Joana Guincho, Luís Baptista, Carlota Sousa
et al.
Introdução: A conjuntivodacriocistorrinostomia (CDCR) está indicada sobretudo em obstruções proximais da via lacrimal, assim como em trauma ou epífora persistente após DCR.
Objetivo: Rever as indicações clínicas da CDCR, descrever a técnica cirúrgica e dificuldades encontradas.
Material e métodos: Série retrospetiva de doentes submetidos a CDCR com tubos de Jones Stop Loss (TJSL). O sucesso anatómico foi definido pela permeabilidade do tubo à irrigação e o sucesso funcional pela resolução da epífora.
Resultados: Foram realizadas 5 CDCR. As etiologias incluíram agenésia congénita da via lacrimal, falência de DCR e estenose iatrogénica do canal lacrimal.
Conclusão: A CDCR com TJSL é uma solução cirúrgica a considerar em casos de obstrução proximal e insucesso da DCR convencional, sendo a técnica endoscópica essencial para o posicionamento do TJSL. Complicações como a migração inferior do tubo e crescimento da conjuntiva continuam a ser um desafio, exigindo seguimento a longo prazo.
Pradosh Kumar Sarangi, Pratisruti Hui, Himel Mondal
et al.
ABSTRACT Background Plain language summary (PLS) are essential for making scientific research accessible to a broader audience. With the increasing capabilities of large language models (LLMs), there is the potential to automate the generation of PLS from complex scientific abstracts. This study assessed the performance of six LLM chatbots: ChatGPT, Claude, Copilot, Gemini, Meta AI, and Perplexity, in generating PLS from radiology research abstracts. Methods A total of 100 radiology abstracts were collected from PubMed. Six LLM chatbots were tasked with generating PLS for each abstract. Two expert radiologists independently evaluated the generated summaries for accuracy and readability, with their average scores being used for comparisons. Additionally, the Flesch–Kincaid (FK) grade level and Flesch reading ease score were applied to objectively assess readability. Results Comparisons of LLM‐generated PLS revealed variations in both accuracy and readability across the models. Accuracy was highest for ChatGPT (4.94 ± 0.18) followed by Claude (4.75 ± 0.31). Readability was highest for ChatGPT (4.83 ± 0.27) followed by Perplexity (4.82 ± 0.29). The Flesch reading ease score was highest for Claude (62.53 ± 10.98) and lowest for ChatGPT (40.10 ± 11.24). Conclusion LLM chatbots show promise in the generation of PLS, but performance varies significantly between models in terms of both accuracy and readability. This study highlights the potential of LLMs to aid in science communication but underscores the need for careful model selection and human oversight.
Medical physics. Medical radiology. Nuclear medicine
Gautier Grouvel, Gautier Grouvel, Gautier Grouvel
et al.
Chronic imbalance is the cardinal symptom in bilateral vestibulopathy patients (BV), and in a subset of symptomatic unilateral vestibulopathy patients (UV), leading to a significant impact on their daily lives. Despite these profound effects, such as the risk of falls, the mechanism of imbalance remains complex, posing challenges both for monitoring patients’ functional status and for evaluating rehabilitation therapies. The aim of this study was to assess the dynamic stability of patients with BV and UV during multiple motor tasks and to provide a summary of the most relevant tasks and biomechanical parameters. The purpose was to propose a “short-form FGA” (Functional Gait Assessment) test to reduce the length and complexity of tests, to be able to evaluate future therapies longitudinally, and to monitor functional follow-up of patients. Dynamic stability, spatio-temporal and kinematic parameters were calculated for 10 BV patients, 10 UV patients and 10 asymptomatic controls while walking at three self-selected walking speeds, while performing dual tasks and while completing the 10 tasks of the FGA battery. Two (validity and interpretability) of the four COSMIN domains and clinical applicability were evaluated to identify relevant tasks and parameters to the study population, i.e., good discriminant and convergent validity, and good clinical applicability. The comfortable and slow gait, as well as the turn pivot, eyes closed, and tandem walk tasks were identified as the most relevant for characterizing dynamic stability in these patients. Easily interpretable and visually assessable parameters, such as walking speed, center of mass displacement, step width, trunk movement, stiffness of the head/trunk, and number of steps, were identified as the most relevant. In contrast, stability parameters such as margin of stability or whole body angular momentum did not prove to be effective parameters. These relevant parameters should enable future studies to evaluate rehabilitation therapies such as vestibular implants or physiotherapy, as well as to monitor patients’ functional status. Future studies should validate these results and assess the missing psychometric properties of these parameters.
