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Pediatric Cholesteatoma: Factors Affecting Recurrence Rates and Hearing Outcomes
No full text<i>Objective</i>: Children with cholesteatoma have been reported to have higher rates of recurrence compared to adults. Clinical factors affecting the rate of disease recurrence and ultimate hearing outcomes were analyzed.<i>Methods</i>: Children diagnosed with cholesteatoma between April 1988 and May 2014 were identified. Medical records were reviewed to determine risk factors for disease recurrence and assess the hearing outcome.<i>Results</i>: One hundred and twenty-two children had sufficient data available for inclusion in our study. Three suffered bilateral disease allowing for 125 patient ears to be analyzed. Of these, 67/125 (53.6%) had recurrence after one surgery with a median time to recurrence of 9 months. There was a mean of 2.5 operations per patient. Five-year cholesteatoma free survival rate was 86.29%. Age (8.04 vs. 8.67 yrs old, p=0.36) and origin (congenital vs. acquired cholesteatoma) (54.8% vs. 53.7%, p=1) did not differ in outcomes. Epitympanic and oval window involvement resulted in a significantly higher recurrence rate (64.5% vs. 37.5%, p=0.0053 and 67.3% vs 45.3%, p=0.0178). Children with recurrence demonstrated more extensive disease with a higher number of middle ear sub-sites involved (3.67 vs. 2.82 areas involved, p=0.0061). Most importantly, children whose disease recurred had worse hearing outcomes with lower rates of air-bone gap closure (-5.319 dB vs. 6.351 dB, p=0.0082).<i>Conclusion</i>: While age was not a factor, pediatric patients with more extensive cholesteatoma are more likely to have recurrent disease and worse hearing outcomes
Telepsychiatry: Current Outcomes and Future Directions
No full textTelepsychiatry is an evolving field in the treatment of mental illness. Although it is used since 1950, its application is widely expanded in the past one decade. Telepsychiatry is defined as the use of technology to communicate with the people and provide psychiatry services from a distance. It requires a collaborative and supportive team consisting of patients, psychiatrists, referring physicians, nurses, families, and health care facilities. Telepsychiatry is very feasible and is applicable to a wide range of patient population having diverse cultural backgrounds. It can also be used in different clinical settings and is proven to be effective in reducing disease severity in several disorders like anxiety, attention deficit hyperactive disorder (ADHD), bipolar disorder, depression, post-traumatic stress disorder (PTSD), schizophrenia, and psychosis. Telepsychiatry is effective both clinically and academically. Clinically, it is used for diagnosing and managing the patient, conducting neuropsychological testing, and providing psychotherapy. Academically telepsychiatry can be used for education, training, and research purposes. Although it is very effective in many ways, few challenges in this field include training and recruiting physicians who can provide care using such services, access to patients, and continuously update health care facilities with the recent advancements in the information and communication technology. Telepsychiatry is mainly helpful to decrease the gap in delivering psychiatric care to people in rural and/or underserved areas. So, more insight should be provided to patients and physicians about the advantages of using telepsychiatry services. In this review, we discussed the challenges, different treatment outcomes, effectiveness, and future directions of telepsychiatry
Right Coronary Artery Anomalous Origin from Left Anterior Descending Artery Detected by Computed Tomography Coronary Angiogram: A Case Report and Review of the Literature
No full textCoronary anomalies are generally rare and recognized in approximately 1.3% of coronary angiograms. The right coronary artery originating from the left coronary system is an extremely rare variation of the single coronary artery anomaly in which the prognosis is usually benign provided that the anomalous vessel does not pass between the aorta and the pulmonary artery. Right coronary artery anomaly can be associated with other congenital cardiovascular anomalies such as bicuspid aortic valve, transposition of the great vessels and tetralogy of Fallot.The clinical significance of coronary anomalies is usually determined by underlying anatomic features of the anomalous coronary origin and/or coronary atherosclerosis. Initial presentations include: chest pain, myocardial infarction, arrhythmias, sudden death, and quite rarely exertion syncope. Although coronary angiography is an important diagnostic method, new non-invasive methods such as coronary computed tomography angiography and cardiac magnetic resonance imaging have important roles to play in characterizing this coronary anomaly. It should be noted that the management strategy of these patients may vary based on clinical presentation and anatomical details.We report a Case of exertion dizziness, diagnosed to have anomalous origin of right coronary artery from left anterior descending artery diagnosed by computed tomography coronary angiography. Medical treatment was effective in relieving the patient's symptoms and ischemia
ORIGINAL RESEARCH: Heparin and Derivatives a New and Possible Treatment of Alzheimer’s Disease
