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.

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 non-syndromic) 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.

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.

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.

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.

Unpredicted clinical manifestation of COVID-19: a unique case report and review of literature

Background

Cervical lymphadenopathy in children is a common problem in daily clinical practice. Many cases of cervical lymphadenopathy after the COVID-19 vaccine were reported. However, there is no yet reporting a case of supraclavicular cervical lymphadenopathy due to COVID-19. 

Case presentation

A 12-year-old girl presented with fever, cough, fatigue, anosmia, and ageusia. COVID-19 was confirmed by real-time PCR. The symptoms were resolved within 10 days. Seven days later, she complained of supraclavicular swelling. Physical examination revealed painless, multiple, and mobile supraclavicular lymph nodes. Ultrasound and fine-needle aspiration cytology were suspicious. Therefore, an excisional biopsy of the largest node was performed. The specimen was sent for histopathology and immunohistochemistry evaluation which confirmed the benign nature of the lymph node.

Conclusion

To our best knowledge, this is the first case of supraclavicular lymphadenopathy in a child with COVID-19. It is essential to put COVID-19 in the differential diagnosis of cervical lymphadenopathy.

COVID-19-related Rhino-orbital-cerebral Mucormycosis

Background: There is an increasing number of COVID-19-related Rhino-orbital-cerebral mucormycosis (ROCM), especially from India.

Objectives: To evaluate the demographic, clinical, radiological, and outcome of the COVID-19-related ROCM cases in a single center.

Materials and Methods: The medical records of the patients with COVID-19-related ROCM were retrospectively reviewed. The study covered 22 months duration from March 2020 to December 2021 in Imam Hussain Medical City, Karbala city, Iraq.

Results: Of the 14 patients with COVID-19-related ROCM, there were 71.4% males with a male-to-female ratio of 2.5:1. The median age was 61 years (age range: 27-80 years). There were 42.9% of patients with a history of being a current smoker. All patients had a history of DM, and 57.1% of patients had a history of hypertension. All patients were without a history of the previous episode of COVID-19 or taking the vaccine. The median duration from the COVID-19 diagnosis to the diagnosis of ROCM was 19 days (duration range of 10-40 days). Most of the cases were of severe type (57.1%). All of the patients were taking corticosteroid and oxygen therapy. Nasal obstruction, nasal discharge, cheek swelling, and necrotic tissue were clinical features in all patients. The majority of the cases were on the left side (71.4%). Stage 3 was found in 42.9%. Amphotericin B was used for all patients and surgical debridement in 13 cases. Five patients have died (35.7%).

Conclusion: COVID-19-related ROCM is an aggressive disease associated with a high mortality rate of 35.7%. Early diagnosis and on-time initiation of treatment are recommended to get the best outcome.

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 trans-plantation, 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 mucor-mycosis 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.

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.

COVID-19-related sudden sensorineural hearing loss

Background: Sudden sensorineural hearing loss (SSNHL) can be a feature of COVID-19. It may present alone or with other symptoms of the disease. However, there is little written in the literature about its occurrence. We aimed to evaluate the socio-clinical characteristics and outcome of confirmed mild- to moderate COVID-19 cases with SSNHL in Tikrit city, Iraq.

Materials and Methods: This descriptive study was conducted at the Otolaryngology Department, Tikrit General Hospital, Tikrit city, Iraq. The period of the study was from December 1, 2020 to June 30, 2021.Mild and moderate COVID-19 subjects confirmed by real-time polymerase reaction were included in the study. Detailed demographic (age, gender, and smoking habit) and clinical characteristics (onset and duration of deafness, side, severity, associated ear, nose, and throat symptoms, and comorbidity) were recorded for every patient. Outcomes following the steroid treatment protocol were also registered.

Results: SSNHL was identified in 26 patients, of whom 20 (76.9%) were women, 20 (76.9%) were in the age group ≥ 30 years, and 21 (80.8%) were non-smokers. Around three-quarters of the subjects were identified within the first week of deafness occurrence. Bilateral (18/26) was more common than unilateral deafness (8/26); therefore, the total number of deaf ears was 44. Besides, bilateral symmetrical deafness (13/18) outnumbered the asymmetrical type (5/18). Around three-quarters were of moderate severity. The most common otological symptom was tinnitus (25/26). The most common nose and throat symptom was anosmia (6/26). The mean hearing threshold before and after treatment with oral steroids ± intratympanic steroids was 50.91 ± 11.777 dB and 40.24 ± 15.693, respectively. One patient with bilateral SSNHL was lost to follow-up; the remaining number of deaf ears was 42, and half of them were partially improved. The outcome of the treatment showed no statistically significant relation with the duration, side, and severity of SSNHL (p>0.05).

