Several authors have recently demonstrated the intimate relationship between nonlinear dynamics and observations in vocal fold vibration (Herzel, 1993; Mende, Herzel, & Wermke, 1990; Titze, Baken, & Herzel, 1993). The aim of this paper is to analyze vocal disorders from a nonlinear dynamics point of view. Basic concepts and analysis techniques from nonlinear dynamics are reviewed and related to voice. The voices of several patients with vocal disorders are analyzed using traditional voice analysis techniques and methods from nonlinear dynamics. The two methods are shown to complement each other in many ways. Likely physiological mechanisms of the observed nonlinear phenomena are presented, and it is shown how much of the terminology in the literature describing rough voice can be unified within the framework of nonlinear dynamics.

Аbstrасt Introduction This study aims to investigate in‐hоsрitаl mоrtаlity in severe асute resрirаtоry syndrоme соrоnаvirus 2 раtients strаtified by serum ferritin levels. Methods Patients were stratified based on ferritin levels (ferritin levels ≤ 1000 or >1000). Results Approximately 89% (118) of the patients with ferritin levels > 1000 had pneumonia, and 51% (67) had hypertension. Fever (97, 73.5%) and shortness of breath (80, 61%) were two major symptoms among the patients in this group. Logistic regression analysis indicated that ferritin level (odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.21–0.62; p < .001), male sex (OR = 2.63, 95% CI = 1.43–5.06; p = .003), hypertension (OR = 4.16, 95% CI = 2.42–7.36; p < .001) and pneumonia (OR = 8.48, 95% CI = 3.02–35.45; p < .001) had significance in predicting in‐hospital mortality. Additionally, the Cox proportional hazards analysis and Kaplan–Meier survival probability plot showed a higher mortality rate among patients with ferritin levels > 1000. Conclusion In this study, higher levels of serum ferritin were found to be an independent predictor of in‐hоsрitаl mоrtаlity.

Earlier investigation did not show any clear distinctive pathological features that differentiate vocal polyps from vocal nodules. The light microscopic distinctive features between the two lesions point in the direction of a more pronounced epithelial reaction and a more fibrous stromal change in vocal nodules. In the present study, 19 vocal polyps and 11 vocal nodules were subjected to ultrastructural examination aiming at finding distinctive features that may be pathognomic for each of these clinically distinct entities. The study was carried out by EM Philips 400 T. The results demonstrate that nodules showed epithelial changes in the form of gaping of the intercellular junctions and absence of the basal lamina in parts. These changes are less apparent in polyps, whereas the stromal changes are more pronounced and varied. The significance of these results and their interpretation are discussed.

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Peritoneal tuberculosis (TB) is a considerable problem in certain developing nations. Current diagnostic tests for peritoneal TB are difficult and time-consuming. This study aimed to determine the effectiveness of an adenosine deaminase (ADA) assay and the QuantiFERON-Gold (QFT-G) assay in the rapid diagnosis of TB peritonitis. Forty-one patients with a presumptive diagnosis of TB peritonitis with ascites were admitted to Mansoura University Hospital and included in the study. Ascitic fluid and blood samples were collected from each patient. Fluid samples were examined biochemically (protein concentration), cytologically (white blood cell count) and microbiologically (Ziehl-Neelsen stain and TB culture in Lö wenstein-Jensen media), and ADA levels were determined using colorimetry. Interferon-c levels in whole-blood samples were measured using the QFT-G assay. Fourteen (34 %) patients received a final clinical diagnosis of TB peritonitis; these patients were subclassified as definite (positive culture for Mycobacterium tuberculosis; eight patients), highly probable (four patients) and probable (two patients) for TB peritonitis. Of the 14 patients with a final clinical diagnosis of TB peritonitis, 3 (21 %) tested positive using an acid-fast bacilli smear, which showed a sensitivity of 21 % and a specificity of 100 %. A receiver operating characteristic curve showed that a cut-off value of 35 IU l "1 for the ADA level produced the best results as a diagnostic test for TB peritonitis, yielding the following parameter values: sensitivity 100 %, specificity 92.6 %, positive predictive value (PPV) 87.5 % and negative predictive value (NPV) 100 %. The QFT-G assay yielded the following values: sensitivity 92.9 %, specificity 100 %, PPV 100 % and NPV 96.4 %. The ADA and QFT-G assays might be used to rapidly diagnose TB peritonitis and initiate prompt treatment while waiting for a final diagnosis using the standard culture approach.