Abstract Background Hearing loss (HL) is the third most common long-term health problem in the world. This number is likely to go up even more in the future. HL is a big problem for people because it makes it challenging for them to talk and affects their quality of life in general. Even though many people use hearing aids (HAs), about 50% of them are unhappy with how their HAs fit. The general character of these fittings, which do not take into account each user’s unique hearing preferences in situations where communication may be difficult, is a big reason why people are unhappy with them. Poorly fitted HAs can make it hard to talk to people and also lower a person’s quality of life. Body of abstract The current technology of artificial intelligence (AI), especially after the admission of machine learning, has been upgraded for HA’s performance and speech clarity. AI has the potential to be incorporated into contemporary HAs to offer creative ways to enhance speech comprehension and quality of life. AI offers numerous choices to enhance the operation of HAs, including personalized adjustments, remote modifications, smartphone applications, and connectivity and streaming capabilities. Conclusions AI has the potential to be integrated into modern HAs to present inventive solutions to improve quality of life and speech understanding. Therefore, AI could potentially reduce the frequent audiologist visits and hence lower costs.
Hosam Mohamed Elgayar, Ahmed Mahmoud zeina, Mohamed Radwan El-Hadidy
et al.
Abstract Introduction Among races, the Egyptian nose is an example of the mixed ethnic nature in terms of its anatomy and morphology. The predominant character in Middle Eastern noses is thick skin and weak cartilages, when compared with those of White noses. The study aimed to classify a group of Egyptian patients with nasal deviation and to develop a convenient algorithm for their management. This study aimed to compare spreader grafts versus clocking sutures for correcting dorsal nasal deviation. Also, it aimed to compare septal extension grafts and columellar struts versus the swinging door technique for correcting caudal nasal deviation. Material and methods In this study, a group of Egyptian patients with a deviated nose was classified according to the orientation of the nasal bony and cartilaginous units relative to the midline. Spreader grafts and clocking sutures were used for the correction of a deviated dorsal cartilaginous septum. In contrast, the swinging door technique, combined with a columellar strut and septal extension graft, was one of the two techniques used for caudal septal correction. Assessment was conducted using Cottle’s test, NOSE score, GIMP software, and Computed Tomography. Results The study was conducted on 60 patients (36 males and 24 females), with a mean age of 25.7 years (range, 16–40 years). Bilateral bony osteotomy was done for all cases. Type I of nasal deviation was the most common (30%), while the least common type was type V (10%). Correction of the deviated angle was significant (P < 0.001). The outcome of spreader grafts was superior to that of clocking sutures in cases of severe deviation. Likewise, the septal extension graft was better for caudal septum correction. Conclusion The Egyptian nose exhibits distinctive features, including thick skin and a weak cartilaginous framework. Of the five types of nasal deviation, type I was the most common type (30%). The angle of nasal deviation showed significant postoperative improvement (P value < 0.001). Level of evidence IV
Abstract Background One of the most common and prevalent cancers is laryngeal squamous cell carcinoma (LSCC), which poses a great threat to the life and health of the patient. Nonetheless, it has been demonstrated that ubiquitination is crucial for the development and course of LSCC. Therefore, it is particularly important to identify biomarkers for ubiquitination-related genes (UbRGs) in LSCC. Methods Differentially expressed genes (DEGs) in the LSCC versus controls were obtained by differential expression analysis. Also, key modular genes associated with LSCC were obtained using weighted gene co-expression network analysis (WGCNA). Next, DEGs, key module genes, and UbRGs were taken to intersect to obtain candidate genes. And then machine algorithms were to screen potential biomarkers, further their diagnostic value were analyzed and validated. Then, therapeutic agents for biomarkers were predict. In addition, the regulatory networks of the biomarkers were mapped. The expression levels of biomarkers were detected in clinical samples using reverse transcription-quantitative PCR (RT-qPCR). Results A total of eight candidate genes were acquired by the overlap 1,911 DEGs, the key modular genes of WGCNA, and 1,393 UbRGs. A sum of four biomarkers (WDR54, KAT2B, NBEAL2 and LNX1) were identified by two machine learning, then these four biomarkers were validated in GSE127165 and the expression trend was consistent with TCGA-LSCC, they were recorded as biomarkers. Moreover, the accuracy of the biomarkers in predicting clinical aspects of LSCC was confirmed by the receiver operating characteristic (ROC) curves. Subsequently, cancers such as malignant neoplasms, colorectal cancers, tumors, and primary malignant neoplasms were significantly associated with the biomarkers, which further suggests that these four biomarkers were strongly associated with cancer. Meanwhile, the drugs garcinol, cocaine, and triazolam, among others, used for LSCC treatment were predicted. Finally, transcription factors (TFs) (BRD4, MYC, AR, and CTCF) were predicted to regulate the biomarkers. RT-qPCR assays illustrated that the expression trends of KAT2B, LNX1 and NBEAL2 remained consistent with the dataset. Conclusion The identification of four biomarkers (WDR54, KAT2B, NBEAL2 and LNX1) associated with UbRGs could ultimately serve as a predictive clinical diagnosis of LSCC and provide insight into the molecular mechanisms of LSCC.
