tertiary government training hospitalbr / strongSubjects:/strong Patients who underwent thyroidectomy for various pathologies were divided into two postoperative treatment arms: one group with insertion of a passive drain, and another group without a drain. Hematoma, wound infection, wound dehiscence and length of hospital stay were the outcomes measured per treatment arm.RESULTS:/strong A total of 66 patients were evaluated. There were 54 females (81.81%) and 12 males (18.18%). The mean age for the drain group was 44.88 years and 43.67 years for the no drain group. Four patients developed complications in the drain group and two developed complications in the no drain group. The rate of complications between both groups was not statistically significant. The mean hospital stay of the drain group was 3.15 days which in the no drain group was 2.51 days. The difference in length of hospital stay was statistically significant.CONCLUSIONS:/strong There was no difference in the development of complications among the drain and no drain group. Thyroidectomy without surgical drains was associated with a significant reduction in hospital stay compared to thyroidectomy with routine placement of drains./p
Human ; Male ; Female ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Thyroid Diseases ; Thyroidectomy-surgery ; Drainage ; Postoperative Care ; Thyroid Gland ; Postoperative Complications ; Hematoma

OBJECTIVES: To report a case of foreign lodged within the sphenoid sinus and its extraction.METHODS:Design: Case report Setting: Tertiary Government Hospital Patient: OneRESULTS: An 11-year-old girl was hit in the eye by an unknown object from an improvised slingshot. She had loss of vision of the left eye and headache without loss of consciousness. A plain craniofacial Computed Tomography (CT) scan showed a round opaque foreign body abutting the left sphenoid sinus, left posterior ethmoid cells and medial aspect of the left orbital region with adjacent soft tissue densities extending into the apparently ruptured, irregular left globe. The left posterior part of the lamina papyracea was not visualized probably fractured or ruptured. Transorbital enucleation of the left eye and endoscopy-assisted removal of the foreign body (a glass marble) were performed with no intra-operative and post - operative complications.CONCLUSION:Foreign body of the sphenoid sinus is a rare condition. Adequate imaging is important for localization and planning the optimal surgical approach. Endoscopic guidance may aid in extraction.
Human ; Female ; Child ; Sphenoid Sinus ; FOREIGN BODIES ; Tomography Scanners, X-Ray Computed

p style=text-align: justify;strongOBJECTIVE:/strong To determine the mean distance of the main trunk of the facial nerve from two commonly employed surgical landmarks (tragal pointer and tympanomastoid suture line) among a sample a Filipino adults undergoing parotidectomy.METHODS:br /Design:/strong Prospective descriptive studybr /strongSetting: /strongTertiary Government Training Studybr /strongSubjects:/strong 22 patients without facial paralysis undergoing surgery for parotid neoplasms were evaluated intraoperatively.RESULTS/strong: The main trunk of the facial nerve was found to be 9.0 mm (standard deviation of 2.8 mm) from the tragal pointer and 6.1 mm (standard deviation of 2.0 mm) from the tympanomastoid suture line.CONCLUSION/strong: The mean distance from the main trunk of the facial nerve to two of the most commonly utilized landmarks in identification of the nerve during parotidectomy was 9.0 mm (standard deviation of 2.8 mm) from the tragal pointer and 6.1 mm (standard deviation of 2.0 mm) from the tympanomastoid suture line. These may serve as reference values for surgeons in safer identification and preservation of the facial nerve during parotidectomy.
Human ; Male ; Female ; Adult ; Facial Nerve ; Sutures ; Anatomic Landmarks ; body regions

OBJECTIVES: To report a benign tonsillar lesion presenting as a pedunculated polyp and discuss its diagnosis and management.
METHODS:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
RESULTS: A 14-year-old lad presented with a seven-year history of an elongated right tonsillar mass without  associated  bleeding, pain,  dysphagia or obstructive sleep  apnea.  Physical  examination revealed  a  pedunculated  mass  about  2  x  1  x  0.5cm  in  size  located  in  the  superior  pole.  After unilateral  tonsillectomy, histopathological  examination  revealed  lymphangectatic  lipomatous fibrotic polyp.
CONCLUSION: Lymphangiomatous polyp of the palatine tonsils  is  an  unusual benign lesion of the head and neck. These  are  commonly  present  as  unilateral,  polypoidal  mass  that  cannot be clinically  differentiated  from  other  benign  tonsillar  lesions. Tonsillectomy  is  the  recommended surgical  approach  for  both  diagnostic  and  therapeutic  purposes.  Histopathological  study  must be done to confirm diagnosis.

