Real-world physician practices on the diagnosis and management of allergic rhinitis in the Philippine setting.

Background: Physician awareness and adherence to guidelines varies among countries and between types of physician practice. Identifying the needs of the physician and patient is essential to improve patient outcome. Data on physician diagnosis and management of allergic rhinitis (AR) in the Philippines is currently limited. Objective: Study objectives are to assess awareness and use of guidelines, practices on diagnosis and management of intermittent and persistent AR, reasons for choice of therapy, and familiarity with immunotherapy. Methods: A cross-section of 590 specialist and 223 subspecialist physicians from 17 regions of the Philippines were surveyed from October 2021 to July 2022. Survey consisted of a 12-point validated online questionnaire on knowledge and use of guidelines for diagnosis and treatment, use of diagnostic tests, preferred pharmacologic treatment, preferred adjuvant therapy, reasons for treatment choice, and familiarity with immunotherapy. Results: Seventy-seven percent of respondents used Allergic Rhinitis and its Impact on Asthma guidelines for diagnosis and management of AR. Three-fifths of respondents "always" routinely evaluated AR patients' history and performed a physical examination for asthma; 57% of respondents "always" routinely evaluated asthma patients' history and performed a physical examination for AR. Allergy testing was "sometimes" recommended by 62.2%. Oral second-generation antihistamines were the preferred choice for the treatment of intermittent AR. Intranasal steroids were the preferred treatment for persistent AR. Top reasons for choice of treatment were guideline recommendations, efficacy, onset of action, cost, and availability of treatment. Conclusion: Filipino specialists and subspecialists are aware and use guidelines in diagnosis and management of AR. Clinical history and physical examination are the cornerstone of diagnosis. Management practices for intermittent and persistent AR are similar for both groups. Recognizing the role of patient treatment preferences and allergen-specific immunotherapy remains to be a gap in the management of AR by Filipino physicians.

Attitudes, practices on allergic rhinitis of three socioeconomic classes of Filipinos in the National Capital Region.

BACKGROUND: Healthcare access and usage may vary according to socioeconomic class (SEC). Knowing this variable's effect on patient attitudes, practices, and health seeking behavior allows better understanding of compliance, adherence to treatment, and educational needs on allergic rhinitis (AR). OBJECTIVE: This study seeks to assess the attitudes and practices on AR of Filipinos in the National Capital Region. METHODS: A cross sectional survey of 301 Filipinos, stratified into socioeconomic groups ABC1, C2, and DE, was conducted from December 2014 to February 2015. A previously validated and pilot tested questionnaire on AR was administered via structured face to face interviews. RESULTS: Most respondents attributed their symptoms to "colds" (ABC1 77%, C2 79%, DE 78%); most did not consult a physician for their symptoms. Only 26% of all respondents were aware of AR. Only the ABC1 group had respondents who specifically used the term AR. Most respondents' symptoms fulfilled criteria for moderate to severe disease. Sleep was the activity most affected by AR (62%). For symptom relief, over the counter antihistamine-decongestants were the most preferred drug preparations (ABC1 30%, C2 38%, DE 34%). Groups ABC1 and C2 cited family, television, and Internet as the top primary sources of health information; DE cited family, television, and friends. CONCLUSION: Regardless of SEC, Filipinos are not aware of AR. Lack of awareness and gaps in knowledge can result to an underestimation of the condition, decrease in health seeking behavior, unmet patient needs, and undertreatment of disease.

