Endoscopic assisted microscopic posterior cordotomy for bilateral abductor vocal fold paralysis using radiofrequency versus coblation.

PURPOSE: To assess the outcomes of endoscopic assisted microscopic posterior cordotomy for bilateral abductor vocal fold paralysis (BAVFP) using radiofrequency versus coblation. METHODS: This was a randomized prospective cohort study that carried out on 40 patients with BAVFP who were subjected to endoscopic/assisted microscopic posterior cordotomy. The patients were randomly allocated into two groups: group (A) patients were operated with radiofrequency, and group (B) patients were operated with coblation. Glottic chink, grade of dyspnea, voice handicap index 10 (VHI10), and aspiration were evaluated pre-operatively and 2 weeks and 3 months post-operatively. RESULTS: There was a significant improvement in the glottic chink and VHI10 scores postoperatively with a non-significant difference between both groups regarding the degree of improvement. In addition, there was a significant improvement of the grade of dyspnea with a non-significant impact on the degree of aspiration in both groups post operatively. There was a lower incidence of oedema and granulation formation in the coblation group but without a statistical significance. CONCLUSION: Both techniques are effective alternatives for performing posterior transverse cordotomy in cases of BAVFP.

TEMPORARY REMOVAL: Prevalence of Non-Proteinuric Preeclampsia at Mansoura University Hospitals.

The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at: https://www.elsevier.com/about/policies/article-withdrawal.

The Role of Empathy in Jordanian Medical Encounters.

Patients' satisfaction with their clinical visits is a common indicator of the latter's success. Their satisfaction is then reflected in the outcomes of the visit as satisfied patients are more likely to accept their doctor's diagnosis, treatment suggestions, and advice, as well as trust their future arrangements. In addition, this satisfaction then provides doctors with insight into the effectiveness of empathizing with patients and in terms of dealing with them as humans rather than as an illness. Therefore, this study investigated the role of empathy in Jordanian clinical encounters. A conversation analysis approach was conducted to reveal the types and functional accomplishments of empathy. The findings reveal three types of empathy: acknowledgment, pursuit, and sharing experiences and feelings. This study also found that empathy contributes to the success of medical visits as it plays a helpful role in these medical encounters, such as motivating patients to take care of their health, allowing the doctor to claim knowledge of the patient's problem, and allowing the sharing of strong feelings. Moreover, the empathy sequences then lead into the suggestion sequences, which are likely to improve patients' satisfaction. These findings provide insight into the usefulness of deploying empathy in clinical visits, which can be boosted by designing training courses that aim to help raise doctors' awareness of the value of empathy in medical encounters.

Optical Detection of SARS-CoV-2 Utilizing Antigen-Antibody Binding Interactions.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease (COVID-19) pandemic, is sweeping the world today. This study investigates the optical detection of SARS-CoV-2, utilizing the antigen-antibody binding interactions utilizing a light source from a smart phone and a portable spectrophotometer. The proof-of-concept is shown by detecting soluble preparations of spike protein subunits from SARS-CoV-2, followed by detection of the actual binding potential of the SARS-CoV-2 proteins with their corresponding antigens. The measured binding interactions for RBD and NCP proteins with their corresponding antibodies under different conditions have been measured and analyzed. Based on these observations, a "hump or spike" in light intensity is observed when a specific molecular interaction takes place between two proteins. The optical responses could further be analyzed using the principle component analysis technique to enhance and allows precise detection of the specific target in a multi-protein mixture.

Electrical Detection of Innate Immune Cells.

Accurately classifying the innate immune players is essential to comprehensively and quantitatively evaluate the interactions between the innate and the adaptive immune systems. In addition, accurate classification enables the development of models to predict behavior and to improve prospects for therapeutic manipulation of inflammatory diseases and cancer. Rapid development in technologies that provide an accurate definition of the type of cell in action, allows the field of innate immunity to the lead in therapy developments. This article presents a novel immunophenotyping technique using electrical characterization to differentiate between the two most important cell types of the innate immune system: dendritic cells (DCs) and macrophages (MACs). The electrical characterization is based on capacitance measurements, which is a reliable marker for cell surface area and hence cell size. We differentiated THP-1 cells into DCs and MACs in vitro and conducted electrical measurements on the three cell types. The results showed average capacitance readings of 0.83 µF, 0.93 µF, and 1.01 µF for THP-1, DCs, and MACs, respectively. This corresponds to increasing cell size since capacitance is directly proportional to area. The results were verified with image processing. Image processing was used for verification because unlike conventional techniques, especially flow cytometry, it avoids cross referencing and by-passes the limitation of a lack of specificity of markers used to detect the different cell types.