Swallowing is mediated by the central nervous system, including cortical and subcortical structures, the cerebellum, and the brainstem. The brainstem contains the swallowing centre that is crucial for initiating and coordinating swallowing. Consequently, brainstem damage due to stroke often leads to severe and persistent dysphagia. The aim of the present narrative review is to provide an overview of dysphagia following brainstem stroke and its management. It summarizes the physiology and pathophysiology of dysphagia following brainstem stroke and the available therapeutic options, and evaluate their effectiveness for dysphagia following brainstem stroke, which would promote the development of therapeutic protocols. Neuromodulatory techniques, including pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), modulate the excitability of corticobulbar circuits. These techniques promote neuroplasticity through peripheral or cortical electrical or electromagnetic inputs. Skill-based swallowing training emphasizes cortical involvement in enhancing swallowing skill, offering a targeted approach to behavioural rehabilitation. Finally, transient receptor potential (TRP) agonists increase sensory inputs to the swallowing system by stimulating the sensory receptors in the oropharynx, potentially activating the swallowing network. While these options have shown promise in dysphagia rehabilitation following stroke, most the available data comes from patients with mixed stroke lesions, with limited data focused specifically on brainstem lesions. Therefore, the evidence for their efficacy in patients with brainstem stroke remains underexplored. Therefore, treatment decisions should rely on the understanding of swallowing physiology, neuroplasticity, and clinical evidence from related stroke populations.
Muhammad Farooq, Muhammad Arif Mahmood, Sajid Razzaq
et al.
Objective: To provide evidence that application of Enhanced Recovery after Surgery Protocol can promote rapid recovery of surgical patients in addition to reduction of duration of hospital stay.
Study Design: Quasi-experimental study.
Place and Duration of Study: Sheikh Khalifa Bin Zayad Alnayan Hospital, Rawalakot Azad Kashmir Pakistan, from Jan 2019 to Jun 2020.
Methodology: Respondents included 210 surgical patients from discipline of Otorhinolaryngology, General Surgery, Urology, Gynecology and Obstetrics. Patients were randomly divided into two equal groups by odd and even numbers. Group-A included 105 surgical patients who were managed by conventional protocol. Group-B included 105 surgical patients who were managed by Enhanced Recovery after Surgery Protocol.
Results: Enhanced Recovery after Surgery Group (Group-B) was found to have shorter preoperative fasting time (146.4±0.47 vs 633.6±1.55 minutes, p<0.001), reduced postoperative fasting time (139.2±0.41 vs 360±0.09 minutes, p<0.001), less use of intravenous fluid (870±0.5 vs 2480ml, p<0.001) and reduced hospital stay (52.8±0.91 vs 80.16±1.17 hours, p<0.001) as compared to Traditional Group. Compared to traditional group (Group-A), the number of highly satisfied patients were more in Group-B (n-95 or 90.48% vs n-42 or 40%, p-value<0.001). No significant difference was noted in post-operative vomiting, surgical wound infection and rate of re-admission among both groups.
Conclusion: There is a significant reduction in duration of hospital stay and swift recovery after surgery, leading to reductions in treatment cost and resource utilization.
Michal Pieniak, Berit Höfer, Jenny Knipping
et al.
