Admission avoidance in tonsillitis and peritonsillar abscess:

pa.ythelady61 shared this article with you from Inoreader Admission avoidance in tonsillitis and peritonsillar abscess: a prospective national audit during the initial peak of the COVID‐19 pandemic Via Clinical Otolaryngology Abstract Objectives To report changes in practice brought about by COVID‐19 and the implementation of new guidelines for the management of tonsillitis and peritonsillar abscess (PTA), and to explore factors relating to unscheduled re‐presentations for patients discharged from the emergency department (ED). Design Prospective multicentre national audit over 12 weeks from 6th April 2020. Setting UK secondary care ENT departments. Participants Adult patients with acute tonsillitis or PTA. Main outcome measures Re‐presentation within 10 days for patients discharged from the ED. Results 83 centres submitted 765 tonsillitis and 416 PTA cases. 54.4% (n=410) of tonsillitis and 45.3% (187/413) of PTAs were discharged from ED. 9.6% (39/408) of tonsillitis and 10.3% (19/184) of PTA discharges re‐presented within 10 days, compared to 9.7% (33/341) and 10.6% (24/224) for those admitted from ED. The subsequent admission rate of those initially discharged from ED was 4.7% for tonsillitis and 3.3% for PTAs. IV steroids and antibiotics increased the percentage of patients able to swallow from 35.8% to 72.5% for tonsillitis (n=270/754 and 441/608) and from 22.3% to 71.0% for PTA (n=92/413 and 265/373). 77.2% of PTAs underwent drainage (n=319/413), with no significant difference in re‐presentations in those drained vs not‐drained (10.6% vs 9.5%, n=15/142 vs 4/42, p=0.846). Univariable logistic regression showed no significant predictors of re‐presentation within 10 days. Conclusions Management of tonsillitis and PTA changed during the initial peak of the pandemic, shifting towards outpatient care. Some patients who may previously have been admitted to hospital may be safely discharged from the ED. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Downregulation of MCM2 contributes to the reduced growth potential of epithelial progenitor cells in chronic nasal inflammation

pa.ythelady61 shared this article with you from Inoreader Downregulation of MCM2 contributes to the reduced growth potential of epithelial progenitor cells in chronic nasal inflammation Via Journal of Allergy and Clinical Immunology Capsule summary: Cell cycle progression candidate MCM2 protein may be a potential target to modulate the epithelial defects (e.g., low proliferation dynamic and impaired barrier function) in chronically airway inflammatory diseases. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Defective neutrophil development and specific granule deficiency caused by a homozygous splice site mutation in SMARCD2

pa.ythelady61 shared this article with you from Inoreader Defective neutrophil development and specific granule deficiency caused by a homozygous splice site mutation in SMARCD2 Via Journal of Allergy and Clinical Immunology Capsule summary: Here we provide the second report of human SMARCD2 deficiency leading to an immunodeficiency syndrome with impaired neutrophil development and function. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laryngeal sarcoidosis

pa.ythelady61 shared this article with you from Inoreader Laryngeal sarcoidosis at a tertiary airway centre: Our experience with 32 patients Via Clinical Otolaryngology Abstract Figure 2. Endoscopic photograph of laryngeal sarcoidosis and its management. A) Intraoperative photograph of larynx prior to intervention, demonstrating a thickened epiglottis, arytenoid mucosa, false vocal folds, as well as tightening of the aryepiglottic folds, particularly the left. B) Intraoperative photograph after intervention, which involved pepper pot technique to epiglottis and arytenoid mucosa, as well as division of left aryepiglottic fold and bilateral false vocal folds. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Fungal sensitisation and positive fungal culture from sputum in children with asthma are associated with reduced lung function and acute asthma attacks respectively

