Various aspects of hearing loss in newborns:A narrative review

Hearing loss is considered the most common birth defect.The estimated prevalence of moderate and severe hearing loss in a normal newborn is 0.1%-0.3%,while the prevalence is 2%-4%in newborns admitted to the newborn intensive care unit.Neonatal hearing loss can be congenital(syndromic or nonsyndromic)or acquired such as ototoxicity.In addition,the types of hearing loss can be conductive,sensorineural,or mixed.Hearing is vital for the acquisition of language and learning.Therefore,early detection and prompt treatment are of utmost importance in preventing the unwanted sequel of hearing loss.The hearing screening program is mandatory in many nations,especially for high-risk newborns.An automated auditory brainstem response test is used as a screening tool in newborns admitted to the newborn intensive care unit.Moreover,genetic testing and screening for cytomegalovirus in newborns are essential in identifying the cause of hearing loss,particularly,mild and delayed onset types of hearing loss.We aimed to update the knowledge on the various aspects of hearing loss in newborns with regard to the epidemiology,risk factors,causes,screening program,investigations,and different modalities of treatment.

Facial basal cell carcinoma:A retrospective study of 67 cases

BACKGROUND Basal cell carcinoma(BCC)is a slow-growing malignant tumor characterized by local invasiveness but an exceptionally rare metastatic potential.It ideally affects sun-exposed skin of older patients with more propensity for the facial region.AIM To evaluate the different clinicopathological characteristics of the facial BCC and the efficacy and safety of diode laser for the treatment of these lesions.METHODS We retrospectively reviewed facial BCC lesions of<1.5 cm in diameter and subjected them to diode laser ablation during the period from September 2016 to August 2021 at Al-Ramadi Teaching Hospital,Ramadi City,Iraq.Data matching the age,gender,duration,site,and clinical and histological types were registered for every subject.The functional and aesthetic outcomes and complications following diode laser ablation for each patient were also recorded.RESULTS Of 67 patients with facial BCC,there was 65.67%from the age group≥60 years and 58.21%males.The mean duration of the lesions was 5.15±1.836 mo.The most involved location was the nose(29.85%).About half of the cases belong to the noduloulcerative type.Solid histological type comprises 40.3%of the cases,while the least was keratotic(13.4%).Moreover,65.2%of the solid cases were from the age group≤60 years and 38.6%of the adenoid type from the age group>60 years(P value=0.007).Excellent aesthetic and functional outcomes were reported in all cases after 6 mo of follow-up.Few complications were reported after diode laser ablation.CONCLUSION Facial BCC was mostly seen in the elderly and men.The mean duration was 5.15 mo.The nose was the commonest involved site.Noduloulcerative lesions were seen in approximately half of the lesions.The age of the patients determined the histological type of the lesion(solid type was mostly seen in the age group≤60 years,while,adenoid in the age group>60 years).Diode laser ablation showed excellent functional and aesthetic outcomes following a 6-mo follow-up.

Elabela is a reliable biomarker for predicting early onset preeclampsia:A comparative study

BACKGROUND Preeclampsia(PE)is a multisystemic metabolic disease with an undetermined etiology.PE is a worldwide cause of maternal and perinatal morbidity,subdivided into early(EoPE)and late-onset(LoPE)according to 34 wk of gestation as a divider.Many researchers investigated biomarkers for predicting PE to halt its consequences on the feto-maternal outcome.Elabela(Ela)is a newly discovered peptide hormone that was implicated in PE pathogenesis.Earlier rodent studies discussed Ela’s role in controlling blood pressure.Moreover,Ela deficiency was associated with PE development.AIM To test whether plasma Ela could serve as a reliable marker for predicting PE based on the time of onset(EoPE vs LoPE)compared to age and body mass matched healthy controls since no definitive treatment exists for PE but to terminate a pregnancy.METHODS This case-control study recruited(n=90)pregnant who fulfilled inclusion criteria;they were allocated into three groups:EoPE(30/90)(<34 wk of gestation);LoPE(30/90)(≥34 wk of gestation);and healthy pregnant(30/90).Demographic criteria;biochemical,hematological,and maternal plasma Ela levels were recorded for comparison.RESULTS Serum Ela was significantly reduced in EoPE compared to LoPE and healthy controls(P=0.0023).The correlation confirmed a strong inverse relationship with mean atrial blood pressure(r=-0.7,P<0.001),while gestational age and platelets count showed a moderate correlation with(r=0.4 with P<0.0001).No correlation was confirmed between the body mass index(BMI)and urine albumin.The predictive ability of 25 centile serum Ela had an Odds ratio of 5.21,95%confidence interval(1.28,21.24),P=0.02 for predicting EoPE.The receiver operator characteristic curve defined the Ela cutoff value at>9.156 with 96.7%and 93.3%sensitivity and specificity,P<0.0001 in predicting EoPE.CONCLUSION A strong correlation of serum Ela with PE parameters with excellent sensitivity and specificity in distinguishing EoPE independent of the BMI,age,and blood pressure which makes Ela a recommendable marker in screening.Further research is warranted to explore prognostic and therapeutic applications for Ela in PE.