Abstract Background Pediatric headache is an increasing medical problem that has adverse effects on children’s quality of life, academic performance, and social functioning. Children with primary headaches exhibit enhanced sensory sensitivity compared to their healthy peers. However, comprehensive investigations including multimodal sensory sensitivity assessment are lacking. This study aimed to compare sensory sensitivity of children with primary headaches with their healthy peers across multiple sensory domains. Methods The study included 172 participants aged 6 to 17 years (M = 13.09, SD = 3.02 years; 120 girls). Of these 80 participants were patients with migraine, 23 were patients with tension-type headache, and 69 were healthy controls. The following sensory measures were obtained: Mechanical Detection Threshold (MDT), Mechanical Pain Threshold (MPT), Mechanical Pain Sensitivity (MPS), detection and pain threshold for Transcutaneous Electrical Nerve Stimulation (TENS), olfactory and intranasal trigeminal detection threshold, and odor identification ability. Sensory sensitivity was compared between groups with a series of Kruskal-Wallis tests. Binomial regression models were used to compare the relative utility of sensory sensitivity measures in classifying participants into patients and healthy controls, as well as into patients with migraine and tension-type headache. Results Patients with migraine had lower MPT measured at the forearm than patients with tension-type headaches and healthy controls. MPS was higher in patients with migraine than in healthy controls. All patients with headaches had lower detection threshold of TENS and higher olfactory sensitivity. Healthy controls showed increased intranasal trigeminal sensitivity. Scores in MPS, TENS, and olfactory and trigeminal thresholds were significantly predicting presence of primary headaches. Additionally, scores in MPT, olfactory and trigeminal threshold were positive predictors of type of headache. Conclusions Children with primary headaches exhibit different sensory profiles than healthy controls. The obtained results suggest presence of increased overall, multimodal sensitivity in children with primary headaches, what may negatively impact daily functioning and contribute to further pain chronification. Trial registration The study was registered in the German Registry of Clinical Trials (DRKS) DRKS00021062.
Objective: The spread of the novel SARS-Cov-2 variant Omicron created a challenging public health situation in a number of countries. In March 2022, Omicron emerged in Changchun, China, and the number of patients infected rapidly increased. The prevalence of Omicron infection symptoms differs from that of Delta, with more upper airway clinical symptoms apparent. This study aimed to investigate the clinical and upper airway characteristics of the Omicron variant. Materials and methods: In this retrospective study, we collected data from participants in Changchun who had tested positive for Omicron with quantitative polymerase chain reaction between 10 March and 30 May 2022 using telephone interviews. The questionnaire was designed by the research team based on the number of upper airway symptoms using the visual analogue scale. We also considered age, sex, vaccination status, general symptoms, and cure period. Results: A total of 3715 patients (2056 males and 1659 females) with mild COVID-19 from the Omicron variant were included. The patients had a mean age of 38.63 ( ± 13.97) years (range 2–86 years). The vaccine uptake rate was 91.33 % (8.66 %, 4.58 %, 65.33 %, and 21.43 % had received zero, one, two, and three doses, respectively). The incidence of upper airway symptoms, including throat and nasal symptoms, was 54.21 %. Throat symptoms were the most common during Omicron infection (49.12 %). Nasal symptoms were also common (20.08 %). The incidence of lower airway symptoms was 25.60 %, and gastrointestinal symptoms was 10.87 %. The incidence of general symptoms was 55.26 %. The cure period ranged from three to 37 days, with a mean of 10.24 ± 4.69 days. We compared the upper airway symptom severity for Omicron among different vaccination statuses and found no differences. Conclusions: The main clinical characteristics of the SARS-Cov-2 Omicron variant are upper airway symptoms and general symptoms. Fever remains the most common symptom, followed by mild dry cough. There was no association between Omicron infection and COVID-19 vaccines, and the vaccination status might have been ineffective against upper airway symptom severity by Omicron.
Infectious and parasitic diseases, Public aspects of medicine
Siti Asmat Md Arepen, Azreen Zaira Abu Bakar, Nour Hanan Daniah Mohd Bakhit
et al.
Introduction:An aberrant carotid artery has distinct terms and may exhibit a submucosal mass in the posterior pharyngeal wall. While it is primarily asymptomatic, an extreme aberrancy doubles the risk of dissection, a cerebrovascular accident (CVA) and an injury intraoperatively.Case Report:We report a case of ‘kissing carotid artery’ in a 65-year-old lady who presented with a foreign body sensation felt in the throat for one week. A finding of flexible nasopharyngolaryngoscopy (FNPLS) showed a bilateral paramedian retropharyngeal pulsating mass. Radiological examinations, including Computed Tomography (CT) of the neck and an angiogram, revealed an aberrant course of bilateral carotid arteries. In view of no malignancy and vascular malformations, there was no further intervention done, and the patient was subjected to yearly surveillance.Conclusion:Retropharyngeal carotid arteries are clinically significant anatomic variants. Such anomalies are potentially life-threatening and a risk factor for a severe hemorrhage during the simplest and commonly performed transoral surgeries. Thus, thorough perioperative assessment with accurate imaging techniques and studies are required to evaluate these anomalies and may avoid any disastrous complications.