Recombinant HBV vaccine enhances the rate of sustained virological response when early initiated after anti-HCV combination therapy.

The overall SVR rate for chronic hepatitis C genotype 4 using the Standard of care is 54.3%. HBV infection can be prevented by the administration of effective and safe vaccine. Evaluation of the vaccination-induced anti-HBs response rates in a cohort of HCV Egyptian patients after being exposed to antiviral combination therapy and the magnitude of its effect on the rate of SVR through its putative role in induction of crossed immunity. (A) 500 HCV patients who had completed the course of antiviral therapy and achieved ETR were retrospectively analyzed and received 20 µg of recombinant DNA vaccine for hepatitis B at time intervals (0, 1, and 4 months). The first dose of the vaccine was initiated one month post treatment. (B) Laboratory analysis: Included routine preliminary investigations to anti viral therapy and specific investigations as determination of anti-HBs antibodies 2 months following the third dose of vaccine. 433 patients showed protective response (86.6%), 67 patients were non-responders (13.4%) (P = 0.003). Adding HBV vaccine 1 month post-treatment increased SVR (400 patients, 80%) (χ(2) = 40.3, P = 0.000). Diabetes affect response to HBV vaccine (P = 0.0001). Adding HBV vaccine to the post treatment care of patients with HCV after termination of antiviral therapy gain two benefits; protection from HBV and significant increase in rates of SVR.

Effect of intravaginal fluorogestone acetate sponges on prolactin levels of Damascus-local cross breed goats.

The effect of intravaginal fluorogestone acetate (FGA) sponges on prolactin levels (PRL) and correlations between PRL and milk somatic cell count (SCC) and steroid hormones levels of Damascus-local cross goats during transitional period to anestrous were investigated in this study. Fifty-six goats were assigned to three groups. Group 1 (FGA, n = 19) was treated with 40 mg FGA and equine chorionic gonadotropin (600 IU, i.m.) at time of sponge withdrawal (day 0). Group 2 (FGA-PGF; n = 19) was treated similar to group 1 but was also injected with dinoprost tromethamine (naturally occurring PGF2α) (10 mg, i.m.) on day 0. Control goats (n = 18) were left untreated. On day 0, five fertile bucks were turned in with all goats. Milk and blood samples were collected on days -13 (day of sponge insertion), -6, 0, 1, 2, 7, 13, and 20. Prolactin levels were at lowest values on day -13 of the study and increased (p < 0.05) from day -6 to day 20 in all groups. A significant positive correlation (p < 0.05) between PRL and progesterone and between PRL and estradiol levels was found in this study. No significant correlation was found between PRL and SCC of all groups during the study except on days 2 and 20 where PRL levels were correlated (p < 0.05) with SCC of left udder halves of FGA group. In conclusion, estrus induction with FGA resulted in significant increase in PRL. A positive correlation was found between PRL and steroid hormones, but there was no correlation between PRL and goat milk SCC.

Enhancing mandibular bone regeneration and perfusion via axial vascularization of scaffolds.

OBJECTIVE: Reconstruction of large and complex bone segments is a challenging problem facing maxillofacial surgery. The majority of current regenerative approaches rely on extrinsic vascularization, which is deficient after cancer ablation and irradiation. The aim of the study was to investigate the efficacy of intrinsic axial vascularization of synthetic bone scaffolds in the management of critical-size mandibular defects. MATERIALS AND METHODS: Scaffold-guided mandibular regeneration in two groups of adult male goats was compared. Only the scaffolds of the second group were axially vascularized via in situ embedding of an arteriovenous loop through microsurgical anastomosis of facial vessels. After 6 months of follow up, both groups were compared through radiological, biomechanical, histological and histomorphometric analysis. RESULTS: The axially vascularized constructs have showed significantly more central vascularization (p = 0.021) and markedly enhanced central bone formation (p = 0.08). The biomechanical characteristics were enhanced, but the difference between both groups was not statistically significant (p = 0.98). CONCLUSIONS: Axially vascularized synthetic mandibular grafts show better vascularization at their central regions, permitting more efficient bone regeneration. CLINICAL RELEVANCE: The encouraging results of the proposed technique could be of benefit in optimizing the reconstruction of large critical-size bone defects.

Effect of Prostate Cancer Education on Saudi Men: Knowledge, Beliefs, and Screening Intentions.

