Acral melanoma of the heel mimicking a pressure sore.

Background: The clinical appearance of acral melanoma is diverse and can cause diagnostic difficulties in individual cases. Case description: We present a clinical case of an 83-year-old patient with a melanoma in the heel area that was initially interpreted as a pressure ulcer, resulting in delayed and more complicated treatment. Conclusions: Melanomas should be included in the differential diagnosis even in "typical" pressure ulcer areas. Against the background of increasingly poor healthcare in rural areas, an increase in such cases can be expected.

The Detrimental Impact of End-Stage Kidney Disease Is Not Reflected in Autopsy Reports.

CONTEXT.­: End-stage kidney disease (ESKD) is defined as renal impairment requiring renal replacement therapy to sustain life. With a 1-year mortality of ∼20% to 30%, many die of complications related to this disease. OBJECTIVE.­: To determine the percentage of autopsy cases of decedents with ESKD in which the contribution of ESKD to death is accurately reflected in the final report. DESIGN.­: Autopsy case records were retrospectively reviewed at 4 institutions (Yale New Haven Hospital, University of Chicago Medical Center, University of Illinois at Chicago Hospital, University of Iowa Hospital). Clinical, macroscopic, and microscopic autopsy findings were reviewed, with attention to renal disease findings. RESULTS.­: One hundred sixty decedents with documented ESKD and premortem dialysis who underwent autopsy assessment were identified. ESKD was implicated as a cause of death (CoD) or significant contributing factor in 44 cases (28%), but not in the remaining 116 cases (72%). Cardiovascular disease was the most common CoD in ESKD. There was significant interpathologist variation in the inclusion of ESKD as a CoD across institutions. These rates ranged from 85% correlation (23 of 27 cases), to 13% (4 of 31 and 8 of 62 cases at 2 institutions), and 22.5% (9 of 40 cases) across the 4 participating institutions. CONCLUSIONS.­: The recognition at autopsy of ESKD as a CoD or contributing CoD at autopsy in patients undergoing dialysis remains low (28%). The detrimental impact of ESKD is not reflected in hospital autopsy reports, which carries implications for collection of vital statistics and allocation of research funding for kidney diseases.

Tolfenamic Acid: A Modifier of the Tau Protein and its Role in Cognition and Tauopathy.

BACKGROUND: Tangles are deposits of hyperphosphorylated tau, which are found in multiple neurodegenerative disorders that are referred to as tauopathies, of which Alzheimer's disease (AD) is the most common. Tauopathies are clinically characterized by dementia and share common cortical lesions composed of aggregates of the protein tau. OBJECTIVE: In this study, we explored the therapeutic potential of tolfenamic acid (TA), in modifying disease processes in a transgenic animal model that carries the human tau gene (hTau). METHODS: Behavioral tests, Western blotting and Immunohistochemical analysis were used to demonstrate the efficacy of TA. RESULTS: Treatment of TA improved improving spatial learning deficits and memory impairments in young and aged hTau mice. Western blot analysis of the hTau protein revealed reductions in total tau as well as in sitespecific hyperphosphorylation of tau in response to TA administration. Immunohistochemical analysis for phosphorylated tau protein revealed reduced staining in the frontal cortex, hippocampus, and striatum in animals treated with TA. CONCLUSION: TA holds the potential as a disease-modifying agent for the treatment of tauopathies including AD.

Impact of Climate Change on Vibrio vulnificus Abundance and Exposure Risk.

Vibrio species are marine bacteria that occur in estuaries worldwide; many are virulent human pathogens with high levels of antibiotic resistance. The average annual incidence of all Vibrio infections has increased by 41% between 1996 and 2005. V. vulnificus (Vv), a species associated with shellfish and occurring in the US Southeast, has ranges of temperature (16-33 °C) and salinity (5-20 ppt) dependencies for optimal growth. Increased water temperatures caused by atmospheric warming and increased salinity gradients caused by sea level rise raise concerns for the effect of climate change on the geographic range of Vv and the potential for increased exposure risk. This research combined monthly field sampling, laboratory analysis, and modeling to identify the current occurrence of Vv in the Winyah Bay estuary (South Carolina, USA) and assess the possible effects of climate change on future geographic range and exposure risk in the estuary. Vv concentrations ranged from 0 to 58 colony forming units (CFU)/mL, salinities ranged from 0 to 28 ppt, and temperature from 18 to 31 °C. A significant empirical relationship was found between Vv concentration and salinity and temperature that fit well with published optimal ranges for growth for these environmental parameters. These results, when coupled with an existing model of future specific conductance, indicated that sea level rise has a greater impact on exposure risk than temperature increases in the estuary. Risk increased by as much as four times compared to current conditions with the largest temporally widespread increase at the most upriver site where currently there is minimal risk.

Vocal characteristics in children with attention deficit hyperactivity disorder.

The aim of this study was to evaluate vocal changes in patients with attention deficit hyperactivity disorder (ADHD). Nineteen children diagnosed to have ADHD according to the Diagnostic and Statistical Manual of Mental Disorders criteria and 19 controls were enrolled in this study. They underwent vocal perceptual evaluation and acoustic analysis. Hoarseness, breathiness, strain, and loudness were graded on a scale of 0-3. The following acoustic parameters were recorded: Fundamental frequency, Shimmer, Relative average perturbation, Noise-to-Harmony ratio, Voice Turbulence Index, and Habitual pitch. Children with ADHD were perceived to have significantly more hoarseness, breathiness, and straining in their voice. They were also louder compared to controls. There were no significant changes in the acoustic parameters except for the Fundamental frequency, which was lower in the ADHD group. The vocal behavior in children with ADHD is different than controls. Early diagnosis of such behavior in this group of children is important.

Vocal technique in a group of Middle Eastern singers.

