No abstract available
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Κυριακή 16 Σεπτεμβρίου 2018
Temporal Changes in Ventilator Settings in Patients With Uninjured Lungs: A Systematic Review
In patients with uninjured lungs, increasing evidence indicates that tidal volume (VT) reduction improves outcomes in the intensive care unit (ICU) and in the operating room (OR). However, the degree to which this evidence has translated to clinical changes in ventilator settings for patients with uninjured lungs is unknown. To clarify whether ventilator settings have changed, we searched MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science for publications on invasive ventilation in ICUs or ORs, excluding those on patients 25% of patients with acute respiratory distress syndrome (ARDS). Our primary end point was temporal change in VT over time. Secondary end points were changes in maximum airway pressure, mean airway pressure, positive end-expiratory pressure, inspiratory oxygen fraction, development of ARDS (ICU studies only), and postoperative pulmonary complications (OR studies only) determined using correlation analysis and linear regression. We identified 96 ICU and 96 OR studies comprising 130,316 patients from 1975 to 2014 and observed that in the ICU, VT size decreased annually by 0.16 mL/kg (−0.19 to −0.12 mL/kg) (P
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Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction: A Multicenter Observational Study From the Pediatric Craniofacial Collaborative Group
BACKGROUND: Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and perioperative complications. The aim of this study was to examine the effect of CCVR surgical case volume on perioperative outcomes. We hypothesized that surgical case volume is not associated with differences in perioperative outcomes. The study primary outcome was total perioperative blood donor exposures. Secondary outcomes included the total perioperative transfusion volume, major complications, and intensive care unit and hospital length of stay. METHODS: The multicenter Pediatric Surgery Perioperative Registry was queried for infants and children undergoing CCVR between June 2012 and September 2016. Institutions were categorized into low, middle, or high surgical case volume groups based on tertiles of the average number of cases performed per month. Primary and secondary outcomes were analyzed with respect to these groupings. RESULTS: The query yielded 1814 CCVR cases from 33 institutions. Demographics were similar among the 3 study groups. An inverse relationship between surgical case volume and total perioperative blood donor exposures was observed (P
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Point-of-Care Ultrasound Abnormalities in Late-Onset Severe Preeclampsia: Prevalence and Association With Serum Albumin and Brain Natriuretic Peptide
BACKGROUND: Pilot studies applying point-of-care ultrasound (POCUS) in preeclampsia indicate the presence of pulmonary interstitial edema, cerebral edema, and cardiac dysfunction. Laboratory markers of oncotic pressure (albumin) and cardiac dysfunction (brain natriuretic peptide [BNP]) may be abnormal, but the clinical application remains unclear. We investigated the prevalence of pulmonary interstitial syndrome (PIS), cardiac dysfunction, and increased optic nerve sheath diameter (ONSD) in late-onset preeclampsia with severe features. The primary aim was to examine the association between PIS or ONSD and maternal serum albumin level. The secondary aims were to explore the association between cardiac dysfunction and PIS, ONSD, BNP, and serum albumin level and between POCUS-derived parameters and a suspicious or pathological cardiotocograph. METHODS: Ninety-five women were enrolled in this prospective observational cohort study. A POCUS examination of lungs, heart, and ONSD was performed. PIS was defined as a bilateral B-line pattern on lung ultrasound and diastolic dysfunction according to an algorithm of the American Society of Echocardiography. ONSD >5.8 mm was interpreted as compatible with raised intracranial pressure (>20 mm Hg). Serum BNP and albumin levels were also measured. RESULTS: PIS, diastolic dysfunction, systolic dysfunction, and raised left ventricular end-diastolic pressure (LVEDP) were present in 23 (24%), 31 (33%), 9 (10%), and 20 (25%) women, respectively. ONSD was increased in 27 (28%) women. Concerning the primary outcome, there was no association between albumin level and PIS (P = .4) or ONSD (P = .63). With respect to secondary outcomes, there was no association between albumin level and systolic dysfunction (P = .21) or raised LVEDP (P = .44). PIS was associated with diastolic dysfunction (P = .02) and raised LVEDP (P = .009; negative predictive value, 85%). BNP level was associated with systolic (P
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https://ift.tt/2D3qwoV
Prospective Multicenter Clinical Trial of a Temperature-Controlled Subcutaneous Microneedle Fractional Bipolar Radiofrequency System for the Treatment of Cellulite
BACKGROUND A bipolar fractional radiofrequency (RF) device was developed to generate cutaneous thermal injuries using a temperature-controlled microneedle electrode array. OBJECTIVE Evaluate safety and efficacy of a novel subcutaneous microneedle RF for treatment of posterolateral thigh cellulite. METHODS The study design was an institutional review board-approved multicenter clinical trial after a per-protocol analysis. Fifty subjects with Nurnberger–Muller Grade II or III cellulite were enrolled at 4 treatment centers and received 1 subcutaneous microneedle RF treatment (67°C/4-second duration). Efficacy was evaluated by blinded grading by 3 dermatologists using randomized, standardized photographs and investigator grading at baseline, 1-, 3-, and 6-month follow-up. As per the Food and Drug Administration, treatment success was defined by ≥1-point improvement on dimple number or severity of undulation irregularities scales by at least 2 of 3 blinded physicians. Study subjects' self-assessments and satisfaction questionnaires and procedural pain levels and adverse events were monitored. RESULTS Blinded physician evaluations revealed a procedural success rate of 93% at 6-month follow-up. Procedural pain level was 3.74 ± 1.96 on a 10-point scale. There were no adverse events. Seventy-five percent of subjects were satisfied with the results at 6-month follow-up. CONCLUSION The results indicate that subcutaneous microneedle RF treatment is safe and effective for long-term treatment of Type II and III cellulite in a single session. Address correspondence and reprint requests to: Macrene Alexiades, MD, PhD, 955 Park Avenue, New York, NY 10021, or e-mail: dralexiades@nyderm.org M. Alexiades, G. Munavalli, and D. Goldberg executed the study protocol, conducted the clinical study, and did not receive any compensation from Syneron Inc. Drs. Shlomit Mann and D. Berube are employed by Syneron Inc. Shlomit Mann performed data compilation and statistical analysis. M. Alexiades and D. Berube prepared the manuscript. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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Growth Factors and Cell Homing in Dental Tissue Regeneration
Abstract
Purpose of Review
To summarize current views on the role and therapeutic potential of growth factors (GFs) within endodontic cell homing.
Recent Findings
Cell homing/revitalization techniques aim to regenerate dentin and pulp using endogenous cells. Clinically, revitalization has successfully created new vital tissue in necrotic permanent teeth with an open apex; however, there is no evidence of new odontoblasts, pulp tissue, or predictable extension in root length. Although the response is reparative rather than regenerative, exciting opportunities to improve these biologically-based strategies remain by (1) efficiently sequestering dentin-matrix-components (DMCs) using irrigants and dental materials (2) designing next-generation GF-releasing scaffold materials and (3) utilizing other sources of GF such as cells and plasma-rich plasma and plasma-rich fibrin.
