Chondrodysplasia punctata presenting with tracheal obstruction

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Claudia Schweiger, Michel N. Nassar, Debora Goebel, Michael J. Rutter
Chondrodysplasia punctata is a group of congenital bone and cartilage disorders characterized by erratic calcification during development. Laryngeal and tracheal calcification and subsequent stenosis, while being reported in several cases of chondrodysplasia punctata, are not frequent findings and there are no proposed management techniques. We describe here a case of an infant with chondrodysplasia punctata associated to tracheal stenosis that was successfully treated with balloon dilation, and with long term follow-up.



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Validation of the LittlEARS Auditory Questionnaire in cochlear implanted infants and toddlers

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Anita Obrycka, Artur Lorens, José-Luis Padilla García, Anna Piotrowska, Henryk Skarzynski
ObjectivesThe LittlEARS Auditory Questionnaire (LEAQ) has so far been validated to assess auditory development in groups of normal-hearing children in over 20 different languages. Considering the huge variability in auditory development of CI children, especially since candidacy criteria have been relaxed, additional evidence to validate the use of LEAQ scores in this particular population is needed. The aim of this study is to provide evidence for the reliability and validity of LEAQ scores for assessing the auditory development of CI infants and toddlers based on an evaluation of LEAQ's internal structure and its relation to other variables.MethodsThe study was prospective, with sequential enrolment and within-subject repeated measures. It included 122 children with profound bilateral sensorineural hearing loss implanted at 6–22 months of age. All children were evaluated with the Polish version of LEAQ on the first day of CI activation and at each of four follow-up visits related to sound processor fitting.The study was undertaken in the light of current psychometric thinking about how assessment instruments should be validated. The main aim of the study was to obtain evidence for the validity of interpreting LEAQ measures from CI children in terms of auditory development. First, in order to collect evidence for score reliability and validity based on LEAQ's internal structure, the psychometric properties of LEAQ scores from CI children were determined. A second step was to confirm validity by investigating the effect of concomitant variables on LEAQ scores. Correlations between LEAQ score and duration of hearing aid (HA) use, and between LEAQ score and duration of CI use, were investigated. Additionally, group differences in LEAQ scores between: 1) early and late implanted children; 2) children with long and short HA experience prior to implantation; and 3) children who showed responses over a wide frequency range from using their HAs (prior to implantation) vs those who did not.ResultsOn each of the five administrations of LEAQ, the item difficulty indices increased (meaning the items became easier) and over the series they progressively increased with a range of: 0.01–0.62, 0.03–0.92, 0.09–1.00, 0.26–1.00, and 0.52–1.00. At the same time, item–total correlations were in the ranges: 0.09–0.77, 0.26–0.62, 0.00–0.65, 0.00–0.65, and 0.00–0.67. Cronbach's alpha values were above 0.80 for all administrations. A positive correlation between LEAQ score and duration of HA use, and subsequent duration of CI use (hearing experience) was found. When the children were stratified into groups according to age at cochlear implantation, duration of HA use before implantation, and audibility provided by HAs prior to implantation, the differences between the groups were reflected in both their rate of auditory development and their LEAQ score.ConclusionThe interpretation of LEAQ scores from CI children in terms of auditory development was supported by the validity evidence of internal structure and from a logical relationship to other variables. (1) Psychometric properties – item difficulty, item–total correlations, and Cronbach's alpha values – indicate that LEAQ measures are highly consistent and reliably gauge the level of a CI child's auditory development. (2) There was a positive correlation between LEAQ scores and the duration of hearing experience with HAs and a later CI; similarly, there were significant differences between groups of children stratified according to the age at cochlear implantation, duration of HA use before implantation, and audibility provided by HAs prior to implantation, all of which demonstrate the expected relation between LEAQ score and concomitant variables.



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An unusual cause of cutaneous ulceration

http://ift.tt/2hMaIvQ

A recently changed, long-standing nodule on the chest wall

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Value of ultrasonography findings for nail psoriasis before and after adalimumab administration

http://ift.tt/2hM9Ua5

Pigmented fungiform papillae of the tongue: the first case in an Italian woman

http://ift.tt/2iJKYx6

How do carers and children with eczema choose their emollient?

http://ift.tt/2hMbt84

Reflectance confocal microscopy as a noninvasive diagnostic tool for naevoid basal cell carcinoma syndrome management

http://ift.tt/2iJNGCr

A bluish nodule with rapid enlargement: a diagnostic challenge

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Rate of positive diagnosis of skin cancer and its stage in two-week wait referrals in England according to age

Summary

Background

The incidence of skin cancer is increasing. The two-week wait conversion rate (TWWCR) is the percentage of urgent suspected skin cancer referrals that are confirmed as cancer.

