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Objectives: The objectives were to investigate the clinical characteristics and course of long COVID, defined as the persistence of symptoms at least one month after the onset of COVID-19, in outpatients and to clarify differences in symptoms between SARS CoV-2 mutant strains. Methods: Our observational study in a primary care institution in Japan included 1053 patients with long COVID who visited our outpatient clinic between April 2021 and March 2023. Symptom distribution, performance status, and patient background at the time of the first outpatient visit were compared between infectious strains (Delta and before group and Omicron group). Background factors and symptoms related to time to remission were also analyzed. Results: The severity of COVID-19 in the acute phase was mild, moderate, and severe in 82.2%, 14.9%, and 2.9% in the Delta and before group; and in 97.6%, 1.7%, and 0.4% in the Omicron group, respectively. Vaccination coverage was significantly different between the Delta and before (37.1%) and Omicron groups (73.1%) (p < 0.001), probably due to the period of vaccine unavailability in the former group. Symptoms of fatigue and headache occurred most frequently, irrespective of infectious strain. The mean number of symptoms per patient was significantly higher in the Delta and before group than the Omicron group (3.4 vs. 2.7, p < 0.0001). The median time overall to remission of long COVID was 169 days. Cox hazard model analysis identified female sex, high body mass index, and dyspnea (but not infectious strain) as significant factors prolonging the time to remission (p < 0.05). Conclusions: Differences in the number of symptoms between infectious strains may be related to differences in viral virulence and/or vaccination coverage. However, the clinical course was found to be minimally influenced by the infectious strain. The present results should improve the understanding of prognosis in patients with long COVID from both the clinical and social perspectives.

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Objective: To determine whether cervical ultrasonography, magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) are useful in the differential diagnosis of etiology and understanding the pathophysiology in cases of apogeotropic direction-changing positional nystagmus (DCPN). Methods: Thirty patients with apogeotropic DCPN were classified into 11 cases of central disease, seven cases of mixed central and peripheral disease, and 12 cases of peripheral disease by differential diagnosis based on various balance function, neuro-otological, and imaging tests.Cervical ultrasonography using the cervical rotation method and MRI and MRA of the head and neck were performed in most patients with apogeotropic DCPN. We reviewed the presence of abnormal imaging findings according to the disease etiology. Results: Of the 30 patients with apogeotropic DCPN, 23 showed vascular abnormalities or central lesions on imaging. Vascular lesions were found in six of the 12 patients with peripheral disease. Cervical ultrasonography with cervical rotation detected blood flow disturbance in the vertebral artery in eight patients in whom the disturbance could not be detected by MRI or MRA of the head and neck. Discussion: We hypothesize that the causative disease of apogeotropic DCPN may be strongly associated with circulatory insufficiency of the vertebrobasilar and carotid arteries, and that impaired blood flow in these vessels may affect peripheral vestibular and central function. In patients with apogeotropic DCPN, examinations of vestibular function, central nervous system symptoms, and brain hemodynamics are valuable for differential diagnosis.

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Primary and metastatic malignancies arising in the sinuses are rare and histologically diverse. The role of fine-needle aspiration cytology (FNAC) and the cytomorphologic characteristics of these tumors have not been specifically addressed. We described two cases of suspected malignant maxillary sinus tumors in 85- and 90-year-old patients with comorbid conditions, both of whom underwent tissue biopsies that failed to yield a definitive diagnosis. We performed FNAC after imaging confirmed that the malignant tumors were outside the maxillary sinus. The 85- and 90-year-old patients were diagnosed with squamous cell carcinoma (SCC) and adenocarcinoma, respectively. In the latter, the cell block method was used to prepare the specimen, rendering individual cells identifiable. Atypia of the histological structure was confirmed without the influence of cell duplication, a known weakness of FNAC. Thus, the diagnosis was made quickly. We believe that FNAC would be utilized more frequently for the definitive diagnosis of sinonasal tumors as the technique and diagnostic technology improve further.