Domenico Testa, Lucia Del Vecchio, Sergio Motta
et al.
Abstract Objectives Bilateral recurrent nerve damage still represents one of the main complications following thyroid surgery, even though the nerve intraoperative monitoring has allowed the decrease of this injury. This observational retrospective study aims to define the onset modalities and the recovery time of different clinical conditions that may occurs after thyroidectomy. Methods From a total of 1417 patients who underwent total thyroidectomy for benign tumors between 2017 and 2022 in ENT Unit of University of Campania “L. Vanvitelli,” this study involved 30 patients with bilateral vocal folds motility deficit. These patients (28 F, 2 M), aged from 24 to 78 years old (average age 51.7), presented a bilateral vocal fold motility deficit. Five patients of the study developed an acute respiratory failure upon the awakening that required a nasotracheal prolonged safe extubation. The other 25 patients underwent 9 months diagnostic and therapeutic process, which started approximately 30 days after thyroid surgery. Results Indeed, there are several outcomes of these complications, like functional laryngeal defects, which are mainly related to respiratory and phonatory activities. These clinical manifestations can evolve in different ways within a context of a wide range of possibilities, from the spontaneous bilateral or monolateral recovery to the necessity of a functional or surgical restoration. Conclusion This study allowed the acquisition of useful information about prognostic indications and an adequate therapeutic process, based on the specific clinical characteristics.
Diego da Silva Ormundo, Mariana Lopes Fávero, Doris Ruthy Lewis
Introduction NB CE-Chirp LS was developed to improve the audiogram estimation by auditory brainstem response (ABR) thresholds during audiological assessment of infants and difficult to test children. However, before we know how the stimulus behaves in several types of hearing loss, it is important we know how the stimulus behaves in normal hearing infants.
Pulmonary drug delivery has the advantages of being rapid, efficient, and well-targeted, with few systemic side effects. In addition, it is non-invasive and has good patient compliance, making it a highly promising drug delivery mode. However, there have been limited studies on drug delivery via pulmonary inhalation compared with oral and intravenous modes. This paper summarizes the basic research and clinical translation of pulmonary inhalation drug delivery for the treatment of diseases and provides insights into the latest advances in pulmonary drug delivery. The paper discusses the processing methods for pulmonary drug delivery, drug carriers (with a focus on various types of nanoparticles), delivery devices, and applications in pulmonary diseases and treatment of systemic diseases (e.g., COVID-19, inhaled vaccines, diagnosis of the diseases, and diabetes mellitus) with an updated summary of recent research advances. Furthermore, this paper describes the applications and recent progress in pulmonary drug delivery for lung diseases and expands the use of pulmonary drugs for other systemic diseases.
Abstract Background Universal newborn hearing screening (UNHS) has been widely adopted worldwide as a standard of care because it enables the detection of congenital hearing loss early in life. Therefore, the concepts of regular measurement of performance using pre-determined quality measures are recommended for continuous improvement of the program. This study aimed to evaluate and update the performance of a UNHS program by measuring the recommended quality measures between 2010 and 2019. A retrospective study analyzing data of 50569 babies screened between January 2010 and December 2019 was performed. The pre-determined quality measures of coverage rate, initial referral rate, return to follow-up rate, diagnosis rate, and age at diagnosis were measured. Results The average coverage rate was 95.5%, with all years achieving the recommended benchmark of ≥ 95% except 2014 (91.8%) and 2019 (89.5%). Generally, the initial referral rate (10%) exceeded the benchmark of ≤ 4%. The program only managed to reach the benchmark for initial referral rate in 2013, 2014, and 2015. Both quality indicators for return to follow-up and diagnosis rates also did not meet the ≥ 95% and ≥ 90% standards, respectively. The return to follow-up ranged from 62 to 72.7%, while the average diagnosis rate was 73.4% (60–100%). One hundred thirty-seven infants were diagnosed with hearing loss at a median age of 3.8 months (± 0.4 months), resulting in a prevalence of 0.27%. Conclusion The findings demonstrated an excellent coverage rate but unsatisfactory performance for other quality indicators. Hence, the current program needs to be revisited to remain relevant and effective.