Aims

To examine the relationships between different epidemiological factors and TWWCR for malignant melanoma (MM) and cutaneous squamous cell carcinoma (SCC).

Methods

We extracted data from the National Cancer Data Repository (NCDR) and National Cancer Waiting Times Monitoring Dataset between 2009 and 2010 for MM and SCC in England. We conducted partial correlation and stepwise multiple regression analysis on TWWCR, age, incidence, detection rate, tumour thickness (MM only), percentage MM/SCC and social deprivation. We also looked at the two-week wait referral rate (TWWRR) and incidence rate with respect to age.

Results

TWWCR was significantly correlated with age when partial correlation was used to control for the factors described above for MM (P < 0.05) and SCC (P < 0.001). Stepwise regression of these factors returned only age as significant in the final model for MM (P < 0.001) and SCC (P < 0.01). Incidence of MM and SCC increased with age. TWWRR also increase with age, but with higher rate in younger people relative to their incidence.

Conclusions

Age is a predictor of TWWCR independent of the other factors measured, including thickness and incidence. This may be explained by the higher number of referrals for younger patients despite the lower incidence of skin cancer in this group. This may reflect a more appropriate rate of referral in order to achieve earlier diagnosis and better outcomes.

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Delayed allergic dermatitis presenting as a keloid-like reaction caused by sting from an Indo-Pacific Portuguese man-o’-war (Physalia utriculus)

Summary

Cnidarian envenomations are common occurrences in the tropics that can affect holidaymakers. The cutaneous reactions are classified as immediate or delayed types. Delayed allergic reactions are persistently recurring dermatitis, which can occur within 1–4 weeks from the initial sting, and may last for several months. Hypertrophic scar-like or keloid-like reactions are rare, and are believed to be a type IV hypersensitivity reaction to sequestered antigens from stinging filaments. We report an unusual case of delayed allergic dermatitis with keloid-like presentation caused by Physalia utriculus.

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Psoriasis and metabolic syndrome in children: current data

Summary

Background

The prevalence of cardiovascular and metabolic disorders in paediatric patients with psoriasis is not well established.

Aim

To conduct a meta-analysis of previously published studies dealing with the occurrence of metabolic disorders in children with psoriasis.

Methods

Data from 7 studies with a total of 965 children with psoriasis were analysed using a random effects model.

Results

Prevalence of metabolic syndrome (MetS) was significantly higher in patients with psoriasis than in healthy controls (HCs). In most studies, significantly decreased levels of high-density lipoprotein (HDL) cholesterol were found in children with psoriasis. Mean level of HDL cholesterol in patients with psoriasis was 2.05 mg/dL lower than in HCs. Patients with psoriasis and HCs did not differ significantly in their mean triglyceride levels, although the difference was at a threshold of statistical significance. Mean level of fasting glucose in children with psoriasis was 5.75 mg/dL higher than in HCs (P < 0.01). The two groups did not differ significantly in mean waist circumference or in systolic and diastolic arterial pressures.

Conclusions

Decreased levels of HDL cholesterol and increased concentrations of fasting glucose may represent very early stages of MetS in children with psoriasis. However, a large population-based study is needed to establish the relationship between psoriasis and MetS in children, including the environmental, genetic and immunological factors leading to their co-occurrence.

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Salicylism from topical wart paint: a novel report

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Early recognition and detection of juvenile psoriatic arthritis: a call for a standardized approach to screening

Summary

Background

National Institute for Health and Care Excellence (NICE) guidelines recommend annual screening for psoriatic arthritis (PsA) in all patients with psoriasis. Currently, no validated assessment tools have been recommended for screening for juvenile PsA (JPsA).

Aim

To determine dermatologists' practice when assessing children's joints and explore the challenges dermatologists experience when looking for joint disease, in order to inform future strategies to improve early detection of arthritis.

Methods

Structured telephone interviews were undertaken with dermatologists identified through the British Society of Paediatric Dermatology. Percentages for binary and categorized responses were calculated. Thematic content analysis was used to generate a set of core themes across the interview data.

