Laryngopharyngeal reflux in war-torn Syria and its association with smoking and other risks: an online cross-sectional population study

OBJECTIVES

To demonstrate the burden of laryngopharyngeal reflux (LPR) in Syria and its associated variables.

DESIGN

This is a cross-sectional study that used online questionnaires that included demographics, smoking, war-related questions and reflux symptom index (RSI).

SETTING

This research was conducted online across Syria and included the general population.

PARTICIPANTS

Participants who lived in Syria, agreed to participate, and responded to all the RSI questions were included. This research comprised 734 participants, with 94.6% response rate, 75.5% being females, and a mean age of 24 years.

RESULTS

Overall, 31.9% of subjects had symptoms suggestive of LPR. Participants who were 30 years and younger had fewer symptoms suggestive of LPR compared with the older group p=0.012 (OR 0.534; 95% CI 0.325 to 0.877). While having an epigastric burning sensation, chest pain and indigestion were the most common symptoms, having a sore throat was the least common. Being distressed from war noises was associated with more symptoms p=0.009 (OR 1.562; 95% CI 1.117 to 2.183). However, losing someone or changing place of living due to war were not significantly associated with these symptoms p>0.05. RSI scores were associated with cigarette and/or shisha smoking p<0.05. Finally, asthma, allergic disorders and having a job were associated with having LPR symptoms p<0.05. No significant findings were observed in consanguinity, marital status, educational level and socioeconomic status.

CONCLUSIONS

War, smoking, asthma, allergies, respiratory conditions and having a job were associated with LPR symptoms. However, they may be associated with these symptoms independently from LPR; for instance, similar symptoms can be caused by the mental disorders from war, the unique environment and irritant substances of the laryngeal mucosa.

Isolated tuberculosis of the spleen presenting with fever of unknown origin in a vaccinated child

Tuberculosis (TB) is one of the top 10 causes of death worldwide and is more common in developing countries. Isolated splenic TB is typically found in trauma, miliary TB and immunocompromised status. We present a very rare case of an immunocompetent child with an isolated primary TB in the spleen. The child only had fever of unknown origin (FUO), and mild anaemia. The diagnosis was not made until splenectomy was performed. The patient took the quadruple therapy for TB, and follow-ups showed no recurrence. This case is unique because this child was immunocompetent with no history of trauma or active TB. TB diagnosis should never be ignored in FUO as this might prevent unnecessary procedures to the patient. Although the child was vaccinated with Bacillus Calmette–Guérin that usually protects against severe TB in first 5 years of life, it did not prevent from affecting the spleen.

Evaluating the quality of internet information for breast cancer

The internet is frequently used by patients for researching information regarding breast cancer. This study aims to assess the quality of these websites using validated tools. The term 'breast cancer' was searched for in 3 search engines. The top 20 results were selected, and duplicates and irrelevant websites were excluded. 26/34 websites were analysed using the DISCERN Plus tool, HONcode and the JAMA benchmarks. 46% of the websites were classed as 'excellent' when assessed with the DISCERN tool. The range of DISCERN scores was wide (range: 25-74). Nine websites were found to be HONcode certified. Seven websites complied with all four JAMA benchmarks. This study shows the quality of breast cancer information on the internet is on the whole good; however the range of quality is wide. We recommend healthcare professionals use all 3 tools together to establish which websites are best to advise which websites patients should trust.

Ultrastructural changes in granulosa cells and plasma steroid levels after administration of luteinizing hormone-releasing hormone in the Western painted turtle, Chrysemys picta

In this study we investigated the effects of treatment by luteinizing hormone-releasing hormone (LHRH) on the morphology and steroid release of ovarian tissues in the Western painted turtle, (Chrysemys picta). In Experiment I, four adult female turtles were injected with synthetic mammalian LHRH (i.p., 500 pg/g bodyweight) and four with saline 2-3 weeks prior to ovulation. Granulosa cells from LHRH-treated turtles vs controls contained both preovulatory follicles (16-20 mm in diameter) and small follicles (0.5-1.00mm in diameter) with increased RER, free ribosomes and mitochondria with swollen cristae. An increase in the amount of cytoskeletal material (microfilaments) was observed in granulosa cells of the experimental turtles compared to the controls. Cytoplasmic extensions of the oocyte and granulosa cells were longer in the small follicles of treated animals, accounting for the observed increase in the thickness of the zona pellucida (ZP) over the controls. In Experiment II, administration of LHRH (i.p.) to 10 turtles during the same period triggered a substantial increase in plasma progesterone and estradiol-17beta levels over the 10 saline-injected controls. This supports the idea that in this species, as in mammals, steroidogenic activity in the ovarian follicles are under the control of the hypothalamic-pituitary axis. The ultrastructure and hormonal levels of the experimental animals were typical of untreated turtles just prior to ovulation. In this species the development of follicles and steroidogenesis can be stimulated prematurely by a releasing hormone from a nonreptilian origin.