Myeloid cells are a major heterogeneous cell population in the tumor immune microenvironment (TIME). Imbalance of myeloid response remains a major obstacle to a favorable prognosis and successful immune therapy. Therefore, we aimed to construct a risk model to evaluate the myeloid contexture, which may facilitate the prediction of prognosis and immune infiltration in patients with head and neck squamous cell carcinoma (HNSCC). In our study, six myeloid signature genes (including CCL13, CCR7, CD276, IL1B, LYVE1 and VEGFC) analyzed from 52 differentially expressed myeloid signature genes were finally pooled to establish a prognostic risk model, termed as myeloid gene score (MGS) in a training cohort and validated in a test cohort and an independent external cohort. Furthermore, based on the MGS subgroups, we were able to effectively identify patients with a poor prognosis, aggressive clinical parameters, immune cell infiltration status and immunotherapy response. Thus, MGS may serve as an effective prognostic signature and predictive indicator for immunotherapy response in patients with HNSCC.
Pancreatic adenocarcinoma rarely metastasizes to the parotid gland. More frequently, pancreatic adenocarcinoma will metastasize to the liver, lung, or peritoneum. Parotid metastasis most often arises from cancers originating in the head and neck such as squamous cell carcinoma. In the setting of facial nerve palsy and a parotid mass, a thorough history should always be obtained. Although rare, knowing the patient has a distant primary tumor can raise suspicion for metastasis to the parotid gland. Immunohistochemistry and pathology combined with a thorough history can be helpful in distinguishing the type of metastasis versus a primary parotid gland tumor when assessing the parotid mass. This report demonstrates a rare case of pancreatic adenocarcinoma metastasizing to the parotid gland. There are several routes of management discussed, but due to this patient's poor prognosis and comorbidities, palliative radiation therapy was the treatment of choice.
Laryngeal squamous cell carcinoma (LSCC) is the main type of laryngeal cancer with poor prognosis. Incidence of LSCC increases every year, posing a great threat to human health. The underlying mechanism needs further study. Neutrophils are the most prevalent type of immune cells, which play vital roles in crosstalk between the microenvironment and cancer cells. In our study, we aim to figure out the complex regulation between neutrophils and LSCC. Our experiments showed that LSCC cells could promote the activation and mobility of neutrophils. And, in return, neutrophils enhanced the proliferation, migration, and invasion of LSCC. The subsequent results showed that IL-17 was highly expressed in neutrophil conditioned medium. Block of IL-17 could effectively inhibit the progression of LSCC induced by neutrophils. What is more, the results showed that IL-17 activated the JAK/STAT3 pathway in LSCC. Inhibition of the JAK/STAT3 pathway could significantly block neutrophil-induced LSCC progression. Our research reveals the complex interaction between neutrophils and LSCC cells, providing new ideas for the treatment of LSCC.
Mohamed Aziz Mohamed Talaat, Amr Elfatatry, Nibras Mohamed Ibrahim Mohamed Noor
et al.
Abstract Background Parkinson’s disease (PD) is a degenerative, progressive, neurological condition that influences the control of a person’s body movements. Computerized dynamic posturography (CDP) is a clinical tool intended to evaluate the integration of visual, vestibular, and somatosensory inputs to maintain postural gait. Posturography can be used to measure postural instability in PD patients. So, the aim of this study was to evaluate the postural control and elaborate on the pathophysiology of the balance impairment in PD patients in the “on” state. Results All antero-posterior (AP) and medio-lateral (ML) sensory balance scores, except vestibular ones, were significantly lower in the study group compared to the control group. AP and ML sway were generally higher in the study group at all frequencies, with AP being mostly greater compared to ML sway in PD subjects. Global sensory scores were shown to deteriorate with increased durations of the disease and treatment. Conclusions PD patients have higher postural instability in comparison to controls with AP sway being higher compared to ML.
Yu. K. Yanov, A. A. Krivopalov, N. A. Tuzikov
et al.
The lecture is devoted to the content and assessment of the quality of medical care in general and specialized otorhinolaryngological care in particular. The lecture provides the basic concepts of medical care in general, its main types and forms of provision. The authors define the concept of specialized otorhinolaryngological care from the viewpoint of regulatory documents of the Ministry of Healthcare of Russia and current regulatory documents, its role in the system of medical care of our country, providing the routing of the patients at all its stages. The lecture presents the approaches to assessing the quality of specialized otorhinolaryngological care. The authors determine the concept of mistake and defect, their main types and causes, their effect on the safety and efficacy of specialized otorhinolaryngological care. The work covers the legal aspects of assessment of provided otorhinolaryngological care quality, pointing out the important problem of the absence of a single approach to such assessment in otorhinolaryngology. The authors substantiate the necessity of original and multipurpose system of expert assessment of quality of provided otorhinolaryngological care based on automatic quality evaluation technology as a prototype. The next work will be devoted to its peculiarities as well as to the problems existing in clinical otorhinolaryngology.
