Objective: This study examined the association between obstructive sleep apnea (OSA) risk and hearing difficulty and evaluated whether oral health problems mediate this relationship in a nationally representative Korean population. Methods: We analyzed 15,163 adults aged ≥40 years from the Korea National Health and Nutrition Examination Survey (KNHANES) 2019–2023 datasets. OSA risk was defined using the snoring, tiredness, observed apneas, pressure, body mass index, age, neck circumference, and gender (STOP-BANG) questionnaire (low risk: 0–2; high risk: ≥3). Oral health problems were operationalized as the summed score of self-reported chewing difficulty and speaking difficulty (two 5-point items; range 2–10). Hearing difficulty was assessed using the KNHANES 4-point self-reported hearing scale (1 = no difficulty to 4 = cannot hear at all). Mediation analyses were conducted using complex-sample hierarchical regression with design-weighted estimation, adjusting for survey year, age, sex, education, marital status, income, smoking, alcohol consumption, metabolic/cardiovascular disease comorbidities, occupational noise exposure, and tinnitus. Results: Adults with high-OSA risk had higher weighted mean hearing difficulty scores than the low-risk group (1.23 vs. 1.16). In the adjusted model, OSA risk was associated with hearing difficulty [total effect β = 0.031, 95% confidence interval (CI): 0.013–0.048, P < 0.001]. Oral problems were associated with OSA risk (β = 0.111, 95% CI: 0.049–0.174, P < 0.001) and hearing difficulty (β = 0.014, 95% CI: 0.000–0.027, p = 0.047). The indirect effect was statistically significant (β = 0.001, 95% CI: 0.001–0.002). The direct effect of OSA risk on hearing difficulty remained significant (β = 0.019, 95% CI: 0.011–0.047, P < 0.001). Conclusions: The risk of OSA based on STOP-BANG was associated with increased hearing difficulty among Korean adults, and oral health problems statistically accounted for a small proportion of this cross-sectional association. These results highlight the potential value of jointly considering sleep-related symptoms, oral function, and hearing outcomes in population health research.
Petar Vranjić, Mladen Vuković, Senka Blažetić
et al.
The ketogenic diet (KD), a high-fat, low-carbohydrate diet, causes profound metabolic adaptations that go beyond energy production and affect endocrine function and thyroid hormone regulation. By shifting the body’s primary fuel source from glucose to fatty acids and ketones, the KD alters insulin signaling, inflammation levels and deiodinase activity, which together affect thyroid hormone metabolism. While this metabolic shift offers potential benefits such as improved insulin sensitivity and reduced systemic inflammation, it also raises concerns about reduced triiodothyronine (T3) levels and altered hypothalamic–pituitary–thyroid (HPT) axis dynamics. This review explores the mechanisms by which the KD affects thyroid function, highlighting both the potential therapeutic benefits and associated risks. Special attention is given to how genetic predispositions, gut microbiota composition and sex-based hormonal differences influence thyroid adaptation to a KD. In addition, there are indications that the influence of the KD on cell metabolism could have therapeutic potential in conditions such as autoimmune thyroid diseases and thyroid cancer. Understanding the delicate balance between the benefits and risks of KD for thyroid health is essential for optimizing its clinical applications and defining individual nutritional strategies.
Background: Nasal obstruction is one of the most prevalent complaints in otolaryngological practice, significantly impairing patients’ quality of life. Inferior turbinate hypertrophy [ITH] is a common cause, often managed surgically when refractory to medical therapy. Aim of The Study: This study aimed to compare the efficacy, operative parameters, and postoperative outcomes of mini-inferior turbinoplasty [tunneling technique] versus bipolar electrocautery for ITH reduction.Patients and Methods: This prospective randomized clinical trial included 60 patients with chronic nasal obstruction due to bilateral ITH unresponsive to medical therapy for over three months. Patients were randomly assigned to two equal groups: Group A [mini-inferior turbinoplasty] and Group B [bipolar electrocautery]. All procedures were conducted at Al-Azhar University Hospitals. Patients were evaluated intraoperatively for bleeding and operative time, and postoperatively for nasal packing, crustation, synechia, nasal obstruction, and recurrence over a 3-month follow-up.Results: Group A had a significantly longer operative time [27.77 ± 3.80 min vs. 13.07 ± 2.72 min, P=0.001] and higher intraoperative bleeding [22.37 ± 3.32 ml vs. 7.83 ± 1.46 ml, P=0.001] than Group B. Postoperative bleeding and need for nasal packing were observed only in Group A [16.7%, P=0.02]. Crustation was significantly more frequent in Group B [96.7% vs. 6.7%, P=0.001], while nasal obstruction at one month was higher in Group B [66.7% vs. 16.7%, P=0.001]. No significant differences were observed in synechia or recurrence.Conclusion: Both mini-inferior turbinoplasty and bipolar electrocautery are effective in ITH reduction. Bipolar electrocautery offers advantages in operative time, minimal bleeding, and no need for nasal packing. However, mini-inferior turbinoplasty yields lower rates of crustation and better early postoperative relief from nasal obstruction.
