Case Report Guidelines Research Articles

CARE Guidelines for Case Reports: Explanation and Elaboration Document. Translation into Russian

Background. Well-written and transparent case reports (1) reveal early signals of potential benefits, harms, and information on the use of resources; (2) provide information for clinical research and clinical practice guidelines, and (3) inform medical education. High-quality case reports are more likely when authors follow reporting guidelines. During 2011–2012, a group of clinicians, researchers, and journal editors developed recommendations for the accurate reporting of information in case reports that resulted in the CARE (CAse REport) Statement and Checklist. They were presented at the 2013 International Congress on Peer Review and Biomedical Publication, have been endorsed by multiple medical journals, and translated into nine languages.Objectives. This explanation and elaboration document has the objective to increase the use and dissemination of the CARE Checklist in writing and publishing case reports.Article design and setting. Each item from the CARE Checklist is explained and accompanied by published examples. The explanations and examples in this document are designed to support the writing of high-quality case reports by authors and their critical appraisal by editors, peer reviewers, and readers.Results and conclusion. This article and the 2013 CARE Statement and Checklist, available from the CARE website [www.care-statement.org] and the EQUATOR Network [www.equator-network.org], are resources for improving the completeness and transparency of case reports.Source. This article is a translation of the original paper «CARE guidelines for case reports: explanation and elaboration document» in the Journal of Clinical Epidemiology (doi: 10.1016/j.jclinepi.2017.04.026), prepared under the permission of the copyright holder (Elsevier Inc.), with supervision from the Scientific Editor by Professor E.G. Starostina, MD, PhD (translator) (Moscow, Russia). Present translation was first published in Digital Diagnostics. doi: 10.17816/DD105291. It is published with minor changes related to the literary editing of the translation itself. Keywords: case report; case study; EQUATOR network; health research reporting guidelines; CARE guideline; timelines; N-of-1 For citation: Riley David S., Barber Melissa S., Kienle Gunver S., Aronson Jeffrey K., von Schoen-Angerer Tido, Tugwell Peter, Kiene Helmut, Helfand Mark, Altman Douglas G., Sox Harold, Werthmann Paul G., Moher David, Rison Richard A., Shamseer Larissa, Koch Christian A., Sun Gordon H., Hanaway Patrick, Sudak Nancy L., Kaszkin-Bettag Marietta, Carpenter James E., Gagnier Joel J. CARE Guidelines for Case Reports: Explanation and Elaboration Document. Translation into Russian. Voprosy sovremennoi pediatrii — Current Pediatrics. 2023;22(2):88–108. (In Russ). doi: https://doi.org/10.15690/vsp.v22i2.2540

Rewarming Young Children After Drowning-Associated Hypothermia and Out-of-Hospital Cardiac Arrest: Analysis Using the CAse REport Guideline.

Extracorporeal membrane oxygenation (ECMO) is recommended in adults with drowning-associated hypothermia and out-of-hospital cardiac arrest (OHCA). Our experience of managing a drowned 2-year-old girl with hypothermia (23°C) and cardiac arrest (58 min) prompted this summary using the CAse REport (CARE) guideline to address the question of optimal rewarming procedure in such patients. Following the CARE guideline, we identified 24 reports in the "PubMed database" describing children less than or equal to 6 years old with a temperature less than or equal to 28°C who had been rewarmed using conventional intensive care ± ECMO. Adding our patient, we were able to analyze a total of 57 cases. The two groups (ECMO vs non-ECMO) differed with respect to submersion time, pH and potassium but not age, temperature or duration of cardiac arrest. However, 44 of 44 in the ECMO group were pulseless on arrival versus eight of 13 in the non-ECMO group. Regarding survival, 12 of 13 children (92%) undergoing conventional rewarming survived compared with 18 of 44 children (41%) undergoing ECMO. Among survivors, 11 of 12 children (91%) in the conventional group and 14 of 18 (77%) in the ECMO group had favorable outcome. We failed to identify any correlation between "rewarming rate" and "outcome." In this summary analysis, we conclude that conventional therapy should be initiated for drowned children with OHCA. However, if this therapy does not result in return of spontaneous circulation, a discussion of withdrawal of intensive care might be prudent when core temperature has reached 34°C. We suggest further work is needed using an international registry.

