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Background & aimsDiscerning whether laryngeal symptoms result from gastroesophageal reflux is clinically challenging and a reliable tool to stratify patients is needed. We aimed to develop and validate a model to predict the likelihood of gastroesophageal reflux disease (GERD) among patients with chronic laryngeal symptoms.MethodsThis multicenter international study collected data from adults with chronic laryngeal symptoms who underwent objective testing (upper gastrointestinal endoscopy and/or ambulatory reflux monitoring) between March 2018 and May 2023. The training phase identified a model with optimal receiver operating characteristic curves, and β coefficients informed a weighted model. The validation phase assessed performance characteristics of the weighted model.ResultsA total of 856 adults, 304 in the training cohort and 552 in the validation cohort, were included. In the training phase, the optimal predictive model (area under the curve, 0.68; 95% CI, 0.62-0.74), was the Cough, Overweight/obesity, Globus, Hiatal Hernia, Regurgitation, and male seX (COuGH RefluX) score, with a lower threshold of 2.5 and an upper threshold of 5.0 to predict proven GERD. In the validation phase, the COuGH RefluX score had an area under the curve of 0.67 (95% CI, 0.62-0.71), with 79% sensitivity and 81% specificity for proven GERD.ConclusionsThe externally validated COuGH RefluX score is a clinically practical model to predict the likelihood of proven GERD. The score classifies most patients with chronic laryngeal symptoms as low/high likelihood of proven GERD, with only 38% remaining as indeterminate. Thus, the COuGH RefluX score can guide diagnostic strategies and reduce inappropriate proton pump inhibitor use or testing for patients referred for evaluation of chronic laryngeal symptoms.

BackgroundNon-sputum-based triage tests for tuberculosis are a priority for ending tuberculosis. We aimed to evaluate the diagnostic accuracy of the late-prototype Xpert MTB Host Response (Xpert HR) blood-based assay.MethodsWe conducted a prospective diagnostic accuracy study among outpatients with presumed tuberculosis in outpatient clinics in Viet Nam, India, the Philippines, Uganda, and South Africa. Eligible participants were aged 18 years or older and reported cough lasting at least 2 weeks. We excluded those receiving tuberculosis treatment in the preceding 12 months and those who were unwilling to consent. Xpert HR was performed on capillary or venous blood. Reference standard testing included sputum Xpert MTB/RIF Ultra and mycobacterial culture. We performed receiver operating characteristic (ROC) analysis to identify the optimal cutoff value for the Xpert HR to achieve the target sensitivity of 90% or more while maximising specificity, then calculated diagnostic accuracy using this cutoff value. This study was prospectively registered with ClinicalTrials.gov, NCT04923958.FindingsBetween July 13, 2021, and Aug 15, 2022, 2046 adults with at least 2 weeks of cough were identified, of whom 1499 adults (686 [45·8%] females and 813 [54·2%] males) had valid Xpert HR and reference standard results. 329 (21·9%) had microbiologically confirmed tuberculosis. Xpert HR had an area under the ROC curve of 0·89 (95% CI 0·86-0·91). The optimal cutoff value was less than or equal to -1·25, giving a sensitivity of 90·3% (95% CI 86·5-93·3; 297 of 329) and a specificity of 62·6% (95% CI 59·7-65·3; 732 of 1170). Sensitivity was similar across countries, by sex, and by subgroups, although specificity was lower in people living with HIV (45·1%, 95% CI 37·8-52·6) than in those not living with HIV (65·9%, 62·8-68·8; difference of 20·8%, 95% CI 13·0-28·6; p

Asthma is a common disease. The clinical diagnosis is usually confirmed on a pulmonary function test, which is not always readily accessible. We aimed to develop a computationally lightweight handcrafted machine learning model for asthma detection based on cough sounds recorded using mobile phones. Toward this aim, we proposed a novel feature extractor based on a one-dimensional version of the published attractive-and-repulsive center-symmetric local binary pattern (1D-ARCSLBP), which we tested on a new cough sound dataset. We prospectively recorded cough sounds from 511 asthmatics and 815 non-asthmatic subjects (comprising mostly healthy volunteers), which yielded 1875 one-second cough sound segments for analysis. Our model comprised four steps: (i) preprocessing, in which speech signals and stop times (silent zones between coughs) were removed, leaving behind analyzable cough sound segments; (ii) feature extraction, in which tunable q-factor wavelet transformation was used to perform multilevel signal decomposition into wavelet subbands, allowing 1D-ARCSLBP to extract local low- and high-level features; (iii) feature selection, in which neighborhood component analysis was used to select the most discriminative features; and (iv) classification, in which a standard shallow cubic support vector machine was deployed to calculate binary classification results (asthma versus non-asthma) using tenfold and leave-one-subject-out cross-validations. Our model attained 98.24% and 96.91% accuracy rates with tenfold and leave-one-subject-out cross-validation strategies, respectively, and obtained a low-time complexity. The excellent results confirmed the feature extraction capability of 1D-ARCSLBP and the feasibility of the model being developed into a real-world application for asthma screening. [ABSTRACT FROM AUTHOR]

