Rediscovering tuberculosis of the middle ear

Tuberculous otitis media (TOM) has no specific clinical presentation. Early diagnosis is necessary in order to avoid serious complications. The aim of this paper is rediscovering this rare forgotten disease that can re-emerge in a globalized society.A case of a 37 year-old woman with persistent unilateral otitis media with ear discharge and deafness since two years is presented. Systemic and topic antibiotic therapy was not effective. She underwent surgery twice with no improvement. As clinical conditions worsened, she was hospitalized. Histological examination and culture for mycobacteria detection revealed Mycobacterium tuberculosis complex infection.The patient was treated with anti-tuberculosis medical therapy for 9 months with clinical improvement.TOM is a diagnostic challenge and is often treated late because not suspected. Chronic otitis media not responding to common antibiotics should be investigated for tuberculous infection. Keywords: Tuberculosis, Otitis media, Atypical tuberculosi

Re: Mastectomy and oophorectomy by menstrual cycle phase in women with operable breast cancer

No abstract availabl

Expression, crystallization and preliminary X-ray crystallographic analysis of glucose-6-phosphate dehydrogenase from the human pathogen Trypanosoma cruzi in complex with substrate. Corrigendum

A correction to the article by Ortíz et al. [(2011), Acta Cryst. F67, 1457–1461]

Congenital Nasal Pyriform Aperture Stenosis: Successful Management of Restenosis After Primary Surgery by Stent Placement

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare anomaly causing respiratory distress in newborns. While the primary surgical technique is well established, the timing of the removal of the stents and the management of restenosis remain a matter of debate. We report a case of a female newborn affected by CNPAS with the recurrence of respiratory distress after primary surgery due to the early removal of nasal stents, causing an overgrowth of granulation tissue. This report notes that restenosis was successfully managed by repeating the procedure over a 14-day period, with soft polyvinyl chloride uncuffed tracheal tubes acting as nasal stents

Spontaneous Upbeat Nystagmus and Selective Anterior Semicircular Canal Hypofunction on Video Head Impulse Test: A New Variant of Canalith Jam?

: We describe a rare case of spontaneous upbeat nystagmus (UBN) attributable to a canalith jam involving the anterior semicircular canal (ASC) in a patient in whom comprehensive vestibular assessment was useful to identify the underlying pathomechanism. A 56-year-old woman with unsteadiness following repositioning procedures for left-sided benign paroxysmal positional vertigo (BPPV) presented with spontaneous UBN that showed slight right torsional components. A vestibular test battery detected isolated left ASC hypofunction on a video-head impulse test (Video-HIT). We postulated a persistent utriculopetal deflection of the left ASC cupula, which was attributable to entrapment of debris in a narrow canal tract, with consequent sustained inhibition of the ampullary afferents. Although spontaneous UBN receded after impulsive physical therapy, unsteadiness deteriorated into positional vertigo secondary to canalolithiasis involving the ipsilateral posterior canal. In our view, physical therapy possibly fragmented the canalith jam and released free-floating otoconia that eventually settled into the ipsilateral posterior canal. Video HIT revealed normalization of ASC hypofunction, and leftsided posterior canal canalolithiasis was successfully treated using appropriate repositioning procedures. We propose that a canalith jam involving the ASC should be considered in the differential diagnosis of spontaneous UBN, particularly in patients with a history of BPPV and isolated ASC hypofunction detected on video HIT

Confocal fluorescence microscopy and confocal raman microspectroscopy of X-ray irradiated LIF crystals

Radiation-induced color centers locally produced in lithium fluoride (LiF) are successfully used for radiation detectors. LiF detectors for extreme ultraviolet radiation, soft and hard X-rays, based on photoluminescence from aggregate electronic defects, are currently under development for imaging applications with laboratory radiation sources, as well as large-scale facilities. Among the peculiarities of LiF-based detectors, noteworthy ones are their very high intrinsic spatial resolution across a large field of view, wide dynamic range, and versatility. LiF crystals irradiated with a monochromatic 8 keV X-ray beam at KIT synchrotron light source (Karlsruhe, Germany) and with the broadband white beam spectrum of the synchrotron bending magnet have been investigated by optical spectroscopy, laser scanning confocal microscopy in fluorescence mode, and confocal Raman micro-spectroscopy. The 3D reconstruction of the distributions of the color centers induced by the X-rays has been performed with both confocal techniques. The combination of the LiF crystal capability to register volumetric X-ray mapping with the optical sectioning operations of the confocal techniques has allowed performing 3D reconstructions of the X-ray colored volumes and it could provide advanced tools for 3D X-ray detection

