Effectiveness of levodropropizine on post-operative sore throat after endotracheal intubation for head and neck surgery: A double-blind randomized controlled trial

@#Objective: To determine the effectiveness of levodropropizine in reducing the incidence of post-operative sore throat (POST) among ear, nose, throat, head and neck (ENT-HNS) patients undergoing general endotracheal anesthesia. Methods: Design: Double-Blind, Randomized, Placebo Controlled Trial Setting: Tertiary Government Training Hospital Participants: Sixty (60) ENT-HNS patients aged between 19 to 60 years old admitted to the Southern Philippines Medical Center from January to March 2019 for surgeries on benign thyroid tumors, benign submandibular gland tumors and tonsils requiring orotracheal intubation were randomized into control and treatment groups of 30 patients each. Results: There was a statistically significant difference (p=.0016) in the incidence of POST 6 hours after surgery between control (25/30; 83%) and treatment (16/30; 53.33%) groups. However, confounders such as length and type of surgery (more females and tonsillectomy cases in the control group) were not fully eliminated by randomization. Conclusion: Perioperative levodropropizine significantly decreases the incidence of moderate (as well as mild) postoperative sore throat. It was not shown to decrease the incidence of severe sore throat. A larger cohort (adjusted for other confounders) may better describe the benefit of this treatment.

Levothyroxine versus levothyroxine with iodine in reduction of thyroid nodule volume: a double-blind randomized controlled trial

@#<p><strong>Objective: </strong>To compare levothyroxine alone and in combination with iodine on thyroid nodule volume reduction.</p><p><strong>Methods: </strong></p><p><strong>Design:           </strong>Double-Blind Randomized Controlled Trial</p><p><strong>Setting:           </strong>Tertiary Government Hospital</p><p><strong>Participants: </strong>Nineteen (19) euthyroid patients age 19-54 with at least 1 cytologically benign thyroid nodule were randomized to receive either levothyroxine + iodine or levothyroxine + placebo, taken once a day for 6 months with ultrasound and thyroid stimulating hormone monitoring on the 3rd and 6th month of intervention.</p><p><strong>Results: </strong>Main outcome measures included thyroid nodule volume reduction after six months of intervention. The mean change in volume from baseline to six months of levothyroxine + iodine group showed no statistically significant difference in nodule volume across time between  levothyroxine + placebo group, -0.010 ± 1.250 (CI -0.521 - 0.501) versus 0.507 ± 1.128 (CI 0.025 - 0.990), p=.158.  There were also new nodules (4 nodules) in the placebo group and none in the iodine group. No major adverse events were noted during the study.</p><p><strong>Conclusion: </strong>The two groups did not significantly differ in terms of nodule volume reduction.</p><p><strong>Keywords:</strong> thyroid nodule, prevention and control; drug therapy; iodine compounds, therapeutic use; levothyroxine, therapeutic use</p>

Bleeding time using Moringa oleifera (Malunggay) leaf extract versus saline control in a rabbit epistaxis model: A randomized controlled trial

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine bleeding time using Moringa oleifera leaf extract versus saline control in an experimental epistaxis model.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Randomized controlled trial<br /><strong>Setting:</strong> Tertiary Government Training Hospital<br /><strong>Participants:</strong> Ten adult male New Zealand White rabbits were acclimatized for 1 week in a standard environment. One-centimeter long, full-thickness mucosal wounds in the junction of the nasal floor and anterior part of the septum were treated randomly with topical Moringa oleifera extract or colored isotonic saline control in either right or left nasal cavity, one site at a time. The duration of bleeding - time bleeding started to time bleeding stopped -- was recorded in seconds. Data was subjected to a t-test for paired samples.<br /><strong>RESULTS:</strong> The mean bleeding time for wounds treated with Moringa extract was 53 seconds (range 38-70 secs), versus 159 seconds (range 100-218 secs) for controls. The bleeding time in the former was significantly shorter than in the latter (p = .000019, t-stat = 8.139), with a mean difference of 106 seconds between the two groups.<br /><strong>CONCLUSION:</strong> Moringa oleifera leaf extract was associated with significantly shorter bleeding time than saline control in this experimental epistaxis model and may be worth investigating further as a hemostatic agent for epistaxis.</p>

A 15-year occult foreign body in the subglottic area of a 50-year-old woman

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present a case of subglottic foreign body (FB) impaction in a 50-year-old woman diagnosed with bronchial asthma for 15 years.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Public Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 50-year-old woman with recurrent cough and dyspnea for 15 years that had been managed as a bronchial asthma developed stridor and halitosis in the last 5 years. Flexible laryngoscopy revealed a subglottic mass and CT scan confirmed a suspicious foreign body in the lumen of the subglottis. Signs and symptoms resolved after peroral endoscopic removal of the foreign body from the larynx. Histopathology of the extracted material from the airway confirmed it to be "bone tissue".<br /><strong>CONCLUSION:</strong> Foreign body aspiration can occur in adults without predisposing factors. Its diagnosis can be challenging as it can mimic respiratory disorders such as bronchial asthma. Endoscopy and computed tomography are valuable for correct diagnosis and management. An incorrect initial diagnosis should be considered in the light of unresolved symptoms and prompt referral to an appropriate specialist may prevent undue suffering and dangerous complications. </p>

Rhinofacial conidiobolomycosis in a 16-year-old girl

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To present the case of a 16-year-old girl with progressive facial disfigurement spanning 11 months due to conidiobolomycosis<br /><strong>METHODS:</strong><br /><strong>Design</strong>: Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 16-year-old girl presented with a severe facial deformity of 11 months duration. The lesion started as a swelling in the right nasal vestibule, which later involved the entire nose, forehead, cheeks, upper and lower lip. A series of tissue biopsies revealed varied results-- chronic inflammation, chronic granulomatous inflammation with foreign body type giant cells, and eosinophilic granuloma- resulting in delayed provision of appropriate treatment. On the fourth biopsy using the Grocott methenamine silver staining technique, septate fungal hyphae were identified. With a diagnosis of rhinofacial conidiobolomycosis, she was started on Itraconazole 100mg three times daily for eight months. Her facial swelling subsided gradually during the course of treatment and no systemic drug-related complications were observed. <br /><strong>CONCLUSION:</strong> Rhinofacial conidiobolomycosis is a rare chronic localized fungal infection that usually affects midline facial structures in immunocompetent hosts. Early detection and diagnosis, and appropriate medication can give rapid resolution. To the best of our knowledge, this may be the first documented case of rhinofacial conidiobolomycosis in the Philippines.</p>

Basosquamous carcinoma of the neck

@#Basosquamous carcinoma, a variant of basal cell carcinoma, is rather rare with an incidence of only 1 – 2% of cases. 1, 2 It has a predilection for the head and neck region (95.6%) with primary sites including the nasal, auricular and periocular area with the neck involved in only 1.1%.1 Unlike typical basal cell carcinoma, basosquamous carcinoma behaves more aggressively with a higher tendency for metastasis and recurrence. Its rarity translates to a lack of management guidelines. Because of its pattern of growth and relative aggressiveness, treatment plans must be well laid; recurrence resulting from poor planning may lead to a worse outcome and poorer prognosis.