Association between habitual snoring,middle ear disease,and speech problems in young children with non-syndromic cleft palate anomalies

The purpose of this study was to investigate the association between habitual snoring (HS), middle ear disease (MED), and speech problems in children with cleft palate. This cross-sectional study included children aged 2.0–7.9 years with non-syndromic cleft palate anomalies. Parents completed the Pediatric Sleep Questionnaire and a questionnaire about MED. Audiograms and speech assessment were also conducted. Ninety-five children were enrolled; 15.2% of families reported HS, 97.6% MED, and 17.1% speech problems. HS (37.5% vs 10.3%, P = 0.007) and early episodes of MED (92.3% vs 58.2%, P = 0.021) were more likely to be reported for children with isolated cleft palate when compared to those with cleft lip and palate. Children with cleft lip and palate had a higher frequency of MED with effusion compared to those with Robin sequence (86.4% vs 57.1%, P = 0.049). The odds ratio for HS in children with ≥1 episode of MED in the last year was 7.37 (95% confidence interval 1.55–35.15, P = 0.012). There was a trend for children with speech problems reported by parents to have HS (30.8% vs 11.5%, P= 0.076). Anatomical factors play a role in the frequency of upper airway symptoms in children with cleft palate. A recent history of at least one episode of MED was associated with an increased frequency of HS.     

Skin regeneration,repair, and reconstruction: present and future

European Surgery - Large skin defects caused by trauma (e.g., burns) or due to other reasons (e.g., tumor-related skin resections) require sufficient skin replacement. The constant improvement of...     

Necrotising myositis – learnings for a plastic surgeon

BackgroundNecrotising myositis (NM) is a life-threatening emergency. Prompt treatment is associated with more favourable outcomes, but early diagnosis is challenging. The initial absence of cutaneous signs and symptoms coupled with delayed recognition commonly result in higher rates of morbidity and mortality.ObjectivesAnalyse data regarding demographics, epidemiology, aetiology, clinical manifestations, diagnosis and treatment of previously reported cases. This publication is intended for plastic surgeons in training to help them look out for this disease.Search methods/criteriaPublications reporting necrotising myositis between 1974 to January 2020 were identified from Embase, Medline All, Web of Science Core Collection, Google Scholar and Cochrane Central Register of Controlled Trial.Data collection and analysis: Identified studies were exported to an end note library. In animal studies, studies relating to statin-induced myotoxicity and auto-immune myositis were excluded. The quality of included case reports was assessed using JBI Critical Appraisal Checklist for Case Reports.Main resultsThe most common initial presentation was a few days of antecedent prodromal flu-like symptoms associated with muscle pain. The mean age was 43.3 years and 82% had no significant medical history. The most frequent misdiagnoses were muscle strain (11%), deep vein thrombosis (10%) and viral illness (9%). Seventy-four per cent of presentations were due to Group A Streptococcus infections and only 3.5% of cases were polymicrobial. The most common clinical course following the initial presentation was rapid deterioration into profound sepsis and progression into multi-organ failure. The overall mortality rate was 36.5%.ConclusionsNM is a life-threatening muscle infection. It is a diagnostic conundrum as initial presentation is often only myalgia without features of preceding trauma. We propose that a high index of suspicion and increased awareness will reduce morbidity.OtherPROSPERO (registration number CRD42018087060). Nil funding/conflict of interest.     

Memory complaints moderate the concordance between self-report and electronically monitored adherence in adults with type 2 diabetes

AimsWe examined the impact of memory complaints on the concordance between self-report (SR) and electronically monitored (EM) medication adherence, independent of depression symptoms, among adults with type 2 diabetes (T2D).MethodsAdults (N = 104, age = 56.6 ± 9.2; 64% female) completed a prospective and retrospective memory questionnaire (PRMQ) and a depression symptom interview at baseline. EM was tracked over 3 months and participants rated adherence using SR. Multiple linear regression evaluated PRMQ as a moderator of the relationship between EM and SR, adjusting for depression and other covariates.ResultsPRMQ was correlated with lower SR (r = ?0.31, p = 0.001), but not with EM. PRMQ moderated the relationship between SR and EM, independent of depression symptoms. At low levels of PRMQ, SR and EM were closely related (β = 0.76, p < 0.001); at high levels of PRMQ the relationship was weaker (β = 0.28, p = 0.02). Participants who under-reported their adherence (SR < EM) had higher PRMQ scores than more concordant reporters (p = 0.016).ConclusionsSR and EM measures were less concordant among adults with T2D who endorsed higher PRMQ scores. Memory complaints may contribute to under-reporting of medication adherence in adults with T2D.