Granulomatosis with polyangiitis (GPA) that is localized to the upper airway presents a diagnostic challenge because of a tendency towards anti-neutrophil cytoplasmic antibody (ANCA)-negativity. The purpose of this study was to investigate whether positivity of ANCA detection might be elicited with combined use of enzyme-linked immunosorbent assay (ELISA) kits.
http://ift.tt/2sZ99x6
Τρίτη 27 Ιουνίου 2017
A novel strategy with combined assays for detection of anti-neutrophil cytoplasmic antibody (ANCA) in clinically ANCA-negative granulomatosis with polyangiitis patients
Unique Infectious Strategy of H5N1 Avian Influenza Virus Is Governed by the Acid-Destabilized Property of Hemagglutinin
Viral Immunology , Vol. 0, No. 0.
http://ift.tt/2sfMXBz
An Automated Critical Event Screening and Notification System to Facilitate Preanesthesia Record Review.
BACKGROUND: Anesthesia information management systems make prior anesthesia records readily available for review when patients return for a subsequent procedure but may create a problem of too much documentation to review in a limited amount of time. We implemented a screening tool to facilitate the identification of critical documentation for review. METHODS: An algorithm was developed to electronically search prior anesthesia records for predefined critical events and flag records containing these events. Our web-based daily case schedule was modified to contain a warning message for any patient on the schedule who has a prior record flagged by the system, in addition to a preexisting hyperlink to view the relevant record. A retrospective analysis was performed to determine the impact of the warning messages on the frequency with which the care team reviewed these records before providing anesthesia care. RESULTS: The screening algorithm flagged 13% of archived cases as critical. There were 3329 and 3369 cases in the 6 months before and after system implementation, respectively, that had prior critical records available for review at that time. One or more of these critical records were viewed before the subsequent case start in 39% vs 59% (P
http://ift.tt/2skvnYr
http://ift.tt/2skvnYr
Anesthetic Management of Narcolepsy Patients During Surgery: A Systematic Review.
BACKGROUND: Narcolepsy is a rare sleep disorder characterized by excessive daytime sleepiness, sleep paralysis, and/or hypnagogic/hypnopompic hallucinations, and in some cases cataplexy. The response to anesthetic medications and possible interactions in narcolepsy patients is unclear in the perioperative period. In this systematic review, we aim to evaluate the current evidence on the perioperative outcomes and anesthetic considerations in narcolepsy patients. METHODS: Electronic literature search of Medline, Medline in-process, Embase, Cochrane Database of Systematic Reviews databases, international conference proceedings, and abstracts was conducted in November 2015 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline. A total of 3757 articles were screened using a 2-stage strategy (title-abstract followed by full text). We included case studies/series, cohort studies, and randomized controlled trials of narcolepsy patients undergoing surgical procedures under anesthesia or sedation. Preoperative narcolepsy symptoms and sleep study data, anesthetic technique, and perioperative complications were extracted. Screening of articles, data extraction, and compilation were conducted by 2 independent reviewers and any conflict was resolved by the senior author. RESULTS: A total of 19 studies including 16 case reports and 3 case series were included and evaluated. The majority of these patients received general anesthesia, whereas a small percentage of patients received regional anesthesia. Reported complications of narcolepsy patients undergoing surgeries were mainly related to autonomic dysregulation, or worsening of narcolepsy symptoms intra/postoperatively. Narcolepsy symptoms worsened only in those patient populations where the preoperative medications were either discontinued or reduced (mainly in obstetric patients). In narcolepsy patients, use of depth of anesthesia monitoring and total intravenous technique may have some advantage in terms of safety profile. Several patients undergoing neurosurgery involving the hypothalamus or third or four ventricles developed new-onset narcolepsy. CONCLUSIONS: We found a paucity of prospective clinical trials in this patient population, as most of the studies were case reports or observational studies. Continuation of preoperative medications, depth of anesthesia monitoring, use of multimodal analgesia with short-acting agents and regional anesthesia techniques were associated with favorable outcomes. Obstetric patients may be at greater risk for worsening narcolepsy symptoms, possibly related to a reduction or discontinuation of medications. For neurosurgical procedures involving the hypothalamus or third and fourth ventricle, postoperative considerations should include monitoring for symptoms of narcolepsy. Future studies are needed to better define perioperative risks associated with anesthesia and surgery in this population of patients. (C) 2017 International Anesthesia Research Society
http://ift.tt/2sPh29G
http://ift.tt/2sPh29G
Intraoperative Detection of Persistent Endoleak by Detecting Residual Spontaneous Echocardiographic Contrast in the Aneurysmal Sac During Thoracic Endovascular Aortic Repair.