Results

Of the 41 consultant dermatologists contacted, 23 agreed to be interviewed. Of these, 78% (18/23) reported they routinely ask about joint disease. Only 13% (3/23) routinely examine the joints of children with psoriasis. Overall, assessment for JPsA lacked a structured, evidence-based approach. The average confidence rating for assessing joint disease was low (score of 3). The two key barriers described for detecting arthritis were a lack of experience and training, and subtle or difficult to detect signs. The two main suggestions for improving detection were the introduction of an assessment tool/guideline and increased clinical experience and training.

Conclusion

There is a clear need for dermatologists to use a standardized approach for screening and to increase their confidence in paediatric musculoskeletal examination. In this article, we provide guidance on screening for psoriatic arthritis in children based on our clinical experience.

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Carcinoma of buccal mucosa with metastasis to thigh

Publication date: Available online 31 December 2016
Source:Oral Oncology
Author(s): Gunjan Agrawal, Ashutosh Gupta, Vivek Chaudhary




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Depression and survival in head and neck cancer patients

Publication date: February 2017
Source:Oral Oncology, Volume 65
Author(s): Katherine Rieke, Kendra K. Schmid, William Lydiatt, Julia Houfek, Eugene Boilesen, Shinobu Watanabe-Galloway
ObjectiveThough depression often afflicts head and neck cancer (HNC) patients, few studies have examined the association between depression and survival in this particular cancer population. The objective of this study is to investigate the five-year survival of HNC patients by depression status.Materials and methodsThis study used SEER-Medicare data from 2002–2010 and identified depression diagnosis two years before and one year after cancer diagnosis. HNC patients were identified using ICD-O3 codes and depression was identified using ICD-9-CM codes from Medicare claims.ResultsOf the 3466 patients included in the study, 642 (18.5%) were diagnosed with depression during the study period. Compared to those who received no depression diagnosis, those diagnosed with depression prior to cancer or after cancer diagnosis were more likely to die of cancer (HR=1.49; 95% CI=1.27, 1.76 and HR=1.38; 95% CI=1.16, 1.65, respectively). Similarly, when looking at death from any cause, those diagnosed with depression prior to cancer diagnosis and those who received a diagnosis of depression after cancer were more likely to die from any death compared to those without depression (HR=1.55; 95% CI=1.36, 1.76 and HR=1.40; 95% CI=1.21, 1.62, respectively).ConclusionsThe results emphasize the need for early identification and treatment of depression in HNC patients, as well as the establishment of policies to routinely screen these patients throughout the cancer treatment process.



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Painful locking of the wrist in a patient with pseudoachondroplasia confirmed by COMP mutation

We report the case of a 40-year-old woman with pseudoachondroplasia (PSACH), with a heterozygous mutation (c.806A > G, p.Asp269Gly) located in the Type 3 repeats domain of the cartilage oligomeric matrix protein gene, who complained of the unusual symptom of painful locking of the wrist. Her condition was caused by a non-traumatic enlargement of the extensor carpi radialis longus (ECRL) and brevis (ECRB) tendons along with bulbous swelling of the synoviums around them. Surgical treatment resolved these unusual tendon-related symptoms. Repetitive mechanical loading of the wrist in daily activities, including distal intersection tenosynovitis between the extensor pollicis longus tendon and ECRL and ECRB tendons, may have contributed to changes in the structural integrity of the tendons. We should pay more attention to tendon-related symptoms in patients with PSACH.

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Resection of giant mediastinal liposarcoma via '{dashv} shape incision

Primary mediastinal liposarcomas are extremely rare conditions often resected through standard median sternotomy or lateral thoracotomy. However, the management of a very huge mediastinal tumor involving hemithorax through these two common surgical approaches is always challenging. Herein, we report a case of applying median sternotomy with a sternum transection plus a right fourth intercostal thoracotomy (' shape' incision) to resect a giant primary anterior mediastinal liposarcoma extending into the whole right thorax. The final pathological diagnosis was a well-differentiated liposarcoma. The patient experienced an uneventful recovery. The ' shape' incision is a good backup for the extension of standard median sternotomy and provides a better exposure for both mediastinum and hemithorax.

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Abdominal wall Type-I complex regional pain syndrome treated effectively with peripheral nerve field stimulation: a case report

Chronic abdominal wall pain is a well-documented complication of abdominal surgery. However, abdominal wall complex regional pain syndrome (CRPS) is a rare medical condition. We present a case of abdominal wall CRPS and its treatment with peripheral nerve field stimulation (PNfS). A 34-year-old female presented with right periumbilical pain for 2 years. She developed burning, sharp and stabbing pain with allodynia (extremely sensitive to wind and light touch) and erythema or pallor 2 weeks after an exploratory appendectomy. The extensive evaluation ruled out the underlining pathology. After she failed conservative therapies, she underwent a 7-day trial of thoracic spinal cord stimulation (SCS) and abdominal wall PNfS. Thoracic SCS failed to provide pain relief; however, PNfS provided significant relief (>90%) of burning sensation. It has now been 5 years since the PNfS was implanted and she continues to demonstrate substantial pain relief.