Summary
GFs can promote reparative-dentinogenesis and pulp-like tissue formation. The future development and clinical approval of GF-functionalized-scaffolds is a priority; however, current focus should be to harness DMCs and target the interaction of stem cells and GFs.
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The role of electrocardiogram in sex verification in a young adult with primary amenorrhea: a case report
The use of electrocardiogram for sex verification in adults is an emerging concept in medicine. It is feasible through the utilization of Ogunlade Sex Determination Electrocardiographic Score. The aim of this ...
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Palmoplantar keratoderma Bothnia type with acrokeratoelastoidosis‐like features due to AQP5 mutations
Clinical and Experimental Dermatology, EarlyView.
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Palmoplantar keratoderma Bothnia type with acrokeratoelastoidosis‐like features due to AQP5 mutations
Clinical and Experimental Dermatology, EarlyView.
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Preliminary study on chronic granulomatous disease in Sri Lanka
Chronic granulomatous disease (CGD) is a rare primary immunodeficiency of the phagocytic cells, which results in absent or diminished levels of microbicidal reactive oxygen species. The disease occurs due to g...
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“AIR LEAK SYNDROME”: An Unusual Presentation of Foreign Body in the Airway
Abstract
Spontaneous onset pneumomediastinum, pneumothorax and subcutaneous emphysema are rare presentations of a foreign body in the airway. The possible mechanism for unexplainable and non traumatic subcutaneous emphysema can be attributed to "Air leak syndrome" following inhalation of foreign body in the airway.
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Role of Proton Pump Inhibitors in Laryngopharyngeal Reflux: Clinical Evaluation in a North Indian Population
Abstract
There has been an escalation of patients presenting with symptoms of Laryngopharyngeal reflux disease (LPRD) in the otorhinolaryngology clinics due to life style and dietary changes. This study was undertaken to evaluate the effect of various proton pump inhibitors in the treatment of LPRD using Reflux symptom index (RSI) and Reflux finding score (RFS). This was a prospective study conducted from June 2016 to February 2017 with a total of 240 patients with symptoms and signs of LPR. The patients were divided into 5 groups. Each group was subjected to particular proton pump inhibitor. There were 124 males 116 females with a mean age 34.3 and rural to urban ratio being 11. After 3 months, RFS and RSI score within each group, improved significantly with Proton pump inhibitor therapy. In our study patients who were treated with omeprazole 20 mg twice daily had the highest improvement in laryngeal symptoms and laryngeal findings. We conclude emphasizing the effectiveness of proton pump inhibitors with incorporation of lifestyle modification in the successful management of LPRD.
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The Prevalence and Causes of Auditory Neuropathy/Dys-synchrony (AN/AD) in Children with Hearing Impairment
Abstract
There are a wide variety of hearing impairments that part of it is auditory neuropathy/dys-synchrony (AN/AD). So, the object of this study was determination the prevalence and causes of AN/AD in children with hearing impairment. This study was a descriptive cross-sectional survey. The sample size consisted of 105 hearing impairment children. All them were under hearing screening tests (tympanometry), distortion and transient evoked otoacoustic emissions (DPOAEs + TEOAE) and automated auditory brainstem response (AABR). If they were suspected to AN/AD, for complete diagnostic measurements were referred to our hospital. Four cases (8 ears) with AN/AD were diagnosed, which had an average age 37 months (SD = 8.67). So, the prevalence of AN/AD was 3.8 % among hearing impaired children. The findings of this study showed that there are the relationships between AN/AD and fluctuating hearing loss, acoustic reflex, high bilirubin, blood exchange after birth, neonatal intensive (NICU) care unit (P < 0.05). The simultaneous use of both ABR and OAE tests in the birth screening provide much more useful information than when each of these tests is used alone.
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Tea waste derived activated carbon for the adsorption of sodium diclofenac from wastewater: adsorbent characteristics, adsorption isotherms, kinetics, and thermodynamics
Abstract
The present experimental study reports the performance of tea waste (TW) derived adsorbent for the adsorption of sodium diclofenac (SD) from aqueous solution (SD concentration = 10–50 mg/L). The waste-derived activated carbon was prepared by chemical activation process of raw waste using H2SO4, KOH, ZnCl2, and K2CO3 as activating agents (TW: activating agent = 1:1 by weight). Subsequently, the oven-dried material was carbonized at 600-°C temperature for 2 h. The synthesized adsorbents were porous and their Brunauer-Emmett-Teller (BET) surface area was ranged 115–865 m2/g. Among all synthesized adsorbents, the adsorbent activated by ZnCl2 exhibited the highest adsorption capacity (= 62 mg/g), though it was much lower compared to 91 mg/g obtained with commercial activated carbon (CAC) (SD concentration = 30 mg/L, adsorbent dose = 300 mg/L and initial wastewater pH = 6.47). SD equilibrium data could be described by Langmuir isotherm adequately, while pseudo-second-order rate model showed better fit to the time based adsorption data. Low activation energy of the adsorption process suggests the reaction to be temperature independent. Thermodynamic parameters showed the spontaneous and endothermic nature of adsorption process conducted in the presence of waste derived adsorbent.
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Insights into adsorption behaviour of binary liquid mixtures in porous media using fast field cycling NMR
Publication date: Available online 16 September 2018
Source: Magnetic Resonance Imaging
Author(s): J. Ward-Williams, L.F. Gladden
Abstract
Fast field cycling, FFC, NMR relaxometry experiments are reported in the frequency range of 10 kHz–40 MHz to characterise the adsorption behaviour of cyclohexane:THF (non-polar:polar) and THF:methanol (polar:polar) binary liquid mixtures adsorbed on a γ-alumina surface of catalytic interest. Laplace inversion of the relaxation rate data is employed to identify the chemical species in the binary mixture. In both systems studied, the more polar molecule preferentially interacts with the surface compared to the co-imbibed species. The relaxation rate data were analysed to explore the relative influences of surface dynamics and surface accessibility on the observed relaxation rates. For both binary systems, the change in relaxation behaviour with composition is interpreted as a change in the surface accessibility of each species caused by a micro-phase separation at the pore surface.
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Fast spatially-resolved T2 measurements with constant-gradient CPMG
Publication date: Available online 15 September 2018
Source: Magnetic Resonance Imaging
Author(s): Stefan A. Hertel, Daan W. de Kort, Isabelle Bush, Andrew J. Sederman, Lynn F. Gladden, Benjamin Anger, Hilko de Jong, Matthias Appel
Abstract
Speed of acquisition is paramount for the application of magnetic resonance to flow experiments through porous rocks. One popular method for imaging core floods is the spatially resolved T2 experiment which can separate fluids either by their viscosity contrast or by doping one fluid with a relaxation agent. Existing techniques for spatial-T2 may suffer from long acquisition times and eddy currents due to the pulsing of magnetic field gradients. Here, we propose a constant gradient method for 1d spatially-resolved T2 which embraces the speed of frequency encoding techniques and avoids eddy currents by the absence of any gradient ramps during the radio frequency (r.f.) pulse train. We provide the operating envelope for this kind of experiment, which is restricted due to the slice selectivity of the r.f. pulses in the presence of the magnetic field gradient. Additionally, we show that the effects of self-diffusion and the mixing of T1 and T2 contributions are manageable. As an illustration, we have applied this technique to an enhanced oil recovery experiment. The two fluid phases were tracked without any doping and with a time resolution of 40 s. In this case, the increased time resolution allowed us to observe dynamic flow phenomena such as fluid fingering and the calculation of the velocity of the fluid displacement fronts.