Conclusion: The majority of COVID-19-related SSNHL cases presented within one week of onset, with bilateral outnumbering unilateral cases. Tinnitus was the most common associated symptom. Treatment with steroids achieved partial improvement in half of the cases, and this outcome was not affected by the duration, side, and severity of deafness.

COVID-19-related sudden sensorineural hearing loss

Background: Sudden sensorineural hearing loss (SSNHL) can be a feature of COVID-19. It may present alone or with other symptoms of the disease. However, there is little written in the literature about its occurrence. We aimed to evaluate the socio-clinical characteristics and outcome of confirmed mild- to moderate COVID-19 cases with SSNHL in Tikrit city, Iraq.

Materials and Methods: This descriptive study was conducted at the Otolaryngology Department, Tikrit General Hospital, Tikrit city, Iraq. The period of the study was from December 1, 2020 to June 30, 2021.Mild and moderate COVID-19 subjects confirmed by real-time polymerase reaction were included in the study. Detailed demographic (age, gender, and smoking habit) and clinical characteristics (onset and duration of deafness, side, severity, associated ear, nose, and throat symptoms, and comorbidity) were recorded for every patient. Outcomes following the steroid treatment protocol were also registered.

Results: SSNHL was identified in 26 patients, of whom 20 (76.9%) were women, 20 (76.9%) were in the age group ≥ 30 years, and 21 (80.8%) were non-smokers. Around three-quarters of the subjects were identified within the first week of deafness occurrence. Bilateral (18/26) was more common than unilateral deafness (8/26); therefore, the total number of deaf ears was 44. Besides, bilateral symmetrical deafness (13/18) outnumbered the asymmetrical type (5/18). Around three-quarters were of moderate severity. The most common otological symptom was tinnitus (25/26). The most common nose and throat symptom was anosmia (6/26). The mean hearing threshold before and after treatment with oral steroids ± intratympanic steroids was 50.91 ± 11.777 dB and 40.24 ± 15.693, respectively. One patient with bilateral SSNHL was lost to follow-up; the remaining number of deaf ears was 42, and half of them were partially improved. The outcome of the treatment showed no statistically significant relation with the duration, side, and severity of SSNHL (p>0.05).

Conclusion: The majority of COVID-19-related SSNHL cases presented within one week of onset, with bilateral outnumbering unilateral cases. Tinnitus was the most common associated symptom. Treatment with steroids achieved partial improvement in half of the cases, and this outcome was not affected by the duration, side, and severity of deafness.

COVID-19-related sudden sensorineural hearing loss

BACKGROUND

Sudden sensorineural hearing loss (SSNHL) can be a feature of COVID-19. It may present alone or with other symptoms of the disease. However, there is little written in the literature about its occurrence. We aimed to evaluate the socio-clinical characteristics and outcome of confirmed mild- to moderate COVID-19 cases with SSNHL in Tikrit city, Iraq.

MATERIALS AND METHODS

This descriptive study was conducted at the Otolaryngology Department, Tikrit General Hospital, Tikrit city, Iraq. The period of the study was from December 1, 2020 to June 30, 2021.Mild and moderate COVID-19 subjects confirmed by real-time polymerase reaction were included in the study. Detailed demographic (age, gender, and smoking habit) and clinical characteristics (onset and duration of deafness, side, severity, associated ear, nose, and throat symptoms, and comorbidity) were recorded for every patient. Outcomes following the steroid treatment protocol were also registered.

RESULTS

SSNHL was identified in 26 patients, of whom 20 (76.9%) were women, 20 (76.9%) were in the age group ≥ 30 years, and 21 (80.8%) were non-smokers. Around three-quarters of the subjects were identified within the first week of deafness occurrence. Bilateral (18/26) was more common than unilateral deafness (8/26); therefore, the total number of deaf ears was 44. Besides, bilateral symmetrical deafness (13/18) outnumbered the asymmetrical type (5/18). Around three-quarters were of moderate severity. The most common otological symptom was tinnitus (25/26). The most common nose and throat symptom was anosmia (6/26). The mean hearing threshold before and after treatment with oral steroids ± intratympanic steroids was 50.91 ± 11.777 dB and 40.24 ± 15.693, respectively. One patient with bilateral SSNHL was lost to follow-up; the remaining number of deaf ears was 42, and half of them were partially improved. The outcome of the treatment showed no statistically significant relation with the duration, side, and severity of SSNHL (p>0.05).

CONCLUSION

The majority of COVID-19-related SSNHL cases presented within one week of onset, with bilateral outnumbering unilateral cases. Tinnitus was the most common associated symptom. Treatment with steroids achieved partial improvement in half of the cases, and this outcome was not affected by the duration, side, and severity of deafness.