A cross-sectional study of the endorsement proportion of reporting guidelines in 1039 Chinese medical journals

BackgroundReporting quality is a critical issue in health sciences. Adopting the reporting guidelines has been approved to be an effective way of enhancing the reporting quality and transparency of clinical research. In 2012, we found that only 7 (7/1221, 0.6%) journals adopted the Consolidated Standards of Reporting Trials (CONSORT) statement in China. The aim of the study was to know the implementation status of CONSORT and other reporting guidelines about clinical studies in China.MethodsA cross-sectional bibliometric study was conducted. Eight medical databases were systematically searched, and 1039 medical journals published in mainland China, Hong Kong, Macau, and Taiwan were included. The basic characteristics, including subject, language, publication place, journal-indexed databases, and journal impact factors were extracted. The endorsement of reporting guidelines was assessed by a modified 5-level evaluation tool, namely i) positive active, ii) positive weak, iii) passive moderate, iv) passive weak and v) none.ResultsAmong included journals, 24.1% endorsed CONSORT, and 0.8% endorsed CONSORT extensions. For STROBE (STrengthening the Reporting of Observational Studies in Epidemiology), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), STARD (An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies), CARE (CAse REport guidelines), the endorsement proportion were 17.2, 16.6, 16.4, and 14.8% respectively. The endorsement proportion for SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials), TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis), AGREE (Appraisal of Guidelines, Research, and Evaluation), and RIGHT (Reporting Items for Practice Guidelines in Healthcare) were below 0.7%.ConclusionsOur results showed that the implementation of reporting guidelines was low. We suggest the following initiatives including i) enhancing the level of journal endorsement for reporting guidelines; ii) strengthening the collaboration among authors, reviewers, editors, and other stakeholders; iii) providing training courses for stakeholders; iv) establishing bases for reporting guidelines network in China; v) adopting the endorsement of reporting guidelines in the policies of the China Periodicals Association (CPA); vi) promoting Chinese medical journals into the international evaluation system and publish in English.

Atrial tachycardia in a patient with severe pectus excavatum

A 68-year-old woman underwent catheter ablation of drug-refractory atrial tachycardia (AT; cycle length 490 ms). A computed tomography scan of her chest showed severe pectus excavatum (PEX) (Figure 1A ). A voltage map using a multipolar high-density mapping catheter with the EnSite X mapping system (Abbott Technologies, Minneapolis, MN) revealed severe distortion of the right atrium (RA) and an extensive low-voltage area (LVA; <0.5 mV), which occupied 32% of the RA surface (Figure 1B). The AT demonstrated a centrifugal activation pattern arising at the inferior portion of the cavotricuspid isthmus (Online Supplemental Video 1), and the AT was eliminated by ablation at the earliest activation site on the LVA. In PEX, distortion of the right heart cavities can cause traction on the myocardial wall resulting in wall thinning. 1 Oezcan S. Attenhofer Jost C.H. Pfyffer M. et al. Pectus excavatum: echocardiography and cardiac MRI reveal frequent pericardial effusion and right-sided heart anomalies. Eur Heart J Cardiovasc Imaging. 2012; 13: 673-679 Crossref PubMed Scopus (44) Google Scholar In the present case, an extensive LVA was found in the area apart from the RA free wall and thus in the lower part of the RA and in the entire peri-tricuspid annulus, where more tractions can exert than normal and may result in wall thinning (Figure 1B). This makes it likely that the mechanism of the AT was either abnormal automaticity or microreentry caused by damage to the RA by severe PEX. This report adhered to CARE case report guidelines (https://www.care-statement.org/).