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The First Report of Multicentric Carpotarsal Osteolysis Syndrome Caused by MAFB Mutation in Asian
Multicentric carpotarsal osteolysis syndrome (MCTO) is a rare skeletal disorder characterized by aggressive osteolysis associated with progressive nephropathy. The early clinical presentation can mimic polyarticular juvenile idiopathic arthritis. Since 2012, MAFB mutations have been discovered in all MCTO patients. Therefore, the early diagnosis can be made based on genetic confirmation. We report the clinical manifestation of mineral bone disease and the molecular genetic study of a Thai female adolescent with MCTO. She presented with end-stage renal disease, bilateral wrist and ankle joint deformities, and subtle facial dysmorphic features. We identified a heterozygous missense MAFB mutation at nucleotide 197 from C to G (NM_005461.4; c.197C>G), predicting the change of amino acid at codon 66 from serine to cysteine (p.Ser66Cys), and the mutation was absent in the parents, indicating a de novo mutation. This report confirms the previous link between MAFB mutation and MCTO. Her unexplained hypercalcemia after a regular dose of calcium and active vitamin D supported an important role of MafB in the negative regulation of RANKL-mediated osteoclast differentiation. Therefore, we would encourage the physicians who take care of MCTO patients to closely monitor serum calcium level and perform a genetic study as a part of the management and investigation.
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Otological surgery in paediatric photosensitive patients
Publication date: Available online 15 September 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): James Bates, Andy Hall, Thushitha Kunanandam, Richard Hewitt
Abstract
There are a wide range of genetic and auto-immune conditions where UV light exposure poses a threat of UV irradiation to the external auditory canal, tympanic membrane and surrounding skin. Preoperative Ultraviolet Light (UV) measurements were taken in the operating theatre with standard operating microscope and an approved UV light meter prior to surgery on a patient with xeroderma pigmentosa. UV light meter readings of UV index 75 were taken at an operating distance of 290mm. Proceeding with otological surgery with a high UV index would result in a significant UV radiation burn. Utilising a Dermagard and a specific UV filter applied to the microscope resulted in acceptable UV light readings. We highlight the potential morbidity of otological surgery in paediatric photosensitive conditions. We also recommend a management plan to avoid damage by UV radiation in photosensitive patients.
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Comparison of extrusion and patency of silicon versus thermoplastic elastomer tympanostomy tubes
Publication date: Available online 15 September 2018
Source: Auris Nasus Larynx
Author(s): Dongwon Kim, Sung-Won Choi, Hyun-Min Lee, Soo-Keun Kong, Il-Woo Lee, Se-Joon Oh
Abstract
Objectives
This study aimed to assess the differences in the extrusion rate, patency and incidence of otorrhea according to the material properties of tubes in tympanostomy tube (TT) procedures.
Subjects and methods
A total of 75 children with bilateral chronic otitis media with effusion were randomized in this prospective trial to receive 1.02-mm-sized TTs (thermoplastic elastomer) in one ear and 1.14-mm-sized TTs (silicone) in the other ear. Data were obtained on ventilation tube type, time to extrusion, comorbidities, tube plugging, incidence of TT otorrhea during following up, and age of the patient. Postoperatively, follow-up by an otologist continued every two months to assess the incidence of otorrhea, plugging, and TT extrusion until all tubes were extruded.
Results
Out of the 75 children, 7 patients were excluded during surgery and 4 were lost during follow-up. The mean extrusion time of 1.02-mm-sized TTs (thermoplastic elastomer) was 10.28 months, whereas that of 1.14-mm-sized TTs (silicone) was 7.36 months, which showed a significant difference. However, thermoplastic elastomer TTs had more plugging events than silicone TTs.
Conclusions
There was a significant increase in the time to extrusion in ears with the 1.02-mm-sized thermoplastic elastomer TT, although, generally, the larger inner diameter of the tube last longer in the eardrum. This contrasting result is thought to be due to the different material properties of both TTs. This information may be helpful for TT selection in clinical practice depending on the patient's condition.
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When a Seemingly Harmless Prescription Turns into Toxicity
Valacyclovir neurotoxicity is commonly seen in the elderly and those with impaired renal function. Differential diagnosis can be challenging as a myriad of medical conditions, including herpes zoster virus associated encephalitis, may present in a similar fashion. We present a case of a 71-year-old male who presented with altered mental status in the setting of recent herpes zoster eruption. His condition was attributed to valacyclovir neurotoxicity, and initiation of appropriate supportive therapy was met with complete resolution of symptoms and normalization of cognitive function.
https://ift.tt/2CZym2M
Nodal Staging of High Risk Cutaneous Squamous Cell Carcinoma
Publication date: Available online 15 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Matthew Fox, Marc Brown, Nicholas Golda, Dori Goldberg, Christopher Miller, Melissa Pugliano-Mauro, Chrysalyne Schmults, Thuzar Shin, Thomas Stasko, Yaohui G. Xu, Kishwer Nehal
Abstract
Background
While progress has been made in defining the clinical and histopathologic features of high-risk cutaneous squamous cell carcinoma (HRcSCC), optimal staging guidelines remain elusive.
Objective
We seek to guide clinical practice regarding nodal staging options for patients with HRcSCC via review of evolving definitions of HRcSCC, nodal staging options and how nodal staging may impact treatment and affect outcomes.
Methods
Retrospective review of published peer-reviewed literature regarding risk stratification, nodal staging and treatment and outcomes for patients with HRcSCC via PubMed search.
Results
For patients without clinical lymphadenopathy, based on literature from head and neck SCC, pre-operative nodal staging with US may be more useful than CT or MRI. Since early nodal disease is usually curable, sentinel lymph node biopsy (SLNB) may be considered in those with negative imaging while we await studies of nodal staging outcomes.
Limitations
More data is needed to validate the relationships between primary tumor stage and SLNB status and to determine if early detection of nodal disease impacts survival for patients with HRcSCC.
Conclusion
It is reasonable to consider nodal staging for patients with HRcSCC (BWH stage T2b and T3) in the absence of clinically palpable lymphadenopathy via radiographic imaging and, if negative, SLNB.
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Assessment of Clinician Accuracy for Diagnosing Melanoma Based on Electrical Impedance Spectroscopy Score Plus Morphology Versus Lesion Morphology Alone
Publication date: Available online 15 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Ryan M. Svoboda, Giselle Prado, Rachel S. Mirsky, Darrell S. Rigel
https://ift.tt/2payN0D
Long-term outcomes of laser treatment for congenital melanocytic nevus
Publication date: Available online 15 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Yeongjoo Oh, Si-Hyung Lee, Jung Min Lim, Kee Yang Chung, Mi Ryung Roh
Abstract
Background
Although various laser treatments have been tried for CMNs, only small retrospective studies with short-term follow-up had been done to assess outcomes.