Socio-clinical characteristics of COVID-19 disease in Anbar Governorate, Iraq

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact worldwide. Clinical symptoms vary in different countries. In addition, a wide range of symptoms involve most of the body systems including the respiratory system. However, COVID-19 has no classical presenting signs. Objective: This study aimed to describe the sociodemographic and clinical characteristics of hospitalized and nonhospitalized COVID-19 patients in Anbar Governorate, Iraq. Patients and Methods: This retrospective study was conducted in Anbar Governorate, Iraq. The study covered the period from May 1 to June 30, 2020. All cases were confirmed by real-time polymerase chain reaction. Data concerning the age, gender, residence, occupation, clinical symptoms, smoking, history of systemic diseases, and disease fate were collected from patients’ records. Results: Of 481 patients, 259 (53.8%) were male. The patient age ranged from 12 to 104 years with a mean age of 45.7 ± 16.11. Majority of the patients aged 36–58 years (n = 204, 42.4%) and were urban dwellers (n = 318, 66.1%), non-healthcare workers (n = 447, 92.9%), and nonsmokers (n = 440, 91.5%). The chief complaint was fever (n = 300, 64.2%). The mortality rate was 5.6% (n = 27). The increasing age, male gender, and a history of systemic illnesses showed an increased effect on the mortality rate (p < 0.05). Residence, occupation, and smoking status did not show significant difference (p>0.05). Conclusion: The mortality rate was 5.6%. Fever was the main feature of COVID-19. Male, older individuals with systemic diseases showed higher mortality rate.

Socio-clinical characteristics of COVID-19 disease in Anbar Governorate, Iraq

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact worldwide. Clinical symptoms vary in different countries. In addition, a wide range of symptoms involve most of the body systems including the respiratory system. However, COVID-19 has no classical presenting signs. Objective: This study aimed to describe the sociodemographic and clinical characteristics of hospitalized and nonhospitalized COVID-19 patients in Anbar Governorate, Iraq. Patients and Methods: This retrospective study was conducted in Anbar Governorate, Iraq. The study covered the period from May 1 to June 30, 2020. All cases were confirmed by real-time polymerase chain reaction. Data concerning the age, gender, residence, occupation, clinical symptoms, smoking, history of systemic diseases, and disease fate were collected from patients’ records. Results: Of 481 patients, 259 (53.8%) were male. The patient age ranged from 12 to 104 years with a mean age of 45.7 ± 16.11. Majority of the patients aged 36–58 years (n = 204, 42.4%) and were urban dwellers (n = 318, 66.1%), non-healthcare workers (n = 447, 92.9%), and nonsmokers (n = 440, 91.5%). The chief complaint was fever (n = 300, 64.2%). The mortality rate was 5.6% (n = 27). The increasing age, male gender, and a history of systemic illnesses showed an increased effect on the mortality rate (p < 0.05). Residence, occupation, and smoking status did not show significant difference (p>0.05). Conclusion: The mortality rate was 5.6%. Fever was the main feature of COVID-19. Male, older individuals with systemic diseases showed higher mortality rate.

Parosmia Due to COVID-19 Disease: A 268 Case Series

Although parosmia is a common problem in the era of the COVID-19 pandemic, few studies assessed the demographic and clinical aspects of this debilitating symptom. We aimed to evaluate the socio-clinical characteristics and outcome of various options of treatment of individuals with parosmia due to COVID-19 infection. The study was conducted at two main Hospitals in the Ramadi and Tikrit cities, Iraq, on patients with a chief complaint of parosmia due to COVID-19 disease. The study involved 7 months (August 2020–February 2021). Detailed demographic and clinical characteristics and treatment options with their outcome were recorded and analyzed. Out of 268 patients with parosmia, there were 197 (73.5%) females. The majority were from age group ≤ 30 years (n = 188, 70.1%), housewives (n = 150, 56%), non-smokers (n = 222, 82.8%), and associated with dysgeusia (n = 207, 77.2%) but not associated with nasal symptoms (n = 266, 99.3%). All patients have complained of anosmia (89.9%) or hyposmia (10.1%). Troposmia was reported in the majority of participants. The majority of the patients were suffering from severe parosmia (65.7%). Around 3 quarters of the cases were presented in ≤ 4 months. Altered quality of life (AQL) was presented in 91.8% of subjects, and there was a significant association with the presence of dysgeusia and type and severity of parosmia. The smoking habit didn't show a significant association with AQL, the severity of parosmia, and the recovery rate. Most of the odor group was the most triggering stimuli eliciting parosmia, while, the sewage was the response odor in above 50% of the cases. The recovery rate was poor with olfactory training plus either tonics or local and systemic steroids. Parosmia due to COVID-19 infection is a common problem with poor results in the short-term treatment and follow-up. The AQL was seen in a greater proportion of patients and strongly associated with the presence of dysgeusia, type, and severity of parosmia.