Study Group Research Articles

Use of Cervical Fascia to Prevent Pharyngocutaneus Fistula After Total Laryngectomy.

This study aimed to compare the pharyngocutaneous fistula (PCF) between patients who underwent reconstruction using cervical fascia after total laryngectomy and those who did not and to investigate the factors affecting PCF rates. We retrospectively compared 22 patients operated between February 2021 and March 2023 who received cervical fascia flap as the study group and 21 patients operated between January 2018 and March 2023 who did not receive fascia flap as the control group. The study included patients who underwent total laryngectomy for Stage 3 and 4 squamous cell laryngeal cancer. We included 43 patients, with 22 (51.2%) and 21 patients (48.8%) in the study and control groups, respectively. The age and sex were not different between the two groups (p = 0.471, p = 0.176, respectively). The distribution of patients as per sex, smoking, alcohol use, chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and multiple comorbidities was similar in both groups (p > 0.05). PCF was observed in one patient (4.5%) and seven patients (33.3%) in the study and control groups, respectively. The PCF rate was significantly lower in the study group (p = 0.021). When the relationship between flap use and risk factors was compared by correlation analysis, a moderate negative relationship was found between flap use and PCF (p = 0.015, r = -0.370). The use of a cervical fascia flap is effective in reducing fistula rates after total laryngectomy. Its main advantages include being technically simpler than alternative techniques, locally available, cost-effective. 3 Laryngoscope, 134:4964-4970, 2024.

Does immunohistochemical staining predict mobilization success in multiple myeloma patients?

BackgroundSo many risk factors for mobilization failure have been described so far. We aimed to identify the risk factors and search the possible effects of bone marrow fibrosis (BMF), CD56, c-myc, and cyclinD1 expression on mobilization. MethodsWe evaluated 189 patients with MM who were admitted for stem cell mobilization before autologous stem cell transplantation (ASCT) between 2015 and June 2021. Clinical, laboratory, treatment features, and survival outcomes were compared in patients who were successfully mobilized and who were not. ResultsMobilization failure rate was 11.1% (21) in our study group. Male gender, mobilization with only G-CSF, history of previous ASCT, lenalidomide exposure, and 2 lines of chemotherapy before stem cell mobilization were observed more commonly in mobilization failure group. There is no relationship between mobilization failure and BMF, CD56, c-myc, and cyclin D1 expression status in patients who received either only G-CSF or G-CSF+ chemotherapy for mobilization. Overall survival (OS) was not different in groups of patients who were successfully mobilized and who were not. Neutrophil engraftment was faster in patients who were transfused > 5 × 106/kg stem cells (p=0.015). ECOG performance status (p=0.004), c-myc expression (p=0.005), lenalidomide therapy before mobilization (p=0.032), and mobilization with G-CSF+chemotherapy was found to be predictive factors for OS. ConclusionEven though we could not find any predictive value of CD56, c-myc, and cyclin D1 expression on mobilization, c-myc was found to be associated with low OS. Further studies with large and homogenous study population would be more informative.

Extracellular Volume and Fibrosis Volume of Left Ventricular Myocardium Assessed by Cardiac Magnetic Resonance in Vaccinated and Unvaccinated Patients with a History of SARS-CoV-2 Infection.

Cardiac magnetic resonance (CMR) enables the assessment of tissue characteristics of the myocardium. Changes in the extracellular volume (ECV) and fibrosis volume (FV) of the myocardium are sensitive and early pathogenetic markers and have prognostic significance. The aim of the study was to assess ECV and FV of left ventricular myocardium in T1 mapping sequence in patients with a history of SARS-CoV-2 infection, considering vaccination status against COVID-19. The study group consisted of 97 patients (52.54 ± 8.31years, 53% women and 47% men). The participants were divided into three subgroups: A) patients with a history of symptomatic SARS-CoV-2 infection, unvaccinated against COVID-19 (n = 39), B) patients with a history of symptomatic SARS-CoV-2 infection, with a full vaccination schedule against COVID-19 (n = 22), and C) persons without a history of SARS-CoV-2 infection constituting the control subgroup (C, n = 36). All patients underwent 1.5T cardiac magnetic resonance. In subgroup A compared to subgroups B and C, both the ECV whole myocardium and ECV segments 2, 5-6, 8, and 10-11 were statistically significantly higher. In addition, the ECV segment 16 was statistically significantly higher in subgroup A than in subgroup C. Also, the FV whole myocardium was statistically significantly higher in subgroup A in comparison to subgroups B and C. There were no significant differences in ECV and FV between subgroups B and C. In summary, unvaccinated against COVID-19 patients with a history of symptomatic SARS-CoV-2 infection have higher myocardial ECV and FV values in the T1 mapping sequence, compared to those without COVID-19 and those suffering from COVID-19, previously vaccinated with the full vaccination schedule.

