Identifying Affecting Factors on Acceptance with CPAP on the First Night of PAP Titration in Sleep Clinic on Patients with Obstructive Sleep Apnea.

Introduction: This research examined the causes of low acceptance with Continuous Positive Airway Pressure Continuous Positive Airway Pressure (CPAP) especially anatomical causes and if eliminating them would result in increasing its adherence. Materials and Methods: This cross sectional study was performed on patients with moderate to severe Obstructive Sleep Apnea Obstructive Sleep Apnea (OSA) undergoing PAP titration in the sleep clinic. CPAP acceptance was evaluated by visual analog scale (VAS) about mask and sleep satisfaction and the possibility of using CPAP in the future, mask complications, physical examination of the upper airway and polysomnographic (PSG) results before and after titration. Results: participants were divided into three groups of non-acceptant, semi-acceptant and acceptant with CPAP based on the satisfaction of the mask and sleep. There were no significant differences between groups based on age, gender, education, BMI and polysomnographic variables. With a study of mask complication, there were significant differences among groups for dry mouth, mask leakage and cold air. (p<0.05) The severity of septal deviation, high arch palate, mallampati, retrognathia and maxillary hypoplasia in the acceptant group was less than the other two groups, but it was not statistically significant. Conclusions: Satisfaction with the sleep and the mask on the first night of titration will significantly increase the likelihood of using CPAP in the future. A number of the pathological physical examinations were lower in the acceptant group than two other groups, but were not significant.

Raynaud's Phenomenon as a Presenting Feature of Hypothyroidism: Case Report.

Raynaud's phenomenon is manifested clinically by demarcated color changes the skin of the digits or extremities, typically may be an early clue to the diagnosis of hypothyroidism. In this report, we describe the 8-year-old patient with diagnosed primary hypothyroidism presenting with ceasing the treatment for 1 month that presenting with Raynaud phenomenon.

Rhinocerebral Mucormycosis Following COVID-19 Infection in Iran.

Background & Objective: Mucormycosis (also called black fungus) is an opportunistic serious fungal infection caused by mucormycetes. It can occur in diabetes mellitus patients and other immunosuppressive conditions with recent predisposing factors such as maxillofacial surgery and corticosteroid usage. Methods: In this study, 14 patients were referred to the otorhinolaryngology or ophthalmology ward of Shafa Hospital (Kerman, Iran) with primary symptoms of nasal fullness and facial nerve dysfunction; they were admitted to the hospital to rule out the fungal infection. An endoscopic biopsy was taken from facial sinuses or orbit, and a microscopic evaluation was performed using hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining methods to rule out mucormycosis. Results: In the histopathological examination, broad-based nonseptate branching fungal hyphae were found in nasal sinuses through the endoscopic biopsy. Most of the patients had diabetes mellitus with a primary symptom of facial nerve palsy; also, most of them received corticosteroids (intravenous [IV] or intramuscular [IM] injection). All patients have recently been infected with COVID-19 (less than 1 month ago). Conclusion: COVID-19 infection might be a predisposing factor for many opportunistic infections, such as fungal elements); thus, the physician should be aware of the dosage and duration of corticosteroid therapy to prevent the development of these infections.

Epidemiology of Sleep Disorders Among Adolescents in Kerman, Iran, in 2019.

It is an important fact that the onset of adolescence is a time of both physiological and social changes that affect sleep. In this study, the prevalence of sleep disorders in adolescents and the association between them were investigated. Anthropometric dimensions (such as height and weight) of individuals in Kerman in 2019 were also assessed. A total of 451 adolescents (mean age: 14.72 years; 51.88% females) of Kerman, Iran, took part in this cross-sectional study. Participants completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and then demographic (age, gender) and anthropometric data (weight and height) were collected. The prevalence of sleep disorders in this population was 31.9%. Among those with self-rated sleep disorders, 53.5% were males. Participants with sleep disorders were younger and showed lower anthropometric values such as height, weight, and body mass index. However, there was no difference between sleep disorders and gender (P-value > .05). This study revealed a relatively high prevalence of sleep disorders among adolescents. This research was done with the aim of encouraging the healthcare organization to design educational programs to evaluate and reduce sleep disorders.

Epidemiology of Sleep Disturbances Among Primary School Students in Kerman, Iran, in 2019.

