The buried gems of disease tolerance in animals: Evolutionary and interspecies comparative approaches: Interspecies comparative approaches are valuable tools for exploring potential new mechanisms of disease tolerance in animals: Interspecies comparative approaches are valuable tools for exploring potential new mechanisms of disease tolerance in animals.

Host defense mechanisms are categorized into different strategies, namely, avoidance, resistance and tolerance. Resistance encompasses mechanisms that directly kill the pathogen while tolerance is mainly concerned with alleviating the harsh consequences of the infection regardless of the pathogen burden. Resistance is well-known strategy in immunology while tolerance is relatively new. Studies addressed tolerance mainly using mouse models revealing a wide range of interesting tolerance mechanisms. Herein, we aim to emphasize on the interspecies comparative approaches to explore potential new mechanisms of disease tolerance. We will discuss mechanisms of tolerance with focus on those that were revealed using comparative study designs of mammals followed by summarizing the reasons for adopting comparative approaches on disease tolerance studies. Disease tolerance is a relatively new concept in immunology, we believe combining comparative studies with model organism study designs will enhance our understanding to tolerance and unveil new mechanisms of tolerance.

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.

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.

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.

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.

Nerve Transfer Versus Nerve Graft for Reconstruction of High Ulnar Nerve Injuries.

PURPOSE: To assess the efficacy of nerve transfer versus nerve grafting in restoring motor and sensory hand function in patients with complete, isolated high ulnar nerve injuries. METHODS: A retrospective chart review was performed, at a minimum 2 years of follow-up, of 52 patients suffering complete, isolated high ulnar nerve injury between January 2006 and June 2013 in one specialized hand surgery unit. Twenty-four patients underwent motor and sensory nerve transfers (NT group). Twenty-eight patients underwent sural nerve grafting (NG group). Motor recovery, return of sensibility and complications were examined as outcome measures. The Medical Research Council scale was applied to evaluate sensory and motor recovery. Grip and pinch strengths of the hand were measured. RESULTS: Twenty of 24 patients (83.33%) in the NT group regained M3 grade or greater for the adductor pollicis, the abductor digiti minimi, and the medial 2 lumbricals and interossei, compared with only 16 of 28 patients (57.14%) in the NG group. Means for percentage recovery of grip strengths compared with the other healthy hand were significantly higher for the NT group than the NG group. Sensory recovery of S3 or greater was achieved in more than half of each group with no significant difference between groups. CONCLUSIONS: Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better improvement of motor power and better restoration of grip functions of the hand. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The role of budesonide intrapolyp injection in the management of type 2 chronic rhinosinusitis with nasal polyps: a randomised clinical trial.

PROBLEM: To assess the efficacy of budesonide intrapolyp injection in chronic rhinosinusitis with nasal polyps. METHOD: Ninety patients were divided into three groups; group A was given oral prednisolone, group B was given budesonide intrapolyp injection weekly for five consecutive weeks and group C was given budesonide as nasal irrigation for one month. Patients were assessed using Sino-Nasal Outcome Test 22 score, total nasal polyp score, serum immunoglobulin E, absolute eosinophilic count, and morning cortisol level before treatment, one week and three months after completing their treatment. RESULTS: Total nasal polyp score decreased significantly in all groups compared to those at baseline. Reduction in the oral and injection groups was greater than the wash group (p2 = 0.004), (p3 < 0.001), and the same trend concerning Sino-Nasal Outcome Test 22 score (p2 < 0.001), (p3 < 0.001). CONCLUSION: Budesonide is an effective agent used in intrapolyp injection with no documented systemic or visual side effects that has comparable results with oral steroids.

The Efficacy of Budesonide as Intrapolyp Injection Agent in the Management of Type 2 CRSwNP.

