Repair of posterior laryngeal cleft: a 10-year experience in a tertiary referral hospital.

OBJECTIVE: This study aimed to present experience with surgical treatment of laryngeal cleft cases through both open and endoscopic approaches. METHOD: A retrospective evaluation of all patients diagnosed as having a laryngeal cleft in a tertiary hospital over 10 years was performed. Pre-operative data, conservative and surgical management of cases, and outcomes were collected, tabulated and analysed. RESULTS: This study included 43 patients aged from 2 to 44 months with a median of 9.19 months. Concerning management technique, 12 patients had conservative treatment and the remaining 31 underwent a surgical procedure (of them, 20 patients underwent endoscopic intervention and 11 had the open surgical technique). In the open group, we used either tibial periosteum (six cases) or harvested costal cartilage (five cases). CONCLUSION: Surgical management in the form of endoscopic Coblation-assisted or an open approach is indicated in severe cases or mild cases not responding to conservative management.

Surgical Management of Bilateral Abductor Paralysis: Diode Laser Versus Coblation; A Prospective Study.

OBJECTIVES: We aimed to compare the results of both diode laser and coblation in the treatment of bilateral vocal fold immobility (BVFI). MATERIALS AND METHODS: This prospective clinical study was performed on 80 non-tracheostomised patients with bilateral vocal fold paralysis divided into two groups; Group A: diode laser, Group B: coblation. Medical Research Council "mMRC" Dyspnea scale, maximal phonatory time (MPT), Voice handicap index (VHI), and functional outcome swallowing scale (FOSS) were assessed preoperatively and postoperatively. Also, the VAS pain scale and operative time of both groups are recorded. RESULTS: Within each group, there was a statistically significant decrease in the mMRC dyspnea scale and maximum phonation time and a significant increase in VHI (P < 0.001). There was a statistically significant difference between the studied groups postoperative and regarding the percent change of the MPT ( more decrease in the coblation group). Concerning the operative time and the VAS pain score, there was a statistically significant difference between the studied groups regarding operating time and the VAS pain scale (significantly lower in the coblation group) (P < 0.001). CONCLUSION: Both Coblation and diode laser are effective tools in the treatment of BVFI with similar minimal voice quality affection. The maximum phonation time decreased more in the coblation group, while the voice handicap index did not significantly differ between both groups. However, Coblation may be superior to diode laser in terms of less operative pain and shorter intraoperative time. Coblation may be more favorable for patients at risk of prolonged general anesthesia duration.

Evaluation of swallowing in children with higher grades glottic web.

PURPOSE: to evaluate the swallowing function in children with higher grades of glottic web and to detect the impact of surgical division of the glottic web on the swallowing parameters. We also performed a voice analysis as a secondary objective in this study. METHODS: This prospective case series study included 12 children with higher grades of the glottic web; grades 3 and 4. Evaluation of the swallowing function was done by clinical swallowing evaluation including symptoms and signs of swallowing dysfunction during feeding, such as vomiting, coughing, choking, or cyanosis, and bedside swallowing assessment using the 3-oz water swallow test. Instrumental evaluation of swallowing function was performed using flexible endoscopic evaluation of swallowing (FEES). The evaluation was performed both preoperatively and postoperatively. RESULTS: The number of children suffering from swallowing difficulties significantly increased during the postoperative evaluation where 6 (50%) children demonstrated choking during feeding after the surgical division of the web in comparison to only 3 (25%) preoperatively. Also, coughing and choking during the 3-oz water swallow test significantly increased following the division of the web with P < 0.001. CONCLUSION: Swallowing assessment is mandatory as children with higher grades of the glottic web, requiring reconstructive surgeries, are at risk of swallowing deficit which can be aggravated postoperatively. With improvement in the airway and surgery-specific outcomes, swallowing function is an important secondary outcome that has a significant impact on the lives of these kids and their families.

A refashioned foley catheter: novel cost-effective available stent in pediatric laryngotracheal reconstruction.

PURPOSE: Pediatric laryngotracheal reconstruction (LTR) for laryngotracheal stenosis (LTS) mandates stenting in certain situations. This study presents a novel commercially available and cost-effective stent, a refashioned foley catheter. METHODS: This prospective clinical study was performed on pediatric cases with LTS up to 8 years. The study was performed in a tertiary referral center. The selection of the proper foley catheter size for age was explained. The atraumatic insertion maneuver of the stent was also shown in detail in different situations of LTS. The endoscopic removal of the stent was also described. The mean follow-up was 6.45 ± 1.3 months. RESULTS: The study included 31 cases using the refashioned foley catheter stents. The study included 17 males and 14 females with a mean age of 3.45 ± 1.09. Subglottic stenosis was the most common cause of LTR in the study (74.2%) cases. The mean duration of stenting was 40.5 ± 3.7 days. Decannulation was achieved in 96.8% of cases. No stent complications were encountered like stent migration, excess granulation tissue, intractable aspiration, or pressure necrosis. CONCLUSION: The refashioned foley catheter is a novel, available, and inexpensive stent that can be utilized for LTR cases for pediatric LTS. The newly described stent is soft, pliable with atraumatic insertion and easy endoscopic removal with minimal complications.

