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Background: Having failed at least two pharmacotherapies, treatment-resistant depression (TRD) constitutes a major burden to healthcare in the US and globally, affecting close to a third of people diagnosed with depression in the US. Several studies have demonstrated the higher economic burden associated with TRD. This study sought to investigate changes in the availability of TRD somatic treatment options (Electroconvulsive therapy [ECT], Ketamine infusion therapy (KIT), and Transcranial Magnetic Stimulation [TMS]) in the US between 2014 and 2020 and the geographic variations in availability of TRD treatment options in the US as of 2020. Method: This study is a cross-sectional study of US mental health facilities providing TRD treatment options between 2014 and 2020. We used the 2014 to 2020 National Mental Health Services Survey (N-MHSS) data from the Substance Abuse and Mental Health Service Administration (SAMHSA). We estimated service availability per 100,000 US adults, both nationally and regionally, and computed a random-effect logistic regression to calculate the changes in the availability of the services over the study period. Result: Overall, availability of any one of ECT, KIT, or TMS in US mental health facilities declined between 2014 and 2019 (0.23 vs. 0.18 per 100,000 US adults) but increased to 0.24 in 2020. While availability of ECT consistently declined between 2014 and 2020, ketamine and TMS reportedly became available only in 2020. North Dakota, Wyoming, and Utah had the highest availability per 100,000 US adults (0.86, 0.67, and 0.65) while Nevada, Oregon and Georgia had the lowest availability (0.04, 0.06, and 0.06) regionally. Conclusion: The US had less than one mental health facility offering somatic treatment options for TRD per 100,000 US adults as of 2020. Also, the observed increase in the availability of somatic treatment options for TRD across the US between 2014 and 2020 did not reflect the increasing need for more treatment options for the treatment of TRD.

Introduction: The pandemic caused by the novel coronavirus virus has altered all facets of clinical practice in the United States. The goal of this study is to better understand the impact of COVID-19 on rhinologic ambulatory and operative practice. Methods: A 27-item survey to assess these objectives was created and approved by the Division of Rhinology faculty at Rush University Medical Center in April 2020. The survey was then distributed to rhinologists in a web based format via www.surveymonkey.com from April 10 through April 23, 2020. Results: A total of 277 U.S based rhinologists responded to the survey (23.04%). The most common practice types were single specialty private (44.9%) and academic (24.6%). 90.2% practice in a state under a shelter in place order. Comparing pre-COVID baseline to during-COVID, there was statistically significant reduction in the number of patients of seen daily in clinic (p < 0.001). The number of nasal endoscopies in the office and surgical procedures fell dramatically. Overall, 5 respondent rhinologists have been infected with COVID-19 and 27 have been furloughed. Conclusion: COVID-19 has drastically affected rhinologic practice. There is a dramatic reduction of in person care in the office setting and surgical management of sinonasal and skull base disease. Enhanced PPE is being used in only half of potentially aerosolizing procedures which represents an area of further education. Novel approaches such as use of virtual encounters and point of care testing should be considered as options to facilitate care. [ABSTRACT FROM AUTHOR]

BackgroundThe COVID-19 pandemic has had global impacts on social interactions and religious activities, leading to a complex relationship between religion and public health policies. This article reviews impact of the COVID-19 pandemic on religious activities and beliefs in relation to the spread of the virus, as well as the potential of religious leaders and faith communities in mitigating the impact of the pandemic through public health measures and community engagement.MethodsA literature review was conducted using PubMed and Google Scholar, with search terms including “religion,” “COVID-19,” “pandemic,” “coronavirus,” and “spirituality.” We included English articles published between January 2020 and September 2022, focusing on intersection of religion and COVID-19.ResultsWe identified two main themes emerging, with the selected 32 studies divided in 15 studies focused on the relationship between religious practices, beliefs, and the spread of COVID-19, while 17 studies explored the role of religious leaders and faith communities in coping with and mitigating the impact of COVID-19. Religious activities were found to correlate with virus spread, particularly in early days of the pandemic. The relationship between religiosity and adherence to government guidelines was mixed, with some studies suggesting increased religiosity contributed to misconceptions about the virus and resistance to restrictions. Religious beliefs were also associated with vaccine hesitancy, particularly conservative religious beliefs. On the other hand, religious leaders and communities played a crucial role in adapting to COVID-19 measures, maintaining a sense of belonging, fostering emotional resilience, and upholding compliance with public health measures. The importance of collaboration between religious leaders, institutions, and public health officials in addressing the pandemic was emphasized.ConclusionsThis review highlights the essential role of religious leaders, faith-based organizations, and faith communities in promoting education, preparedness, and response efforts during the COVID-19 pandemic. Engaging with religious leaders and communities can improve pandemic control and prevention efforts. Collaboration between religious leaders, governments, and healthcare professionals is necessary to combat vaccine hesitancy and ensure successful COVID-19 vaccination campaigns. The insights from this review can guide future research, policy development, and public health interventions to minimize the impact of the pandemic and improve outcomes for individuals and communities affected.

