Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

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Η λίστα ιστολογίων μου

Πέμπτη 8 Νοεμβρίου 2018

Caries detection enhancement using texture feature maps of intraoral radiographs

Abstract

Objectives

Dental caries are caused by tooth demineralization due to bacterial plaque formation. However, the resulting lesions are often discrete and thus barely recognizable in intraoral radiography images. Therefore, more advanced detection techniques are in great demand among dentists and radiographers. This study was performed to evaluate the performance of texture feature maps in the recognition of discrete demineralization related to caries plaque formation.

Methods

Digital intraoral radiology image analysis protocols incorporating first-order features (FOF), co-occurrence matrices, gray tone difference matrices, run-length matrices (RLM), local binary patterns (LBP), and k-means clustering (CLU) were used to transform the digital intraoral radiology images of 10 patients with confirmed caries, which were retrospectively reviewed in a dental clinic. The performance of the resulting texture feature maps was compared with that of radiographic images by radiologists and dental specialists.

Results

Significantly improved detection of caries spots was achieved by employing the CLU and FOF texture feature maps. The caries-affected area with sharp margins was well defined using the CLU approach. A pseudo-three-dimensional effect was observed in outlining the demineralization zones inside the cavity with the FOF 5 protocol. In contrast, the LBP and RLM techniques produced less satisfactory results with unsharp edges and less detailed depiction of the lesions.

Conclusions

This study illustrated the applicability of texture feature maps to the recognition of demineralized spots on the tooth surface debilitated by caries and identified the best performing techniques.



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Otorrinolaringología multidisciplinaria



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Nueva alternativa para relleno y camuflaje de dorso nasal: Injerto mixto de L-PRF y cartílago

RESUMEN Introducción: Entre las alteraciones del dorso nasal puede encontrarse desde un rádix bajo hasta un aplastamiento severo del dorso nasal, siendo fundamental el uso de injertos y material de relleno. Objetivo: Proponer una nueva alternativa de relleno y camuflaje en rinoplastía mediante un injerto mixto de L-PRF más cartílago picado en una matriz de fibrina autóloga. Material y método: Evaluación de los pacientes operados de rinoseptoplastía en quienes se utilizó el injerto mixto entre febrero y septiembre del año 2016 en el Servicio de Otorrinolaringología del Hospital Regional de Concepción. Evaluación de resultados respecto a reabsorción e irregularidades del injerto y autoevaluación del grado de satisfacción. Resultados: Fueron operados 7 pacientes. Cuatro de ellos presentaban aplastamiento severo de dorso nasal y tres un rádix profundo. Se logró el relleno y camuflaje del área deseada en todos los casos. No se presentó desplazamiento ni reabsorción del injerto en ninguno de los casos. El uso de este injerto no significó mayor costo económico, y el grado de satisfacción fue alto en todos los casos. Conclusión: Primer estudio en utilizar un injerto mixto de cartílago más L-PRF en una matriz de fibrina autóloga en rinoplastía, demostrando ser una alternativa asequible, efectiva, reproducible y segura, particularmente útil en casos de revisión.


ABSTRACT Introduction: Among the alterations of the nasal dorsum there can be found from a low radix to a severe crushing of the nasal dorsum, being fundamental the use of grafts and filling materials. Aim: To propose a new filling and camouflage alternative in rhinoplasty by means of a mixed graft of L-PRF and chopped cartilage in an autologous fibrin matrix. Material and method: Evaluation of the operated patients of rhinoseptoplasty in whom the mixed graft was used between February and September 2016 in the Otorhinolaryngology unit of the Hospital Regional de Concepción. Evaluation of results regarding resorption and graft irregularities and self-assessment of degree of satisfaction. Results: Seven patients were operated. Four of them presented severe crushing of the nasal dorsum and three of them a deep radix. The filling and camouflage of desired area was achieved in all cases. There were no displacement or resorption of the graft in any case. The use of this graft did not mean greater economic cost, and the degree of satisfaction was high in all cases. Conclusions: First study to use a mixed graft of cartilage and L-PRF in an autologous fibrin matrix in rhinoplasty, proving to be an affordable, effective, reproducible and safe alternative, particularly useful in revision surgeries.

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Rinoseptoplastía: Experiencia de 3 años en la Pontificia Universidad Católica de Chile

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RESUMEN Introducción: La rinoseptoplastía es una cirugía compleja y desafiante. Permite resolver problemas estéticos y funcionales de la nariz. Objetivo: Describir la experiencia en rinoseptoplastías realizadas en el Comité de Nariz en nuestro centro. Material y método: Estudio descriptivo de pacientes sometidos a rinoseptoplastía entre 2013 y 2015. Resultados: Se operaron 265 pacientes en 3 años, 164 (61,8%) fueron mujeres y la edad promedio fue de 29 años (rango 13-73). Las cirugías fueron principalmente primarias (secundarias: 2,6%). El abordaje más utilizado fue abierto (92,5%). Se realizó trabajo de punta nasal en 253 (95,5%) pacientes; resección del dorso osteocartilaginoso en 252 (95,1%), y aumento de éste en sólo 5 (1,9%). Las osteotomías fueron frecuentes: paramedianas en 229 (86,4%), percutánea lateral bilateral en 217 (81,9%) y percutánea lateral unilateral en 17 (6,4%). El vástago columelar fue el injerto de punta más frecuentemente utilizado, en 241 (90,9%) pacientes, seguido del escudo en 69 (26,0%). En el dorso, se utilizaron autoespaciadores en 124 (46,7%) pacientes, y espaciadores en 109 (41,1%). Conclusiones: El abordaje abierto fue el más frecuente, demostrando ser favorable en nuestro centro por la exposición y aprendizaje de nuestros residentes. Se constató 2,6% de cirugías secundarias. Se destaca el uso de vástago columelar para otorgar soporte a la punta nasal dada la alta prevalencia de nariz hispana en nuestro centro.
ABSTRACT Introduction: Rhinoseptoplasty is a complex and challenging surgery. It addresses nasal aesthetics and functionality. Aim: To describe the experience in rhinoseptoplasty performed by the Nose Committee at our medical center. Material and method: Descriptive study, of the all rhinoseptoplasties performed by the Nose Committee between 2013 and 2015. Results: 265 patients underwent surgery in the 3-year period; 164 (61.8%) were women and the mean age was 29 years (range 13-73). Most were primary surgeries (secondary: 2.6%). An external approach was most commonly used (92.5%). Nasal tip surgery was performed in 253 (95.5%) patients; osteocartilaginous dorsum reduction in 252 (95,1%), and augmentation in only 5 (1,9%). Osteotomies were frequent: paramedian in 229 (86.4%), bilateral percutaneous lateral osteotomies in 217 (81.9%) and unilateral percutaneous lateral in 17 (6.4%). Regarding nasal tip grafts, columellar strut was most often used, in 241 (90,9%) patients, followed by the shield graft in 69 (26,0%). For the dorsum, autospreaders were used in 124 (46.7%), and spreader grafts in 109 (41.1%). Conclusions: Open rhinoseptoplasty was the most commonly used approach. This has shown favorable for residents due to better exposition of nasal anatomy. Only 2.6% were secondary rhinoseptoplasties. We emphasize the use of the columellar strut for nasal tip support as we frequently encounter hispanic noses at our center.

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Evaluación del proceso de decanulación en pacientes traqueostomizados en el Hospital Carlos van Buren. Una cohorte retrospectiva

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RESUMEN Introducción: El proceso de decanulación consiste en la evaluación de las competencias de la vía aérea superior que conlleva al retiro definitivo de una cánula de traqueostomía. La predicción de su éxito resulta dificultosa debido al alto número de variables que la afectan. Para conseguir este objetivo, es fundamental contar con un protocolo adecuado a la institución de salud, que se sume a un manejo multidisciplinario. Objetivo: El objetivo propuesto fue evaluar el éxito de decanulación en los pacientes adultos del Hospital Carlos van Buren que siguieron el protocolo institucional. Material y método: Estudio de cohorte retrospectivo que se desarrolló durante el primer semestre del año 2016. Se evaluó el éxito de decanulación en pacientes adultos traqueostomizados que cumplieron con los criterios de inclusión. La muestra final fue de 18 pacientes, de los cuales se obtuvieron datos de interés desde las historias clínicas y registros del servicio de medicina y rehabilitación. Resultados: De los 18 pacientes incluidos en el estudio ninguno cumplió con los criterios de ingreso al protocolo de decanulación institucional al momento de la evaluación inicial por el Servicio de Medicina Física y Rehabilitación, requiriendo todos entrenamiento para aplicar dicho protocolo. Finalmente, un total de 15 pacientes lograron decanulación exitosa, requiriendo una mediana de 22 días de entrenamiento fonoaudiológico y kinesiológico. Conclusiones: Tras el entrenamiento terapéutico se logró 83% de éxito en la decanulación, lo que requirió un trabajo coordinado entre las diferentes disciplinas del servicio de medicina física y rehabilitación y del apoyo del servicio de otorrinolaringología. Se deberá revaluar el protocolo institucional para ajustarlo a la realidad local.
ABSTRACT Introduction: The decannulation process consist in the evaluation of the upper airways competences which carry the definite extraction of the traqueostomy cannula. The prediction of its success is difficult due to the high number of variables that affect it. In order to reach this goal, is fundamental to count with an adequate protocol of the health institution, which assumes the multidisciplinary management. Aim: The proposed goal was to evaluate the success of decannulation in adult patients of Carlos van Buren hospital who followed the institutional protocol. Material and method: The cohort retrospective study that developed during the first semester of 2016. The decannulation success was evaluated in adult patients tracheostomized who fulfilled the inclusion criteria. The final sample was of 18 patients, of which were obtained data of interest from the clinical histories and register of the Medicine and Rehabilitation Service. Results: Of the 18 patients in this study none of them met the entry criteria of the institutional decannulation protocol at the time of the initial evaluation by the Physical Medicine and Rehabilitation Service, requiring all training in order to apply the protocol. Finally, a total of 15 patients achieved a successful decannulation requiring a median of 22 days of phonoaudiological and kinesiological training. Conclusions: After the therapeutic training it was achieved a 83% of success in decannulation, which required a coordinated work between the different disciplines of the Physical Medicine and Rehabilitation Service and the support of the Otorhinolaryngology Service. The institutional protocol should be evaluated to adjust it to the local reality.