Pesticide Residues in Vegetables and Fruits from Farmer Markets and Associated Dietary Risks.

The use of pesticides leads to an increase in agricultural production but also causes harmful effects on human health when excessively used. For safe consumption, pesticide residues should be below the maximum residual limits (MRLs). In this study, the residual levels of pesticides in vegetables and fruits collected from farmers' markets in Sharkia Governorate, Egypt were investigated using LC-MS/MS and GC-MS/MS. A total number of 40 pesticides were detected in the tested vegetable and fruit samples. Insecticides were the highest group in detection frequency with 85% and 69% appearance in vegetables and fruits, respectively. Cucumber and apple samples were found to have the highest number of pesticide residues. The mean residue levels ranged from 7 to 951 µg kg-1 (in vegetable samples) and from 8 to 775 µg kg-1 (in fruit samples). It was found that 35 (40.7%) out of 86 pesticide residues detected in vegetables and 35 (38.9%) out of 90 pesticide residues detected in fruits exceeded MRLs. Results for lambda-cyhalothrin, fipronil, dimothoate, and omethoate in spinach, zucchini, kaki, and strawberry, respectively, can cause acute or chronic risks when consumed at 0.1 and 0.2 kg day-1. Therefore, it is necessary for food safety and security to continuously monitor pesticide residues in fruits and vegetables in markets.

Surgical management of laryngeal bilateral abductor palsy: comparative study between carbon dioxide and diode lasers.

This study aims to compare the results of both CO2 laser and diode laser combined arytenoidectomy with posterior cordectomy in managing patients with bilateral vocal fold paralysis. A prospective study involved 80 bilateral vocal cord immobility patients in adduction. They are divided into two groups according to the laser used, whether CO2 (with a wavelength of 10.6 µm) or diode (with a wavelength of 980 nm). We used mMRC (Modified Medical Research Council) dyspnea scale to assess dyspnea in our patients, while the voice was evaluated by both maximum phonation time and the voice handicap index. Quantitative variables were described using means and standard deviations, while categorical variables were described using frequencies and were compared using the chi-square test, Fisher exact test, and Monte Carlo test. There was a statistically non-significant difference between the studied groups regarding mMRC dyspnea scale and Voice Handicap Index preoperatively and postoperatively. There is a statistically significant difference between the two groups regarding maximum phonation time postoperatively (significantly higher in the CO2 laser group) (p < 0.001). The CO2 laser and diode laser could be used safely for the management of bilateral vocal cord paralysis. The CO2 laser maintains better voice parameters and less postoperative pain, while the diode laser gives less operative time, lower cost, and simplicity of use.

Biological silicon nanoparticles maximize the efficiency of nematicides against biotic stress induced by Meloidogyne incognita in eggplant.

Nemours effective management tactics were used to reduce world crop losses caused by plant-parasitic nematodes. Nowadays the metallic nanoparticles are easily developed with desired size and shape. Nanoparticles (NPs) technology becomes a recognized need for researchers. Ecofriendly and biosafe SiNPs are developed from microorganisms. Recently, silicon nanoparticles (SiNPs) have gained novel pesticide properties against numerous agricultural pests. This study assessed the biosynthesis of SiNPs from Fusarium oxysporum SM5. The obtained SiNPs were spherical with a size of 45 nm and a negative charge of -25.65. The nematocidal effect of SiNPs against egg hatching and second-stage juveniles (J2) of root-knot nematode (RKN) (Meloidogyne incognita) was evaluated on eggplant,Solanum melongena L. plants. In vitro, all tested SiNPs concentrations significantly (p ≤ 0.05) inhibited the percentage of egg hatching at a different time of exposure than control. Meanwhile, after 72 h, the percent mortality of J2 ranged from 87.00 % to 98.50 %, with SiNPs (100 and 200 ppm). The combination between SiNPs and the half-recommended doses (0.5 RD) of commercial nematicides namely,  fenamiphos (Femax 40 % EC)R, nemathorin (Fosthiazate 10 % WG) R, and fosthiazate (krenkel 75 % EC) R confirmed the increase of egg hatching inhibition and J2 mortality after exposure to SiNPs (100 ppm) mixed with 0.5 RD of synthetic nematicides. The findings suggest that the combination between SiNPs, and 0.5 RD of nematicides reduced nematode reproduction, gall formation, egg masses on roots and final population of J2 in the soil. Therefore, improving the plant growth parameters by reducing the M. incognita population.