Objective
We analyzed the long-term outcomes of laser treatment for CMN and compared the outcomes with the combination treatment of partial excisions and lasers.
Methods
Patients with CMN treated with lasers were retrospectively reviewed and patients with more than 3-year follow-up were grouped as the long-term follow-up group.
Results
A total of 67 cases of CMN were reviewed. Among 20 patients (20/52, 38.5%) with nearly total clearance during laser-only treatment, 11 patients were in long-term follow-up group and 5 of them showed repigmentation. 15 patients showed repigmentation regardless of clearance, and the mean period until repigmentation was 3.93 years from the initial treatment. Patients with combination treatment of partial excision and lasers showed higher Investigator's Global Assessment (IGA) scores, less number of laser treatments and shorter treatment period compared to patients with laser-only treatment.
Limitations
This is a retrospective study and various laser devices were used.
Conclusion
More than 4 years of follow-up is required to evaluate the efficacy of lasers in CMN and combination treatment of partial excision and lasers can be an effective treatment option.
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Long-term safety results from a Phase 3 open-label study of a fixed combination halobetasol propionate 0.01% and tazarotene 0.045% (HP/TAZ) lotion in moderate-to-severe plaque psoriasis
Publication date: Available online 15 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Mark G. Lebwohl, Jeffrey L. Sugarman, Linda Stein Gold, David M. Pariser, Tina Lin, Radhakrishnan Pillai, Gina Martin, Susan Harris, Robert Israel
https://ift.tt/2pexr4N
Analysis of Dermatologic Procedures Billed Independently by Non-Physician Practitioners in the United States
Publication date: Available online 15 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Qiaochu Qi, Brian P. Hibler, Brett Coldiron, Anthony M. Rossi
Abstract
Background
Non-physician practitioners (NPPS), including nurse practitioners (NPs) and physician assistants (PAs) are expanding their scope of practice outside of primary care and performing more procedures in dermatology.
Objective
To understand the scope and geographic pattern of practice by NPs and PAs in dermatology in the US.
Methods
Cross-sectional retrospective cohort analysis of dermatology practices in the 2014 Medicare Physician/Supplier Procedure Summary Master File, which reflects Part B carrier and durable medical equipment fee-for-service claims in the US.
Results
Over 4 million procedures were billed independently by NPs and PAs, which accounts for 11.51% of all. Injection, simple repair, and biopsy were the most commonly billed by non-physician practitioners, but complex procedures were also increasingly billed independently by NPs and PAs. Proportions of their claims are higher in the East Coast, Midwest, and Mountain states.
Limitations
Data is at the state level, limited to Medicare beneficiaries, and doesn't include billing incident-to physicians.
Conclusions
This study demonstrated the increasing scope of practice of NPs and PAs in dermatology, despite limited training and lack of uniform regulations. To ensure quality and safety of care, it is prudent to set benchmarks for proper supervision and utilization of procedures in dermatology.
https://ift.tt/2MAYS2b
Rouleaux: a microscopic clue that helps distinguish psoriasis from dermatitis
Publication date: Available online 15 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Ying Luo, Brett Keeling, Jessica A. Forcucci, Dirk M. Elston
https://ift.tt/2pc8irL
Safe and efficacious treatment of purpura with Nd:YAG laser in Skin Types IV-VI
Publication date: Available online 15 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Dana S. Saade, Neelam A. Vashi
https://ift.tt/2MAYGzZ
Quantitative analysis of biofilm bacteria according to different stages of early childhood caries
Publication date: Available online 15 September 2018
Source: Archives of Oral Biology
Author(s): Beatriz Gonçalves Neves, Rafael Nóbrega Stipp, Daniela da Silva Bezerra, Sarah Florindo de Figueiredo Guedes, Lidiany Karla Azevedo Rodrigues, B.G. Neves, R.N. Stipp, D.S. Bezerra, S.F.F. Guedes, L.K.A. Rodrigues
ABSTRACT
Objective
Monitoring selected key species related to health or diseases may facilitate caries risk assessment and discovery of novel ecological preventive and therapeutic approaches. This study aimed at quantifyingActinomyces naeslundii, Bifidobacterium spp., Lactobacillus acidophilus, Lactobacillus casei group, Streptococcus gordonii, Mitis group and Streptococcus mutans by quantitative polymerase chain reaction (qPCR) in dental biofilm from Brazilian children with different stages of early childhood caries (ECC).
Design
Seventy-five preschool children were clinically evaluated by ICDAS criteria and divided into groups: caries-free (CF; n = 20), enamel caries lesions (ECL; n = 17) and dentine caries lesions (DCL; n = 38). Plaque sample from all children was collected for detection and quantification of the selected bacteria.
Results
L. acidophilus and L. casei group were absent in almost all plaque samples. No differences in relative proportions of A. naeslundii, Mitis group and S. gordonii were observed in any stage of caries. However, S. mutans and Bifidobacterium spp. were present at higher concentrations in the biofilm of children with DCL (p < 0.001). Multivariate analysis showed that S. mutans and Bifidobacterium spp. were strongly associated with biofilm in children with DCL.
Conclusion
Differences were observed in the proportion of acidogenic and aciduric bacteria with dental caries progression. The data indicate thatS. mutans and Bifidobacterium spp. in dental biofilm may be involved in some progression processes for ECC.
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Toll-like receptor signaling induces the expression of lympho-epithelial Kazal-type inhibitor in epidermal keratinocytes
Publication date: Available online 15 September 2018
Source: Journal of Dermatological Science
Author(s): Saeko Sugimoto, Shin Morizane, Hayato Nomura, Mina Kobashi, Satoru Sugihara, Keiji Iwatsuki
Abstract
Background
Lympho-epithelial Kazal-type inhibitor (LEKTI) tightly controls the activities of serine proteases such as kallikrein-related peptidase (KLK) 5 and KLK7 in the epidermis. LEKTI is known to be an essential molecule for the epidermal skin barrier, as demonstrated by SPINK5 nonsense mutation, which results in Netherton syndrome. Toll-like receptors (TLRs) recognize pathogen-associated molecular patterns or damage-associated molecular patterns and produce inflammatory cytokines, chemokines, and antimicrobial peptides. However, the effect of TLR signaling on the expression of LEKTI is not clear.
Objective
To investigate whether TLR signaling can affect expression of LEKTI in epidermal keratinocytes.
Methods
We stimulated a panel of TLR ligands and investigated the expression of LEKTI in normal human epidermal keratinocytes (NHEKs). We further measured trypsin or chymotrypsin-like serine protease activity in NHEK cultured media under stimulation with TLR3 ligand, poly (I:C). Immunostaining for LEKTI was performed using skin samples from skin infectious diseases.
