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Abstract Objectives Upper lip tie (ULT) is a clinical condition with restrictive attachment of the superior labial frenulum (SLF), which may inhibit flanging of the lips. Objective outcome studies are lacking in part due to unreliable classification systems that rely solely upon a single attachment parameter of the SLF. This study's objectives are to describe a novel 3‐point classification system for ULT and compare its inter‐rater reliability to the Kotlow and Stanford systems. Methods Five raters used the Kotlow and Stanford systems, as well as our novel 3‐point scale to score images of the SLF from 20 newborns seen at our institution between September 1, 2017 and April 1, 2018. Newborn birth weight, gestational age, and demographic data were collected from the infant's medical record. Fleiss's kappa was used to calculate inter‐rater reliability for all classification systems. Results The parameters for our novel 3‐point classification system for ULT were as follows: length from alveolar edge to frenulum gingival attachment, length of frenulum on stretch, and free‐lip to total‐lip length ratio. Our novel scale yielded the highest inter‐rater reliability of 0.41, compared to 0.24 and 0.25 under the Kotlow and Stanford systems. Conclusion While the Kotlow and Stanford systems are based upon a single anatomical parameter, our novel 3‐point classification scale uses three oral parameters that encompass anatomical points of attachment as well as the maximal length of the ULT on stretch. Our classification scheme is the first to incorporate a functional parameter of the SLF, and thereby more fully characterizes ULT. Level of Evidence: Level 4.

Objective. To describe a rare case of pediatric actinomycotic rhinosinusitis with orbital subperiosteal abscess and review the current literature to assess methods of diagnosis, treatment modalities, and outcomes with appropriate treatment. Methods. A case report and a review of the literature. Results. A 12-year-old patient with Crohn’s disease on infliximab presented with rhinosinusitis with orbital subperiosteal abscess formation. Endoscopic sinus surgery was performed and cultures grew actinomyces. A prolonged course of antibiotics was started, resulting in the complete resolution of the infection. In a literature review, all cases of uncomplicated and complicated actinomyces rhinosinusitis managed with appropriate surgery and prolonged antibiotics resulted in a cure. Our case is the first reported in a pediatric patient and the first taking immunosuppressive medication. Overall, only 3 cases of actinomyces rhinosinusitis in immunosuppressed individuals have been reported, each with uncontrolled diabetes and each also responded well to surgery and appropriate antibiotics. Conclusion. Actinomycosis of the paranasal sinuses poses a diagnostic challenge, with infections varying widely in presentation and extent of disease. A high index of suspicion, appropriate testing, and early aggressive treatment are critical in managing patients with this infection. Our case and prior published studies show that actinomyces rhinosinusitis can be successfully managed with endoscopic sinus surgery, abscess drainage as necessary, and a prolonged course of antibiotics, even in immunocompromised and pediatric populations.

Oxysterol binding protein (OSBP) translocation between Golgi and vesicular/cytoplasmic compartments is affected by conditions that alter cholesterol and sphingomyelin homeostasis, indicating a role in lipid and sterol regulation in this organelle. In this study, we show that OSBP dissociation from the Golgi apparatus was inhibited when LDL cholesterol efflux from lysosomes was blocked in Niemann-Pick C (NPC) or U18666A {3-β-[2-(diethylamino)ethoxy]androst-5-en-17-one}-treated fibroblasts. Dissociation of OSBP from the Golgi apparatus in response to LDL was independent of de novo cholesterol biosynthesis. OSBP did not localize with filipin-stained lysosomal cholesterol, and the NPC defect did not alter OSBP expression or phosphorylation. However, OSBP in the Golgi apparatus was progressively dephosphorylated (as assessed by a molecular mass shift on SDS-PAGE) in U18666A-treated fibroblasts or Chinese hamster ovary cells as a result of combined inhibition of LDL cholesterol transport and de novo cholesterol synthesis. In vivo phosphopeptide mapping and mutagenesis of OSBP was used to identify the cholesterol-sensitive phosphorylation sites at serines 381, 384, and 387 that were responsible for the altered mobility on SDS-PAGE.NPC-1 protein-mediated release of LDL-derived cholesterol and de novo biosynthesis regulates OSBP localization and phosphorylation. This indicates that OSBP responds to or senses altered cellular sterol content and transport.—Mohammadi, A., R. J. Perry, M. K. Storey, H. W. Cook, D. M. Byers, and N. D. Ridgway. Golgi localization and phosphorylation of oxysterol binding protein in Niemann-Pick C and U18666A-treated cells. J. Lipid Res. 2001. 42: 1062–1071.

