Introduction: Thyroid nodule is a common clinical finding. Ultrasound (US) and Fine-needle Aspiration (FNA) are the main methods used for investigating thyroid nodules, with questionable predictive values in Multinodular Goiter (MNG) compared to Solitary Thyroid Nodule (STN) due to the presence of multinodularity.

Objective: The present study was conducted to detect the independent predictors of malignancy in patients with MNG.

Patients & Methods: Medical records of patients who were admitted for thyroidectomy at Alexandria Main University Hospital and Medical Research Institute Hospital between January 2013 and January 2016 were reviewed. Demographic and clinical data, US reports, FNA reports, and final histopathological results were recorded and analyzed by univariate and multivariate analysis. Patients with a STN, hyper- or hypo-thyroidism, previous history of surgery for thyroid cancer or those with incomplete data were excluded.

Results: Reports of 1014 patients were reviewed, 419 patients with euthyroid MNG were included in the study. Malignancy rate was 19.3% (81/419). Micro-calcification, solid consistency, ill-defined margins, and presence of suspicious cervical lymph nodes by US were statistically significant predictors. Rate of malignancy in Bethesda II was 8.9% (false negative). Malignant rate increased with increasing in Bethesda rating from Bethesda IV (17.4%) to Bethesda V (51.7%), and lastly Bethesda VI (90.9%). Multivariate analysis revealed that micro-calcifications, suspicious cervical lymph nodes and Bethesda VI FNA were the independent predictors of malignancy. Other malignancy predictors that were only significant by univariate analysis were solid component of the nodule, and ill-defined margins.

Conclusion: Based on the data presented, it may be concluded that the independent predictors of malignancy in patients with MNG were US findings of micro-calcifications and suspicious cervical LNs as well as Bethesda VI on FNA

The major aim of this article is to report experimental results about the numerical quantities of the different shapes of human are ear concha as well as to classify them into defined shape groups. To the best of the author knowledge this approach has never been applied. The results are based on 2425 pictures of ears. The major results are: (1) The author has succeeded to classify all ears concha into 36 groups demonstrated in Figure 2. On the left is the absolute number of concha of a certain type where on the right is the percentage of it. (2) The most widespread concha, number 29, is that which appeared 393 times and is 16.2% of the total number. The less widespread shape, number 34, appears one time namely 0.04% of the total. In addition to the numerical results the following subjects are elaborated with respect to human’s ear: its anatomy, its different shapes as well as their relation to human’s character

Objective: We aimed to investigate the differences in incidence of nasal anatomic abnormalities between the patients with and without headache and the outcome of surgical treatment for the headache patients with mucosal contact point.

Background: “Mucosal contact point headache” has been defined by Headache Classification Committee of the International Headache Society. Whether the type of nasal anatomic abnormalities associates with incidence of headache and whether surgical treatment is necessary remain undefined.

Study Design: Observational study.

Methods: We recruited 107 subjects without headache and 78 subjects with refractory headache for more than 2 years. Subjects underwent high-resolution sinus CT scans and the incidence of nasal anatomic abnormalities was calculated in both groups and results were compared. An additional 25 patients underwent surgical treatment.

Results: Mucosal contact points were observed in 85.9% of patients with refractory headache and also in 80.4% of subjects without headache. The most common mucosal contact point among headache group patients was between deviated nasal septum and lateral nasal wall (55.1%) and the incidence of this type of contact point was significantly different between groups (P <0.05). An additional 25 headache patients with mucosal contact point were corrected via endoscopic surgery. Average pain scale scores decreased significantly between pre- and post-operative measurements (P<0.001). Only 44% of patients had recovered from headache 7 days postoperatively.

Conclusion: Some patients with recurrent headache and mucosal contact point may not meet the diagnostic criteria of mucosal contact point headache since pain was not resolved within 7 days after surgical treatment.

