Nerve Sonography in Charcot-Marie-Tooth Disease: A Systematic Review and Meta-analysis of 6061 Measured Nerves.

Because of the insidious character and variations in presenting symptoms, Charcot-Marie-Tooth (CMT) disease is challenging to diagnose in children. Diagnosis is based on clinical and nerve conduction studies, as well as genetic examination. Therefore, competent nerve imaging techniques and non-invasive alternatives to nerve conduction studies are a necessity, especially in children. We performed a systematic review and meta-analysis to evaluate the current evidence and effectiveness of ultrasound in investigating nerve cross-sectional area (CSA) in those with CMT compared with healthy controls and to pool the CSA measurements. We included studies published in international peer-reviewed journals that measured nerve CSA by ultrasound in patients with CMT. We implemented double-arm meta-analyses to compare the mean CSA of nerves between patients with CMT and healthy controls by calculating the pooled mean difference in CSA. Moreover, we performed subgroup analyses by stratifying the studies according to the site of CSA measurement and examined the difference in nerve CSA between CMT1A and other CMT types. The included studies provide measurements of 12 nerve roots and nerves (vagus, C3, C4, C5, C6, greater auricular, phrenic, median, ulnar, fibular, tibial and sural nerves) in 628 patients with CMT and 586 healthy controls with a total of 6061 measured nerves. Meta-analyses of sonographic nerve CSA are provided to express nerve ultrasonography in the diagnosis of CMT patient.

The Nature and Risk Factors of Minimal Associated Pathological Lesions of Vocal Folds at Two Hospitals in the Gulf Area.

OBJECTIVE: To identify the possible risk factors related to etiology of the minimal associated pathological lesions (MAPLs) of the vocal folds and their impacts on the recurrence of lesion. METHODS: This analytical cross-sectional study included 200 subjects presented with dysphonia to the Phoniatrics/Voice Clinics in two hospitals in Gulf region (KSA and UAE). Same number of matched voluntaires from the same hospitals (hospital staffs, employees and their relatives) and relatives of subjects with typical voice quality were included as well. Both groups underwent a simple questionnaire consists of 15 items related to previously accused risk factors of MAPLs. RESULTS: The bivariant analysis by Fisher's exact test showed that male gender, presence of kids, misuse of voice, alcohol, gastroesophageal reflux diseases and voice handicapping are associated with significant risk to have MAPLs with P values < 0.001 for all except for alcohol (P = 0.015). Welch's t test revealed higher smoking index in subject than control groups with significant difference (P < 0.001). In contrast, spices, family shouting and nearby industry were not potent risk factors in our study group. CONCLUSION: Vocal trauma especially in females and children is a potent risk factor for vocal fold nodules and cysts. The gastroesophageal reflux is a suggested risk factor for Reinke's edema and contact granuloma. Smoking is the risk factor for MAPLs particularly polyp, contact granuloma, and Reinke's edema. Also, alcohol consumption is a possible risk factors for Reinke's edema. Identification of risk factors of the MAPLs is an important step in planning therapy. Risk factors which are highly related to a specific type of MAPLs should be involved in any planned program for protection, voice rehabilitation and/or prevention of recurrence of that lesion.

Cabergoline versus calcium infusion in the prevention of ovarian hyperstimulation syndrome: a randomised controlled study.

The aim of this study was to compare the efficacy of calcium infusion versus cabergoline in the prevention of ovarian hyperstimulation syndrome (OHSS) in IVF patients at high risk for OHSS. One hundred and seventy patients who were stimulated using the long luteal GnRH agonist protocol and at high risk for developing OHSS were randomised in a 1:1 ratio to cabergoline group and calcium gluconate group. In cabergoline group, 0.5 mg of cabergoline was administered once daily p.o. for eight days starting on the day of HCG administration. In calcium gluconate group, intravenous calcium gluconate (10%, 10 ml in 200 ml of physiologic saline) was administered daily for four days starting on the day of ovum pickup. Six patients in cabergoline group and eight patients in calcium gluconate group developed moderate OHSS. One patient in each group developed severe OHSS. The incidence of moderate/severe OHSS was comparable between both groups (8.24% vs. 10.59%, p value = .599, OR = 0.76, 95% CI [0.269-2.138]). The implantation, clinical and ongoing pregnancy rates were similar in the two groups (16.91% vs. 15.84%, p = .771, 35.29% vs. 32.94%, p = .746, and 30.59% vs. 28.24%, p = .736, respectively). In conclusion, calcium infusion and cabergoline have comparable effectiveness in the prevention of OHSS. Both drugs are well tolerated, cheap and have no adverse effects on the reproductive outcomes of IVF cycle.Clinical trial registration: The trial was registered on clinical trials.gov database [NCT02875587].Impact StatementWhat is already known on this subject? The effectiveness of cabergoline in the prevention of OHSS in IVF patients at high risk for OHSS is confirmed by overwhelming scientific evidence. Calcium infusion is a novel strategy for prevention of OHSS. Few studies reported the use of calcium infusion in the prevention of OHSS. A retrospective study and a randomised controlled study revealed that calcium infusion reduces the incidence of OHSS. Moreover, a quasi-randomised study revealed that calcium infusion is as effective as cabergoline in the prevention of OHSS.What the results of this study add? Calcium infusion and cabergoline have comparable effectiveness in the prevention of OHSS. Both drugs are well tolerated, cheap and have no adverse effects on the reproductive outcomes of IVF cycle.What the implications are of these findings for clinical practice and/or further research? Calcium infusion should be used to minimise the incidence of OHSS in IVF patients at high risk for OHSS.