OBJECTIVES: To assess the efficacy and safety of budesonide as an intrapolyp injection in chronic rhinosinusitis with nasal polyps (CRSwNP) in comparison to control and systemic steroids. METHOD: In a prospective double-blinded controlled randomized clinical trial, 150 patients with CRSwNP were divided into 3 groups in a ratio 1:1:1 where group (A) was given oral prednisolone 1 mg/kg tapered daily for 2 weeks, group (B) was given budesonide intrapolyp injection weekly for 5 consecutive weeks, and group (C) was given intrapolyp injection with saline as the control group. Patients were assessed upon Sinonasal Outcome Test (SNOT-22) score, Total Nasal Polyp score (TNPS), Serum IgE, absolute eosinophilic count, and morning cortisol level before treatment, 1 week and 6 months after completing their treatment protocol. RESULTS: SNOT 22 score improved significantly in all groups compared to those at baseline. Reduction in the oral and injection groups was much greater than the control group (P2 < 0.001), (P3 < 0.001), and the same trend concerning TNPS score (P2 < 0.001), (P3 < 0.001) but with no significant change in the control group. CONCLUSION: Intrapolyp steroid injection is considered a safe and effective method in nasal polyposis with limited side effects in comparison to systemic steroids. Using Budesonide as an agent for intrapolyp injection appears to be promising. It's advisable in patients with multiple relapses or high-risk patients to avoid repeated courses of oral steroids. LEVEL OF EVIDENCE: 2 Laryngoscope, 134:2085-2092, 2024.

The Prevalence and Association of Biofilms With Otitis Media With Effusion: A Systematic Review and Meta-Analysis.

PURPOSE: We aimed to identify the role of bacterial biofilms in the chronicity of otitis media with effusion and its resistance to antibiotics. We illustrated this role by reviewing, analyzing, and correlating the findings with the results of the included studies to reach clear evidence. METHODS: A comprehensive search of electronic databases (Scopus, PubMed, Web of Science, Cochrane, and GHL databases) was performed for all studies using the following strategy till April 2021 with the search terms: Biofilm and Middle ear effusion. We found 935 references, 421 were duplicates, and 514 were needed for further screening, and it was as follows: PubMed 215, Scopus 18, Cochrane 130, Web of Science 136, and GHL 15. RESULTS: The pooled prevalence of culture-positive effusions was estimated to be 40% (95% CI [28%, 53%]) of the total OME population. Overall, the prevalence of PCR-positive effusions was estimated to be 97% (95% CI [95%, 99%]) of the total OME population. The pooled prevalence of EM-positive effusions was estimated to be 82% (95% CI [69%, 95%]) of the total OME population. CONCLUSION: The data presented in this study coincide with the significant role of bacterial biofilms in the pathogenesis of chronic otitis media with effusion. The involvement of bacterial biofilm as a component of the OME pathogenic process can help us to explain why antimicrobial therapy is not always effective in the eradication of the disease process and, also explain the recurrence of middle ear effusion after treatment with tympanostomy tubes either with or without adenoidectomy.

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.

Does surgery affect the neurodevelopmental outcome of moderate laryngomalacia?

BACKGROUND: Moderate laryngomalacia lies in the grey zone where the parents and treating team might hesitate to decide the treatment plan for the child. Neurodevelopmental assessment of the child was neither assessed nor incorporated in surgical decision-making in the past. OBJECTIVES: To evaluate the neurodevelopmental outcome of moderate laryngomalacia treatment strategies (surgery versus conservative). METHODS: We conducted an observational multicentric cohort study. We compared two groups of patients according to their moderate laryngomalacia treatment strategy: surgical treatment and no treatment. The neurodevelopmental outcome was assessed by Griffiths-III developmental scales. RESULTS: A total of 150 children were diagnosed with moderate laryngomalacia of which 56 were successfully treated with surgery and 94 improved without intervention. The median Griffiths-III developmental quotients (DQs) of subscales A, B, C, E, and general development were significantly higher in the surgically treated group compared to conservatively treated ones. CONCLUSION: Untreated moderate laryngomalacia cases have worse neurodevelopmental outcomes than surgically treated cases.

Lower Four Cranial Nerves in the Management of Glomus Jugulare: Anatomical Study.