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Upper lobe cavity with intracavitary mass: an unexpected diagnosis

Description

A 77-year-old man, with diabetes and a smoker, with no other medical history, presented with cough with sputum and chest pain that had started 2 months earlier. He had no fever, no haemoptysis and no constitutional symptoms. He had a diminished murmur on right chest auscultation and reported of ipsilateral pleuritic pain. Routine blood tests were unremarkable. The chest X-ray (figure 1) showed a right upper lobe cavity with air-crescent in the periphery of a mass inside. It was better characterised with CT (figure 2) that showed an upper lobe cavitary mass with intracavitary content and adjacent pleural thickening. The mass showed no cleavage plane with the thoracic wall. Despite being highly suggestive of invasive aspergilosis (aspergiloma),12 the differential diagnosis included other fungal infections, mycobacterial infection and neoplasm.

Figure 1

Chest X-ray.

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Retronychia: clinical diagnosis and surgical treatment

Description

Retronychia is the term used for proximal ingrowth of the nail and was first described by De Berker and Rendall1 in 1999. It frequently affects women (~82%), and the great toes are the most common location.2 The most frequent trigger is (micro) trauma.3 With trauma the nail plate separates completely from the matrix, a new plate grows under the old plate, pushes it upwards and is buried into the ventral aspect of the proximal nail fold (PNF), causing inflammation. This condition is rarely diagnosed and in 70% of the cases patients have been inadequately treated with oral antibiotics and antifungals.4

We report the case of a 14-year-old girl who was referred to our outpatient clinic with oedema, erythema and pain of the proximal nail fold of the right hallux (figure 1A). This condition had been present for...

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Fluctuating drowsiness following cardiac catheterisation: artery of Percheron ischaemic stroke causing bilateral thalamic infarcts

An 81-year-old man underwent cardiac catheterisation to investigate breathlessness and left ventricular impairment of unknown cause. He had unobstructed coronary arteries. Immediately following the procedure, he became suddenly unresponsive with vertical gaze palsy, anisocoria and bilateral upgoing plantar responses. He made a rapid recovery to his premorbid state 25 min later with no residual focal neurological signs. He then had multiple unresponsive episodes, interspaced with complete resolution of symptoms and neurological signs. MRI of the brain identified bilateral medial thalamic infarcts and midbrain infarcts, consistent with an artery of Percheron territory infarction. By the time the diagnosis was reached, the thrombolysis window had elapsed. The unresponsive episodes diminished with time and the patient was discharged to inpatient rehabilitation. At 6-month review after the episode, the patient has a degree of progressive cognitive impairment.

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Rare Occurrence of a Poorly Differentiated Neuroendocrine Tumor of the Bladder

Neuroendocrine tumors rarely occur in the urinary bladder. They can be carcinomatous, subdivided into small cell and large cell pathology. Small cell carcinoma of the bladder is a rarity that may present at an advanced pathologic stage. No treatment regimens have been standardized for local or metastatic disease. Review of the recent literature shows equivalent survival data for localized disease treated with chemoradiotherapy combined with either bladder sparing surgery or radical cystectomy. Patients with significant comorbidities are an additional challenge. We report a case of poorly differentiated neuroendocrine tumor of the bladder, which could not be classified as small or large cell carcinoma, complicated by significant comorbidities. After management with transurethral resection of the tumor, adjuvant chemotherapy, and radiation, the patient is alive and asymptomatic nearly 1 year after initial TURBT with no evidence of disease recurrence.

http://ift.tt/2iAnzRu

Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the treatment of patients with moderate to severe psoriasis with randomized withdrawal and retreatment: Results from the phase III, double-blind, placebo- and active comparator–controlled VOYAGE 2 trial

Phase II data suggested that guselkumab, an anti-interleukin-23 monoclonal antibody, was efficacious in psoriasis.

http://ift.tt/2iAnHQO

Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparator–controlled VOYAGE 1 trial

Guselkumab, an interleukin-23 blocker, was superior to adalimumab in treating moderate to severe psoriasis in a phase II trial.