Acoustic-phonetic speech training mitigates confusion between consonants and improves phoneme identification in noise. A novel training paradigm addressed two principles of perceptual learning. First, training benefits are often specific to the trained material; therefore, stimulus variability was reduced by training small sets of phonetically similar consonant–vowel–consonant syllables. Second, the training is most efficient at an optimal difficulty level; accordingly, the noise level was adapted to the participant’s competency. Fifty-two adults aged between sixty and ninety years with normal hearing or moderate hearing loss participated in five training sessions within two weeks. Training sets of phonetically similar syllables contained voiced and voiceless stop and fricative consonants, as well as voiced nasals and liquids. Listeners identified consonants at the onset or the coda syllable position by matching the syllables with their orthographic equivalent within a closed set of three alternative symbols. The noise level was adjusted in a staircase procedure. Pre–post-training benefits were quantified as increased accuracy and a decrease in the required signal-to-noise ratio (SNR) and analyzed with regard to the stimulus sets and the participant’s hearing abilities. The adaptive training was feasible for older adults with various degrees of hearing loss. Normal-hearing listeners performed with high accuracy at lower SNR after the training. Participants with hearing loss improved consonant accuracy but still required a high SNR. Phoneme identification improved for all stimulus sets. However, syllables within a set required noticeably different SNRs. Most significant gains occurred for voiced and voiceless stop and (af)fricative consonants. The training was beneficial for difficult consonants, but the easiest to identify consonants improved most prominently. The training enabled older listeners with different capabilities to train and improve at an individual ‘edge of competence’.
Christopher Metcalfe, Mehmet Dogan, Nina Glazzard
et al.
Abstract Objectives This study summarizes the introduction of a novel telescopic pathway, which streamlines 2‐week‐wait suspected head and neck cancer referrals to our unit, describes the logistics of the pathway, and analyzes referral numbers and outcomes. We also discuss wider issues surrounding remote assessment in head and neck cancer. Methods Data were collected prospectively between January and May 2021, capturing all 2‐week‐wait referrals to our unit following the introduction of a telescopic pathway which utilized a nurse‐led clinic for nasendoscopic examination of selected patients and consultant‐led remote assessment using store and forward technology. Information on referral numbers, waiting times and outcomes was recorded. Results Three hundred and forty (185 high risk, 155 low risk) patients entered the telescopic pathway with the remaining 74 patients seen on the conventional standard of care pathway. Cancer conversion rates were 17%, <1%, and 5.4% for the high‐risk telescopic, low‐risk telescopic and standard of care pathways respectively. No patients discharged from the telescopic pathway were re‐referred within 3 months. Review capacity for endoscopic examination was higher per consultant on the telescopic pathway versus the standard of care (p = .01). Conclusion A combination of risk stratification and asynchronous telescopic assessment shows promise for the management of suspected head and neck cancer referrals. Potential benefits include consultant‐led care for all patients and enhanced documentation. Digital communication with patients may also assist with adherence to the new NHS 28‐day diagnostic standard for cancer referrals. Ongoing data collection is required to assess how the pathway functions over a longer period. Level of Evidence 2c
Oluwatoyin Akinfenwa, Huey-Jy Huang, Birgit Linhart
et al.
IgE-mediated allergy to birch pollen affects more than 100 million patients world-wide. Bet v 1, a 17 kDa protein is the major allergen in birch pollen responsible for allergic rhinoconjunctivitis and asthma in birch pollen allergic patients. Allergen-specific immunotherapy (AIT) based on therapeutic administration of Bet v 1-containing vaccines is an effective treatment for birch pollen allergy but no allergen-specific forms of prevention are available. We developed a mouse model for IgE sensitization to Bet v 1 based on subcutaneous injection of aluminum-hydroxide adsorbed recombinant Bet v 1 and performed a detailed characterization of the specificities of the IgE, IgG and CD4+ T cell responses in sensitized mice using seven synthetic peptides of 31-42 amino acids length which comprised the Bet v 1 sequence and the epitopes recognized by human CD4+ T cells. We then demonstrate that preventive systemic administration of a mix of synthetic non-allergenic Bet v 1 peptides to 3-4 week old mice significantly reduced allergic immune responses, including IgE, IgG, IgE-mediated basophil activation, CD4+ T cell and IL-4 responses to the complete Bet v 1 allergen but not to the unrelated major grass pollen allergen Phl p 5, without inducing Bet v 1-specific allergic sensitization or adaptive immunity. Our results thus demonstrate that early preventive administration of non-allergenic synthetic T cell epitope-containing allergen peptides could be a safe strategy for the prevention of allergen-specific IgE sensitization.
Yousef A. Fouad, Tougan Taha Abdelaziz, Anas Askoura
et al.