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Efectividad de cinco sesiones de rehabilitación vestibular en mujeres mayores de 60 años con hipofunción vestibular

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RESUMEN Introducción: Los síntomas vestibulares son motivo frecuente de consulta en la atención médica, el adulto mayor y en especial el género femenino está expuesto a riesgo de caída por esta causa. Es común que el tratamiento de este grupo de pacientes sea los supresores vestibulares, y la terapia de rehabilitación vestibular (RV) se indique excepcionalmente, olvidando en ocasiones que los elementos anatomofuncionales involucrados en las disfunciones vestibulares son la integración del aparato visual, vestibular, y somatosensorial, pilares en los que se fundamenta la RV. Objetivo: El objetivo de este estudio es determinar si cinco sesiones RV son suficientes para disminuir la discapacidad funcional y el riesgo de caída en un grupo de pacientes con patología vestibular. Material y método: Estudio prospectivo con 14 pacientes de género femenino mayores de 61 años con diagnóstico de patología vestibular periférica. Se realizó evaluación de (dizziness handicap inventory) DHI, (timed up and go) TUG y (video head impulse test) vHIT previo y posterior a la intervención de cinco sesiones de RV. Resultados: Las tres variables estudiadas (DHI, TUG y vHIT) demostraron mejorías estadísticamente significativas en el grupo de pacientes. Conclusión: Los resultados obtenidos en este estudio permiten sugerir que la terapia de RV en pacientes adultos mayores, con patología vestibular periférica y sin medicación de supresores vestibulares, es una modalidad terapéutica adecuada y eficiente.
ABSTRACT Introduction: Vestibular symptoms are frequent reason for consultation in medical care, the elderly and especially the female gender is exposed to fall risk from this cause. It is common for the treatment of this group of patients to be vestibular suppressors while vestibular rehabilitation therapy is indicated exceptionally, sometimes forgetting that the anatomic and functional elements involved in vestibular dysfunctions are the integration of the visual, vestibular, and somatosensory, pillars in those that are based on vestibular rehabilitation (VR). Aim: The objective of this study is to determine if five VR sessions are sufficient to provide concrete quantitative data on the decrease of disability and risk of falling in a group of patients with vestibular pathology. Material and method: This prospective study included 14 female patients over 61 years of age with diagnoses of peripheral vestibular pathology. Dizziness handicap inventory (DHI), timed up and go (TUG) and video head impulse test (vHIT) were performed and after the intervention of five sessions of vestibular rehabilitation. Results: The three variables studied (DHI, TUG and vHIT) showed statistically significant improvements in the group of patients. Conclusions: The results obtained in this study allow us to suggest that VR therapy in elderly patients with peripheral vestibular pathology and without vestibular suppressor medication is an adequate, efficient and promising therapeutic modality.

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Confiabilidad interevaluador de la prueba video head impulse test en estudiantes de primer año de la generación 2016 de la Escuela de Fonoaudiología de la Universidad de Valparaíso Casa Central

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RESUMEN Introducción: El video head impulse test es un método rápido, no invasivo y cómodo para evaluar el reflejo vestíbulo ocular, el cual está siendo utilizado con mayor frecuencia en la evaluación de pacientes con alteraciones del equilibrio. Sin embargo, en Chile se evidencia una falta de estudios relacionados a la confiabilidad interevaluador de dicha prueba. Objetivo: Determinar el nivel de concordancia de los resultados de la eficiencia del reflejo vestíbulo ocular de los canales semicirculares horizontales, obtenidos mediante la aplicación de la prueba video head impulse test, por parte de 3 evaluadores. Material y método: Estudio cuantitativo, correlacional, no experimental transversal descriptivo, con muestreo no probabilístico, de participación voluntaria. La prueba video head impulse test fue aplicada por 3 examinadores a 30 estudiantes que cumplieron con los criterios de inclusión. Resultados: El método de Bland y Altman mostró gran concordancia en las mediciones realizadas entre los 3 examinadores. La correlación intraclase para la ganancia del canal semicircular horizontal derecho e izquierdo fue de 0,85 y 0,91 respectivamente y de 0,75 para el valor de asimetría. Conclusión: El estudio mostró una confiabilidad interevaluador adecuada de la prueba video head impulse test para la evaluación de los canales semicirculares horizontales.
ABSTRACT Introduction: The video head impulse test is a rapid, non-invasive and comfortable method for the evaluation of the vestibulo-ocular reflex that is being used more often in the evaluation of patients with balance disorders. In Chile there is a lack of studies related to the inter-rater reliability for this test. Aim: To determine the level of agreement on the results for the vestibulo-ocular reflex of the horizontal semicircular canals obtained by the execution of the video head impulse test by 3 raters. Material and method: Quantitative, correlational, non-experimental, cross-sectional descriptive study with a type of non-probability sampling with voluntary participation. The video head impulse test was applied by 3 raters to 30 students who fulfilled the inclusion criteria. Results: The Bland-Altman method demonstrated good agreement in the measurements made between the 3 raters. The inter-rater reliability for the gain of the left and right horizontal semicircular canals was 0.85 and 0.91 respectively and 0.75 for the asymmetry value. Conclusion: The study showed an adequate inter-rater reliability for the video head impulse test in the evaluation of the horizontal semicircular canals.

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Resultados del programa de implantes cocleares de Clínica Las Condes a 20 años de su inicio: Serie clínica 1994-2015

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RESUMEN Introducción: La hipoacusia sensorioneural es la tercera causa de discapacidad en Chile, con incidencia en recién nacidos de 1 a 3 casos cada 1.000 recién nacidos vivos, y prevalencia en adultos de hasta 70%, siendo muchos casos susceptibles de ser tratados mediante implante coclear. Objetivo: Describir resultados de los pacientes sometidos a cirugía de implante coclear en Clínica Las Condes (CLC). Material y método: Estudio longitudinal de cohorte retrospectiva, se analizaron a 237 pacientes implantados en Clínica Las Condes desde 1994 al año 2015. Resultados: Se analizan 237 pacientes, 106 mujeres (44,7%) y 131 hombres (55,3%). El 65,5% de los pacientes se implantaron entre los 2-6 años de vida. Las etiologías más frecuentes fueron hipoacusia congénita no sindrómica (45,9%), genética tardía (11,8%) y posmeningitis (11,4%). Se encontró asociación significativa entre promedio tonal de la palabra (PTP) y presencia de malformación coclear (p =0,008). Sólo 9,9% de los pacientes presentaron otra discapacidad asociada a la hipoacusia. La tasa de reimplante fue 16,3% y sólo la variable malformación coclear se asoció a ella (p =0,016). Conclusión: El implante coclear es una herramienta beneficiosa en pacientes hipoacúsicos que no se benefician de otros dispositivos auditivos ofreciendo la posibilidad de reinsertarlos social y laboralmente con bajo riesgo quirúrgico y alta tasa de éxito.
ABSTRACT Introduction: Sensorineural hearing loss is the third leading cause of disability in Chile, with incidence in infants 1 to 3 cases per 1,000 newborn and prevalence in adult up to 70%, with many cases that can be treated with cochlear implant. Aim: to describe outcomes of our series of patients undergoing cochlear implant surgery at Clinica Las Condes (CLC). Material and method: Retrospective longitudinal cohort study, 237 patients implanted in our center since 1994 to 2015 were analyzed. Results: 237 patients, 106 women (44.7%) and 131 men (55.3%) received a cochlear implant during this period. 65.5% of patients were implanted between 2-6 years of age. The most common etiologies were; non-syndromic congenital deafness (45.9%), late genetic onset (11.8%) and meningitis (11.4%). A significant association between the average pure tone average and presence of cochlear malformation (p =0.008) was demonstrated. Only 9.9% of patients had other disabilities associated with hearing loss. Re-implantation rate was 16.3% and only the variable cochlear malformation was associated to it (p =0.016) Conclusions: The cochlear implant provides clear benefits to patients with hearing impairment who do not benefit from other hearing devices offering the possibility of social and labor reintegrating, with low surgical risk and high success rate.

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Abordaje endoscópico al cavum de Meckel: Resección endoscópica endonasal de Schwannoma del nervio trigémino

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RESUMEN El cavum de Meckel (CM) es un divertículo localizado en la fosa media adyacente al seno cavernoso. Las neoplasias de esta región son extremadamente raras y representan un desafío para el cirujano debido a las estructuras neurovasculares que se encuentran en la región. Para los tumores ubicados en esta área se han descrito diversos abordajes quirúrgicos, los cuales no logran una adecuada exposición a la porción anteromedial del CM. En la última década, se ha postulado el abordaje endoscópico endonasal extendido (AEE) como una alternativa quirúrgica para el manejo de lesiones ubicadas en esta región. Se presenta el caso de un paciente portador de un schwannoma del nervio trigémino situado en el CM derecho tratado mediante AEE.
ABSTRACT The Meckel's cave (CM) is a diverticulum located in the middle fossa adjacent to the cavernous sinus. The neoplasms of this region are extremely rare and represent a challenge for the surgeon due to the neurovascular structures that occupy and surround the parasellar region. For tumors located in this area, several surgical approaches have been described, all of which do not achieve an adequate exposure to the anteromedial portion of CM. In the last decade, the extended endonasal endoscopic approach (EEA) has been postulated as an alternative for the surgical management of tumors located in this region. We present the case of a patient with a trigeminal schwannoma located in the right CM treated by EEA.

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Carcinoma papilar de tiroides no captante de radioyodo (I131): A propósito de un caso

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RESUMEN El carcinoma papilar de tiroides (CPT) corresponde a una neoplasia frecuente en el mundo y en nuestro país. Generalmente se asocia a buen pronóstico y altas tasas de sobrevida, gracias a características propias del tumor, precisas herramientas diagnósticas y terapias eficaces. Formas infrecuentes de CPT suelen tener comportamientos más agresivos y respuestas parciales a tratamientos habituales, tales como el CPT no captante de radioyodo (5% de los casos). Poca literatura existe respecto a este último y a su manejo. Diversas opciones de tratamiento han sido propuestas, según si hay evidencia de tejido tumoral, como el uso empírico de I131, cirugía, radioterapia, embolización e inhibidores de tirosina kinasa, sin embargo, sigue habiendo una respuesta incierta.
ABSTRACT Papillary thyroid carcinoma (PTC) is a common cancer in the world and in our country. It is usually associated with good prognosis and high survival rates, due to the tumor's characteristics, precise diagnostic tools and effective therapies. Unusual varieties of PTC have more aggressive behaviors and partial responses to usual treatments, such as negative uptake to radioiodine PTC (5% of cases). There is few literature about this variety and its treatment. Diverse treatment options have been proposed, according to whether there is evidence of tumor tissue, such as the empirical use of I131, surgery, radiotherapy, embolization and inhibitors of thyrosine kinase, however an uncertain response remains.

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Fasceítis necrotizante cervical: Consideraciones para el manejo precoz

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RESUMEN La fasceítis necrotizante cervical (FNC) es una infección que afecta la fascia cervical y tejido subcutáneo, diseminándose rápidamente a través de los planos fasciales con una alta tasa de mortalidad. Si bien, las imágenes son una herramienta de apoyo fundamental para el diagnóstico, éste sigue siendo eminentemente clínico, presentando una rápida progresión de síntomas en pocas horas. El objetivo de esta presentación fue identificar factores descritos con peor pronóstico en el diagnóstico precoz de la FNC. Se realizó un estudio descriptivo de serie de casos de pacientes con diagnóstico de FNC en los últimos 10 años en el Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau (HBLT). Se identificaron 5 pacientes, dentro de los cuales, los parámetros clínicos y de laboratorio a destacar fueron el dolor desproporcionado y rápido deterioro de exámenes de laboratorio. En los casos que había signos sugerentes de FNC en la tomografía computarizada, se favoreció el manejo quirúrgico agresivo, mientras que, en quienes no había imágenes sugerentes de FNC, se postergó el diagnóstico y su manejo precoz, provocando un desenlace fatal. La FNC constituye un cuadro grave en el que la sospecha clínica y rapidez de inicio del tratamiento resultan fundamental en el pronóstico.
ABSTRACT Cervical necrotizing fasciitis (CNF) is an infection that affects the cervical fascia and subcutaneous tissue. It is characterized by a rapid dissemination trough the fascial planes, with a high rate of mortality. Even tough imaging results a fundamental diagnostic tool, it is still made by clinic signs with rapid progression of symptoms in few hours. Here, we identify worse prognostic factors in the precocious diagnosis of CNF, from five cases presented in our center. A descriptive case-series study was performed in patients with CNF in the last ten years in the Otolaryngology Department of Barros Luco Trudeau Hospital. Five patients were identified, between the clinical and laboratory parameters. A disproportional pain and rapid deterioration of the laboratory exams were the most highlighted features. In the cases with suggestive signs of CFN in the CT scan, allowed an aggressive surgical management, while in those that had no suggestive images the diagnosis was delayed and therefore their management ended in a fatal outcome. CFN constitutes a severe picture in wich clinical suspicion and a prompt initiation of treatment are fundamental in its prognosis.