Persistent endoleaks may lead to adverse events after endovascular aortic repair. We prospectively examined the relationship between intraoperative residual spontaneous echocardiographic contrast (SEC) within the aneurysmal sac and the incidence of postoperative endoleaks in 60 patients undergoing thoracic endovascular aortic repair. Patients with SEC had a higher incidence of postoperative endoleaks than did patients without SEC within a few days postoperatively (60.0% vs 12.5%, respectively; P
http://ift.tt/2sPzPC0
http://ift.tt/2sPzPC0
Validation of a Real-Time Minute-to-Minute Urine Output Monitor and the Feasibility of Its Clinical Use for Patients Undergoing Cardiac Surgery.
Acute kidney injury after cardiac surgery is associated with increased morbidity and mortality. Methods for measuring urine output in real time may better ensure renal perfusion perioperatively in contrast to the current standard of care where urine output is visually estimated after empiric epochs of time. In this study, we describe an accurate method for monitoring urine output continuously during cardiopulmonary bypass. This may provide a means for setting patient-specific targets for blood pressure and cardiopulmonary bypass flow as a potential strategy to reduce the risk for acute kidney injury. (C) 2017 International Anesthesia Research Society
http://ift.tt/2skRvl8
http://ift.tt/2skRvl8
Nail findings in patients with psoriatic arthritis: A cross-sectional study with special reference to transverse grooves
Patients with psoriatic arthritis (PsA) commonly present with nail manifestations; however, little is known about these manifestations.
http://ift.tt/2ugq7GB
Treatment of xanthelasma palpebrarum with a 1064-nm, Q-switched Nd:YAG laser
Xanthelasma palpebrarum is the most common cutaneous xanthoma characterized by soft, yellow papules or plaques that arise on the periorbital skin. As these lesions can be cosmetically disfiguring, many patients seek medical help to remove these lesions.
http://ift.tt/2tiTgnp
Methotrexate-induced Hypersensitivity Pneumonitis appearing after 30 years of use: a case report
Methotrexate has been implicated in a variety of lung complications, one of which is hypersensitivity pneumonitis. Hypersensitivity pneumonitis most often occurs within the first year of starting low-dose oral...
http://ift.tt/2sP7L1n
Lateral cervical approach for supracricoid partial laryngectomy
Source:American Journal of Otolaryngology
Author(s): Giuseppe Spriano, Giuseppe Mercante, Giovanni Cristalli, Raul Pellini, Fabio Ferreli
IntroductionThe supracricoid partial laryngectomy has been described for the treatment of T3 laryngeal glottic and supraglottic tumors as well as upfront and salvage surgery. Good oncological and functional outcomes are expected, while the post-operative rehabilitation can be quite difficult for the patient. Early and late complications can occur especially in salvage surgery. Neck dissection according to the T stage is often associated with the resection of the primary tumor.ObjectiveTo verify the feasibility of a minimally invasive procedure for supracricoid partial laryngectomy by adopting the lateral cervical approach.Methods/resultsA 61-year old man affected by a cT3N0 glottic cancer already treated 10years prior with radiotherapy for oropharyngeal cancer underwent supracricoid laryngectomy using the lateral approach. The key point of the procedure was a subfascial dissection with the harvesting of anterior cervical flap including skin, fat, platysma, fascia superficialis, anterior jugular veins, homo- and sterno-hyoid muscles.ConclusionSupracricoid laryngectomy by a lateral approach is feasible and safe; it allows to perform a simultaneous neck dissection and the removal of the entire laryngeal specimen preserving ample healthy tissue compared to the classic anterior approach.