Serum microRNA qPCR profiling and validation indicate upregulation of circulating miR-145-5p and miR-26a-5p in migraineurs

Abstract Background In recent years, miRNAs found in biological fluids have gained interest as biomarkers of numerous conditions, including migraine. This study aimed to identify differences in the levels of circulating miRNAs in the serum of migraineurs as compared to healthy controls, as well as between patients with different types of migraine and during the ictal and nonictal phases of the condition. Methods The screening phase of the study included serum from 13 migraine patients and 13 sex and age matched controls. A panel of 179 miRNAs was analysed using locked nucleic acid SYBR based qPCR. Based on statistical analysis (U Mann-Whitney test) and data from existing literature, nine miRNAs were selected for validation by TaqMan qPCR in an independent cohort of 26 migraineurs and eleven healthy controls. For comparison between the study and control group, U Mann-Whitney test was performed. The differences between patients with chronic and episodic migraine, migraine with and without aura and in ictal and nonictal phases were analysed with Kruskal-Wallis test. The results were corrected for multiple comparisons using Benjamini-Hochberg method. In all analysis p value ≤ 0,05 was considered as significant. Results Two miRNAs, miR-145-5p and miR-26a-5p were significantly upregulated in serum of migraineurs compared to healthy controls. MiRNA-19a-3p was downregulated in patients currently experiencing migraine headache compared to those in the interictal period. No differences were found between patients with different migraine types. Conclusion The results of our study add to the growing body of evidence for dysregulation of the circulating miRNA profile by migraine. They are further supported by previous reports on differential expression of miR-145-5p, miR-26a-5p and miR-19a-3p in migraineurs. However, more research on larger populations is needed to validate these findings, as well as elucidate the role of circulating miRNAs in the condition. Moreover, to wholly explore the biomarker potential of miRNAs, migraine patients should not only be compared to healthy controls but also to populations with different headache disorders. Graphical Abstract

A double-edged sword effect of silver nanoparticles on angiogenesis in 4T1 breast cancer-bearing mice.

Silver nanoparticles (AgNPs) are increasingly known to have anticancer effects, but few studies have examined their adverse effects, so the underlying mechanisms are not yet fully understood. The current study investigated the critical influence of AgNPs on angiogenesis in 4T1 breast cancer-bearing mice. The sub-lethal dose of AgNPs (0.25mg/kg) was carried out. Female BALB/c mice (N = 35) were divided into 7 groups; normal control, cancer control, AgNPs control (one dose of (0.25mg/kg) AgNPs), single dose AgNPs before cancer, single dose AgNPs after cancer, 5 doses AgNPs after cancer, and doxorubicin. 4T1 breast cancer cell induction was performed subcutaneously on the left flank. Intraperitoneal (IP) administration of AgNPs and doxorubicin was carried out for all studied groups. Weight gain was normal in all study groups except the doxorubicin-treated group. Administering AgNPs before cancer induction promotes tumorigenesis, raises MMP-2 and MMP-9 activity, and increases CD31 and Ki67 expression. The cancer control group experienced the same outcomes. On the other hand, depending on the administered doses, the injection of AgNPs after tumor induction resulted in a notable decrease in tumor volume.In the doxorubicin-treated group, similar results were observed, while a dose of AgNPs‌ before cancer induction lead to increasing tumor volume compared to the cancer control group. The differences of biochemical markers including LDH, ALP, AST, ALT, BUN, and Cr between different groups were not significant. Significant differences were seen among all studied groups except doxorubicin and single dose AgNPs before cancer groups for serum TAC levels. It appears that AgNPs are considered a double-edged sword in the fight against cancer. AgNPs not only have anti-cancer effects on tumor size and angiogenesis, but they also might have cancer-stimulating roles. To confirm this conclusion, more detailed investigations are needed.