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Tinnitus pulsátil: Caso clínico y revisión de la literatura

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RESUMEN El tinnitus pulsátil es un síntoma otológico infrecuente pero requiere un estudio acabado. Una historia y examen físico detallados, son primordiales para orientar el estudio imagenológico posterior, con lo que se llega al diagnóstico en gran parte de los casos. El tratamiento debe ser dirigido a corregir la causa subyacente. En este trabajo, se presenta un caso clínico de tinnitus pulsátil, revisión del tema y orientación al enfoque diagnóstico.
ABSTRACT Pulsatile tinnitus is an infrequent otologic symptom but requires a thorough study. A detailed history and physical examination are essential to guide the subsequent imaging study, with which the diagnosis is reached in a large number of cases. The treatment should be aimed at correcting the underlying cause. In this study, a clinical case of pulsatile tinnitus, review of the subject and orientation to the diagnostic approach is presented.

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Tumor triquilemal proliferante: Reporte de un caso y revisión de la literatura

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RESUMEN El tumor triquilemal proliferante es una neoplasia poco frecuente, usualmente sólida o parcialmente quística que se origina de la vaina externa de la raíz de un folículo piloso. Ocurre principalmente como una lesión solitaria en el cuero cabelludo de mujeres mayores. Presentamos el caso de una mujer de 56 años con un tumor cervical de nueve años de evolución. El estudio de la pieza de resección confirmó el diagnóstico.
ABSTRACT Trichilemmal proliferating tumor is an infrequent neoplasia, usually solid or partially cystic, originating in the external root sheath of hair follicle. It occurs mainly as a solitary lesion in the scalp in older women. We report the case of a 56 years old woman with a cervical tumor of nine years of growth. Histology of the resection specimen confirmed the diagnosis.

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Piomiositis primaria del músculo esternocleidomastoideo: Reporte de un caso y revisión de la literatura

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RESUMEN La piomiositis es una infección bacteriana del músculo estriado, siendo extremadamente rara la afectación de la musculatura cervical. Se ha asociado en nuestro medio a enfermedades crónicas como la diabetes y a la inmunodepresión. Presentamos a un paciente de 67 años que acude al servicio de urgencias por tumoración laterocervical de rápido crecimiento, negando antecedentes de interés a excepción de diabetes mellitus tipo II. Se le realizó estudio de imagen con tomografía computarizada con contraste, observándose aumento de volumen del músculo esternocleidomastoideo izquierdo y se empezó tratamiento empírico con antibióticos endovenosos. Dada la evolución tórpida finalmente se realizó drenaje quirúrgico bajo anestesia general con mejoría de los parámetros clínicos y analíticos. La piomiositis de los músculos cervicales es muy rara (0,4%-1% de todos los casos) siendo el esternocleidomastoideo el músculo del cuello más frecuentemente afectado. La tomografía computarizada representa la prueba de imagen de elección, permitiendo un rápido diagnóstico llegando a poder diferenciar este cuadro de otros similares. Considerando que muchos de estos pacientes presentan comorbilidades asociadas y/o inmunosupresión, es de extrema importancia diagnosticarlos precozmente y empezar un tratamiento adecuado que dependerá del grado y extensión de la infección. A pesar de ser una entidad poco frecuente, su incidencia está en aumento en nuestro medio asociada a la infección por VIH y otras condiciones de inmunodepresión. Hay que tenerla en mente en el diagnóstico diferencial de las tumoraciones laterocervicales porque solo con una alta sospecha clínica se podrá llevar al cabo un diagnóstico precoz y un tratamiento adecuado.
ABSTRACT Pyomyositis is a bacterial infection of the striated muscle that may affect the cervical musculature in very few cases. In the occidental world it has been associated with chronic diseases as diabetes and immunosuppression. We present a 67 years old patient attended to the Emergency Department because of a laterocervical fast growth tumor, without an interesting clinical history with the exception of type II diabetes mellitus. A CT scan with contrast showed an increased volume in the left sternocleidomastoid muscle, so an empiric treatment with intravenous antibiotics was started. Because of a bad evolution we finally performed a surgical drainage of the abscess under general anesthesia with an improvement of symptoms and laboratory markers. The pyomyositis of cervical muscles is very rare (0.4-1% of all cases) and the sternocleidomastoid muscle is the most commonly affected cervical muscle. CT scan is the gold standard imaging technique, because it allows to diagnose this disease and rule out other similar entities. If we consider that many patients present with associated comorbidities and/ or immunosuppression, it's very important to perform a rapid diagnosis and to begin a correct treatment that depends on the grade and extension of the infection. Although polymyositis of the sternocleidomastoid muscle is rare, its incidence is increasing associated to HIV infection and other immunosuppressive conditions. We have to keep in mind this pathology in the differential diagnosis of laterocervical tumors because high clinical suspicion is necessary to make a rapid diagnosis and a correct treatment.

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Anosmia congénita aislada: Reporte de un caso clínico

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RESUMEN Los trastornos del olfato son frecuentes, aunque la anosmia e hiposmia son síntomas poco referidos, suelen afectar de forma importante la calidad de vida de los pacientes. Las causas de anosmia pueden ser adquiridas o congénitas, y la prevalencia de anosmia congénita aislada en la población general se estima en 1:10.000. En estos casos, la anosmia es el único síntoma referido por el paciente. Se presenta el caso de un paciente de sexo masculino de 23 años, sin antecedentes mórbidos de importancia, diagnosticado con anosmia congénita aislada. La historia y evaluación clínica, evaluación neuroendocrinológica, y el uso de la resonancia magnética de cerebro permitió establecer el diagnóstico final.
ABSTRACT Disorders of olfaction are common, however, anosmia and hyposmia are not frequently self-reported, and these symptoms can lead to a significant impairment in quality of life. Causes of anosmia can be acquired or congenital, and the prevalence of isolated congenital anosmia is estimated to be 1:10000 in the general population. In these cases, anosmia is the only symptom referred by the patient. We hereby present the case of a 23-year-old male patient, with no prior medical history, diagnosed with isolated congenital anosmia. The findings from the medical history and physical examination, neuroendocrine evaluation, and the use of magnetic resonance imaging of the brain helped reach a final diagnosis.

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Complicaciones de traqueostomía en pacientes pediátricos. Revisión de la literatura

RESUMEN Las indicaciones de traqueostomía en niños han cambiado considerablemente en los últimos años, así como el perfil epidemiológico de los pacientes y la morbimortalidad de este procedimiento. Las complicaciones de este procedimiento pueden ser clasificadas en intraoperatorias, inmediatas y tardías. La mortalidad global en pacientes pediátricos llevados a traqueostomía oscila entre el 13% y 19%. Sin embargo, menos del 5% es directamente atribuible a la cirugía. La presente revisión abarcará las complicaciones más frecuentes asociadas a traqueostomía pediátrica con recomendaciones en su prevención y manejo.


ABSTRACT Indications of tracheostomy in children have changed considerably in recent years, as well as the epidemiological profile of patients, and morbidity and mortality related to this procedure. Complications of pediatric tracheostomy can be classified into intraoperative, immediate and late. Overall mortality in pediatric patients with tracheostomy ranges from 13% to 19%. However, less than 5% is directly attributable to tracheostomy. This review will cover the most frequent complications associated with pediatric tracheostomy with recommendations for its prevention and management.

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Vacuna contra el virus papiloma humano como tratamiento para la papilomatosis respiratoria recurrente

RESUMEN Una de las manifestaciones clínicas del virus papiloma humano (VPH) es la papilomatosis respiratoria recurrente (PRR), que se caracteriza por la proliferación de lesiones epiteliales verrucosas recurrentes en la mucosa respiratoria, pudiendo progresar a obstrucción de vía aérea o presentar transformación maligna. El tratamiento de primera línea quirúrgico, pero dada su alta recurrencia ha tomado peso el tratamiento adyuvante, como la vacuna tetravalente contra VPH. Sin embargo, existe controversia respecto a su eficacia. El objetivo de esta revisión es analizar la efectividad de la vacuna contra VPH como tratamiento adyuvante de la PRR, para lo cual hicimos una revisión de la literatura sobre la efectividad de la vacuna tetravalente contra VPH para PRR, realizando una búsqueda en diversas fuentes: Pubmed, MEDLINE, EMBASE, Cochrane, Google Scholar y Epistemonikos. Se seleccionaron los estudios que responden a la pregunta y se analizaron los datos de los estudios primarios. Se encontraron cinco estudios primarios no aleatorizados, todos a favor de la vacuna como tratamiento. Concluimos con baja certeza de evidencia, que la vacuna es posiblemente efectiva para pacientes con PRR en disminuir el número de recurrencias, aumentar el intervalo entre cirugías, lograr remisión completa o parcial de la enfermedad y aumentar significativamente los títulos de anticuerpos anti-VPH.


ABSTRACT A clinical manifestation of human papillomavirus (HPV) is recurrent respiratory papillomatosis (RRP), characterized by the proliferation of recurrent verrucous epithelial lesions in the respiratory mucosa, which may progress to airway obstruction or malignant transformation. First-line treatment is surgery, but given its high recurrence the use of adjuvant therapy, such as the quadrivalent vaccine, has gained importance. However, there is controversy regarding its effectiveness. To analyze the effectiveness of the HPV vaccine as an adjuvant treatment for RRP a review of the literature on the effectiveness of HPV tetravalent vaccine for RRP was performed by searching databases such as Pubmed, MEDLINE, EMBASE, Cochrane, Google Scholar and Epistemonikos. We selected the studies that answered the question and analyzed the data from all of which supported the vaccine as treatment. None were randomized controlled trials. We conclude, with low certainty of evidence, that the vaccine is possibly effective for RRP in decreasing the number of recurrences, increasing the intersurgical interval, achieving complete or partial remission of disease and significantly increasing anti-HPV antibodies.

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Entrenamiento olfatorio. Revisión de literatura

RESUMEN La disfunción olfatoria es una patología frecuente que trae consigo una disminución importante en la calidad de vida de los pacientes y que incluso conlleva una mortalidad aumentada respecto a la población general. Sin embargo, es una condición subdiagnosticada, ya sea por desconocimiento de los profesionales o por falta de un método diagnóstico adecuado. A la fecha no existe un tratamiento efectivo para estos pacientes y generalmente se les deja sin tratar. Una alternativa para este gran problema es el entrenamiento olfatorio, tratamiento propuesto recientemente con resultados promisorios.


ABSTRACT Olfactory dysfunction is a frequent pathology associated with an important decrease in the quality of life of patients and an increased mortality respect to the general population. However, it is an underdiagnosed condition, either due to lack of knowledge of the professionals or due to the lack of an adequate diagnostic method. To date there is no effective treatment for these patients and they are usually left untreated. An alternative to this problem is olfactory training, a treatment recently proposed with promising results.