pa.ythelady61 shared this article with you from Inoreader Fungal sensitisation and positive fungal culture from sputum in children with asthma are associated with reduced lung function and acute asthma attacks respectively Via Clinical & Experimental Allergy ABSTRACT Background Sensitisation to thermotolerant fungi, including filamentous fungi and Candida albicans, is associated with poor lung function in adults with severe asthma. Data in children are lacking. Environmental exposure to fungi is linked with acute severe asthma attacks but there are few studies reporting the presence of fungi in the airways during asthma attacks. Methods We investigated the association between fungal sensitisation and/or positive fungal sputum culture and markers of asthma severity in children with chronic and acute asthma. Sensitisation was determined using serum specific IgE and skin prick testing against a panel of five fungi. Fungal culture was focused toward detection of filamentous fungi from sputum samples. Results We obtained sensitisation data and/or sputum from 175 children: 99 with chronic asthma, 39 with acute asthma and 37 controls. 34.1% of children with chronic asthma were sensitised to thermotolerant fungi compared to no children without asthma (p=<0.001). These children had worse pre‐bronchodilator lung function compared to asthmatics without sensitisation including a lower FEV1/FVC ratio (p<0.05). The isolation rate of filamentous fungi from sputum was higher in children with acute compared to chronic asthma. Conclusions Fungal sensitisation is a feature of children with chronic asthma. Children sensitised to thermotolerant fungi have worse lung function, require more courses of systemic corticosteroids and have greater limitation of activities due to asthma. Asthma attacks in children were associated with the presence of filamentous fungi positive sputum culture. Mechanistic studies are required to establish whether fungi contribute directly to the development of acute asthma. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Peanut induced anaphylaxis in children and adolescents: data from the European Anaphylaxis Registry

pa.ythelady61 shared this article with you from Inoreader Peanut induced anaphylaxis in children and adolescents: data from the European Anaphylaxis Registry Via Allergy Abstract Background Peanut allergy has a rising prevalence in high‐income countries, affecting 0.5–1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. Methods Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in‐depth review of food induced anaphylaxis cases in a tertiary paediatric allergy centre. Results 3514 cases of food anaphylaxis were reported between July 2007 ‐ March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs 38%; p=0.001), asthma comorbidity (47% vs 35%; p<0.001), relevant co‐factors (29% vs 22%; p=0.004) and biphasic reactions (10% vs 4%; p=0.001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs 56% and grade IV 1.1% vs 0.9%; p=0.001). Self‐administration of intramuscular adrenaline was low (17% vs 15%), professional adrenaline administration was higher in non‐peanut food anaphylaxis (34% vs 26%; p=0.003). Hospitalisation was higher for peanut anaphylaxis (67% vs 54%; p=0.004). Conclusions The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life‐threatening allergic reactions in European children, with some characteristic features e.g. presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes

pa.ythelady61 shared this article with you from Inoreader Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes Via Allergy Analysis of cross-reactivity is necessary for prescribing safe cephalosporins for penicillin allergic patients. Amoxicillin (AX) is the betalactam most often involved in immediate hypersensitivity reactions (I... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Leukotriene D4 Paradoxically Limits LTC4 Driven Platelet Activation and Lung Immunopathology

pa.ythelady61 shared this article with you from Inoreader Leukotriene D4 Paradoxically Limits LTC4 Driven Platelet Activation and Lung Immunopathology Via Journal of Allergy and Clinical Immunology Capsule summary. LTD4, the conversion product of LTC4, potently elicits bronchoconstriction, but blocks LTC4-induced platelet activation, pulmonary eosinophilia, and IL-33 induction through CysLT2R. Conversion to LTD4 may limit the severity of allergic inflammation potentiated by LTC4 production. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Influence of Surface Electromyography Visual and Clinician Verbal Feedback on Swallow Effort Ratio at Different Bolus Volumes in a Healthy Population