An association between the blood perfusion parameters in foot tissues and the severity of arterial occlusion and stenosis in the lower extremities

Rationale: Peripheral artery disease (PAD) is common among the elderly and increases the risk of cardiovascular events, disability and death. PAD course and outcomes depend not only on the condition of macrovasculature but also on the tissue perfusion. We have previously shown that Type 2 diabetic patients with lower extremity ischemia have significantly lower perfusion than healthy volunteers, and the ratio of basal perfusion in the arm and leg (BP1/BP3) measured by incoherent optical fluctuation flowmetry (IOFF) allows to identify hemodynamically significant stenoses. Aim: To analyze associations between perfusion parameters registered by IOFF and the severity of vascular involvement in PAD patients. Methods: This single center cross-sectional study included 38 PAD patients admitted to the Department of Vascular Surgery and Coronary Artery Disease. The arteries were assessed with duplex Doppler ultrasonography (DDU), according to the results of which the PAD severity score and ankle-brachial index (ABI) were calculated. Skin microhemodynamic parameters were recorded by IOFF. The basal perfusion on the arm (BP1), the dorsal foot surface and the toe (BP2 and BP3), the ratio BP1/BP3, local thermal hyperemia (LTH2 and LTH3) and an increase in perfusion after heating on two leg zones (LTH2-BP2, LTH3-BP3) were evaluated and expressed in perfusion units (PU). BP1, BP3, and BP1/BP3 values were additionally measured with laser Doppler flowmetry (LDF). The analysis was performed depending on the degree of arterial involvement determined by DDU for each limb separately (n = 73). There were ≥ 50% stenoses in 15 extremities (Group 1), occlusion of one of the major arteries in 42 (Group 2) and ≥ 2 occlusions in 16 lower extremities (Group 3). Results: In the groups 1, 2 and 3, the values of most parameters estimated by IOFF decreased with an increase in severity of limb lesions. As an example, the respective perfusion parameters for the big toe in the study groups were as follows: BP3 4.0 [2.0; 9.8], 2.2 [0.9; 3.7] and 1.1 [0.7; 2.6] PU (p = 0.007); LTH3 10.0 [6.4; 14.9], 5.0 [1.5; 7.8] and 2.5 [1.4; 4.5] PU (p 0.001), and LTH3-BP3 3.8 [2.6; 7.8], 2.4 [0.6; 4.3] and 1.2 [0.4; 1.5] PU (p = 0.001). The BP1/BP3 ratio in the above mentioned group increased: 1.8 [0.8; 7.7], 7.2 [3.4; 21.3] and 14.2 [6.6; 18.3] (p = 0.004), respectively. No similar trend was found for this parameter registered by LDF. There were significant correlations between the lower extremities perfusion parameters measured by IOFF and ABI, with the correlation coefficients ranging from 0.365 to 0.717 (p 0.05). Conclusion: The functional parameters of the skin microhemodynamics vary with different PAD severity. In addition, they correlate with clinical indicators of atherosclerosis. The IOFF technique can be promising as an additional quantitative method for assessment of microvascular blood flow in patients with PAD.