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“Hanger” in Intubation and Laryngoscopy

Abstract

Achieving an adequate exposure in laryngoscopy is an extremely tedious task for the operating surgeon, especially for the anterior commissure lesions. Various maneuvers have been described to overcome this difficulty, but failed in providing an adequate exposure leading to a poor outcome. To create a device that can deliver uniform pressure over the laryngeal cartilage and succeed in providing an adequate exposure of the glottic lesion. A total of 44 patients were included in the study, divided into two groups containing 22 patients each. The distance at the level of anterior commissure from the superior border of the distal end of the laryngoscope was noted and compared. Group A subjected to digital cricoid pressure showed a mean distance of 9.09 of exposure with variance of 1.22 and Group B subjected to cricoid pressure with the cricoid catapult showed a mean distance of 11.76 with variance of 1.59. The groups were statistically analyzed using Anova Test and the test was found to be very significant (p < 0.0001). The catapult is made of a hanger defining its economics, which has a vital role in difficult intubations especially in anterior placed larynx, short neck and obese patients, also succeeds in providing an adequate exposure of the glottic lesion, (especially the anterior commissure) by delivering uniform pressure over the laryngeal cartilage, leading to a superior operative outcome.



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Completely Endoscopic Approach Using a Skeeter Drill to Treat Bilateral Congenital Choanal Atresia in a 33 Week Born Pre-term Baby

Abstract

Choanal atresia (CA) is a relatively rare condition manifesting with respiratory distress. Endoscopic approaches have superseded transnasal and transpalatal approaches. We present a case of a premature baby of 1.10 kg, who developed respiratory distress and was diagnosed with bilateral CA. A nasal airway was created endoscopically using a skeeter drill.



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Human Immunodeficiency Virus Infection: Does Highly Active Antiretroviral Therapy Influence Ear Nose Throat Manifestations?

Abstract

To study the change in trend of ear, nose and throat (ENT) manifestations in patients who were on treatment, before and after availability of highly active antiretroviral therapy (HAART). To find out the prevalence of ENT manifestations in human immunodeficiency virus (HIV) infected people who were on treatment, in the year of 2004 (before the availability of HAART) and in 2014 (after the availability of HAART). Design A combination of a retrospective and prospective study. Setting Anti Retroviral Therapy (ART) Center at Our Hospital. Subjects Patients with HIV infection on ART. Methods Retrospective review of case records of the patients visiting the center in the year 2004 and prospective study of the patients visiting in the year 2014 was conducted. Sample size was calculated as 200 in each group based on 95% confidence and 96% power. Convenience sampling was used in our study. The prevalence of ENT manifestations in HIV patients were found to be 86% in 2004 and 93% in 2014. Among ENT manifestations oropharyngeal manifestations were most common. Lesser the CD4 count more was the prevalence of disorders in oropharynx. Our study showed a high prevalence of ENT manifestations in HIV patients who were on treatment, irrespective of the gap of 10 years and introduction of HAART therapy. Most common ENT manifestation both in 2004 and 2014 was oropharyngeal candidiasis. Lesser the CD4 count more was the prevalence of disorders in oropharynx.



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Robot Assisted Trans Axillary Thyroidectomy: A Subcontinent Experience



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Aural Atresia with Cholesteotoma and Its Management Strategies

Abstract

The term congenital aural atresia is used to describe failure of external auditory canal to open. Thus it results in conductive hearing loss. There are ways to improve the transmission of sound to the healthy inner ear, we have performed surgery to open the ear canal and restore the natural sound-conducting mechanism to the inner ear. Thus avoiding multiple surgeries. The study was conducted among patients aged between 12 and 24 years, our study included 8 patients with aural atresia with cholesteotoma. After a detailed examination of patients were subjected to surgery. In our study with the sample size of eight patients Where, all our patients underwent canal wall down mastoidectomy with simultaneous single stage reconstruction of ossicular chain. All our patients were discharge free and Had subjective improvement in hearing with the post operative period was well accomplished to < 35 dB. In our study all eight patients who underwent canal wall down mastoidectomy had good hearing outcome. As to avoid unnecessary recurrence and complications which are usually seen in intact canal wall down mastoidectomies, we suggest canal wall down and single stage reconstruction.



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Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience

Abstract

The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72 years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and January 2017. All patients were subjected to the following s iter: anamnesis with Epworth Sleepiness Scale, NOSE scale, evaluation of "CPAP usage data." Upper airway optical fiber endoscopy with Müller's maneuver. We performed various type of nasal surgery (septoplasty, decongestion of the lower turbinates and FESS) 6 months after the surgery, CPAP usage was evaluated and the NOSE scale has been reapplied. All patients had a subjective degree of obstruction classified in severe or extreme by the NOSE scale before surgery. Almost all patients reported a mild degree of obstruction after the surgery. About CPAP usage, the average usage has passed by 2, 3 h at night to 6, 8 h after the surgery. The result is significant because it shows how the nasal functional surgery can make selected patients suitable to ventilation therapy. As our work shows, a better nasal function allows to reduce the CPAP pressure, Therefore, we believe that all patients with medium to severe obstructive apnea syndrome and for whom night-time ventilation therapy (CPAP) is advised should be evaluated with endoscopy and anamnesis oriented to evaluate nasal obstructive pathologies that may reduce effectiveness of CPAP.



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Poultry biogas slurry can partially substitute for mineral fertilizers in hydroponic lettuce production

Abstract

Poultry biogas slurry, a by-product of the biogas production process, is rich in nutrients. However, improper handling increases the potential for serious environmental contamination and resource waste. The preparation of nutrient solutions for hydroponic lettuce production requires large amounts of mineral fertilizers, which provides an opportunity for poultry biogas slurry to enter the crop nutrient cycle. To assess the feasibility of the application of poultry biogas slurry, we used different proportions of biogas slurry and mineral fertilizers in a hydroponics experiment with lettuce. Four treatments were established: HS (half-strength Hoagland solution), BS (2.6% biogas slurry), BS + HS (1.3% biogas slurry + quarter-strength Hoagland solution), and BS + MF (2.6% biogas slurry + mineral fertilizers). The addition of poultry biogas slurry (BS + HS) did not have an adverse effect on lettuce growth, significantly increased the soluble sugar concentration, reduced the nitrate concentration, and the concentrations of heavy metals were still within the safety standards. In addition, the application of poultry biogas slurry could effectively reduce the production costs, energy consumption, and greenhouse gas emissions of hydroponically grown lettuce. Based on our study, poultry biogas slurry could replace 50% of the mineral fertilizer used in hydroponic lettuce production. The key is to control the electrical conductivity and replenish the nutrients that are lacking in the biogas slurry, especially magnesium.



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Prevalence of nasal colonization by methicillin-resistant Staphylococcus aureus in outpatients living with HIV/AIDS in a Referential Hospital of the Northeast of Brazil.

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Prevalence of nasal colonization by methicillin-resistant Staphylococcus aureus in outpatients living with HIV/AIDS in a Referential Hospital of the Northeast of Brazil.

BMC Res Notes. 2018 Nov 06;11(1):794

Authors: Regina Pedrosa Soares C, de Lira CR, Cunha MAH, Romão de Souza Junior V, Lopes de Melo F, de Araújo PSR, Maciel MAV

Abstract
OBJECTIVE: The purpose of this study is to investigate the prevalence of MRSA among people living with HIV/AIDS (PLHA) being monitored in a tertiary outpatient hospital in the state of Pernambuco, in the Brazilian Northeast.
RESULTS: Staphylococcus aureus was isolated from a nasal swab and found in 31.4% of the individuals (95% CI 27.3-35.5), of whom 4.4% (95% CI 8.5-19.5) were MRSA, as confirmed by the presence of the mecA gene. For individuals whose S. aureus was recovered, the mean age was 41.5 years; 93.6% were on antiretroviral treatment. This group had CD4 cell counts > 200 (92%) and viral load ≤ 100 copies (79.1%). Use of antimicrobial agents in the past 12 months was found among 21% of the individuals, and 24.2% reported use of illicit drugs at lease once in their lifetime. Prevalence of nasal colonization by MSSA (26.7%) and MRSA (4.4%) was higher in comparison to other studies of this population; nevertheless, we were unable to establish factors associated with risk.

PMID: 30400979 [PubMed - in process]



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Contaminated sites, waste management, and green chemistry: new challenges from monitoring to remediation



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Multi-material Three-Dimensional Food Printing with Simultaneous Infrared Cooking

3D Printing and Additive Manufacturing, Ahead of Print.


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Relevance of Reference Centers in Sarcoma Care and Quality Item Evaluation: Results from the Prospective Registry of the Spanish Group for Research in Sarcoma (GEIS)

AbstractBackground.Reference centers (RCs) are a key point for improving the survival of patients with soft‐tissue sarcomas (STS). The aim of this study was to evaluate selected items in the management of patients with STS, comparing results between RC and local hospitals (LHs).Materials and Methods.Diagnostic and therapeutic data from patients diagnosed between January 2004 and December 2011 were collected. Correlation with outcome was performed.Results.A total of 622 sarcomas were analyzed, with a median follow‐up of 40 months. Imaging of primary tumor preoperatively (yes vs. no) correlated with a higher probability of free surgical margins (77.4% versus 53.7%; p = .006). The provenance of the biopsy (RC vs. LH) significantly affected relapse‐free survival (RFS; 3‐year RFS 66% vs. 46%, respectively; p = .019). Likewise, 3‐year RFS was significantly worse in cases with infiltrated (55.6%) or unknown (43.4%) microscopic surgical margins compared with free margins (63.6%; p < .001). Patients managed by RCs had a better 3‐year overall survival compared with those managed by LHs (82% vs. 70.4%, respectively; p = .003). Perioperative chemotherapy in high‐risk STS, more frequently administered in RCs than in LHs, resulted in significantly better 3‐year RFS (66% vs. 44%; p = .011). In addition, patients with stage IV disease treated in RCs survived significantly longer compared with those in LHs (30.4 months vs. 18.5 months; p = .036).Conclusion.Our series indicate that selected quality‐of‐care items were accomplished better by RCs over LHs, all with significant prognostic value in patients with STS. Early referral to an RC should be mandatory if the aim is to improve the survival of patients with STS.Implications for Practice.This prospective study in patients diagnosed with soft‐tissue sarcoma shows the prognostic impact of reference centers in the management of these patients. The magnitude of this impact encompasses all steps of the process, from the initial management (performing diagnostic biopsy) to the advanced disease setting. This is the first prospective evidence showing improvement in outcomes of patients with metastatic disease when they are managed in centers with expertise. This study provides extra data supporting referral of patients with sarcoma to reference centers.

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Age and the Risk of Paclitaxel‐Induced Neuropathy in Women with Early‐Stage Breast Cancer (Alliance A151411): Results from 1,881 Patients from Cancer and Leukemia Group B (CALGB) 40101

AbstractPurpose.A few previous studies report a direct relationship between older age and chemotherapy‐induced neuropathy. This study further evaluated this adverse event's age‐based risk.Methods.CALGB 40101 investigated adjuvant paclitaxel (80 mg/m2 once per week or 175 mg/m2 every 2 weeks) in patients with breast cancer and served as a platform for the current study that investigated age‐based differences in neuropathy. Grade 2 or worse neuropathy, as per Common Terminology Criteria for Adverse Events version 4, was the primary endpoint; patients were assessed at baseline, every 6 months for 2 years, and then annually for 15 years.Results.Among these 1,881 patients, 230 were 65 years of age or older, 556 were 55–64 years, and 1,095 were younger than 55; 1,226 neuropathy events (commonly grade 1 or 2) were reported in 65% of the cohort. The number of grade 2 or worse events was 63 (27%), 155 (28%), and 266 (24%) within respective age groups (p = .14). In univariate analysis, only motor neuropathy had a higher age‐based incidence: 19 (8%), 43 (8%), and 60 (5%), respectively (p = .04); in multivariate analyses, this association was no longer statistically significant. Other endpoints, such as time to onset of neuropathy (time from trial enrollment to neuropathy development) and time to improvement (time from maximal grade sensory neuropathy to a one‐category improvement), showed no statistically significant age‐based differences. In contrast, obesity was associated with neuropathy, and every 2‐week paclitaxel was associated with trends toward neuropathy.Conclusion.Although paclitaxel‐induced neuropathy is common, older age is not an independent risk factor. Clinical trial identification number. NCT00041119 (CALGB 40101).Implications for Practice.Age alone is not an independent risk factor for paclitaxel‐induced neuropathy.