PURPOSE: To evaluate the efficacy of a prostate cancer educational program in enhancing knowledge, beliefs, and screening intentions among Saudi men. METHODS: A quasi-experimental design with a non-equivalent control group was employed. Participants (n=152) were randomly assigned to either the intervention or control group. Assessments of knowledge, beliefs, and screening intentions were conducted at baseline and one-month post-intervention. Independent samples t-tests were used for data analysis. RESULTS: Significant improvements were observed in the intervention group compared to the control group after one month. The mean score for knowledge increased by 7.72 (p = 0.001). Beliefs regarding susceptibility, severity, and benefits of prostate-specific antigen (PSA) and digital rectal examination (DRE) also improved significantly (p < 0.005). Additionally, health motivation and intention to screen increased (p < 0.005).   Conclusion: Prostate cancer educational programs can effectively enhance knowledge, address beliefs, and promote screening intentions among Saudi men. Implementing these programs holds promise for increasing awareness and reducing the burden of prostate cancer through early detection and timely intervention.

Nurses' Insights and Experiences in Palliative Chemotherapy Care.

OBJECTIVE: The study sought to provide an overview of the perspectives and experiences of Jordanian nurses in the context of caring for patients undergoing palliative chemotherapy. METHODS: A phenomenological qualitative design was used to explore the perspectives and experiences of 11 Jordanian nurses providing care to patients receiving palliative chemotherapy at a governmental cancer care center. RESULTS: The nurses identified two main themes: "Patient Persistence in Hope" and "Positive Impacts of Palliative Chemotherapy." They observed that some patients held onto false hopes of a cure when consenting to palliative chemotherapy, often influenced by family pressure. However, despite acknowledging fatigue as a major side effect, the nurses generally had a positive view of palliative chemotherapy, especially when it improved patients' quality of life or relieved pain. The nurses believed that the patients' resilience and positive attitude during treatment were encouraging. CONCLUSION: To better support patients, the study suggests that nurses should gain a deeper understanding of the significance patients attach to hope in advanced cancer situations to avoid misinterpreting it as denial or false optimism.

Factors Influencing Prostate Cancer Screening Intentions in Lebanese Men.

OBJECTIVE: The objective of this study is to investigate the perceived obstacles and willingness of Lebanese men aged 40 and above to undergo screening for prostate cancer. MATERIAL AND METHOD: A cross-sectional research design was employed. The study utilized a survey questionnaire to collect data on various factors influencing screening behaviors. The research instrument consisted of a comprehensive survey questionnaire that incorporated validated scales to assess barriers to prostate cancer screening, intention to screen, and the International Prostate Symptom Score (IPSS). RESULTS: The study found that the 120 participants had an average IPSS score of 7.20 ± 2.23, most people (70%) had mild symptoms of prostate cancer, whereas others had moderate (20%) or severe symptoms (10%). The majority of the men indicated a low to moderate inclination to undergo screening through Prostate-specific antigen testing, or digital rectal examination (DRE) (PSA), with 76% considering DRE and 70% considering PSA. The main barriers to screening included the dread of receiving distressing outcomes (48%) and a lack of understanding about the screening procedure (54%). The study identified key factors affecting the intention to undergo a prostate cancer screening. Regarding DREs, these factors included the perceived danger of the illness and prior information from doctors about prostate conditions. When it came to the intention to undergo screening through the prostate-specific antigen test (PSA), determinants included the perceived threat of the disease, one's general health perception, and prior information from doctors about prostate-related issues. Additionally, a significant proportion of participants believed that prostate cancer was not a serious illness (56%) and 57% thought DRE was embarrassing. CONCLUSIONS: The participants displayed a low willingness to get screened for prostate cancer. Implementing interventions that focus on increasing awareness of the disease and its associated risks could potentially reduce the barriers and boost participation in prostate cancer screening.

Clinical Significance and Prognostic Implications of Discontinuous Growth Pattern in Esophageal Adenocarcinoma: A Multi-Institutional Study.