Revisiting tuberculosis diagnosis: the prospect of urine lipoarabinomannan assay as a diagnostic tool in people living with human immunodeficiency virus

Abstract Background Tuberculosis, since its discovery has become a global health burden, continuously spreading across the nations of the earth with increased mortality. Its effect on human immunodeficiency virus (HIV) progression and immune cell deterioration cannot be overlooked. The widespread use of traditional and molecular TB diagnostic methods has been hindered by several factors. Nonetheless, the development of a rapid, sensitive, timely, non-invasive diagnostic protocol could revolutionise the diagnostic era and halt the spread of this infectious agent. It could also help in the early diagnosis of the infection in poorly developed areas. The detection efficacy of urine lipoarabinomannan assay as a prospect in tuberculosis diagnosis in HIV-positive patients was assessed in this study. Urine samples were collected into a wide-mouthed universal container from HIV-positive patients with signs and symptom of tuberculosis and HIV advanced disease. Alere determine urine lateral flow—LAM test was used for the detection of LAM antigen in urine samples of HIV-positive patients. The CD4 count of the HIV-positive patients was also documented. Results A total of 85 HIV-positive subjects were included in the analysis based on the inclusion criteria. Urinary LAM was reactive in 29 (34.1%) of 85 HIV-positive patients and non-reactive in 56 (69.1%). The majority of the participants had a CD4+ count < 200 cells/µL 60 (70.6%), while others had CD4+ count ≥ to 200 cells/µL 25 (29.4%). There was no statistically significant difference between CD4 count and LAM positivity. Most of the affected age groups in the study were 31–45 years, and females had preponderance in comparison to male subjects. Conclusions The use of urinary LAM in HIV-positive patients is a helpful tool for TB screening. It also has a promising ability for early TB diagnosis in the study group and other TB-associated disease conditions in resource-deprived settings. For the general populace, further research is required to certify its sensitivity and specificity.

How Do Teachers Perceive Lifelong Learning and Adult Education?

The objective of this study is to explore the perspectives of middle school teachers on the concepts of lifelong learning and adult education. The qualitative research involved 25 middle school teachers, and their responses, gathered through semi-structured interviews, underwent content analysis. Thematic analysis was employed to derive the results. The findings underscore that teachers attribute value to lifelong learning and adult education for various purposes, such as personal development, adaptation to evolving times, sustained learning, quality time utilization, social integration, and meeting educational needs. A consensus within the study group indicates that individuals across professions should engage in lifelong learning beyond their initial undergraduate education. The research reveals that continuous lifelong learning among teachers positively impacts performance, fostering open-mindedness, cultivating versatile thinking, facilitating effective lesson delivery, and improving interaction with students. Identified factors hindering lifelong learning include physical and economic conditions, environmental factors, health issues, motivation, and the repercussions of disasters. Additionally, teacher opinions shed light on shortcomings in lifelong learning and adult education within the Turkish context. Lastly, the study observes a general lack of adequate knowledge among teachers regarding global lifelong learning and adult education activities.

Determination of spontaneous and stimulated cytokine production in cell culture in patients with COVID-19 associated multisystem inflammatory syndrome

To date, the pathogenesis of COVID-19 associated multisystem inflammatory syndrome (MIS-C) remains unclear. Despite this, it becomes obvious that the pathogenesis of MIS-C is directly related to a certain immune dysregulation, however, a clear understanding of the mechanisms of this dysregulation has not yet been formulated. In order to identify the cytokine profile in patients with MIS-C, spontaneous and stimulated production of certain cytokines in cell culture was identified. Materials and methods. The study was conducted in the following study groups: group 1 — patients with MIS-C (n = 52); group 2 (comparison group) — patients with COVID-19 associated pneumonia (n = 15); group 3 (control group) — conditionally healthy patients (n = 23). The following stimulating agents were used: S58 — recombinant antigen Spike_SARS-Cov-2; NP is a recombinant NP antigen of the coronavirus SARS-CoV-2 and a standard mitogen. Results. Тhe absence of the initially expected hyperproduction of the main pro-inflammatory cytokines (IL-6, IL-8, TNF-α, etc.) was recorded. Statistically significant developments were recorded between patients of the study groups in the spontaneous production of MCP-1, in particular, the indicated indicator was 40010.82 (19698.1; 64812.1); 643.7 (214.6; 1695.4) and 622.7 (214.6; 1068.1), respectively. The indicated spontaneous hyperproduction of MCP-1 in patients with MIS-C allows us to consider as a probable completely new theory of the pathogenesis of MIS-C associated with dysregulation of the type 2 immune response. The presence of statistically significant differences, primarily in the spontaneous production of this cytokine, can apparently be explained by the presence of genetically determined determinants associated with subsequent dysfunction of the Th2 helper immune response, a potential trigger for which is a previous COVID-19 infection. Thus, further study of the immunopathogenesis of COVID-19 associated MIS-C is required.