Objective: To determine if there was an increase in the rate of cases presenting with rhino-orbital-cerebral mucormycosis (ROCM) to a tertiary care center during the first wave of the coronavirus disease 2019 (COVID-19) pandemic and the characteristics of the presenting cases.Methods: Retrospective observational study reviewing ROCM cases presenting from March 25 until September 25, 2020. Cases fulfilling the clinical, radiological, and pathological/microbiological criteria for diagnosis with ROCM were included. The number of cases presenting during the designated interval, their COVID-19 status, comorbidities, and clinical presentation were analyzed. The number of cases during the corresponding interval in the previous 3 years was used as reference to detect if there was a recent spike.Results: Of the 12 ROCM cases identified, 5 had a concurrent positive reverse transcription PCR (RT-PCR) test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 had a prior positive result, and 6 did not have concurrent nor prior positive test results. Nine of the 12 cases had poorly controlled diabetes mellitus, and 2 cases had a hematological malignancy. All cases had orbital invasion, and eight cases had cerebral invasion. The number of cases identified during the interval is much higher than the numbers presenting in the prior 3 years during equivalent intervals (range, one to two cases) than those reported in the literature in different settings in the pre-pandemic era.Conclusions: There is an increased rate of ROCM cases presenting to our center during the first wave of the COVID-19 pandemic. This is a preliminary report, and further studies are needed to corroborate the findings and explain possible underlying links.
Mafalda de Sousa, Gil Coutinho, Helena Silveira
et al.
Ortner’s syndrome is a rare entity, characterized by dysphonia caused by recurrent laryngeal nerve (RLN) palsy, secondary to cardiovascular disorders.
This work reports two cases of Ortner’s Syndrome. A 81-year-old male presented with dysphonia for a week. Physical examination showed left vocal fold palsy. Computed tomography (CT) revealed left atrial dilation. A 76-year-old male, had complaints of dysphonia for two weeks. Left vocal fold paralysis was observed. CT showed an aortic arch aneurysm.
RLN is responsible for the innervation of the intrinsic laryngeal muscles, with exception of the cricothyroid muscle. Unilateral RLN palsy usually causes hoarseness. Bilateral RLN paralysis may be associated with more severe symptoms, such as dyspnea and stridor.
Many benign and malign causes can affect the nerve through its course, whereby imaging is crucial in differential diagnosis. Despite being rare, Ortner’s syndrome may be the cause of vocal fold paralysis.
Elisabeth Wallhäusser-Franke, Tobias Balkenhol, Svetlana Hetjens
et al.
Objectives: Patient-reported outcomes gain importance for the assessment of auditory abilities in cochlear implant users and for the evaluation of auditory rehabilitation. Aims of the study were to explore the interrelation of self-reported improvements in auditory ability with improvements in speech comprehension and to identify factors other than audiological improvement that affect self-reported auditory ability.Study Design: Explorative prospective analysis using a within-subjects repeated measures design.Setting: Academic tertiary care center.Participants: Twenty-seven adult participants with bilateral sensorineural hearing loss who received a HiRes 90K CI and continued use of a HA at the non-implanted ear (bimodal hearing).Intervention: Cochlear implantation.Main Outcome Measures: Self-reported auditory ability/disability assessed by the comparative version of the Speech, Spatial and Qualities of Hearing Scale (SSQ-B), and monosyllable as well as sentence comprehension in quiet and within speech modulated noise from different directions assessed pre- as well as 3 and 6 months post-implantation.Results: Data of 17 individuals were analyzed. At the endpoint of the study, improvement of self-reported auditory ability was significant. Regarding audiometric measures, significant improvement was seen for CI-aided pure tone thresholds, for monaural CI-assisted and bimodal sentence comprehension in quiet and in speech-modulated noise that was presented from the same source or at the side of the HA-ear. Correlations between self-reported and audiometric improvements remained weak, with the exception of the improvement seen for monaural CI-aided sentence comprehension in quiet and self-perceived improvement of sound quality. Considerable correlations existed between self-reported improvements and current level of depression and anxiety, and with general self-efficaciousness. Regression analyses substantiated a positive influence of self-efficaciousness on self-reported improvement in speech comprehension and between the improvement of monaural CI-aided sentence comprehension in quiet and perceived sound quality as well as a negative influence of anxiety on self-reported improvement in spatial hearing. Self-reported improvements were significantly better in the subgroup with intensive as compared to regular rehabilitation.Conclusions: Self-reported auditory ability/disability represents an important measure for the success of bimodal CI-provision. It is influenced by personal and mental health factors that may improve CI-rehabilitation results if addressed during rehabilitation.
