Co-existence of multiple pathologies affecting a patient poses a challenge in the diagnosis and management. A rare combination of early tongue cancer, maxillary fungal rhinosinusitis, calcified thyroid nodule and primary hyperparathyroidism in a 70-year-old female is described. The evidences used for disease probabilities based on diagnostic results and effectivess of treatment modalities are presented. The decision-making process to come up with an individualized management is discussed.

OBJECTIVE: To describe outcomes of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks).
METHODS: Students were shown a 6-minute video on intubation. Students were exposed to video-assisted learning, video-assisted learning with instructor-guided simulation, and video-assisted learning with experiential learning. Each student was assessed by a non-graded 11 point objective structured clinical examination.
RESULTS AND DISCUSSION: The three learning strategies: 1. Video-assisted learning, 2. Video-assisted learning with instructor-guided simulation, 3. Video-assisted learning with experiential learning (self-discovery learning) simulation showed OSCE mean scores (standard deviations) of 5.76 (2.16), 7.21 (2.35) and 7.60 (1.72), respectively. Failure of intubation was 21% (8/38), 2% (1/40) and 0% (0/36), respectively. There is an absolute risk reduction of 27-30% in failure of intubation when either VGL or VEL is used. Students recognized the contribution of the simulation-based activities to the development of their intubation skills. They appreciated the opportunity to actually perform intubation in a rehearsal setting before doing the procedure on real patients.
CONCLUSION: Medical simulation enhanced student skills development. Experiential learning or self-discovery learning method may be as effective as instructor guided simulation.

OBJECTIVE: The objective of the study is to describe the pattern of nodal metastasis in papillary thyroid carcinoma (PTC) among Filipinos and to determine the possible clinicopathologic factors associated with level V involvement.
METHODS: This study included patients >18 years old with PTC with clinically positive neck node (cN1b) who underwent total thyroidectomy with lateral neck dissection (levels II-IV) or posterolateral neck dissection (II-V) from 2011-2016 at the Department of Otorhinolaryngology-Head and Neck Surgery, Philippine General Hospital. Histopathology reports were reviewed for the presence of nodal metastasis per level, tumor size, tumor location, gross extrathyroidal involvement and subtype. Univariate analysis utilized Pearson Chi-square test or the Fischer exact test. Multivariate analysis utilized logistic regression.
RESULTS: Lymph node involvement in the lateral neck was highest in level III (87.04%), followed by level IV (81.48%), IIa (66.67%), V (60.00%) and IIb (42.59%). No clinicopathologic factor was found to be associated with level V involvement.
CONCLUSION: The pattern of lymph node metastasis among Filipinos is similar but higher than that reported in the literature. Level V involvement is high and thus, this study suggests including level II-V in the neck dissection among Filipinos with cN1b papillary thyroid carcinoma.

OBJECTIVE: This study describes the quality of Thiel soft-embalmed cadavers as training model for endoscopic sinus surgery in terms of color and consistency of the tissues and similarity of performing the surgical steps to live surgery.

METHODS: This is a cross-sectional descriptive study. Six Thiel soft-embalmed cadavers from the University of the Philippines, College of Medicine, Department of Anatomy were used as training models. The Thiel-preserved cadavers utilized the soft embalming protocol being employed at the Virginia State Anatomical Program in Richmond, Virginia, USA. Ten otorhinolaryngologists were recruited to evaluate the cadavers using a questionnaire with three parts. The first two parts utilize a 10-point Likert scale with 1 as the least similar to live patient while 10 as simulating the live patient. The third part is an open-ended question regarding the suitability of Thiel soft-embalmed cadavers in the training for endoscopic sinus surgery.

RESULTS: Endoscopic sinus surgery was successfully performed in all cadavers. The Thiel soft-embalmed cadaver closely replicates the color and consistency of the anatomic structures important in endoscopic sinus surgery. All the surgical steps were performed with ease simulating live surgery.

CONCLUSION: Thiel soft-embalmed cadaver is a suitable model for training in endoscopic sinus surgery.