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The Basophil Activation Test reduces the need for a food challenge test in children suspected of IgE‐mediated cow's milk allergy

Abstract

Background

The gold standard for the diagnosis of cow's milk allergy is the Double‐Blind Placebo‐Controlled Food Challenge (DBPCFC) test. However, disadvantages of the DBPCFC are the potential risk of anaphylactic reactions, the time consuming procedure and high costs.

Objective

The aim of this study is to determine the reliability of the Basophil Activation Test (BAT) both for the initial diagnosis of cow's milk allergy in children and for determination of tolerance in children with cow's milk allergy.

Methods

97 BATs and cow's milk specific IgE (sIgE) tests were performed in 86 infants/young children, suspected of (persistent) cow's milk allergy, who were qualified for an in‐hospital DBPCFC. The BAT was performed with cow's milk extract and the purified major allergens casein, α‐lactalbumin, β‐lactoglubulin. Basophil activation was determined by CD63 up‐regulation measured by flow cytometry. The BAT results were compared to the DBPCFC outcomes.

Results

Based on unequivocal DBPCFC and BAT result combinations (80%), the BAT had a sensitivity and specificity of 100% (CI 86‐100% and 68‐100%, respectively) in IgE sensitized children (41% of the tested children). All non‐IgE sensitized children (59%) had a negative DBPCFC and BAT, except for five patients. These latter showed delayed and relatively mild symptoms in the DBPCFC with a negative BAT, supporting a non‐IgE mediated allergy in these children.

Conclusions and Clinical Relevance

The BAT seems reliable and cost‐effective to diagnose patients with an IgE‐mediated cow's milk allergy. In IgE sensitized patients a BAT might replace a DBPCFC. For non‐IgE sensitized patients presenting with mild symptoms we propose to consider a (double‐blind) extended (time) challenge test at home.

This article is protected by copyright. All rights reserved.



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Klippel‐Feil syndrome with associated cervical rib in a human skeleton from Wągrowiec (Poland, 14th–17th centuries)

Abstract

This paper presents congenital anomalies characteristic of Klippel‐Feil syndrome, type II, diagnosed in the skeleton of a young to middle‐aged woman uncovered in a cemetery adjacent to the Church of St Jacob the Apostle in Wągrowiec (Poland), from a grave within an archaeological layer dated to the 14th–17th centuries. A rare type of fusion was identified between the sixth and seventh cervical vertebrae only, co‐occurring with a well‐developed right cervical rib fused to the shaft of the first thoracic rib and articulated via synovial joints with the seventh cervical vertebra. The fusion of the cervical vertebrae involved their bodies, right laminae, and parts of the right articular processes. The interpretation of the presence of Klippel‐Feil syndrome is additionally supported by the absence of any evidence of trauma in the cervical region of the spine or of pathological changes in the skeleton indicative of diffuse idiopathic skeletal hyperostosis or ankylosing spondylitis. The formation of Schmorl's nodes and degenerative changes in apophyseal joint surfaces diagnosed in the cervical vertebrae were probably secondary in relation to the observed congenital anomalies. Additionally, examinations revealed ossified insertions of the ligamentum flavum and degenerative changes of the vertebrae in the lower region of the spine as well as incomplete posterior bridge of the atlas, torus mandibularis, and humerus septal aperture.



https://ift.tt/2AWlTdl

Hydroxychloroquine sulphate therapy of erosive oral lichen planus

Abstract

Background/Objectives

Erosive oral lichen planus (LP) may be painful and debilitating. Symptomatic oral LP has been treated with a wide spectrum of topical and systemic therapies, but few have been evaluated in large series. Hydroxychloroquine is suggested to be effective in oral LP.

Methods

Twenty‐one consecutive patients with erosive, biopsy‐confirmed oral LP were prescribed. hydroxychloroquine sulphate 400 mg/day. Symptomatic improvement was evaluated by means of a visual analogue scale into three groups: no change, moderate to marked improvement and complete remission.

Results

Five (24%) patients obtained complete remission, 12 (57%) patients showed moderate to marked improvement, 3 (14%) patients did not improve at all and in one patient therapy was terminated after 1 month due to side effects. Response to therapy was observed after 2–4 months. Side effects which ultimately led to termination of therapy in three patients were elevated creatinine serum levels (after 1 month), visual field defects (after 8 months) and hyperpigmentation (after 24 months). Among six patients who responded to therapy, three flared on stopping.

Conclusions

Hydroxychloroquine sulphate may be effective and relatively safe treatment for erosive oral LP.



https://ift.tt/2qxDhz8

Efficacy of erbium glass laser in the treatment of Old World cutaneous leishmaniasis: A case series

Abstract

Background

Treatment of cutaneous leishmaniasis remains a challenge; new physical treatment modalities including laser systems are of interest in the treatment of localized lesions.

Method

Fourteen patients (10 females) with 20 lesions of Old World cutaneous leishmaniasis underwent weekly treatments of 1540 nm erbium glass fractional laser (Palomar) using 10 mm spot size hand piece in four passes of 50–70 mJ/cm2 fluence and 10 ms pulse duration.

Results

Twelve lesions were available for assessment: six (50%) improved at 6 weeks and eleven lesions (91.7%) at 12 weeks. There were no recurrences at 6‐ and 12‐month follow‐ups.

Conclusion

Erbium glass fractional laser may be an alternative treatment for localized cases of Old World cutaneous leishmaniasis.



https://ift.tt/2Fffb6l

Hydroxychloroquine sulphate therapy of erosive oral lichen planus

Abstract

Background/Objectives

Erosive oral lichen planus (LP) may be painful and debilitating. Symptomatic oral LP has been treated with a wide spectrum of topical and systemic therapies, but few have been evaluated in large series. Hydroxychloroquine is suggested to be effective in oral LP.

Methods

Twenty‐one consecutive patients with erosive, biopsy‐confirmed oral LP were prescribed. hydroxychloroquine sulphate 400 mg/day. Symptomatic improvement was evaluated by means of a visual analogue scale into three groups: no change, moderate to marked improvement and complete remission.

Results

Five (24%) patients obtained complete remission, 12 (57%) patients showed moderate to marked improvement, 3 (14%) patients did not improve at all and in one patient therapy was terminated after 1 month due to side effects. Response to therapy was observed after 2–4 months. Side effects which ultimately led to termination of therapy in three patients were elevated creatinine serum levels (after 1 month), visual field defects (after 8 months) and hyperpigmentation (after 24 months). Among six patients who responded to therapy, three flared on stopping.

Conclusions

Hydroxychloroquine sulphate may be effective and relatively safe treatment for erosive oral LP.



https://ift.tt/2qxDhz8

Efficacy of erbium glass laser in the treatment of Old World cutaneous leishmaniasis: A case series

Abstract

Background

Treatment of cutaneous leishmaniasis remains a challenge; new physical treatment modalities including laser systems are of interest in the treatment of localized lesions.

Method

Fourteen patients (10 females) with 20 lesions of Old World cutaneous leishmaniasis underwent weekly treatments of 1540 nm erbium glass fractional laser (Palomar) using 10 mm spot size hand piece in four passes of 50–70 mJ/cm2 fluence and 10 ms pulse duration.

Results

Twelve lesions were available for assessment: six (50%) improved at 6 weeks and eleven lesions (91.7%) at 12 weeks. There were no recurrences at 6‐ and 12‐month follow‐ups.

Conclusion

Erbium glass fractional laser may be an alternative treatment for localized cases of Old World cutaneous leishmaniasis.



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Seltene Differenzialdiagnose einer Tonsillopharyngitis

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Laryngo-Rhino-Otol
DOI: 10.1055/a-0762-4033



© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text



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Nationwide survey of congenital cholesteatoma using staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society

This study was undertaken to determine the characteristics of congenital cholesteatoma (CC) in Japan, via a nationwide survey using staging and classification criteria for middle ear cholesteatoma, as proposed by the Japan Otological Society (JOS).

https://ift.tt/2OyXPRs

Comparative on plant stoichiometry response to agricultural non-point source pollution in different types of ecological ditches

Abstract

Long-term agricultural development has led to agricultural non-point source (NPS) pollution. Ecological ditches (eco-ditch), as specific wetland systems, can be used to manage agricultural NPS water and achieve both ecological and environmental benefits. In order to understand which type of eco-ditch systems (Es, soil eco-ditch; Ec, concrete eco-ditch; Eh, concrete eco-ditch with holes on double-sided wall) is more suitable for plant nutrient balance meanwhile reducing NPS water (total nitrogen [TN], about 10 mg/L; total phosphorus [TP], about 1 mg/L), it is essential to evaluate the plant (Vallisneria natans) stoichiometry response to water in different types of eco-ditches under static experiment. The results indicated that there were no significant differences in TP removal efficiency among three eco-ditches, yet Eh systems had the best TN removal efficiency during the earlier experimental time. Addition of agricultural NPS water had varying effects on plants living in different types of eco-ditch systems. Plant organ stoichiometry of V. natans varied in relation to eco-ditch types. Plant stoichiometry (C:N, C:P, and N:P) of V. natans in Eh systems could maintain the homeostasis of nutrients and was not greatly affected by external changing environment. V. natans in Es systems can more easily modify the nutrient contents of organs with regard to nutrient availability in the environment. Our findings provide useful plant stoichiometry information for ecologists studying other specific ecosystems.



https://ift.tt/2yYM1mx

Resection versus preservation of the middle turbinate in surgery for chronic rhinosinusitis with nasal polyposis: a randomized controlled trial

Chronic rhinosinusitis (CRS) affects up to 16% of the population. When medical treatment fails, endoscopic sinus surgery (ESS) is considered. The value of resecting the middle turbinate to optimize surgical ou...