http://ift.tt/2iWo5pu

Saudi Journal of Anaesthesia (Saudi J Anaesth)

Table of Contents - 
2017 | January-March | Volume 11 | Issue 1

EDITORIAL

Saudi Journal of Anesthesia is indexed in Emerging Sources Citation Index (ESCI) [pg. 1]
Abdelazeem Eldawlatly
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ORIGINAL ARTICLES

A comparative study on the efficacy of dexmedetomidine and tramadol on post-spinal anesthesia shivering [pg. 2]
Tanveer Singh Kundra, Gaurav Kuthiala, Anupam Shrivastava, Parminder Kaur
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Effect of nebulized budesonide on respiratory mechanics and oxygenation in acute lung injury/acute respiratory distress syndrome: Randomized controlled study [pg. 9]
Hatem Saber Mohamed, Mona Mohamed Abdel Meguid
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Tissue type determination by impedance measurement: A bipolar and monopolar comparison [pg. 15]
Jack Sharp, Kaddour Bouazza-Marouf, Dorita Noronha, Atul Gaur
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Radiofrequency ablation of hepatocellular carcinomas: A new spectrum of anesthetic experience at a tertiary care hospital in Pakistan [pg. 21]
Faisal Shamim, Ali Asghar, Saman Tauheed, Muhammad Yahya
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Effectiveness of sodium thiopentone, propofol, and etomidate as an ideal intravenous anesthetic agent for modified electroconvulsive therapy [pg. 26]
Altaf Hussain Mir, Nida Farooq Shah, Mehraj Ud Din, Shabir Ahmad Langoo, Fayaz Ahmad Reshi
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Acoustic puncture assist device™ versus conventional loss of resistance technique for thoracic paravertebral space identification: Clinical and ultrasound evaluation [pg. 32]
Monaz Abdulrahman Ali, Ashraf Abualhasan Abdellatif
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Comparison of intrathecal clonidine and fentanyl in hyperbaric bupivacaine for spinal anesthesia and postoperative analgesia in patients undergoing lower abdominal surgeries [pg. 37]
Baljit Singh Bajwa, Arwinder Pal Singh, Angelina K Rekhi
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Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy [pg. 41]
Hala Saad Abdel-Ghaffar, Seham Mohamed Moeen, Ahmed Mohamed Moeen
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The bilateral bispectral and the composite variability indexes during anesthesia for unilateral surgical procedure [pg. 49]
Pedro Lopes-Pimentel, Maylin Koo, Javier Bocos, Antoni Sabaté
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Role of intercostal nerve block in reducing postoperative pain following video-assisted thoracoscopy: A randomized controlled trial [pg. 54]
Zulfiqar Ahmed, Khalid Samad, Hameed Ullah
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Ultrasound-guided transversus abdominis plane block: What are the benefits of adding dexmedetomidine to ropivacaine? [pg. 58]
Manjaree Mishra, Shashi Prakash Mishra, Somendra Pal Singh
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion [pg. 62]
Ahmed M Hasanin, Ali M Mokhtar, Shereen M Amin, Ahmed A Sayed
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Comparison of topical oxybuprocaine and intravenous fentanyl in pediatric strabismus surgery [pg. 67]
Ibrahim Yousafzai, Abdul Zahoor, Butrov Andrey, Nauman Ahmad
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Sub-Tenon's injection versus paracetamol in pediatric strabismus surgery [pg. 72]
AN Ibrahim, T Shabana
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Ultrasound-guided axillary brachial plexus block versus local infiltration anesthesia for arteriovenous fistula creation at the forearm for hemodialysis in patients with chronic renal failure [pg. 77]
WH Nofal, SM El Fawal, AA Shoukry, EAS Sabek, WFA Malak
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CASE REPORTS

