Radiographic measurement of Nasopharyngeal Depth from the Anterior Nasal Spine (ND-ANS) among Filipino adults

Objective@#To determine a normative value for the nasopharyngeal depth from the anterior nasal spine (ND-ANS) among normal adult Filipinos using Computed Tomography scans.@*Methods@#Design: Cross-sectional study. Setting: Tertiary National University Hospital. Participants: Of 516 adult patients that underwent facial, neck and temporal bone CT scans in our hospital between January 1 to June 30, 2019, 100 cases were randomized to be included in the study and 91 CT scans were analyzed.@*Results@#The mean nasopharyngeal depth from the anterior nasal spine among Filipino adults is 7.17 ± 0.42. There was a significant difference between sexes with a mean measurement of 7.23 cm ± 0.44 in males and 7.09 ± 0.37 cm in females. There was no statistically significant difference in mean nasopharyngeal depth across age groups.@*Conclusion@#A statistically significant difference was observed between sexes in our study sample. Our study provides initial normative values of nasopharyngeal depth among adult Filipinos, and additional studies may use this as a basis for further research.

Validation of snort-spit saliva in detecting COVID-19 using RT-PCR and Rapid Antigen Detection Test

@#Objective. To determine the diagnostic accuracy of self-collected snorted and spit saliva in detecting COVID-19 using RT-PCR (ssRT-PCR) and lateral flow antigen test (ssLFA) versus nasopharyngeal swab RT-PCR (npRT-PCR). Methods. One hundred ninety-seven symptomatic subjects for COVID-19 testing in a tertiary hospital underwent snort-spit saliva self-collection for RT-PCR and antigen testing and nasopharyngeal swab for RT-PCR as reference. Positivity rates, agreement, sensitivity, specificity, and likelihood ratios were estimated. Results. Estimated prevalence of COVID-19 using npRT-PCR was 9% (exact 95% CI of 5.5% - 14.1%). A higher positivity rate of 13% in the ssRT-PCR assay suggested possible higher viral RNA in the snort-spit samples. There was 92.9% agreement between ssRT-PCR and npRT-PCR (exact 95% CI of 88.4% to 96.1%; Cohen’s Kappa of 0.6435). If npRT-PCR will be assumed as reference standard, the estimated Sensitivity was 83.3% (exact 95% CI of 60.8% to 94.2%), Specificity 93.9% (exact 95% CI of 89.3% to 96.5%), Positive predictive value of 57.7% (exact 95% CI of 38.9% to 74.5%), Negative predictive value of 98.2% (exact 95% CI of 95% to 99.4%), positive likelihood ratio of 3.65 (95% CI of 7.37 to 24.9), negative likelihood ratio of 0.178 (95% CI of 0.063 to 0.499). There was 84.84% agreement (95% exact CI of 79.1% to 89.5%; Cohen’s Kappa of 0.2356) between ssLFAvs npRT-PCR, sensitivity of 38.9% (exact 95% CI of 20.3% to 61.4%), specificity of 89.4% (exact 95% CI of 84.1% to 93.1%), PPV of 26.9% (95% CI of 13.7% to 46.1%), NPV of 93.6% (exact 95% CI of 88.8% to 96.4%), LR+ of 3.67 (95% CI of 1.79 - 7.51), LR – of 0.68 (95% CI of 0.47 - 0.99). Conclusion. Our data showed that snort-spit saliva RT-PCR testing had acceptable diagnostic performance characteristics and can potentially be used as an alternative to the standard nasopharyngeal/oropharyngeal swab RT-PCR test for COVID-19 in certain situations. However, our data also showed that snort-spit saliva antigen testing using lateral flow assay did not offer acceptable performance.

Surgical simulation of endoscopic sinus surgery using Thiel soft-embalmed human cadaver

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study describes the quality of Thiel soft-embalmed cadavers as training model for endoscopic sinus surgery in terms of color and consistency of the tissues and similarity of performing the surgical steps to live surgery.</p><p style="text-align: justify;"><strong>METHODS:</strong> This is a cross-sectional descriptive study. Six Thiel soft-embalmed cadavers from the University of the Philippines, College of Medicine, Department of Anatomy were used as training models. The Thiel-preserved cadavers utilized the soft embalming protocol being employed at the Virginia State Anatomical Program in Richmond, Virginia, USA. Ten otorhinolaryngologists were recruited to evaluate the cadavers using a questionnaire with three parts. The first two parts utilize a 10-point Likert scale with 1 as the least similar to live patient while 10 as simulating the live patient. The third part is an open-ended question regarding the suitability of Thiel soft-embalmed cadavers in the training for endoscopic sinus surgery.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Endoscopic sinus surgery was successfully performed in all cadavers. The Thiel soft-embalmed cadaver closely replicates the color and consistency of the anatomic structures important in endoscopic sinus surgery. All the surgical steps were performed with ease simulating live surgery.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Thiel soft-embalmed cadaver is a suitable model for training in endoscopic sinus surgery.</p>

Tumoral calcinosis in secondary hyperparathyroidism

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To  report  a  case  of  tumoral  calcinosis  from  secondary hyperparathyroidism  and  to describe its surgical management.<br /><strong>METHODS:</strong><br /><strong> Design:</strong> Case Report<br /> <strong>Setting:</strong> Tertiary Public University Hospital<br /> <strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 34-year-old woman presented with progressively-enlarging bilateral upper extremity masses. Diagnostic tests revealed hyperfunctioning parathyroid glands. The patient underwent subtotal  parathyroidectomy,  right  thyroid  lobectomy  with  isthmusectomy,  and  transcervical thymectomy.    Follow-up  revealed  marked  decrease  in  parathyroid  hormone,  and  progressive resolution of the tumoral calcinosis.<br /><strong>CONCLUSION:</strong> Subtotal  parathyroidectomy  and  transcervical  thymectomy  have  a  role  in  the management  of  tumoral  calcinosis,  and  in  this  case  led  to  excellent  post-operative  results. The rare  presentation  of  secondary  hyperparathyroidism  and  intervention  in  this  patient  may  have potential lessons for future management of similar cases.</p>

Congenital nasal chondromesenchymal hamartoma

Objectives: To report the case of a congenital nasal chondromesenchymal hamartoma in a oneyear- old female and review the literature, identifying problems encountered in confirming the diagnosis and in treatment of this patient. Methods: Design: Case Report Setting: Tertiary Public General Hospital Patient: One Results: A one-year-old female with an intranasal mass noted at birth and with subsequent unilateral maxillary enlargement is described. Computed tomography showed calcifications and erosion of adjacent bony structures. Histopathology and immunohistochemistry of an intranasalbiopsy were interpreted as chordoma, a malignant tumor. Following surgical excision, the final histopathologic diagnosis was chondroid hamartoma. Conclusion: Only 20 cases of nasal chondromesenchymal hamartoma have been reported in the literature worldwide. These tumors may present clinically, histopathologicaly and radiologically as malignant tumors and may mislead even the experts. The whole clinical picture should be taken together to avoid misdiagnosis as a malignancy and to facilitate appropriate management.