Management of cerebrospinal fluid leak in the lateral recess of the sphenoid sinus with transpterygoid approach: A case report

BackgroundCerebrospinal fluid (CSF) leak that occurred in the lateral sphenoid sinus is a rare and difficult case. This paper aims to report a case of defect closure in the lateral recess of the sphenoid sinus endoscopically with a transpterygoid approach.Case presentationA 38-year-old Indonesian woman reported a CSF leak, and identified a defect in the lateral recess of the left sphenoid sinus. CSF leak was repaired with endoscopic transethmoid-pterygoid or transpterygoid endoscopic surgery and no CSF leak was found. The surgical procedure was successful even though it was only performed by an otorhinolaryngologist.DiscussionEndoscopic transethmoid-pterygoid or transpterygoid endoscopic surgery is effective in repairing defects in the lateral recess of the sphenoid sinus in which surgical procedure is performed by a single otorhinolaryngologist.ConclusionEndoscopic transpterygoid approach gained access to lateral site of sphenoid sinus was an effective approach in managing CSF leak of lateral sphenoid recess. Closure of the defect using a bone graft and mucosa of the middle turbinate was proven to be effective. It had been carried out successfully in Indonesia.     

The determinants of willingness to care for people living with HIV-AIDS: A cross-sectional study in Indonesia

Acceptance and willingness to care for people living with HIV-AIDS (PLHA) in society is still a concern. The purpose of this study is to analyse the determinants of willingness to care for PLHA in Indonesia. A cross-sectional study was conducted to process the secondary data from the Indonesian Demographic Health Survey (IDHS) conducted in 2017. A total sample of 13,731 individuals was obtained by a two-stage stratified cluster sampling technique. The variables used were socioeconomic characteristics (age, sex, education, wealth quintile, residence, employment status and earnings), knowledge about HIV-AIDS, information about HIV-AIDS and willingness to care for PLHA. Binary logistic regressions were used to analyse the data. According to the data from IDHS 2017, 71.84% of total respondents in Indonesia are willing to care for PLHA. Female respondents, individuals in all wealth quintiles and those who have more information are more likely to care for PLHA. Respondents aged 35–49 years old and currently working are less likely to care for PLHA. However, level of education, level of knowledge, residence and earnings are not related willingness to care for PLHA. The dissemination of correct and accurate information about HIV-AIDS can help the community and society understand this condition. Thus, community members can accept PLHA and become more willing to provide care. The government can determine further policies for the appropriate dissemination of information, maximally and in accordance with recommendations. Collaborations among the government, health workers and the community are needed.     

Transnasal endoscopic neochoanal technique: An effective procedure for bilateral choanal atresia in adult female

BackgroundSurgery on bilateral choanal atresia surgery is challenging and this case is rare in adults. In addition, stenosis issue postoperatively is commonly seen.Case presentationTransnasal endoscopic neochoanal technique was performed on a 27 years old female with the detailed surgical procedure was described. Neither stent nor nasal tamponade was applied. Ten months follow-up revealed a patent-wide neochonae.DiscussionTransnasal endoscopic neochoanal technique without stent and nasal tamponade can be considered the procedure of choice in the management of CA cases.ConclusionsTransnasal endoscopic neochoanal technique is considered an effective surgical procedure on bilateral choanal atresia.     

Color change of primary teeth following exposure to an experimentally synthesized liposomal nano-encapsulated ferrous sulfate drop versus the commercially available iron drops

ObjectivesThis study aimed to assess the color change of primary teeth following exposure to an experimentally synthesized liposomal nano-encapsulated ferrous sulfate drop compared with the commercially iron drops.Materials and methodsIn this in-vitro study, liposomal nano-encapsulated ferrous sulfate (lipo-nano-ferr) drop was first synthesized. Next, 110 extracted primary anterior teeth were randomized into two equal groups (sound and demineralized). Each group was randomly divided into 5 subgroups (n = 11) and exposed to Irofant, Feroglobin, Sideral, and lipo-nano-ferr drops for 540 cycles. One subgroup was remained in artificial saliva as the negative control. Tooth color was analyzed before and after the interventions visually, and the rate of iron adsorption was analyzed by atomic absorption spectrometry (AAS), and energy-dispersive X-ray spectroscopy/scanning electron microcopy (EDS/SEM). Data were analyzed using t-test, one-way ANOVA, and LSD test.ResultsIron adsorption was significantly higher by the demineralized specimens than the sound specimens in all subgroups (P < 0.001). A significant difference was noted in iron adsorption among the four subgroups in each of the sound and demineralized groups (P < 0.001). Iron adsorption in the lipo-nano-ferr subgroup was significantly lower than that in Irofant and Feroglobin groups (P < 0.001). The visual inspection results were similar to AAS results. EDS-SEM showed that the atomic percentage of iron in Sideral and lipo-nano-ferr groups was significantly lower than that in Irofant and Feroglobin groups (P < 0.001).ConclusionUse of nano-encapsulation technology in production of iron drops can significantly decrease the resultant tooth discoloration, causing a clinically negligible color change.