http://ift.tt/2tmhais
Treatment of laryngopharyngeal reflux using a sleep positioning device: A prospective cohort study
Source:American Journal of Otolaryngology
Author(s): William S. Tierney, Scott L. Gabbard, Claudio F. Milstein, Michael S. Benninger, Paul C. Bryson
ObjectiveLaryngopharyngeal reflux (LPR) symptoms are often resistant to management and cause significant quality of life impairment to patients with this disease. This study assesses the utility of a sleep-positioning device (SPD) in treating LPR.DesignSingle center prospective cohort study.SettingTertiary medical centerParticipants27 adult patients with diagnosed laryngopharyngeal reflux.InterventionAn SPD consisting of a two-component wedge-shaped base pillow and a lateral positioning body pillow (Medcline, Amenity Health Inc.) was given to patients with a diagnosis of LPR. Subjects slept using the device for at least 6h per night for 28 consecutive nights.Main outcomesPrimary outcomes were Nocturnal Gastroesophageal Reflux Symptom Severity and Impact Questionnaire (N-GSSIQ) and the Reflux Symptoms Index (RSI) survey instrument. Each was collected at baseline, after 14, and after 28days of SPD use.Results27 patients (19 female and 8 male; age 57.1±12.8, BMI 29.0±8.1) were recruited. At baseline mean N-GSSIQ was 50.1±22.4 and mean RSI of 29.6±7.7. Repeated measure analysis showed that subjects' total N-GSSIQ scores decreased by an average of 19.1 (p=0.0004) points by two weeks and 26.5 points by 4weeks (p<0.0001). RSI decreased an average of 5.3 points by 2weeks (p=0.0425) and an average of 14.0 points by 4weeks (p<0.0001).ConclusionsIn patients with LPR, SPD treatment significantly improves self-reported symptoms of nocturnal reflux as well as symptoms specific to LPR. These results support the therapeutic efficacy of a SPD for patients with LPR.
http://ift.tt/2tVN02P
Prospective analysis of 231 elective neck dissections in oral squamous cell carcinoma with node negative neck—To decide the extent of neck dissection
Source:Auris Nasus Larynx
Author(s): Sangeet Kumar Agarwal, Nisha Rajrattansingh Akali, Deepak Sarin
ObjectiveTo evaluate the incidence of level IIB and IV lymph node metastases in patients of oral carcinoma with N0 necks. This study will help to decide the extent and need of routine comprehensive removal of these specific lymph node groups in selective neck dissection.MethodsProspective analytical study of 231 patients of oral carcinoma with N0 necks undergoing neck dissections were prospectively analyzed. The incidence of metastases at level IIB and IV were then observed.Results71 (30.73%) out of 231 cases had microscopic metastatic lymphadenopathy. Lymph node metastases from oral cancers were seen predominantly at levels IB and IIA. Metastases at levels IIB and IV were very rare (0.86% and 0%, respectively). Metastases at level IIB was associated with metastases at the level IIA in both cases (100%) and with level IB in 1 case (50%). 27 (11.68%) out of 231 cases had positive IIA nodes and conversely, only 7.4% (2/27) of all level IIA metastases had positive nodes at level IIB.ConclusionSelective neck dissection from I–III may be adequate for majority of patients with oral cancers. Level IIB and IV need not be dissected in N0 patients.
http://ift.tt/2sk2f3y
Ocular vestibular evoked myogenic potential in patients with myasthenia gravis
Source:Auris Nasus Larynx
Author(s): Mohammad El-Sayed Mojahed, Elsaeid Mohamed Thabet, Mohamed Galal El-Khateeb, Ashraf Elsayed Morgan
ObjectiveMyasthenia gravis (MG) is an archetypic disorder of neuromuscular junctions (NMJs) and autoantibody-mediated disease causing fatigable weakness of skeletal muscles with an ocular onset in up to 85%. The aim of this study was to detect extra ocular muscles (EOMs) abnormalities in MG patients using ocular vestibular evoked myogenic potential (oVEMP) n10 response.MethodsThe oVEMP was performed on 40 myasthenia gravis patients that were divided into three groups: newly diagnosed (10 patients), uncontrolled on treatment (15 patients) and controlled on treatment (15 patients) groups in addition to a control group of 10 subjects. Also a comparison of oVEMP response was held between patients with generalized and ocular MG.ResultsThe oVEMP n10 showed significant difference between the 3 study groups and the control. The n10 showed no significant difference between the newly diagnosed group and the other 2 groups. There was also significant difference between uncontrolled and controlled on treatment group and between generalized and ocular types of myasthenic patients.ConclusionThe oVEMP can be usefully used in diagnosis of new MG patients as regard n10 amplitude, threshold and AR except n10 latency with no therapeutic or monitoring value of oVEMP in MG.