pa.ythelady61 shared this article with you from Inoreader The Influence of Surface Electromyography Visual and Clinician Verbal Feedback on Swallow Effort Ratio at Different Bolus Volumes in a Healthy Population Via Folia Phoniatrica et Logopaedica Background/Aims: The effortful swallow is a common treatment intervention requiring increased intensity to facilitate adaptations and modify swallow kinematics. The type of feedback and bolus volume provided may influence the intensity of the effortful swallow. To determine the increased effortful swallow intensity, a clinician can collect the peak amplitude of an effortful swallow and a typical swallow and compute a "swallow effort ratio" (SER). Dividing the effortful swall ow surface electromyography (sEMG) peak amplitude by the typical swallow sEMG peak amplitude derives the SER. A higher SER suggests increased intensity. An increase in the SER may have clinical relevance in swallowing therapy as a threshold of intensity is required to elicit neuroplastic change. The purpose of this investigation was to determine whether sEMG visual and clinician verbal feedback increases the SER. Additionally, the investigation examined whether the SER is influenced by different liquid bolus volumes. Methods: Eighty-two nondysphagic, healthy adults were assigned at random to 2 groups. One group received no feedback, and the other received verbal and visual feedback while performing typical and effortful swallows at 3 liquid volumes. Results: An analysis of covariance compared the typical and effortful peak swallow amplitudes among 3 volumes in the 2 feedback groups. There was a significant effect on the peak amplitude values by feedback g roup F(2, 79) = 22.82, p #x3c; 0.001. There were no differences in peak amplitude by volume regardless of feedback F(2, 78) = 0.413, p = 0.663. Conclusion: It appears that sEMG visual and clinician verbal feedback increases the SER, which may be a surrogate for intensity. An increased SER may have a positive effect on swallow intervention as intensity is known to influence outcomes of exercise and elicit neuroplastic change. Folia Phoniatr Logop View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Perdida de peso involuntaria: causas

pa.ythelady61 shared this article with you from Inoreader Perdida de peso involuntaria: causas Via Cuida tu tiroides La pérdida de peso involuntaria y que no se explica por un cambio de hábitos es una preocupación que puede tener causas diferentes. Entre ellas están las alteraciones en el funcionamiento de la glándula tiroides.  La pérdida de peso involuntaria puede deberse a causas diversas: Efectos secundarios de algunos medicamentos (algunos de los que se emplean para tratar condiciones de la tiroides) Alteraciones de la salud mental o el estado de ánimo Alcoholismo Anorexia nerviosa Dificultad para tragar (un síntoma de diferentes enfermedades) Alteraciones de la salud bucodental Alteraciones cognitivas Problemas intestinales Cáncer  Hipertiroidismo, hipotiroidismo, hiperparatiroidismo, hipoadrenalismo Pérdida de peso y problemas de tiroides Los científicos han comprobado hace tiempo que la relación entre las enfermedades de la tiroides, el peso corporal y el metabolismo es estrecha, pero no necesariamente sencilla. Aunque las hormonas de la glándula tiroides son importantísimas para el peso corporal, no son ni mucho menos el único elemento que determina una posible pérdida de peso involuntaria. Hay otras hormonas, proteínas y procesos del organismo que pueden explicar por qué una persona pierde peso. Las hormonas tiroideas regulan el metabolismo. Si la medida del metabolismo se obtiene en reposo, el resultado se denomina tasa metabólica basal (TMB, o BMR por sus siglas en inglés).  Los expertos en endocrinología han investigado la relación entre TMB y han llegado a las siguientes conclusiones: La TMB en valores bajos está asociada con niveles bajos de hormonas tiroideas en el organismo La TMB en valores altos está asociada con niveles elevados de hormonas tiroideas (hipertiroidismo), una de las posibles causas de pérdida de peso involuntaria La TMB ya casi no se emplea debido a la complejidad de la prueba y a que hay más factores que causan pérdida de peso, pero su relación con la tiroides está establecida.  En cuanto a la relación entre TMB y condiciones de la tiroides, se ha documentado que los valores elevados en esta prueba en personas con hipertiroidismo llevan asociados en muchas ocasiones pérdida de peso involuntaria. Además, la pérdida de peso es mayor si el hipertiroidismo es severo. Por ejemplo, si la tiroides está extremadamente hiperactiva -produciendo hormonas en cantidades sustancialmente excesivas- la TMB del paciente se incrementa. Eso hace que el cuerpo necesite más calorías para mantener su actividad normal. Es una de las causas de pérdida de peso relacionada con la actividad de la tiroides. Puesto que el hipertiroidismo es un estado alterado del organismo, puede predecirse que la pérdida de peso se corregirá cuando la tiroides recupere la normalidad. De todas formas, los especialistas suelen recordar que los factores que controlan nuestro apetito, metabolismo y actividad son extremadamente complejos. Las hormonas de la glándula tiroides son únicamente uno de esos factores. Si sospechas que puedes padecer alguna enfermedad de la glándula tiroides debes hablar con tu médico. En el siguiente test te damos algunas pistas.   FUENTES American Thyroid Association. Thyroid and Weight FAQs. Torlinska B et al 2019 Patients treated for hyperthyroidism are at increased risk of becoming obese: findings from a large prospective secondary care cohort. Thyroid 29:1380–1389. PMID: 31375059. Gang L, et al. Abstract 11438: Thyroid Hormones and Changes in Body Weight and Metabolic Parameters in Response to Weight-Loss Diets: The POUNDS LOST Trial. Circulation. 2016;134:A11438 La entrada Perdida de peso involuntaria: causas se publicó primero en Cuida tu tiroides. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Rhinologic disease and its impact on sleep: a systematic review