Evaluation of predisposing factors in patients with ingrown toenails: a prospective, case-control study.

Ingrown toenails (IGTN) are a prevalent, debilitating nail disorder that occurs when the edge of the nail plate grows abnormally to penetrate the periungual dermis. Multiple risk factors have been identified in the etiology. In this study, we aimed to investigate the risk factors that predispose patients to IGTN. This prospective, case-control study consisted of 130 patients with IGTN and 130 age- and sex-matched controls. The sociodemographic data, clinical features, and predisposing factors were questioned. Multivariate logistic regression (Enter and Forward: LR) analysis was applied to determine the risk factors related to IGTN. The IGTN group comprised 63 (48.5%) females and 67 (51.5%) males with a median age of 31 (IQR = 28.25) years. The most common type of IGTN in the study group was distal-lateral ingrowing in 115 (88.5%) patients. The median duration of IGTN was 5.5 (IQR = 10) months. In the multivariate regression analyses, the presence of improper nail trimming (OR: 7.063; 95% CI: 3.604-13.843), presence of hyperhidrosis (OR: 2.648; 95% CI: 1.198-5.853), poor foot hygiene (OR: 4.873; 95% CI: 2.271-10.456), presence of foot/toe deformity (OR: 5.413; 95% CI: 1.508-19.427), presence of increased curvature of the nails (OR: 2.588; 95% CI: 1.024-6.543), presence of onychomycosis (OR: 3.506; 95% CI: 1.267-9.705), increase in BMI (OR: 1.126; 95% CI: 1.038-1.221) were found to be the predisposing factors that increased the risk of IGTN. Improper nail trimming, hyperhidrosis, poor foot hygiene, onychomycosis, increased curvature of the nails, foot/toe deformity and increase in BMI were found to contribute significantly to the etiopathogenesis of the disease. Considering that most of these risk factors were modifiable, informing the public about risk factors will reduce the frequency of IGTN, and modifying risk factors in patients will enable rapid control of the disease and reduce recurrences.

Correlation of serum vitamin D and IL-8 to stages of periodontitis: a case-control analysis.

The current literature lacks the correlation between serum levels of vitamin D and interleukin-8 (IL-8) to the stages of periodontitis. The present research objectives are to evaluate the serum levels of vitamin D and IL-8 in periodontitis participants and healthy controls and to measure their correlation with the stages of periodontitis. The current case-control study was conducted on patients with periodontitis and healthy controls. After obtaining a questionnaire from the participants, the following clinical parameters were measured; periodontal probing depth (PPD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and tooth count. The serum levels of vitamin D and IL-8 were measured using ELISA kits. Then, we measured the correlation of the stages of periodontitis with the serum levels of vitamin D and IL-8. Ninety-eight participants; 52 with periodontitis and 46 healthy controls were included. The patients with periodontitis showed a significantly lower level of vitamin D, higher PPD, CAL, BOP, and lower number of teeth than the controls. In addition, serum vitamin D significantly correlated with the stages of periodontitis. Serum IL-8 showed no significant difference between the study and control groups while it does not significantly correlate with the stages of periodontitis. The current study's findings suggest a potential association between serum level of vitamin D with severity of periodontitis which necessitates screening vitamin D status in patients with periodontitis and investigating the possibility of vitamin D supplementation in decreasing the progression of periodontitis.

