Hearing is considered an important sense of the human being. Hearing impairment cannot be visible and hence its effects are not seen by others so the deaf suffer in silence. Hearing impairment is not only a communication problem but also a community problem. Hearing loss, which is gradual and permanent, can be brought on by congenital or acquired damage to the auditory nerve and cochlear hair cells. It reduces the working ability and performance of an individual, thus diminishing one’s participation. Hearing loss is often associated with loneliness and social isolation which has an impact on cognitive and psychosocial health. Early identification of hearing impairment in a child is vital for effective management. Hearing loss has a detrimental impact on family dynamics and, as a result, the child’s development. The widespread prevalence of deafness necessitated a reliable management system and simple clinical implementation. This public health burden can be managed by raising awareness of hearing impairment. There are plenty of clinical assessment and therapy options in hearing impairment research, but lack of knowledge about it implies that public education or awareness should be prioritized more. This review article discusses the epidemiology, etiopathogenesis, clinical features, impact of hearing impairment, and its impact on the community along with current treatment options.

The operator has to place a needle in the vicinity of the nerve and inject a local anesthetic to accomplish a block.[1] A needle is a sharp object whereas, a nerve is a vulnerable structure. To simplify, a nerve is like a telephone cable with hundreds of tiny wires inside it. If a needle makes its way into the cable, it is likely to cut some wires; but the cable may still be functional. It is because not all wires are cut, but there may be functions that cannot be replaced because of specific transmission of the cut tiny wires are lost. In the nerve block analogy, it means that some connecting neurons will become dysfunctional
transiently or permanently.

Background: Coronavirus disease 2019 (COVID‑19) is an acute respiratory disease caused by novel severe acute respiratory syndrome coronavirus 2. COVID‑19 infection presents with mild flu‑like symptoms to severe respiratory illness, even respiratory failure. Oral cavity lesions are currently documented in the COVID‑19 infections, which increases the morbidity of the patients. Objective: The aim of this study is to evaluate the different types of the oral cavity lesions in COVID‑19 patient, including its symptoms and signs. Materials and Methods: This is a prospective observational study. COVID‑19 patients were evaluated for oral cavity manifestations. The age ranges from 18 years to 65 years. All these patients underwent detailed examinations of the oral cavity and oropharynx with the help of headlight, along with wearing personal protective equipment. Results: Fifty‑six COVID‑19 patients showed oral cavity manifestations during their treatment period. The most common clinical entity in this study was gustatory disturbance (26.78%), followed by oral mucositis (14.28%), glossitis (12.50%), and ulcers (8.92%) in the oral cavity of the COVID‑19 patients. Conclusion: COVID‑19 infection significantly affects the oral cavity and salivary glands. Clinicians should keep in mind different lesions in the oral cavity and taste disturbances of COVID‑19 patients, which will help the early diagnosis, treatment and avoid the morbidity of the patient.

Background: Asthma is a chronic disorder caused by complex interactions between genetic and environmental influences. Objective: Investigatethe possible correlation between interleukin-4 (IL-4) gene polymorphisms and development of specific Chlamydia pneumoniae immunoglobulin (Ig) E levels. Materials and Methods: A total of 87 children, including 57 males and 30 females with asthma with ages between 1 and 16 years, attended the Respiratory Clinic at Karbala Pediatric Hospital, with a nonasthmatic children group which have the same age and gender. Restriction fragment length polymerase chain reaction was performed to determine IL‑4 C‑589T genetic polymorphisms. Total IgE level, C. pneumoniae IgG, and C. pneumoniae IgE antibodies were measured using the commercial quantitative enzyme-linked immunosorbent assay kits. Results: C. pneumoniae IgG and IgE antibodies were significantly increased in patients as compared with controls (P < 0.001 and P = 0.024, respectively). The CT genotype of IL‑4 C‑589T polymorphism was associated with asthmatic children (P < 0.01). A high C. pneumoniae IgE levels were found to be associated with CC genotypes(P = 0.01). On the other hand, there were no significant differences in serum C. pneumoniae IgG levels depending on different IL‑4 C589T genotypes (P = 0.662). Conclusion: The development of C. pneumoniae IgE antibody in asthmatic children did not depend on IL-4 polymorphism.