The significance of discontinuous growth (DG) of the tumor to include tumor deposits and intramural metastasis in esophageal adenocarcinoma (EAC) is unclear. Esophagectomy specimens from 151 treatment-naïve and 121 treated patients with EAC were reviewed. DG was defined as discrete (≥2 mm away) tumor foci identified at the periphery of the main tumor in the submucosa, muscularis propria, and/or periadventitial tissue. Patients' demographics, clinicopathologic parameters, and oncologic outcomes were compared between tumors with DG versus without DG. DGs were identified in 16% of treatment-naïve and 29% of treated cases ( P =0.01). Age, gender, and tumor location were comparable in DG+ and DG- groups. For the treatment-naïve group, DG+ tumors were larger with higher tumor grade and stage and more frequent extranodal extension, lymphovascular/perineural invasion, and positive margin. Patients with treated tumors presented at higher disease stages with higher rates of recurrence and metastasis compared with treatment-naïve patients. In this group, DG was also associated with TNM stage and more frequent lymphovascular/perineural spread and positive margin, but not with tumor size, grade, or extranodal extension. In multivariate analysis, in all patients adjusted for tumor size, lymphovascular involvement, margin, T and N stage, metastasis, neoadjuvant therapy status, treatment year, and DG, DG was found to be an independent adverse predictor of survival outcomes in EAC. DG in EAC is associated with adverse clinicopathologic features and worse patient outcomes. DG should be considered throughout the entire clinicopathologic evaluation of treatment-naïve and treated tumors as well as in future staging systems.

Analyzing Depressive Symptoms Among Elderly Cancer Patients: A Comprehensive Examination of Demographic and Medical Correlates.

OBJECTIVE: This study aimed to explore the relationship between depressive symptoms and demographic as well as health-related variables in elderly individuals diagnosed with cancer. METHODS: A cohort of 50 elderly cancer patients participated in the study. Data collection involved the completion of surveys and assessments encompassing demographic characteristics, medical profiles, levels of depression, cognitive functioning, activities of daily living, and perceived social support. RESULTS: Findings revealed that among the elderly participants, 45% experienced mild depression, 20% exhibited moderate depression, and 5% showed severe depression. Depression levels were found to be linked to marital status (P = 0.03), with widowed individuals reporting the highest depression rates (80%) and single individuals reporting the lowest (4%). Living arrangements were significantly associated with depression (P = 0.012), with participants cohabiting with their partner and children showing lower depression rates (6%) compared to those living solely with their children (40%). Additionally, depression showed a significant correlation with income (P = 0.01), as individuals reporting insufficient income for living expenses displayed higher levels of depression (58%). Furthermore, depression was notably linked to chronic health conditions like diabetes and respiratory ailments (P = .023), with individuals grappling with respiratory issues reporting the highest depression scores. CONCLUSION: Recognizing and addressing factors such as marital status, living situation, income level, and the presence of chronic illnesses hold the potential for healthcare professionals to tailor interventions effectively to meet the specific requirements of this vulnerable demographic. This tailored approach has the capability to contribute significantly to enhancing the overall well-being and mental health outcomes of elderly cancer patients.

Nurses' assessment and management practices of pain among intensive care patients in King Khalid Hospital, Kharj, Riyadh.

Background: Pain is a disagreeable combination of sensory and emotional sensations. Employing behavioral pain assessment tools is strongly associated with improved identification of pain. Purpose: The main purpose of the study is to investigate Nurses' Assessment and Management Practices of Pain among Intensive Care Patients in King Khalid Hospital, Kharj, Riyadh. Materials and methods: A self-administered questionnaire was employed in a descriptive cross-sectional study. The study focused on nurses employed in the intensive care unit at King Khalid Hospital in Al-Kharj Province. The researchers utilized convenience sampling to recruit participants. Out of the total 48 nurses approached 45 of them provided responses, leading to a response rate of 94%. The Critically Ill questionnaire was utilized to gather information regarding the treatment and evaluation of pain in patients who were in critical condition. Descriptive statistics and inferential statistics were employed to analyze the collected data. Principal results: it was found that 88% of them utilized instruments to evaluate pain in patients who could express themselves. Among these instruments, the numeric rating scale was the most commonly employed. Furthermore, 77% of the nurses (35 in total) used a pain assessment tool for patients who were unable to communicate, with the Adult Nonverbal Pain Scale being the most frequently used tool in this case. The nurses' perception of the significance of pain assessment was positively associated with the regular utilization of pain assessment tools. Additionally, the nurses considered the use of pain assessment tools with patients who could communicate as more important compared to using such tools with patients who could not communicate. Conclusions: Most ICU nurses utilized nurses' pain assessment instruments to assess the discomfort levels of both patients who could communicate and those who couldn't express themselves effectively. By employing such tools, nurses can improve patient outcomes, ensure effective pain management, and demonstrate a high standard of professional care.

Investigating Saudi Nursing Students' Health Beliefs about Testicular Cancer and Testicular Self-Examination: A Cross-Sectional Study Using the Health Belief Model.