Laryngeal and Voice Disorders in Patients with Pulmonary Tuberculosis.

INTRODUCTION: Laryngeal tuberculosis (LTB) is the most frequent granulomatous disease of the larynx. The aim of the present work was to study the laryngostroboscopic features and voice quality of patients with laryngeal TB secondary to pulmonary TB. MATERIALS AND METHODS: Participants were 35 patients diagnosed as having pulmonary TB and dysphonia. All patients had a complete history, clinical and laboratory workup. Patients were assessed using a protocol of voice assessment which included Auditory-perceptual analysis of voice, voice analysis using the Multidimensional Voice Profile (MDVP), and laryngostroboscopy. RESULTS: The participants were 24 males and 11 females and their mean age was 43.7 years. The voice acoustic analysis revealed a significant difference from normal in jitter percent, shimmer percent, and harmonic to noise (H/N) ratio. Laryngeal gross lesions were found in 11 patients while the other 24 patients had normal laryngoscopic findings with nonspecific stroboscopic changes as reduced mucosal waves and mild glottic gap. Diffuse lesion of the whole vocal folds was found in 5 patients and anterior predilection in 4 patients. The type of lesions were granulomatous lesions in 7 patients and non-specific inflammatory mild exophytic lesions in 4 patients. CONCLUSIONS: Voice disorders in pulmonary TB include disturbance in the mechanism of voice production with or without detectable laryngeal lesion. Videostroboscopy has the advantage of showing the extension of laryngeal involvement, vocal folds vibrations, and mucosal waves.

Recommendations for the Development and Reform of Microtia and Atresia Services.

BACKGROUND: The initial step in setting up standardized microtia-atresia service is investigating the current status of the service and comparing this to internationally recognized guidelines or care standards. In many countries, documented information about microtia care is lacking. This study is an initiative to guide reform efforts of national microtia service in any country. The UK care standards for microtia-atresia can be a useful model to help set up a comprehensive microtia-atresia service. METHODS: The authors conducted a survey to investigate different aspects of microtia service in Egypt. The major plastic surgery centers (n = 22) were surveyed by a structured questionnaire. The results were compared with the UK care standards for microtia-atresia to identify the aspects that need improvement. Thorough analysis of the main problems in microtia-atresia service is presented. RESULTS: The authors found that microtia service is fragmented between the surveyed centers with 65% of the centers treating less than 10 microtia cases annually. Multiple surgeons are responsible for ear reconstruction in 90% of centers and only 25% of them practise a multidisciplinary team approach. None of the centers uses validated tools of aesthetic or psychological patient-reported outcome measures. RECOMMENDATIONS: These 5 recommendations are the keys to reforming microtia service in any country:(1) Establishing nationally designated centers to concentrate the required expertise.(2) Assigning fewer high-volume surgeons to optimize the surgical outcomes.(3) Providing treatment by experienced multidisciplinary teams.(4) Using validated tools of patient-reported outcome measures.(5) Collecting and keeping standardized records for regular audit and intercenter studies.

The role of three-dimensional ultrasonography fetal lung volume measurement in the prediction of neonatal respiratory function outcome.

BACKGROUND: Respiratory distress is commonly encountered among premature babies immediately after birth resulting in significant neonatal morbidity or mortality. OBJECTIVES: To evaluate the possible correlation between three dimensional fetal lung volumes (FLVs) and neonatal respiratory outcomes. STUDY DESIGN: A cohort study included 100 pregnant women who participated in the study and were divided into two groups; group A (n: 50 - women pregnant ±34-37 weeks) and group B (n: 50 - women pregnant ±37+1 to 40 weeks). A three dimensional measurement of the right fetal lung was made using virtual organ computer-aided analysis (VOCAL) software then correlated to neonatal respiratory functions namely Apgar score at birth and the occurrence of respiratory distress syndrome (RDS). RESULTS: In group A, FLV was negatively correlated with Apgar score and the occurrence of RDS. In group B, FLV showed no statistical correlation with Apgar score and the occurrence of RDS. CONCLUSIONS: Three dimensional fetal lung volumes might be an accurate noninvasive predictor for the development of RDS among preterm fetuses.