Results
TLR1/2, 3, 5, and 2/6 ligands induced the expression of LEKTI in NHEKs. The trypsin or chymotrypsin-like serine protease activity in NHEKs was up-regulated with the stimulation of poly (I:C). The gene expressions of KLK6, KLK10, KLK11, and KLK13 were also increased by poly (I:C). An immunohistochemical analysis demonstrated that the expression of LEKTI was up-regulated in the lesions of varicella, pyoderma, and rosacea.
Conclusions
TLR signaling induces the expression of LEKTI in epidermal keratinocytes, which might contribute to the control of aberrant serine protease activities in inflammatory skin diseases.
https://ift.tt/2NO7vuR
Utilization of Transoral Robotic Surgery (TORS) in patients with Oropharyngeal Squamous Cell Carcinoma and its impact on survival and use of chemotherapy
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Sujith Baliga, Rafi Kabarriti, Julie Jiang, Vikas Mehta, Chandan Guha, Shalom Kalnicki, Richard V. Smith, Madhur K. Garg
Abstract
Objective
To determine whether patients with Oropharyngeal Squamous Cell Carcinoma (OPSCC) treated with Transoral Robotic Surgery (TORS) have similar survival to patients treated with definitive RT.
Materials and methods
Using the National Cancer Database (NCDB) registry, we identified patients with newly diagnosed clinical T1-T2, N0-N2b OPSCC between 2010 and 2014. A multivariable logistic regression was utilized to determine the association between chemotherapy use and primary treatment modality (TORS vs definitive RT). Kaplan Meier survival analysis was used to estimate overall survival. Propensity score matching was utilized to address selection bias.
Results
We identified 17,150 patients, of which 14,470 (84.4%) received primary RT and 2,680 (15.6%) underwent TORS. The median follow-up for the cohort was 31.4 months. Propensity score matching demonstrated similar 5-year OS for patients treated with either definitive RT or TORS (81% vs 84%, log rank p = 0.10). There was no difference in survival outcomes by treatment selection (TORS or definitive RT) in either HPV positive or HPV negative subtypes. Patients treated with TORS were less likely to receive chemotherapy compared to patients treated with definitive RT and this was also demonstrated in a propensity matched analysis (OR: 0.09, 95%CI 0.078–0.12, p < 0.001). Only 68.4% of TORS treated patients underwent adjuvant RT, compared to 100% of patients in the primary RT cohort (p < 0.001).
Conclusions and relevance
For patients with OPSCC, TORS results in similar OS outcomes and is associated with decreased chemotherapy and RT use compared to definitive RT. Our results demonstrate the feasibility of TORS in a select subgroup of OPSCC patients.
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HPV status predicts for improved survival following chemotherapy in metastatic squamous cell carcinoma of the oropharynx
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Luke R.G. Pike, William L. Hwang, Trevor J. Royce, Nina N. Sanford, Brandon A. Mahal
Abstract
Objective
We sought to further define prognostic and predictive value of human papillomavirus (HPV) status in metastatic squamous cell carcinoma of the oropharynx (OPC).
Materials and methods
A Surveillance, Epidemiology, and End Results custom database identified 5940 adult patients, >18-years-old, with primary SCCHN and known HPV status, diagnosed from 2013 to 2014. Wilcoxon rank-sum and Mantel-Haenszel χ2 tests compared distributions of continuous and categorical covariates. Fine-Gray competing risks regressions estimated hazard ratios by HPV status, and predictive analyses were performed including the interaction term HPV status × Receipt of Chemotherapy.
Results
182 of 5940 patients (4.0%) had metastatic OPC at diagnosis (106/3925 [2.7%] HPV+ and 76/1894 [4.0%] HPV−). HPV+ disease was prognostic for improved 20-month cancer-specific mortality (CSM) (47.1% vs 72.5%, HR 0.43, 95% CI 0.26–0.74, p = 0.002) on univariable analysis. HPV status was predictive of response to chemotherapy—adjusted HRs for receipt of chemotherapy were 0.11 (95% CI 0.03–0.37) and 0.34 (95% CI 0.18–0.64) for HPV+ versus HPV− disease, respectively (PHPV status∗Chemotherapy = 0.036).
Conclusion
HPV status has known prognostic value in locally advanced OPC, but data on metastatic OPC are sparse. In this work, we demonstrate that HPV status is strongly prognostic for CSM in metastatic OPC and show for the first time that HPV status predicts for response to chemotherapy.
https://ift.tt/2NP49HY
Internal Auditory Canal Duplicity
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): María Fernanda Vargas Gamarra, Carlos de Paula Vernetta, Miguel Mazón
https://ift.tt/2MDtqjG
Mammary Analogue Secretory Carcinoma of Salivary Glands: Report of Clinical Case
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Carlota Rovira, Xavier León, Celina P. Vásquez, Montserrat López
https://ift.tt/2xetrWF
Myopericytoma of the tongue base: A case report
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Stefano Rubino, Rita De Berardinis, Daniele Colombo, Alessandro De Padova
https://ift.tt/2MDtlwo
Paediatric Bilateral Vocal Cord Paralysis: Our Experience
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): María Laura Scatolini, Hugo A. Rodriguez, Cinthia G. Pérez, Alejandro Cocciaglia, Hugo A. Botto, Mary Nieto, Lucas Bordino
Abstract
Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The aim of this study was to describe the demographic features, aetiology, comorbidities, and management of our patients with BVCP.
Material and methods
We conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP seen at the Department of Respiratory Endoscopy between 2011 and 2015.
Results
47 patients were included. Mean age at diagnosis was 1 month and male sex predominated (63%). The aetiology was congenital in 59% and acquired in 41% of the infants. The cause was most frequently idiopathic in the former group and secondary to postoperative injury in the latter. Overall, 42 patients (89%) required tracheostomy, without statistically significant differences between the causes. Of all the patients, 39% regained vocal-cord mobility; 44% of those with congenital BVCP, 31% of those with acquired BVCP and 62.5% with idiopathic BVCP. In five patients a laryngotracheoplasty was performed with a posterior costal cartilage graft and one underwent posterior cordectomy. All were decannulated. In one patient vocal-cord lateralisation was performed, avoiding tracheostomy.
Conclusion
BVCP was most commonly of congenital cause and was mainly idiopathic within this group of patients, with a slight male preponderance. A high percentage of patients required tracheostomy. A higher recovery rate of vocal-cord mobility was observed in idiopathic BVCP, which allowed for successful decannulation. In this series, decannulation was possible in all patients that underwent surgery; however, further studies with comparison of techniques and objective assessment of swallowing and phonation are necessary.
Resumen
La parálisis bilateral de cuerdas vocales (PBCV) es la segunda causa más frecuente de estridor neonatal. Nuestro objetivo es describir la demografía, etiología, comorbilidades y tratamientos instaurados.
Materiales y métodos
Revisión retrospectiva de las historias clínicas de pacientes con diagnóstico de PBCV de 2011 a 2015.