Yonca Coluk, Guven Yildirim, Sembol Yildirmak
et al.
Abstract Background Brain-derived neurotrophic factor (BDNF) is among the modulators associated with cognition and sleep that play a role in sleep disorders. This study aimed at investigating the effects of chronic sleep deprivation and REM sleep deprivation on BDNF levels and oxidative stress markers. Methods A total of 24 healthy male Wistar albino rats were separated into 3 groups as REM sleep deprivation group, control sleep deprivation group and control group. To create models of 21-day REM sleep deprivation and control sleep deprivation, we used the platform technique. After 21 days blood BDNF, brain tissue BDNF, brain tissue malondialdehyde, glutathione, ascorbic acid, nitrite and nitrate were evaluated. Results Compared with the control group, control sleep deprivation group showed a significant increase in brain tissue levels of BDNF (p = 0.038), whereas a significant decrease was observed in the levels of glutathione (GSH) and nitric oxide (NO) (p:0.036). No statistical difference was observed between the blood levels of BDNF in either group (p: 0.795). Conclusion Our results showed decreases in GSH and NO levels and increases in malondialdehyde levels in the sleep deprivation models, reflecting oxidative stress in the brain. Additionally, we observed increases in brain BDNF levels in the control sleep deprivation model.
Objectives: To determine the characteristics of tinnitus and its association with clinical and demographic variables including psychological health.
Methodology: This cross-sectional study recruited N=80 tinnitus cases from ENT outpatients of District Head Quarter Hospital Chakwal from over a period of 6 months from 1st Jan 2019 to 31st June, 2019, using convenience sampling. Sample included both genders, aged 18-75 years with tinnitus for at least three months. Tinnitus Handicap Inventory (THI) & Depression Anxiety and Stress Scale 21 (DASS-21) were utilized for data collection & analysis done using SPSS-version 20. Anova statistics & Pearsons correlation was determined for THI and DASS-21. Chi-square was used to see any association with clinic-demographic variables. P<0.05 was considered significant.
Results: Study revealed 30(37.5%) cases with mild, 20(25%) each with moderate and severe while least 4(5%) catastrophic tinnitus. Tinnitus severity was significant associated with gender (p=0.005), age (p=0.035), educational level (p=0.049), occupation (p=0.002), duration of tinnitus (p=0.038), site of tinnitus (P<0.001) and type of tinnitus sound (P=0.003). Duration of tinnitus was associated with anxiety (p=0.024), site of tinnitus was associated with THI (p=0.016), anxiety (p=0.021), stress (p<0.001) and depression (p=0.02) and total DASS-21 (p=0.005). A significant positive correlation was present between tinnitus handicap, Anxiety, stress, depression and DASS-21 total score (P<0.001).
Conclusion: Mild tinnitus was most prevalent (37.5%) with Tinnitus severity having significant association with gender, age, educational level, occupation, duration of tinnitus, site of tinnitus, and type of tinnitus sound. Duration of tinnitus was also associated with anxiety while site of tinnitus has association with THI, anxiety, stress, depression and total DASS-21. Significant positive correlation is present between THI and Anxiety, stress, depression and DASS-21 total score.
Vocational rehabilitation. Employment of people with disabilities, Therapeutics. Psychotherapy
Magalí Blanco, Glenda Ernst, Alberto Rabino
et al.
Introduction Many patients abandon CPAP treatment because they find the mask uncomfortable. Therefore, specialists may benefit from the predictive value of airway assessment tools.