Background: Although previous research suggests that wearable devices (WD) are feasible and readily acceptable among mental health populations, there is a scarcity of national United States (US) data on the key factors related to the adoption of WD among people with mental disorders. This study aims to examine rates of WD adoption and identify factors associated with the use and willingness to share WD data among a national sample of adults with depression and/or anxiety in the US. Methods: Data were obtained from the 2019 and 2020 iteration of the Health Information National Trends Survey (HINTS). Logistic regression was performed to identify factors associated with WD adoption and willingness to share WD data with clinicians. Results: Of the 2,021 adults with depression and/or anxiety, 30.8% endorsed past 12-month use of WD and of these, 85.9% of WD users indicated their willingness to share their WD data with clinicians. Significant predictors of WD adoption and willingness to share WD data with clinicians include age, gender, education status, and previous experience with technology. Conclusions: About 1 in 3 adults with depression use WD. However, several sociodemographic and technology factors may limit large scale integration of these tools in mental health delivery.

Introduction: Prostate cancer (PCa) is the commonest maliganacy among men of African descent. The possible role of trace elements like Zinc in its aetiogenesis and disease severity remains controversial. This paper aims to identify the relationship between tissue zinc concentration and the occurrence of prostate cancer. And to identify the relationship between the tissue zinc concentration and the disease severity (using the prostate specific antigen (PSA) and Gleason scores (GS)). Methodology: A cross-sectional study of 41 consecutive consenting men with histologically confirmed PCa and 41 age-matched controls. Toe-nail clippings were obtained from both groups and assayed for zinc using the Particle induced X-ray emission (PIXE) technique. Zinc concentrations were compared between cases and controls. A correlation analysis was performed to determine relationship between Zinc concentration and disease severity (PSA and GS). Results: Forty one men each were recruited in the Prostate cancer and control groups for this study. PCa group had a mean age of 72.83 ± 7.06 years while the control group was 70.73 ±6.40 years. There was statistically significant higher toe-nail Zn concentration among Prostate cancer patients than controls (P= 0.028, t=2.28, df=40). The mean PSA values among the Prostate cancer group was 46.10 ± 40.62ng/ml and mode GS was 8.There was neither a correlation between toe-nail Zn concentration and serum PSA levels (p=0.386) nor with the GS. Conclusion: This study found a statistically significant higher toe-nail Zn concentration among men with PCa compared with age-matched controls. There was however no correlation between toe-nail Zn concentration and the serum prostate specific antigen or Gleason score.

The SARS-CoV-2 virus is highly infectious resulting in increased infection and death among the front-line Healthcare Workers (HCW) because of limited access to personal protective equipment (PPE). This study assesses the availability and self-reported use of PPE amongst HCW during the COVID-19 pandemic in Nigeria. A mixed-method study was conducted through a cross-sectional survey and in-depth interviews amongst HCW. Quantitative data analysis was done using SPSS version 26 and thematic analysis was done for the in-depth interview. A total of 258 HCW completed the survey while 15 HCW took part in the in-depth interview. The mean age was 40 (±8.6) years, 67.4% were female and 83.3% were married. 49% were Doctors, 21.1% were Nurses, 28.7% were other allied HCW and 62.2% had at least 10 years of practice experience. Only 22.1% of HCWs had regular access to PPE and only 20.6% had access to N-95 facemask compare to other PPEs. Male HCWs and those working at secondary or tertiary facilities had access to N-95 facemask (p-value 0.025 and 0.010 respectively). The facilitator of PPE use is leadership quality of hospital head and donation of PPE to the facilities while the barriers to PPE use include a limited supply of PPE, as well as facility's infrastructural and operational challenges. The study reported limited access to essential PPE with varying perspectives on its use. Therefore, access, knowledge, and appropriate use of PPE need urgent attention with improved implementation of infection control policy at the facility level.

