Hearing outcomes in children with Congenital Cytomegalovirus: A multi-center, single-enterprise experience.

BACKGROUND: Cytomegalovirus (CMV) is the most common cause of non-genetic sensorineural hearing loss (SNHL) in the United States; yet screening for congenital CMV (cCMV) remains controversial. CMV related SNHL can be present at birth, or develop in a delayed manner, and it is a consistent feature in children with either symptomatic or asymptomatic disease. A retrospective chart review was performed to determine the characteristics of patients diagnosed with cCMV and SNHL. METHODS: The electronic database warehouse of the Nemours Children's Health System (NCHS) was queried from 01/01/2004 to 10/05/2019. ICD 9 (771.1) and ICD 10 (B25.9, P35.1) diagnostic codes were used to identify patients throughout the system with a diagnosis of cCMV infection. Patient demographics including gender, race/ethnicity, age of diagnosis, results of newborn hearing screening (NBHS), detection and progression of hearing loss, presence of antiviral therapy, and frequency of monitoring were collected, and descriptive statistics performed. RESULTS: Of the 170 patients confirmed to have cCMV, 153 (90%) were symptomatic and 17 (10%) were asymptomatic. CNS involvement (63.5%), radiographic evidence of disease present (69.4%), and SNHL (50.6%) were the most common manifestations of the disease. Of these 170 patients, 83 (48.8%) were determined to have SNHL eligible for evaluation. For these patients with SNHL, the average time of hearing monitoring was 50.6 months. At the time of initial reported detection 63 of 83 (76%) had bilateral hearing loss and 20 (24%) had unilateral loss. Over the study period 3 (15%) progressed from unilateral to bilateral involvement, and 32 (47%) had a deterioration in hearing, with severe to profound SNHL in at least one ear identified at the last visit in 53 (64%) patients. Newborn hearing testing results were available for 69 (83%) of those with hearing loss and 26 patients passed initial testing. However, of the 26 patients who passed, 22 (85%) eventually developed SNHL by their last visit. Within our cohort, females with cCMV were significantly more likely to have SNHL than males with cCMV (62.3% versus 37.6%; p < 0.01). CONCLUSION: In the absence of targeted or universal cCMV screening, the majority of children identified with this condition present symptomatically. Approximately one half of children with symptomatic cCMV failed NBHS at birth while at least 25% develop SNHL later in life. Children with cCMV are at high risk of delayed onset loss and such children, particularly females, should be monitored closely.

Endocannabinoid System and the Otolaryngologist.

The endocannabinoid system is located throughout the central and peripheral nervous systems, endocrine system, gastrointestinal system, and within inflammatory cells. The use of medical cannabinoids has been gaining traction as a viable treatment option for varying illnesses in recent years. Research is ongoing looking at the effect of cannabinoids for treatment of common otolaryngologic pathologies. This article identifies common otolaryngologic pathologies where cannabinoids may have benefit, discusses potential drawbacks to cannabinoid use, and suggests future directions for research in the application of medical cannabinoids.

Developing Medical Student Competencies, Clinical Skills, and Self-Efficacy With an Emergency Medical Responder Certification Course.

Introduction Previous studies have claimed gap year clinical experiences before medical school matriculation increase student self-efficacy and clinical confidence. At the University of Central Florida College of Medicine, 41 first-year medical students participated in a new certification course to become emergency medical responders before beginning their coursework. This study describes the results of a follow-up study that aims to investigate the impact the course had on student competency, self-efficacy, and clinical efficacy and if the course would prepare students similarly to previous clinical experience. Methods First-year medical students completed a 30-question survey consisting of a Likert scale and free-response questions. Questions were based on the Accreditation Council for Graduate Medical Education core competencies: medical knowledge, practice-based learning and improvement, systems-based practice, patient care, professionalism, and interpersonal and communication skills. Questions on the perceived benefit of the emergency medical responder course and previous clinical experiences were also included. Responses were separated based on participation in the emergency medical responder course and prior clinical experience. Two-tail Welch's t-tests were performed on the data to determine significance. Results Of 98 responses: 20.4% (20/98) of participants of the emergency medical responder course had previous clinical experience, 21.5% (21/98) of participants of the course had no clinical experience, 26.5% (26/98) did not participate in the course but had previous clinical experience, and 31.6% (31/98) did not participate in the course nor had previous clinical experience. Students with previous clinical experience reported the emergency medical responder course improved both their patient care skills and performance in courses that emphasized patient interviewing and physical exams. Students with clinical experience had significantly higher medical knowledge (p < 0.1) and professionalism (p < 0.1) Likert scores. Eighty-seven percent of students agreed the course had a positive impact on their patient care skills. Conclusion Larger sample size is needed to make stronger conclusions; however, the responses show the emergency medical responder course had a positive subjective impact on students with previous medical experience. Previous clinical experience leads to the most positive subjective reporting of competencies such as medical knowledge and professionalism. Early clinical exposure, such as an emergency medical responder certification course, may improve self-efficacy and patient care skills for medical students with no previous clinical experience.