Resultados
Se incluyeron 47 pacientes. La edad media de diagnóstico fue un mes de vida, con predominio de sexo masculino (63%). El 59% fue por causa congénita y el 41% adquirida, por lo general idiopática y postoperatoria, respectivamente. Se realizó traqueostomía (TQT) en 42 pacientes (89%), sin diferencias significativas en relación con la causa. La recuperación de la movilidad cordal fue del 39% en toda la muestra, 44% en la congénita, 31% en la adquirida y 62,5% en la idiopática. A 5 pacientes se les realizó laringotraqueoplastia con injerto costal posterior y a un paciente cordectomía posterior. Todos fueron decanulados. A un paciente se le realizó lateralización cordal, evitando la TQT.
Conclusión
Las causas congénitas fueron las más frecuentes, en su mayoría idiopáticas. Se registró una leve predilección por el sexo masculino. Un alto porcentaje de pacientes requirieron de TQT. La tasa de recuperación de la movilidad es mayor en causas idiopáticas. Se decanularon todos los pacientes operados, pero se requieren trabajos con mayor número de participantes, comparación de técnicas y evaluación de la deglución y la fonación de forma objetiva.
https://ift.tt/2xgHXxb
Otoacoustic Emissions in Children Treated With Gentamicin in a Secondary Hospital
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Jose Miguel Sequi Canet, Carlos Miguel Angelats Romero, Jose Miguel Sequi Sabater, Ana Miralles Torres, Miguel Boronat Garcia, Marta Gomez Delgado
Abstract
Introduction
The National Commission for the Early Detection of Hearing Loss (CODEPEH) recommends the re-evaluation of hearing in children who have suffered any potentially harmful event, such as the prescription of ototoxic antibiotics such as gentamicin. The evoked otoacoustic emissions (EOAE) are a good method for assessing the integrity of cochlear functionality.
Material and method
A prospective study is presented, including 92 children who were treated with intravenous gentamicin for septic risk/sepsis or urinary tract infection. The children underwent serial EOAE: on admission, at the end of treatment and one month later (if altered on discharge).
Results
In the end, none of the subjects were affected by the treatment.
Conclusion
Gentamicin appears to be a safe antibiotic in treatments lasting <10 days and at the doses described. EOAE are an inexpensive, fast, non-invasive and reliable method to check for gentamicin ototoxicity. This could save in the determination of drug levels.
Resumen
Introducción
Las recomendaciones de la Comisión Nacional para la Detección Precoz de la Hipoacusia (CODEPEH) aconsejan re-valorar la audición de aquellos niños que hayan sufrido algún evento potencialmente dañino para la audición como es la utilización de antibióticos ototóxicos como la gentamicina. Las otoemisiones evocadas son un buen método de evaluación de la integridad de la función coclear.
Material y método
Se presenta un estudio prospectivo que incluye a 92 niños, sin otros factores de riesgo auditivo, en los que se pautó tratamiento con gentamicina intravenosa por riesgo séptico/sepsis o infección urinaria y en los que se realizaron otoemisiones seriadas: al ingreso, al finalizar el tratamiento y al mes del alta (si estaban alteradas).
Resultados
Ningún sujeto presentó otoemisiones alteradas al final del seguimiento.
Conclusión
La gentamicina parece un antibiótico seguro en tratamientos con una duración <10 días y a las dosis descritas. Las otoemisiones son un método barato, rápido, incruento y fiable para comprobar la posible ototoxicidad por gentamicina. Su realización podría ahorrar la determinación de niveles del fármaco.
https://ift.tt/2ME0bxc
Emotional Reaction Evaluation Provoked by the Vestibular Caloric Test Through Physiological Variables Monitoring
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Rafael Barona-de-Guzmán, Claudio Krstulovic-Roa, Elena Donderis-Malea, Luz Barona-Lleó
Abstract
Introduction and objectives
The emotional evaluation of the causes of vertigo is made using the clinical records and several subjective questionnaires. The aim of the present study is to evaluate the emotional response objectively, in normal subjects, during an induced vertigo crisis.
Material and method
A caloric vestibular test with cold water was performed on 30 healthy subjects. The following physiological parameters were monitored during the 60 s prior to and the 60 s after the stimulation: Skin Conductivity, Peripheral Pulse Volume, Body Temperature, Muscle Contraction, Heart Rate, and Respiratory Rate. The maximum angular speed of the nystagmus slow phase at each stimulation was assessed.
Results
Skin conductance presented a statistically significant increase during the vertigo crisis in relation to the prior period while the peripheral pulse volume presented a statistically significant decrease. There was no relationship between the slow phase of the provoked nystagmus angular speed and skin conductance and peripheral pulse volume changes. The decrease in peripheral pulse volume was significantly higher in the second vertigo crisis.
Conclusions
Skin conductance and peripheral pulse volume changed significantly during a vertigo crisis. There was no relation between the provoked vertiginous crisis intensity and the changes produced in those variables. The stress generated by the caloric stimulation is higher in the second crisis, when the subject has experience of the vertigo caused by the stimulation.
Resumen
Introducción y objetivos
La valoración emocional que provoca el vértigo se realiza mediante la historia clínica y diversos cuestionarios subjetivos. El objetivo del presente trabajo es valorar la respuesta emocional de forma objetiva, en sujetos normales, durante la crisis de vértigo inducida.
Material y método
Se realizó la prueba vestibular calórica con agua fría en 30 sujetos sanos. Durante los 60 s previos a la estimulación y los 60 s posteriores a la misma se monitorizaron las siguientes variables fisiológicas: Conductabilidad cutánea, Volumen de pulso periférico, Temperatura corporal, Contracción muscular, Frecuencia cardiaca y Frecuencia respiratoria. Se valoró la velocidad angular máxima de la fase lenta del nistagmo provocado en cada estimulación.
Resultados
Durante las crisis de vértigo, la conductabilidad cutánea presentó un aumento estadísticamente significativo con relación al periodo previo a las mismas, mientras que el volumen de pulso periférico presentó una disminución estadísticamente significativa. No hubo relación entre la velocidad angular de la fase lenta del nistagmo provocado y los cambios de la conductabilidad y el volumen de pulso periférico. La disminución provocada en el volumen de pulso periférico fue significativamente mayor en la segunda crisis de vértigo.
Conclusiones
La conductabilidad cutánea y el volumen de pulso periférico cambiaron de forma significativa durante las crisis de vértigo. No Hubo relación entre la intensidad de la crisis vertiginosa provocada y los cambios producidos en estas variables. El estrés generado por la estimulación calórica es mayor en la segunda crisis, cuando el sujeto tiene experiencia del vértigo que provoca la estimulación.
https://ift.tt/2xbDtYs
Analysis of Scientific Production in Otolaryngology in Spain in the Period 2011–2015
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Jose A. Lopez-Escamez, Raquel Manrique-Huarte, Eduardo Martin-Sanz, Gabriel Trinidad, COMISIÓN DE INVESTIGACIÓN de la SEORL-CCC
Abstract
Introduction
Publishing in scientific journals is an indicator of hospital quality and has become a standard of excellence for medical doctors and institutions. The aim of the study is to identify the scientific publications performed by Otolaryngology Departments in Spain within the period 2011–2015 and to compare them to a previous period between 1998–2002.