Coblation supraglottoplasty: a ten-year experience in a tertiary referral hospital.

PURPOSE: The present study aims to review the outcomes of coblation supraglottoplasty performed for children with different types of laryngomalacia, and we discuss the factors affecting these outcomes. METHODS: We retrospectively reviewed the medical records of laryngomalacia patients admitted to the Otorhinolaryngology Department, Mansoura University, from 2010 to 2020. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, oxygen saturation, and final outcomes. RESULTS: Our study included 235 patients; 122 patients responded to medical therapy, while 113 underwent surgical management. There is a significant relation between the types and therapy they underwent (p ≤ 0.001). Larger percentage within type I underwent medical therapy. There is a statistically significant difference between the studied groups regarding age at surgery. On pairwise comparison, patients with type II had the lowest age significantly at the surgery when compared with each other individual group (p ≤ 0.001). On multivariate regression analysis, the presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention by 17.32 and 5.803 folds, respectively. CONCLUSIONS: Coblation supraglottoplasty is effective and safe to treat severe laryngomalacia. Different morphological types of laryngomalacia require slight surgical variations of coblation supraglottoplasty. The presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention.

Fluctuation in amino acids content in Triticum aestivum L. cultivars as an indicator on the impact of post-emergence herbicides in controlling weeds.

This study was carried out in a demonstrated field in El-Sharkia Governorate, Egypt, during the winter of season 2020 to evaluate the leverage of four post-emergence herbicides i.e., tribenuron-methyl, clodinafop- propargyl, pyroxsulam and pinoxaden compared to control on total protein and amino acid contents in three wheat cultivars (Shandwel 1, Giza 171, and Sakha 95). Generally, the use of foliar herbicides led to a significant decrease in essential, non-essential amino acids and protein contents. However, tribenuran-methyl herbicide signifcantly increased the levels of proline, glycine, arginine, and histidine, but cystine and threonine not affected as compared to control. On the other hand, foliar herbicide application was significantly increased physiological , biochemical parameters and yield of Shandweel cultivar as compared to the other varieties. The physiological and biochemical models of dual-herbicide-tolerant wheat cultivars add to our understanding of the crop. In recent agricultural systems, herbicide tolerant plants are important for long-term weed management. Therefore, the study recommended the safely usage of Tribenuran-methyl as foliar herbicide in weed managment.

Do the herbicides pinoxaden, tribenuron-methyl, and pyroxsulam influence wheat (Triticum aestivum L.) physiological parameters?

Herbicides reduce the unsafe effects of weeds, but they are likely to have negative impact on essential and secondary metabolism in crops. However, the combined effect of different herbicides on chemical constituents of different varieties of wheat is still not fully obvious. The current investigation was carried out to determine the effects of three post-emergence herbicides (pinoxaden, tribenuron-methyl, and pyroxsulam) on total protein, lipid, and carbohydrate concentrations of three bread wheat cultivars (Misr 1, Giza 171, and Gemmiza 11). These herbicides were added individually and in combinations at recommended and/or half recommended doses. Our findings revealed that the individual application of herbicides decreased total protein and total lipid concentrations in fresh shoots of the three studied wheat cultivars, but increased total carbohydrate concentration. Combined addition of herbicides at recommended and half recommended doses generally decreased the concentrations of total proteins, total lipids, and total carbohydrates. However, the combined addition of tribenuron-methyl and pinoxaden at recommended dose enhanced total protein and total lipid concentrations under Misr1 and Gemmiza 11 cultivars compared to control treatment. Furthermore, the combined addition of tribenuron-methyl and pyroxsulam at half recommended dose enhanced total protein concentration in Giza 171 up to 15.05% and Gemmiza 11 up to 15.09% cultivars, and total lipid concentration in Misr 1 (7.53%) and Giza 171 (9.81%) cultivars against control treatment, where it was the lowest. Total carbohydrate concentration was enhanced by the sole application of pinoxaden by 53.55%, 52.40%, and 51.79% for Misr 1, Giza 171, and Gemmiza 11 cultivars, respectively. Moreover, individual or combined additions of the studied pesticides at recommended and half recommended doses negatively affected wheat grains under all cultivars via decreasing their concentration of nutrients (nitrogen, phosphorus, and potassium) as well as total protein and total carbohydrates. The highest reduction of nitrogen, phosphorus, and potassium concentrations compared to control was observed when tribenuron-methyl+pyroxsulam was applied at the half recommended dose under the three studied cultivars. However, the combined application of tribenuron-methyl+pyroxsulam at the half recommended dose caused the great depression in total proteins and total carbohydrates of wheat grains. Under the stress effect of herbicides, individual application of pinoxaden gave the best results for nitrogen and potassium content as well as total protein and total carbohydrate concentrations in the three studied wheat grain cultivars.

