Objective: Research interest in minimally invasive spine surgery (MIS) is increasing; however, significant heterogeneity often exists among reported surgical techniques broadly classified as minimally invasive. High-quality data specifically addressing MIS techniques for intradural spinal pathology remain particularly scarce. Here, we present our experience, along with that of other groups, utilizing MIS techniques with an emphasis on tubular retraction for treating intradural extramedullary (IDEM) spinal pathology. Methods: Twenty-four patients with IDEM pathology were treated using MIS techniques, including tubular retraction, from 2006 to 2018. Additionally, a systematic literature review was conducted to enable a pooled analysis of patient demographics and perioperative outcomes. Results: In addition to our own patient series, 16 other case series were identified through systematic review. The resulting combined dataset from these 17 series included 323 patients available for pooled analysis. Nerve sheath tumors and meningiomas represented over 80% of the pathologies. Gross total resection was achieved in 93% of the pooled MIS IDEM cases. The mean estimated blood loss was 131 mL, the mean operative duration was 169 minutes, and the mean hospital stay was 4.1 days. Conclusion MIS resection using tubular retraction is a safe and effective approach for managing IDEM pathology. Our pooled cohort provides valuable comparative data for assessing outcomes against open surgical techniques.

Human ; Case Reports ; Publications

OBJECTIVE

To discuss a rare case of ectopic intranasal eruption of a tooth presenting as chronic rhinosinusitis focusing on the cause of the delayed diagnosis and emphasizing the role of otorhinolaryngologists in the management of this disease entity.

Design: Case Report

Setting: Tertiary Government Training Hospital

Patient: One

A 25-year-old, partially edentulous woman initially presented with a four-year history of foul-smelling right nasal discharge accompanied by nasal congestion, nasal pain, and epistaxis. Several general physicians prescribed unrecalled antibiotics and pain medications which provided only temporary relief of the symptoms. Due to the persistence of the foul-smelling discharge which was recalcitrant to medications, culture and sensitivity testing at our institution revealed moderate growth of pseudomonas aeruginosa and computed tomography scans of the paranasal sinuses showed a right intranasal tooth, thickening of the inferior turbinate and septal deviation to the right. Following endoscopic removal of the intranasal tooth and septoplasty, there was resolution of symptoms and no complications.

Ectopic intranasal eruption of tooth has not yet been reported in the Philippines. Delays in diagnosing and starting proper management can lead to morbidity and serious complications such as development of antibiotic resistance. A high index of suspicion by an ENT-HNS physician with thorough nasal physical examination could have aided in the early diagnosis and management of the intranasal tooth.

BACKGROUND & OBJECTIVE

Scabies, caused by the mite Sarcoptes scabiei var. hominis, is a highly contagious condition with significant public health implications. Standard treatments for scabies can be expensive, particularly in economically disadvantaged areas. This study aimed to determine the efficacy of 1% permethrin shampoo compared to the standard 5% permethrin lotion in treating scabies, assessing Total Lesion Count (TLC), Skin Infection Rating Scale (SIRS), clinical response, adverse events, and treatment acceptability.

This is an open-label, randomized clinical trial conducted in Barangay Malagutay, Zamboanga City, Philippines, involving 28 participants (14 per group). After dermatologic confirmation of diagnosis and a skin irritation test, participants were randomly assigned to receive either 5% permethrin lotion or 1% permethrin shampoo. Outcome measurements included Total Lesion Count (TLC) and SIRS, which evaluated erythema, crusting, purulence, itching, and pain. These were assessed on Days 0, 3, and 7. Clinical response, treatment acceptability, and adverse events were also monitored throughout the 7-day study period.

Results showed both treatments were effective with comparable outcomes on Day 3. Improvement in lesions, SIRS-erythema, crusting, purulence, pain, and itching was observed for both groups from Day 0 to Day 7. No significant difference was noted between the groups (p > 0.05) on Day 3. Both 1% and 5% permethrin treatments showed complete symptom resolution by Day 7, achieving 100% treatment success with 1% permethrin shampoo and 93% with the 5% permethrin lotion.