The major aim of this article is to report experimental results about the numerical quantities of the different shapes of human nose as well as to classify them into defined shape groups. To the best of the author knowledge this approach has never been applied. The results are based on 1793 pictures of noses of which 403 are artworks, 498 are photographs taken by the author in Europe - Holland, Belgium and France - while visiting these places, 801 were photographed in Israel and 91 are not clear where exactly photographed. 1081 were photographs of men and 712 of women. The author has succeeded to classify all the noses into 14 groups demonstrated in Figure 2 where for each nose shape it was possible to find also an artistic demonstration. The detailed results for the number of noses versus their shape and sources: artworks and photographing places - Europe and Israel - are reported in Table 1. The most widespread nose is shape 1, the fleshy nose in Figure 2, 24.2%, where the less widespread nose is shape 4, turned-up nose, 0.45%. It should be emphasized also that shape 14 photographed in Israel is extremely unique and the only one existing among the 1793 noses that were considered. In addition to the numerical results the following subjects are elaborated with respect to human’s nose: its anatomy, its different shapes as well as their relation to human’s character and facial attractiveness. And finally it is important to mention the development of electronic/artificial noses as systems for the automated detection and classification of odors, vapors, and gases.

Objectives: To observe difference of Substance P (SP) and NK-1 Receptor (NK-1R) expression in tissues at contact point and non-contact point among the patients with intranasal mucosal contact point headache and speculate the role of SP and NK-1R in mucosal contact point headache.

Methods: SP and NK-1R in tissues of contact point and non-contact point among 40 patients with intranasal mucosal contact point headache were stained histologically by immunohistochemistry, and the mRNA level was detected by RT-PCR.

Results: SP was located in cytoplasm of acini epithelial cells, distributed in nasal mucosa tissues at both contact point and non-contact point. But stain intensity was significantly increased at contact point (Z=-2.554, P<0.05). NK-1R was located in cytoplasm of acinar epithelial cells, inflammatory cells and nerve fibers of contact point; only in cytoplasm of acinar epithelial cells and nerve fibers of non-contact point. Tinctorial rate of NK-1R increased significantly at contact point (χ2 =40.438, P<0.01). mRNA level of SP and NK-1R was up-regulated in nasal mucosa at contact point compared with non-contact point.

Conclusion: Distribution of SP and NK-1R, especially NK-1R, in nasal mucosal tissue at contact point was higher compared with non-contact point. It was suggested that SP and NK-1R were associated with mucosal contact point headache.

Background: Hearing loss is a leading cause of disability worldwide and it is a significant public health problem.

Objectives: To determine the associated factors of unilateral sensorineural hearing loss among different age groups in Sudanese patients.

Methods: 115 Sudanese patients presented to Khartoum state ENT hospitals complaining of unilateral hearing loss were included.

Results: In this study 115 patients were included. Male to female ratio 1:1.3, 49 patients (42.6%) were from Khartoum state and the rest were from different areas in Sudan. The most frequent age group was from 1-15 years representing (38.3%) with a mean age of 24.48 ± 1.5. The commonest associated factor in this study was mumps and it was found in 47 of patients (40.9%), tinnitus was the commonest presenting symptoms in unilateral Sensorineural hearing loss 81 patients (70.4%) were assessed audiologically with pure tone audiometry and 34 patients (59.1%) assessed by Auditory Brain Stem Response (ABR).

Conclusion: Unilateral Sensorineural hearing loss commonly presents during school-age. Mumps is the most common associated factor. Pure tone audiometry and auditory brain stem response are suitable method for the assessment and the diagnosis.

T he term far-advanced otosclerosis was introduced by House and Sheehy  to indicate clinical otosclerosis with air conduction thresholds of more than 85 dB HL, Theotosclerotic process commonly involves the otic capsule and may cause quite widespread demineralisation which leads to a progressive and often profound bilateral sensorineural hearing loss.

Lobular Capillary Hemangioma (LCH) is a benign proliferation of capillary blood vessels adopting a lobular configuration. A laryngeal origin of LCH is exceedingly rare. Here, we describe a case of an 11-year-old boy presenting with a subglottic lesion, leading to a subglottic stenosis. Histopathologic findings of the lesion implicated an LCH, which was removed successfully by a coblator. This is the first report of a subglottic LCH. Physicians should be aware of this unique lesion and laryngeal LCH should be considered in diagnosing the cause of a subglottic stenosis. Additionally, coblation should be an effective treatment for laryngeal LCH.

Purpose: Hereditary hearing loss is associated with several mutated genes; among them mutant GJB2 is the main cause. We conduct this study to provide initial information about types, rates, and influences of mutations in Vietnamese patients.

