Background
The prevalence of dysphagia in the early phases of multiple sclerosis is 30–40%, with an estimated of 30% of cases going undiagnosed cases. Such complications can lead to malnutrition, ...dehydration, and aspiration pneumonia and have a great impact on the quality of life and psychosocial status of a person with MS. The aim of this study was the validation of dysphagia in multiple sclerosis self-assessment questionnaire (DYMUS) in the Croatian language.
Methods and patients
The cross-cultural adaptation process included a back-forward translation technique of the English language version of DYMUS to the Croatian language, with pilot testing on 30 participants. The validity and reliability of the Croatian version of DYMUS (DYMUS-Hr) was applied to 106 MS patients, with comparison to the Eating Assessment Tool (EAT10), the Water Swallowing Test (WST), and a dichotomous self-assessment question. In the assessment of test-retest reliability, 99 MS patients were included.
Results
Internal consistency of DYMUS-Hr was very good (Cronbach’s alpha—0.837); Cronbach’s alpha was 0.819 for the “dysphagia for solids”, and 0.562 for “dysphagia for liquids” subscale. A significant correlation (
p
< 0.001) was found between DYMUS-Hr and EAT10 (Spearman’s rho—0.787), and WST (Spearman’s rho—0.483). Construct validity was assessed with the self-assessment question and interpreted with the Mann–Whitney
U
test. Test-retest reliability showed moderate to substantial Cohen’s Kappa reliability for each item.
Conclusion
DYMUS-Hr is a valid and reliable screening assessment tool for patients with MS. There is a general lack of awareness about dysphagia symptoms among patients with MS; consequently, this disorder receives inadequate attention and often goes untreated.
The aim of this study was to explore standard anthropometric airway characteristics of patients with obstructive sleep apnea syndrome (OSAS) and determine the incidence and risk factors for difficult ...airway management. Final analysis included 91 patients with polysomnography-verified diagnosis of OSAS who underwent sleep breathing disorder surgery under general anesthesia with direct laryngoscopy oroendotracheal intubation. The incidence of difficult manual mask ventilation during anesthesia induction, difficult intubation and immediate postextubation respiratory complications was 17.6%, 7.7% and 7.7%, respectively. Compared to patients without difficult manual mask ventilation, the group of OSAS patients with difficult manual mask ventilation had a higher rate of body mass index (BMI) ≥25 kgm-2 (p=0.010), Mallampati score ≥3 (p=0.024) and Cormack-Lehane score ≥3 (p=0.002). The OSAS patients with difficult intubation had more Cormack-Lehane score ≥3 (p=0.002) in comparison to those without difficult intubation. Our study demonstrated that manual mask ventilation during anesthesia induction was the most troublesome airway management task in OSAS patients during sleep breathing disorder surgery. Cormack-Lehane score was a relevant determinator of difficult mask ventilation and difficult intubation, while Mallampati score and BMI were relevant determinators only for difficult manual mask ventilation.
Objective: The aim of this study was to validate the performance of a self-assessment hearing loss screening tool for adults against audiometric evaluation. Different audiological measurements were ...compared with the results of a 10-item Likert-type questionnaire named the Hearing Self-Assessment Questionnaire (HSAQ) to investigate its psychometric characteristics. Design: Participants underwent audiological evaluation and completed the HSAQ. The screening performance of the HSAQ was evaluated against three definitions of hearing loss: better-ear mean pure-tone thresholds >25 dBHL at 500-2000 Hz, 500-4000 Hz and 1000-4000 Hz. Study sample: The study enrolled 112 participants aged between 24 and 88 years (mean age 56.24 years, ±12.92). Results: The HSAQ had high Cronbach's alpha and intraclass correlation coefficients and showed construct, concurrent and discriminant validity. Its screening characteristics proved very good or excellent, depending on the definition of hearing loss. Receiver operating characteristic curve analysis showed excellent accuracy of the HSAQ in the identification of better-ear high-frequency hearing loss and better-ear speech-frequency hearing loss, with respect to different cut-off points. Conclusions: Given the ease with which it is administered and its good screening properties, the HSAQ can be useful in deciding whether adult clients should be referred to audiological evaluation due to reasonable suspicion of hypoacusis.
The aim of this study was to assess preoperative airway history data and single anthropometric screening tests of difficult face mask ventilation (FMV) and difficult direct laryngoscopy intubation ...(DLI) in otorhinolaryngological surgery. Final analysis included 62 patients aged ≥14 years undergoing elective surgery with endotracheal intubation at a single center during a one-month period. Data on difficult intubation history, airway symptoms and pathology related to difficult airway were prospectively collected. Han scoring classification of FMV and Intubation Difficulty Score (IDS) were used. There were 14 (22.6%) patients with a history of current airway tumors or abscesses. Only two (3.2%) patients were preoperatively evaluated as anticipated difficult airway. Both were slightly difficult to ventilate and scored IDS 5 and IDS 8. FMV was graded as easy in 50 (80.5%), slightly difficult in 10 (16.1%) and difficult in 2 (3.2%) cases. There were 29 (46.78%) slightly difficult DLIs and one (1.6%) case of difficult DLI. The study confirmed clinically relevant incidence of difficulties with FMV and DLI in otorhinolaryngologic surgery patients. However, there should be stronger evidence to identify a single preoperative variable predicting difficult airway.