Introduction The surgical management that achieves minimal morbidity and mortality for patients with glomus and non-glomus tumors involving the jugular foramen (JF) region requires a comprehensive understanding of the complex anatomy, anatomic variability, and pathological anatomy of this region. Objective The aim of this study is to propose a rational guideline to expose and preserve the lower cranial nerves (CNs) in the lateral approach of the JF. Methods The technique utilized is the gross and microdissection of 4 fixed cadaveric heads to revise the JF's surgical anatomy and high part of the carotid sheath compared with surgical cases to understand and preserve the integrity of lower CNs. The method involves radical mastoidectomy, microdissection of the JF, facial nerve, and high neck just below the carotid canal and the JF. The CNs IX, X, XI, and XII are microscopically dissected and kept in sight up to the JF. Results This study realized well the surgical and applied anatomy of the lower CNs with relation to the facial nerve and JF. Conclusions The JF anatomy is complicated, and the key to safely operate on it and preserving the lower CNs is to find the posterior belly of the digastric muscle, to skeletonize the facial nerve, to remove the mastoid tip preserving the stylomastoid foramen, to skeletonize the sigmoid sinus and posterior fossa dura not only anterior but also posteroinferior to reach and drill the jugular tubercle.

Growth of polyoxomolybdate with a porous pyramidal structure on carbon xerogel nanodiamond as an efficient electro-catalyst for oxygen reduction reaction.

The slow kinetics of the oxygen reduction reaction (ORR) limits the large-scale usage of the fuel cells. Thus, it is crucial to develop an efficient and stable electrocatalyst for the ORR. Herein, facile synthesis of three-dimensional nitrogen-doped carbon xerogel diamond nanoparticles, CDNPs support is reported. The as-prepared CDNPs support was functionalized with a Keggin-type polyoxomolybdate via the hydrothermal process (POM@CDNPs). As the characterization techniques revealed, this nanocomposite possesses a three-dimensional structure, high density of nitrogen doping, and well-dispersed porous pyramidal morphology of POM, making it a promising catalyst for ORR in alkaline medium. The POM@CDNPs nanocomposite exhibits an outstanding activity for ORR with a limiting current density that reaches -7.30 mA cm-2 at 0.17 V vs. RHE. Moreover, a half-wave potential of 0.773 V is delivered with a stability of about 99.9% after the 100th repetitive cycle as this catalyst forces the ORR to the direct-four-electron pathway. This work spots the advantages of hybridizing the sp3 of the nanodiamond with the sp2 of the carbon xerogels to increase the conductivity of the support material. In addition, the role of the porous pyramidal morphology of the POM on the activity of the nanocomposite was evaluated. This study suggests using advanced carbon-based electro-catalysts with outstanding activity and stability.

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.

Dual Mobility Cup in Fractures of the Femoral Neck in Neuromuscular Disorders and Cognitive Dysfunction Patients above 60 years-old.

Objectives: Dislocation rate of total hip arthroplasty (THA) can be as high as 20% for patients with fracture neck of femur, which is a disastrous complication in these vulnerable patients. Numerous techniques, including bipolar arthroplasty and constrained liner, have been adopted to minimize the risk of dislocation. We aimed to evaluate the role of dual mobility Cups in treating patients with fractures of the femoral neck with high risk of postoperative dislocation due to neuromuscular instability disorders. Methods: A prospective cohort study was conducted (place is blinded as asked during submission), between 2016 and 2019, with a post-operative follow up period of two years. We included skeletally mature patients with femoral neck fractures having neuromuscular disorders and cognitive dysfunction who are candidates for THA above 60 years. Patients were then followed up clinically and radiographically at the clinic using Harris Hip Score (HHS) and x-rays at six weeks, six months, one year and two years postoperatively. Results: Twenty patients (20 hips) with femoral neck fractures with high risk of postoperative dislocation due to neuromuscular instability disorders undergoing dual mobility cup were included. The mean age of patients was 70.5 ±6.42 years. There is highly significant difference between HHS preoperatively and postoperatively (six weeks, six months and one, two years) p<0.001.Infection occurred in one case (5 %), sciatic nerve injury occurred in one case (5%), and none of the patients had postoperative dislocation. Conclusion: Dual mobility cup is effective in preventing early dislocation in patients suffered from fracture neck of femur with muscle weakness due to neurologic disorders.