Think Global, Act Local

Think Global, Act Local

The Addition Of Bilateral Neurodynamics In Ultrasound Therapy And Manual Traction Intervention In Cervical Radiculopathy

Background: Cervical radiculopathy is a condition that characterized by pain and/or sensorimotor deficits caused by compression of one or more cervical nerve roots. The aim of this case series is to serve as a preliminary study to determine the effectiveness of adding bilateral neurodynamics to the intervention of ultrasound therapy and manual traction in cervical radiculopathy.&#x0D; Methods: The research writing method used CARE (CAseREport) guidelines, which consisted of: introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic intervention, follow-up and outcome, and discussion. The measuring instrument used in this study was the Visual Analogue Scale (VAS) in assessing tension pain when given neurodynamics and neck disabilities using the Indonesian version of the Neck Disability Index (NDI). The intervention was carried out 12 times (3 times a week for 4 weeks) and a follow-up was done at week 5.&#x0D; Results: The results showed that there was an improvement in the score of neck pain and disability in the 2 patients both at post-test and at follow-up.&#x0D; Conclusion: Based on these findings, it can be concluded that the application of additional bilateral neurodynamics in the intervention of ultrasound therapy and manual traction can help reduce pain and improve neck disability.

Case report papers guidelines: Recommendations for the reporting of case studies or action research in Business Management

Objective: To provide a working guide which facilitates the accuracy, transparency, and usefulness for academics and practitioners of case report papers as an article type which are fit for publishing in impact journals. In this way, we aim to increase the use and dissemination of recommendations in aid of the writing and publication of case study and action research. Theoretical framework: A case report paper presents a story in narrative form and includes current individual or organisational concerns, situational diagnoses, interventions, outcomes including adverse events, and follow-up. The narrative should include a discussion of the rationale for any conclusions and lessons learned. Method: We analysed the prevalence of these type of articles in publications as indexed in Web of Science (WOS) and in Scopus; we explain how we customised the case report guidelines (CAse REport or CARE) to optimise them for the scientific field of Management focussing particularly on Operations Management and Human Resources Management. We shared for discussion and feedback the adapted proposal among a group of academics and professionals in the field of Management. Outcomes/Implications: Robust reporting guidelines help to improve research performance, reduce bias risk, provide information on the implementation of management practices, support the training of management professionals, and enable informed editorial decisions by journal editors and reviewers.

Insufficient Evidence to Ascertain the Long-Term Survival of PEEK Dental Prostheses: A Systematic Review of Clinical Studies.

Introduction: Polyetheretherketone (PEEK) is a polymer that is used in the construction of orthopaedic and dental implants. It is also used to construct removable and fixed dental prostheses due to its superior mechanical and esthetic properties compared to conventional materials. This systematic review aims to analyse and appraise the literature concerning PEEK dental prostheses critically. Methods: The following focused question was constructed ‘Are dental prostheses made of PEEK inferior to those made of other materials in terms of clinical- and patient-reported outcomes?’. The CONSORT (Consolidated Standards of Reporting Trials) tool was used for the quality assessment of the randomised clinical trials. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) quality assessment tool was used to assess the quality of observational studies and the case reports were evaluated using the CARE (Case Report) guidelines. Results: A total of 12 studies were included in this review. Two case studies received an overall grade of medium and the overall quality of six studies was graded as ‘low’. All three observational studies and the only randomised controlled trial received scores of ‘medium’. Conclusion: PEEK-based dental prostheses may provide a viable and more esthetic alternative to conventional prosthodontic appliances. However, within the limitations of this study is the evidence to ascertain the long-term viability of PEEK-based dental prostheses. Future studies should focus on conducting large-scale, multicenter trials to compare the survival rate of PEEK prostheses to that of conventionally available prosthodontic appliances.