https://ift.tt/2PkoVkc

Early risk factors for cow's milk allergy in children in the first year of life



https://ift.tt/2RHYLF6

Extrinsic warming of low-osmolality iodinated contrast media to 37°C reduced the rate of allergic-like reaction



https://ift.tt/2Dt40oZ

Effect of indoor air quality on the natural history of asthma in an urban population in Poland



https://ift.tt/2RH3lmX

Effect of indoor air quality on the development of rhinitis in an urban population in Poland



https://ift.tt/2DtC0kX

Atopic dermatitis: A disease “More common in families that sneeze and wheeze”



https://ift.tt/2REco8a

The burden of atopic dermatitis



https://ift.tt/2DuxkLK

Severe atopic dermatitis: Therapeutic update



https://ift.tt/2RH3ff5

The effect of preoperative penicillin allergy testing on perioperative non‐beta-lactam antibiotic use: A systematic review and meta-analysis



https://ift.tt/2Ds3B64

Cross-sectional study on Asthma Insights and Management in the Gulf and Russia



https://ift.tt/2RGFXpu

Impact of patient satisfaction with his or her inhaler on adherence and asthma control

aap.gif



https://ift.tt/2Dv2en8

Assessment of atopic dermatitis as a risk factor for chronic spontaneous urticaria in a pediatric population



https://ift.tt/2RJU39z

Challenges in managing patients referred for eosinophilic esophagitis: A telephone survey and retrospective review



https://ift.tt/2DuR55R

Correlation of negative skin-prick test results for tree nuts and successful tree nut challenges among children with peanut allergy



https://ift.tt/2RJ5zCd

Human factors engineering validation study for a novel 0.1-mg epinephrine auto-injector



https://ift.tt/2Dy2hyG

Pearls and pitfalls in the diagnosis of cough variant asthma



https://ift.tt/2RIlrES

Generalized rash and pruritus in a 58-year-old woman



https://ift.tt/2Dt3OGh

For the Patient



https://ift.tt/2RLkpbA

Effect of indoor air quality on the development of rhinitis in an urban population in Poland



https://ift.tt/2Dt6TpH

Early risk factors for cow's milk allergy in children in the first year of life



https://ift.tt/2RHYLF6

Extrinsic warming of low-osmolality iodinated contrast media to 37°C reduced the rate of allergic-like reaction



https://ift.tt/2Dt40oZ

Effect of indoor air quality on the natural history of asthma in an urban population in Poland



https://ift.tt/2RH3lmX

Effect of indoor air quality on the development of rhinitis in an urban population in Poland



https://ift.tt/2DtC0kX

Atopic dermatitis: A disease “More common in families that sneeze and wheeze”



https://ift.tt/2REco8a

The burden of atopic dermatitis



https://ift.tt/2DuxkLK

Severe atopic dermatitis: Therapeutic update



https://ift.tt/2RH3ff5

The effect of preoperative penicillin allergy testing on perioperative non‐beta-lactam antibiotic use: A systematic review and meta-analysis



https://ift.tt/2Ds3B64

Cross-sectional study on Asthma Insights and Management in the Gulf and Russia



https://ift.tt/2RGFXpu

Impact of patient satisfaction with his or her inhaler on adherence and asthma control

aap.gif



https://ift.tt/2Dv2en8

Assessment of atopic dermatitis as a risk factor for chronic spontaneous urticaria in a pediatric population



https://ift.tt/2RJU39z

Challenges in managing patients referred for eosinophilic esophagitis: A telephone survey and retrospective review



https://ift.tt/2DuR55R

Correlation of negative skin-prick test results for tree nuts and successful tree nut challenges among children with peanut allergy



https://ift.tt/2RJ5zCd

Human factors engineering validation study for a novel 0.1-mg epinephrine auto-injector



https://ift.tt/2Dy2hyG

Pearls and pitfalls in the diagnosis of cough variant asthma



https://ift.tt/2RIlrES

Generalized rash and pruritus in a 58-year-old woman



https://ift.tt/2Dt3OGh

For the Patient



https://ift.tt/2RLkpbA

Effect of indoor air quality on the development of rhinitis in an urban population in Poland



https://ift.tt/2Dt6TpH

The risk of neurodegeneration in REM Sleep Behavior Disorder: A systematic review and meta-analysis of longitudinal studies

Several studies report an association between REM Sleep Behavior Disorder (RBD) and neurodegenerative diseases, in particular synucleinopathies. Interestingly, the onset of RBD precedes the development of neurodegeneration by several years. This review and meta-analysis aims to establish the rate of conversion of RBD into neurodegenerative diseases. Longitudinal studies were searched from the PubMed, Web of Science, and SCOPUS databases. Using random-effect modeling, we performed a meta-analysis on the rate of RBD conversions into neurodegeneration.

https://ift.tt/2PgmmQm

Neurobiological and Immunogenetic Aspects of Narcolepsy: Implications for Pharmacotherapy

Excessive daytime sleepiness (EDS) and cataplexy are common symptoms of narcolepsy, a sleep disorder associated with the loss of hypocretin/orexin (Hcrt) neurons. Although only a few drugs have received regulatory approval for narcolepsy to date, treatment involves diverse medications that affect multiple biochemical targets and neural circuits. Clinical trials have demonstrated efficacy for the following classes of drugs as narcolepsy treatments: alerting medications (amphetamine, methylphenidate, modafinil/armodafinil, solriamfetol [JZP-110]), antidepressants (tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors), sodium oxybate, and the H3-receptor inverse agonist/antagonist pitolisant.

https://ift.tt/2QBCf08

Prognostic Factors, Treatment, and Survival in Cutaneous Pleomorphic Sarcoma

Cutaneous pleomorphic sarcoma (CPS) is an aggressive tumor with local recurrence and potential for metastasis. This SEER database study male gender identifies white race, age >39, primary site in the head/neck, size >15mm, distant disease as negative prognostic factors and demonstrates that surgical treatment of high risk patients improves outcomes.

https://ift.tt/2qDcKjU

CORRECTION



https://ift.tt/2QuvpcS

Methylococcaceae are the dominant active aerobic methanotrophs in a Chinese tidal marsh

Abstract

Although coastal marshes are net carbon sinks, they are net methane sources. Aerobic methanotrophs in coastal marsh soils are important methane consumers, but their activity and populations are poorly characterized. DNA stable-isotope probing followed by sequencing was used to determine how active methanotrophic populations differed in the main habitats of a Chinese coastal marsh. These habitats included mudflat, native plant-dominated, and alien plant-dominated habitats. Methylococcaceae was the most active methanotroph family across four habitats. Abundant methylotroph sequences, including methanotrophs and non-methane-oxidizing methylotrophs (Methylotenera and Methylophaga), constituted 50–70% of the 16S rRNA genes detected in the labeled native plant-dominated and mudflat soils. Methylotrophs were less abundant (~ 20%) in labeled alien plant-dominated soil, suggesting less methane assimilation into the target community or a different extent of carbon cross-feeding. Canonical correspondence analysis indicated a significant correlation between the active bacterial communities and soil properties (salinity, organic carbon, total nitrogen, pH, and available phosphorus). Importantly, these results highlight how changing vegetation or soil features in coastal marshes may change their resident active methanotrophic populations, which will further influence methane cycling.



https://ift.tt/2OzJLXR

Fumonisin B 1 -induced oxidative stress triggers Nrf2-mediated antioxidant response in human hepatocellular carcinoma (HepG2) cells

Abstract

Fumonisin B1 (FB1), a causative agent for animal-related mycotoxicoses, has been implicated in human and animal cancer. FB1 induces oxidative stress but the related survival responses are not well established. Central to this response is the transcription factor, nuclear factor erythroid 2 p45–related factor 2 (Nrf2). The effects of FB1 on Nrf2-related survival responses in human hepatoma (HepG2) cells were investigated. HepG2 cells were treated with 200 μmol/l FB1 (IC50–24 h). Cellular redox status was assessed via the quantification of intracellular reactive oxygen species (ROS), lipid peroxidation, protein oxidation and the antioxidant glutathione (GSH). The protein expression of oxidative stress and mitochondrial stress response proteins [Nrf2, phosphorylated-Nrf2 (pNrf2), superoxide dismutase 2 (SOD2), catalase (CAT), sirtuin 3 (Sirt 3) and Lon-protease 1 (Lon-P1)] were quantified by western blotting, while gene expression levels of SOD2, CAT and GPx were assessed using quantitative polymerase chain reaction (qPCR). Lastly, the fluorometric, JC-1 assay was used to determine mitochondrial polarisation. FB1 significantly increased ROS (p ≤ 0.001), and induced lipid peroxidation (p < 0.05) and protein carbonylation (p ≤ 0.001), which corresponded with the increase in GSH levels (p < 0.05). A significant increase in pNrf2, SOD2, SOD2, CAT (p < 0.05), CAT (p ≤ 0.01) and GPx (p ≤ 0.001) expression was observed; however, total Nrf2 (p > 0.05) was reduced. There was also a minor reduction in the mitochondrial membrane potential of HepG2 cells (p < 0.05); however, the expression of Sirt 3 and Lon-P1 (p ≤ 0.001) were upregulated. Exposure to FB1 induced oxidative stress in HepG2 cells and initiated Nrf2-regulated transcription of antioxidants.



https://ift.tt/2zHiKMO

Exposure of human lymphoma cells (U-937) to the action of a single mycotoxin as well as in mixtures with the potential protectors 24-epibrassinolide and selenium ions

Abstract

The progressive contamination of food products by mycotoxins such as zearalenone (ZEN) has prompted the search for specific substances that can act as protectors against an accumulation of these toxins. This paper discusses the effect of selenium ions and 24-epibrassinolide (EBR) as non-organic and organic compounds that preserve human lymphoblastic cells U-937 under ZEN stressogenic conditions. Based on measurements of cell viability and a DAPI test, concentrations of ZEN at 30 μmol/l, Se at 2.5 μmol/l and EBR at 0.005 μmol/l were selected. The addition of both protectors resulted in an increase in the viability of ZEN-treated cells by about 16%. This effect was connected with a decrease in lipid peroxidation (a decrease in the malonyldialdehyde content) and the generation of reactive oxygen species, which were determined by a cellular ROS/superoxide detection assay and the SOD activity. The Se protection was observed as the blocking of the all excess ROS, while the EBR action was mainly concentrated on something other than the superoxide radical itself. The experiments on the model lipid membranes that mimic the environment of U-937 cells confirmed the affect of ZEN on the structure and physicochemical properties of human membranes. Although the presence of both Se and EBR reduced the effect of ZEN by blocking its interaction with a membrane, the action of Se was more evident.



https://ift.tt/2SSqDYi

Growth and biochemical changes in quail bush ( Atriplex lentiformis (Torr.) S.Wats) under Cd stress

Abstract

Halophytes have several advantages to be more effective in metal phytoextraction. Little is known about the Cd-phytoextraction potential of Atriplex lentiformis under different levels of Cd. Seven levels of Cd (0, 40, 80, 120, 160, 200, and 240 mg per kg of soil) were added to A. lentiformis plants grown on pots filled with 5 kg of sandy loam soil. A. lentiformis plants achieve different defense mechanisms to meet the high concentration of Cd in the soil and plant. These mechanisms include reducing the number and area of leaves, minimizing chlorophyll synthesis, and enhancing synthesizing of oxalic acid, phenols, and proline. The critical point of Cd was 9.35 and 183 mg kg−1 for available soil Cd and leaves concentrations, respectively. The maximum level of Cd displayed a 66% decrease in the chlorophyll content of the leaves. On the other hand, the oxalic acid, phenols, and proline in the leaves were increased significantly by 129, 100, and 200% when Cd increased from 0 to 240 mg. The tested plant removed 3.6% of the total soil Cd under the low Cd concentration (40 mg) but under the high level of Cd (240 mg), it only removed a negligible amount of soil Cd (0.74%). The current study confirmed that A. lentiformis plants lost the ability to cleanup Cd from contaminated soil under the high levels of contamination due to the high reduction in the production of dry matter.



https://ift.tt/2z0m8To

Early adiposity rebound in patients with Prader-Willi syndrome

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


https://ift.tt/2qBtMz1

Evidence for neurogenic inflammation in lichen planopilaris and frontal fibrosing alopecia pathogenic mechanism

Abstract

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are lymphocytic scarring alopecias affecting primarily the scalp. Although both diseases may share some clinical and histopathological features, in the last decade, FFA has become an "epidemic" particularly in Europe, North and South America with unique clinical manifestations compared to LPP, thus, raising the idea that this disease may have a different pathogenesis. Symptoms such as scalp burning, pruritus, or pain are usually present in both diseases, suggesting a possible role for nerves and neuropeptides in the pathogenesis of both diseases. Based on some previous studies, neuropeptides, such as substance P (SP) and calcitonin gene‐related peptide (CGRP), have been associated with lipid metabolism and many chronic inflammatory disorders. In this study we asked if these neuropeptides are associated with LPP and FFA scalp lesions. Alteration in the expression of SP and CGRP in affected and unaffected scalp skin from patients with both diseases was found with examination of sections using immunohistochemical techniques and confocal microscopy. We then quantitatively assessed and compared SP and CGRP expression from control, LPP and FFA scalp biopsies. Although LPP and FFA share similar histopathologic findings, opposite results were found in affected and unaffected scalp in the ELISA tests, suggesting that these diseases may have different pathogenic mechanisms. We also found presence of histopathological inflammation irrespective of evident clinical lesions, which raises the possibility that both diseases may be more generalized processes affecting the scalp.

