Overcoming difficulties in implementing a universal newborn hearing screening program

The aim of this paper was to present our experience with a universal newborn hearing screening program, including the specific problems and difficulties faced since its beginning, along with the measures used to overcome them and to improve its efficiency. We analyzed data from 22,195 newborns screened by transiently evoked otoacoustic emissions (TEOAE) performed during the first days after birth. 84.8% of the newborns passed on the first test and another 12.15% passed on rescreening before hospital discharge. This produced a "not pass" rate (false-positive and true positive) of 3.05%. The rate of newborns who did not undergo screening and the rate of "lost to follow-up" newborns were reduced in time, due to various applied modifications to the protocol. It may be thus concluded that our protocol proved to be successful in attaining low refer rates for follow-up screening. A major problem that remains unresolved is the absence of effective follow-up

Dihimo-γ-linolenic acid inhibits several key cellular processes associated with atherosclerosis

Atherosclerosis and its complications are responsible for one in three global deaths. Nutraceuticals show promise in the prevention and treatment of atherosclerosis but require an indepth understanding of the mechanisms underlying their actions. A previous study showed that the omega-6 fatty acid, dihomo-γ-linolenic acid (DGLA), attenuated atherosclerosis in the apolipoprotein E deficient mouse model system. However, the mechanisms underlying such protective effects of DGLA are poorly understood and were therefore investigated. We show that DGLA attenuates chemokine-driven monocytic migration together with foam cell formation and the expression of key pro-atherogenic genes induced by three pro-inflammatory cytokines in human macrophages. The effect of DGLA on interferon-γ signaling was mediated via inhibition of signal transducer and activator of transcription-1 phosphorylation on serine 727. In relation to anti-foam cell action, DGLA inhibits modified LDL uptake by both macropinocytosis and receptor-mediated endocytosis, the latter by reduction in expression of two key scavenger receptors (SR-A and CD36), and stimulates cholesterol efflux from foam cells. DGLA also improves macrophage mitochondrial bioenergetic profile by decreasing proton leak. Gamma-linolenic acid and prostaglandin E1, upstream precursor and key metabolite respectively of DGLA, also acted in an anti-atherogenic manner. The actions of DGLA extended to other key atherosclerosis-associated cell types with attenuation of endothelial cell proliferation and migration of smooth muscle cells in response to platelet-derived growth factor. This study provides novel insights into the molecular mechanisms underlying the anti-atherogenic actions of DGLA and supports further assessments on its protective effects on plaque regression in vivo and in human trials

Microtraumatic stapedotomy

Several modifications have been introduced during the 35 years following the first stapedectomy. The size of the footplate fenestration into the vestibule defines the type of the surgical technique, varying from total stapedectomy to partial stapedectomy or small fenestra stapedotomy. This paper presents a new microtraumatic modification of stapedotomy. After the incudostapedial joint is separated and following the fracture of the stapes crura, the stapes superstructure with the stapes tendon intact is left lying or bending on the promontory. Then, a 4.5-mm-long Schuknecht prosthesis is inserted and the oval window is sealed with small pieces of connective tissue filling the oval window niche and the area between the stapes crura. The results of the new microtraumatic technique with regard to hearing were similar to the standard small fenestra stapedotomy (closure of the air-bone gap). However, multifrequency tympanometry revealed that the new technique provides the patient with a complete physiological middle ear function postoperatively, which was not the case when the other stapedotomy techniques were used. This was reflected in a better hearing quality and less loud-noise intolerance reported by the patients who had been operated on with the new microtraumatic technique. Copyright © 2007 S. Karger AG

Evaluation of a Dermoplasty Technique for the Control on Nasal Polyps

To evaluate the efficacy of a dermoplasty technique in controlling nasal polyps comparing to the conventional endoscopic approach. Prospective observational study Tertiary private hospital. Twenty-nine patients underwent surgery for replacement of the middle meatus mucosa with skin. Some patients (41.4%) suffered from allergies, 44.8% from asthma, and 27.6% from aspirin intolerance. Polyps were staged according to the Lildholdt system, and patients completed a sino-nasal outcome test (SNOT-22) pre and post-operatively. Also, patients were interrogated as for medication relevant to the nose received pre and post-operatively. In twenty-six patients dermoplasty was applied in one nostril while the contralateral was treated with the conventional endoscopic technique allowing us to compare the two techniques in the same patient. Median follow-up period was 1.2 years (IQR 0.8, 2.0; range 0.4–5.8). Median drop in SNOT-22 score was 38.2 percentage units. Patients (79.3%) controlled symptoms by topical corticosteroids for 2.5–3 months per year at most. Seventy percent (70.8%) reported improvement in subjective olfaction. Results compare favorably to those reported in the literature after functional endoscopic approach. Lildholdt stage dropped post-operatively on both sides but significantly more (p value < 0.001) on the dermoplasty side comparing to the conventional endoscopic side. Dermoplasty appears to outbalance the conventional endoscopic removal of polyps and clearance of paranasal sinuses. No matter how extensive the removal of endonasal tissue, it is not sufficient for controlling nasal polyps unless mucosa is prevented from recovering the denuded areas by the use of a skin graft. © 2018, Association of Otolaryngologists of India

Extensive primary Ewings' sarcoma in the greater wing of the sphenoid bone

We describe a rare case of an extensive primary cranial Ewing’s sarcoma located in the greater wing of the sphenoid bone with extension to the orbit, the endocranium, the parapharyngeal and infratemporal space. The patient presented with diplopia, anosmia and prolapse of the left eye. He was given chemo- and radiotherapy and was free of symptoms on re-examination 1.5 years later. The prognosis of Ewing’s sarcoma in the absence of surgery is uncertain, but prompt treatment appears to have a satisfactory therapeutic outcome. In the future, more cases should be studied in order to investigate the biological behaviour of a primary cranial Ewing’s sarcoma. Copyright (C) 2003 S. Karger AG, Basel

Primary nasal tuberculosis: Report of a case

Despite the worldwide increase in tuberculosis lately, primary nasal tuberculosis remains a rare manifestation of the disease, presenting sometimes a confusing diagnostic problem. In this paper, we report the case of a middle-aged female patient, who presented with a lesion of the left nasal cavity and symptoms indicative of malignancy. From the results of the biopsy, a tuberculous nasal granuloma was suspected, and tissue cultures confirmed the diagnosis. Further investigation did not prove any other primary tuberculous lesion, and treatment with standard antituberculosis drugs resulted in complete remission of the disease. Copyright © 2003 S. Karger AG, Basel