Methodology and reporting quality of 544 studies related to ageing: a continued discussion in setting priorities for ageing research in Africa

Background The quality assessment provides information on the overall strength of evidence and methodological quality of a research design, highlighting the level of confidence the reader should place on the findings for decision making. This paper aimed to assess the quality (methodology and quality of reporting) of ageing studies in Sub-Saharan Africa (SSA). Method This paper is the second of a Four-Part Series paper of a previous systematic mapping review of peer-reviewed literature on ageing studies conducted in SSA. We updated the literature search to include additional 32 articles, a total of 544 articles included in this paper. Downs &amp; Black checklist, Case Report guidelines checklist, the 45-items Lundgren et al. checklist, and the Mixed Method Appraisal Tool were used to assess the methodological quality of quantitative, case reports, qualitative, and mixed-method studies. Quality assessment was piloted and conducted in pairs for each study type. Depending on the checklist, each study was classified as excellent, good, fair, or poor. Result Of the 544 articles, we performed the quality assessment of a total of 451 quantitative studies [Randomized control trials (RCTs) and pre-post (n=15), longitudinal (n=122), case-control (n=15) and cross-sectional (n=300); 4 case reports, 74 qualitative and 15 mixed-method studies. Only 20.4% (n=111) articles were of high quality [one RCT, 27 longitudinal, 4 case-control, 48 cross-sectional studies, 19 qualitative, and 12 mixed-method studies]. The remaining 433 were rated as moderate quality (n=292, 53.7%), fair quality (n = 96, 17.7%) and poor quality (n = 45, 8.2%). Most (80%) quantitative articles’ sample size is small, resulting in insufficient power to detect a clinically or significant important effect. Three-quarter (75%) of the qualitative studies did not report their research team characteristics and a reflexivity component of the 45-items Lundgren et al. checklist. Mixed-method studies with low quality did not report the qualitative studies properly. Conclusion We conclude that the methodological and quality reporting of published studies on ageing in SSA show variable quality, albeit primarily moderate quality, against high quality. Studies with a large sample size are recommended, and qualitative researchers should provide a section on research team members’ characteristics and reflexivity in their paper or as an appendix.

Medial Epicondyle and Capitellar Fractures in a 4-Year-Old Girl: A Case Report

Although medial epicondyle fractures are responsible for 12% of pediatric elbow fractures, they rarely occur concurrently with a capitellar fracture, and the treatment approach and indications are controversial. According to the case report (CARE) guidelines, here we present a case of the medial epicondyle and capitellar fractures with elbow dislocation in a 4-year-old girl who underwent K-wire fixation and splint application. After four months of follow-up, the patient showed good results and a full range of motion. Open reduction and internal fixation may be reasonable options for medial epicondyle and concomitant capitellar fractures using the medial and lateral approaches. We suggest using K-wires, especially in the pediatric population.

CARE guidelines for case reports: explanation and elaboration document. Translation into Russian

BACKGROUND: Well-written and transparent case reports (1) reveal early signals of potential benefits, harms, and information on the use of resources; (2) provide information for clinical research and clinical practice guidelines, and (3) inform medical education. High-quality case reports are more likely when authors follow reporting guidelines. During 20112012, a group of clinicians, researchers, and journal editors developed recommendations for the accurate reporting of information in case reports that resulted in the CARE (CAse REport) Statement and Checklist. They were presented at the 2013 International Congress on Peer Review and Biomedical Publication, have been endorsed by multiple medical journals, and translated into nine languages.&#x0D; OBJECTIVES: This explanation and elaboration document has the objective to increase the use and dissemination of the CARE Checklist in writing and publishing case reports.&#x0D; ARTICLE DESIGN AND SETTING: Each item from the CARE Checklist is explained and accompanied by published examples. The explanations and examples in this document are designed to support the writing of high-quality case reports by authors and their critical appraisal by editors, peer reviewers, and readers.&#x0D; RESULTS AND CONCLUSION: This article and the 2013 CARE Statement and Checklist, available from the CARE website [www.care-statement.org] and the EQUATOR Network [www.equator-network.org], are resources for improving the completeness and transparency of case reports.&#x0D; SOURCE: This article is a translation of the original paper CARE guidelines for case reports: explanation and elaboration document in the Journal of Clinical Epidemiology (doi: 10.1016/j.jclinepi.2017.04.026), prepared under the permission of the copyright holder (Elsevier Inc.), with supervision from the Scientific Editor by Professor E.G. Starostina, MD, PhD (translator) (Moscow, Russia).