Response of Irritable Bowel Syndrome to Abdominal Fat Reduction

Objectives: The study aimed to evaluate the response of Irritable Bowel Syndrome (IBS) among patients having central obesity to reducing abdominal fat using Focused Ultrasound (cavitation) in addition with aerobic exercise as well as a low calorie, low-FODMAPs diet. Methods: A total of 60 individuals, between the ages of 20 and 45, who were diagnosed with both irritable bowel syndrome (IBS) as well as abdominal obesity, having a body mass index (BMI) ranging from 30 to 39.9 kg/m², were divided into two groups of similar size by a random assignment process. Group A were given focused ultrasound cavitation accompanied by moderate aerobic exercise and a low calorie, low-FODMAPs diet over a period of three months, whereas Group B (control group) were given moderate aerobic exercise and a low calorie, low-FODMAPs diet only. Assessments of total body fat, abdominal fat, severity of IBS, as well as quality of life related to IBS were conducted prior to and after the study period. Results: Overall body fat mass, abdominal fat mass, IBS severity, and IBS quality of life were all significantly improved in both groups. All evaluated variables showed a highly significant improvement in favor of the study group when comparing the two groups. Conclusion: Focused Ultrasound (cavitation) in addition with aerobic exercise as well as a low calorie, low-FODMAPs diet cause more improvement of irritable bowel syndrome symptoms and quality of life.

Quadruple-D score in the success rate of extracorporeal shock wave lithotripsy of renal stones in pediatric population.

Evaluation of the validity of the Quadruple-D score in the prediction of success in pediatric stone disease. Of the 292 children treated with SWL between 2007 and 2023, a total of 158 children who had adequate follow-up data and evaluated with non-contrast computed tomography before SWL, were included in the study. Parameters were calculated for each of the stone volume (SV), skin-to-stone distance (SSD), stone density (SD) and stone location (SL) variables. Receiver operator characteristic analysis was used to set cut-off values. Quadruple-D scores were calculated, and success rates were determined for each score. Stone-free status was determined as complete clearance after three months of final SWL. The median age of the study group was 8 (range 1 to 16). One hundred and one of the 158 (64%) children had stone-free status. Mean SV, SSD and SD values were significantly higher in SWL failed group than stone-free group after detecting cutoff values of 150 mm3, 6.7 cm, and 540 HU, respectively. Stone-free rates were detected as 19.6%, 24.7%, 37.2%, 76.2%, and 90.2% with the Quadruple-D scores of 0, 1, 2, 3 and 4 points. Quadruple-D scoring system can further improve Triple-D scoring system by adding stone position parameter to clarify SFR with a simple and easy calculation. We believe that the Quadruple-D score will have better clinical significance than the Triple-D scoring system in predicting the success of SWL in children.

Effect of ultrasound-guided individualized positive end-expiratory pressure on the severity of postoperative atelectasis in elderly patients: a randomized controlled study.

Postoperative pulmonary complications (PPCs) are common in patients undergoing general anesthesia, with atelectasis being a key contributor that increases postoperative mortality and prolongs hospitalization. Our research hypothesis is that ultrasound-guided individualized PEEP titration can reduce postoperative atelectasis. This single-center randomized controlled trial recruited elderly patients for laparoscopic surgery. Patients were randomly assigned to two group: the study group (individualized PEEP groups, PEEP Ind group) and the control group (Fixed PEEP group, PEEP 5 group). All patients in these two groups received volume-controlled ventilation during general anesthesia. Patients in the study group were given ultrasound-guided PEEP, while those in the control group were given a fixed 5 cmH2O PEEP. Bedside ultrasound assessed lung ventilation. The primary outcome was the severity of atelectasis within seven days post-surgery. Eighty-nine patients scheduled for elective laparoscopic radical surgery for colorectal cancer were enrolled in our study. Lung ultrasound scores (LUSs) in the study group during postoperative seven days was significantly decreased compared with that in the control group (P < 0.05). The severity of postoperative atelectasis in the study group was significantly improved. The incidence of PPCs during postoperative 7 days in the study group was significantly less than that in the control group (48.6% vs. 77.8%; RR = 0.625; CI = 0.430-0.909; P = 0.01). In elderly patients undergoing laparoscopic radical resection, lung ultrasound-guided individualized PEEP can alleviate the severity of postoperative atelectasis.Clinical trial number and registry URL: No. ChiCTR2200062979 ( https://www.chictr.org.cn ).