Benefits of vaginal misoprostol prior to IUD insertion in women with previous caesarean delivery: a randomised controlled trial.

OBJECTIVE: The aim of the study was to evaluate the value of vaginal misoprostol 6 h prior to intrauterine device (IUD) insertion in women with previous Caesarean delivery. METHODS: A double-blind randomised controlled trial was conducted in 120 women who were eligible for IUD insertion. Participants were randomly divided to receive either 600 µg vaginal misoprostol or placebo 6 h before IUD insertion. The primary outcome measure was the pain score during the procedure. Secondary outcome measures were failure of insertion, insertion difficulty score, complications of IUD insertion and side effects related to misoprostol. RESULTS: Pain and insertion difficulty scores were significantly lower in the misoprostol group compared with the placebo group (5.7 ± 1.4 vs. 6.5 ± 0.9 and 4.1 ± 1.1 vs. 5.4 ± 2.2, respectively; p < .001). More women experienced nausea, vomiting (5 vs. 0; p = .06) and cramps (10 vs. 0; p < .001) in the misoprostol group than in the placebo group, respectively. CONCLUSIONS: The use of misoprostol before IUD insertion is associated with less painful and easier placement.

Lipoma of right pyriform sinus.

We present a case of large mass arising from the right pyriform sinus extending inferiorly to the postcricoid area and superiorly to the right aryepiglottic fold causing a foreign body sensation and obstructive symptoms, its histological examination following the endoscopic surgical excision showed a lipoma. We are also describing the endoscopic, radiological and intraoperative findings with a brief literature review.

Early voice therapy in patients with unilateral vocal fold paralysis.

OBJECTIVE: The purpose of this work was to study the efficacy of early voice therapy in the management of patients with unilateral vocal fold paralysis. PATIENTS AND METHODS: Three groups of patients suffering from unilateral vocal fold paralysis were subjected to a protocol of voice evaluation including auditory-perceptual voice analysis, the Dysphonia Severity Index (DSI) and the 20-item Voice Problem Self-Assessment Scale (VPSS-20). Patients were also examined using video laryngostroboscopy. The early voice therapy group was enrolled in a voice therapy program for 16 sessions as soon as the patients were diagnosed; the second group of patients did not receive voice therapy during the course of their ailment. The late voice therapy group was enrolled in a voice therapy after a period of at least 6 months following the onset of vocal fold paralysis. All studied patients were reevaluated after a period of 2 months. RESULTS: The early voice therapy group showed better outcomes regarding VPSS-20 scores, auditory-perceptual voice analysis as well as the DSI. CONCLUSION: Early onset of voice therapy may enhance the reduction in glottal gap and improvement of voice quality by hindering the development of faulty hyperfunctional compensatory behaviors; early voice therapy may therefore enhance the patient's quality of life.

Value of subcutaneous drainage system in obese females undergoing cesarean section using pfannenstiel incision.

OBJECTIVE: To determine whether closed subcutaneous drainage systems were efficacious in reducing the rate of wound breakdown of Pfannenstiel incision after cesarean section (CS) in obese females. DESIGN: Prospective controlled clinical trial. PARTICIPANTS: 118 obese pregnant females with a body mass index >32 undergoing CS were divided into two groups: group I (n = 78) with closed subcutaneous drainage system and group II (n = 40) without drainage system. Incision closure technique was standardized. Prophylactic antibiotics were given routinely to both groups. OUTCOME MEASURES: Primary outcomes were the incidence of wound breakdown in both groups together with rate of hematoma formation and occurrence of fever. Secondary outcomes were amount of fluid drained, need for redressing. RESULTS: Wound breakdown occurred in 9 cases in group I (11.5%), while it happened in 5 cases in group II (12.5%) (p > 0.05). Relative risk was 0.92 (95% CI 0.26-3.75). Hematoma formation was observed in only 1 case in the nondrainage group (group II). Fever was observed in 18 cases in group I (23.1%) in the first 24 h postoperative while in group II, 13 cases developed fever (32.5%) (p > 0.05). The need for redressing within the first 24 h was only in 2.5% of cases in group I while it was 17.9% in group II (p < 0.05). CONCLUSION: We found no significant benefit in using a subcutaneous drain as a prophylactic measure against wound breakdown in obese pregnant females undergoing CS as long as they received a prophylactic antibiotic.