Ultrasonography-guided pulsed radiofrequency of sciatic nerve for the treatment of complex regional pain syndrome Type II [pg. 83]
Yi Hwa Choi, Dong Jin Chang, Woon Suk Hwang, Jin Hwan Chung
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Sequestrated caudal catheter in a child: An anesthetic nightmare and surgical dilemma [pg. 86]
Chong Soon Eu, Shyamala V Kumar, Saedah Ali, Shamsul Kamalrujan Hassan
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Anesthetic management of a case of Gilbert's syndrome for mitral and aortic valve replacement: Role of transesophageal echocardiography [pg. 89]
PS Nagaraja, Naveen G Singh, S Subash, N Manjunatha, CG Prabhushankar, N Sathish
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Ultrasound-guided probe-generated artifacts stimulating ventricular tachycardia: A rare phenomenon [pg. 93]
Rafat Shamim, Rudrashish Haldar, Ashutosh Kaushal
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A simple technique to achieve vascular access for continuous venous-venous ultrafiltration in a toddler [pg. 96]
Joseph Drew Tobias
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Unsuspected subglottic web in a child managed for severe respiratory obstruction[pg. 99]
Reena , Arun Kumar, Shrawin Kumar Singh, Vineet Agrawal
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Subdural hematoma occurred after spinal anesthesia in a human immunodeficiency virus-infected patient [pg. 102]
Kyung Tae Kim, Ji Yeon Kim, Eun Mi Kim, Jun Hyun Kim
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Septo-optic dysplasia/de Morsier's syndrome [pg. 106]
Pedro Reis, Joana Mourão
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Fracture of epidural catheter: A case report and review of literature [pg. 108]
Reena , A Vikram
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Can ultrasound-guided subcostal transverse abdominis plane block be used as sole anesthetic technique? [pg. 111]
Pooja Bihani, Pradeep Bhatia, Swati Chhabra, Pradeepika Gangwar
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Hyperkalemia caused by rapid red cell transfusion and the potassium absorption filter [pg. 114]
Yasuhiko Imashuku, Hirotoshi Kitagawa, Takayoshi Mizuno, Yutaka Fukushima
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Difficulty in the removal of epidural catheter for labor analgesia [pg. 117]
Mohamed S Hajnour, Rashid Saeed Khokhar, Abdul Aziz Ahmed Ejaz, Tariq Al Zahrani, Naveed Uddin Kanchi
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LETTERS TO EDITOR

Perioperative anesthetic management of children having Inborn errors of metabolism [pg. 120]
Faisal Shamim, Sheema Siraj, Bushra Salim, Bushra Afroze
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Lung point and power slide signs help to improve the accuracy of lung ultrasound to diagnose pneumothorax [pg. 121]
Swapnil Y Parab, Sohan Lal Solanki
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Hemodynamic disturbance during watertight dural closure? Mind the direction of saline irrigation!!! [pg. 122]
Surya Kumar Dube, Hirok Roy, Gyaninder P Singh, Arvind Chaturvedi
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Giant sacrococcygeal teratoma: Management concerns with reporting of a rare occurrence of venous air embolism [pg. 124]
Anudeep Jafra, Deepak Dwivedi, Divya Jain, Indu Bala
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Lung ultrasound versus chest radiography for the diagnosis of pneumothorax in critically ill patients: A prospective, single-blind study [pg. 126]
Mahmood Dhahir Al-Mendalawi
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Concerns about use of WhatsApp for sharing preanesthesia evaluation form among anesthesiologists [pg. 127]
Anjana S Wajekar
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Fear of going under general anesthesia: A cross-sectional study [pg. 128]
Mikail Kilinc, Ayse B Ozer
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Suction catheter as a crucial rescuer in lost tracheostomy tract situation during percutaneous tracheostomy [pg. 129]
Ankur Khandelwal, Ashutosh Kaushal, Gyaninder Pal Singh, Surya Kumar Dube
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Swallowed table "Spoon"! [pg. 130]
Abdelazeem Eldawlatly, Tariq Alzahrani, Sami Alnassar, Waseem Hajjar, Abdulaziz Almulhem, Ahmad Alqatari
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Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Gemella Species Bacteremia and Stroke in an Elderly Patient with Respiratory Tract Infection

Gemella species are part of normal human flora. They are rarely associated with infections. As opportunistic pathogens, they can cause life-threatening infection in individuals with risk factors. We present an unusual case of an elderly patient, with no predisposing risk factors, who presented with respiratory tract infection and Gemella species bacteremia and suffered a stroke in the absence of features of endocarditis.

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Unsupervised network mapping of commercially available immunoassay yields three distinct chronic rhinosinusitis endotypes

Background

Endotyping chronic rhinosinusitis (CRS) through simplified cytokine assays may help direct individualized therapy such as corticosteroids, antibiotics, or biologics. We performed an unsupervised network analysis to endotype CRS and control subjects using a commercially available cytokine-chemokine immunoassay.

Methods

A 41-plex cytokine-chemokine array along with major basic protein (MBP) assay was performed on sinonasal surgical tissue of 32 adults. Subjects were defined as non-CRS controls (n = 6), CRS with nasal polyps (CRSwNP; n = 13), and CRS without nasal polyps (CRSsNP; n = 13). Unsupervised network modeling was performed to reveal association cytokine-chemokine ("analyte") clusters and "subject" groups.