Material and methods
Original papers published by Otolaryngology Departments in Spain in PubMed within 2011–2015 were retrieved. They were classified according to the type of journal published (international or Acta ORL Española) and the following subspecialty areas: Otology, Audiology and Neuro-Otology, Head and Neck Surgery (including Oncology), Rhinology and Paediatric ENT. Hospitals were ranked according to: number of original papers, accumulated impact factor and total number of publications.
Results
Between 2011 and 2015, 49 342 publications were included in PubMed, 1.44% from Otolaryngology Departments in Spain. Between 1998 and 2002, 3.80% publications were from Spanish ENT departments. Of the 712 papers published within the period 2011–2015, 389 were published in Acta ORL Española and 323 in international journals. From the latter, 20.7% belong to the Otology area, 19.2% to Audiology-Neuro-otology, 30.6% to Head and Neck Surgery, 15.2% to Rhinology and 3.4% to Paediatric ENT. Five tertiary centres published at least 10 original papers in the same period.
Conclusions
Spanish otolaryngology's contribution to international journals has decreased in the last 12 years. A few institutions are responsible for the majority of publications and they have notably increased the cumulative impact factor.
Resumen
Introducción
La publicación de artículos científicos es un indicador de calidad del hospital y se ha convertido en un criterio de excelencia entre los indicadores clínicos que acreditan a un profesional o a una institución. Se evaluaron las publicaciones científicas realizadas en los servicios de otorrinolaringología españoles durante el período 2011-2015 comparándolas con el periodo 1998-2002.
Material y métodos
Se extrajeron los artículos de Pubmed publicados por los servicios de ORL de España en el periodo 2011-2015, clasificándose según el tipo de revista (Acta Otorrinolaringológica Española o internacional) y el área de conocimiento: otología, audiología y otoneurología, cirugía de cabeza y cuello incluyendo oncología, rinología y ORL pediátrica. Se estableció un ranking de hospitales considerando el número total de originales, el factor de impacto acumulado y el número total de publicaciones.
Resultados
En el periodo 2011-2015 se han identificado 49.342 publicaciones, de las cuales el 1,44% proceden de España, mientras que entre 1998-2002 el 3,80% proceden de España. De los 712 artículos hay 389 publicados en Acta Otorrinolaringológica Española y 323 internacionales. De estas últimas el 20,7% pertenecen a la sección de otología, el 19,2% a audiología-otoneurología, el 30,6% a cirugía de cabeza y cuello, el 15,2% a rinología y el 3,4% ORL pediátrica. Cinco centros hospitalarios publicaron al menos 10 artículos originales en el período estudiado.
Conclusiones
La producción científica de la ORL española a nivel internacional ha descendido en los últimos 12 años. Se observa un fenómeno de concentración en determinados centros, asociado a un incremento considerable del factor de impacto acumulado.
https://ift.tt/2MzQS1v
Auditory steady-state response in cochlear implant patients
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Alejandro Torres-Fortuny, Isabel Arnaiz-Marquez, Heivet Hernández-Pérez, Eduardo Eimil-Suárez
Abstract
Introduction and objective
Auditory steady state responses to continuous amplitude modulated tones at rates between 70 and 110 Hz, have been proposed as a feasible alternative to objective frequency specific audiometry in cochlear implant subjects. The aim of the present study is to obtain physiological thresholds by means of auditory steady-state response in cochlear implant patients (Clarion HiRes 90K), with acoustic stimulation, on free field conditions and to verify its biological origin.
Methods
11 subjects comprised the sample. Four amplitude modulated tones of 500, 1000, 2000 and 4000 Hz were used as stimuli, using the multiple frequency technique. The recording of auditory steady-state response was also recorded at 0 dB HL of intensity, non-specific stimulus and using a masking technique.
Results
The study enabled the electrophysiological thresholds to be obtained for each subject of the explored sample. There were no auditory steady-state responses at either 0 dB or non-specific stimulus recordings. It was possible to obtain the masking thresholds. A difference was identified between behavioral and electrophysiological thresholds of −6 ± 16, −2 ± 13, 0 ± 22 and −8 ± 18 dB at frequencies of 500, 1000, 2000 and 4000 Hz respectively.
Conclusions
The auditory steady state response seems to be a suitable technique to evaluate the hearing threshold in cochlear implant subjects.
Resumen
Introducción y objetivos
Los potenciales evocados auditivos de estado estable (PEAEE) por estimulación con tonos modulados en amplitud entre 70 y 110 Hz han sido propuestos como una alternativa factible para realizar una audiometría objetiva en pacientes con implante coclear. El objetivo del presente estudio es verificar el origen biológico de los umbrales auditivos obtenidos mediante PEAEE por estimulación acústica y en condiciones de campo libre, en pacientes con implante coclear (Clarion HiRes 90K).
Métodos
La muestra constó de 11 pacientes. Cuatro tonos modulados en amplitud con frecuencias portadoras de 500, 1.000, 2.000 y 4.000 Hz y presentados simultáneamente fueron empleados como estímulo. Se registraron series de intensidad hasta alcanzar el umbral auditivo, así como registros a 0 dB HL, con estímulos no específicos y empleando técnicas de enmascaramiento.
Resultados
El estudio permitió obtener los umbrales electrofisiológicos par cada paciente de la muestra explorada. No hubo respuesta de estado estable ni a 0 dB ni al emplear estímulos no específicos. Fue posible obtener los umbrales de enmascaramiento. Se identificó una diferencia entre los umbrales conductuales y electrofisiológicos de −6 ± 16 dB, −2 ± 13 dB, 0 ± 22 dB y −8 ± 18 dB a las frecuencias de 500, 1.000, 2.000 y 4.000 Hz, respectivamente.
Conclusiones
Los PEAEE pueden constituir una técnica apropiada para evaluar el umbral auditivo en sujetos con implante coclear.
https://ift.tt/2xmpjUH
Azathioprine Reduces the Risk of Audiometric Relapse in Immune-mediated Hearing Loss
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Nieves Mata-Castro, Javier Gavilanes-Plasencia, Rafael Ramírez-Camacho, Alfredo García-Fernández, José Ramón García-Berrocal
Abstract
Introduction
Current schemes for treatment of immune-mediated hearing loss with sporadic short-course, low-dose corticosteroids, are insufficient.
Methods
To determine the role of azathioprine in the control of auditory impairment, a longitudinal, observational, descriptive study was performed with 20 patients treated with azathioprine (1.5–2.5 mg/kg/day into two doses) for 1 year. The loss of 10 dB on two consecutive frequencies or 15 dB on an isolated frequency was considered as relapse.
Results
The mean age of the patients was 52.50 years (95% CI: 46.91–58.17), half were women. Bilateral affectation was 65%. 75% had organ specific disease and 25% had systemic autoimmune disease. The difference between baseline PTA (46.49 dB; DS 18.90) and PTA at 12 months (45.47 dB; DS 18.88) did not reach statistical significance (P=.799). There was a moderate positive correlation between female sex and the presence of systemic disease (R=.577). By applying Student's t for paired data, a significant difference (P=.042) was obtained between the PTA in frequencies up to 1000 Hz (PTA 125–1000 Hz). The relative incidence rate of relapse per year was .52 relapses/year (95% CI: .19–1.14]). The median time to audiometric relapse-free was 9.70 months (DS 1.03).
