Adan Hospital

Multi-dimensional voice assessment is critical for monitoring recovery in patients treated with radiotherapy (RT) for early glottic carcinoma. This study investigated the longitudinal cross-parametric correlations between subjective (AVHI-10), functional (LVS), and objective (acoustic) voice measures at baseline and 6 months post-RT. Thirty-seven patients with T1–T2N0M0 glottic carcinoma were prospectively evaluated. Spearman correlation matrices (ρ) were employed to analyze the relationships between the Voice Handicap Index-10 (AVHI-10), laryngeal videostroboscopy (LVS), and acoustic parameters (HNR, Jitter, Shimmer and MPT). All parameters showed significant clinical improvement at 6 months (P < 0.001). Post-RT, the AVHI-10 demonstrated exceptionally strong concordance with objective efficiency measures, specifically HNR (ρ = − 0.893) and MPT (ρ = − 0.844), as well as robust correlations with perturbation metrics (Jitter: ρ = 0.761; Shimmer: ρ = 0.753). In contrast, while functional LVS parameters remained significantly correlated with acoustic output, these associations were more moderate (ρ ranging from = 0.41 to 0.67). Glottic closure was the most prominent functional predictor of acoustic spectral purity (ρ = − 0.674 with HNR), whereas mucosal wave parameters (Phase Symmetry and Periodicity) exhibited a relative weakening in their correlation with acoustic instability, suggesting a complex interplay following radiation-induced tissue changes. Subjective handicap (AVHI-10) serves as a highly reliable surrogate for objective acoustic efficiency in the post-RT larynx. While functional laryngeal dynamics improve universally, the attenuation of correlations observed between mucosal wave parameters and acoustic output highlights the complex, non-linear impact of radiation-induced fibrosis. Residual glottic closure remains the primary functional determinant of vocal efficiency, emphasizing its role as a key clinical biomarker for post-treatment success.

Early glottic carcinoma primarily affects the vocal folds and most commonly presents with the symptom of dysphonia, which is an effect of the tumor interfering with normal vocal fold vibration. Radiotherapy for early glottic carcinoma is highly effective in controlling the tumor while preserving the larynx and voice. The aim of this study was to evaluate changes over time in voice outcomes among patients with early stage glottic cancers treated with definitive radiotherapy using stroboscopy as well as voice acoustic analysis. The assessment was applied on 24 patients with T1 and T2 glottic carcinoma. It was conducted pre-radiotherapy, 3 months and 6 months post-radiotherapy as follow-ups. The assessment included laryngoscopic, videostroboscopic examination, and voice acoustic analysis. Marked improvement was found in videostroboscopic parameters, with parameters highly significant differences across the three phases for nearly all stroboscopic parameters, p-values (<0.001), with a significant difference noted specifically for the periodicity of mucosal waves in the right vocal fold p-value (0.005). Significant improvement was detected in voice acoustic analysis parameters, including the increase in harmonic to noise ratio and maximum phonation time, and reduction in jitter and shimmer by 6 months (p < 0.001). The overall outcomes of the current study pointed to improved glottic manifestations based on videostroboscopy parameters and voice acoustic analysis parameters by 6 months post-radiotherapy.

BackgroundEmapalumab, an interferon-γ (interferon-gamma)–blocking monoclonal antibody, has emerged as a targeted therapy for refractory hemophagocytic lymphohistiocytosis (HLH). This scoping review summarizes real-world evidence of its clinical use across HLH subtypes.MethodsA comprehensive search of PubMed, Scopus, and Web of Science through September 2025 identified studies reporting emapalumab use outside clinical trials. Case reports, series, and observational studies describing clinical outcomes were included.ResultsThirty-one publications comprising 86 patients were analyzed. Disease contexts included familial/genetic HLH (n = 11), rheumatology-associated macrophage activation syndrome (MAS; n = 12), malignancy-associated HLH (n = 25), infection-associated HLH (n = 22), CAR-T/IEC-HS or cytokine-release-syndrome–related HLH (chimeric antigen receptor T-cell/immune effector cell–associated hemophagocytic syndrome; n = 11), and other secondary HLH (n = 5). Across all categories, emapalumab achieved rapid suppression of hyperinflammation, typically within 1–2 weeks. Clinical response rates were 100% in familial HLH, 91.7% in rheumatology-associated MAS, 72.7% in infection-associated HLH, 90.9% in CAR-T/IEC-HS–related HLH, and 80% in other secondary HLH. In contrast, only 6 of 25 patients with malignancy-associated HLH (24%) showed partial or complete responses, reflecting inferior outcomes due to underlying disease progression. Overall survival was highest in familial and infection-associated subgroups. The reported adverse events were generally infrequent and mild in the published cases, but causality cannot be reliably established given the complexity of the underlying disease and concurrent therapies.ConclusionReal-world evidence demonstrates that emapalumab induces rapid and durable disease control across diverse HLH subtypes, with a favorable tolerability profile. However, outcomes remain markedly inferior in malignancy-associated HLH, where response rates are limited to approximately 24%, primarily due to the impact of underlying malignancy. Its role as rescue or bridging therapy to hematopoietic stem-cell transplantation (HSCT) is increasingly supported in both pediatric and adult populations.

