Comparison of short nozzle and long nozzle spray in sinonasal drug delivery: a cadaveric study.

The aim of this study is to compare the delivery site of topical drugs using the short nozzle and the long nozzle. Fourteen fresh frozen cadaver heads were obtained. All cadaver specimens underwent bilateral endoscopic wide maxillary antrostomy, frontal sinusotomy, and complete sphenoethmoidectomy. The right nasal cavity of each cadaver was sprayed with radiolabeled saline using the short nozzle (short nozzle group), while the left nasal cavity was sprayed using the long nozzle (long nozzle group). The distribution of radioactive saline within the sinus cavities was determined using single-photon emission computed tomography/computed tomography. The distribution of the radiolabeled saline in reference with the maxillary line, vestibule, maxillary, ethmoid, sphenoid, and frontal sinus was compared between the 2 groups using Fisher exact test. The number of specimens that demonstrated radioactivity above the maxillary line is higher in the long nozzle group (14 cadavers, 100%) compared to short nozzle group (9 cadavers, 64.3%; p = .02). There are fewer specimens that demonstrated deposition of radioactive saline in the vestibule in the long nozzle group (6 cadavers, 42.86%) compared to short nozzle group (13 cadavers, 92.86%; P = .006). Compared to short nozzle group, there are more specimens demonstrating radioactivity in the maxillary, ethmoid, sphenoid, and frontal sinus in the long nozzle group, but the differences were not statistically significant (p = 0.241, 0.347, 0.126, 0.5). Compared to short nozzle, long nozzle more frequently delivers intranasal drugs beyond the maxillary line and less frequently in the vestibule. These findings support the hypothesis that the use of long and narrow nozzle, instead of the conventional short nozzle, can improve sinonasal drug delivery in post-endoscopic sinus surgery nose.

Risk factors for recurrent papillary thyroid carcinoma

OBJECTIVE: To identify risk factors associated with disease recurrence among Filipinos with papillary thyroid carcinoma (PTC).METHODS:Design: Retrospective Cohort StudySetting: Tertiary National University HospitalParticipants: 76 patients diagnosed with papillary thyroid carcinoma, classified as low and low-to-intermediate risk (2015 ATA classification) that underwent total thyroidectomy with or without neck dissection from 2010-2014 and were followed up from 10 months to 5 years. Log rank and Cox regression analyses were used to determine significant risk factors for recurrence.RESULTS: 29 (38.15%) had recurrence. On univariate analysis, age, tumor size, multifocality, extrathyroidal extension, presence of lateral neck nodes and RAI therapy were statistically associated with recurrence. However, on multivariate analysis, no clinicopathologic factor was statistically associated with recurrence.CONCLUSION: Age of >45 years, female sex, tumor size of >2 cm, multifocality, presence of microscopic extrathyroidal extension and lymph node metastasis might contribute to the recurrence of papillary thyroid cancer while post-operative radioactive ablation may have some protective effect. However, this study suggests that other factors must be included in the model to better understand the relationship between these factors and recurrence.

Prevalence and reasons for non-follow-up of newborns with "refer" results on initial hearing screening

OBJECTIVE: To determine the prevalence rate of follow-up among infants who had a "refer" result on initial newborn hearing screening and to identify reasons for default by parents or guardians.METHODS:Design: Cross-Sectional StudySetting: Tertiary National University HospitalParticipants: 79 parents or guardians whose newborns obtained a "refer" result on initial hearing screening were interviewed over the phone.RESULTS: Among those babies who had a "refer" result on initial hearing screening, 51% followed up for repeat testing. The most common reasons for non-follow up by parents or guardians include being busy, distance from the hospital and baby's health condition.CONCLUSIONS: The follow-up rate in this study is higher compared to previous figures (27%), but is still below target. The reasons for non-follow-up obtained suggest problems may exist on all levels of the healthcare system. Appropriate solutions to address these problems should be explored.

Prevalence of sensorineural hearing loss and its association with glycemic control in Filipino patients with diabetes at the Philippine General Hospital / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Sensorineural hearing loss (SNHL) is a form of diabetic neuropathy. Its prevalence rate varies from 21.7-73.3% among different populations. The association of this complication with long-term glycemic control has not been described extensively.<br /><strong>OBJECTIVES:</strong> The study aims to determine the prevalence of SNHL in Filipino patients with diabetes consulting in a tertiary hospital; and to determine the association of SNHL with the degree of blood sugar control as measured by the mean hemoglobin bA1c (HbA1c) for the last five years.<br /><strong>METHODOLOGY</strong>: A cross-sectional study of 128 patients in a tertiary hospital was done. Patients were recruited via stratified random sampling with the different clinics as the stratifying variable. They underwent physical examination and pure tone audiometry (PTA) to detect presence of SNHL and presence of distal peripheral neuropathy. Chart review was done to gather the HbA1c levels for the last five years, as well as data on the presence of retinopathy and nephropathy. The average HbA1c levels, and other clinical and demographic factors and their association with SNHL were analyzed using logistic regression.<br /><strong>RESULTS:</strong> The prevalence of SNHL among patients with diabetes is 45.31%. Glycemic control does not seem to be associated with SNHL (p value 0.451, OR 1.447). Age was found to be significantly associated with SNHL (p value=0.046, OR=1.035). Among patients age 60 years old and below, retinopathy was significantly associated with SNHL (p value 0.023, OR=3.564). Multivariate analysis did not show any significant predictor for SNHL. There was no observed difference in the proportion of patients with SNHL among males (48.94%) compared to females (43.21%), p value of 0.530. A more advanced age is associated with SNHL among males (p value 0.024, OR=1.095) and a family history of hearing loss is an independent predictor of SNHL (p value 0.047, OR=1.088).<br /><strong>CONCLUSION:</strong> There is a high prevalence rate of SNHL among Filipino patients with diabetes. SNHL does not seem to be associated with glycemic control. Screening for SNHL maybe warranted for patients with diabetes due to its high prevalence rate regardless of glycemic control. Hearing care, focusing on prevention of hearing loss, should be advocated for patients with diabetes mellitus</p>