Clinical profile of Filipino patients with epistaxis in a university hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE: </strong>To present the demographic profile, etiology and treatment outcome of patients presenting with epistaxis in our local setting.</p><p style="text-align: justify;"><strong>METHODS:</strong></p><p style="text-align: justify;"><strong>         Design:            </strong> Retrospective Study</p><p style="text-align: justify;"><strong>         Setting:</strong>           Tertiary Private University Hospital</p><p style="text-align: justify;"><strong>         Participants:</strong> Records of 188 patients who presented with epistaxis at the emergency room as well as in-patient admissions and referrals due to epistaxis from January 2017 to December 2017 were reviewed.</p><p style="text-align: justify;"><strong>RESULTS:  </strong>There were a total of 188 patients who presented with epistaxis, with a male to female ratio of 2:1. Peak incidence was noted in young children aged 0-10 years old and again rising in adults above 60 years of age. The most common cause of epistaxis was noted to be trauma (56, 29.79%), followed by hypertension (41, 21.81%) and mucositis at (38, 20.21%). Conservative management were done in majority of the cases (187, 99.47%) with an overall success rate of 95.19% (178 out of 188).</p><p style="text-align: justify;"><strong>CONCLUSION: </strong>One of the most common emergencies that people may encounter in their lifetime is epistaxis. Understanding the demographic profile, etiology, intervention and treatment outcome of patients with epistaxis is essential for the establishment of cost-effective treatment guidelines, protocols and preventive strategies. Health education remains to be a key in reducing morbidity and mortality resulting from epistaxis.</p><p> </p>

Morbidity outcomes of prophylactic central neck dissection with total thyroidectomy versus total thyroidectomy alone in patients with node-negative papillary thyroid cancer: a meta-analysis of observational studies

@#<p><strong>Objective: </strong>The primary objective of this meta-analysis is to compare locoregional recurrence, vocal cord paralysis, and permanent hypoparathyroidism in patients with thyroid papillary carcinoma without neck node metastases, after total thyroidectomy with and without prophylactic central neck dissection.</p><p><strong>Methods: </strong>Two independent reviewers performed a detailed literature search of MEDLINE (PubMed), HERDIN and Cochrane Library electronic databases to assess research studies until 2018 for inclusion. The primary endpoints of locoregional recurrence, permanent hypoparathyroidism, and vocal cord paralysis were included in the assessment.</p><p><strong>Design:           </strong>Meta-analysis of Retrospective Cohort Studies</p><p><strong>Setting:          </strong>University Hospitals and Tertiary Referral Centers</p><p><strong>Participants:            </strong>Patients with node-negative papillary thyroid cancer who underwent either total thyroidectomy alone or total thyroidectomy with prophylactic central neck dissection (either unilateral or bilateral).</p><p><strong>Results: </strong>This meta-analysis showed that there is a significantly increased risk for locoregional recurrence in the total thyroidectomy alone group (1.96% TT with pCND VS 2.60% TT, RR=0.62, 95% Cl=0.40-0.95, p=.03), permanent hypoparathyroidism in the total thyroidectomy with prophylactic central neck dissection group (5.72% TT with pCND vs 3.34% TT, RR=2.19, 95% Cl=1.62-2.98, p=.00001) and no significant difference for vocal cord paralysis between the 2 groups (RR=1.56, 95% Cl=0.86-2.84, p=.14).</p><p><strong>Conclusion: </strong>This meta-analysis revealed that performing pCND in patients with node-negative PTC increases the risk of morbidity for hypoparathyroidism but not for vocal cord paralysis. More importantly, the incidence of recurrence is decreased in the pCND group, which may have implications on the overall survival of patients. The benefit of performing pCND may outweigh the risk but the role of prophylactic CND in the treatment of patients with PTC with clinically negative lymph nodes is still debatable in terms of overall survival.</p><p> </p><p><strong>Keywords:</strong>  thyroidectomy, complications; neck dissection; papillary thyroid carcinoma; lymph node dissection; recurrence; vocal cord paralysis; hypoparathyroidism</p>