Patients and Methods: Genomic DNA is extracted from peripheral blood samples of 96 childhood patients and 100 healthy control subjects. Primers are designed to amplify GJB2 gene, encoding Cx26 protein, followed by detecting mutations with Sanger sequencing technology.

Results: Exon 2 of GJB2 gene was sequenced from all 96 samples. We detected 9 variants of GJB2 gene from 56 patients (c.235delC, c.299_300delAT, c.634T>A, c.79G>A, c.608T>C, c.368C>A, c.11G>A, c.341A>G and c.109G>A). Of which, c.634T>A is a novel variant expected to be a causing disease mutation. Variants detected in 56 cases create 14 genotypes, including 2 causing disease genotypes (c.235delC and c.79G>A / c.299_300delAT), 7 genotypes with controversial role in disease (c.109G>A; c.11G>A; c.109G>A / c.341A>G; c.109G>A / c.608T>C; c.109G>A / c.634T>A; c.79G>A / c.109G>A / c.341A>G and c.79G>A / c.341A>G / c.368C>A), and 5 genotypes containing benign single nucleotide polymorphisms (c.79G>A; c.608T>C; c.79G>A / c.341A>G; c.79G>A / c.368C>A and c.79G>A / c.341A>G / c.368C>A).

Conclusion: We have detected the types and rate of mutations appearing on protein coding region of GJB2 gene from 96 Non-Syndromic Hearing Loss children. Most of the mutations are missense heterozygous or compound heterozygous and under controversy. We suspect that in Vietnamese population, hereditary hearing loss might be caused by interaction between disturbance of GJB2 and other genes such as GJB6, SLC26A4 or 12S rRNA on mitochondria. Next generation sequencing should be use to clarify multigenic defects of hereditary hearing loss in Vietnamese children.

Purpose: To detect a de novo paired box gene 3 (PAX3) mutations, mutational analysis, and associated phenotypes in the Vietnamese Children patients with Waardenburg syndrome type I (WS1). We conduct this study to provide initial information about types, rates, and influences of this particular PAX3 mutations gene in the Vietnamese patients.

Patients and Methods: Three unrelated patients with suspected WS1 were selected from our Genomic extraction DNA, probe and sequence the primers, PCR technique. PAX3 were amplified by polymerase chain reaction (PCR), and then amplicons PCR were analyzed by cycle sequencing. Variations were detected, documented and recognized as “de novo” mutation. We also compared the severity of hearing impairment, phenotypically variations among these individual affected patients.

Results: Number variations of mutations in PAX3 were detected in three patients, respectively: c.955delC (Gln319fsX380), c.667C>% (Arg223Stop). One mutation proved to be de novo as their parents did not carry the mutations, and had never been found in any previous study in Vietnam. All three patients with PAX3 mutations had different iris color, fundi between their two eyes, dystopia canthorum and profound hearing loss. We report the phenotypic expression of WS1 in these three patients and explore the implications for possible genotype phenotype correlations. Sensorineural hearing loss was present in 80% of affected individuals, and spectrum of hearing loss with very high frequency.

Conclusion: De novo mutation in PAX3 has not been reported in Vietnam before. Finally, our finding has detected deletion mutation c.667>T (p.Arg223X) in PAX3 identified in three children individual with WS1. Our analyses indicated that these mutations might constitute a pathogenic-genetic-hearing loss associated with WS1. It is very clinical importance as such patients may be misdiagnosed as congenital hearing loss since it is uncommon in Southern Vietnamese population.

Purpose: To detect a de novo paired box gene 3 (PAX3) mutations, mutational analysis, and associated phenotypes in the Vietnamese Children patients with Waardenburg syndrome type I (WS1). We conduct this study to provide initial information about types, rates, and influences of this particular PAX3 mutations gene in the Vietnamese patients.

Patients and Methods: Three unrelated patients with suspected WS1 were selected from our Genomic extraction DNA, probe and sequence the primers, PCR technique. PAX3 were amplified by polymerase chain reaction (PCR), and then amplicons PCR were analyzed by cycle sequencing. Variations were detected, documented and recognized as “de novo” mutation. We also compared the severity of hearing impairment, phenotypically variations among these individual affected patients.