http://ift.tt/2skdV67
A novel strategy with combined assays for detection of anti-neutrophil cytoplasmic antibody (ANCA) in clinically ANCA-negative granulomatosis with polyangiitis patients
Source:Auris Nasus Larynx
Author(s): Kaori Tateyama, Satoru Kodama, Kan Kishibe, Yasuaki Harabuchi, Masashi Suzuki
ObjectiveGranulomatosis with polyangiitis (GPA) that is localized to the upper airway presents a diagnostic challenge because of a tendency towards anti-neutrophil cytoplasmic antibody (ANCA)-negativity. The purpose of this study was to investigate whether positivity of ANCA detection might be elicited with combined use of enzyme-linked immunosorbent assay (ELISA) kits.MethodsTwenty-nine serum samples obtained from GPA patients were used in this study. In addition to routine biochemical investigation for ANCA, tests for detecting PR3-, MPO-ANCAs, and minor ANCAs were performed with commercially available ELISA kits. Cytoplasmic (C)-ANCA and perinuclear (P)-ANCA were evaluated using the indirect immunofluorescence (IIF) technique.ResultsTwelve patients were positive for PR3- or MPO-ANCA in the clinical laboratory test, and 17 patients were negative for both ANCAs. Of the 17 ANCA-negative patients, four were positive for PR3- or MPO-ANCA, and three were positive for minor ANCA according to results obtained from six different ELISA kits. These findings indicated that performing detection tests with six different ELISA kits might improve the positivity of ANCA and might contribute to establishing the diagnosis of ANCA-associated vasculitis. Together with results from IIF, the samples of eight patients with clinically ANCA-negative results (8/17, 47.1%) were converted to ANCA-positive results, and the ANCA detection rate was significantly improved from 12/29 (41.4%) to 20/29 (69.0%, p=0.03).ConclusionsAdditional detection techniques should be used to confirm the results of clinically ANCA-negative samples, particularly when vasculitis is suspected. Minor ANCAs should also be evaluated with detection tests when PR3- and MPO-ANCA are negative.
http://ift.tt/2sOW36U
US News Releases Top Peds Hospital List, With Few Surprises
Boston Children's Hospital took first place in the magazine's 2017-2018 honor roll for the third straight year.
Medscape Medical News
http://ift.tt/2te1UmP
The association between interleukin-28B gene polymorphisms as a potential biomarker and the risk of chronic Periodontitis in an Iranian population
Chronic Periodontitis (CP) is a common inflammatory disease affects supporting tissues of the teeth and can lead to tooth loss. The objective of this s...
http://ift.tt/2rYqPrm
Oral Manifestations of Gastrointestinal Disorders
Publication date: Available online 26 June 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Lina Maria Mejia
http://ift.tt/2thASeE
LEI0258 microsatellite variability and its association with humoral and cell mediated immune responses in broiler chickens
Source:Molecular Immunology, Volume 90
Author(s): Atefeh Esmailnejad, Gholamreza Nikbakht Brujeni, Maryam Badavam
Major histocompatibility complex (MHC) has a profound influence on disease resistance or susceptibility, productivity and important economic traits in chicken. Association of the MHC with a wide range of immune responses makes it a valuable predictive factor for the disease pathogenesis and outcome. The tandem repeat LEI0258 is a genetic marker which is located within the B locus of chicken MHC and strongly associated with serologically defined haplotypes. LEI0258 microsatellite marker was applied to investigate the MHC polymorphism in Ross 308 broiler chicken (N=104). Association of LEI0258 alleles with humoral and cell mediated immune responses to Newcastle disease (ND), Infectious bursal disease (IBD) and Avian influenza (AI) vaccines were also examined. LEI0258 polymorphism was determined by PCR-based fragment analysis, and association of LEI0258 alleles with immune responses were evaluated using multivariate regression analysis and GLM procedures. A total of seven alleles ranging from 195 to 448bp were found, including two novel alleles (263 and 362bp) that were unique in Ross 308 broiler population. Association study revealed a significant influence of MHC alleles on humoral and cellular immune responses in Ross population (P<0.05). Alleles 385 and 448bp were associated with increased peripheral blood lymphocyte proliferation response. Alleles 300, 362 and 448bp had a positive effect on immune responses to Infectious bursal disease vaccine, and allele 263bp was significantly correlated with elevated antibody titer against Newcastle disease vaccine. Results obtained from this study confirmed the important role of MHC as a candidate gene marker for immune responses that could be used in genetic improvement of disease-resistant traits and resource conservation in broiler population.
