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Indications and Short-Term Outcomes for In-Office Therapeutic Superior Laryngeal Nerve Block

OBJECTIVE

Superior laryngeal nerve (SLN) block consists of injection of steroid and anesthetic at the internal branch of the SLN entry site. Prior case series have demonstrated beneficial effects on neurogenic cough. SLN blocks have also recently shown benefit for paralaryngeal pain. We describe short-term outcomes for multiple symptoms of irritable larynx syndrome (ILS) including neurogenic cough, dysphonia related to laryngeal hypersensitivity, inducible laryngeal obstruction (ILO), paralaryngeal pain, and isolated globus.

METHODS

Retrospective review from 2 institutions of patients undergoing a single SLN block for the indications listed. Variables include age, sex, indication(s), known vagus neuropathy, and patient-reported outcomes at short-term follow-up.

RESULTS

A total of 209 patients were included (59 males, 150 females; age: 58 ± 13 years). Twenty-six patients (12%) had a history of a vagus nerve injury. Indications included neurogenic cough (n = 149), dysphonia related to laryngeal hypersensitivity (n = 66), paralaryngeal pain (n = 50), ILO (n = 23), and isolated globus (n = 3). Some patients had multiple indications. Significant improvements in patient-reported measures occurred after a single SLN block within 2 to 4 weeks for neurogenic cough (cough severity index; 25.2 ± 11.2 to 19.0 ± 12.8; P < .001), dysphonia (voice handicap index-10; 22.1 ± 12.2-18.0 ± 13.3; P = .005), and ILO (dyspnea index; 21.0 ± 14.9-14.7 ± 15.7; P = .017). Subjective pain improved in 23 of 39 patients with paralaryngeal pain. There was no observed improvement for isolated globus. Presence of known vagal neuropathy or therapy around the time of SLN block did not affect outcome.

CONCLUSION

SLN block can be an effective component of treatment for a variety of ILS symptoms. Patients may experience some improvement after 1 injection.

LAY SUMMARY

Symptoms of irritable larynx syndrome, such as neurogenic cough, paralaryngeal pain, inducible laryngeal obstruction, and dysphonia related to laryngeal hypersensitivity can be challenging to manage. In-office Superior Laryngeal Nerve blocks can serve as a quick, well tolerated, adjunctive treatment with positive short-term outcomes.

LEVEL OF EVIDENCE

4.

Clinical predictions of COVID-19 patients using deep stacking neural networks

The coronavirus disease 2019 (COVID-19) pandemic, which emerged in late 2019, has caused millions of infections and fatalities globally, disrupting various aspects of human society, including socioeconomic, political, and educational systems. One of the key challenges during the COVID-19 pandemic is accurately predicting the clinical development and outcome of the infected patients. In response, scientists and medical professionals globally have mobilized to develop prognostic strategies such as risk scores, biomarkers, and machine learning models to predict the clinical course and outcomes of COVID-19 patients. In this contribution, we deployed a mathematical approach called matrix factorization feature selection to select the most relevant features from the anonymized laboratory biomarkers and demographic data of COVID-19 patients. Based on these features, developed a model that leverages the deep stacking neural network (DSNN) to aid in clinical care by predicting patients' mortality risk. To gauge the performance of our suggested model, performed a comparative analysis with principal component analysis plus support vector machine, deep learning, and random forest, achieving outstanding performances. The DSNN model outperformed all the other models in terms of area under the curve (96.0%), F1-score (98.1%), recall (98.5%), accuracy (99.0%), precision (97.7%), specificity (97.0%), and maximum probability of correction decision (93.4%). Our model outperforms the clinical predictive models regarding patient mortality risk and classification in the literature. Therefore, we conclude that our robust model can help healthcare professionals to manage COVID-19 patients more effectively. We expect that early prediction of COVID-19 patients and preventive interventions can reduce the mortality risk of patients.

Family support during childhood as a predictor of mate retention and kin care in adults during the COVID-19 pandemic in Brazil: an exploratory study

Introduction

Experiences during development help to explain behavior expression in adulthood.

Aims

In this study, we explored how unpredictability and harshness experienced during childhood may have impacted the occurrence of reproductive milestones in adulthood and the expression of fundamental motives related to self-protection, disease avoidance, mate seeking, mate retention, and kin care (children/family) during the pandemic.

Methods

This was an exploratory study with 438 participants. Through the administration of online questionnaires, participants were assessed and categorized based on their childhood experiences, resulting in three groups: low unpredictability, high unpredictability with family support, and high unpredictability without family support.

Results

We found that family support experienced during childhood predicts a slow life-history strategy. This involves an emphasis on growth and parenting efforts at the expense reproduction and was relevant even for participants who faced financial unpredictability. During the pandemic, we also observed that mate retention and kin care (family) motives were predominant among individuals who had greater family support during childhood.

Discussion

Overall, the findings suggest that unpredictability experienced during childhood is crucial for the development of life-history strategies and the manifestation of fundamental motives in adulthood.

Health care of the disadvantaged: chronic obstructive pulmonary disease in later life

Introduction

Chronic diseases have emerged as the foremost causes of death and disability worldwide. This article employs an ethnographic approach to conduct a gerontological investigation of chronic obstructive pulmonary disease (COPD), the third leading cause of global mortality, trailing only cardiovascular diseases and cancers.