Background: Handheld echocardiography (HHE) has been increasingly used for rheumatic heart disease screening and in adult emergency room settings. Aims: This study aimed to validate the accuracy of HHE in the diagnosis of congenital heart disease (CHD). Settings and Design Methodology: This is a prospective study carried out at three pediatric cardiology outpatient clinics in Khartoum, Sudan. All patients with suspected CHD were evaluated by clinical examination followed by HHE, performed using a modified segmental approach. Then, a complete study was performed using a standard echocardiography machine. The results were then compared using appropriate statistical tools. Results: A total of eighty cases were included with the following diagnoses either in isolation or combination: ventricular septal defect (n = 23), atrial septal defect (n = 10), pulmonary stenosis (n = 7), tetralogy of Fallot (n = 7), patent ductus arteriosus (n = 6), atrioventricular septal defect (n = 6), transposition of the great arteries (n = 6), and other diagnoses (n = 15). Agreement between HHE and SE was excellent both for visualizing heart segments (κ =77%–100% with a mean of 92.9%) and for diagnosis of CHD (κ =66%–100% with a mean of 91.7%). The sensitivity of HHE was 69.2%–100% (mean = 90.2%) and specificity was 98.5%–100% (mean = 99.3%). Conclusion: This study supports extending the utility of HHE in children for screening of CHD in addition to its current role in rheumatic heart disease screening.

There are growing concerns on the varying pattern of advanced prostate cancer (PCa) presentation across the world. We report some of the unusual presentations of PCa at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, South-Western Nigeria.A review of all patients with histologically confirmed PCa who had unusual presentations between January 2014 and December 2015 was done. Unusual presentation was defined as an atypical feature in the absence of lower urinary tract symptoms (LUTS), with the diagnosis of PCa only suspected after abnormal digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) assay. Thirteen patients had an unusual presentation in OAUTHC during the study period. Five (38.5%) had left supraclavicular swellings while four (30.8%) had haematochyzia and tenesmus. Other unusual presentations include large bowel obstruction requiring emergency colostomy (2;15.4%) and a scalp mass (1;7.7%). All patients had appropriate treatment for stage of CaP and are being followed up in the out-patient clinic. The change in presentations of PCa may suggest the need for DRE and serum PSA assay among all middle-aged and elderly men presenting at health facilities. Large scale studies on PCa across different population groups may also help at identifying related clinical, demographic and epidemiological factors as well as possible validation of some of these unusual presentations.

Background: Unlike plant phytochemicals, little has been done to explore the metabolites from phyllosphere bacterial flora, some of which enabled them to survive interspecific competition through amensalism. This study evaluated the antimicrobial activity of metabolites from Phyllospheric Bacteria (PB) isolated from Funtumia elastica (FE), against selected bacterial and fungal pathogens. Phenotypic and molecular methods were used to identify the isolated phyllo-microbiota., Methods: The PB were aseptically isolated by sonication. Their metabolites were obtained from the fresh overnight culture of the organisms. The cell-free supernatants containing the metabolites were used for antimicrobial assays against the pathogens. The DNA of the bacterial isolates were isolated using a NIMR-BIOTECH DNA extraction kit, while their 16S rRNA was amplified with the primer: 799F 5'-AACACGGATTA GATACC-3', 1193R 5'- ACGTCATCCCCACCTTCC-3', using SolisFast* Master Mix, (Solis Biodyne-Estonia). The BLAST of the sequence was done from the NCBI Gen-bank. The PB strains identified were submitted to NCBI and accession numbers were assigned to them., Results: The phyllosphere of FE yielded 21 bacterial isolates: 7 Gram-positives and 14 Gram-negatives. The metabolites from these isolates showed varying degrees of bioactivity against Staphylococcus aureus (ATCC29213), Escherichia coli (ATCC 25922) Klebsiella pneumoniae (ATCC 35659); Trychophyton rubrum , Candida albicans and Microsporum canis. Fifteen bioactive isolates sequenced yielded four genera, Enterobacter ( E. hormaechei 98.44%), Bacillus ( B. cereus 100%), Pontoea ( P. dispersa 99.72%), Staphylococcus ( S. arlettae 99.72%)., Conclusion: Bacteria from FE phyllosphere, produced metabolites antagonistic ( cidal ) to some human pathogens. This has great potential for possible drug discovery., (Copyright© 2024 Avicenna Research Institute.)

