A case report on obstructive sleep apnea in a pediatric patient with achondroplasia

@#A 22-month-old male diagnosed with achondroplasia was referred for difficulty in sleeping and was diagnosed to have severe obstructive sleep apnea (OSA) on polysomnography (PSG) (AHI 50.1). This patient had macrocephaly, midface hypoplasia, flat nasal bridge, relative macroglossia and enlarged palatine and adenoid tonsils. The patient underwent bilateral tonsillectomy with adenoidectomy without complication. Six months post-op, repeat polysomnography revealed a still severe (AHI 15.7) OSA with preferential recovery of REM and N3 sleep. Further outpatient follow-up and management is warranted. OSA despite being common in this subset of patients remains overlooked and not prioritized because of the multitude of coexisting concerns. Management of OSA in children with achondroplasia shows improved sleep structure and is helpful for further growth and development.

Outcomes of COVID-19 positive and COVID-19 negative adult patients who underwent tracheostomy for prolonged intubation in a COVID-19 referral center during the pandemic

Objective@#To compare outcomes of COVID-19 positive and COVID-19 negative patients who underwent tracheostomy for prolonged intubation in terms of weaning duration, length of ICU and hospital stay, overall and 30-day mortality, and explore risk factors for particular outcomes (mortality, 30-day mortality and weaning duration post tracheostomy). @*Methods@#Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Participants: Of 122 adult patients that underwent tracheotomy between March 30, 2020 and March 30, 2021; 76 adult patients underwent tracheostomy for prolonged intubation were analyzed.@*Results@#Open tracheotomy was performed on 122 adult patients. Seventy six (62.3%) due to prolonged intubation and 46 (37.7%) for airway prophylaxis. Among the former, the mean age was 58.46±16.81 and 54 (71.05%) patients were female, 22 (28.95%) tested COVID-19 positive and 54 (71.05%) tested negative. Mean APACHE II score was 16.62±6.78. Average days of intubation prior to tracheostomy was 29.14±17.66 days. No statistically significant difference in outcomes (weaning days, length of stay, days discharge from ICU and hospital, 30-day mortality, days to death) were noted between COVID19 positive and negative patients who underwent tracheostomy for prolonged intubation. Mortality rates post tracheostomy in this institution appear to be higher than existing literature. On multiple linear regression analysis, days of intubation prior to tracheostomy was associated with increased weaning time post-tracheostomy (OR: 0.35 CI:0.18-0.51 95% p = <.001). This implies that for every additional day of intubation prior to tracheostomy, weaning days increase by 0.35 of a day. @*Conclusion@#Outcomes of COVID-19 compared to non-COVID-19 patients undergoing tracheostomy for prolonged intubation do not seem to be significantly different which is consistent with existing literature.

Filipino translation and validation of the University of Washington – Quality of Life Questionnaire (Version 4) for patients with head and neck tumors in the Philippine General Hospital

Objectives@#This study aims to develop a Filipino translation of the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, and determine its internal consistency and test-retest reliability. @*Methods@#This was a cross sectional mixed methods study comprised of two parts. The first part consisted of Filipino translation of the UW-QOL version 4 questionnaire. The second part validated the internal consistency and testretest reliability through statistical analysis. @*Results@#The Cronbach’s coefficient was high (0.88) which denotes good internal consistency. Pearson’s correlation coefficient was obtained to determine the test-retest reliability of the translated questionnaire. A p value of <0.05 indicates that the questionnaire has good test-retest reliability. The p value was high in most of the items of the questionnaire. @*Conclusion@#The internal consistency of the translated questionnaire is high and comparable to other translations of the same questionnaire. The test-retest reliability is low owing to the interventions done between the test and retest.

Task-oriented learning in head and neck anatomy using virtual, formalin-preserved, soft-embalmed, and plastinated cadavers

Background and Objective@#The COVID 19 pandemic has changed the way the human anatomy is taught. A necessary shift towards online instruction, combined with a decrease in cadaver donation has resulted in the need for maximizing formalinized, soft-embalmed, computerized, and plastinated cadaver specimens. Task-oriented activities allow students to demonstrate acquired knowledge and skills. It is the aim of this study to get the perspective of students in the utilization of available laboratory materials.@*Methods@#One hundred forty-three students participated in task-oriented activities. Students demonstrated anatomy of the facial nerve, recurrent laryngeal nerve, and phrenic nerve by parotidectomy, thyroidectomy, and posterior neck dissection using formalinized cadaver and VH dissector™. Deep neck and sagittal structures in the plastinated specimen were identified using laser pointers. Ossicular mobility of the middle ear, and endoscopy of the nose and larynx were demonstrated using the soft embalmed cadaver. Students were surveyed on their perceptions on the utility of each cadaver specimen.@*Results@#Formalinized and soft-embalmed cadaver were observed to present the most accurate anatomy, while the virtual dissector and plastinated specimens were seen to be the most sustainable and reusable. @*Conclusion@#Task-oriented learning in head and neck anatomy may use different cadaveric materials with varied accuracy and utility.

Filipino translation and validation of the University of Washington - Quality of Life Questionnaire (Version 4) for patients with head and neck tumors in the Philippine General Hospital

Objectives@#This study aims to develop a Filipino translation of the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, and determine its internal consistency and test-retest reliability. @*Methods@#This was a cross sectional mixed methods study comprised of two parts. The first part consisted of Filipino translation of the UW-QOL version 4 questionnaire. The second part validated the internal consistency and testretest reliability through statistical analysis. @*Results@#The Cronbach’s coefficient was high (0.88) which denotes good internal consistency. Pearson’s correlation coefficient was obtained to determine the test-retest reliability of the translated questionnaire. A p value of <0.05 indicates that the questionnaire has good test-retest reliability. The p value was high in most of the items of the questionnaire. @*Conclusion@#The internal consistency of the translated questionnaire is high and comparable to other translations of the same questionnaire. The test-retest reliability is low owing to the interventions done between the test and retest.

A case report on obstructive sleep Apnea in a pediatric patient with Achondroplasia

@#A 22-month-old male diagnosed with achondroplasia was referred for difficulty in sleeping and was diagnosed to have severe obstructive sleep apnea (OSA) on polysomnography (PSG) (AHI 50.1). This patient had macrocephaly, midface hypoplasia, flat nasal bridge, relative macroglossia and enlarged palatine and adenoid tonsils. The patient underwent bilateral tonsillectomy with adenoidectomy without complication. Six months post-op, repeat polysomnography revealed a still severe (AHI 15.7) OSA with preferential recovery of REM and N3 sleep. Further outpatient follow-up and management is warranted. OSA despite being common in this subset of patients remains overlooked and not prioritized because of the multitude of coexisting concerns. Management of OSA in children with achondroplasia shows improved sleep structure and is helpful for further growth and development.