Acute Medial Ankle Pain in a 17-Yr-Old Basketball Player.

This study conforms to all case report guidelines and reports the required information accordingly (see Supplementary Checklist, Supplemental Digital Content 1, https://links.lww.com/PHM/B586). A 17-yr-old male collegiate basketball player with no medical history presented one day after developing new-onset left medial ankle pain during a practice in which he took 700 consecutive jump shots. The pain progressed, eventually limiting his ability to bear weight. He denied any previous left lower limb injuries. Pertinent physical examination findings included focal tenderness over the distal tibia 4 cm proximal to the medial malleolus, pain with passive dorsiflexion/eversion, and pain with both resisted plantarflexion/inversion and toe flexion. There was no adjacent erythema or effusion about the ankle present. The differential diagnosis included distal tibia stress reaction/fracture, posterior tibialis (PT), or flexor digitorum longus (FDL) tendinopathy, and flexor retinaculum injury. Radiographs were negative. Magnetic resonance imaging (MRI) demonstrated fluid signal and edema about the distal PT and FDL myotendinous junctions, with grossly normal-appearing tendons (Fig. 1).FIGURE 1: Axial oblique (A and B) and sagittal oblique (C) T2-weighted MRI of the left ankle demonstrating fluid signal and edema about the distal PT and FDL myotendinous junctions (arrows) within the distal medial lower leg. Panel D demonstrates corresponding AP plain films of the left ankle. Ant, anterior; EDL, extensor digitorum longus; EHL, extensor hallucis longus; FHL, flexor hallucis longus; G-S-A, gastroc-soleus-Achilles complex; Inf, inferior; Lat, lateral; Med, medial; PB, peroneus brevis; PL, peroneus longus; Post; posterior; Sup, superior.The final diagnosis was chiasma crurale intersection syndrome. After MRI ruled out bone stress injury (no evidence of periosteal or bone marrow edema), he was started on a 7-day course of oral ibuprofen 400 mg 3 times daily. He was weaned from his walking boot over the course of 5 days guided by pain-free ambulation, after which he started progressive strengthening. Ibuprofen was not recommended until after the MRI to minimize possible impairment in bone healing, had there been a stress injury. At 3 wks after injury, he had returned to play without symptoms. Chiasma crurale refers to the intersection of the PT and FDL tendons. A symptomatic intersection syndrome at the crossover of these two tendons has not been previously reported. Theoretically, an intersection syndrome can develop at any point where two tendons cross and have no tendon sheath or paratenon separating them, as this predisposes them to increased friction forces and inflammation in the setting of overuse. Intersection syndromes elsewhere in the body have been reported, most notably where the 1st dorsal extensor compartment crosses over the 2nd in the forearm.1,2 Diagnosis can be confirmed through MRI or ultrasound. Ultrasound findings in intersection syndromes include anechoic fluid with loss of the hyperechoic plane separating the tendons and possible increased power Doppler signal.3,4 Cadaveric studies have found that the chiasma crurale has no intervening tissue at its center, making it a potential site for an intersection syndrome.5 On average, its center is located 4.2 cm above the tibiotalar joint.5 Gross irregularities of the tendons at the chiasma crurale may be seen on imaging, without histologic evidence of tendon degeneration.5 When this is the case, a concurrent symptomatic PT tendinopathy should be considered and clinically evaluated for, although classically that pain is present closer to the tendon’s distal insertion. Treatment of intersection syndromes is similar to that of other overuse conditions. Initially, activity modification and load management education are implemented, followed by progressive mobilization, strengthening, and incorporation of sport-specific activities in athletes.6 For cases recalcitrant to the above measures, a corticosteroid injection can be considered. Surgical release and debridement of inflamed tenosynovium are rarely needed but remain an option when nonoperative measures have been exhausted. TEACHING POINTS Chiasma crurale refers to the intersection of the PT and FDL tendons in the posteromedial distal leg. Magnetic resonance imaging findings of fluid signal and edema about the distal PT and FDL myotendinous junctions within the distal lower leg, coupled with grossly normal-appearing tendons, suggest inflammation from an intersection syndrome. Chiasma crurale intersection syndrome is a rare cause of medial ankle pain and is generally responsive to conservative treatment.