1% permethrin shampoo offers effective treatment for scabies, with comparable efficacy to 5% permethrin lotion.

Ewing’s sarcoma is a rare cancerous tumor of bone or soft tissue that usually occurs mostly in young adults. The diagnosis of Ewing’s sarcoma in pregnancy, most especially the subtype extraskeletal Ewing’s Sarcoma, is very rare with only few cases published in the literature worldwide. We present a case of a primigravida diagnosed with extraskeletal Ewing’s sarcoma at 6 weeks age of gestation. Currently, because of the rarity of this condition, there is lack of a universal consensus on the recommended therapeutic approach. A multidisciplinary management involving the generalist obstetrician, perinatologist, medical oncologist, and neonatologist was initiated at the outset to provide timely balance between optimal maternal treatment and fetal well-being. The maternal and fetal condition was stable all throughout the course of the chemotherapy using doxorubicin during pregnancy. Close interdisciplinary coordination regarding the treatment plans across these subspecialists resulted in a successful pregnancy outcome.

As critically ill COVID-19 patients are prone to infections by other respiratory pathogens, this study aimed to investigate the detection of respiratory co-pathogens in such patients, by employing a multiplex respiratory molecular panel. Conducted at Universiti Sains Malaysia Specialist Hospital (HPUSM) from November 1, 2021, to November 1, 2022, this retrospective cross-sectional study analysed adults admitted with confirmed COVID-19. Oropharyngeal/ nasopharyngeal swabs collected upon admission were tested using the Fast Track Diagnostic (FTD®) Respiratory Pathogens 33 multiplex kit to detect other respiratory pathogens. Within 48 hours of admission, the presence and type of organisms were determined to assess community co-infections. Among 48 critically ill COVID-19 patients (26 male; mean age, 62.2 years), clinically significant organisms were found in 32 patients (67%). Bacterial co-infections or co-colonization were detected in 91% (29/32) of these patients, with Klebsiella pneumoniae (40%) and Staphylococcus aureus (23%) were the most common, followed by Streptococcus pneumoniae (11%), Moraxella catarrhalis (4%), and Haemophilus influenzae (2%). Fungal (6%) and viral (2%) co-infections were less frequent. The use of syndromic respiratory panel in critically ill COVID-19 patients offers the advantage of being highly sensitive, rapid, and able to detect multiple pathogens. However, detection of multiple respiratory pathogens needs to be interpreted with caution, taking into consideration patient’s clinical and radiological findings, as well as quantitative molecular data.

Objective: To assess the quality of care of telemedicine consultation during the COVID-19 pandemic at the Jose R. Reyes Memorial Medical Center in 2022. : Methods Design: Cross-Sectional Study Setting: Tertiary Government Training Hospital Participants: 210 patients Results: Majority of the respondents were female, less than 40 years of age, unemployed, consulted for the first time, lived < 25km distance from the hospital, consulted because of an ear problem, consulted without symptoms suggestive of COVID-19 and had higher outcomes of face-to-face consultation. The overall satisfaction with teleconsultation was good with majority of patients satisfied and very satisfied with teleconsultation (4.29±1.083). Occupational status, technical problems encountered in the teleconsultation, and those who were bothered by the absence of clinical examination were associated with the perceived quality of care of the ENT teleconsultation (p < .05). Among the population who were satisfied to ENT teleconsultation, 82 (43%) were from the working population (OR 2.2 [1.1-4.7]), 158 (95%) were satisfied with quality of response (OR 23.7 [9.4-59.8]) and 154 (93%) were satisfied with image quality (OR 16.9 [7.3-39.0]). Conclusion Teleconsultation for ENT has proven useful in terms of satisfying the urgent concerns of patients in a pandemic setting.
Telemedicine