Methods

This study is rooted in an extensive amalgamation of biomedical literature and official epidemiological data. Additionally, it offers enriched insights through an extensive ethnographic research methodology, encompassing ethnographic fieldwork, participant observation, interviews, and focus groups.

Results

The findings expound that individuals grappling with chronic obstructive pulmonary disease often undergo intricate cognitive and emotional experiences, necessitating holistic solutions that consider psychological processes, contextual factors, and subjective age. These challenges extend beyond the purview of a purely medical perspective.

Conclusion

This article concludes that the lens of gerontology is invaluable in comprehending chronic obstructive pulmonary disease, particularly due to its association with old age and increased longevity. Among older individuals, diagnosing the condition presents a formidable challenge. Breathlessness, a cardinal symptom, often overlaps with normal age-related declines in pulmonary function, rendering COPD's insidious onset misconstrued as a consequence of aging-related changes.

Knowledge, attitudes, and practices related to COVID-19 in Indonesia: A post delta variant wave cross-sectional study

Introduction

Public information and regulations related to the coronavirus disease 2019 (COVID-19) have been widely published and continuously changed. The Indonesian government has responded to the emerging evidence by regularly updating its unprecedented and preventive measures against the transmission of COVID-19 to the public. It is important to understand how the public responded to these updates. This study aimed to investigate the knowledge, attitudes, and practices of Indonesians toward COVID-19 after the emergence of the delta variant wave.

Methods

A cross-sectional study was conducted among the adult population of non-healthcare workers in Indonesia through an online questionnaire using the SurveyMonkey platform. A total of 1,859 respondents completed this survey from September to October 2021. The knowledge, attitudes, and practices data were analyzed descriptively to find their frequency and percentage. A multivariate analysis was conducted to confirm the factors affecting the respondents' knowledge, attitudes, and practices with a p-value of <0.05 set as significant.

Results

Being female, having a higher education level, and having a higher frequency of access to COVID-19 news showed significant impacts on knowledge, attitudes, and practices (p<0.001). Older age stratification influenced the knowledge level (p<0.05) but had no significant effect on people's attitudes and practices toward COVID-19. Respondents' perceived probability of being exposed to COVID-19 (p < 0.05) and their COVID-19 infection frequency (p < 0.001) significantly influenced their knowledge. Household income and respondents' knowledge significantly affected their attitudes toward COVID-19. Furthermore, only their attitudes had a significant impact on the respondents' practices. Perceived severity, perceived susceptibility, and vaccination status did not significantly influence their knowledge, attitudes, and practices (p > 0.05).

Conclusion

After more than a year of the COVID-19 pandemic, Indonesians maintain their high level of knowledge, attitudes, and practices. COVID-19 disinformation must be combatted by strengthening authorized media, empowering communities, and improving governance among institutions during and post-pandemic.

Disease-related disgust promotes antibody release in human saliva

The behavioral immune system (BIS) comprises manifold mechanisms, that may assist the physiological immune system (PIS) in counteracting infection and can even reduce the risk of contagion. Previous studies have found initial evidence for possible interactions between the two systems. However, most of these findings were correlative and have not been replicated. Further, none of these studies examined whether disease stimuli that indicate an enhanced airborne transmission risk may trigger a different immune response in comparison to stimuli that predominantly evoke core disgust. In the present study, we employed a video-priming approach to get further insight in the influence of the perception of disgust- and disease-related stimuli on the rapid physiological immune response, as indicated by changes of secretory immunoglobulin A (S-IgA) in saliva. We created three video primers that represented different categories of disgust- and/or disease-associated content. Two of the videos showed disease-related situations that were associated with contagious respiratory virus infections, varying in concealment of aerosols. The third video incurred no heightened airborne contagion risk, but comprised situations that are known to elicit core disgust, such as rotten foods, decaying animal carcasses, or cockroaches. A fourth video acted as control showing landscape impressions. The different video primers varied in their contagion risk and disgust-evoking potential. Given the role of S-IgA in the mucosal immune defense, we expected differences in the S-IgA response between the two videos indicating a heightened airborne contagion risk and the core disgust video, with the highest S-IgA to occur after the aerosol video. For this, we used the data of 107 healthy participants in a between-subjects design with the four video primers. We found a significant increase of S-IgA in response to both the disease- and the disgust-related videos, which correlated positively with the perceived contagion risk of the displayed situations. Nevertheless, there was no significant difference in the increase between the three disease- and disgust-related videos. We also found that people with a high contamination disgust produced less S-IgA in such situations, which is a hint for a compensating relationship between the BIS and PIS. Our observations suggest that the mere visual perception of videos showing realistic situations of an increased contagion risk can elicit a heightened release of salivary antibodies.

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Realistic videos of respiratory diseases are efficient to trigger immune responses.

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Secretory Immunoglobulin A (S-IgA) in saliva increases after video-priming.

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S-IgA increase is positively correlated with perceived contagion risk.

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S-IgA increase is inversely correlated with the trait contamination disgust.