Electrochemical and computational estimations of cephalosporin drugs as eco-friendly and efficient corrosion inhibitors for aluminum in alkaline solution.

In this study, the anionic state of Ceftriaxone sodium (Cefx) and Ceftazidime (Cefz) medication corrosion inhibition capabilities for Al in 0.1 M NaOH solution are explored using various electrochemical analyses. Furthermore, the morphological structure and surface chemical composition of the impact of these drugs on the Al substrate in NaOH are investigated. For the prediction and analysis of interactions between molecule structure and inhibition efficiency, quantum chemical calculations (QC), Monte Carlo simulations (MC), and molecular dynamics (MD) simulations (MD) are performed. The electrochemical findings reveal that the inhibitory effectiveness increases with increasing drug concentrations and declines with rising temperature, reaching a maximum value of 78.4% for 300 ppm Cefx while 59.5% for 300 ppm Cefz at 293 K, implying that Cefx outperforms for Cefz. In addition, the studied drugs act as cathodic inhibitors, and their adsorption is spontaneous and mixed type adsorption in its nature that obeys Freundlich isotherm for Cefz while Temkin isotherm is the best-fitted one for Cefx. Surface analysis and wettability measurements imply that Cefx and Cefz shield the Al against corrosion by surface adsorption and generating a protective hydrophobic film. Thermodynamic activation parameters in the absence and presence of 300 ppm of the studied drugs are calculated and discussed. The energies of the border molecular orbitals and computed molecular parameters for the investigated drugs revealed that anionic Cefx is more readily adsorbed on the Al surface than Cefz. This finding is validated further using MC and MD simulations. Overall, the proposed cephalosporin drugs delivered a cost-effective and facile approach for boosting the efficiency of corrosion inhibitors for Al under aggressive conditions.

The Impact of COVID-19 on the Daily Life and Medical Practice of Otolaryngology Physicians.

Introduction The coronavirus disease 2019 (COVID-19) has made otolaryngologists more susceptible than their counterparts to its effect. Objective This study aimed to find if COVID-19 had a different impact on ear, nose, and throat (ENT) physicians' of various categories (residents, registrars, and consultants ) regarding many aspects of the quality of life (protection, training, financial, and psychological aspects). Methods We included 375 ENT physicians, of different categories (residents, registrars, and consultants), from 33 general hospitals and 26 university hospitals in Egypt. The study was conducted using a 20-item questionnaire with a response scale consisting of three categories: yes, no, and not sure. It covered infection control and personal protective equipment (PPE) usage; medical practice and safety; online consultation and telemedicine,; webinars and online lectures; COVID-19 psychological, financial, and quarantine period effects; and future expectations. Results The results of the questionnaire showed that COVID-19 had a statistically significant impact on the daily life of the responders. There were statistically significant differences among the three involved categories, based on their answers. Conclusion This study showed a statistically significant difference regarding the impact of COVID-19 on many aspects of the quality of life (protection, training, financial, and psychological aspects) of ENT physicians of various categories (residents, registrars, and consultants), and these effects may persist for a long time.

The larvicidal effect of neemazal T/S, clove oil and ginger oil on tomato leafminer, Tuta absoluta compared to coragen.

The present study aimed to evaluate the toxicity and biochemical changes of Tuta absoluta 3rd instar larvae affected by neemazal T/S, clove oil and ginger oil. These compounds were evaluated compared to the recommended pesticide, Coragen 20% SC. by means of sublethal concentrations, LC25 and LC50 under constant laboratory conditions. Results showed that neemazal T/S is more toxic than detected oils compared with higher toxicity of coragen with LC50 values of 57.52, 159.94, 633.38 and 930.71 µg mL-1 for coragen, neemazal, ginger oil and clove oil, respectively. There were highly significant differences between all treatments and untreated larvae. Neemazal possessed the greatest effect on activity level of most physiological parameters than selected oils. Larval content of digestive enzymes was decreased significantly 48 h after all treatments except for lipase, α-esterase and ß-esterase (in case of coragen and clove oil). Also, total proteins, total carbohydrates, total lipids and total free amino acids take the same trend. Based on this study, these sublethal doses caused a significantly dose-dependent perturbation in determined components.