This article is protected by copyright. All rights reserved.



https://ift.tt/2FebbTP

Component resolved analysis of ash pollen allergy in Bavaria

Sensitization to ash pollen is underestimated in various regions. The prevalence in Germany is about 10%. However, allergy to ash pollen is widely overlooked by allergists, since the pollination period of ash ...

https://ift.tt/2F98PFK

Sweet syndrome: a rare feature of ANCA-associated vasculitis or unusual consequence of azathioprine-induced treatment

Sweet syndrome is a rare skin condition characterised by fever, neutrophilia, and tender erythematous skin lesions and has been reported to occur in association with anti-neutrophil cytoplasmic antibodies (ANC...

https://ift.tt/2qAN2wl

Aetiology of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka

The aetiology of anaphylaxis differs according to types of foods consumed, fauna and foliage and cultural practices. Although the aetiology of anaphylaxis in Western countries are well known, the causes in Sou...

https://ift.tt/2FfiHxx

Impact of pharmacists’ counseling on caregiver's knowledge in the management of pediatric atopic dermatitis

Abstract

Background

Atopic dermatitis (AD) is a common skin condition in childhood. AD management can be complex, and caregivers may have inadequate information on the disease, aggravating factors, and management. Comprehensive therapeutic education has been closely associated with increased compliance and is recommended for all patients. There are, as yet, no studies on the impact of a pharmacist‐led eczema counseling service.

Objectives

The primary objective was to assess the impact of a pharmacist‐led eczema counseling service on improving caregivers' knowledge. The secondary objective was to evaluate caregivers' satisfaction of the service and their confidence in handling the patient's condition after counseling.

Methods

This was a prospective, questionnaire‐based observational study. After obtaining informed consent, caregivers were required to complete questionnaire A, containing items on demographics and knowledge assessment. Caregivers then underwent a counseling session by a dermatology‐trained pharmacist. After counseling, caregivers were required to complete questionnaire B containing items on satisfaction and confidence level. A follow‐up phone call was conducted after initial counseling session, during which knowledge‐based questionnaire C would be completed.

Results

Data from 32 participants were included in the analysis. There was a significant improvement in caregivers' knowledge score after receiving counseling, with mean precounseling score of 8.38 ± 3.92 and mean postcounseling score of 13.88 ± 3.65 (P < 0.001). Majority was satisfied with the service and was confident in handling their child's condition.

Conclusion

Pharmacist‐led eczema counseling has a positive impact on caregiver's knowledge and can lead to improved compliance. The service was well received, although more time could be spent during the counseling.



https://ift.tt/2yYuU4h

Sub-lethal effects induced by a mixture of different pharmaceutical drugs in predicted environmentally relevant concentrations on Lithobates catesbeianus (Shaw, 1802) (Anura, ranidae) tadpoles

Abstract

The increasing consumption of medications by humans has negative effects such as the increased disposal of these compounds in the environment. Little is known about how the disposal of a "drug mix" (DM) in aquatic ecosystems can affect their biota. Thus, we evaluated whether the exposure of Lithobates casteibeianus tadpoles to a DM composed of different medication classes (antibiotic, anti-inflammatory, antidepressant, anxiolytic, analgesic, and antacid drugs)—at environmentally relevant concentrations—may change their oral morphology, trigger behavioral disorders, and have mutagenic effects on erythrocyte cells. Based on our data, animals exposed to the DM showed changes in mandibular sheath pigmentation, dentition, and swimming activity, as well as atypical behavior in the social aggregation test [with co-specific and interspecific (Physalaemus cuvieri) individuals] and antipredatory defensive response deficit (chemical stimulus from Odonata larvae), after 15 exposure days. The mutagenic analysis revealed higher frequency of nuclear abnormalities in the erythrocytes of tadpoles exposed to the DM (e.g., multilobulated, blebbed, kidney-shaped, notched nucleus, binuclear, and micronucleated erythrocytes). Given the chemical complexity of the DM, we assumed that several organic functions may have been affected, either by the isolated, synergistic, antagonistic, or additive action of DM compounds. Finally, our study confirms the toxicological potential of DM in L. catesbeianus tadpoles, with emphasis to impacts that can affect the fitness of individuals and their natural populations. Thus, we suggest that more attention should be given to the disposal of medications in the environment and reinforce the need of improving water and sewage treatment systems.



https://ift.tt/2DbaMi1

Transformation of cadmium-associated schwertmannite and subsequent element repartitioning behaviors

Abstract

Schwertmannite is an important sink for cadmium (Cd) in acid mine drainage (AMD) environments and is unstable when environmental conditions change. However, the release and redistribution of Cd during schwertmannite transformation with respect to pre-bound Cd are poorly understood. In this work, the transformation of cadmium-associated schwertmannite and subsequent Cd repartitioning behaviors were investigated. The way of schwertmannite associated with Cd was predominant by absorption, and the diffuse layer model (DLM) showed that Cd2+ existed as monodentate complexes ≡Fe(1)OCd+ and ≡Fe(2)OCd+ on schwertmannite surfaces. Kinetics of SO42− release and mineralogical characterization both showed that the mineral transformation rates decreased and more lepidocrocite aggregated with increasing adsorbed Cd levels. The shrinking core model revealed that Fe(II)-induced process would affect mineral dissolution by changing surface reaction-controlled step to internal diffusion-controlled step, and significantly promote the dissolution rate of Cd-adsorbed schwertmannite. Adsorbed Cd blocked the surface sites for later Fe(II) adsorption and the Fe(II)-Fe(III) electron transfer, then resulted in the decelerated transformation and the accumulation of intermediate phase lepidocrocite. The maximum release of aqueous Cd occurred after 1 mM Fe2+ addition, then over 69% of initial added Cd(aq) re-bound to solid-phase accompanying with mineral transformation, and finally, Cd was mainly associated with the secondary minerals by complexation with surficial OH groups. These findings are useful for developing the strategies for treating Cd contamination in AMD affected areas.



https://ift.tt/2PPZ4QI

Severe Nasal Swelling

A 32-year-old Hispanic man presented with progressive nasal pain, swelling, and crusting extending to his upper lip, without fever or leukocytosis. What is your diagnosis?

https://ift.tt/2qzQyHd

Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years

This cohort study assesses whether untreated hearing loss is associated with increased health care costs and utilization.

https://ift.tt/2Fl0v5U

Association of Age-Related Hearing Loss With Multiple Adverse Health Outcomes

Age-related hearing loss (ARHL) has recently received much attention owing to its recognition as a potential modifiable risk factor for dementia. An increasing number of observational studies, mostly published in the last decade, have associated ARHL with cognitive decline, cognitive impairment, and dementia, igniting increasing interest in ARHL. Livingston et al reported that interventions for peripheral hearing loss may reduce the prevalence of dementia by 9% globally, which is a result higher than that for any other modifiable risk factor. Interestingly, ARHL has also been associated with a higher risk for other common age-related conditions, including depression and falls, suggesting that ARHL is connected with a broader decline in health. However, the association of ARHL with adverse health outcomes other than dementia has been less well studied, despite the prevalence of ARHL as a chronic malady in older age (more than half of US adults older than 60 years have clinically meaningful hearing loss).

https://ift.tt/2qBMLJO

Analysis of Clinical Features of Mammary Analog Secretory Carcinoma Using the SEER Database

This population-based study uses data from the Surveillance, Epidemiology, and End Results database to analyze the typical clinical characteristics of mammary analog secretory carcinoma.

https://ift.tt/2F8AshR

The Invisible Costs of Hearing Loss

In this issue of JAMA Otolaryngology–Head & Neck Surgery, data from the administrative claims supplied by the OptumLabs database and analyzed by Reed et al indicate significantly longer inpatient stays, higher 30-day hospital readmission rates, and increased overall health care costs among persons with untreated hearing loss. The authors used data from this large, diverse medical claims database representing over 125 million individuals in the United States and found evidence that untreated hearing loss may be influencing health care in more ways than we previously imagined. The prevalence of hearing loss, which is strongly associated with age, is increasing as our population ages, with most US adults 75 years and older experiencing hearing loss. Coupled with the fact that hearing loss is not only common, but also connected with social isolation, reduced cognitive function, poorer physical and psychological health, increased risk of falls and hospitalization, and worse patient-clinician communication, the health care system should do more to improve screening and treatment of individuals with hearing loss.

https://ift.tt/2qzOpeT

Incident Hearing Loss and Comorbidity

This retrospective, propensity-matched cohort study assesses the association between hearing loss and medical comorbidities.

https://ift.tt/2FbWu3w

Issues and Findings in Common Cavity Deformity

This narrative review describes the various aspects of common cavity deformity and examines cochlear implant, the first-line option for achieving hearing function in patients with common cavity deformity.

https://ift.tt/2qCJM3K

Additive Chemotherapie mit Cisplatin und Gemcitabin nach kurativ intendierter Radiochemotherapie verbessert das rezidivfreie Überleben von Nasopharynxkarzinompatienten mit noch nachzuweisender EBV-DNA-Last nicht



https://ift.tt/2SX8tov

Efficiency of sequential UV/H 2 O 2 and biofilm process for the treatment of secondary effluent

Abstract

In response to the shortage of water resources, multiple processes have been applied to turn wastewater secondary effluent (SE) into potable water. However, trace organic contaminants (TOrCs) and high concentrations of organic matter contained in SE pose a significant challenge to the reclamation. In this manuscript, combined UV-based and biofilm processes were used to treat the SE spiked with ibuprofen (IBU) and clofibric acid (CA). The efficiency of these sequential treatments was characterized in terms of changes in dissolved organic carbon (DOC), absorbance at 254 nm (A254), fluorescence excitation-emission matrix (FEEM), the concentration of IBU and CA, and molecular weight of SE. Parallel factor (PARAFAC) was applied as the analysis method for FEEM of the samples and two fluorescent components were successfully identified: humic-like substances (C1) and protein-like matter (C2). Large reductions in A254, C1, C2, IBU, and CA were observed during the UV-based processes, especially with the addition of H2O2. Nearly 50% of A254, 80% of the component C1 were decreased and almost complete removal of the component C2 and TOrCs was achieved by UV/2.0 mM H2O2 after 90-min treatment. During the oxidation processes, the formation of lower molecular weight (LMW) compounds was detected, and the biodegradability of the organic matters was greatly increased. Although no significant DOC reduction was obtained in UV-based processes, an obvious further DOC reduction (30~60%) was achieved by biofilm treatment following UV-based processes, especially after UV/H2O2 treatments. In the meantime, large amounts of LMW were removed in the biofilm treatment process. This manuscript provides an effective advanced treatment of SE for the removal of DOC and TOrCs, facilitating the wastewater reclamation.