Acquired bilateral facial palsy: a systematic review on aetiologies and management

ObjectiveTo systematically review the published cases of bilateral facial palsy (BFP) to gather evidence on the clinical assessment and management of this pathology.MethodsFollowing PRISMA statement recommendations, 338 abstracts were screened independently by two authors. Inclusion criteria were research articles of human patients affected by BFP, either central or peripheral; English, Italian, French or Spanish language; availability of the abstract, while exclusion criteria were topics unrelated to FP, and mention of unilateral or congenital FP. Only full-text articles reporting the diagnostic work-up, the management, and the prognosis of the BFP considered for further specific data analysis.ResultsA total of 143 articles were included, resulting a total of 326 patients with a mean age of 36 years. The most common type of the paralysis was peripheral (91.7%), and the autoimmune disease was the most frequent aetiology (31.3%). The mean time of onset after first symptoms was 12 days and most patients presented with a grade higher than III. Associated symptoms in idiopathic BFP were mostly non-specific. The most frequently positive laboratory exams were cerebrospinal fluid analysis, autoimmune screening and peripheral blood smear, and the most performed imaging was MRI. Most patients (74%) underwent exclusive medical treatment, while a minority were selected for a surgical or combined approach. Finally, in more than half of cases a complete bilateral recovery (60.3%) was achieved.ConclusionsBFP is a disabling condition. If a correct diagnosis is formulated, possibilities to recover are elevated and directly correlated to the administration of an adequate treatment

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Studio dell’estensione del danno vestibolare nei pazienti affetti da ipoacusia improvvisa

