Association of excessive daytime sleepiness and obesity with apnea-hypopnea index in adult patients suspected of obstructive sleep apnea syndrome

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine whether excessive daytime sleepiness (EDS) as assessed by the Epworth Sleepiness Scale (ESS) is significantly correlated with body mass index (BMI) and Apnea-Hypopnea Index (AHI) in patients suspected of OSAS and whether obesity as assessed by BMI is associated with AHI.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Non-concurrent cohort study<br /><strong>Setting:</strong> Tertiary Private Hospital<br /><strong>Population:</strong> The charts of 389 patients suspected to have sleep disorders and referred for polysomnography (PSG) at the Center for Snoring and Sleep Disorders in year 2009 were reviewed. Inclusion criteria were patients aged 19 and above with complete data. A total of 238 patient charts were included in the study.<br /><strong>RESULTS:</strong> The study included a total of 238 patient charts. Results showed no significant association between ESS and AHI (p-value >0.05) even when correlated with the different severities of OSAS (p-value>0.05). Sensitivity and specificity of ESS was found to be 54% and 57%, respectively, indicating that ESS is not a sensitive and specific tool to predict the presence of OSAS. These findings suggest that ESS may not be able to significantly identify patients with OSAS. However, BMI showed a significant association with ESS (p-value<0.05) representing more patients with EDS belonging to the obese category. Conversely, obese patients were twice more likely to have EDS, represented by ESS scores of >=10. BMI was also significantly associated with AHI using one-way Anova test.<br /><strong>CONCLUSION:</strong> This report concludes that the ESS alone is insufficient to identify patients with OSAS. Nevertheless, questionnaires like the ESS supplement relevant history to help diagnose patients with sleep disorders particularly OSAS. On the other hand, the ESS showed a significant association with BMI representing more obese patients had excessive daytime sleepiness. The likelihood ratio of having excessive daytime sleepiness is two times more for obese patients. BMI was also significantly associated with AHI which confirms the well established relationship of obesity with OSAS, and shows that obese patients are at higher risk for severe OSAS.</p>

Congenital maxillomandibular fusion: A rare case of isolated true bony syngnathia

@#<p><strong>OBJECTIVE: </strong>To present a rare case of congenital maxillomandibular fusion or syngnathia<br /><br /><strong>METHODS</strong>:<br /><strong>Study Design:</strong>Case Report<br /><strong>Setting:</strong> Tertiary Public Teaching Hospital<br /><strong>Participant:</strong> One patient<br /><br /><strong>RESULTS:</strong> A 3-year-old girl with oral adhesion (syngnathia) caused by a mandibular to maxillary fibrous band with bony fusion underwent successful surgical division and release. Subsequent monitoring and serial oral dilations were performed post operatively, resulting in mouth opening of 24mm over a period of three months. Currently, the patient is able to tolerate a general liquid diet.<br /><br /><strong>CONCLUSIONS</strong>: Congenital maxillomandibular fusion is a very rare condition with few cases reported. We hope this report contributes to its diagnosis and management in other children.</p>

Kimura's disease initially diagnosed as malignancy then extra-pulmonary tuberculosis

Objective@#To describe a rare case of Kimura’s disease initially misdiagnosed as malignancy then tuberculosis.@*Methods@#Design: Case report Setting: Tertiary Private Hospital Patient: One @*Results@#A 30-year-old male with a 6-year history of gradually-enlarging right infra-auricular mass revealed an enlarged mass in the right infraauricular area and multiple cervical lymphadenopathies on physical examination. Initial fine-needle aspiration biopsy was interpreted as pleomorphic adenocarcinoma but succeeding work-ups and imaging studies led to treatment for tuberculosis. Subsequent biopsies finally led to the proper histopathologic diagnosis of Kimura’s disease and the patient was shifted to appropriate treatment with oral prednisone. @*Conclusion@#Kimura’s disease is rare and may be confused with other diseases such as malignancy or tuberculosis. Histopathologic diagnosis is necessary as its treatment differs from tuberculosis and other diseases.