INTRODUCTION: Testicular cancer (TC) is a serious health issue, which requires early detection through testicular self-examination (TSE). OBJECTIVES: To investigate Saudi nursing students' health beliefs about TC and TSE using the Health Belief Model (HBM) scale and assess the validity and reliability of the HBM scale. METHODS: This cross-sectional study recruited a convenience sample of 374 nursing students from six nursing colleges in different cities in Saudi Arabia. Data were collected through self-report questionnaires that included demographic and academic information, as well as a valid and reliable HBM scale for TC and TSE. RESULTS: Most participants were single (88.8 %), in their third year of nursing education (43.9 %), had excellent or very good health (83.2%), had no family history of TC (88.9%), and had no medical problems with their testicles (92.8%). The participants had low susceptibility to TC and moderate beliefs about the seriousness of TC. Furthermore, participants reported moderate levels of perceived benefits and health motivation for preventing TC and practicing TSE, but high levels of perceived barriers and low levels of self-efficacy for practicing TSE. The internal reliability (Cronbach's alpha) of susceptibility, benefits and health motivation, seriousness, barriers, self-efficacy, and health motivation and promotion sub-scales was 0.91, 0.89, 0.88, 0.84, 0.67, and 0.65, respectively. Significant relationship between students' performing TSE and their health beliefs about Susceptibility (t=1.93, p=0.04) and Seriousness of having TC (t=2.88, p=0.03), and self-efficacy (t=3.91, p<0.001) and barriers (t=-2.51, p=0.04) to practice TSE. CONCLUSION: The study concluded that Saudi nursing students had moderate levels of health beliefs about TC and TSE, with high perceived barriers and low levels of self-efficacy for practicing TSE.

Health professionals and family members during cardiopulmonary resuscitation: A qualitative study on the experience of witnessing resuscitation in Jordanian critical care units.

BACKGROUND: The interaction between healthcare professionals (HCPs) and family members during cardiopulmonary resuscitation (CPR) in critical care units (CCUs) has received significant attention. In the Arabic region, family members are typically excluded from participating in critical care treatments, despite the cultural and religious significance of their presence. This highlights a lack of policies and research addressing the cultural factors related to family involvement in CPR within this context. OBJECTIVES: The purpose of this study was to explore the nature of the relationship between HCPs and family member relations during CPR in Jordanian CCUs. METHODS: This study employed a qualitative research design. Data were collected through semi-structured interviews with 45 participants, including 31 HCPs and 14 family members of patients who had undergone CPR in Jordan. Data was managed, organized, and thematically analyzed using NVivo. RESULTS: The study revealed three main themes: Family-Witnessed Resuscitation (FWR) through the eyes of HCPs, FWR through the eyes of family members, and the relationship between HCPs and family members during CPR. The last theme has three subthemes: "Looking out for the Patient," "Looking out for Ourselves," and "Looking out for Each Other." These themes highlighted the complex and dynamic relationships between HCPs and family members during CPR in Jordan. Participants emphasized the importance of clear communication, mutual respect, and a collaborative approach to decision-making during CPR. CONCLUSION: The resultant study model uniquely explains the relationship between Jordanian health professionals and family members during CPR, with important implications for clinical practice and healthcare policies regarding family involvement during resuscitation in Jordan. Further research is needed to explore the cultural and societal factors influencing family involvement in resuscitation in Jordan and other Arab countries.

Artificial intelligence reveals features associated with breast cancer neoadjuvant chemotherapy responses from multi-stain histopathologic images.

Advances in computational algorithms and tools have made the prediction of cancer patient outcomes using computational pathology feasible. However, predicting clinical outcomes from pre-treatment histopathologic images remains a challenging task, limited by the poor understanding of tumor immune micro-environments. In this study, an automatic, accurate, comprehensive, interpretable, and reproducible whole slide image (WSI) feature extraction pipeline known as, IMage-based Pathological REgistration and Segmentation Statistics (IMPRESS), is described. We used both H&E and multiplex IHC (PD-L1, CD8+, and CD163+) images, investigated whether artificial intelligence (AI)-based algorithms using automatic feature extraction methods can predict neoadjuvant chemotherapy (NAC) outcomes in HER2-positive (HER2+) and triple-negative breast cancer (TNBC) patients. Features are derived from tumor immune micro-environment and clinical data and used to train machine learning models to accurately predict the response to NAC in breast cancer patients (HER2+ AUC = 0.8975; TNBC AUC = 0.7674). The results demonstrate that this method outperforms the results trained from features that were manually generated by pathologists. The developed image features and algorithms were further externally validated by independent cohorts, yielding encouraging results, especially for the HER2+ subtype.