Abducens Nerve Schwannoma: Case Report and Literature Review

AbstractThe authors describe a rare case of abducens nerve schwannoma, manifested with headache and diplopia, associated to right side cerebellar syndrome. During surgery, the authors identified that the origin of the tumor was from the abducens nerve, and the histopathological diagnosis confirmed that it was a schwannoma. A gross total tumor resection was performed, and the patient recovered from her symptoms 1 month after surgery. The authors followed the Case Report guidelines (CARE) guideline and the patient authorized the authors to publish the present case report by signing an informed consent form.

Protocol for developing the reporting guidelines for radiological case reports: Case Report for Radiology statement.

BackgroundIn radiology, case reports play an important role in the presentation of a new disease or an unusual form of a common disease using radiological images. Radiology practitioners can refer to the CAse REport (CARE) statement to write and improve the quality of case reports; however, some CARE items are not applicable to the field of radiology. This protocol seeks to describe the methods and processes used to develop CARE extensions for radiology.MethodsWe plan to extend the existing CARE guidelines to radiological case reports. We will follow the steps recommended by the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network to develop the CAse Report for Radiology (CARR) statement and checklist for the reporting of case reports. The working group will constitute a multidisciplinary international team of experts, including methodologists, content experts (radiologists and clinicians), journal editors, and possibly consumer representatives. We will discuss and generate a list of initial items based on the CARE statement. Two to three rounds of the Delphi survey will be administered and an online consensus meeting will be held to reach a consensus and develop the final CARR checklist. The full reporting guidelines should be finalized within 1.5 years.DiscussionThe annual number of published radiological case reports has increased over the past 20 years; however, the quality of reporting still needs to be improved. Our protocol envisages the process and methodology for the development of the CARR guidelines, which we anticipate will be available soon and will help radiology practitioners.Trial RegistrationWe have registered the protocol on the EQUATOR network (https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-observational-studies/#CARR)

Adherence of unpublished case reports to the Case Report (CARE) guidelines: a retrospective cross-sectional analysis of 139 case report manuscripts initially submitted to AME medical journals

Adherence of unpublished case reports to the Case Report (CARE) guidelines: a retrospective cross-sectional analysis of 139 case report manuscripts initially submitted to AME medical journals

Annals for Educators - January 2022.

Annals for Educators - January 2022.

Bilateral vestibulopathy and disabling vertigo: A CARE case series

IntroductionThe term bilateral vestibulopathy (BV) was recently defined by the Bárány Society. Loss of otolith function was not included in their criteria. Although spontaneous progression to complete bilateral impairment of vestibular function is expected, it is unlikely that patients with advanced BV will continue to present episodes of intense vertigo. Here, following CARE case report guidelines, we report the case of patients meeting the criteria for BV and still disabled by vertigo. Case seriesThree patients evaluated in our department meeting the Bárány criteria for definite BV but still complaining of disabling rotatory vertigo were included. All underwent clinical and instrumental vestibular examination. The observations are reported. ConclusionIn case of BV, the conservation of a stable otolithic reference frame could allow patients to optimize postural strategy. It would be useful to revisit a classification of BV by stages, by introducing an evaluation of otolithic function and postural control for possible subsequent vestibular implantation.