Objective: We sought to characterize the prevalence of ankyloglossia in our neonatal intensive care unit (NICU) population and to determine characteristics of this cohort compared to infants in the birth center (BC). Methods: Prospective data were collected using a standardized flow sheet. Breastfeeding infants undergoing evaluation for tongue‐tie in the BC and NICU were included. Coryllos type, tip to frenulum length, tongue function, frequency of frenotomy, and breastfeeding outcomes were compared. Results: Of 20,879 infants birthed at or admitted to the institution during the study period, there were fewer patients diagnosed with ankyloglossia in the BC compared to the NICU (3.3% BC vs. 5.4% NICU, p < 0.01). Of these, 163 underwent frenotomy: 86 in the BC and 77 in the NICU. For those undergoing frenotomy, gestational age (39.1 ± 1.3 BC, 34.4 ± 4.4 NICU, p < 0.01) and age at time of procedure (3.2 days BC, 29.2 NICU, p < 0.01) were the only demographic factors significantly different between the groups. There was no difference in Coryllos type or function score. In a subset of NICU infants with multiple assessments over time, function scores after frenotomy were significantly improved compared to pre‐frenotomy (p < 0.01). Conclusion: Standard assessment tools appear to be appropriate for use in infants in the NICU, despite the higher rates of prematurity, low birth weights, and increased comorbidities. Assessment and intervention for tongue‐tie can be one critical intervention to move these patients closer to oral feeding and discharge to home. Level of Evidence: 3 Laryngoscope, 134:5152–5159, 2024 [ABSTRACT FROM AUTHOR]

Objective: To compare supraglottoplasty versus non-surgical treatment in children with laryngomalacia and mild, moderate and severe obstructive sleep apnoea. Methods: Patients were classified based on their obstructive apnoea hypopnoea index on initial polysomnogram, which was compared to their post-treatment polysomnogram. Results: Eighteen patients underwent supraglottoplasty, and 12 patients had non-surgical treatment. The average obstructive apnoea hypopnoea index after supraglottoplasty fell by 12.68 events per hour (p = 0.0039) in the supraglottoplasty group and 3.3 events per hour (p = 0.3) in the non-surgical treatment group. Comparison of the change in obstructive apnoea hypopnoea index in the surgical versus non-surgical groups did not meet statistical significance (p = 0.09). Conclusion: All patients with laryngomalacia and obstructive sleep apnoea had a statistically significant improvement in obstructive apnoea hypopnoea index after supraglottoplasty irrespective of obstructive sleep apnoea severity, whereas patients who received non-surgical treatment had more variable and unpredictable results. Direct comparison of the change between the two groups did not find supraglottoplasty to be superior to non-surgical treatment. Larger prospective studies are recommended. [ABSTRACT FROM AUTHOR]