Development and validation of STEM motivation scale for middle school students

Understanding motivational beliefs such as expectancy and value that shape students’ persistence and decision to pursue a STEM career, obtaining valid and reliable measures for these dimensions, and developing strategies using this data are critically important to ensure students’ persistence in the STEM pipeline. Therefore, this study aims to develop a tool to measure middle school students’ STEM motivations within the expectancy and value concepts framework. The trial version of the scale was conducted on 967 middle school students in the 5th, 6th, 7th, and 8th grades. The study group was randomly divided into two groups. EFA was conducted on the data obtained from the first sub-group (n=479), and CFA was performed using the data obtained from the second sub-group (n=488). The results of a series of CFA performed to test three different models developed based on the theoretical structure, Model 3, the second-order single-factor structure composed of 5 sub-dimensions was found to be a successful model. This measurement tool would allow determining motivational beliefs within the expectancy-value concept that can be targeted to encourage students’ interest in STEM fields, as well as help design interventions for these structure(s), and evaluate the effectiveness of these interventions.

Effectiveness of virtual reality glasses with integrated sign language in reducing dental anxiety during pulpotomy in children with hearing impairment: a randomized controlled trial.

Children with hearing impairment (HI) face communication challenges during dental procedures due to hearing loss. Studies suggest that distraction techniques, like virtual reality (VR), can effectively divert their focus from stressful stimuli, resulting in a more comfortable dental experience. The present study aims to assess the effectiveness of distracting children with moderate to severe (HI) with virtual reality glasses that show cartoons in sign language during pulpotomy treatment compared to conventional management techniques. Forty children aged five to seven participated in a randomized controlled parallel two-arm clinical trial-the type of behavioral management employed determined which two groups children were randomly placed into. Group I (Study group) used virtual reality glasses as a diversion, while Group II (Control group) used the conventional behavior management approach. Local anesthesia was administrated, and a pulpotomy procedure was performed on the selected tooth, followed by stainless steel crown restoration (SSC). There were three methods used to assess dental anxiety before and after the procedure: the physiological method, which used heart rate (HR); the objective measure, which used the Venham Clinical Anxiety Scale (VCAS); and the subjective measure, which used the modified Facial Affective Scale (FAS). An independent t-test was employed for HR analysis of the difference between the groups as a continuous variable. The Pearson Chi-square test assessed differences between groups for categorical variables, such as (VCAS) (FAS). No significant differences were found in mean (HR) or (VCAS) between the two groups throughout the procedures: during local anesthesia (p = 0.659, 0.282), pulpotomy (p = 0.482, 0.451), and stainless steel crown preparation (p = 0.090, 0.284). Anxiety levels by (FAS) remained statistically comparable between the two groups before and after the procedures (p = 0.507, 0.749), respectively. The use of VR glasses revealed no significant advantages in managing children with HI during the dental visit compared to the conventional method of child behavior management. The trial was prospectively enrolled on 11/11/2023 under the identification number NCT06153823 on ClinicalTrials.gov.

A Case Series of Foreignbody Oesophagus and its Management at Tertiary Care Hospital

Objectives: To study the role of clinical examination as well as radiological investigations to rule out oesophageal foreign bodies as well as its plan of management.  Methodology: In total 10 patients with foreign body oesophagus came to Emergency department and ENT OPD in GGH, Anantapuram were prospectively analysed. The study period was from january 2023 to june 2023.A detailed clinical examination and radiological investigations done.  Results: There was male preponderance with children younger than 10 years compromising 50% of the patients. Upper oesophagus 80% was the favoured site for foreign body lodgement. were coins (60%) ,bones of chicken and meat(30%) gold chain (10%). There were no mortality or no major complications in this study group.  Conclusion: The complications due to oesophageal foreinbodies can be prevented by the early identification as well as referring the patients helps in proper management.The treatment of foreign body of oesophagus with the help of rigid esopaghoscopy was an effective ,safe and reliable procedure.

