Evolution and Otitis Media: A Review, and a Model to Explain High Prevalence in Indigenous Populations

Inflammation of the middle ear (otitis media) comprises a group of disorders that are highly prevalent in childhood, and indeed are amongst the most common disorders of childhood. Otitis media is also heritable, and has effects on fecundity. This means that otitis media is subject to evolution, yet the evolutionary selection forces that may determine susceptibility to otitis media have never been adequately explored. Here I undertake a critical analysis of evolutionary forces that may determine susceptibility to middle ear inflammation. These forces include those determining function of the middle ear, those affecting host immunity, and those affecting colonization by, and pathogenicity of bacteria. I review existing mathematical evolutionary models of host-pathogen interaction and co-evolution, and apply these to develop a better understanding of the complex evolutionary landscape of middle ear infection and inflammation in humans. This includes an understanding of factors determining the transition between stable evolutionary strategies for host and bacterial pathogens. This understanding will be later applied to analysis of otitis media in indigenous populations. In the second part of this article, I apply the approach of population genetics to devise a new theory for the high prevalence of otitis media in certain indigenous populations: the Australian Aborigine, the Native American, the Inuit, and the Maori. I suggest that high prevalence in such groups may have occurred as a result of colonization of these previously isolated populations by European immigrants in the 15th and 16th Centuries. This exposed them to new strains of bacteria to which their immune system had not evolved immunity, perturbing a previously stable host- pathogen co-evolutionary state

Environmental impact and life cycle financial cost of hybrid (reusable/single-use) instruments versus single-use equivalents in laparoscopic cholecystectomy

Background Hybrid surgical instruments contain both single-use and reusable components, potentially bringing together advantages from both approaches. The environmental and financial costs of such instruments have not previously been evaluated. Methods We used Life Cycle Assessment to evaluate the environmental impact of hybrid laparoscopic clip appliers, scissors, and ports used for a laparoscopic cholecystectomy, comparing these with single-use equivalents. We modelled this using SimaPro and ReCiPe midpoint and endpoint methods to determine 18 midpoint environmental impacts including the carbon footprint, and three aggregated endpoint impacts. We also conducted life cycle cost analysis of products, taking into account unit cost, decontamination, and disposal costs. Results The environmental impact of using hybrid instruments for a laparoscopic cholecystectomy was lower than single-use equivalents across 17 midpoint environmental impacts, with mean average reductions of 60%. The carbon footprint of using hybrid versions of all three instruments was around one-quarter of single-use equivalents (1756 g vs 7194 g CO2e per operation) and saved an estimated 1.13 e−5 DALYs (disability adjusted life years, 74% reduction), 2.37 e−8 species.year (loss of local species per year, 76% reduction), and US $ 0.6 in impact on resource depletion (78% reduction). Scenario modelling indicated that environmental performance of hybrid instruments was better even if there was low number of reuses of instruments, decontamination with separate packaging of certain instruments, decontamination using fossil-fuel-rich energy sources, or changing carbon intensity of instrument transportation. Total financial cost of using a combination of hybrid laparoscopic instruments was less than half that of single-use equivalents (GBP £131 vs £282). Conclusion Adoption of hybrid laparoscopic instruments could play an important role in meeting carbon reduction targets for surgery and also save money

Re: The Carbon Footprint of Single-Use Flexible Cystoscopes Compared with Reusable Cystoscopes: Methodological Flaws Led to the Erroneous Conclusion That Single-Use Is "Better"

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The genetics of cholesteatoma study. Loss‐of‐function variants in an affected family

The aetiology of cholesteatoma remains elusive. In a recent systematic review, we discussed reports of multiple cases of cholesteatoma within families, which suggests a genetic predisposition in some cases (1). We have established a U.K. database and DNA sample bank that can be used to identify genetic variants that co‐segregate with cholesteatoma in multiply‐affected families. Recruitment to this Genetics of Cholesteatoma (GOC) Study is via the U.K. National Institute of Health Research Clinical Research Network. This preliminary communication describes the results of whole exome sequencing (WES) of DNA extracted from participants in the first fully sequenced family recruited to the study. Rare variants were filtered for co‐segregation with the cholesteatoma phenotype, and for their putative functional impact. We have identified loss of function variants in the genes EGFL8 and BTNL9 as candidate variants of interest. These are preliminary observations and the variants are of unknown significance to the disease pathology without replication or further investigation

ENT from afar : opportunities for remote patient assessment, clinical management, teaching and learning

Remote communication in ENT has been expanding, spurred by the COVID-19 pandemic. Conferences and teaching have moved online, enabling easier participation and reducing financial and environmental costs. Online multi-disciplinary meetings have recently been instigated in Africa to discuss management of cases in head and neck cancer, or cochlear implantation, expanding access and enhancing patient care. Remote patient consultation has also seen an explosion, but existing literature suggests some caution, particularly because many patients in ENT need an examination to enable definitive diagnosis. Ongoing experience will help us to better understand how remote communication will fit into our future working lives, and also where face-to-face interaction may still be preferable.http://www.wileyonlinelibrary.com/journal/coahj2022Speech-Language Pathology and Audiolog

Genome-wide association analysis reveals variants on chromosome 19 that contribute to childhood risk of chronic otitis media with effusion

To identify genetic risk factors of childhood otitis media (OM), a genome-wide association study was performed on Finnish subjects, 829 affected children, and 2118 randomly selected controls. The most significant and validated finding was an association with an 80 kb region on chromosome 19. It includes the variants rs16974263 (P = 1.77 x 10(-7), OR = 1.59), rs268662 (P = 1.564 x 10(-6), OR = 1.54), and rs4150992 (P = 3.37 x 10(-6), OR = 1.52), and harbors the genes PLD3, SERTAD1, SERTAD3, HIPK4, PRX, and BLVRB, all in strong linkage disequilibrium. In a sub-phenotype analysis of the 512 patients with chronic otitis media with effusion, one marker reached genome-wide significance (rs16974263, P = 2.92 x 10(-8)). The association to this locus was confirmed but with an association signal in the opposite direction, in a UK family cohort of 4860 subjects (rs16974263, P = 3.21 x 10(-4), OR = 0.72; rs4150992, P = 1.62 x 10(-4), OR = 0.71). Thus we hypothesize that this region is important for COME risk in both the Finnish and UK populations, although the precise risk variants or haplotype background remain unclear. Our study suggests that the identified region on chromosome 19 includes a novel and previously uncharacterized risk locus for OM.Peer reviewe

Plastics in healthcare: time for a re-evaluation

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