Results

Network mapping and unsupervised clustering revealed 3 analyte clusters and 3 subject groups. Analyte cluster-1 was composed of T helper 1 (Th1)/Th17 type markers, analyte cluster-2 Th2 markers, and analyte cluster-3 chemokines (CC) and growth factors (GF). Subject group-1 was devoid of CRSwNP, had fewer asthmatics, and was associated most strongly with analyte cluster-3 (CC/GF) (p < 0.001). Subject group-2 was characterized with the most asthmatics (86%) and CRSwNP (100%) patients, and was associated with analyte cluster-2 (Th2; p < 0.001). Subject group-3 was associated with both analyte cluster-1 (Th1/Th17) and analyte cluster-3 (CC/GF) (p < 0.001), and had the highest proportion of CRSsNP patients (62.5%). Tissue levels of MBP, eosinophilia, and computed tomography (CT) scores were significantly higher in subject group-2 vs other groups (p ≤ 0.05).

Conclusion

An unbiased network-mapping approach using a commercially available immunoassay kit reveals 3 distinct tissue cytokine-chemokine signatures that endotype CRS patients and controls. These signatures are prominent even in a limited number of patients, and may help formulate individualized therapy and optimize outcomes.

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Vitamin D insufficiency in the first 6 months of infancy and challenge-proven IgE-mediated food allergy at 1 year of age: a case-cohort study

Abstract

Background

Ecological evidence suggests vitamin D insufficiency (VDI) due to lower ambient ultraviolet radiation (UVR) exposure may be a risk factor for IgE-mediated food allergy. However there are no studies relating directly measured VDI during early infancy to subsequent challenge-proven food allergy.

Objective

To prospectively investigate the association between VDI during infancy and challenge-proven food allergy at 1 year.

Methods

In a birth cohort (n=1074), we used a case-cohort design to compare 25-hydroxy-vitamin-D₃ (25(OH)D₃) levels among infants with food allergy versus a random subcohort (n=274). The primary exposures were VDI (25(OH)D₃<50 nmol/L) at birth and 6 months of age. Ambient UVR and time in the sun were combined to estimate UVR exposure dose. IgE-mediated food allergy status at 1 year was determined by formal challenge. Binomial regression was used to examine associations between VDI, UVR exposure dose and food allergy, and investigate potential confounding.

Results

Within the random subcohort VDI was present in 45% (105/233) of newborns and 24% (55/227) of infants at 6 months. Food allergy prevalence at 1 year was 7.7% (61/786) and 6.5% (53/808) were egg allergic. There was no evidence of an association between VDI at either birth (aRR 1.25, 95% CI 0.70-2.22) or 6 months (aRR 0.93, 95% CI 0.41-2.14) and food allergy at 1 year.

Conclusions

There was no evidence that VDI during the first 6 months of infancy is a risk factor for food allergy at 1 year of age. These findings primarily relate to egg allergy and larger studies are required.

This article is protected by copyright. All rights reserved.

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Pla a 2 and Pla a 3-reactivity identify Plane tree-allergic patients with respiratory symptoms or food allergy

Abstract

Nine hundred thirty-nine rPla a 1, nPla a 2 and rPla a 3 ImmunoCAP ISAC reactors were studied. nPla a 2^pos MUXF3^pos but Pla a 1/2^neg subjects were excluded from the study because they were CCD reactors. Amongst the 764 remaining participants, 71.9% were Pla a 3^pos, 54.1% Pla a 2^pos and 10.9% Pla a 1^pos. Among Pla a 3 reactors, 89.6% were Pru p 3^pos and 86.8% Jug 3^pos, but the strongest IgE recognition relationship was observed between Pla a 3 and Jug r 3. Distinctive clinical subsets could be documented among plane-tree allergic patients. Pla a 3 reactors had both local and systemic food-induced reactions, but lower past respiratory symptoms occurrence. Pla a 2 reactivity was associated with respiratory symptoms but inversely related to systemic reactions to food. Co-sensitization to Pla a 2 and Pla a 3 was associated with a lower past incidence of severe food-induced reactions.

This article is protected by copyright. All rights reserved.

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Antituberculosis Drug-Induced Liver Injury with Autoimmune Features: Facing Diagnostic and Treatment Challenges

The authors present a case report of antituberculosis drug-induced liver injury that offered diagnostic challenges (namely, the possibility of drug-induced autoimmune hepatitis) and treatment difficulties.