Background/aim: There is significant variation in post-treatment surveillance imaging for sinonasal malignancies. This study examined the utility of surveillance imaging in detecting recurrence in patients treated for sinonasal malignancies., Patients and Methods: We performed a retrospective review on an IRB-approved dataset of patients with sinonasal malignancies treated at a single institution between 2005 to 2021. Patients were categorized into groups based on the frequency of annual imaging and total number of imaging studies. We compared time-to-recurrence between the groups using log-rank test. A two-sided p-value of <0.05 was considered as the threshold for significance., Results: A total of 93 patients were eligible for this study with a median follow up of 42.3 months and 25.8% (n=24) of patients had documented recurrence. Sensitivity and specificity for recurrence based on computed tomography (CT) scans within one year of treatment completion were 50.0% and 19.5%; positron emission tomography/CT was 90.0% and 19.5%; and magnetic resonance imaging was 60.0% and 61.0%, respectively. Regardless of the type of imaging, symptomatic presentation after treatment had a specificity of 91.0% with a positive likelihood ratio of recurrence of 2.95 (95%CI=1.06-8.22). The frequency of scans was not associated with the risk of recurrence (HR=0.55; 95%CI=0.23-1.29, p=0.17). Similarly, no association was noted between the total number of scans and risk of recurrence (HR=0.64; 95%CI=0.27-1.51, p=0.31)., Conclusion: The total number of frequency of scans within the first year after treatment had no association with time to recurrence of sinonasal malignancies. Symptomatic presentation was strongly associated with recurrence and should be investigated with appropriate imaging., (Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background and Importance: Symptomatic tethering of the optic nerves and chiasm is a rare occurrence and has been reported following both surgical and medical treatment of pituitary adenoma. Here we present a case of primary optic chiasm tethering in a patient with empty sella syndrome., Clinical Presentation: The patient was a 61-yr-old female who presented with progressively worsening bitemporal hemianopsia. Magnetic resonance imaging (MRI) brain revealed an empty sella with herniation of the optic chiasm into the sella. The patient underwent an endoscopic, endonasal/trans-sphenoidal approach to the sella, where the optic chiasm was then detethered via lysis of arachnoid adhesions and ultimately buttressed with an abdominal fat graft. Postoperatively, the patient did well with subjective and objective improvements in her visual fields., Conclusion: We report a rare case of primary tethered optic chiasm, which was successfully treated via an endoscopic, endonasal approach with abdominal fat graft harvest., (© Published by Oxford University Press on behalf of Congress of Neurological Surgeons 2020.)