Background: Dysgeusia or altered taste is a rare complication following suspension microlaryngoscopy with the incidence ranging from 2.9 to 12.1%. We report this with recommendations to avoid similar complications following suspension laryngoscopy, tonsillectomy, and tongue base surgery which require pressure to be placed on the tongue for better surgical field visualization. Case presentation: A 53-year-old man with underlying diabetes mellitus presented with long standing history of irritative cough, globus sensation, and evidence of laryngopharyngeal reflux. A left ventricle swelling was noted on flexible laryngoscopy and neck. He underwent direct laryngoscopy and biopsy of the left ventricle lesion which revealed to be acute on chronic inflammation. Day 1 postoperatively, patient complained of reduced sensation over left hemi-tongue. A referral to a neurologist was made for further examination and he was found to have loss of taste over anterior two-third of tongue and treated with vitamin B complex. To date, dysgeusia remains persistent. Patient relayed his grievances to the hospital following these complications. Review of literature on relevant topic was made through PubMed, Web of Science, and Cochrane Library Database by two reviewers, working independently. Twenty-three papers, available in full, written in English language, containing number of cases, type of surgery, and complications were extracted and studied. Conclusions: Risk of dysgeusia and paresthesia postoperatively should be informed during consent taking for all patients undergoing tonsillectomy, laryngeal microsurgery, and tongue base surgery. Zinc deficiency should be investigated in patients with persistent taste disturbance post-tonsillectomy. Intermittent release during suspension laryngoscopy beyond 30 min to reduce post-surgical complications. Greater care should be taken to reduce the amount of force during the suspension laryngoscopy due to smaller oral and oropharyngeal structure in female. Keeping close to the tonsillar capsule particularly in mid and lower pole areas should be done in tonsillectomy using diathermy dissection. [ABSTRACT FROM AUTHOR]

A study conducted in Uganda suggests that using C-reactive protein (CRP) levels to guide the evaluation of young children with lower respiratory tract infections (LRTIs) may help reduce the prescription of antimicrobial therapy without increasing treatment failure rates. LRTIs are a leading cause of morbidity and mortality in children, but there is no clinically feasible reference standard for their diagnosis. The study found that incorporating CRP into the routine management of LRTIs among young children resulted in a nearly 25% reduction in antimicrobial therapy prescriptions, with no difference in clinical outcomes. However, further research is needed to determine the optimal CRP level for withholding antimicrobial therapy and to consider the potential inconveniences and costs associated with implementing this approach. [Extracted from the article]

Background: Reports on coronavirus disease 2019 (COVID-19) in neonates are limited, especially in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) Omicron variant. This study aims to analyze the clinical characteristics and identify risk factors associated with severe COVID-19 in neonates infected with Omicron variant. Methods: The study population was represented by neonates with COVID-19, who were admitted to The Affiliated Children's Hospital of Xi'an Jiaotong University in northwest China, from December 10, 2022 to January 20, 2023. Chinese Center for Disease Control and Prevention (CDC) announced that all local COVID-19 cases were infected with Omicron variant during the study period. Clinical and laboratory data were collected retrospectively. We used logistic regression analysis to investigate the risk factors for severe COVID-19, and derived odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). Results: A total of 108 neonates, with median age of 18.1 days (interquartile range 9.4–23.0), were affected by COVID-19, of whom 84 had a mild disease, while 24 a severe one (22.2%). Of them, 6.5% were premature. No deaths were observed in the study population. The most common clinical manifestations were fever (88.9%) and cough (55.6%), with 5 cases (4.6%) complicated by pneumonia. 4 cases (3.7%) received respiratory support, including 2 cases of high-flow oxygen and 2 cases of continuous positive airway pressure. Gestational age at birth (OR: 0.615; 95% CI: 0.393–0.961), neutrophil count (NEU) (OR:0.576; 95% CI : 0.344–0.962) and lymphocyte count (LYM) (OR: 0.159; 95% CI: 0.063–0.401) were independent risk factors for severe COVID-19. The combination of NEU and LYM had the largest receiver operating characteristic area under the curve [0.912 (95% CI:0.830–0.993)] for identifying severe COVID-19, with a sensitivity of 0.833 and a specificity of 0.917. Conclusions: The general presentations and outcomes of neonatal COVID-19 caused by Omicron variant were not severe, and very few patients required respiratory support. The simultaneous decrease in NEU and LYM can be used to identify severe infection. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsBecause patients infected with respiratory syncytial virus (RSV) have been reported to be older than patients infected with influenza virus, the more frequent incidence of complications in RSV-infected patients may be age-related. This study compared clinical characteristics and outcomes in hospitalized adults infected with RSV with findings in age- and sex-matched adults infected with influenza virus.The medical records of hospitalized adult patients infected with RSV or influenza virus at two university hospitals from 2013 to 2022 were retrospectively analyzed. Virus infection was confirmed by real-time polymerase chain reaction. Each RSV-infected patient was matched by age and sex with two influenza virus-infected patients, and their clinical symptoms, laboratory parameters and hospital courses were compared.The study cohort consisted of 552 patients, 184 infected with RSV and 368 infected with influenza virus. Fever (71.2% vs. 79.9%, p = .022) and cough (70.1% vs. 80.4%, p = .007) were significantly less frequent in the RSV than in the influenza group, whereas white blood cell counts (9132/mm3 vs. 7616/mm3, p < .001) and C-reactive protein concentrations (10.25 vs. 8.88 mg/dL, p = .029) were significantly higher in the RSV group. The frequency of oxygen therapy was higher (60.3% vs. 48.6%, p = .010) and hospital stay was longer (8 vs. 6 days, p = .003) in RSV than in influenza virus-infected patients.Clinical symptoms were less frequent, but disease was more severe, in hospitalized adult patients infected with RSV than in age- and sex-matched patients infected with influenza. Greater attention should be paid to diagnosing and preventing RSV infection in adults. [ABSTRACT FROM AUTHOR]