No full textOur finding of the ability of heparin sulfate to control an psychiatric disorder as the onset of an acute myocardial infarction in elderly patients, led us to use this drug in Alzheimer‘s disease. A 78-year-old female patient with Alzheimer ‘s disease (AD) in moderate stage, was the first case that received heparin sulfate; initial dose of 10000 Uds, in 500 mls of 5% Dextrosa for IV inyection, weekly; demonstrating a significant improvement several hours after the initial treatment, in the cognitive impairment, especially in the memory and spatial orientation. Subsequently, five patients with AD received heparin having similar benefitial effect. We reported for the first time in the literature, both the atypical presentation of a myocardial infarction, controlled by heparin and, the effective response of Alzheimer’s disease after received this drug.In conclusion, the initial results showed that the non-anticoagulant action of heparin and derivatives is effective for Alzheimer’s disease which could be a targeted drug for this disease
Regulation of Collagen-Rich Matrix Remodeling in Wound Healing, Inflammation and Cancer
No full textCD44 plays multiple roles in the context of inflammation and cancer including leukocyte recruitment, activation, and intratumoral migration [1,2]. CD44 also plays a role in the uptake of its principal ligand, hyaluronic acid (HA), and accumulation of soluble factors involved in stromal cell activation [1,2]. The role of CD44 in matrix remodeling is less well understood. Wound healing, inflammation and the microenvironment of solid tumors are all characterized by the accumulation and remodeling of HA and collagen-rich extracellular matrices. We have found that genetic deletion of CD44 results in increased fibrillar collagen accumulation in each of these conditions and that this phenotype is recapitulated in isolated fibroblast-derived matrices generated by CD44-deficient fibroblasts compared to wild-type fibroblasts in vitro. The mechanisms underlying CD44-mediated matrix remodeling and the consequences of altered matrix remodeling in each of these conditions in CD44-deficient mice compared to wild-type mice were discussed
Dr. Saul Hertz Discovers The Medical Uses of Radioiodine (RAI) to Treat Graves' Disease and Cancer: A Daughter's Tribute as Pre-sented "Autoimmunity in 2017; Where Are We Now?"
No full textAbstrac
Non-Native Raters and Native Speech: Other Perspective for the Research on Comprehensibility of Second Language Input
No full textThis study examines how specific variables such as age, first language, nationality, school grade and socioeconomic status (SES) affect the comprehensibility of second language (L2) speech in 92 second/non-native language learners. Comprehensibility refers to the degree of speech understanding. Fluency, rhythm, grammatical features and word stressing are concurrent factors for the listening comprehension (and the listener comprehensibility) mainly in L2 context. Research evidence focused the quality and differences of speech samples produced by the L2 learners and the comprehensibility rated by native speakers. In reverse scenario there is less evidence on the judgment of L2 learners for speech samples produced by native speakers. In this study we analysed if the comprehensibility ability of 92 young Portuguese L2 learners differ in the following conditions: age, nationality, home language, school grade, proficiency and socioeconomic status. Speech (one text) was recorded by a native speaker and was judged by L2 speakers using 1-5 Likert scale for comprehension difficulty. Main results showed that neither age nor home language had influence for comprehensibility, but socioeconomic, nationality and grades accounted for statistical differences between the groups tested. Also, data suggested that phonetic features are more likely important for the beginner in second language learning compared to the semantic features of speech that heavily depend on vocabulary domain
Association of Lymphocytic Thyroiditis and Thyroid Papillary Cancer
No full textIntroduction: The association between the papillary thyroid carcinoma (PTC) and the lymphocytic thyroiditis (LT) is common and remains controversial.Objectives: Define the prevalence of the association of LT with PTC and the characteristics of patients who suffer from PTC with LT compared to those without LT.Methods: This is a retrospective cross-sectional study of patients followed for PTC within the Department of Endocrinology of Casablanca between 1986 and 2015. The statistical analysis was performed using SPSS 16.Results: Among 348 files of patients who suffer from PTC, 49 patients had associated LT, giving a frequency of about 14.1%. The patients were divided into two groups: group with PTC + LT and group with PTC without LT. A female predominance was noticed in both groups. The tumor size was lower in the group with PTC + LT: 0.6cm vs 1.4cm in patients without LT (p = 0.001). TNM1 class was predominant in the LT group (p = 0.004). There was no difference in recurrence rates in both groups.Conclusions: The association of PTC with LT is common; patients with LT typically present with smaller tumor size and lower TNM stage and have a generally good prognosis
Acute Urinary Retention by Hematocolpos in an Adolescent Girl with Imperforate Hymen: A Case Report
No full textMechanical obstruction by hematocolpos can result in acute urinary retention. This is an adolescent girl 15 year old who presented amenorrhea, cyclic abdominal pain and acute retention of urine. On examination patient was found to have imperforate hymen. She underwent hymenectomy. Postoperative period was uneventful. We conclude that in peripubertal female with acute urinary retention, hematocolpos should be considered