Jeong-Hwan Hwang, Yeon Seok You, Sang Woo Yeom
et al.
In order to prepare for the twindemic of influenza and SARS-CoV-2 infection, we investigated the association between influenza infection and subsequent severity of SARS-CoV-2 infection. A population-based nationwide cohort study was performed using data from the National Health Insurance Service (NHIS) in the Republic of Korea. This study included 274,126 individuals who underwent SARS-CoV-2 PCR testing between 20 January 2020 and 1 October 2020. Among these patients, 28,338 tested positive for SARS-CoV-2, and 4,003 of these individuals had a history of influenza. The control group was selected through 1:1 propensity score matching. In the group of 4,003 COVID-19-positive individuals with no history of influenza, 192 (4.8%) experienced severe illness from COVID-19 infection. In the group of 4,003 COVID-19-positive individuals with a history of influenza, 260 (6.5%) had severe illness from COVID-19, and the overall adjusted odds ratio (aOR) was 1.29 (95% confidence interval 1.04–1.59). Among the 4,003 COVID-19-positive individuals with a history of influenza, severe COVID-19 infection was experienced by 143 of 1,760 (8.1%) with an influenza history within 1 year before the onset of COVID-19, 48 of 1,129 (4.3%) between 1 and 2 years, and 69 of 1,114 (6.2%) between 2 and 3 years before COVID-19 onset, and the aORs were 1.54 (1.20-1.98), 1.19 (0.84-1.70), and 1.00 (0.73-1.37), respectively. In conclusion, individuals who had an influenza infection less than 1 year before COVID-19 infection were at an increased risk of experiencing severe illness from the SARS-CoV-2 infection. To control the public health burden, it is essential that effective public health control measures, which include influenza vaccination, hand washing, cough etiquette, and mask use are in place.
Jonas Engert, Bjoern Spahn, Linda Bieniussa
et al.
The medial geniculate body (MGB) is a nucleus of the diencephalon representing a relevant segment of the auditory pathway and is part of the metathalamus. It receives afferent information via the inferior brachium of the inferior colliculus and transmits efferent fibers via acoustic radiations to the auditory cortex. Neural stem cells (NSCs) have been detected in certain areas along the auditory pathway. They are of great importance as the induction of an adult stem cell niche might open a regenerative approach to a causal treatment of hearing disorders. Up to now, the existence of NSCs in the MGB has not been determined. Therefore, this study investigated whether the MGB has a neural stem cell potential. For this purpose, cells were extracted from the MGB of PND 8 Sprague-Dawley rats and cultured in a free-floating cell culture assay, which showed mitotic activity and positive staining for stem cell and progenitor markers. In differentiation assays, the markers β-III-tubulin, GFAP, and MBP demonstrated the capacity of single cells to differentiate into neuronal and glial cells. In conclusion, cells from the MGB exhibited the cardinal features of NSCs: self-renewal, the formation of progenitor cells, and differentiation into all neuronal lineage cells. These findings may contribute to a better understanding of the development of the auditory pathway.
Purpose: Post-tonsillectomy hemorrhage is a serious complication and is one of the most common reasons for emergency department visits following tonsillectomy. A percentage of these patients require a return trip to the operating room for hemostasis. A variety of methods exist for control of post-tonsillectomy hemorrhage. We report the use of nebulized tranexamic acid (TXA) in two adult and two pediatric patients who presented with post-tonsillectomy hemorrhage. Methods: A retrospective chart review was conducted on four patients at two tertiary care hospital centers. Patients were identified if they experienced post-tonsillectomy hemorrhage and were administered nebulized TXA during their hospital course for bleeding control. Results: Two pediatric (8 and 15 years old) and two adult (27 and 31 years old) patients who presented to the emergency department with post-tonsillectomy hemorrhage were treated with 500 mg of nebulized TXA. All patients had previously undergone extracapsular tonsillectomy. One patient required additional bedside cautery with silver nitrate after nebulized TXA, but no patients required a return trip to the operating room. No patients experienced adverse medication side effects. Conclusions: In this study we report on the use of nebulized TXA in a series of patients with post-tonsillectomy hemorrhage. All patients presented with significant post-tonsillectomy hemorrhage and were successfully managed without a return trip to the operating room. One patient required bedside silver nitrate cautery in addition to nebulized TXA. Additional studies need to be performed to confirm safety and efficacy of this potential new modality.