Objective: To achieve consensus on critical steps and create an assessment tool for actual and simulated pediatric tracheostomy emergencies that incorporates human and systems factors along with tracheostomy‐specific steps. Methods: A modified Delphi method was used. Using REDCap software, an instrument comprising 29 potential items was circulated to 171 tracheostomy and simulation experts. Consensus criteria were determined a priori with a goal of consolidating and ordering 15 to 25 final items. In the first round, items were rated as "keep" or "remove". In the second and third rounds, experts were asked to rate the importance of each item on a 9‐point Likert scale. Items were refined in subsequent iterations based on analysis of results and respondents' comments. Results: The response rates were 125/171 (73.1%) for the first round, 111/125 (88.8%) for the second round, and 109/125 (87.2%) for the third round. 133 comments were incorporated. Consensus (>60% participants scoring ≥8, or mean score >7.5) was reached on 22 items distributed across three domains. There were 12, 4, and 6 items in the domains of tracheostomy‐specific steps, team and personnel factors, and equipment respectively. Conclusions: The resultant assessment tool can be used to assess both tracheostomy‐specific steps as well as systems factors affecting hospital team response to simulated and clinical pediatric tracheostomy emergencies. The tool can also be used to guide debriefing discussions of both simulated and clinical emergencies, and to spur quality improvement initiatives. Level of Evidence: 5 Laryngoscope, 133:3588–3601, 2023 [ABSTRACT FROM AUTHOR]

Abstract Background Critical care nurses (CCNs) around the globe face other health challenges compared to their peers in general hospital nursing. Moreover, the nursing workforce grapples with persistent staffing shortages. In light of these circumstances, developing a sustainable work environment is imperative to retain the current nursing workforce. Consequently, this study aimed to gain insight into the recalled experiences of CCNs in dealing with the physical and psychosocial influences of work-related demands on their health while examining the environments in which they operate. The second aim was to explore the complex social and psychological processes through which CCNs navigate these work-related demands across various CCN wards. Methods A qualitative study following Thorne’s interpretive descriptive approach was conducted. From October 2022 to April 2023, six focus groups were organised. Data from a diverse sample of 27 Flemish CCNs engaged in physically demanding roles from three CCN wards were collected. The Qualitative Analysis Guide of Leuven was applied to support the constant comparison process. Results Participants reported being exposed to occupational physical activity, emotional, quantitative, and cognitive work-related demands, adverse patient behaviour, and poor working time quality. Exposure to these work-related demands was perceived as harmful, potentially resulting in physical, mental, and psychosomatic strain, as well as an increased turnover intention. In response to these demands, participants employed various strategies for mitigation, including seeking social support, exerting control over their work, utilising appropriate equipment, recognising rewards, and engaging in leisure-time physical activity. Conclusions CCNs’ health is challenged by work-related demands that are not entirely covered by the traditional quantitative frameworks used in research on psychologically healthy work. Therefore, future studies should focus on improving such frameworks by exploring the role of psychosocial and organisational factors in more detail. This study has important implications for workplace health promotion with a view on preventing work absenteeism and drop-out in the long run, as it offers strong arguments to promote sufficient risk management strategies, schedule flexibility, uninterrupted off-job recovery time, and positive management, which can prolong the well-being and sustainable careers of the CCN workforce.

OBJECTIVES: This prospective study aimed to investigate the relation between occupational physical activity (OPA), leisure-time physical activity (LTPA) and sickness absence (SA). A second aim was to explore the possible interaction effects between OPA and LTPA in determining SA.METHODS: The study is based on data from 304 workers in the service and manufacturing sector. Moderate-to-vigorous physical activity (MVPA) was measured by two Axivity AX3 accelerometers for 2–4 consecutive working days. Participants reported on the level of their physically demanding tasks by using a 5-item scale from the Job Content Questionnaire. Data on SA was provided by the administration departments of the participating companies during a 1 year follow-up period. We used negative binomial regression models for our statistical analysis.RESULTS: After adjusting for potential confounders, physically demanding tasks were significantly associated with a higher number of SA episodes and days. Accelerometer-assessed MVPA during leisure time but not during work was correlated with lower SA. Our results show a significant interaction effect between MVPA during work and leisure time in the sense that more MVPA during work increased the risk for SA days only among workers with low LTPA, but not among workers with moderate-to-high LTPA.CONCLUSIONS: Our results indicate that LTPA and OPA are related to opposite SA outcomes. MVPA during leisure time and work interact in their effect on SA, whereas we found no interaction effect between LTPA and self-reported physically demanding tasks in determining SA.

