Pharyngocutaneous Fistula after Laryngectomy: Incidence, Predisposing Factors, and Outcome

Pharyngocutaneous fistula is a common and troublesome postoperative complication after total laryngectomy. The objective of this report was to determine the incidence, predisposing factors, and outcome of postlaryngectomy pharyngocutaneous fistula in patients operated on in our department and to describe the management of the complication. The medical records of 146 consecutive patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx between 1990 and 2005 were assessed. All patients had similar preoperative/postoperative care. We studied a number of factors that could influence fistula formation such as age, gender, smoking, systemic disease, preoperative radiotherapy, previous tracheotomy, site of tumor, surgical procedure, positive surgical margins, type of closure (T vs. vertical), concurrent neck dissection, suture material, clinical stage, histologic grade, and experience of surgeon (consultant vs. resident). A pharyngocutaneous fistula was observed in 13% (19/146) of the patients within a mean time of 9.6 days from surgery. Spontaneous closure with local wound care was noted in 17 (89%) patients whereas a surgical closure was necessary in two. One patient required surgical closure by direct suture of the pharyngeal mucosa. Pectoralis major myocutaneous flap was used in another one. Our findings showed that fistula formation was significantly more common in patients who received previous radiotherapy or who had positive surgical resection margins or had a systemic disease. The mean healing time was 26 days. We concluded that pharyngocutaneous fistula remains a troublesome complication of the early postoperative period after total laryngectomy. There are many conflicting reports in the literature concerning the predisposing factors, but our data showed that the presence of systemic diseases, previous radiotherapy, and positive surgical margins can all be important predisposing factors, or at least underlying causes. Our experience confirmed that most fistulas can be successfully managed with conservative treatment

Pathologic Fractures: A Neglected Clinical Feature of Parathyroid Adenoma

The pattern of clinical presentation of primary hyperparathyroidism (pHPT) has changed dramatically from a severe disease to an asymptomatic condition in Western countries. The story is completely different in Eastern countries. Bone and joint related sign and symptoms like bone pain and multiple fractures are common in these patients. Imaging and nuclear medicine studies will be helpful specially in patient who candidate for surgical removal of the abnormal parathyroid gland. Here, we present a 48-year-old man with multiple typical fractures in long bones and a single adenoma in his right inferior parathyroid gland. pHPT is a severe, symptomatic disease with serious complications and high morbidity in Iran. Advanced skeletal disease is the most common pattern of presentation

Association between individual, household, and area-level socioeconomic status indicators and sensorineural hearing loss in adults in southwest Iran: a population-based study

IntroductionHearing loss is the fourth most common chronic disease, but studies on the relationship between hearing loss and socioeconomic factors are limited. We aimed to examine the association between hearing loss and socioeconomic factors among 35–70 year adults in southwest Iran.Materials and methodsThis population-based cross-sectional study was conducted in the baseline of Hoveyzeh cohort study in adults aged 35–70 in southwest Iran between 2017 and 2021. Information on socioeconomic factors, demographic characteristics, comorbidities, family history of hearing loss, and noise exposure was collected. We assessed the relationship between three levels of socioeconomic factors (individual, household, and area level) with sensorineural hearing loss (SNHL). Multiple logistic regression was used to adjust the potential confounders.ResultsAmong a total of 1,365 assessed participants, 485 patients were diagnosed as having hearing loss, and the other 880 individuals were diagnosed without hearing loss, which is considered the case and the control group, respectively. At the individual level of socioeconomic, the odds of having hearing loss in the participants with high school education and diploma, [OR = 0.51 (95%CI:0.28–0.92)], and the individuals with university education [OR = 0.44 (95%CI:0.22–0.87)] were significantly lower than the illiterate participants. At the household socioeconomic level, the odds of having hearing loss were lower for those with poor [OR = 0.63 (95%CI:0.41–0.97)] and moderate [OR = 0.62 (95%CI:0.41–0.94)] wealth status vs. those with the poorest wealth status. In the area level socioeconomic, although the odds of hearing loss in the residents of affluent areas were slightly lower than the residents of deprived areas, there was no significant difference among the groups.ConclusionThe individuals with hearing loss may have insufficient education and income

The Role of Health Literacy in Reducing Healthcare Costs and Referring to the Hospital among Elderly

Introduction: Health literacy is the capacity of individuals to obtain, process and understand information about basic health services needed to make appropriate health decisions. Inadequate health literacy is associated with a variety of adverse health consequences and inappropriate use of health care. The purpose of this study is to investigate the relationship between patients' health literacy level and the cost of treatment among the elderly. Methods: The present study was a descriptive-analytical study. The research sample was 1008 main pensioners of the Social Security Organization in Ahvaz. The research instruments were two questionnaires entitled Test Of Functional Health Literacy  in Adults (TOFHLA) and Health Services Utilization Questionnaire. The obtained data were analyzed by SPSS software. Descriptive statistics (frequency, mean and standard deviation) and analytical statistics (Pearson and Spearman correlation) with a significance level of 0.5 were used. Results: The findings of this study showed that more than 80% of the participants have inadequate health literacy. The results also show the inverse and negative relationship between people's health literacy and the number of referrals to health centers and also its inverse relationship with treatment costs. Conclusion: Improving the level of health literacy reduces the cost of treatment in the health system and also increases the level of welfare and health in individuals, and this is especially important in the elderly whose health needs are higher than ordinary people. To educate and promote health literacy, one must turn to social contact points with the elderly, including libraries and librarians