Kin P. Tao, Marc K.C. Chong, Kathy Y.Y. Chan
et al.
Background: Influenza virus (IV) and the rhinovirus (RV) are the two most common circulating respiratory viruses circulating. Natural viral interference has been suggested between them. The effect of such at the population level has been described in temperate region, while its effect at the individual and cellular levels warrants further validation. In this study, we described the respiratory virus epidemiology and the co-infection landscape in the hospitalized population and investigated the distinct molecular pathways involved in the inhibition of virus replication. Methods: Nasopharyngeal aspirates (NPAs) collected from patients during 2015 to 2019 were examined for the presence of respiratory viruses. The correlation of the monthly prevalence between all the tested respiratory viruses, the co-infection rate and the temporal interference of RV and IV were tested. The viral interference was validated in vitro by conducting sequential RV and IV infections in the well-differentiated primary human airway epithelial cells. The contributing molecular pathways were determined by transcriptome analysis. Findings: A total of 112,926 NPAs were evaluated, and the Enterovirus/RV was the most prevalent respiratory virus detected. The negative correlation between EV/RV and IVs prevalence was independent of age and meteorological factors. Compare with other viruses, EV/RV had a significantly lower incidence of co-infection with IVs. Prior exposure to RV inhibited the replication of IV species A, B and oseltamivir-resistance stain in vitro. RV uniquely downregulated genes related to processing of viral mRNA, ribosomal proteins, translation and influenza infection. Interpretation: Epidemiological surveillance and the sequential infection in vitro suggested viral interference between EV/RV and IV operates at the population, individual and cellular levels. Funding: This study was supported by the General Research Fund (Ref: 24107017 and 14103119 to RWYC) and the Chinese University Direct Grant for Research (Ref: 2019·073 to RWYC).
Yuki Fujihara, Koji Yamanegi, Yasuyuki Nagasawa
et al.
Circulating lymphocytes infiltrate into local foci at the inflammatory phase of acute wound healing for activation of the immune system and express an immune checkpoint protein programmed cell death 1 (PD-1) at the resolution phase for inactivation of the immune system. Conversely, the PD-1 expression was still found even on circulating lymphocytes of the elder patients with chronic tonsillitis at the palliative stage. Recently, an adhesion G protein coupled receptor 56 (GPR56) was reported to at least work as a proliferation factor for infiltrated lymphocytes into local foci at the resolution phase of acute wound healing. To preliminary examine a similar role of PD-1 and GPR56 at local foci at chronic inflammation, palate tonsils were prepared from small amounts of patients with chronic tonsillitis and tonsillar hypertrophy. A positive relationship of RNA expression might be observed between PD-1 and GPR56 in the elder patients with chronic tonsillitis. In regard to immunohistopathological findings, there were huge and small amounts of PD-1 and GPR56 expression at the marginal zone of lymphoid follicles of palate tonsils with chronic tonsillitis. Moreover, the positive relationship of RNA expression between PD-1 and GPR56 confirmed in large numbers of the elder patients with chronic tonsillitis. Probably, GPR56 participates in a supplement of PD-1+ lymphocytes to circulating bloods of the elder patients with chronic tonsillitis through a lymphocyte cell maintenance system at the marginal zone of the lymphoid follicles of palate tonsils.
David M. Poetker MD, MA, David R. Friedland MD, PhD, Jazzmyne A. Adams MPH
et al.
Objective The objective of this study was to determine the impact of patient demographics and socioeconomic factors on the utilization of tertiary rhinology care services in an upper Midwestern academic medical center. Study Design Retrospective review of electronic health records. Setting Academic medical center. Methods The electronic health record of our academic center was interrogated for the demographics and diagnosis of chronic rhinosinusitis (CRS) among adult patients seen by fellowship-trained rhinologists from 2000 to 2019. Patient characteristics (age, sex, race, insurance status) and population-level data (median income and education level) were compared with utilization of tertiary rhinology services for CRS. Utilization rates were calculated for each regional zip code and correlated with census data for median income and education. The association between determinants of health and tertiary rhinology utilization was assessed by multivariate regression analyses. Results A total of 8325 patients diagnosed with CRS used tertiary rhinology services. Patients were older (median, 58.9 years) and more likely to be female (57.6%), White (85%), and privately insured (60%) when compared with patients seen across our hospital system ( P < .001). Adjusted analyses showed median income, education level, and White race to be independently correlated with tertiary care utilization. Private insurance alone was not an independent contributing factor to access. Conclusion Utilization of tertiary rhinology services correlated with income, race, and education level. Private insurance was not an independent factor. These results highlight social differences in determinants of access to tertiary otolaryngologic care.