Liver dysfunction-related COVID-19:A narrative review

The coronavirus 2019 disease(COVID-19)is caused by a novel coronavirus,severe acute respiratory syndrome coronavirus 2.This disease was designated by the World Health Organization as a pandemic on March 11,2020,which is not seen before.There are no classical features among the cases of the disease owing to the involvement of nearly all body tissues by the virus.Hepatic involvement is one of the characteristics of the COVID-19 course.There are six possible mechanisms of such involvement:Direct virus injury,drug-induced effect,inflammatory cytokine storm,hypoxia-ischemic destruction,abnormalities in liver function tests,and pre-existing chronic liver diseases.Liver abnormalities are seen commonly in the severe or critical stage of COVID-19.Therefore,these abnormalities determine the COVID-19 severity and carry a high rate of morbidity and mortality.The elderly and patients with comorbidities like diabetes mellitus and hypertension are more vulnerable to liver involvement.Another issue that needs to be disclosed is the liver manifestations following the COVID-19 vaccination,such as autoimmune hepatitis.Of note,complete vaccination with third and fourth booster doses is necessary for patients with previous chronic liver diseases or those who have been subjected to liver transplantation.This review aims to explore the various aspects of liver dysfunction during the COVID-19 course regarding the epidemiological features,predisposing factors,pathophysiological mechanisms,hepatic manifestations due to COVID-19 or following vaccination,role of liver function tests in the assessment of COVID-19 severity,adverse effects of the therapeutic agents for the disease,and prognosis.

Wet cupping(Al-hijamah)as a strange cause of ear trauma:A case report

BACKGROUND Cupping therapy is used across the globe since ancient Egypt.It is used as a complementary or alternative to daily clinical practice.Cupping therapy could be dry or wet(Al-hijamah)type.It is considered a relatively safe procedure for a variety of clinical problems like lower backache,shoulder pain,neck pain,headache,and migraine.Application of cupping therapy over body orifices is contraindicated.CASE SUMMARY A 27-year-old gentleman presented with sudden left-sided hearing loss and tinnitus for 7 d.He gave a history of upper respiratory tract infection 14 d before his complaints.He received Al-hijamah over his left ear 3 d before seeking advice from the Otolaryngology clinic,but without benefit.Physical examination showed a dull-looking left ear drum,hemotympanum in the posterior part of the tympanic cavity,two blood clots over the eardrum,and multiple bleeding points over the external ear canal and tympanic membrane.A pure tone audiogram and tympanogram confirmed the diagnosis of middle ear effusion.Conservative treatment(avoidance of water entry,antibiotics,and local and systemic decongestants)was given for 5 d.The presenting symptoms as well as ear injuries resolved completely two weeks after the follow-up.CONCLUSION We do not recommend using Al-hijamah directly over the ear as a treatment option for hearing loss to avoid unwanted ear trauma as well as there is no benefit from this kind of treatment.

Update on hydroxychloroquine use in pregnancy

It is well-known that hydroxychloroquine(HCQ)treats malaria,systemic lupus erythematosus,and rheumatoid arthritis in women for its immunomodulatory and anti-inflammatory action.Additionally,HCQ was used in cases with refractory antiphospholipid syndrome.HCQ safety was reinforced in pregnant women owing to insignificant reports of adverse pregnancy outcomes and major congenital malformation.Recently,HCQ was tested in cases with chronic placental inflammation with a promising result of increased life birth;however,its benefit needs further validation.We aimed to highlight the recent updates for HCQ use in various conditions in pregnancy.