Mandibular ameloblastoma with lung metastasis 10 years after resection

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present a case of mandibular ameloblastoma with pulmonary metastasis after ten years and discuss the possible pathophysiology, diagnostic and therapeutic options.<br /><strong>METHODS:</strong><br /><strong> Design:</strong> Case Report<br /> <strong>Setting:</strong> Tertiary Private Hospital<br /><strong> Patient:</strong> One<br /><strong>RESULTS:</strong> A  27-year-old  woman  diagnosed  with  follicular  variant  ameloblastoma  underwent left  segmental  mandibulectomy  with  iliac  bone reconstruction  in  2004.  The  titanium  plates were  removed  in  2008  because  of  a  recurrent  orocutaneous  fistula.  She  was  apparently  well until 2014, when she complained of intermittent, non-radiating, sharp and piercing, right upper back pains. Work-ups revealed multiple bilateral lung nodules.  A CT scan-guided percutaneous needle  biopsy  of  the  right  upper  lung  nodule  revealed  metastatic  ameloblastoma.  Opting  for observation  instead  of  chemoradiation,  she  remains  asymptomatic  on  regular  follow-ups  with medical oncology, pulmonary medicine and otorhinolaryngology.<br /><strong>CONCLUSION:</strong> Though  benign,  ameloblastoma  has  a  high  propensity  for  local  invasion  and  may metastasize.  It  is  difficult  to  predict metastasis, even  with  adequate  treatment  of  the  primary lesion. There is no standard protocol to prevent or detect metastatic ameloblastoma, but regular and close follow up may ensure early diagnosis.</p>

Attitudes, practices on allergic rhinitis of generalists and specialists in Philippine National Capital Region.

BACKGROUND: Treatment of allergic rhinitis (AR) consistent with consensus guidelines is reported to result in better patient outcomes. However, physicians may manage patients independently of guidelines. Asian data on physician perspectives regarding AR diagnosis and management is limited. OBJECTIVE: The study objective is to assess attitudes and practices on AR of Filipino specialists and generalists. METHODS: A cross sectional survey of 100 specialists and 100 generalists was conducted from November 2014 to January 2015. A previously validated and pilot tested questionnaire was administered via structured face to face interviews. RESULTS: Specialists reported greater adequate knowledge of AR (specialists, 58%; generalists, 39%) and adherence to guidelines (specialists, 84%; generalists, 54%). Diagnostic tests were not routinely used (specialists, 81%; generalists, 92%). Monotherapy, specifically antihistamines, was preferred for mild AR. For moderate-severe AR, preference for monotherapy versus combination therapy (specialists, 49% vs. 51%; generalists, 44% vs. 56%) was similar. Both groups preferred intranasal corticosteroid spray (INCS) for monotherapy and antileukotrienes, antihistamines, INCS for combination therapy. For adjuvant therapy, specialists (82%) preferred nasal irrigation/douche. Primary consideration for choice of therapy was efficacy. Cost was the perceived reason for patients' noncompliance with treatment. CONCLUSION: Despite differences in awareness of and adherence to guidelines, prescribing patterns on management of mild and moderate-severe AR are similar among Filipino specialists and generalists. This can be attributed to a shared perception of efficacy and cost as drivers for therapeutic choices.

Pterygopalatine fossa infiltration: A radio-anatomic study among adult patients in a tertiary private hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> As   a   guide   to   the   clinical   practice   of   infiltration   of   local   anesthesia   into   the pterygopalatine fossa via the greater palatine canal, this study sought to determine and record the  mean  CT  scan  measurements  of  the  following:  1)  palatal  mucosal  thickness,  2)  length  and width  of  greater  palatine  canal,  and  3)  length  and  width  of  pterygopalatine  fossa  among  adult patients in a private tertiary hospital in Quezon City.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective, Descriptive Study<br /><strong>Setting:</strong> Tertiary Private Hospital<br /><strong>Subjects:</strong> Paranasal Sinus (PNS) CT Scans of 113 adult patients from January 2014 to May 2014 were reviewed and evaluated. Excluded were images with pathology that distorted the anatomy of the sinuses and surrounding structures.<br /><strong>RESULTS:</strong> Our study showed average CT scan measurements of 5.98 mm palatal mucosal thickness, 16.99  mm  greater  palatine  canal  length,  18.75  mm  pterygopalatine  fossa  length,  2.37  mm greater palatine canal width and 2.58 mm pterygopalatine fossa width. Comparison of average measurements  by  sex  was  not  statistically  significant.  There  was  statistical  significance  when comparing the right palatal mucosal thickness of 5.86 mm with the left which was 6.11 mm with p-value of 0.001. Comparison between the length of the right pterygopalatine fossa of 18.48 mm with the  left side at 19.01 mm showed statistical significance with p-value of 0.01.<br /><strong>CONCLUSION:</strong> As the average measurement of the mucosal palatal thickness combined with the length of the greater palatine canal was 22.97 mm, we recommend bending the needle 23 mm from  the  tip  in  a  45  degree  angle  for  adult  patients  who  will  undergo  sinus surgery,  control  of posterior epistaxis, trigeminal nerve block and minor oral cavity surgeries.</p>