Electrophoretic banding patterns of protein induced by pinoxaden, tribenuron-methyl, and pyroxsulam herbicides in wheat leaves (Triticum aestivum L.).

Herbicides are the most effective tool against weed flora in cereal crops that help to maintain and increase crop yields. This investigation was conducted in the winter season of 2018 to study the stress effect of three post-emergence herbicides including pinoxaden, tribenuron-methyl, and pyroxsulam on the biochemical changes at the molecular cell level of wheat. These herbicides were applied either lonely with a rate of 0.45 L.ha-1, 22.5 gm.ha-1, and 0.16 Ib a.i/A, respectively, or in combinations together on three Egyptian varieties of bread wheat known as Misr 1, Giza17 1, and Gemmiza 11. Firstly, the abovementioned herbicides were used at the recommended and half recommended doses with their combinations for these varieties to investigate DNA-protein linkage as a signal effect of herbicides at the molecular cell level.Our data showed that the treatment of wheat varieties with the tested herbicides induced new bands with low and high molecular weights of 37.49, 40.08, 146.55, and 147.23 KDa with relative mobility of 0.1574, 0.1603, 0.2166, and 0.2168, respectively. These bands were not presented in the control treatment, suggesting that it might be used as a biochemical marker for plant defense genes. Meanwhile, the control treatment exhibited only five or six bands in the three varieties. However, the tested varieties showed that the same number of bands, the molecular weights of bands, and their relative mobility were significantly varied between the single and the combinations treatment of herbicides. The best treatment was achieved by the combination between pinoxaden and tribenuron-methyl at a recommended dose which induced a large number of protein bands compared to the control treatment on the wheat variety cv. Misr 1, which gave one band with low molecular weight 71.44 KDa at Rf 0.1854 and other with the highest molecular weight 147.23 KDa at Rf 0.2168, compared to the control treatment.

Management of bilateral abductor paralysis: posterior cordectomy with partial arytenoidectomy using diode laser.

PURPOSE: This study aims to assess the role of diode laser-assisted posterior cordectomy with partial arytenoidectomy in the management of bilateral vocal fold paralysis patients. METHODS: Posterior cordectomy with partial arytenoidectomy using diode laser was performed to thirty-nine patients with bilateral vocal fold paralysis. Voice was evaluated by maximal phonation time and Arabic version of the voice handicap index, while breathing difficulty was assessed by mMRC (Modified Medical Research Council) dyspnea scale. RESULTS: There is a statistically significant decrease in mMRC from 2.8 ± 0.645 preoperatively to 0.84 ± 0.554 postoperatively (p < 0.001). However, maximum phonation time is significantly decreased from 8.04 ± 0.978 preoperatively to 6.92 ± 0.997 postoperatively (p < 0.001); there is a statistically non-significant increase in vocal handicap index from 37.12 ± 6.26 preoperatively to 37.24 ± 6.22) postoperatively (p > 0.05). CONCLUSIONS: The diode laser is a viable method that should be considered for the management of bilateral vocal cord paralysis. It seems to be a very promising laser device, so we expect that new diode laser wavelengths (980 nm) will continue to emerge, making it a good alternative to the CO2 laser, but with lower cost, accurate manipulation, portability, shorter duration, and simplicity of use. LEVEL OF EVIDENCE: 4.

Managing obstructive sleep apnea patients with CPAP failure with a novel Lateral Pharyngoplasty as a stand-alone procedure.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is caused by a complete or partial obstruction of the upper airway. A new Cahali lateral pharyngoplasty as a stand-alone procedure for the treatment of OSA patients, whatever the level and pattern of airway obstruction in patients with CPAP failure or non-compliant patients, is it? PATIENTS AND METHODS: 40 patients with known OSAS non-compliant with CPAP or CPAP failures included. BMI, Stop-Bang score, and sleep study parameters were reported before and after the new Cahali pharyngoplasty operation. Preoperative DISE was done for all cases. RESULTS: There were 28 (70%) cases with successful operation outcomes, and 12 (30%) failed cases. Postoperative Stop Bang score, AHI, snoring index were significantly reduced in comparison to preoperative data (p-value <0.001); however, minimal SpO2 and baseline SpO2 were significantly increased in comparison to preoperative data. There was a significant improvement in AHI postoperative. Patients collapse at the level of lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, all significantly predict failure outcome of the operation (p-value = 0.022). However, the absence of laryngeal collapse (L0) had a successful prediction outcome. The high snoring index significantly predicts operation failure. However, preoperative high baseline SpO2 predicts operation success significantly. CONCLUSION: The new Cahali lateral pharyngoplasty can be used as a stand-alone procedure in the absence of lateral wall collapse at the level of the hypopharynx (LH), high tongue base collapse (TH), laryngeal collapse (L1) or tongue palate interaction.