Conclusions
Azathioprine maintains the hearing threshold, decreases the risk of relapse, and slows down the rate at which patients relapse, altering the course of immune-mediated inner ear disease.
Resumen
Introducción
Los esquemas actuales de tratamiento de la hipoacusia inmunomediada con corticoides, a dosis baja y pauta corta, son insuficientes.
Métodos
Para determinar el papel de la azatioprina en el control del deterioro auditivo se ha llevado a cabo un estudio observacional descriptivo longitudinal con 20 pacientes tratados con azatioprina por vía oral (1,5-2,5 mg/kg/día en dos dosis) durante 1 año. Se consideró recaída la pérdida de 10 dB en dos frecuencias consecutivas o de 15 dB en una frecuencia aislada.
Resultados
La edad media de los pacientes fue de 5250 años (IC 95%: 46,91-58,17), y la mitad fueron mujeres. La afectación bilateral fue del 65%. Un 75% presentaban enfermedad organoespecífica y un 25%, enfermedad autoinmune sistémica. La diferencia entre la PTA basal (46,49 dB; DE 18,90) y la PTA a los 12 meses (45,47 dB; DE 18,88) no alcanzó significación estadística (p=0,799). Existía una correlación positiva moderada entre sexo femenino y presencia de enfermedad sistémica (R=0,577). Aplicando t de Student para datos apareados se obtuvo una diferencia significativa (p=0,042) entre el descenso de la PTA en frecuencias hasta 1.000 Hz (PTA 125-1.000 Hz). La tasa relativa de incidencia de recaída por año fue de 0,52 recaídas/año (IC 95%: 0,19-1,14). El tiempo medio de supervivencia libre de recaída audiométrica fue de 9,70 meses (DE 1,03).
Conclusiones
La azatioprina mantiene el umbral de audición, disminuye el riesgo de recaída y frena la velocidad con la que los pacientes recaen, alterando el curso de la enfermedad inmunomediada del oído interno.
https://ift.tt/2MASDeT
Survey on the Knowledge of Cochlear Implant Indication in the Treatment of Hearing Loss in Spain
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Manuel Manrique, Ángel Ramos, Beatriz Pradel, Carlos Cenjor, Diego Calavia, Constantino Morera
Abstract
Introduction
This study aims to analyse the knowledge of cochlear implant (CI) candidacy criteria of otorhinolaryngology specialists in Spain, and from the results, consider whether it is necessary to implement training measures aimed at improving knowledge in this area.
Material and methods
A questionnaire was designed for measuring the level of knowledge of cochlear implant candidacy criteria (CI) in people with hearing loss. The questionnaire collected the demographic data of the respondents and their knowledge on the conventional and emergency indications for CI, technical characteristics of CI and results in the implanted population.
Results
A total of 222 Spanish specialists in otorhinolaryngology answered the questionnaire (10.29% of the sample surveyed).
Conclusions
The 50% of all respondents showed a medium-high knowledge about CI. Epidemiological data suggest that a high percentage of adults with postlocutive deafness and candidates for a CI are not referred for treatment. The lack of knowledge about the criteria for the indication of CI by otorhinolaryngology specialists may contribute to inadequate guidance of patients who are potential candidates for CI. The greatest shortcomings are found in the most emergency indications for a CI. Among otorhinolaryngology professionals, the greatest knowledge about CI is found in those who work in tertiary hospitals in the areas of otology and otoneurology, either in the public or private sector. This study suggests that training on CI should be increased for otorhinolaryngology professionals, especially for general otorhinolaryngologists.
Resumen
Introducción
Este trabajo pretende analizar el conocimiento del especialista en Otorrinolaringología en España sobre los criterios de indicación de los implantes cocleares (IC) y, según los resultados, considerar si es necesario implementar medidas de formación dirigidas a mejorar el conocimiento en esta área.
Material y métodos
Se diseña un cuestionario dirigido a conocer el nivel de conocimiento sobre la indicación de IC en personas con hipoacusia. Este cuestionario recogía información demográfica de los encuestados y conocimientos sobre aspectos como indicaciones convencionales y emergentes de los IC, características técnicas de los IC y resultados en la población implantada.
Resultados
Un total de 222 especialistas españoles en Otorrinolaringología respondieron el cuestionario (10,29% de la muestra encuestada).
Conclusiones
Un 50% de los encuestados mostraron unos conocimientos medios-altos sobre IC. Datos epidemiológicos sugieren que un alto porcentaje de adultos con sorderas poslocutivas candidatos a un IC no son referidos para tratamiento. El desconocimiento de los criterios para la indicación de IC por parte de los especialistas en Otorrinolaringología puede contribuir a una inadecuada orientación de los pacientes potencialmente candidatos a un IC. Las mayores deficiencias se encontraron en las indicaciones más emergentes de un IC. Dentro de los profesionales de la Otorrinolaringología los mayores conocimientos sobre IC se concentraron en aquellos que trabajaban en hospitales terciarios, especializados en Otología y Otoneurología, y desempeñaban su actividad laboral en el sector público y privado. Este estudio sugiere la conveniencia de incrementar acciones formativas sobre IC en los profesionales de la Otorrinolaringología, especialmente para otorrinolaringólogos generales.
https://ift.tt/2xetqSB
Postoperative pain management for tracheoesophageal fistula repair using transverse, in-plane, ultrasound guided paravertebral technique in a 2 kg neonate
We read with interest the recent paper discussing an ultrasound guided oblique intercostal approach for paravertebral catheters placement in 2 neonates scheduled for tracheoesophageal fistula repair [1]. While we applaud the author's choice of using for paravertebral catheters (PVBCs) in such small neonates, we question the technique used; an ultrasound image was not presented, and the figure and block details do not seem to be in concordance with the approach used. The depth of paravertebral space with intercostal approach is only few millimiters, making this approach extremely challenging, with a high risk of pneumothorax and intrapleural catheter placement.
https://ift.tt/2D1ciVz
Attenuation of murine allergic airway inflammation with a CXCR1/CXCR2 chemokine receptor inhibitor
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Op2LJ7
Precision and reproducibility of automated computer‐guided PASI measurements in comparison to trained physicians
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Qzgmz9
Precision and reproducibility of automated computer‐guided PASI measurements in comparison to trained physicians
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Qzgmz9
The vascular morphology of melanoma is related to Breslow index: an in vivo study with dynamic optical coherence tomography
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Qy2Prz
Mechanisms of Pathogenic Effects of Eosinophil Cationic Protein and Eosinophil Derived Neurotoxin on Human Keratinocytes
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Oo5OkP
Associations among two vitamin D receptor (VDR) gene polymorphisms (ApaI and TaqI) in acne vulgaris: A pilot susceptibility study
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2xgDjiq
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