Rosai-Dorfman disease presenting as recurrent nasal polyposis

@#OBJECTIVES: To present a case of Rosai-Dorfman disease in an individual with a 14-year history of recurrent nasal polyposis and discuss its clinical presentation, physical examination, radiologic findings, histopathologic characteristics and available treatment. METHODS: Design: Case Report Setting: Tertiary Government Hospital Patient: One RESULTS: A 26-year-old Filipino diagnosed and repeatedly treated medically and surgically for recurrent nasal polyposis underwent repeat endoscopic sinus surgery. A histopathologic impression of Rosai-Dorfman disease was confirmed by positive S-100 and CD1a negative immunochemistry in conjunction with the morphologic findings. CONCLUSION: Rosai-Dorfman disease is a rare entity which should be considered when dealing with recurrent nasal polyposis that is intractable to initial medical and surgical therapies. Histopathologic findings of emperipolesis and immunohistochemical S-100 stains play a key role in the diagnosis but there is yet no definite treatment for this disease.

Papillary thyroid carcinoma presenting with a right preauricular and intracranial mass

p style=text-align: justify;strongOBJECTIVE:/strong To describe a case of a papillary thyroid carcinoma presenting with a preauricular and an intracranial mass and review the literature on the metastatic nature and invasiveness of papillary thyroid carcinoma.br /br /strongMETHODS:/strong br /strongDesign:/strong Case Report br /strongSetting:/strong Tertiary Private Hospital br /strongPatient:/strong One br /br /strongRESULTS:/strong A 46-year-old female with a 12-year anterior neck mass and a two-year right pre-auricular pleomorphic adenoma on fine needle aspiration biopsy was found to have an intracranial mass on CT- scan. Total thyroidectomy and section biopsy of the preauricular mass yielded a final histopathologic report of follicular variant of papillary carcinoma, thyroid gland; and metastatic papillary thyroid carcinoma, follicular type, pre-auricular mass. The condition of the patient precluded neurosurgical intervention and RAI therapy and she underwent 23 sessions of external radiotherapy using 46Gy with significant diminution in size of the intracranial metastasis.br /br /strongCONCLUSION:/strong Papillary thyroid malignancy may be an indolent tumor but it is capable of distant metastasis. We should be alerted by host and tumor factors which can be predictors of a more radical papillary malignant disease whose management entails proper staging evaluation and good communication of prognostic data and available, realistic therapeutic options to patients using a multidisciplinary approach./p

A new ossicle homograft inactivation/preservation procedure: clinical results.

A new NaOH-autoclaving inactivation/preservation procedure (IPP) for ossicle homografts, complying with the actual infectious disease guidelines, has been developed and used in our institution for 5 years. This study compares the clinical and audiological results of middle ear reconstruction using the new NaOH-autoclaving inactivated ossicle homografts (22 patients) and the previously used cialit-formaldehyde inactivation procedure (28 patients). During the follow-up period, no homograft extrusion, resorption or disease transmission was observed either for the NaOH-autoclaving or for the cialit-formaldehyde protocol. A postoperative air-bone gap of less than 20 dB in 44% and a postoperative hearing improvement of 10-50 dB in 70% of patients complies with the published success rates of homograft ossiculoplasty in the literature. The analysis and comparison of both tested IPP-patient groups showed no statistically significant differences in the clinical and the audiological results. The NaOH-autoclaving inactivation/preservation protocol should increase ossicle homograft safety even with respect to prion exposure. The good anatomic and audiological long-term results of the new IPP protocol confirm homograft ossicles as a valid and inexpensive approach for middle ear reconstruction.