Healthcare workers' compliance with the catheter associated urinary tract infection prevention guidelines: an observational study in Yemen.

BACKGROUND: Catheter-associated urinary tract infection is a global problem but it can be prevented with the appropriate implementation of evidence-based guidelines. This study was conducted to assess the level of compliance of healthcare workers with the catheter-associated urinary tract infection prevention guidelines during the insertion of a urinary catheter. METHODS: An observational study using a descriptive cross-sectional design was conducted at Sana'a City hospitals, Yemen. All the nurses and physicians from the governmental, teaching, and private hospitals were eligible to participate in the study. The data collection was performed through convenience sampling from March 2020 to December 2020, using a structured observational checklist prepared specifically for this study. RESULTS: The majority of the urinary catheter insertions were performed by nurses. There were no written policy or procedures for an urinary catheter insertion and no in-service education or training departments in the majority of the hospitals. The overall mean score of compliance was 7.31 of 10. About 71% of the healthcare workers had a high or acceptable level of compliance and 29% had an unsafe level of compliance. Compliance was low for maintaining aseptic technique throughout the insertion procedure, using a single use packet of lubricant jelly, performing hand hygiene immediately before insertion, and securing the urinary catheter once inserted. Factors affecting the healthcare workers compliance were gender, the working ward/unit of the healthcare workers, the availability of a written policy/procedure and a department or unit for in-service education. CONCLUSION: Yemeni healthcare workers' overall compliance was acceptable but it was unsafe in several critical measures. There is an urgent need for developing, implementing, and monitoring national guidelines and institutional policy and procedures for catheter-associated urinary tract infection prevention. Periodical in-service education and training programs and adequate access to the necessary materials and supplies are paramount.

Nurses' Perceptions of Prognosis-Related Communication.

INTRODUCTION: Effective communication is an important aspect in providing health care. Communications optimize the patient-caregiver relationship and improve patient care and family and caregiver welfare. The main objective of this study was to explore nurses' experience of prognosis-related communication (PRC). METHODS: Phenomenological research design was used to do this study. A total of 248 members of the local oncology nursing association were invited to complete this online survey from January 2016 to March 2016. Then, focus groups were held to discuss and improve themes derived from the analysis of online written responses. Five focus groups were performed, each consisting of 6 to 8 participants. No new data were generated by the fifth focus group and data saturation was achieved. NVivo 11 was used to manage data and facilitate the development of themes. RESULTS: The participants were almost female, with a mean nursing experience of 13 years and almost 8 years of working experience in oncology ward. Three themes were extracted following data analysis, namely the importance of collaboration, impact of PRC, and communication of prognostic information. One hundred and fifty nurses (60%) reported that they received no formal training or education about PRC. CONCLUSION: There is a need to improve the knowledge and attitude of physician toward engaging nurses in the process of PRC.

Painful Diabetic Neuropathy as a Cause for Refractory Ear Pain in Type 2 Diabetic Patients.

OBJECTIVE: To assess painful diabetic neuropathy (PDN) as a cause for refractory ear pain in type 2 diabetics. DESIGN: An observational prospective case series study. SETTING: Otolaryngology departments of tertiary referral hospitals from November 2019 to January 2021. PATIENTS: Sixty-eight patients with type 2 diabetes with refractory ear pain of more than 1-month duration not responding to the routine analgesics. INTERVENTION: Diagnostic intervention. MAIN OUTCOME MEASURE: The primary outcome measure was the prevalence of painful diabetic neuropathy among different causes of ear pain in the study sample of type II diabetics with refractory ear pain with an assessment of the response of these cases to routine neuropathic pain treatment with pregabalin. RESULTS: Fifteen out of 68 (22.1%) were diagnosed as having painful diabetic neuropathy based on the "Douleur Neuropathique en 4 Questions" (DN4) questionnaire with its mean value being 6.47±1.19. There was a highly significant improvement of the 10 items of painful diabetic neuropathy scales after 1 month of treatment ( p < 0.001 for all). There was a significant positive correlation between the Hemoglobin A1c level and duration of diabetes at one hand and intensity of pain derived from the painful diabetic neuropathy scale at the other hand ( p = 0.0002, and p = 0.032 respectively). CONCLUSION: Painful diabetic neuropathy showed a potential correlation with refractory ear pain in type II diabetic patients with significant improvement after painful diabetic neuropathy treatment. Further studies are needed to confirm these findings.