Abstract Several diagnostic methods are currently being used to diagnose LPRD (laryngopharyngeal reflux disease), but have the disadvantage of being invasive, subjective, or expensive. Our purpose in this study was to investigate the correlation between pepsin and MMP-7 (Matrix Metalloproteinase-7) in pharyngeal secretions of subjects according to RSI (Reflux Symptom Index) score to find out the diagnostic value of MMP-7. We recruited 173 subjects aged between 19 and 85 years who completed the RSI scale. All samples were taken after waking up, and the amount of the pepsin and MMP-7 in saliva were measured by means of an enzyme activity assay. There was a significant increase of pepsin and MMP-7 activity in the study group with an RSI score of 13 or higher. The sensitivity and specificity of MMP-7 for predicting the possibility of an RSI of 13 or more was higher than that of pepsin. When MMP-7 and pepsin were combined, this sensitivity and specificity increased. An enzyme assay of MMP-7 in saliva may be a noninvasive and easy technique for diagnosing LPRD.
Stephen Garry, Mel Corbett, Naisrin Elsafty
et al.
Respiratory Epithelial Adenomatoid Hamartoma is a rare, benign tumour arising typically in the upper aerodigestive tract. It is commonly misdiagnosed as either an inflammatory polyp or as something more sinister such as a malignant tumour. Surgical excision, typically by endoscopic resection, is a definitive curative treatment. We present a case whereby a 57-year-old lady presented with a unilateral nasal obstruction and few other distinguishable symptoms. She had no red flags in her history. On sinuscopy a lobulated lesion was seen arising from the postero-superior aspect of the nasal septum, confirmed on CAT scan sinuses. The patient underwent an endoscopic surgical excision of this gritty atypical looking mass. Primary histopathology initially reported an inflammatory polyp, however on multidisciplinary discussion and histopathology review the lesion was diagnosed as a Respiratory Epithelial Adenomatoid Hamartoma. The patient made a full recovery from the operation and thankfully her symptoms have resolved without any evidence of recurrence.
Philippine Medical Association President Dr. Jojo Santiago, Missy and my Central Tagalog Region One Day Family; Singapore Association of Medical Journal Editors President Professor Wilfred Peh and my Singapore family- Mom, Bernie, Miranda, Angie and Lilli; Philippine Association of Medical Journal Editors (PAMJE) President Elect Professor Cecile Maramba – Lazarte and Asawa Ramel, Anak Miggy, Pamangkin Zoe, Tatay Dr. Tomas Maramba and Nanay Professor Emeritus Dr. Nelia Cortez Maramba; my dear PAMJE Colleagues Professors Caster Palaganas and Joseph Quebral and Doctors Phel Esmaquel and Mads Tandoc, PAMJE members and our hardworking Secretariat, Philippine Council for Health Research and Development -Department of Science and Technology (PCHRD-DOST) Director Mel Opeña and Belle Intia, World Health Organization - Western Pacific Region Office (WHO-WPRO) Ms. Alma Prosperoso, guests, friends, ladies and gentlemen:
“It was the best of times, it was the worst of times,
it was the age of wisdom, it was the age of foolishness,
it was the epoch of belief, it was the epoch of incredulity,
it was the season of Light, it was the season of Darkness,
it was the spring of hope, it was the winter of despair.”
— Charles Dickens, A Tale of Two Cities1
Who would have thought that our vision of 2020 had been so blurred, so obscured by rose-colored lenses and peripheral blinders of what we once considered normal, that we were oblivious to the insidious turn of events that continues even today to change our lives and our world? This evening is an example (however small) of that change - originally set for March 16 at Ibarra’s Garden, we are celebrating virtually and remotely from separate venues five months hence. What will today be seen as from the perspective of another five months?