Art Ambrosio MD, Kastley Marvin MD, Colleen Perez MD
et al.
Objective Difficult airway management is a key skill required by all pediatric physicians, yet training on multiple modalities is lacking. The objective of this study was to compare the rate of, and time to, successful advanced infant airway placement with direct laryngoscopy, video-assisted laryngoscopy, and laryngeal mask airway (LMA) in a difficult airway simulator. This study is the first to compare the success with 3 methods for difficult airway management among pediatric trainees. Study Design Randomized crossover pilot study. Setting Tertiary academic medical center. Methods Twenty-two pediatric residents, interns, and medical students were tested. Participants were provided 1 training session by faculty using a normal infant manikin. Subjects then performed all 3 of the aforementioned advanced airway modalities in a randomized order on a difficult airway model of a Robin sequence. Success was defined as confirmed endotracheal intubation or correct LMA placement by the testing instructor in ≤120 seconds. Results Direct laryngoscopy demonstrated a significantly higher placement success rate (77.3%) than video-assisted laryngoscopy (36.4%, P = .0117) and LMA (31.8%, P = .0039). Video-assisted laryngoscopy required a significantly longer amount of time during successful intubations (84.8 seconds; 95% CI, 59.4-110.1) versus direct laryngoscopy (44.9 seconds; 95% CI, 33.8-55.9) and LMA placement (36.6 seconds; 95% CI, 24.7-48.4). Conclusions Pediatric trainees demonstrated significantly higher success using direct laryngoscopy in a difficult airway simulator model. However, given the potential lifesaving implications of advanced airway adjuncts, including video-assisted laryngoscopy and LMA placement, more extensive training on adjunctive airway management techniques may be useful for trainees.
En Abstract Background Allergic rhinitis is a common disorder that can significantly impact the quality of life of patient. It is strongly linked to asthma and conjunctivitis. The classic symptoms of the disorder are nasal congestion and itching, rhinorrhea, and sneezing. Currently, steroids have played a role in the management of allergic rhinitis. The aim of the study was to assess the efficacy and safety of triamcinolone in the treatment of allergic rhinitis in Egypt. Patients and methods A total of 308 Egyptian patients who were suffering from moderate-to-severe allergic rhinitis and were prescribed triamcinolone were enrolled. The improvement in the quality of life of patients receiving triamcinolone after 4 weeks of treatment was assessed using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). All adverse events were recorded during the study duration. Results The RQLQ showed a significant improvement in the quality of life of patients after using triamcinolone. The mean RQLQ score before triamcinolone administration was 2.99±1.015 versus 0.68±0.706 after 4 weeks of treatment (P<0.001), with a mean percent reduction of −76.78±23.62%. The individual domain scores of the RQLQ after 4 weeks of treatment showed a significant improvement in the level of all domains. No adverse events were reported and the drug showed a high tolerability profile. Conclusion Triamcinolone is considered an efficient and safe drug in the management of allergic rhinitis. It has a positive impact on the quality of life of patients with moderate-to-severe persistent allergic rhinitis under conditions of daily practice in patients receiving triamcinolone after 4 weeks of treatment.
Mariane Barreto Brandão Martins, Francis Vinicius Fontes de Lima, Carlos Alberto Mendonça
et al.
Summary
Introduction: Juvenile nasopharyngeal angiofibroma is a rare, highly vascular, and histologically benign tumor, generally observed in male adolescents. It shows very aggressive behavior due to local invasiveness and is associated with various symptoms. Juvenile nasopharyngeal angiofibroma originates in the sphenopalatine forame, causing epistaxes and nasal obstruction.
Objective: To retrospectively describe our experience in the diagnosis and treatment of patients with juvenile nasopharyngeal angiofibroma.
Scientific drawing: Retrospective, descriptive study conducted after approval from the Ethics Committee of the Federal University of Sergipe (protocol 0114.0.107.000 -11).
Methods: We analyzed findings in 20 patients who underwent surgery between 2004 and 2011. Factors analyzed include patient age and gender, symptoms, stages, treatment, length of surgery, intraoperatory bleeding, postoperative need for nasal tampons, hospitalization time, complications, and tumor recurrence.
Results: Patients were aged 10–29 years. All patients were treated surgically, including 17 who underwent endoscopic surgery. The mean operation time was 120 min, and the mean bleeding volume was 300 mL. Seventeen patients required clamping of the external carotids and tumor embolization.
Conclusion: Endoscopic surgery alone or with other conventional techniques was safe for the treatment of angiofibromas of different stages.