Results: Number variations of mutations in PAX3 were detected in three patients, respectively: c.955delC (Gln319fsX380), c.667C>% (Arg223Stop). One mutation proved to be de novo as their parents did not carry the mutations, and had never been found in any previous study in Vietnam. All three patients with PAX3 mutations had different iris color, fundi between their two eyes, dystopia canthorum and profound hearing loss. We report the phenotypic expression of WS1 in these three patients and explore the implications for possible genotype phenotype correlations. Sensorineural hearing loss was present in 80% of affected individuals, and spectrum of hearing loss with very high frequency.

Conclusion: De novo mutation in PAX3 has not been reported in Vietnam before. Finally, our finding has detected deletion mutation c.667>T (p.Arg223X) in PAX3 identified in three children individual with WS1. Our analyses indicated that these mutations might constitute a pathogenic-genetic-hearing loss associated with WS1. It is very clinical importance as such patients may be misdiagnosed as congenital hearing loss since it is uncommon in Southern Vietnamese population.

Objective: To investigate the profile of deaf children who attended a teaching-clinic of Speech Language Therapy located in a city in the South of Brazil from 2009 to 2015.

Method: The study was conducted by collecting and analyzing the data found in patients with some degree of hearing loss profiles, in which the following variables were searched: age, gender, referral (who forwarded), origin, age of the diagnosis, hearing aids, complaints, Speech language therapy feedback.

Results: The most recurrent complaint in this clinic is hearing loss, the most frequent speech-language therapeutic feedback is the impairment in the development of the oral language due to hearing loss. As for the age of the diagnosis, 27 were diagnosed between 1 and 3 years old, 6 between 1 and 11 months old, 6 between 4 and 10 years old. Regarding the degree of the hearing loss, 15 present a profound hearing loss, 11 present moderate hearing loss, 7 present a mild hearing loss, and 6 present severe hearing loss. There was not sex prevalence, mean age was about 4 and a half years old, most patients are from Curitiba, and all of them were taken to the clinic by family members and referred by health professionals or by their school.

Conclusion: Many patients with oral language and hearing problems were found in this study, which demonstrates the need of prevention and health promotion actions in those areas.

Objective: To alert the clinician suspecting of an autoimmune disorder like Sjogren Syndrome for children affected by recurrent parotitis, particularly in case of bilateral involvement in order to timely recognize this disease and to facilitate the treatment and the screening for complications.

Materials and Methods: All patients with recurrent parotid swelling between 0 and 14 years, 7 in total referred to the Multidisciplinary Department of Medical and Dental Specialities, Division of Oral and Maxillofacial Surgery (Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy) in the last 2 years, were subjected to clinical, serological, microbiological and ultrasound screening for excluding tumors or infectious diseases. In patients thus selected were diagnosed with Juvenile Recurrent Parotitis and were treated with sialoendoscopy (intraductal wash of saline solution and steroids) or other anti inflammatory drugs. From the formulation of diagnosis, patients were subjected to careful follow-up checks with 6, 12 and 18 months during which they proceeded to repeat initial serological screening if the endoscopic or systemic therapy became ineffective.

Results: Patient 1: Following interventional sialoendoscopy treatment with mechanical dilation and washing with physiological solution and cortisone, howed remission at 18 months. Patient 2: Following interventional sialoendoscopy treatment with mechanical dilation and washing with physiological solution and cortisone showed remission at 18 months. Patient 3: She took prednisone and hydroxychloroquine, with complete resolution of parotid swelling and no further recurrences. Patient 4: Following endoscopic treatment with mechanical dilation and washing with physiological solution and cortisone did not show relapse after 18 months. Patient 5: She took hydroxychloroquine 12 months later with resolution of parotitis symptoms. Patient 6: Following interventional sialoendoscopy treatment with mechanical dilation and washing with physiological solution and cortisone showed remission at 18 months. Patient 7: Following the interventional sialoendoscopy treatment with mechanical dilation and washing with physiological solution and cortisone showed remission of relapse at 18 months.

Conclusions: Recurrent parotitis should alert the clinician to the possibility of pSS especially if it does not respond to treatment with anti-inflammatory therapy and sialoendoscopic washing.