BACKGROUND:Major trauma is the sixth leading cause of death worldwide and the leading cause of death and disability in the population aged 5 years to 45 years. The assessment is typically guided by strict protocols to quickly identify life-threatening conditions before conducting a comprehensive evaluation of other injuries. Whole-body computed tomography (WBCT) is often indiscriminately used in trauma cases. AIM:To assess the effective use of WBCT in patients with trauma across radiology departments in State of Kuwait, evaluate the true incidence of critical injuries, and minimize unnecessary radiation exposure. METHODS:This multicenter, retrospective study across seven radiology departments included 1367 patients with trauma who underwent WBCT between 2022 and 2023, according to the American College of Radiology guidelines. Data on age, sex, injury mechanism, clinical indications, dose-length product, and WBCT findings were collected and analyzed using IBM SPSS version 25. RESULTS:Of 1367 referrals, 578 (42.3%) had no significant findings, while 789 (57.7%) showed positive trauma-related results. Among the positive findings, 530 patients (38.8%) had major injuries, including solid organ and vertebral column injuries. The most common causes of WBCT referrals were road traffic accidents (911 patients, 66.6%), falls from height (182 patients, 13%), falls of heavy objects (112 patients, 8%), head trauma (82 patients, 6%), buggy accidents (28 patients, 2%) and others. Negative WBCT findings had a mean effective dose of 19.98 ± 10.26 mSv. CONCLUSION:This national audit demonstrates that a substantial proportion of WBCT scans in patients with trauma are negative (42.3%), underscoring the need to rationalize imaging practices. The findings highlight the importance of evidence-based stewardship to enhance trauma care delivery in State of Kuwait.

Major depressive disorder (MDD) is a heterogeneous, debilitating disorder. A distinct subgroup within the MDD spectrum is identified to have treatment-resistant depression (TRD). There is an impetus to find alternative treatments for TRD to reduce disease burden and improve quality of life. Psychedelics have been used in the treatment of various psychiatric disorders since the 1950s, with potential benefits in TRD. Aiming to summarize the evidence of using psychedelics for TRD by exploring mechanisms and potential benefits, we conducted a literature search on different psychedelics with their mechanisms from clinical and preclinical evidence. Psychedelics have been examined in many preclinical studies for efficacy and mechanisms with fewer clinical studies on patients with TRD. Besides serotonergic agonism, glutamate surge and monoamine release, psychedelics promote neuroplasticity, corticolimbic function, and epigenetic changes. Psilocybin, ketamine, and esketamine are the most researched agents of psychedelics in the context of TRD. Psilocybin-assisted therapy has been shown to induce short-term improvement in symptoms that can persist for weeks and months, with some meta-analyses consolidating such findings. Ketamine, as an atypical psychedelic, in many clinical trials of intravenous, subcutaneous, and oral forms, had rapid and robust effects in reducing depressive symptoms and relapses without decreasing cognitive function. Similarly, esketamine induced early and clinically meaningful improvements in function and productivity. Ayahuasca also showed fast and sustained effects with higher remission rates and good safety. Psychedelics have significant potential in TRD with superior mechanisms over traditional antidepressants. Despite the encouraging findings of the existing studies, large, well-designed studies are needed to extend their use as part of standard recommendations.