https://ift.tt/2PRNJj0

The use of biochar and crushed mortar in treatment wetlands to enhance the removal of nutrients from sewage

Abstract

An experimental study was carried out using in pilot-scale constructed wetland systems, operated in parallel to treat raw sewage. Each system consisted of a vertical flow (VF) unit that was filled with biochar as the main media, followed by a horizontal flow (HF) unit filled with crushed cement mortar. Hydraulic loading (HL) ranged 340–680 mm/day was applied on the VF wetland units, where high total nitrogen (TN) mass removal rate (20–23 g N/m2 d) was obtained, demonstrating that biochar media had a beneficial effect on the degradation of nitrogenous pollutants. Total phosphorus (TP) removal percentage (concentration based) was ≥ 86% in HF wetlands packed with mortar materials. In one system, the flow direction of the sewage was directed by the deployment of downflow pipes and vertical baffles, aiming to facilitate the formation of aerobic and anaerobic zones in the wetland matrices. The effects of such arrangement were analyzed by comparing pollutant removal efficiencies in the two systems. On average, 99, 96, 93, and 86 percentage removals were obtained for ammonia (NH4-N), TN, biochemical oxygen demand (BOD), and TP, respectively, during the experiments. Biochar and crushed mortar proved to be a highly effective combination as media in subsurface flow constructed wetlands for wastewater treatment.



https://ift.tt/2DcjWeu

Sludge nematodes, cestodes, and trematodes eggs variation from lagooning, activated sludge and infiltration-percolation wastewater treatment system under semi-arid climate

Abstract

The prevalence and the identification of the helminth eggs load of raw sewage sludge was assessed of three different wastewater treatment systems. The results showed a variety of parasite species with following average concentrations; five taxa belonging to three classes nematodes, cestodes and trematodes were inventoried. The class of nematodes is the most diverse with 5 taxa. It is represented by the eggs of Ascaris sp., Capillaria sp., Trichuris sp., Toxocara sp., and Ankylostome sp., then comes the cestodes class, this is represented by the eggs of Tænia sp. The trematode class is represented by Schistosoma sp. The lagooning station of Chichaoua shows the highest load 7 species with Ascaris 21 eggs/g; Capillaria sp., 11 eggs/g; Trichuris sp., 6 eggs/g; Toxocara sp., 2 eggs/g and Ankylostome sp., 1 egg/g; Taenia sp., 2eggs/g; and Schistosoma sp., 1 egg/g. Infiltration-percolation sludge show the presence of 4 species of helminths eggs in sludge from anaerobic settling with different rates: 15 eggs/g for Ascaris sp., 15 eggs/g for Trichuris sp., 13 eggs/g for Capillaria sp., and 8 eggs/g for Taenia sp. However, in sand filter pool, the sludge helminth eggs load was decreased by 47% of Ascaris sp., 85% of Capillaria sp., and 75% of Taenia sp., Nevertheless, an increase of Trichuris eggs load was noted in the second sludge by 17%. Five helminth eggs was detected in primary sludge coming from decantation pools in activated sludge plant in Marrakech, that is Ascaris sp., with a load of 16 eggs/g; Capillaria sp., with 3 eggs/g, Trichuris eggs with 2 eggs/g; Taenia sp., with 4 eggs/g; and Schistosoma sp., with 2 eggs/g. The abatement load of Ascaris sp. with 81% and Schistosoma and Taenia sp., with 100% was noted in biological sludge. Nevertheless, an increase load of Capillaria and Trichuris eggs 81% and 75% respectively was observed in this sludge coming from biological pools. The distribution of parasitic helminth eggs is linked to the differences in demographic and socio-economic status, seasonal variation, physico-chemical characteristic of helminth eggs, and the purification wastewater system performance.



https://ift.tt/2PPcbBy

Moving Precision Oncology Forward Amid Myths and Misconceptions—Reply

In Reply We are grateful for the broad interest in our article. In our study, we sought to estimate the percentage of US patients with cancer who are eligible for and may benefit from US Food and Drug Administration (FDA)–approved genome-driven cancer therapies, assuming universal testing and access to these therapies. We found that, as of 2018, the percentage of patients eligible for genome-directed therapies was 8.33%, and the percentage of patients benefiting (ie, those whose response may be attributed to the drug) was 4.90%. These percentages increased linearly at approximately 0.5% annually between 2006 and 2018 (as shown in eFigure 1 in the Supplement of our study). We emphasized the need to pursue research on genomic treatment alongside broader therapeutic strategies, such as immunotherapy and cytotoxic drugs.

https://ift.tt/2FaT2Gd

Moving Precision Oncology Forward Amid Myths and Misconceptions

To the Editor In the article by Marquart et al, the proportion of patients with advanced cancers eligible for and benefiting from US Food and Drug Administration–approved genome-driven treatments between 2006 and 2018 is estimated. A key finding is that such strategies would only benefit 6.62% of patients in 2018. These results need to be interpreted with caution, especially because they are approximated using multiple retrospective data assumptions and sensitivity analyses that do not consider key clinical trial details. For example, the 16% response rate of trastuzumab was based on a trial that included 23% of patients with moderate (2+) human epidermal growth factor receptor 2 (ERBB2/HER2) expression breast cancers who are unlikely to respond to treatment unless they have HER2 amplification, and the trial assessed trastuzumab monotherapy rather than chemotherapy combinations where trastuzumab provides the most benefit, with response rates ranging from 42% to 72%. Progress in cancer medicine is achieved by building on Food and Drug Administration–approved drugs through improved patient selection and combination strategies. A major constraint of the study by Marquart et al is that such evolving advances are not considered (eg, a 10% response rate of gefitinib in non–small cell lung cancer was based on an unselected patient population). These historical statistics do not reflect today's clinical practice and are potentially misleading.

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Palliative Care

This Patient Page defines palliative care and explains who may most benefit, when it is most appropriate, and which clinicians might help administer it.

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CancerMoving Precision Oncology Forward Amid Myths and Misconceptions

To the Editor The article by Marquart et al is a clarion call for the strategic application of genome therapies. The study includes patients with metastatic cancer who were eligible for genomic therapy from 2006 through 2018 and concludes that the number of patients eligible for these therapies has increased over time. This increase in eligibility coincides with increasing costs; the price of the chimeric antigen receptor T-cell–based genome therapy Kymriah (Novartis) is $475 000, which restricts public accessibility. Many of these genome therapies lack information about adverse effects or long-term efficacy and have been approved on the basis of single-arm uncontrolled studies with response rates 10% to 20% higher than those reported in subsequent studies or in real-world experience. Marquart et al report that clinical benefits associated with genome therapies were seen in a minority of patients, and the estimated percentage of patients who would have benefited in 2018 did not exceed 4.41%.

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Performance of a Multigene Classifier in Thyroid Nodules With Indeterminate Cytology

This prospective study examines the diagnostic accuracy of a multigene genomic classifier test for diagnosis of benign disease or cancer in thyroid nodules with indeterminate cytology.

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Is Precision Medicine an Oxymoron?

This Viewpoint discusses the initials results of the NCI-MATCH trial, a phase 2 study that seeks to determine whether targeted therapies for specific gene mutations will lead to objective responses agnostic to the primary cancer type.

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Local Control of Brain Metastases With Stereotactic Radiosurgery vs Surgical Resection

This exploratory secondary analysis of a randomized clinical trial evaluated local control of brain metastases among patients treated with stereotactic radiosurgery vs surgical resection in the European Organization for the Research and Treatment of Cancer 22952-26001 phase 3 trial.

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Resection versus preservation of the middle turbinate in surgery for chronic rhinosinusitis with nasal polyposis: a randomized controlled trial

Abstract

Background

Chronic rhinosinusitis (CRS) affects up to 16% of the population. When medical treatment fails, endoscopic sinus surgery (ESS) is considered. The value of resecting the middle turbinate to optimize surgical outcomes has been hypothesized but remains controversial and unproven. Whether the middle turbinate should be left in place or resected is controversial. Our objective is to determine if middle turbinectomy improves objective surgical outcomes after ESS.

Methods

Sixteen patients (15 men, 15 primary surgery) undergoing bilateral complete ESS for CRS with nasal polyposis were recruited. Nasal cavities were randomized so that middle turbinectomy was performed on one side while the middle turbinate was preserved on the other. Each participant acted as their own control. Nasal cavities were compared using Perioperative Sinus Endoscopy (POSE) and Lund-Kennedy (LKES) scores pre-operatively, and at 1, 3 and 6 months after ESS. Results were analyzed using Wilcoxon signed-rank test.

Results

Pre-operatively, the POSE (12.4 ± 2.9 vs 12.8 ± 2.6, p = 0.33, for the preserved side and the resected side, respectively) and LKES (5.0 ± 1.0 vs 4.8 ± 1.2, p = 0.33) scores were similar between sides. During follow up, resection was associated with more crusting at 1 month following ESS (1.0 ± 0.7 vs 0.4 ± 0.6, p = 0.02). There was a small, but statistically significant, difference between the nasal cavities at 3 months, where the resected side showed better endoscopic appearance (2.0 ± 2.2 vs 3.4 ± 2.8, p = 0.01). No difference was found at 6 months. Frontal sinus scores were similar between sides at 6 months (0.7 ± 0.5 vs 0.7 ± 0.5, p = 1.00).

Conclusion

Our results show no sustained objective endoscopic benefit of routine middle turbinectomy, at least within the first six postoperative months, in patients undergoing primary ESS for CRS with polyposis.

Trial registration

NCT, NCT02855931. Registered 16 August 2016.



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Zinc, copper, cadmium, and lead levels in cattle tissues in relation to different metal levels in ground water and soil

Abstract

The objective of the present study was to investigate the interaction between environmental (water and soil) levels of zinc, copper, cadmium, and lead levels, as well as their content in Hereford beef cattle tissues in five districts (D1—western area, D2 and D3—central area, D4 and D5—eastern area) of the Orenburg region. Soil metal levels were assessed using atomic emission spectrometry, whereas water and tissue (liver, kidney, muscle, heart) metal content was studied using inductively coupled plasma-mass spectrometry. The obtained data demonstrate that the highest levels Zn in soil and water (p < 0.001), as well as cattle muscle, liver, and kidney (p < 0.05) were observed in D4 and D5 (eastern area), exceeding the maximum permissible concentration levels (MPCL) for drinking water and muscle for all regions. Similar associations were found for Cu levels. The highest soil and water Cd and Pb content were observed in D2 (central area) and D5 (eastern area), respectively. At the same time, cattle tissue Cd and Pb content did not correspond to the respective environmental levels. Correlation analysis demonstrated that water and soil Zn and Cu content directly correlated with muscle, liver, and kidney, but not heart metal content. At the same time, water Cd levels were negatively interrelated with muscle cadmium content but correlated directly with hepatic metal content. Both water and soil Pb levels positively correlated with renal metal levels in cattle. In turn, soil lead content was inversely associated with muscle metal levels. Regression analysis also demonstrated a significant association between environmental and tissue levels of Zn and Cu. The models adjusted for all studied elements demonstrated a significant effect of metal interaction on tissue metal levels. Hypothetically, excessive environmental Zn, and possibly Cu, levels may affect the uptake of heavy metals including Cd and Pb from the environment.



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