Bilateral Vocal Fold Abduction Dysfunction: A Report of Two Neonatal Cases.

Stridor is caused by oscillation of the narrowed upper airway. The most common cause of neonatal stridor is laryngomalacia, followed by vocal fold abduction dysfunction. Herein, we present two neonatal cases of idiopathic dysfunction of vocal fold abduction. A neonate was admitted to the neonatal intensive care unit (NICU) on day 4 of life for inspiratory stridor, intermittent subcostal retraction, and cyanosis. A second neonate was admitted to the NICU on day 7 of life for inspiratory stridor and cyanosis when crying. Neither patient had dysmorphic features or unusual cardiac ultrasonography findings. The diagnosis was confirmed by laryngo-bronchoscopy. Conservative treatment with biphasic positive airway pressure was effective in both cases and symptoms resolved within a few months. Resolution of vocal fold abduction dysfunction was confirmed by repeat endoscopy. Clinical manifestations of vocal fold abduction dysfunction vary widely. Although most cases resolve spontaneously, prolonged tube feeding, or even tracheostomy, is needed in some severe cases. Diagnosis of vocal fold abduction dysfunction requires a laryngo-bronchoscopy study; thus, there may be a large number of undiagnosed patients. Vocal fold abduction dysfunction should be considered in the differential diagnosis for neonatal inspiratory stridor.

Adolescent Loneliness in 70 Countries Across Africa, America, and Asia: A Comparison of Prevalence and Correlates.

PURPOSE: Emerging studies address adolescent loneliness a public health problem due to its negative associations with adverse health. However, evidence concerning adolescent loneliness and its correlation in nonwestern, low- and middle-income countries is scarce. This study examined the prevalence of loneliness and its correlates (i.e., sex, bullying victimization, and peer support) across 70 countries from five WHO regions. METHODS: Data were collected from the Global School-based Student Health Survey of children aged 13-17 (2003-2018) years. Loneliness was defined as feeling lonely most of the time or always in the past 12 months based on self-reports. The prevalence of loneliness was estimated, and multivariable logistic regression ascertained prevalence ratios of correlates by country. Meta-analysis was used to examine regional and overall pooled estimates. RESULTS: Among the 248,017 students included in the study, the overall prevalence of loneliness was 11.7% (95% confidence interval (CI): 10.6-12.7), with significant variations across countries. Girls (vs. boys prevalence ratio (PR = 1.4 95% CI: 1.3-1.4), students who experienced bullying victimization (PR = 2.2, 95% CI: 2.1-2.3), and students who reported a lack of close friends (PR = 1.8, 95% CI: 1.7-1.9) were at increased risk of experiencing loneliness. There was significant heterogeneity between countries for sex and lack of close friends but not for bullying victimization. DISCUSSION: Adolescent loneliness is prevalent globally, especially in Africa and the Eastern Mediterranean. The considerable heterogeneity in its prevalence and correlates suggest that tailoring to the country context may benefit policy initiatives. Bullying may be a common intervention target in all countries.

Relationship between sleep-disordered breathing and central systolic blood pressure in a community-based population: the Toon Health Study.

Sleep-disordered breathing (SDB) is linked with brachial blood pressure. Although central systolic blood pressure (cSBP) is a better predictor of cardiovascular diseases than is brachial blood pressure, the association between SDB and cSBP is not fully understood. This cross-sectional study included 1484 participants without cardiovascular diseases who were enrolled in the Toon Health Study between 2009 and 2012. The respiratory disturbance index (RDI) was estimated with a one-night sleep test using an airflow monitor. Participants were grouped into three categories according to RDI level: mild (<10 events/h), moderate (10 to <20 events/h), and severe (≥20 events/h). The cSBP was measured using a noninvasive automated tonometer. Multivariable-adjusted cSBP means for the mild, moderate, and severe RDI categories were, respectively, 116.0, 118.0, and 120.7 mm Hg (p for trend = 0.02) for men and 111.8, 113.7, and 111.7 mm Hg (p for trend = 0.59) for women. The association for men was no longer significant after adjusting for BMI. When stratified by BMI (<22 or ≥22 kg/m2), the RDI was associated with cSBP among men with BMI ≥ 22 kg/m2, and this association was of borderline significance. Augmentation index, pulse pressure amplification, and brachial blood pressure were not significantly associated with the RDI. Higher RDI values were associated with increased multivariable-adjusted cSBP means among men. This association was more evident among those with BMI ≥ 22 kg/m2. In conclusion, we found that the RDI was associated with cSBP among men, and this association was independent of confounding variables among individuals above the ideal weight.