Background: SIRT6, a chromatin‑associated nuclear protein, exhibits beneficial and pivotal functions in longevity, cardiovascular diseases, and cancer. However, the significant and controversial clinical value of SIRT6 in cancers has not been fully defined. In this manuscript, we performed an updated and comprehensive meta-analysis of all relevant clinical data in order to gain an exhaustive summary of the clinicopathological roles of SIRT6 in various human cancers. Materials and Methods: A systematic literature searching was performed in PubMed, Web of Science, Embase, and CNKI up to April 2019. Studies enrolled in our quantitative meta‑analysis were selected according to inclusion and exclusion criteria. Our meta‑analysis was performed using total effect analyses and subgroup analyses to evaluate the relationship between SIRT6 expression and overall survival, clinicopathological parameters of multiple types in cancer patients including cancer/noncancer tissues, lymph node metastasis, metastasis, distant metastasis, differentiation, tumor stage and tumor node metastasis (TNM) stage, tumor size, gender, estrogen receptor, and progesterone receptor. The hazard ratios (HRs) or odds ratios (ORs) of the 95% confidence intervals (CIs) were calculated to reveal the risk or hazard association. All analyses were conducted using the Cochrane Collaboration Review Manager 5.3 software. Results: A total of twenty studies comprising 2700 patients from five countries who represented nine cancer types were included to assess the association between SIRT6 immunohistochemical expression and overall survival or clinicopathological characteristics. Cancer type subgroup analysis showed that high SIRT6 expression was associated with worse OS in hepatocellular carcinoma (HR: 1.49, 95% CI: [1.22, 1.81], P < 0.0001, I2 = 0%), osteosarcoma (HR: 2.05, 95% CI: [1.28, 3.30], P = 0.003, I2 = 0%), and non‑small cell lung cancer (NSCLC) (HR: 1.88, 95% CI: [1.02, 3.47], P = 0.004, I2 = 73%). In addition, our results demonstrated that SIRT6 expression was statistically significant in noncancer tissues higher than in cancer tissues (OR = 0.32, 95% CI = 0.13–0.79, P = 0.01, random‑effects model). Furthermore, it has been shown that SIRT6 expression was well correlated with lymph node metastasis in patients with breast carcinoma (OR = 1.76, 95% CI = 1.17– 2.66, P = 0.007, fixed‑effects model), the stages of pathological differentiation in cancer patients (OR = 1.53, 95% CI = 1.08–2.18, P = 0.02, fixed‑effects model), tumor stages (I–IV) in NSCLC patients (OR = 0.40, 95% CI = 0.20–0.80, P = 0.01, fixed‑effects model), and TNM stages in colon cancer patients (OR = 2.41, 95% CI = 1.38–4.20, P = 0.002, fixed‑effects model). Nevertheless, there was no detectable correlation between SIRT6 expression and other clinicopathological parameters in total or subgroup analyses. Conclusion: Our current meta-analysis indicates that the expression level of SIRT6 is highly associated with overall survival and clinical features in specific cancers.

The vestibulo‑ocular reflex (VOR) causes movements of the eye that are intended to compensate for head and body movements so that vision remains stable on the retina. VOR helps to stabilize the retinal image by rotating the eyes to compensate for movements of the head. The VOR keeps us steady and balanced even though our eyes and head are continuously moving during the performance of actions. The VORs are driven by signals coming from vestibular labyrinths and use subcortical, short‑latency pathways from vestibular afferents to the extraocular motor neurons. The relatively simple neural architecture of these reflexive responses, coupled with their stereotyped but adaptable nature, makes them ideal to understand simple sensorineural transformations. Without VOR, when an individual walks down the street, it is difficult to read signs or even recognize faces. Even an inaccurate VOR can result in a slip of visual image concerning photoreceptors, causing blurring of the images. If the VOR is injured, the retinal slip occurs which causes instability in gaze during rapid head movements. The disruption of the VOR results in oscillopsia and abnormal nystagmus. Oscillopsia causes blurred vision when the head is in motion and objects appear to jiggle and bounce as this object does not fix at one point in the retina. The objective of this review article is to discuss the anatomy of VOR with its bedside examinations, clinical implications, and management of VOR failure.