BackgroundThe emergence of the Speech-Language and Hearing (SLH) professions in South Africa took place during the era of racial segregation. Consequently, the culture and language of these professions have predominantly reflected the minority White population, even in SLH training programs. English has remained the language of learning and teaching (LOLT) in most South African tertiary institutions, with a strong Western cultural influence. Given the increasing diversity in these institutions, a mismatch between the language of instruction and that of English Additional Language (EAL) students poses academic challenges for this population, prompting the need for this study.AimThis study aims to investigate the learning and social experiences of EAL undergraduate students enrolled in South African SLH training programs, with a specific focus on exploring their engagement with academic content in the curriculum.MethodsA cross-sectional online survey design was employed, and a total of 24 EAL students participated in the study. Descriptive and thematic analysis methods were utilized for data analysis.ResultsThe findings revealed that EAL students encountered academic challenges primarily related to their proficiency in the LOLT, which were most pronounced in lectures and examinations, while being relatively less pronounced in assignments. Complementary use of indigenous languages, simplification of complex terminology and self-employed strategies to cope in response to the existing academic language challenges are highlighted. These findings underscore the significance of addressing pedagogical approaches, language policies, and curriculum transformation towards a more Afrocentric perspective.ConclusionThe study highlights the academic difficulties faced by EAL students in South African SLH training programs. The implications for future interventions in this context are highlighted. The findings emphasize the need for pedagogical reforms, language policy considerations, and curriculum transformation that embraces Afrocentric perspectives. Addressing these issues is crucial to ensure equitable educational experiences and support the success of EAL students in the SLH field.

Objectives: There is debate among otolaryngologists and other practitioners about whether upper lip tie contributes to difficulty with breastfeeding and whether upper lip tie and ankyloglossia are linked. Our objectives were to evaluate the anatomy of the upper lip (maxillary) frenulum, to determine if the visual anatomy of the upper lip has an effect on breastfeeding, and to determine whether the occurrence of lip tie and tongue tie are correlated. Methods: A prospective cohort study of 100 healthy newborns was examined between day of life 3–7. Surveys were completed by the mother at the time of the initial exam and 2 weeks later. The maxillary frenulum was graded based on the Stanford and Kotlow classifications by two independent reviewers. Inter‐rater reliability and relationships between tongue tie, lip tie, and the infant breastfeeding assessment tool (IBFAT) were calculated. Results: Inter‐rater reliability showed fair agreement (κ = 0.302) using the Kotlow scale and better agreement using the Stanford classification (κ = 0.458). There was no correlation between the upper lip tie classification and breastfeeding success score. Lastly, there was a modest inverse correlation in the degree of tethering for the tongue and lip. Conclusions: There was no correlation between maxillary frenulum grade and comfort with breastfeeding, pain scores, or latch. There was also no relationship between tip to frenulum length (tongue tie) and visualized lip anatomy, suggesting that tongue tie and lip tie may not cluster together in infants. Level of Evidence: 2 Laryngoscope, 131:E1701–E1706, 2021 [ABSTRACT FROM AUTHOR]