Abstract
Sarcomas are a rare heterogeneous group of neoplasms of mesenchymal origin. In the redistribution of all head and neck malignancies, sarcomas are represented by only 1%. Herein, we report a ...case of a 66-year-old patient with right maxillary sinus sarcoma that spread through the ostiomeatal complex, infiltrated the septum, all ethmoid cells, frontal sinus, involved the entire right nasal cavity and penetrated to the nasopharynx. Patient was treated with neoadjuvant chemotherapy, surgery and adjuvant radiotherapy. The histopathology indicated poorly differentiated sarcoma with elements of Ewing’s sarcoma, but also with elements consistent with osteosarcoma. Molecular pathological analysis excluded Ewing's sarcoma. Samples were also sent for review to the other Pathology Clinics. They suggested poorly differentiated high-grade pleomorphic sarcoma with elements of osteosarcoma. The accurate diagnosis of the head and neck sarcoma type can be a histopathology dilemma posing a great challenge in the choice of therapeutic approach, and thus the treatment outcome.
Liposarkomi su učestali tumori mekih tkiva u odraslih, međutim u regiji glave i vrata predstavljaju samo 2–9% malignih mezenhimalnih tumora. Najčešće su to liposarkomi subkutanog tkiva lica, ...vlasišta, dubokih mekih tkiva vrata, parafaringealnog i retrofaringealnog prostora te aerodigestivnog trakta (larinksa, orofarinksa i hipofarinksa). Opisani su i liposarkomi žlijezda slinovnica i štitne žlijezde. Prikazani bolesnik je u trenutku dijagnoze imao samo 32 godine, što je iznimna rijetkost, jer se dob bolesnika sa liposarkomima prema podatcima iz dostupne literature kreće u rasponu od 40 do 60 godina. Lokalizacija tumora u prednjoj regiji vrata suprasternalno također predstavlja rijetko sijelo koje do sada nije opisano u dostupnoj literaturi. Liposarkomi su zloćudni tumori koji najčešće nastaju de novo. U prikazanog pacijenta tumor je smješten u regiji 6 na vratu, citološki dijagnosticiran kao lipom, uz redovite kontrole ultrazvukom praćen u vremenskom intervalu od tri godine. Zbog kliničke slike ubrzanog rasta i početnih znakova volumne kompresije postavljena je sumnja na mogućnost postojanja sarkoma podrijetla masnog tkiva. Zbog nepovoljne lokalizacije i nemogućnosti postizanja širokih resekcijskih rubova, u bolesnika je učinjena potpuna kirurška resekcija tumora s resekcijskim rubovima diktiranim anatomskim smještajem vitalnih struktura vrata i medijastinuma. Kako je u patohistološkom nalazu reseciranog tumora bio opisan proboj čahure, u dogovoru s onkologom provedena je postoperativna adjuvantna radioterapija.
Snoring is an acoustic phenomenon, which is a consequence of vibrations of the soft tissue caused by partial obstruction of the upper breathing pathway while sleeping. It is estimated that 20% of men ...and 5% of women between 30 and 35 years of age snore and this rate increases to 50% of men and 30% of women over 60 years of age. The aim of this study was to evaluate the efficiency of radiofrequency assisted uvulopalatopharyngoplasty in the treatment of snoring by comparing snoring index and other polysomnography values before and after surgical treatment. The study included 22 patients (men 87% and women 13%), mean age 43.09 +/-9.6 (range, 28-67) years, treated for obstructive sleep apnea syndrome at University Department of ENT and Head and Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, during a 2-year period. Snoring was evaluated by preoperative and postoperative polysomnography at Department of Psychophysiology, Vrapce Psychiatric Hospital, Zagreb. Results were analyzed using Wilcoxon test. Postoperative reduction of snoring was statistically significant (P = 0.00052). Snoring index was decreased in 83% of patients, yielding a mean reduction of 83%. In 50% of patients, reduction of snoring index was over 95%. These results confirm the high efficiency of the procedure in the treatment of patients suffering from snoring.
Oštećenje sluha stekne svaka četvrta osoba u dobi iznad 60. godine. Ono otežava komunikaciju i time narušava društveni život, emocionalnu dobrobit, funkcionalni status i mentalno zdravlje. Smanjenje ...njegova utjecaja na kvalitetu života suvremena intervencija nastoji ostvariti psihosocijalnim pristupom. To podrazumijeva nadogradnju dodjele slušnog pomagala instrukcijskim aktivnostima, komunikacijskim treningom i savjetovanjem koje provode različiti stručnjaci radi osnaživanja novih korisnika slušnih pomagala u prihvaćanju gubitka sluha, maksimalnom iskorištavanju preostalog sluha za uspješnu komunikaciju te sprječavanju socijalne izolacije. Ovaj rad opisuje pretpostavke i sastavnice holističkog, interdisciplinarnog procesa intervencije u području stečenog oštećenja sluha kod starijih osoba. U radu je izneseno do sada spoznato o: složenim posljedicama oštećenja sluha i njihovoj vrlo individualnoj prirodi; ovisnosti uspjeha intervencije o utvrđivanju i zadovoljavanju različitih specifičnih pojedinačnih potreba proizašlih iz gubitka sluha; načinima strukturiranja i evaluacije psihosocijalne intervencije; doprinosu holističkog modela intervencije prevenciji i/ili ublažavanju ukupnog utjecaja gubitka sluha na kvalitetu života.
More studies about possible increasing prevalence of stress fractures in figure skaters and contributing factors are lacking (Dubravcic-Simunjak et al., 2003 ; Moran, 2000 ; Pecina et al., 1990). ......the aim of this study was to obtain data about the current stress fracture cumulative risk among elite junior and senior figure skaters, as well as possible factors that may contribute to stress fracture incidence. ...the data suggest that the cumulative risk of stress fractures is high in figure skating, especially among single figure skaters and female pair skaters. Proper education to athletes and coaches about training regimes, together with early recognition of stress fracture symptoms may help to decrease the stress fracture risks. Because of the large number of competitions and shows in a short period of time, it is recommended to critically review the competitive schedule.
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