Benign paroxysmal positional vertigo (BPPV) is the mos common cause of peripheral vertigo. The pathophysiology of BPPV is canalolithiasis which includes free‑floating otoconial debris within the endolymph of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula. The posterior and/or lateral semicircular canals are often affected in BPPV. It is characterized by a brief episode of
rotatory vertigo associated with positional and/or positioning nystagmus, which is elicited by specific head positions or changes in head position relative to gravity. In the case of the posterior canal type of BPPV, torsional nystagmus is induced by the Dix‑Hallpike test. In patients of lateral canal type of BPPV, horizontal geotropic or apogeotropic nystagmus is induced by the supine roll test. The observation of positional and/or positioning nystagmus is needed for the diagnosis of BPPV. The treatment of BPPV includes canalith repositioning procedure (CRP). By series of head position changes, the CRP moves the otoconial debris from the involved semicircular canal to the utricle. This review article presents operational diagnostic criteria for BPPV, formulated by the Committee for Classification of Vestibular Disorders of the Barany Society. This classification reflects the current knowledge of the clinical aspect and pathophysiology of BPPV. These diagnostic criteria will be helpful for the understanding of the disease and will lead to further development in the management of BPPV.

We read the manuscript entitled “Spectrum of Neurological Complications of Pregnancy on Magnetic Resonance Imaging” on the esteemed “Matrix Science Medica” with great interest.[1] Posh et al. assessed the role of neuroimaging in neurological complications of pregnancy. The authors found that posterior reversible encephalopathy syndrome and cerebral venous thrombosis are responsible for more than 60% of the cases. Furthermore, they stated that magnetic resonance imaging is essential for promptly diagnosing possible neurological complications without risking fetal
safety.

Background: Diabetes mellitus is one of the major problems in health systems and a global public health threat and diabetic foot ulcers and lower extremity amputations are common, complex, costly, and disabling complications of diabetes. Poor foot care knowledge and practices are important risk factors for foot-related problems among diabetic people. Aims: The aim of the study is to assess the knowledge about foot care, foot care practices, the prevalence and risk factors of diabetic foot and foot-related complications in adult diabetic patients. Settings and Design: The cross-sectional study was conducted in 204 consecutive diabetic patients attending the outpatient department of a tertiary care hospital. Methods: A questionnaire including demographic details, knowledge questionnaire, attitude, and awareness for foot problems based on the Nottingham Assessment of Functional Foot Care Revised 2015 questionnaire was administered. This was followed by a foot examination for various aspects related to foot care and risk stratification. Statistical Analysis Used: Descriptive analysis with frequency distribution for knowledge and practice scores, univariate analysis, and multiple logistic regressions to find significant variables associated with good foot care knowledge and practice scores. Results: About 30.39% had good knowledge score. Rural background (adjusted odds ratio [OR]: 1.98, 95% confidence interval [CI]: 1.08–3.65), poor education status (adjusted OR: 4.63, 95% CI: 1.04–20.54), poor glycemic control (adjusted OR: 1.46, 95% CI: 0.83–2.58), and previous history of foot ulcer (adjusted OR: 3.05, 95% CI: 1.42–6.65) were significantly associated with poor knowledge on foot care. Conclusion: Our study shows that knowledge and practice of foot care of diabetic patients are still substandard. Poor communication between patients and nurses/physicians, rural background, poor education, and poor glycemic control were significant barriers of foot care. Policymakers should initiate foot care education programs throughout the regional state for increasing awareness about proper foot care practice in diabetic patients to reduce the incidence of complications.

Background: Nasosinus mucoceles are expansile cystic masses originating at the paranasal sinuses by chronic retention of the mucus in a sinus cavity due to ostial obstruction. Aim: This study aims to evaluate the risk factors, clinical presentations, and management of nasosinus mucoceles. Materials and Methods: This is a retrospective study carried out over 5 years from August 2017 to September 2022 at a tertiary care teaching hospital. The diagnosis of nasosinus mucoceles was done by the clinical presentations and imaging of the paranasal sinuses. Results: There were 38 cases of nasosinus mucoceles included in the study. This study included 20 males and 18 females and male‑to‑female ratio of 1.11:1, with a mean age of 52.6 years (age range from 16 to 78 years). Computed tomography (CT) scan and magnetic resonance imaging were the main imaging done among study patients. All patients underwent endoscopic sinus surgery with marsupialization. Out of 38 patients, 2 (5.26%) had recurrence during the follow‑up period. Conclusion: Orbital symptoms were major manifestations found in this study. CT scan was an important imaging performed in preoperative assessment. Endoscopic endonasal surgery is currently the gold standard for the treatment of nasosinus mucoceles. A satisfactory outcome was achieved after endonasal endoscopic marsupialization.