Compare the management of granular myringitis: carbon dioxide laser and caustic agent cauterization

Background and Objectives Granular myringitis is troublesome for otologist because uncertain etiology and often been overlooked due to vague clinical symptoms and signs. The ideal treatment is elusive. Our study was to investigate the clinical characteristics of granular myringitis and analyzing the effect of the two different strategies, including carbon dioxide laser (CO2 laser) and caustic agent cauterization to manage granular myringitis. Study Design: Retrospective review Subjects and Methods One hundred and thirty patients with granular myringitis receiving treatment at a single medical center from July 2009 to January 2018 were enrolled. We retrospectively reviewed the charts and surgical records. The main two different strategies to manage focal refractory granular myringitis were analyzed, including carbon dioxide laser and caustic solution. We also recorded the clinical course and determine which strategy is better. Results One hundred and thirty patients with granular myringitis were enrolled. 47/130 (36.1%) had previous otologic procedures. Frequent ototrrhea is the most common symptom (66.1%). Posterior-inferior quadrant is the most common site of involvement (58%). The successful rate of CO2 laser, caustic agent were 94.9% and 79.2%. The recurrence rate was comparable between CO2 laser and caustic agent. No major complication was found in either individual group. Conclusion: Otologic procedure may be a predisposing factor of focal chronic myringitis. Ear drops had poor efficacy compared to other treatments. It can be apply only on minor and fresh symptom cases. In this study, we suggest CO2 laser can be the first line treatment, especially for the troublesome or refractory GM cases, which had the higher successful rate and less complication comparing to caustic agent cauterization.

Confluent and reticulated papillomatosis of Gougerot-Carteaud in a North African patient

Confluent and reticulated papillomatosis (CRP) is a rare skin condition of uncertain etiology. The anti-bacterial and most importantly the anti-inflammatory mechanisms of some antibiotics seem to explain the effectiveness of these medications. Other measures such as reducing weight and treating an underlying endocrine disorder may be helpful.

Prediction of the Occurrence of Leprosy Reactions Based on Bayesian Networks

Background: Leprosy reactions (LR) are severe episodes of intense activation of the host inflammatory response, of uncertain etiology, today the leading cause of permanent nerve damage in leprosy patients. Several genetic and non-genetic risk factors for LR have been described; however, there are limited attempts to combine this information in order to estimate the risk of a leprosy patient to develop LR. Here we present an artificial intelligence (AI)-based system able to estimate risk of LR using clinical, demographic and genetic data.Methods: The study includes four datasets from different regions of Brazil, totalizing 1,450 leprosy patients followed prospectively for at least two years to assess the occurrence of LR. Data mining using WEKA software was performed following a two-step protocol to select the variables included in the AI system, based on Bayesian Networks and developed using the NETICA software.Results: Analysis of the complete database resulted in a system able to estimate LR-risk with 82.7% accuracy, 79.3% sensitivity, and 86.2% specificity. When using only databases for which host genetic information associated with LR was included, the performance increased to up to 87.7% accuracy, 85.7% sensitivity, and 89.4% specificity.Conclusion: We produced an easy-to-use, online, free-access system that allows the identification of leprosy patients at high risk of developing LR. Risk assessment of LR for individual patients may detect candidates close monitoring, with potential positive impact upon the prevention of permanent disabilities, the quality of life of the patients, as well as upon leprosy control programs.

Saccular portal vein aneurysm complicating laparoscopic cholecystectomy

Portal vein aneurysm (PVA) is a rare vascular entity of uncertain etiology. Saccular PVA is the less frequently reported morphology but often with more symptoms or complications. Ultrasound, along with color doppler study, is a valuable tool in the diagnosis and follow-up.

Clinical Profile of Polycystic Ovarian Syndrome Patients In Tertiary Care Hospital

ABSTRACT: Background: Polycystic ovarian syndrome (PCOS)is common gynecological endocrinopathy characterized by chronic anovulation and hyperandrogenism affecting 5-10% of women worldwide. It is a heterogenous, multifactorial, complex genetic disorder with uncertain etiology and is one of the most common treatable cause of infertility. AIM: To study the various clinical presentations in polycystic ovarian syndrome. MATERIALS AND METHODS: Present study is cross sectional observational study carried out in tertiary care centre. This study was performed in the Out Patient Department of Obstetrics and Gynecology. RESULTS: The mean age of 41 patients in the study was 23.6 years. Most common presenting symptom in patients is menstrual irregularities (89%) followed by infertility and hirsutism. USG (abdo+pelvis) showing polycystic ovarian syndrome ovaries. Around 39% patients with PCOS developed insulin resistance. KEYWORDS: - Amenorrhea, Infertility, Oligomenorrhea, Polycystic Ovarian Syndrome.