Ear,nose,and throat manifestations of COVID-19 and its vaccines

Coronavirus disease 2019(COVID-19)is a highly infectious disease and was designated a pandemic by the World Health Organization(WHO)on March 11,2020.There are no classical manifestations of the disease.The most prevalent symptoms include fever,cough,dyspnea,myalgia and headache.The main route of transmission of the severe acute respiratory syndrome coronavirus-2 is through the upper respiratory tract.Therefore,it is not strange to find different ear,nose and throat(ENT)symptoms in individuals infected with this virus.Olfactory dysfunction is a common feature of COVID-19;either it is the only presenting symptom or it accompanies other manifestations of the disease.Other otolaryngological features such as sudden sensorineural hearing loss(SSNHL),dysphonia,nasal obstruction,sore throat,etc.are less frequent manifestations of COVID-19.These features,in addition,to being presented early in the disease process,certain long-standing symptoms like parosmia,dysphonia,and persistent deafness,are other characteristics of the disease.Geographical variation in otorhinolaryngological prevalence is another problem with this debilitating disease.Local and systemic adverse effects(local site injection pain,fever,myalgia,headache,and others)of the COVID-19 vaccines are more frequent than otolaryngological side effects(anosmia,hyposmia,Bell’s palsy,SSNHL,etc.).We aimed in this review to summarize the early and persistent ENT symptoms of COVID-19 or after the various COVID-19 vaccines.

Neurotrophins differentially stimulate the growth of cochlear neurites on collagen surfaces and in gels

The electrodes of a cochlear implant are located far from the surviving neurons of the spiral ganglion, which results in decreased precision of neural activation compared to the normal ear. If the neurons could be induced to extend neurites toward the implant, it might be possible to stimulate more discrete subpopulations of neurons, and to increase the resolution of the device. However, a major barrier to neurite growth toward a cochlear implant is the fluid filling the scala tympani, which separates the neurons from the electrodes. The goal of this study was to evaluate the growth of cochlear neurites in three-dimensional extracellular matrix molecule gels, and to increase biocompatibility by using fibroblasts stably transfected to produce neurotrophin-3 and brain-derived neurotrophic factor. Spiral ganglion explants from neonatal rats were evaluated in cultures. They were exposed to soluble neurotrophins, cells transfected to secrete neurotrophins, and/or collagen gels. We found that cochlear neurites grew readily on collagen surfaces and in three-dimensional collagen gels. Co-culture with cells producing neurotrophin-3 resulted in increased numbers of neurites, and neurites that were longer than when explants were cultured with control fibroblasts stably transfected with green fluorescent protein. Brain-derived neurotrophic factor-producing cells resulted in a more dramatic increase in the number of neurites, but there was no significant effect on neurite length. It is suggested that extracellular matrix molecule gels and cells transfected to produce neurotrophins offer an opportunity to attract spiral ganglion neurites toward a cochlear implant.

Screening antioxidants for the protection of cochlear sensory cells

Sensory cell damage is a major cause of hearing loss： Sensorineural hearing loss （SNHL） is a common sensory deficit characterized by tissue damage and/or cell death in the cochlea. Moderate and severe SNHL causes deficits in communication, associated with increased isolation from human relationships, and negativly impacts employabflity. Many etiologies have been associated with SNHL： Noise overexposure, certain drugs, inner or middle ear infection or immune-induced inflammation being common. However, the most prevalent form of SNHL is presbycusis or age-related hearing loss, often aggravated by other factors including a history of noise exposure, diabetes or high blood pressure （Wong and Ryan, 2015）. Though systemic steroids are used in the treatment of sudden SNHL, other drugs to prevent or cure hearing loss have not yet been developed. Cochlear sensory cells, known as hair cells （HCs） and neurons have very limited repair capacity. Moreover since these cells do not regenerate, making any loss permanent, prevention of cell damage is critical to protecting hearing.

Rhino-orbital-cerebral mucormycosis as a complication of coronavirus disease 2019

Coronavirus disease 2019 is a highly contagious respiratory disease caused by severe acute respiratory syndrome coronavirus 2.This disease as well as its various treatments like steroids,antivirals,and antibacterials can alter the immune state of the affected individuals and result in secondary infections such as mucormycosis.Mucormycosis is a well-known opportunistic fungal infection that affects immunocompromised subjects,particularly those with diabetes mellitus,prolonged antibiotic or steroid use,and patients with organ transplantation,neutropenia,and hematological malignancies.Rhino-orbital-cerebral mucormycosis is an aggressive disease owing to its ability to invade the blood vessels by fungal hyphae,leading to necrosis of the involved structures.Large cases were reported from India,indicating that this clinical entity shows a geographical variation.The affected patients are suffering on a clinical spectrum depending on the stage of the disease.Radiological assessment,including computerized tomography and magnetic resonance imaging,is necessary to evaluate the stage of the disease and choose the appropriate surgical treatment.A multidisciplinary approach is required to treat rhino-orbital-cerebral mucormycosis and includes local or intravenous antifungal drugs,debridement of the dead tissues,and appropriate management of any predisposing conditions.The disease has a very poor prognosis with a death rate of 50%.This review aimed to sum-marize the demographic and clinical risk factors,investigations,treatments,and outcomes of coronavirus disease 2019 patients with rhino-orbital-cerebral mucormycosis.