Background: The lip trill is a semi-occluded vocal tract exercise found to have positive outcomes on vocal parameters of healthy individuals after a single session. However, the effect of several lip trill sessions has not been studied. Objective: This study investigated the effect of a 3- to 4-week lip trill exercise program on Maximum Phonation Time (MPT), Maximum Phonation Frequency Range (MPFR), Harmonics-to-Noise Ratio (HNR), and mean Speaking Fundamental Frequency (mean SFF). Methods: Three vocally untrained healthy females with perceptually normal voices participated in a multiple-baseline, single-case experimental research. Five to seven direct training sessions were randomly assigned. Self-implementation was encouraged thereafter. Participants were assessed on all outcome measures for 15 sessions. Data were visualized and inspected. Cohen’s d was also derived using Standardized Mean Difference for single-subject research. Results: Visual and statistical analyses revealed a decreased MPT when training was introduced, increased MPFR variability during the training phase, and increased stability in mean SFF post-training. Perceived effects include vocal freedom, decreased laryngeal stress, and vocal conditioning. Vocal outcomes in one participant yielded a significant effect on MPFR and mean SFF and a small effect on HNR. Conclusion There is evidence of lip trill effect on pitch control and vocal conditioning. Findings also revealed that motivation, exercise frequency, and adherence could contribute to positive gains in vocally healthy speakers. Further investigation in consideration of the study findings and limitations is warranted.
prevention

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. METHODS: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR). RESULTS: We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR. CONCLUSION Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.
Humans ; Cross-Sectional Studies ; Pandemics ; COVID-19/epidemiology* ; Burnout, Psychological ; Health Personnel

Background. Subacute sclerosing panencephalitis (SSPE) is a fatal neurodegenerative disease caused by prolonged persistent infection of the central nervous system with a measles virus mutant. Though various treatment modalities have been tried, there is no effective treatment to completely cure SSPE and new therapeutic strategies are needed.

Objective. This is a prospective uncontrolled observational open label trial to describe the short-term outcomes and safety of intraventricular ribavirin in combination with oral isoprinosine in Filipino SSPE patients.

Methods. Sixteen (16) unrelated SSPE patients between ages 3-26 years and in various clinical stages were included in this study. Demographic data were described. Intraventricular instillation of ribavirin (1-3 mg/kg/dose) through an Ommaya reservoir was given for a duration of 3-6 months in 13 patients. The duration of follow-up was 48 weeks. The clinical outcome was assessed before, during, and after treatment using the Neurological Disability Index (NDI), Brief Assessment Examination (BAE), and clinical staging using the Jabbour Classification. Adverse side effects from intraventricular ribavirin were enumerated.

Results. Six of 13 (46.15%) patients mostly in Stage III illness had clinical improvement showing decreasing NDI and BAE scores during treatment and the clinical improvement was maintained or improved further during the 48-week follow-up period. Clinical improvement manifested as improved mental alertness, decrease in spasticity and reduction of seizures. The clinical staging of those who improved remained stable during and after treatment was discontinued. Five (38.46%) patients in Stage II disease worsened and progressed to Stage III despite ribavirin therapy including 1 (7.6%) patient who died after the treatment phase due to pneumonia and brainstem failure. The clinical course of two (15.38%) patients remained unchanged. Minor adverse side effects of ribavirin included transient fever, rash, oral sores, seizure episodes, drowsiness, bladder retention and mild increase in transaminases. Ommaya reservoir infection was a serious adverse event in 5 (31.25%) patients.

Conclusion. There is still no definitive cure for SSPE. Although ribavirin may help alleviate some of the symptoms of SSPE and prolong life, it may not reverse or halt the progression of the disease. Long term follow-up of these patients and continuous use of intraventricular ribavirin will better clarify its role in modifying the fatal course of SSPE. The role of ribavirin in Stage I patients and a controlled clinical trial in Stage II SSPE needs further studies.