Infected Thyroglossal Duct Cyst in a Neonate: A Report of a Rare Case.

BACKGROUND Thyroglossal duct cysts are the most common congenital cervical anomalies, often presenting as midline neck cysts. The mean age of presentation of pediatric thyroglossal duct cysts varies between 5 and 9 years old, with rare cases younger than 1 year old. This case report details a rare case of an infected thyroglossal duct cyst presenting during the neonatal period as an upper airway obstruction. CASE REPORT A 3-week-old neonate born full-term with no complications during pregnancy or labor presented with a 5-day history of worsening nasal congestion and upper airway obstruction after an upper respiratory infection. Physical examination revealed a large midline neck mass measuring 3.1×4.2×3.2 cm abutting the hyoid with internal echogenicity consistent with a thyroglossal duct cyst, causing posterior tongue compression of the airway and airway distress. The patient was emergently taken to the operating room for incision and drainage, where she underwent a difficult intubation due to superior-posterior tongue displacement and global supraglottic edema. She was discharged on postoperative day 5 on a course of Augmentin after cultures grew methicillin-sensitive Staphylococcus aureus. The patient had no further complications, with successful excision using a Sistrunk procedure 6 months later. CONCLUSIONS Pediatric thyroglossal duct cysts most often present as an asymptomatic midline neck mass, with rare sequelae of infection and upper airway obstruction. This case report highlights the pathophysiology and presenting symptomology of thyroglossal duct cysts, explores the rarity of infected thyroglossal duct cysts in neonates, and reviews the current literature on management strategies for these patients.

The Mystery of Ehlers-Danlos Syndrome: An Autobiographical Case Report.

Ehlers-Danlos syndrome (EDS) most often presents with the classic symptoms of skin hyperelasticity, hypermobility of joints, atrophic scarring, and fragility of blood vessels. However, EDS can also have uncommon presentations which are much more insidious. This case report details the author's lifelong experience living with EDS, which was diagnosed after many seemingly unrelated afflictions including fatigue, spontaneous pneumothorax, and gastroesophageal reflux disease. Studies indicate that these complications warrant investigation of the connective tissue disorder with further lifelong follow-up of disease progression. Extra care should be taken to differentiate the disorder from other heritable connective tissue disorders as well as consider the psychosocial issues these patients experience.

Metastatic renal cell carcinoma presenting as chronic bleeding from the stomach: a rare case report.

Renal cell carcinoma (RCC) most commonly metastasizes to the lung, adrenals, brain and pancreas, but metastasis to the stomach is uncommon. We present a 77-year-old male who underwent left nephrectomy 9 years previously for RCC with known metastatic disease to the lungs, diaphragm and stomach, and required multiple transfusions for acute blood loss anemia. A previous esophagogastroduodenoscopy revealed a large, friable, ulcerated mass at the gastric cardia. Biopsies of the mass demonstrated clear-cell carcinoma compatible with metastatic RCC. After multiple attempts at endoscopic, procedures and embolization were unsuccessful at controlling bleeding, the patient was treated with palliative total gastrectomy with Roux-en-Y gastric bypass. At discharge, the patient had been hemodynamically stable and tolerating a liquid diet. This case report highlights the presenting symptomology of RCC, explores the rarity of gastric metastases, and reviews current literature on management strategies for these patients.