pa.ythelady61 shared this article with you from Inoreader Rhinologic disease and its impact on sleep: a systematic review Via International Forum of Allergy & Rhinology Background Rhinologic disease can be responsible for systemic symptoms affecting mood, cognition, and sleep. It is unclear whether sleep disturbance in specific rhinologic disorders (chronic rhinosinusitis [CRS], rhinitis, and nasal septal deviation [NSD]) is an obstructive phenomenon or due to other mechanisms. In this review we examine the impact of CRS, rhinitis, and NSD on objective and subjective sleep outcome metrics and draw comparisons to normal controls and patients with known obstructive sleep apnea (OSA). Methods A systematic review of 4 databases (PubMed, Scopus, Cochrane Library, and Web of Science) was performed. Studies reporting on objective (apnea‐hypopnea index [AHI], respiratory disturbance index [RDI], oxygen nadir) and subjective (Epworth Sleepiness Scale [EpSS], Pittsburgh Sleep Quality Index [PSQI], Fatigue Severity Scale [FSS]) sleep parameters and disease‐specific patient‐reported outcome measures (PROMs; 22‐item Sino‐Nasal Outcome Test [SNOT‐22], Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ], Nasal Obstruction Symptom Evaluation [NOSE]) were included. Results The database search yielded 1414 unique articles, of which 103 were included for analysis. Baseline PROMs were at the high end of normal to abnormal for all 3 conditions: EpSS: CRS (9.8 ± 4.0), rhinitis (9.7 ± 4.3), and NSD (8.9 ± 4.6); and PSQI: CRS (11.0 ± 4.5), rhinitis (6.1 ± 3.7), and NSD (8.6 ± 3.5). Objective measures demonstrated a mild to moderate OSA in the studied diseases: AHI: CRS (10.4 ± 11.5), rhinitis (8.6 ± 8.8), and NSD (13.0 ± 6.9). There were significant differences when compared with reported norms in all measured outcomes (p < 0.001). Conclusion Sleep quality is impacted by rhinologic (CRS, rhinitis, NSD) disease. There is likely a mild obstructive component contributing to poor sleep, but other contributing factors may be involved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Risk factors for subsequent recurrence after surgical treatment of recurrent pleomorphic adenoma of the parotid gland

pa.ythelady61 shared this article with you from Inoreader Risk factors for subsequent recurrence after surgical treatment of recurrent pleomorphic adenoma of the parotid gland Via Head & Neck Abstract Background Recurrent pleomorphic adenoma (PA) can be a lifelong disease, and rates of subsequent recurrence are high. Methods Patients between 2000 and 2015 were identified. Primary outcome was subsequent recurrence after surgical salvage. Results Twenty‐seven of 84 patients developed a subsequent recurrence. Risk factors for subsequent recurrence included a higher number of previous recurrences (P < .01), worse preoperative facial nerve function (P < .01), and deep parotid lesion(s) (P < .01). Interval since last surgery was protective (P < .01), specifically >10 years since last surgery (P < .01). For patients with a >10‐year interval since their last surgery, the subsequent recurrence‐free rate at 10 years follow‐up was 80.2% vs 31.8%. Conclusions For patients presenting with a >10‐year interval since their last surgery, subsequent recurrence rates are low, which may allow for as needed surveillance recommendations. For patients presenting with recurrent PA and ≤10 years since their last surgery, a closer surveillance is warranted. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.