Human ; Male ; Adolescent ; Palatine Tonsil ; Hamartoma ; Tonsillectomy ; Lymphangioma ; Deglutition Disorders ; Neck ; Head ; Sleep Apnea, Obstructive ; Polyps ; Pain ; Physical Examination

Objective: To present a rare case of facial schwannoma manifesting as a parotid mass and discuss its diagnosis and treatment. Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: One Results: A 48-year-old female was seen for a 2-year progressive left hemifacial paralysis and a 5-month gradually enlarging left infraauricular mass with episodes of tinnitus but intact hearing and balance. Physical examination showed a left-sided House Brackmann grade VI facial paralysis and a 5 x 4 x 3 cm soft, ill-defined, slightly movable, nontender, left infraauricular mass. Gadolinium-enhanced magnetic resonance imaging revealed a 5 cm heterogeneouslyenhancing lobulated mass centered within the deep lobe of the left parotid gland extending to the left mastoid, with facial nerve involvement. A diagnosis of a facial nerve tumor, probably a schwannoma, was entertained. Pure tone audiometry revealed normal hearing thresholds for both ears with dips at 6-8 KHz on the left. The patient underwent total parotidectomy with facial nerve tumor resection via transmastoid approach, with simultaneous facial – hypoglossal nerve anastomosis reconstruction. Histopathologic findings confirmed the diagnosis of a schwannoma. Postoperative facial function was Grade VI. Hearing and hypoglossal nerve function were preserved. Conclusion A progressive hemifacial paralysis of chronic duration with or without the presence of an infra-auricular mass should raise the suspicion of a facial nerve tumor. Gadolinium-enhanced magnetic resonance imaging is valuable since intraparotid facial nerve schwannomas are mostly diagnosed intraoperatively when the neoplasm and the nerve are exposed and determined to be contiguous. The clinician should be aware that not all parotid masses are salivary gland in origin.
Human ; Female ; Middle Aged ; NEURILEMMOMA ; PARALYSIS ; NEUROLOGIC MANIFESTATIONS ; FACIAL PARALYSIS ; MAGNETIC RESONANCE IMAGING ; DIAGNOSTIC IMAGING ; PHYSICAL EXAMINATION ; DIAGNOSIS ; THERAPEUTICS ; THERAPY

BACKGROUND: Entamoeba histolytica is an important etiologic agent of diarrhea. Globally, it is estimated to infect 40 to 50 million people and cause 40,000 to 100,000 deaths per year. Metronidazole is effective but can cause adverse reactions in certain individuals. In search of alternatives, traditional medicinal plants are being studied. Several plants in Family Simaroubaceae have shown anti-amoebic activity. Quassia amara, a member of this family has not been tested.
OBJECTIVE: To determine the effect of Q. amara crude extract on Entamoeba histolytica in vitro.
METHODS: Initial testing of 104 µg/ml ethanolic bark extract was performed. Counts were made after 72 hours. Three trials in triplicates were performed.
Nine (9) dilutions of extract were then tested (18.8 to 5,00 µg/ml). Test tubes were checked for viable amoeba after 24-hour and 72-hour incubation. Minimum inhibitory concentrations (MIC) were determined for the two incubation periods. At least two trials in triplicates for each dilution were performed. metronidazole served as positive control.
RESULTS: At 104 µg/ml incubated for 72 hours, no viable amoeba was obtained and counted. The MIC after 24 hours was 5,000 µg/ml, while the MIC at 72 hours was 37.5 µg/ml.
CONCLUSION: Q. amara crude extract has inhibitory effects on E. histolycain vitro.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Quassia ; Metronidazole ; Entamoeba Histolytica ; Plants, Medicinal ; Amoeba ; Simaroubaceae ; Microbial Sensitivity Tests ; Diarrhea

OBJECTIVES: This study is a retrospective cohort that aims to describe the profile of orthopedic geriatric patients aged 60 years old and above with acute hip fractures occurring within one month of admission in the Philippine General Hospital managed by a multidisciplinary team approach. METHODS: Data collection from the database was done to gather information regarding the patient profile, time to surgery, causes for delay in consultation, length of hospital stay, and follow-up rate, since this model was implemented. RESULTS: Overall, we saw a decrease in the time from admission to surgery and a decrease in the length of hospital stay, when compared to previous data. Follow-up rates and compliance to maintenance medication are at 96% and 72% respectively. CONCLUSION: The implementation of a multidisciplinary approach and fracture liaison service presents us with favorable results in addressing hip fractures and osteoporosis.
Orthopedics ; Osteoporotic Fractures ; Geriatrics ; Interdisciplinary Research ; Osteoporosis ; Orthopedic Procedures