OBJECTIVE: We aimed to report on the vocal technique in a group of Middle Eastern singers. SUBJECTS AND METHOD: A total of 78 Middle Eastern singers were assessed. Demographic data included age, gender, training status and number of years of singing. All singers had laryngeal videoendostroboscopy. Description and grading of posture, tension, type of breathing, type of phonation, resonance and tone quality are reported. Proportions and means (+/- SD) were used to describe the sample for categorical and continuous variables respectively. Associations between endostroboscopy and voice technique were determined by chi(2) or Fisher's exact test. RESULTS: There were 43 males and 35 females with an age ranging between 16 and 32 years and a mean of 23 +/- 4 years. Of these, 88.5% were nontrained singers and 50% had more than 3 years of singing experience. Around 80% of Middle Eastern singers rely on either thoracic or clavicular breathing. Posture was average in 68% and moderate tension was present in 63% of the cases. Two thirds had a bright voice, 61% were hypernasal and almost 46% had a strained phonation. There was a significant correlation between posture and tension. CONCLUSION: Middle Eastern singing relies more on thoracic breathing and is characterized by tension.

Formant frequencies in Middle Eastern singers.

PURPOSE: This work was conducted to describe the formant frequencies in a group of Middle Eastern singers and to look for the presence of the singer's formant described in operatic singers. MATERIAL: A total of 13 Middle Eastern singers were enrolled in this study. There were 5 men and 8 women. METHOD: Descriptive analysis was performed to report the various formants (F1, F2, F3, and F4) in both speaking and singing. The Wilcoxon test was used to compare the means of the formants under both conditions. RESULTS: For both sexes combined, for the /a/ vowel, F1 singing was significantly lower than F1 speaking (P = .05) and F3 singing was significantly higher than F3 speaking (P = .046). For the /u/ vowel, only F2 singing was significantly higher than F2 speaking (P = .012). For the /i/ vowel, both F2 and F3 singing were significantly lower than F2 and F3 speaking, respectively (P = .006 and .012, respectively). There was no clustering of the formants in any of the Middle Eastern sung vowels. CONCLUSION: Formant frequencies for the vowels /a/, /i/, and /u/ differ between Middle Eastern singing vs speaking. There is absence of the singer's formant.

Voice disorders in teachers. The role of family physicians.

OBJECTIVE: To look at the prevalence and impact of voice problems on teachers and assessing the teachers knowledge on vocal hygiene and habits, as well as which parameters mostly triggered the seeking of medical attention and how family doctors could intervene in this spectrum. METHODS: A survey that consists of 16 questions was used to look at the prevalence and impact of voice problems on teachers and to identify the associated risk factors at the American University of Beirut, Lebanon, during the year 2005. RESULTS: A considerable proportion (46%) perceived their voice as fair or worse, and 79% had never consulted a throat specialist. Voice disorders affected most of teachers particularly on their job. The mean number of vocal habits per person was estimated at 2.4 with smoking being the most common (38.7%). Two thirds of teachers were unaware of more than half the factors that can negatively affect their voice. Symptoms exceeding 6 months significantly increased the probability of consulting a physician by 2.5 folds. CONCLUSION: Family physicians can reduce the prevalence of vocal dysfunction in teachers through education and by pointing the various symptoms necessitating a specialist's early consultation especially when history of smoking is present.

The use of a screening questionnaire to determine the incidence of allergic rhinitis in singers with dysphonia.

OBJECTIVES: To report the incidence of allergic rhinitis in singers with nonspecific laryngeal examination findings and to correlate the incidence of allergic rhinitis with their vocal symptoms when present. DESIGN: A retrospective review of all the medical records of singers with nonspecific laryngeal findings who presented to a specialty voice center for either vocal training or therapy between June 2002 and September 2005. SETTING: Specialty voice center. PARTICIPANTS: Forty-five singers with nonspecific laryngeal findings who presented to a specialty voice center for either vocal training or therapy. MAIN OUTCOME MEASURES: A standardized validated questionnaire for evaluation of allergic rhinitis was filled out by all the subjects. A score above 0 was considered positive. RESULTS: The total prevalence of allergic rhinitis was 87% (39 of 45 subjects). The singers with vocal symptoms were approximately 15% more likely to have allergic rhinitis than those with no vocal symptoms (92% vs 84%). Singers with more than 2 vocal symptoms had a 25% higher likelihood of having allergic rhinitis. CONCLUSIONS: The incidence of allergic rhinitis in singers is extremely high. Hidden respiratory allergies may affect the professional voice. Proper awareness and a multidisciplinary approach are indispensable for proper diagnosis and treatment.

Laryngeal biomechanics in Middle Eastern singing.

UNLABELLED: We would like to describe the muscle tension patterns observed in Middle Eastern singing and correlate these findings with demographic data. MATERIAL: A total of 42 candidates were included in this study. The medical charts and video records of their fiberoptic nasopharyngeal laryngoscopy were reviewed. Demographic information included age, sex, history of smoking, history of reflux, history of voice overuse/abuse, status in singing (professional vs. amateur), and style of singing (classical vs pop). Each frame was analyzed for each of the four muscle tension patterns (MTPs): MTP I, MTP II, MTP III, and MTP IV. STATISTICAL METHOD: Nonparametric Mann-Whitney U test was conducted. RESULTS: Twenty-six subjects were professional singers and half sang classical singing. The mean MTP total score for all subjects was 35.58 +/- 21.98% (+/- standard deviation). The highest muscle tension score was obtained for type III pattern followed by type II. There were no statistical differences in the mean MTP total, MTP II, and MTP III scores among the professional singers versus the amateurs. Similar results were obtained when MTP scores were compared by style of singing. CONCLUSION: The vocal technique and status of singing did not seem to affect the muscle tension score.