OBJECTIVE

To present the case of a 17-year-old girl who was readmitted post-tonsillectomy due to dengue fever, hematemesis and late tonsillar bleeding three weeks after the surgery.

METHODS

Design:Case Report

Setting:Tertiary Government Training Hospital

Patient: One

RESULTS

A previously healthy 17-year-old Filipino girl underwent uncomplicated elective tonsillectomy for chronic hypertrophic tonsillitis. Twenty days post-operatively, she developed fever, thrombocytopenia and massive hematemesis. Despite intensive care management for severe dengue fever with concurrent late post-tonsillectomy bleeding, the patient died from hemorrhagic shock on post-operative day 21.

CONCLUSION

This appears to be the first reported case of concurrent late post-tonsillectomy hemorrhage and dengue fever in a previously healthy adolescent girl. In dengue-endemic areas, post-tonsillectomy patients should be counseled about dengue prevention and advised to seek medical attention for persistent fever. Early recognition and management of this potentially fatal combination is crucial for improving patient outcomes.

Human ; Female ; Adolescent: 13-18 Yrs Old ; Tonsillectomy ; Mortality ; Dengue ; Severe Dengue ; Dengue Hemorrhagic Fever

Objective: To compare subjective nasal airflow and overall pain score (as well as safety and added cost of) using an improvised nasal airway tube (nasogastric tube) versus nasal packing after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods: Design: Quasi - Experimental Prospective Cohort Study Setting: Tertiary Government Training Hospital Participants: Twenty-six (26) consecutive patients aged 18 to 77 years old diagnosed with CRSwNP who underwent ESS were alternately assigned to an experimental group (A) of 13, where an improvised nasal airway (nasogastric) tube was placed in addition to the nasal pack or a control group (B) of 13 with nasal packing alone. Results: There was a significant difference in subjective nasal airflow between experimental (A) and control (B) groups during the immediate postoperative period where the mean subjective airflow was 8.07 and 0.00 over 10.00, respectively. No significant difference was noted between the groups in terms of age, gender, severity of polyposis and overall pain score. No complications such as bleeding, Toxic Shock Syndrome, vestibular or alar injury and septal necrosis were noted immediately post-op and after one week follow-up in both groups. An approximate cost of PhP 25 was added to group A. Conclusion: An improvised nasal airway using a nasogastric tube provides adequate airflow without additional pain in the immediate postoperative period. It is safe to use and an affordable option for patients in need of nasal airway stents residing in areas where a preformed nasal packing with incorporated tube stent is not available.
stents ; nasal obstruction ; nasal polyps ; sinusitis

Objective:To compare the therapeutic efficacy of kalachuchi (Plumeria acuminata Ait.) bark extract ointment (KO) and clotrimazole cream 1% (CC) in the treatment of otomycosis. Methods Design: Randomized double blind controlled trial Setting: Outpatient otorhinolaryngology clinic of a tertiary government hospital Subjects: Patients aged 18-years-old and above diagnosed clinically to have otomycosis with a positive potassium hydroxide (KOH) smear were randomly assigned to kalachuchi (Plumeria acuminata Ait.) bark extract ointment or clotrimazole cream 1% in unlabeled containers. Selfapplication thrice daily for two weeks followed initial detailed instructions and demonstration. Symptoms, physical findings and repeat KOH smears were recorded after the first and second weeks of treatment. Results: Eighteen patients with otomycosis were enrolled in the study. There was one dropout per treatment group with no intention to treat. There were no statistically significant differences between KO and CC, with 75% (n=8) and 87.5% (n=8) cure rates, respectively. One subject in the KO arm reported severe ear pain. Conclusion: Kalachuchi extract ointment may be a promising topical antifungal agent. Multicenter clinical trials to establish its efficacy and safety as an effective alternative in the management of otomycosis should be conducted.

Objective: To determine the antimycotic activity of the four medicinal plant extracts, kalachuchi bark (Plumeria acuminata Ait.), atsuete bark (Bixa orellana Linn.), akapulko leaves (Cassia alata Linn.), and neem leaves (Azadirachta indica Adr. Juss), when compared to the standard clotrimazole in the treatment of otomycosis.Study Design: Experimental StudyMethods: Taxonomically identified plants, kalachuchi, atsuete, akapulko, and neem tree were collected and deposited in an herbarium. Extracts of these plants and the standard clotrimazole were tested against isolates of Aspergillus flavus, Aspergillus niger, and Candida albicans taken from patients with otomycosis. Three trials were made for each extract using different solvents and results subjected to statistical analysis.Result: Of the four medicinal plant extracts studied, only kalachuchi bark extract exhibited antifungal activity against Aspergillus flavus and Aspergillus niger using methylethylketone as solvent when compared to the standard clotrimazole. It was equally effective in inhibiting the growth of A. flavus and A. niger. However, all plantextracts using all types of solvents were equally ineffective in inhibiting the growth of Candida albicans.Conclusion: This in vitro study suggested that kalachuchi (Plumeria acuminata Linn.) bark extract inhibits the growth of Aspergillus species and was comparable to the standard clotrimazole. Following appropriate further studies and clinical trials, it may be a potential alternative treatment option for otomycosis caused by Aspergillus species.
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