Si definisce ipoacusia improvvisa una perdita uditiva neurosensoriale ≥30 dB in tre frequenze adiacenti del campo uditivo tonale. Il meccanismo eziopatogenetico non è noto nella maggior parte dei casi. Studi precedenti hanno evidenziato, oltre ad alcuni indicatori prognostici (es. età del paziente, ritardo nel trattamento, grado di ipoacusia,…), anche l’importanza della valutazione della funzionalità vestibolare; ad esempio è stato dimostrato che la neuronite vestibolare e l’ipoacusia improvvisa associata a vertigine presentano esiti diversi al vHIT, suggerendo differenti eziologie. Obiettivi dello studio sono: descrivere l’estensione del danno maculare e canalare nei pazienti con ipoacusia improvvisa, studiare l’associazione tra il danno vestibolare e la prognosi uditiva e descrivere pattern di danno vascolare. Sono stati inclusi nello studio 86 pazienti con nuova diagnosi di ipoacusia improvvisa afferenti ad un centro di terzo livello. Criteri di inclusion: età >18 anni. Criteri di esclusione: follow up interrotto, pregresse patologie uditive omo- o contro-laterali, patologie dell’orecchio medio. I pazienti sono stati trattati secondo I protocolli ospedalieri e i dati clinici e strumentali relative a vHIT e VEMPs sono stati raccolti in modo prospettico. L’analisi statistica è stata svolta con il software SPSS 20.0 (IBB SPSS, IBM Corp., Armonk, NY). Le variabili continue sono state riportate come media ± DS o mediana e range. I test di Pearson (chi-squared) o il test di Fischer sono stati utilizzati per confrontare le variabili categoriche; i test ANOVA, Mann-Whitney U test o Kruskal-Wallis per le variabili continue. Una P<0.05 è stata considerata per la significatività statistica. L'età media è stata di 55.7 anni (22-84). Il 73.3% (63/86) dei pazienti ha riferito vertigine. È stata trovata un’anormalità ai cVEMPs e ai oVEMPs rispettivamente nel 45.3% e 41.9% dei casi. La funzionalità canalare era alterata nel 16.3% dei casi per il canale laterale, 20.9% per il posteriore e 10.6% per l’anteriore. I pazienti sono stati suddivisi in 3 gruppi: pazienti con vertigine, pazienti senza vertigine e gruppo menierico. Alterazioni sacculari, del canale posteriore o di 3 o più recettori sono state riscontrate con maggiore frequenza nei pazienti del primo gruppo (p<0.05). UN deficit tricanalare si è verificato unicamente nei pazienti con vertigine. Sono stati identificati come fattori prognostici negative per la funzionalità uditiva le anormalità sacculari e l’elevato numero di alterazioni recettoriali (p<0.05). Inoltre, I pazienti con vertigine presentavano valori più elevati alla scala di Fazekas (p<0.05). I pazienti con pattern ischemico si presentavano con vertigine, perdite uditive più severe e prognosi peggiore (p<0.05). In conclusione, uno studio complete dei recettori vestibolari e delle vie afferenti potrebbe migliorare la definizione dell’estensione del danno in questi pazienti, oltre che a fornire indicazioni prognostiche e permettere di identificare pattern a possibile patogenesi vascolare. La presenza di vertigine come sintomo associato, di un alto numero di alterazioni recettoriali e pattern lesionali ischemici sono associati ad un peggior recupero della funzione uditiva.Sudden sensorineural hearing loss (SSHL) is the loss ≥30 dB in three consecutive frequencies. The exact mechanism underlying SSHL remains elusive. Several prognostic indicators of favourable or unfavourable outcome in SSHL have been proposed (age, delay of treatment, the severity of hearing loss, etc.). The importance of the assessment of vestibular function was evidenced by previous studies. A recent study showed that vHIT results were different in vestibular neuritis and SSHL with vertigo, suggesting different causes of vestibular neuritis and SSHL. The primary aim of the study is to describe the extension of macular and canal injury in patients affected by SSHL with or without vertigo. Secondary aims are to study the association between canal and macular function with hearing prognosis and to describe ischemic patterns of inner ear damage. Consecutive patients with SSHL with or without vertigo who referred to Otolaryngology Unit of a tertiary hospital were consecutively recruited for one year. Inclusion criteria were: age ≥18 years, new diagnosis of SSHL. Exclusion criteria were: incomplete follow-up, previous ear disease, contralateral hearing loss. The usual therapeutic and diagnostic protocol was followed. Demographic, clinical and instrumental data were prospectively collected. o-/c-VEMPs and vHIT results were compared with hearing recovery and the presence of ischemic alterations at head MRI. Statistical analysis was performed using SPSS 20.0 (IBB SPSS, IBM Corp., Armonk, NY). Quantitative variables were checked for normal distribution using Kolmogorov-Smirnov and Shapiro-Wilk tests. Continuous variables were described by mean ± standard deviation or median and range. Comparisons between groups were performed by Pearson’s chi-squared test or Fischer’s exact test for categorical variables, one-way analysis of variance, Mann-Whitney U test or Kruskal-Wallis test for continuous variables. Differences between groups were considered significant at p<0.05. 147 patients had SSHL during the study period, 61 patients were excluded, 86 patients met the inclusion criteria and were included in the study. Median age was 55.7 years (22-84). Vertigo occurred in 73.3% (63/86) of cases. cVEMPs or oVEMPs abnormalities were found in 45.3% and 41.9%, respectively. Canal function was altered at the vHIT in lateral 16.3% for lateral, 20.9% for posterior and 10.6% for anterior canal. Three groups of patients were identified: patients without vertigo, patients with vertigo, patients with Meniere’s disease. Saccular dysfunction was more frequent in patients with vertigo (p<0.05). Posterior canal dysfunction was more frequent in patients with vertigo (p<0.05). Complete canals deficit was present only in patients with vertigo. Deficit of three or more receptors was more frequent in patients with vertigo (p<0.05). Impaired saccular function and high number of impaired receptors were associated with poor hearing outcome (p<0.05). Patients with vertigo had more severe Fazekas scale scores at head MRI (p<0.05). Patients with ischemic patterns had also vertigo (p<0.05), severe hearing loss and poor outcomes (p<0.05). In conclusion, a complete assessment of vestibular receptors and afferents could help to better define the extension of the injury in SSHL and give information about the prognosis. Certain patterns of canal and macular injury could suggest ischemic cause. Vertigo, high number of injured receptors and certain patterns of canal or macular injuries are associated with poor outcome