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Mutational analysis of GSC, HOXA2 and PRKRA in 106 Chinese patients with microtia

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Shaojuan Hao, Lei Jin, Chenlong Li, Huijun Wang, Fengyun Zheng, Duan Ma, Tianyu Zhang
ObjectiveMicrotia is defined as a developmental malformation characterized by a small, abnormal shaped auricle, with atresia or stenosis of the auditory canal. Genes responsible for nonsyndromic microtia have remained elusive. We therefore report a mutational analysis of GSC, HOXA2 and PRKRA in 106 congenital microtia patients without any combined malformation to explore the relationship between GSC, HOXA2, PRKRA and nonsyndromic microtia.MethodsA total of 106 patients with a clinical diagnosis of congenital microtia and a control group (100 unaffected controls) were recruited through the Eye and ENT Hospital of Fudan University in China. Genomic DNA was extracted following a standard protocol. DNA sequencing analysis was performed in all exons and the exon-intron borders of GSC, HOXA2 and PRKRA.ResultsWe identified 5 genomic variants in GSC, HOXA2 and PRKRA. As to the GSC, we obtained a reported variant g.994C > T in exon 2, which resulted in no change of protein. Our results revealed that g.994C > T was also detected in 10 control cases. We also detected 2 novel variants, g.90G > A and g.114A > C, in the 5′UTR of HOXA2. No class 5 or 4 genomic variant of PRKRA was identified in our microtia patients. Additionally, two previously reported SNVs in GSC and PRKRA were also presented.ConclusionsWe suggest that g.994C > T is a new SNV, which is different from the previous report. Further study is needed to prove the function of 2 novel variants in the 5′UTR of HOXA2, and to explore the possible mechanism of these variants in the occurrence of microtia.



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Results of VSB implantation at the short process of the incus in children with ear atresia

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Charlotte Célérier, Briac Thierry, Cyrille Coudert, Marion Blanchard, Natalie Loundon, Erea Noel Garabédian, Françoise Denoyelle
Objective(s)To describe a new and more simple surgical procedure for implanting the Vibrant Soundbridge (VSB) on the short process of the incus in children with ear atresia and atretic plate and present the audiometric results.MethodsSince 2014, pre- and post-operative audiometric tests with tonal and vocal audiometryat the maximal follow up, respectively 33, 22 and 12 months were performed after VSB implantation at the ENT department, Necker Enfants Malades Hospital, Paris, France. 3 children aged 11, 9 and 15 years with conductive hearing loss due to high grade ear atresia and absent ear canal were implanted. The malformed and fused malleus-incus complex was found to be immobile in two of the subjects, who then underwent a superior tympanotomy to carefully remobilize the malleus. Stapes were mobile in all cases. The FMT clip was customized and crimped on the short process, stabilized by the metallic wire.ResultsAt the maximum follow-up time, the bone conduction was unchanged, and the mean aided ACPTA was 21 dB, 29 dB and 30 dB, compared to 66 dB, 63 dB and 68 dB unaided, respectively. The word recognition score (WRS) at 65 dB SPL increased from 10%, 10% and 70% (unaided) respectively to 100% (aided).ConclusionsThe long process of the incus is usually very hypoplastic in patients with ear atresia with a fused malleus-incus complex lateral to the stapes. VSB coupling to the long process of the incus or the stapes may be challenging in small mastoids. Coupling to the short process of the incus is comparatively a simple procedure, since there is no need for posterior tympanotomy and has no proximity to the facial nerve. The results of this study are similar to other ear atresia cases in the literature with classic FMT placement on the stapes or long process of the incus. Outcomes should be confirmed in a larger number of patients.



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Surgery of the head and neck in patient with Kniest dysplasia: Is wound healing an issue?

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Qasim Husain, Jungsuk Cho, Jay Neugarten, Vikash K. Modi
Kniest dysplasia is a type II collagen disorder that arises from a genetic mutation of the COL2A1 gene that results in short stature, midface anomalies, tracheomalacia, and hearing loss. Disruption of the normal collagen pathway can lead to many changes given its critical role in the body, and can cause complications with respect to wound healing. We present a case in which a patient with Kniest dysplasia successfully underwent multiple procedures in the head and neck region including cochlear implantation, mandibular distraction, palatoplasty, and laryngotracheal reconstruction. All procedures did not have any associated complications with respect to wound healing, indicating that surgery in this population can take place as indicated and surgery should not be contraindicated or delayed.



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