Indeed, the past months have seen the worst of times. We remember our fears and frustrations as we battled an unseen enemy that mercilessly claimed our plans and programs as it killed our friends and colleagues. It was an age of foolishness as we witnessed the unrelenting spread of COVIDIOTS in disbelief and bewilderment. An epoch of incredulity as our scientific expertise and social interventions proved inutile while our so-called leaders failed to lead, engaging in petty pathetic distractions as they selfishly pillaged and plundered our nation and people instead. A depressing season of darkness heralding a cold, cruel winter of despair.
But we did not surrender. As medical professionals and researchers, reviewers and editors, we took up stethoscope and scalpel, pen and paper and patiently plodded on. Informing ourselves with the latest and best evidence (or engaging in research to add to that evidence), we sifted through the “infodemic” to cope with the pandemic as we navigated seemingly-endless zoom meetings and webinars, researched, reviewed or edited and published our findings, and attended to patients. The boundaries between night and day, weekday and weekend, office and home disappeared as we worked from home, or tried to make a home of our workplaces (fearful of contaminating our families with the dread disease).
Thus, these are the best of times, because we continue to hold the fort, the last line of defense. Against all odds (including personal burnout and the very real possibility of becoming COVID positive ourselves), we persist in upholding our sacred pledge to consecrate our lives to the service of humanity, in whatever manner possible. It is an age of wisdom. Those of us who continue to pursue research, to review and edit, to write and publish, and who facilitate the means for others to do so in these trying times add to that wisdom. Indeed, as the novelist-playwright Edward Bulwer-Lytton has Cardinal Richelieu (on discovering a plot to kill him) proclaim: “The pen is mightier than the sword!”2 None are more cognizant of this than we who have taken up the daunting but thankless role of editor. If in the words of the great Doctor José Protacio Rizal (through the jeweler Simoun’s discourse with Basilio)3 “It is a useless life that is not consecrated to a great ideal ... like a stone wasted on a field without becoming a part of any edifice,” then our lives consecrated to publishing vital health information and dispelling disinformation for the benefit of our patients and the public, and informing clinical practice and health policy are far from useless. Let us continue to serve as Sentinels of Science and bring about the epoch of belief.
It is time to move forward, and we do that by looking back. As Doctor Rizal also said, drawing on the popular Tagalog proverb4
“Ang hindi marunong lumingon sa pinanggalingan hindi makakarating sa paroroonan” (they who do not know how to look back at whence they came from will not reach their destination). The past decade would not have been possible without the many people who made PAMJE happen. In particular, I thank the PCHRD-DOST for the unwavering support of our plans, programs and projects. Director Merl Opeña and “Merl’s girls” headed by Ms. Belle Intia, our Secretary Tine Alayon, and Executive Director Dr. Jimmy Montoya. The WHO WPRO Ms. Alma Mila Prosperoso (and the Medical and Health Librarian’s Association of the Philippines, MAHLAP), Chandani Thapa, Marie Villemin-Partow, and Charlie Raby. We have come a long way from the first set of office bearers- - Vice Presidents Drs. Ric Guanzon (The Filipino Family Physician) and Nenet Santiago - San Juan (Philipp J Obstetrics and Gynecology), Secretary Dr. Madeline Sosa (Philipp J Neurology) and Treasurer Dr. Gerard Goco (Philipp J Nuclear Medicine), Dr. Pat Khu (Philipp J Opthalmol), the other Joey Avila (Acta Medica Philippina) and Linda Varona (PJIM), and so many others. Forgive a senior citizen’s memory if I inadvertently failed to mention you. To my steadfast colleagues, Cecile Maramba-Lazarte, Caster Palaganas, Joseph Quebral and Phel Esmaquel, none of this would have been possible without you. Maraming Salamat po. It is but fitting that together with Mads Tandoc, you take up the torch and usher in a season of light and awaken a spring of hope.
Ikaw ba’y makikibaka at hindi maduduwag,
Na gisingin ang mga panatikong bingi’t bulag
Kasinungalingan labanan hanggang mabuwag
Di niyo ba naririnig? Tinig ng bayan na galit
Himig ito ng Pilipinong di muli palulupig
Dudurugin ang dilim, ang araw ay mag-aalab
At mga pusong nagtimpi ay magliliyab!
— Di Niyo Ba Naririnig5
Mabuhay kayo; Mabuhay tayo. Mabuhay ang PAMJE!