Purpose: This retrospective study was conducted to assess the epidemiological, clinical and histologic characteristics of incidentally identified and presurgically diagnosed papillary thyroid microcarcinomas less than or equal to 5 mm in size (small PTMC)., Materials and Methods: Cases from October 2003 to February 2018 were retrieved from pathology databases, and their clinicopathological features were reviewed., Results: There were a total of 182 cases of small PTMCs, 141 women and 41 men. The mean age at diagnosis was 53.5. Most of the small PTMCs were not detected on clinical examination and workup and were diagnosed incidentally during pathologic examination. 21.4% of small PTMCs showed multifocality, with 21 cases of unilateral multifocal lesions and 18 cases with bilateral multifocal tumors. Small PTMCs were most often follicular variant (51.9%) followed by classic type (47.5%). The average size of follicular variants appeared to be larger than that of the classic type PTMCs (2.84 ± 1.43 mm vs 2.26 ± 1.51 mm, P = 0.01). A total of 66 cases (36.3%) had regional lymph node sampling or selective neck dissection and 15 of these cases identified lymph node metastasis (22.7%). 46.7% of patients with node positive microcarcinomas were male compared with 16% male in group with negative lymph nodes (P = 0.03)., Conclusions: Small PTMCs (≤5 mm) are often multifocal and bilateral and histology is commonly both the classical and follicular variant of PTC. While often diagnosed incidentally small PTMC can lead to regional lymph node involvement in a significant portion of cases and evaluation of the regional lymph nodes should be considered in the clinical management of these patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To evaluate outcomes and survival in young patients with oral tongue cancer (OTC)., Methods: Retrospective chart review of patients aged 18-40 with OTC treated between 2000 and 2016. Tumor characteristics of p16 expression, perineural invasion (PNI), and lymph-vascular invasion (LVI) were evaluated. Recurrence-free (RFS) and overall survival (OS) data were analyzed according to Kaplan-Meier method with univariate analysis., Results: A total of 23 patients were identified: 12 with early stage disease (ESD, stage I), and 11 with advanced stage disease (ASD, stage III or IV), (17 men and 6 women). Mean age at presentation was 34.5 years (±5 months) and mean follow-up was 46.6 months. For all patients, 5-year RFS was 62% and OS 66%. RFS for ESD was 73% and ASD 25% (log rank p = 0.011). OS for ESD was 100% and ASD 55% (log rank p = 0.012). 22% indicated tobacco use >5 pack-years and 9% heavy alcohol use. Factors associated with worse OS were neck disease (log rank p = 0.073), positive margins (log rank p = 0.001), and LVI (log rank p = 0.002). Factors associated with worse RFS were chemotherapy or radiation therapy prior to surgery (log rank p = 0.002), neck disease (log rank p = 0.047), positive margins (log rank p = 0.039), and PNI (log rank p = 0.001). Expression of p16 was observed in five cases and was not significantly associated with OS or RFS., Conclusion: In young patients with OTC, factors associated with worse outcomes are similar to known predictors in older patients. Expression of p16 was not statistically associated with improved OS. OS in patients with ESD was excellent (100%), and significantly worse for ASD., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background Structured histopathology reporting facilitates better understanding of the underlying pathophysiologic mechanisms of chronic rhinosinusitis. The microbiology of chronic rhinosinusitis has been studied extensively; however, distinct histopathologic changes associated with bacteria isolated in chronic rhinosinusitis are largely unknown. Objective The goal of this study is to better understand the relationship between culturable bacteria and histopathology in chronic rhinosinusitis. Methods A structured histopathology report was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery in a group of patients with chronic rhinosinusitis refractory to medical therapy. Patients with cystic fibrosis or ciliary dysfunction were excluded. Histology variables included eosinophil count per high-power field, neutrophil infiltrate, basement membrane thickening, subepithelial edema, hyperplastic/papillary changes, mucosal ulceration, squamous metaplasia, fibrosis, fungal elements, Charcot-Leyden crystals, and eosinophil aggregates. Baseline Lund-Mackay score and Sinonasal Outcome Test 22 score were also collected. The association of culture data with the aforementioned variables was assessed. Results A total of 59 chronic rhinosinusitis patients who underwent functional endoscopic sinus surgery were included. Chronic rhinosinusitis patients with Pseudomonas aeruginosa had significantly increased neutrophil infiltrate (71.4% vs. 26.9%, p = 0.048), subepithelial edema (28.6% vs. 3.8%, p = 0.047), and a trend toward increased fungal elements (28.6% vs. 5.8%, p = 0.071). Chronic rhinosinusitis patients with Staphylococcus aureus had significantly more hyperplastic changes (20% vs. 2.3%, p = 0.050) and a trend toward increased squamous metaplasia (33.3% vs. 14.2%, p = 0.069). Conclusion Distinct histopathologic changes were noted based on sinus culture data for S. aureus and P. aeruginosa. These findings may have important implications on the extent of surgical management and prognosis after surgery.