Investigating the Effect of Cochlear Size in Insertion of Electrode Depth in Patients with Cochlear Implantation evaluated by CT-Scan

Background Cochlear implant surgery is an invasive procedure for patients with bilateral Sensorineural hearing loss and may cause some risks such as cochlear damage. We aimed to evaluate the effectiveness of cochlear measures obtained by computed tomography (CT) scan in predicting depth of cochlear implant insertion. Materials and Methods This study was conducted in a retrospective and cross-sectional study on 39 patients undergoing cochlear implantation with MED-EL Device. High-resolution radiographs provided preoperative by CT-Scan were used to determine electrode array insertion depth and diameter of the cochlea’s basal turn. The insertion was considered deep when the electrode was placed at least 22 mm into the cochlea. Demographic data, CT-Scan results and cochlear implantation outcomes (deep or shallow) were evaluated. Data were analyzed by SPSS22 software and the significance level was less than 0.05. Results The mean age of patients was 8.026±1.77 years. The depth of insertion of the electrode in 34 (87.18%) patients was deep and in 5 (12.82%) patients was shallow that the difference was statistically significant (

A study on anti-diabetic and anti-hypertension herbs used in Lorestan province, Iran

Introduction: Diabetes and hypertension are amongst the most prevalent diseases in the world, while they can be controlled and prevented, create many problems and complications for affected patients. This study was aimed to identify and report the most important and effective herbs for diabetes and high blood pressure treatment in Lorestan province (West of Iran). Methods: By gathering and integrating indigenous data from local inhabitants of Lorestan, Iran, the goal of this study was accomplished. Data were gathered by cooperation of the agents of public health services network all over the towns of Dorud, Boroujerd, Khorramabad, Aleshtar, Poledokhtar, Aligoodarz, Nurabad and Kouhdasht. Results: Results of this study showed that there were overall 17 medicinal plants which were used for treatment and controlling of diabetes and high blood pressure. Conclusion: Medicinal plants reported in this study are indigenous to the Lorestan province. Some of the foresaid herbs seem to have some unknown therapeutic effects which are reported in this study for the first time, and some others have various known therapeutic effects mentioned in other similar studies. It is essential for researchers to find out the actuality of clinical effectiveness of the herbs and their active substances. Once the positive effects of these herbs proved, it would be possible to produce drugs which are useful in curing and controlling diabetes and hypertension.</p

Development and psychometric evaluation of the Persian version of the Phoneme Recognition Test A central auditory processing measure

&nbsp; Objectives The present study evaluating the psychometric properties of the Persian version of the Phoneme Recognition Test (P-PRT) in normal subjects and cochlear implant (CI) users. Material &amp; Methods This study includes developing the Persian phoneme recognition test (PRT), determining its validity and reliability, and comparing the results of a control group versus CI users. The test reliability was examined through a test-retest with an approximately five-week interval. In the present survey, 363 subjects were investigated in three stages. The face validity evaluation stage was conducted on 40 subjects. The psychometric properties of the P-PRT were evaluated in 323 individuals (225 normal subjects and 98 CI users). The test-retest reliability was examined in all the 225 subjects in the control groupand 40 CI users. ResultsThe results confirmed the face validity of the P-PRT. No significant differences were observed between the two genders in terms of performance in the P-PRT. Significant differences were observed between the control and CI groups. Evaluating the test-retest reliability suggested perfect reliability (r&gt;0.9) in both groups. Significant differences were observed in the P-PRT between the adults and the 7-year-old subjects compared to other age groups. Conclusion The P-PRT can be used as a valid and reliable test for clinically evaluating phoneme recognition abilities and monitoring the rehabilitation progres

A novel pathogenic variant in the MARVELD2 gene causes autosomal recessive non-syndromic hearing loss in an Iranian family

BACKGROUND AND AIMS: Hearing loss (HL) is the most common sensorineural disorder and one of the most common human defects. HL can be classified according to main criteria, including: the site (conductive, sensorineural and mixed), onset (pre-lingual and post-lingual), accompanying signs and symptoms (syndromic and non-syndromic), severity (mild, moderate, severe and profound) and mode of inheritance (Autosomal recessive, autosomal dominant, X-linked and mitochondrial). Autosomal recessive non-syndromic HL (ARNSHL) forms constitute a major share of the HL cases. In the present study, next-generation sequencing (NGS) was applied to investigate the underlying etiology of HL in a multiplex ARNSHL family from Khuzestan province, southwest Iran. METHODS: In this descriptive study, 20 multiplex ARNSHL families from Khuzestan province, southwest of Iran were recruited. After DNA extraction, genetic linkage analysis (GLA) was applied to screen for a panel of more prevalent loci. One family, which was not linked to these loci, was subjected to Otogenetics deafness Next Generation Sequencing (NGS) panel. RESULTS: NGS results showed a novel deletion-insertion variant (c.1555delinsAA) in the MARVELD2 gene. The variant which is a frameshift in the seventh exon of the MARVELD2 gene fulfills the criteria of being categorized as pathogenic according to the American College of Medical Genetics and Genomics (ACMG) guideline. CONCLUSION: NGS is very promising to identify the molecular etiology of highly heterogeneous diseases such as HL. MARVELD2 might be important in the etiology of HL in this region of Iran