Marija Rowane OMS-II, Ryan Shilian DO, Devi K. Jhaveri DO, FAAP, FACOP
et al.
Introduction Allergic rhinitis (AR) is a widely prevalent immunoglobulin E-mediated inflammatory nasal condition resulting from reexposure to an allergen in a sensitized individual. The genetic associations behind AR and other allergic conditions have been studied. However, familial success with AR therapies, specifically allergen desensitization through subcutaneous immunotherapy (SCIT), has never been reported in the literature. Pharmocogenetics has been gradually applied to link heritable genetic variants with drug responses, such as intergenic region variants APOBEC3B and APOBEC3C and β2-adrenergic receptor and glycoprotein ADAM33 polymorphisms as predictive biomarkers for biologic treatment response in asthma. We provide the first reported survey of familial success with SCIT. Methods We administered a month-long, institutional review board-approved (20190493) questionnaire to 200 adult patients receiving SCIT in a suburban allergy/immunology practice. The anonymous survey inquired about demographics, target allergens for their SCIT, current symptom improvement on SCIT, and family history of allergies and SCIT management. Results Twenty-six percent (52 of 200, 26%) SCIT patients reported familial success with the same allergy treatment modality. AR diagnosis and symptom improvement from SCIT was similar among previous/same (18 of 52, 38%; 26 of 52, 54%) and subsequent (10 of 52, 21%; 19 of 52, 40%) generations of family members. A combination of seasonal and perennial allergies was most prevalent (81%) among this population. Conclusion In a subpopulation of SCIT patients, there appears to be a familial success rate with this allergen desensitization treatment. This is the first reported pharmocogenetic evidence of assessing hereditary influence on effective AR therapy. Understanding pharmacogenetic associations involved with SCIT may improve allergists’ recommendations for this treatment option.
Skin fibroblasts and tumor fibroblasts were extracted from a 64-year old male patient clinically diagnosed with laryngeal carcinoma. Control and tumor specific induced pluripotent stem cells were reprogrammed with 5 reprogramming factors, Klf-4, c-Myc, Oct-4, Sox-2, and Lin-28, using the messenger RNA reprogramming system. The transgene-free iPSC lines showed pluripotency, confirmed by immunofluorescence staining. The iPSC lines also showed normal karyotype, and could form embryoid bodies in vitro and differentiate into the 3 germ layers in vivo. This in vitro cellular model can be used to study the oncogenesis and pathogenesis of laryngeal carcinoma.
Lisa M. Bartnikas M.D., William J. Sheehan M.D., Katherine L. Tuttle M.D.
et al.
Background Ovomucoid is the dominant allergen in hen's egg. Although several studies evaluated the utility of ovomucoid specific immunoglobulin E (sIgE) levels in predicting baked (e.g., muffin or cupcake) or raw egg food challenge outcomes, studies that evaluated ovomucoid sIgE as a predictor of cooked egg (e.g., scrambled or hard boiled) challenge outcomes are limited. Objective To determine the relation of ovomucoid sIgE levels with cooked egg food challenge outcomes. Methods A retrospective review of 44 children who underwent cooked egg food challenge and who had the ovomucoid sIgE level measured. Results Thirty-six of 44 children (81.8%) passed cooked egg challenge. The ovomucoid sIgE level predicted cooked egg challenge outcome (passed median, <0.35 kU/L [range, <0.35–0.64 kU/L]; failed median, 0.40 kU/L [range, <0.35–3.13 kU/L]; p = 0.004). Ovomucoid sIgE levels correlated with egg white (EW) sIgE levels (Spearman correlation coefficient, 0.588; p = 0.001). Receiver operating characteristic curve analysis of ovomucoid and EW sIgE demonstrated areas under the curve of 0.711 and 0.766, respectively. No significant difference was observed among those immunologic parameters in their abilities to predict cooked egg challenge outcome (p = 0.559). Conclusion The ovomucoid sIgE level may be helpful in predicting cooked egg challenge outcomes. However, our study did not support a role for ovomucoid sIgE replacing EW sIgE testing in evaluating egg allergy.