The sensitivity of laryngeal findings in predicting high-grade dysplasia in patients with vocal fold leukoplakia undergoing office-based biopsies: A retrospective analysis of 100 cases.

Objective: To investigate the sensitivity of laryngeal findings in predicting high-grade dysplasia/carcinoma in situ (CIS) and squamous cell carcinoma (SCC) in patients with vocal fold leukoplakia. Methods: A retrospective review of the medical records and video recordings of the laryngeal examination of patients with vocal fold leukoplakia who underwent un-sedated office-based laryngeal biopsy in a tertiary referral center between January 2022 and August 2023 was conducted. Laryngeal findings included the size, surface, projection, and edges of the lesion. Vocal fold leukoplakia was classified according to the WHO as benign, low-grade dysplasia, high-grade dysplasia/CIS, and squamous cell carcinoma. Results: Seventy patients with 100 vocal fold leukoplakia were included. Size was found to have the highest sensitivity with an AUC of 0.730 (95% CI [0.618-0.842], p = 0.002) followed by surface and projection with AUCs of 0.672 (95% CI [0.548-0.795], p = 0.019) and 0.675 (95% CI [0.546-0.804], p = 0.017), respectively. Furthermore, the odds of diagnosing high-risk lesions (high-grade dysplasia/CIS and SCC) were the greatest when the lesion was large and rough (OR = 10.28; 95% CI [3.08-34.36]). Conclusion: The morphological features of vocal fold leukoplakia may assist the physician in predicting the risk of malignancy. Large and rough lesions were more likely to harbor high-grade dysplasia/CIS and SCC compared to small and smooth lesions.

Effect of Vitamin D Deficiency on Voice: A Review of the Literature.

OBJECTIVE: The purpose of this study is to review the current literature on the effect of hypovitaminosis D on voice. STUDY DESIGN: Narrative review. METHODS: The literature search from electronic databases included PubMed/MEDLINE, EMBASE, SCOPUS, and Google Scholar. Search terms included voice, voice quality, voice disorders, larynx, laryngology, acoustic analysis, vitamin D, calcitriol, cholecalciferol, vitamin D deficiency, and vitamin D insufficiency. All studies on patients with vitamin D deficiency, which included subjective and objective voice assessments, were reviewed. RESULTS: A total of 39 studies were retrieved. Only four studies met the above-mentioned inclusion criteria and hence were included in this review. The total number of subjects analyzed was 466. The subjective voice outcome measures used were the Voice Handicap Index-10 (VHI-10), self-reported phonatory symptoms, and the GRBAS scale. Objective voice outcome measures included fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, maximum phonation time, and dysphonia severity index. CONCLUSION: Vitamin D deficiency has no significant effect on laryngeal muscles. There was no statistically significant difference in VHI-10 score, self-reported dysphonia, perceptual voice evaluation scores, or any of the acoustic measures between those with or without vitamin D deficiency.

Incidence of pediatric tonsillitis, otitis and upper respiratory infectious entities in the pre and post COVID-19 quarantine eras.

BACKGROUND: At this point of the COVID-19 pandemic, with the worldwide loosening of health restrictions, there has been an observed jump in infectious load especially of the upper airways.Aims/Objectives: To shed light on children's immunity and potential health risks after the COVID-19 pandemic. METHODS: A retrospective chart review from May 2019 to January 2022. Pediatric patients with a discharge diagnosis suggestive of an upper respiratory or ENT infection were included. The sample was divided into three groups according to the date of presentation. RESULTS: A total 4356 patients were diagnosed with ENT infectious aetiology. The mean age was 4.69 years. The three periods studied were: Period-1 (May 2019-January 2020), period-2 (February 2020-April 2021) and period-3 (May 2021-January 2022). The distribution of adenoiditis and MEE is the same across all periods (p > .05). The incidence of URTI, AOM and tonsillitis were significantly highest during period-3 followed by period-1, which in turn was significantly higher than during period-2 (p < .05). The incidence of sinusitis was the highest during period-3 (p < .001). CONCLUSION: There seems to be a heightened susceptibility to acute infection in children after the pandemic.Significance: It is important to keep in mind the changes in microbiota and implement measures to promote healthy gut flora, timely vaccination, and prompt medical interventions.Summary BoxWhat is already known: We already know that quarantine has significantly decreased infectious load especially in children.This study adds an objective assessment of this decrease with an assessment of the infectious load post-quarantine.This study is a model for future pandemics on the importance of vaccinations and the importance of microbiota changes after pandemics.