Background: Acute invasive fungal rhinosinusitis (AIFRS) represents a fulminant, potentially fatal, disease process in immunocompromised patients. The diagnosis often rests on high index of clinical suspicion, with relative paucity of data on the diagnostic and therapeutic implications of intraoperative frozen sections., Methods: Retrospective review was performed for 18 cases undergoing endoscopic sinus surgery for AIFRS. Reliability of intraoperative frozen section diagnosis was evaluated for all patients using final pathology as the gold standard., Results: A total of 66 frozen sections were performed. Diagnostic accuracy of frozen sections illustrated sensitivity of 72.7% (95% confidence interval [CI], 0.57 to 0.85), specificity of 100% (95% CI, 0.85 to 1.00), positive predictive value (PPV) of 100% (95% CI, 0.89 to 1.00), and negative predictive value (NPV) of 64.7% (95% CI, 0.46 to 0.80). There was no statistically significant difference in sensitivity of frozen sections in cases of Mucor and Aspergillus at 68.8%% and 76.2%, respectively (p = 0.61)., Conclusion: This study represents the largest series assessing the diagnostic accuracy of frozen section analysis in AIFRS. Frozen section analysis is an effective tool for guiding intraoperative decision making in patients with AIFRS with a high PPV. A Low NPV underscores the importance of clinical suspicion and intraoperative decision making based on endoscopic findings when negative frozen section results are encountered. Further, frozen section analysis appears to be equally effective in detecting either Mucor or Aspergillus., (© 2017 ARS-AAOA, LLC.)

The variable location and indistinct features of parathyroid glands can make their intraoperative identification challenging. Currently, there exists no routine use of localization methods during surgery. Dynamic optical contrast imaging (DOCI) leverages a novel realization of temporally dependent measurements of tissue autofluorescence that allows the acquisition of specific tissue properties. A prospective series of patients with primary hyperparathyroidism was examined. Parathyroid lesions and surrounding tissues were collected; fluorescence decay images were acquired via DOCI. Ex vivo samples (81 patients) were processed for histologic assessment. DOCI extracts relative fluorescence decay information in a surgically relevant field of view with a clinically accessible acquisition time <2 minutes. Analysis of DOCI revealed microscopic characterization sufficient for tissue type identification consistent with histology ( P < .05). DOCI is capable of efficiently distinguishing parathyroid tissue from adjacent tissues. Such an intraoperative tool would be transformative, helping surgeons to identify lesions, preserve healthy tissue, and improve patient outcomes.

Importance: Primary tumors of the lacrimal gland are rare and are associated with substantial morbidity and mortality. The literature regarding these tumors is limited to case series and case reports., Objective: To examine the incidence, treatment, and overall survival (OS) and disease-specific survival (DSS) of patients with cancer of the lacrimal gland., Design, Setting, and Participants: Population-based cohort analysis using the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with primary tumors of the lacrimal gland from 1973 to 2010., Main Outcomes and Measures: Overall survival and DSS., Results: A total of 321 patients with nonlymphoid tumors of the lacrimal gland were identified. The most common histological subtypes were adenoid cystic carcinoma (ACC) (32.1%) and squamous cell carcinoma (SCC) (29.9%). Survival analysis revealed a 5-year OS and DSS for all lacrimal gland tumors of 60% and 75%, respectively. On univariate analysis, low tumor grade (P = .04) and surgical treatment (P < .001) were associated with significantly better OS. For ACC tumors, surgery (P = .009), but not radiotherapy (P = .44), was found to significantly improve OS. For SCC tumors, surgical treatment significantly improved both OS (P < .001) and DSS (P = .004); radiation therapy also significantly improved OS (P = .03). Using a multivariable analysis model, age (hazard ratio [HR], 1.03 [95% CI, 1.01-1.04]; P < .001), surgery (HR, 0.43 [95% CI, 0.25-0.75]; P = .003), and T stage at presentation (HR, 1.18 [95% CI, 1.01-1.37]; P = .03) were found to be independent predictors of OS. For ACC alone, age (HR, 1.04 [95% CI, 1.02-1.06]; P < .001) and surgery (HR, 0.35 [95% CI, 0.13-0.91]; P = .03) were independent predictors of OS. For SCC, age (HR, 1.05 [95% CI, 1.02-1.09]; P = .005), surgical resection (HR, 0.31 [95% CI, 0.12-0.83]; P = .02), and radiation therapy (HR, 0.33 [95% CI, 0.14-0.80]; P = .01) were independent predictors of OS., Conclusions and Relevance: Our study demonstrates that ACC is the most common malignant epithelial neoplasm of the lacrimal gland. Determinants of survival for tumors of the lacrimal gland include age at diagnosis and surgical therapy. Radiation therapy is associated with improved DSS in SCC but not in ACC.