Redefining the impact of professional development in education with ProDES (Professional Development Evaluation Scale)

This study introduces the Professional Development Evaluation Scale (ProDES), a tool that has been developed to evaluate the impact of professional development as it relates to participants' Learning and Use of New Knowledge and Skills, Organisational Support, Student Learning Outcomes, and reactions. Grounded in Guskey’s (2000) framework for evaluating Professional Development, ProDES was developed with data from five study groups in Turkey and underwent refinement across four factors. Exploratory and Confirmatory Factor Analyses confirmed the scale's structure, accounting for 62.72% of the total variance, with robust fit indices. Within this, ProDES demonstrated high internal consistency and test-retest reliability, with significant correlations validating its effectiveness. The scale's high internal consistency and test-retest reliability ensure that it can be used to make evidence-informed decisions that can foster more effective and supportive professional development activities. As a result, by identifying which professional development initiatives lead to improvements, those associated with professional development can use resources more efficiently, leading to enhanced school and system-wide improvements. Moreover, the use of ProDES can also help schools and education systems track progress over time, making ProDES an invaluable tool for continuous improvement and strategic planning.

Sympathetic nerve activity and response to physiological stress in Takotsubo syndrome.

The prevailing hypothesis posits that Takotsubo syndrome (TTS) is caused by massive sympathetic activation, yet supporting evidence remains inconsistent. The objectives of the present study were to determine whether sympathetic activity and reactivity are enhanced in the recovery phase of TTS, and to evaluate the effect of selective β1-receptor blockade on sympathetic reactivity. We conducted a case-control study that included 18 female patients with TTS and 13 age- and sex-matched controls. Muscle sympathetic nerve activity was measured through microneurography of the peroneal nerve at rest and during the cold pressor test. In the TTS group, recordings were repeated after randomisation to intravenous metoprolol or placebo. In 10 TTS patients, cardiac sympathetic activity was assessed using iodine123-metaiodobenzylguanidine scintigraphy. Blood samples were collected during hospitalisation. Microneurography was performed a median of 27.5days after patient admission. There were no significant differences in burst incidence, burst frequency, burst height or burst area between the TTS patients and the controls at rest, during stress or after administration of intravenous metoprolol. Iodine123-metaiodobenzylguanidine scintigraphy was performed a median of 12.5days after admission, revealing decreased early 1.54 ± 0.13 and late 1.40 ± 0.13 heart-to-mediastinum ratios, and an increased washout rate of 41.8 ± 12.1%. Catecholamine metabolites were comparable between the study groups. General sympathetic hyperactivity or hyperreactivityunlikelycontributesto TTS, as catecholamine levels and muscle sympathetic nerve activity at rest and during stress were similar between the TTS patients and the controls.As scintigraphy showed increased cardiac sympathetic activity, a pathological cardiac adrenergic response and vulnerability to sympathetic activationmay be crucial for the development of the syndrome.

To evaluate the reliability of Urea and Creatinine values in vaginal wash fluid for the diagnosis of PROM

Background &amp; Methods: The aim of the study is to evaluate the reliability of urea and creatinine values in vaginal wash fluid for the diagnosis of PROM. Study performed on pregnant women in the third trimester between 28 and 37 weeks of gestation with history of possible leakage of amniotic fluid at tending in the department of Obstetrics and Gynaecology. Results: Total 50 subjects were recruited. Group 1 is PROM confirmed 25 subjects . Group 2 were controls and in each group 25 subjects were allotted. The comparison of co-morbidity between study groups in vaginal wash fluid to diagnosis the high rupture of membrane. Around 24% of subjects had co-morbidity in PROM confirmed category. Conclusion: In PROM confirmed subject urea level was 9.99 ± 4.16 and in controls it was around 4.12 ± 2.65. This shows that both PROM confirmed and suspected subjects had increased urea level than the control group. Thus urea and creatinine levels in vaginal wash fluid serves as an excellent diagnostic marker in diagnosing premature rupture of membrane. In conclusion, our study demonstrated that the measurement of vaginal fluid urea and creatinine is a simple and reliable test for diagnosis of PROM.