Prevalence of Obesity in Patients with Dysphonia.

OBJECTIVE: To investigate the prevalence of obesity in patients with dysphonia and the association between Body Mass Index (BMI) and the Voice Handicap Index-10 (VHI-10). MATERIAL AND METHODS: This is a retrospective study that included 304 patients who visited the senior author's Otolaryngology practice between the years 2018 and 2020. Patients were divided into two groups, those presenting for dysphonia and those presenting for other otolaryngologic complaints (Controls). Patients were also stratified as Normal weight (BMI < 25 kg/m2) vs. Overweight (BMI between 25-30 kg/m2), vs. Obese (BMI ≥ 25 kg/m2). The VHI-10 was used as a subjective outcome measure reported by patients with dysphonia. RESULTS: A total of 304 patients included in this study, 203 presenting with dysphonia and 101 with other otolaryngologic complaint. Within the dysphonia group, a significantly higher percentage of patients had a BMI ≥ 25 (70.4%) as compared to the control group (57.4%). The odds ratio were 1.76, meaning that obese patients were 1.76 times more likely to present with dysphonia. There was a weak negative correlation between overweight, obesity, and VHI-10 scores (r=-0.007 and r=-0.039, respectively). CONCLUSION: There was a significantly higher prevalence of overweight and obesity in patients with dysphonia vs. patients with no dysphonia. Although there was a weak correlation between BMI and VHI, our results demonstrate that overweight and obese patients are more likely to have dysphonia.

Epidemiology, etiology, and outcomes of in-hospital cardiac arrest in Lebanon.

BACKGROUND: In-hospital cardiac arrest (IHCA) constitutes a significant cause of morbidity and mortality. As data is scarce in the Middle East and Lebanon, we devised this study to shed some light on it to better inform both hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon. METHODS: We analyzed retrospective data from 680 IHCA events at the American University of Beirut Medical Center between July 1, 2016 and May 2, 2019. Sociodemographic variables included age and sex, in addition to the comorbidities listed in the Charlson comorbidity index. IHCA event variables were day, event location, time from activation to arrival, initial cardiac rhythm, and the total number of IHCA events. We also looked at the months and years. We considered the return of spontaneous circulation (ROSC) and survival to discharge (StD) to be our outcomes of interest. RESULTS: The incidence of IHCA was 6.58 per 1,000 hospital admissions (95% CI: 6.09-7.08). Non-shockable rhythms were 90.7% of IHCAs. Most IHCA cases occurred in the closed units (87.9%) (intensive care unit, respiratory care unit, neurology care unit, and cardiology care unit) and on weekdays (76.5%). ROSC followed more than half the IHCA events (56%). However, only 5.4% of IHCA events achieved StD. Both ROSC and StD were higher in cases with a shockable rhythm. Survival outcomes were not significantly different between day, evening, and nightshifts. ROSC was not significantly different between weekdays and weekends; however, StD was higher in events that happened during weekdays than weekends (6.7%vs. 1.9%, P = 0.002). CONCLUSIONS: The incidence of IHCA was high, and its outcomes were lower compared to other developed countries. Survival outcomes were better for patients who had a shockable rhythm and were similar between the time of day and days of the week. These findings may help inform hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.

Hepatoid Adenocarcinoma of the Stomach: A Challenging Diagnostic and Therapeutic Disease through a Case Report and Review of the Literature.

Hepatoid adenocarcinoma of the stomach (HAS) is a rare aggressive tumor with hepatocellular differentiation. HAS often produces alpha fetoprotein (AFP) and metastasizes to the lymph nodes and the liver. Molecular studies revealed Her2 amplification and overexpression, association with p53 mutations, but no association with KRAS mutations. EGFR and BRAF mutations have not yet been evaluated in hepatoid carcinoma of the stomach so far. Hereby, we present a case of a 41-year-old female patient with HAS with high AFP level and liver metastases. Molecular analysis revealed Her2 overexpression by immunohistochemistry (IHC), but no EGFR, KRAS, or BRAF mutations were detected. The patient underwent chemotherapy type DCX (docetaxel, cisplatinum, and capecitabine) every 3 weeks with partial response after two cycles, maintained for eight cycles, and then was on maintenance therapy with trastuzumab for 7 months before relapsing and dying 18 months from the day of diagnosis. Conclusively, HAS may be misdiagnosed as hepatocellular carcinoma; therefore, it should be considered in the differential diagnosis of multiple hepatic nodules with high AFP and no history of hepatitis, liver fibrosis or cirrhosis.