Objective: Assessing vocal cord mobility by flexible nasolaryngoscopy (FNL) can be difficult in neonates. To date, prospective studies evaluating the incidence and diagnostic accuracy of vocal cord paralysis (VCP) after surgical patent ductus arteriosus (PDA) ligation are limited. It is unknown whether video FNL improves diagnosis in this population. This study compared video recordings with bedside evaluation for diagnosis of VCP and determined inter-rater reliability of the diagnosis of VCP in preterm infants after PDA ligation. Methods: Prospective cohort of preterm neonates undergoing bedside FNL within two weeks of extubation following PDA ligation. In a subset, FNL was recorded. Two pediatric otolaryngologists, blinded to the initial diagnosis, reviewed the FNL video recordings. Results: Eighty infants were enrolled and 37 with a recorded FNL were included in the cohort. Average gestational age at birth was 25.2 weeks (SD: 1.2) and postmenstrual age at FNL was 37.0 weeks (SD: 4.5), which was 9.5 days (SD: 14.7) after extubation following PDA repair. There were 6 diagnosed with left VCP (16.2%; 95% CI: 4.3-28.1%) at bedside, and 9 diagnosed by video review (24.3%; 95% CI: 10.5-38.1%) (P =.56). Videos confirmed all 6 VCP diagnosed initially, but also identified 3 additional cases. Though imperfect, reviewing FNL by video showed substantial reliability (kappa =.75), with 91.9% agreement. Conclusion: Video recorded FNL most often confirms a bedside diagnosis of VCP, but may also identify discrepancies. Physicians should consider the limitations of diagnosis especially when infants persist with symptoms such as weak voice or signs of postoperative aspiration. Level of Evidence: 2b [ABSTRACT FROM AUTHOR]

Background: Decolonisation of the Speech-Language and Hearing (SLH) professions in South Africa to be Afrocentric is a current focus. These professions continue to hold white Eurocentric English and/or Afrikaans knowledges and practices, which are reflective of the minority. As diversity of students in higher education increases, the obvious incongruency between the language of learning and teaching (English) and institutional culture of the programmes and students who use English as an Additional Language (EAL) becomes heightened. Objectives: The study’s aim was to explore the learning and social experiences of EAL undergraduate students in a South African SLH training programme, with a specific focus on students’ experiences in patient, clinical supervisor and peer interactions in clinical situations. Method: A total of 24 participants recruited through purposive sampling were included in this cross-sectional mixed-method online survey design study. Data from the survey were analysed through descriptive and thematic analysis approaches. Results: Findings reveal a less than positive impression of EAL students in the current SLH training programme as far as their clinical experiences were concerned. The institutional culture of the SLH programme was reported to be disadvantageous to EAL students. These findings raise important implications for SLH training programmes, the regulator and the country’s SLH professions as a whole. Conclusion: This study sheds light on the significant incongruency between the existing institutional culture and the increasing diversity of students, particularly those who use EAL, in South African SLH training programmes. Contribution: Findings not only illuminate the challenges but also offer a path forward towards a more inclusive and representative SLH profession in South Africa, aligned with the principles of decolonization and Afrocentrism.

Like elsewhere around the globe, SARS-CoV-2 infection is spreading in rural Egypt. Due to high sensitivity and specificity, the gold standard of diagnostics is reverse transcription polymerase chain reaction PCR (RT-PCR). Rural areas without access to certified laboratories cannot take advantage of RT-PCR testing, and thus are dependent upon rapid antigen testing, a point-of-care test that requires less training and can produce results within 15 minutes. Rapid antigen testing can give an advantage to medical teams in rural settings by affording effective and early control of SARS-CoV-2 infection spread. We sought to assess the contribution of different COVID-19 testing procedures in rural Egypt. We conducted a prospective cohort study in a rural lab in Giza, Egypt. Approximately 223 individuals with potential SARS-CoV-2 infection were involved in the study during the pandemic peak in Giza, Egypt, from March 4 – May 30, 2021. Subjects were subjected to RT-PCR and rapid antigen testing, and the performance of each testing procedure was compared. Between March 4 – May 30, 2021, approximately 223 symptomatic individuals were included in this study. 190 patients (85.2%) were indicated as PCR positive for SARS-CoV-2, while 33 (14.8%) were PCR negative. In comparison, a rapid antigen test showed 178 out of 223 patients (79.8%) were indicated as positive, or 94% of the PCR-positive individuals. In Giza, a rural area of Egypt, RT-PCR had an optimal balance of sensitivity and specificity, however, the turnaround time was a limiting factor. Antigen testing, performed as a rapid point-of-care test, can play an effective role in rural outbreak control due to its ease of use and rapid results.