Effects of Manna of Alhagi persarum (Taranjabin) and Portulaca oleracea (Khorfeh) Seed Administration on Nickel-induced Allergic Contact Dermatitis: A Case Report

A 19-year-old girl with documented nickel-induced allergic contact dermatitis was referred to the department of traditional Persian medicine five weeks after the sudden onset of bolus and erythematous skin rash to receive treatment based on complementary and alternative medicine. A detailed history of jewelry exposures, lifestyle, food intake, and dietary habits was obtained, as well as the history of other physicians� visits and administered treatments within the past eight weeks. Despite receiving treatment with corticosteroids, anti-histamines, and antibiotics, no satisfactory remission was achieved, and the patient discontinued the treatments. As the alternative medicine approach, treatment was started based on avoiding contact with nickel, administration of Manna of Alhagi persarum and Portulaca oleracea seeds, and avoidance of consuming tomato sauce, cocoa, coffee, and bitter chocolate. Within six weeks, a complete remission of the skin lesions and symptoms occurred. Moreover, normal clinical follow-up was observed after 12 months. Notably, the CARE (CAse REport) guidelines were used in the preparation of this case report.

A new genetic variant causing auditory neuropathy: A CARE case report

IntroductionAuditory neuropathy refers to impaired synchronization of the auditory signal along the cochlear nerve. The present study, following CARE case report guidelines, describes a case of auditory neuropathy secondary to a genetic variant not previously described. ObservationAn 18-year-old patient was followed for multiple learning disorder. His main complaint was speech comprehension, especially in noise. Auditory neuropathy was diagnosed on electrophysiological criteria, linked to a 2.66Mb deletion on the short arm of chromosome 16, at 16p13.11p12.3 (15,492,317-18,162,167, according to the hg19 version of the human reference genome). Adapted speech therapy sessions with auditory training for intelligibility in noise and a hearing aid with high-frequency microphone were prescribed. At 6months, the patient reported improvement in understanding speech in noise. ConclusionThe involvement of this 16p13.11 deletion in the patient's symptomatology was not obvious, in a probable context of incomplete penetrance and variable expression. Early diagnosis of auditory neuropathy allowed implementation of better adapted multidisciplinary specialized management.

Recovery from Idiopathic Facial Paralysis (Bell’s Palsy) Using Photobiomodulation in Patients Non-Responsive to Standard Treatment: A Case Series Study

Diminished facial movement and marked facial asymmetry can lead to a consistent psychological burden. Bell′s palsy (BP) is one of the most common causes of facial nerve illness, which comes with unilateral acute facial paresis. Nowadays, no clear guidelines for treating BP are available. We carried out a case series study to test the efficacy of photobiomodulation (PBM) therapy in patients with BP non-responsive to standard treatment. The study was experimentally performed at the Department of Surgical and Diagnostic Sciences, University of Genoa (Genoa, Italy), in accordance with case report guidelines. Patients were referred to our department by colleagues for evaluation to be included in the case series because no consistent improvement was observed at least 3 months from the diagnosis of BP. All the patients interrupted their pharmacological therapy before the initiation of PBM therapy. PBM therapy (808 nm, 1 W irradiated in continuous-wave for 60 s on spot-size 1 cm2; 1 W/cm2; 60 J/cm2; and 60 J) was administered every 2 days until complete resolution. Evaluation of the House-Brackmann scale was performed before and after treatments. Fourteen patients were screened as eligible for the study. Patients were Caucasians (36% females and 64% males) with a mean age ± standard deviation of 56.07 ± 15.21 years. Eleven patients out of 14, who experienced BP a maximum of 6 months, completely recovered through PBM. The three patients that did not show improvement were those who had experienced BP for years. PBM could be a supportive therapy for the management of BP in patients non-responsive to standard treatment. However, randomized controlled trials are necessary to sustain our encouraging results, exclude bias, and better explain the boundary between the time from diagnosis and the recovery of BP through PBM therapy.