Background: The purpose of this study was to identify the incidence of atypical Mycobacterium identified by routine sinus cultures and review the recent literature on management., Methods: A retrospective case series was performed in a tertiary academic hospital. A retrospective case series of all patients treated with atypical Mycobacterium rhinosinusitis from 2005 to 2010 was performed. Cases were identified from a prospective database of 676 endoscopically guided sinus cultures., Results: Eight patients with atypical Mycobacterium sinusitis were identified. There were five women and three men. Median age was 63 years (range, 55-71 years). All patients had prior endoscopic sinus surgery a median of 14 months (range, 0.8-162 months) before a positive culture result. Species identified included Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium abscessus, and Mycobacterium avium complex. Chief presenting symptoms were postnasal discharge (88%), followed by decreased smell and taste (63%), and facial pain/pressure (38%). Patients were treated based on sensitivity results with long-term oral antibiotics for at least 2 months based on improvements on endoscopy. Median follow-up for patients in this study after treatment was 1.3 years (range, 0.6-4.6 years)., Conclusion: In this study, atypical mycobacteria were identified in <1% of sinus cultures. Prolonged, culture-directed antibiotic therapy remains the mainstay of treatment when there is clinical evidence of infection. Previous endoscopic sinus surgery may represent a risk factor for colonization and subsequent infection. Further research is necessary to determine the optimal treatment duration and management to prevent disease relapse.

The hearing status of an experimental animal is typically assessed in the laboratory setting by the combined use of auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAEs), carried out in succession, with the former assay preceding the latter. This study reports a cautionary finding that the use of this accepted regimen yields a reduced DPOAE response. When the DPOAEs were performed after ABR testing, transient reduction of the DPOAE amplitudes was observed at all frequencies in both the inbred, C57/B6 and FVB/N, and the outbred, SW mouse strains. DPOAEs were reduced post-ABR in multiple mouse strains which suggests that this finding is not strain-specific but a general consequence of the preceding ABR analysis. The reduction in DPOAE was temporary: when re-tested at one hour, DPOAE amplitudes recovered to pre-ABR levels. In contrast to the ABR's impact on DPOAE response, ABR thresholds were not altered or reduced when preceded immediately by DPOAE measurements. The molecular alterations underlying the ABR-induced transient reduction of DPOAE remain to be determined. To investigate the potential role of reactive oxygen species in post-ABR DPOAE reduction, transgenic mice over-expressing SOD1, the cytoplasmic enzyme critical for removal of superoxide radicals were subjected to the same auditory testing regimen. Similar to their wild type littermates, the SOD1 transgenic mice also demonstrated post-ABR DPOAE reduction, and thus do not support a role for superoxide radicals in transient reduction of DPOAE. While toxic noise exposure is known to negatively impact OAE, transient decrease in DPOAE levels following standard ABR assay has not been previously described. A practical outcome from this study is a recommendation for reversal of the traditional order for carrying out auditory tests, with the OAE measurements preceding ABR assessment, thus ensuring that the DPOAE response is unaffected.

Objectives: To investigate the influence of age, and age-at-implantation, on speech production intelligibility in prelingually deaf pediatric cochlear implant recipients., Methods: Forty prelingually, profoundly deaf children who received cochlear implants between 8 and 40 months of age. Their age at testing ranged between 2.5 and 18 years. Children were recorded repeating the 10 sentences in the Beginner's Intelligibility Test. These recordings were played back to normal-hearing listeners who were unfamiliar with deaf speech and who were instructed to write down what they heard. They also rated each subject for the intelligibility of their speech production on a 5-point rating-scale. The main outcome measures were the percentage of target words correctly transcribed, and the intelligibility ratings, in both cases averaged across 3 normal-hearing listeners., Results: The data showed a strong effect of age at testing, with older children being more intelligible. This effect was particularly pronounced for children implanted in the first 24 months of life, all of whom had speech production intelligibility scores of 80% or higher when they were tested at age 5.5 years or older. This was true for only 5 out of 9 children implanted at age 25-36 months., Conclusions: Profoundly deaf children who receive cochlear implants in the first 2 years of life produce highly intelligible speech before the age of 6. This is also true for most, but not all children implanted in their third year., (Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.)