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Objective Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is characterized by respiratory events such as apnea and hypopnea predominately or exclusively during REM sleep. Several studies have revealed clinical predictors of adherence to the use of continuous positive airway pressure (CPAP). However, the effect of REM-related OSA on adherence to CPAP use remains unclear. Therefore, we investigated the effects of REM-related OSA on adherence to CPAP use 6 months after treatment initiation. Methods We enrolled 161 patients in this study and divided them into 3 groups: the good adherence, poor adherence, and dropout groups. We compared polysomnographic data and clinical findings, including those regarding morbidity of REM-related OSA, among the three groups to identify predictors of adherence to CPAP use. Results None of the 43 patients in the good adherence group had REM-related OSA. Multivariate logistic regression analysis of the good adherence and dropout groups indicated that REM-related OSA was the only factor associated with adherence to CPAP use (odds ratio, 41.984; 95% confidence interval, 2.257-781.007). Conclusions REM-related OSA is a reliable risk factor for dropout from CPAP therapy.

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The aim of this study was to investigate the potential polysomnographic predictors of CPAP adherence using polysomnographic parameters at the time of obstructive sleep apnea diagnosis that distinguished between REM and NREM sleep. This was a retrospective cross-sectional study of 173 patients. Patients who used CPAP for more than 4 hours per night for at least 70% of nights over a 6-month period were considered to have good adherence. The poor adherence group included those who had used CPAP for 6 months from initiation, but did not fulfill the definition of good adherence or gave up the treatment within 6 months of treatment initiation. Of the 173 participants, 44 patients had good CPAP adherence and 129 patients had poor adherence. Univariate analysis showed that patients with good adherence had significantly higher apnea-hypopnea index during NREM sleep (p = 0.043), oxygen desaturation index during NREM sleep (p = 0.011), and cumulative percentage of time spent at saturations below 90% (CT90) during NREM sleep (p < .001). In multiple logistic regression analysis including all variables, CT90 during NREM sleep was the only factor independently associated with CPAP adherence (odds ratio, 0.693; 95% confidence interval, 0.582-0.824; p <.0001). The area under the receiver-operating characteristic curve of CT90 during NREM sleep was 0.823 (95% confidence interval, 0.745-0.901).Evaluating NREM sleep is important in reliably predicting CPAP adherence using polysomnographic parameters. CT90 during NREM sleep was the best predictor of CPAP adherence.

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Acute epiglottitis may trigger death because of serious airway obstruction. It is necessary to perform emergency and accurate airway intervention. In this retrospective study we present 216 cases of acute epiglottitis in adults. Airway management was done in 39 cases (18.1%), but most cases were treated conservatively. The mean patient age was 53 years and the male-to-female ratio was 1.9 to 1.0. The most frequent symptoms were sore throat (88%). The mean duration from symptom onset to consultation to our hospital was 1.9 days in the airway management group and 2.9 days in the conservatively treated group, which was statistically significant (p<0.05). Focusing on epiglottal swelling seen under the flexible laryngoscope, the percentage of airway management was 52.6% for swelling of the unilateral false vocal cords and 12.9% for swelling of the aryepiglottic fold. A statistically significant difference was also seen in complaints of respiratory difficulties (p<0.01), the rise of WBC (p<0.01), the rise of CRP (p<0.01), and diabetes mellitus (p<0.01).

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BACKGROUND: Laryngopharyngeal reflux (LPR) is defined as the retrograde flow of gastric contents up through the esophagus to the larynx and hypopharynx; this is an extra-esophageal manifestation of gastroesophageal reflux disease (GERD). Although both LPR and GERD are caused by reflux of stomach contents, their clinical presentations and treatments differ. PATIENTS AND METHODS: In the present study, we assessed esophago-gastroendoscopic findings related to GERD, specifically endoscopic-positive esophagitis (EE), laryngopharyngeal findings, and GERD symptoms on the 12-question frequency scale for the symptoms of gastroesophageal reflux disease (FSSG). Then, independent predictors of EE were analyzed, and relationships among EE, laryngopharyngeal findings, and patients' symptoms and characteristics were investigated. RESULTS: Hiatal hernia (odds ratio [OR]: 2.70; 95% confidence interval [CI]: 1.17-6.23, P-value 0.019) and edema of theinterarytenoid mucosa (OR, 3.77; 95% CI, 1.26-16.3; P-value 0.035) were significantly related with EE and independent predictors of EE. However, patients' characteristics and the FSSG score had no significant relationship with EE; there was no relationship between patients' characteristics and EE, regardless of its severity. CONCLUSIONS: Although LPR symptoms had no significant relationship with the findings of EE, hiatal hernia and edema of the interarytenoid mucosa were significantly related with EE and were considered to be independent predictors of EE.

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