Hemoglobin levels among male agricultural workers: analyses from the Demographic and Health Surveys to investigate a marker for chronic kidney disease of uncertain etiology

Introduction: Chronic kidney disease of uncertain etiology (CKDu) has been found at high frequency in several lowland agricultural areas including Meso-America and Sri Lanka. Whether CKDu also occurs in other countries with large agricultural populations remains uncertain, primarily due to lack of systematic data on kidney function. Hemoglobin (Hgb) levels could be an ancillary marker for presence of kidney dysfunction. Our goal is to estimate the causal effect of agricultural work on Hgb level in men. A causal effect may indicate the presence of CKDu. Methods: We use Demographic and Health Surveys (DHS) data from seven African and Asian countries (Ethiopia, Lesotho, Namibia, Senegal, Uganda, Zimbabwe, and India). We use optimal full matching and permutation inference to estimate the causal effect of agricultural work on altitude-adjusted Hgb levels after adjusting for six known confounders. To assess potential bias due to unmeasured socioeconomic differences, we use multiple control groups that differ in non-agricultural occupation. We then conduct sensitivity analyses to assess the robustness of our causal conclusions to unmeasured confounding. Results: Data were available for 41,180 agricultural workers and 55,705 non-agricultural workers in seven countries. On average, Hgb levels were 0.09 g/dL (95% CI [-0.12, -0.07]) lower among agricultural workers compared to matched controls. Significant effects were observed in Ethiopia, India, Lesotho, Senegal, and Uganda, with effects from 0.10 to 0.32 g/dL lower hemoglobin among agricultural workers. The effect was not attenuated in sensitivity analyses involving both better-off and worse-off occupational controls. Discussion: We find evidence that men engaged in agricultural work in five of the seven countries studied have modestly lower Hgb levels compared with other men living in rural areas. Since underlying kidney disease could be a potential explanation for this finding, our data support consideration to integrating kidney function assessments within DHS surveys and other population-based surveys.

STRA6 (vitamin A receptor), as a Novel binding receptor of COVID-19

A global pandemic of pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, at the end of 2019. Although, the ACE2 receptor has been shown to be the main entry receptor of COVID-19, but here, in our docking analysis , we predicted and discovered a novel receptor called STRA6 that may play a critical role in the pathogenicity of COVID-19 and explain the common pre and post COVID-19 symptoms with uncertain etiology. STRA6 receptor expressed in many organs and immune cells, upregulated by retinoic acid jm6 (STRA6) was the first protein to be identified in a novel category of proteins, cytokine signaling transporters, due to its ability to function as both a cell surface receptor and a membrane protein that binds to retinol binding protein facilitating cellular uptake of retinol. In agreement to our findings, the main ligand of STRA6 (vitamin/retinol) was found to be significantly reduced during COVID-19 infection.

Fluoride releasing kinetics in a weathered bearing biotite gneiss

In several regions of the dry zone of Sri Lanka, excessive quantities of fluoride (F-) in groundwater have affected the water quality significantly. Apart from the well-known prevalence of dental fluorosis, Chronic Kidney Disease of uncertain etiology (CKDu) is widespread in different pockets in the dry zone of Sri Lanka [1]. Fluoride is one of the substances suspected of being causative of CKDu in the area. Since the kidneys retain more F- than in any other soft tissue and excess F- exposure can cause kidney disease. Within the same zone, the prevalence of CKDu varies by geographic area in a ground water and spatial distribution of selected trace elements in groundwater. The optimum F- level in drinking water, according to WHO guidelines, is 1.5 (mg/L); however, due to the unfavorable climatic conditions that exist in tropical countries, people ingest more water than normal intake, resulting in a high F- intake. The source of F- is geogenic. It has been found that the F- content of basement rocks ranges from 9.5×10-5 to 1.44×10-3 kg/L in the region [3]. Farmers consume about 2-3 liters of water a day to quench their thirst, resulting in a daily F- intake of 3×10-3-1×10-2 kg/L [4].