Primary sleep disturbances are common in both children and adults and can lead to cognitive problems and educational and psychological disorders. In this study, we evaluated the epidemiology of sleep disturbances among children in Kerman, Iran, in 2019. This cross-sectional study was done in 2019 with 561 children in elementary schools of Kerman, Iran. Data were collected by a Pittsburgh Sleep Quality Index (PSQI) questionnaire that was filled out by parents and analyzed statistically. A total of 561children with a mean age of 9.54 ± 1.55 years were enrolled. The ratio of boys to girls was 1.01 and consistent across age groups. The prevalence of sleep disturbances in this population study was 26.7% (150 patients); 51.3% of them were girls. Sleep disturbances were associated with mothers' lower education level and parents' higher job positions (P < .05). This study showed the relatively high prevalence of sleep disturbances among children in this region. It can be reduced by a program such as sleep training or by promoting the level of parents' education. We recommend some educational programs and preschool screening to evaluate sleep disturbances and educating the parents to increase their responsiveness.

Association of cagA Positive Helicobacter pylori Infection and Laryngeal Squamous Cell Carcinoma: A PCR Approach.

Helicobacter pylori is a gram-negative bacillus causing benign and malignant gastric diseases such as gastroesophageal reflux (GER). In larynx, H. pylori causes chronic inflammation and mucosal destruction that may lead to malignant changes. Although, H. pylori poses several virulence factors, cagA is probably the main factor in this regard. To evaluate the role of cagA gene in laryngeal squamous cell carcinoma (LSCC), a case-control study was conducted on patients with laryngeal complaints during 2010-2012. Seventy-two patients with LSCC (case group) and 72 patients without malignancy (control group) were included in the study. The H. pylori and cagA factor were assessed in laryngeal specimen of patients with PCR technique. 33 % of patients in case group (24 patients) and 45.8 % (33 patients) of control group were positive for H. pylori. CagA gene was present in 13.8 % (10 patients) of case group specimens and 31.9 % (23 patients) of control group. This difference was statistically significant with Mantel-Haenszel statistical test analyses. The results showed that patients with LSCC have significantly lower incidence of laryngeal H. pylori infection and cagA virulence factor than those without LSCC. Findings from this study support the protective effect of H. pylori infection against laryngeal cancer.

Orbital Extension of a Giant Ethmoidal Sinus Osteoma in a 30-Year-old Female.

INTRODUCTION: Osteoma is a benign tumor rarely found in the paranasal sinuses. CASE REPORT: A 30-year-old female presented with an 8-month history of proptosis of the right eye that was progressing slowly. She was diagnosed with ethmoid osteoma and managed with collaborative surgery at the ophthalmology and otolaryngology departments. After surgery, the patient suffered visual loss that was managed medically. The surgical steps and protocol used for safe removal are discussed in the report. CONCLUSION: Management of a giaint osteoma extending to orbital tissue needs meticulous dissection through open approach and collaborative surgery by otolaryngologist and ophthalmologist.

Surrounding ipsilateral eruptive seborrheic keratosis as a warning sign of intraductal breast carcinoma and Paget's disease (Leser Trelat sign).

Paget disease of the breast, most often occurs in middle-aged women. Leser-Trelat sign is a rare cutaneous manifestation of internal malignancy that is usually associated with visceral-type adenocarcinoma. We report a patient with Paget disease of the nipple and intraductal carcinoma who presented with ipsilateral, eruptive grouped seborrheic keratoses of the areola and nipple of the breast.

Urticaria and lip fasciculation may be prodromal signs of brain malignancy.

The association of urticaria and cancer usually is seen with lymphoreticular system malignancies. Recalcitrant intra-nostril pruritus has been associated with fourth-ventricle tumors of the brain. Rarely, urticaria has been described with cancer of the lung, usually small-cell adenocarcinoma. We describe a girl who suffered with chronic urticaria for 3 months before lip fasciculation began to be observed. CT scan revealed a brain tumor adjacent to the cerebellum, which was diagnosed as astrocytoma grade II. Because of the location, the tumor was not operable, but after one course of radiotherapy, both the urticaria and lip fasciculation disappeared.

Cryotherapy as a treatment for psoriasis.

There are very few publications on the use of cryotherapy in the treatment of psoriasis. We performed an evaluation to determine its efficacy in small plaque psoriasis. We selected 63 patients who had a clinical diagnosis of chronic plaque-type psoriasis and and for each patient we evaluated two psoriatic plaques of almost the same size and severity on similar areas of the body. One plaque was sprayed with liquid nitrogen every other day for two weeks and the other plaque was untreated as a control. Complete resolution of the plaque occurred in four patients (6.35 %), mild to moderate resolution was evident in 19 cases (30.1 %), and no improvement occurred in 40 patients (63.5 %). Only one complication, superimposed infection, occurred. Cryotherapy may mediates mild resolution of plaques by inducing normal re-epithelization following the physical destruction of the lesions via a reverse Koebner phenomenon. Our findings suggest that cryotherapy is safe to use in the treatment of small-plaque psoriasis but that its efficacy is limited.