http://ift.tt/2ueTKYJ
Activating transcription factor 3 protects mice against pseudomonas aeruginosa-induced acute lung injury by interacting with lipopolysaccharide binding protein
Source:Molecular Immunology, Volume 90
Author(s): Yunfeng Zhao, Xiulin Wu, Lanlan Qian, Liang Guo, Jiangrong Liao, Xueling Wu
Excessive inflammatory response is critical event in the pathogenesis of acute lung injury (ALI). Previous study has shown that activating transcription factor 3 (ATF3) plays a role in downregulate inflammatory responses including ventilation-induced ALI. We hypothesized that ATF3 have a protective effect in ALI induced by pseudomonas aeruginosa. PA was intra-tracheally administrated to ATF3 knock-out (KO) mice to establish ALI model. Inflammatory factors, BALF protein, lung wet to dry ratio, lung injury score and mortality were determined. The activation of NF-κB was detected by western blot and Co-immunoprecipitation (Co-ip) was used to determinate the binding of ATF3 to LBP. Peritoneal macrophages were isolated from ATF3 KO mice and stimulated by PA. PA increased the expression of ATF3 in the lung tissues in ATF3 wild type (WT) mice. ATF3 deficiency significantly increased the concentration of TNFα, IL-6 and IL-1β in the supernatant of peritoneal macrophages, lung tissue and BALF after PA stimulation and also enhanced the activity of NF-κB. ATF3 deficiency also enhanced the BALF protein concentration and increased the lung wet to dry ratio. The lung injury score and mortality were higher in ATF3 KO mice treated with PA. Moreover, ATF3 was demonstrated to bind to LBP These finding suggest ATF3 protect mice against ALI induced by PA partly due to the binding to LBP.
http://ift.tt/2thrR5b
Severe hidradenitis suppurativa responding to treatment with secukinumab: a case report
Abstract
An inappropriate immunologic response to an unknown antigen has been suggested to play a role in the pathogenesis of Hidradenitis suppurativa (HS). Studies have identified elevated levels of several proinflammatory cytokines, including IL-17A and TNF-α, nominating these as possible therapeutic targets.1 Secukinumab is an Il-17A monoclonal antibody, which binds to Il-17A and inhibits the cytokine interaction with the Il-17 receptors, inhibiting the inflammatory cascade. Here we report on a case of a 47-year-old man, with Hurley Stage III lesions at the neck, axillae, breasts, genital skin and buttocks, who had experienced only temporary benefit from different medical treatments over the years. After 12 weeks of treatment with secukinumab the number of lesions reported reported by the patient within the period of the last 4 weeks was reduced from 23 to 7, pain VAS was reduced from 5 to 3 and pain/utility/handicap VAS was reduced from 7 to 4. The results may be taken to imply that IL-17 blockade could provide a possible therapeutic approach in HS.
This article is protected by copyright. All rights reserved.
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Endoscopic Myringoplasty Versus Microscopic Myringoplasty in Tubotympanic CSOM: A Comparative Study of 120 Cases
Abstract
Myringoplasty is one of the commonest operations performed on the middle ear. Our aim was to compare the results of endoscopic permeatal myringoplasty with that of conventional myringoplasty by post aural approach using operating microscope. A total of 120 patients having central perforation of tympanic membrane were randomly divided into two equal groups of 60 patients each. In the first group, endoscope was used and in the second group microscope was used to do myringoplasty. Temporalis fascia was used as a graft material. The patients were kept in follow-up for 1 year. The pre-operative and post-operative audiograms, post-operative pain, graft uptake and time taken for surgery were compared in both the groups. The graft uptake rate was 91.67% in the endoscopic group, whereas it was 93.3% in the microscopic group. Post-operative pain was significantly less in the endoscopic group as compared with microscopic group and not much difference was found in the gain in A-B gap in either group. The mean ABG gain was 16.16 dB (SD = 4.68) in endoscopic group and 19.54 dB (SD = 3.45) in microscopic group. On applying the Mann–Whitney U test, this finding was statistically significant (p value = 0.0001). In our study success rate was equal between endoscopic and microscopic technique. In terms of morbidity and postoperative recovery endoscope produced better results. Endoscopic tympanoplasty can be a good alternative of microscopic tympanoplasty.
http://ift.tt/2udwbPR
Phase 1 Clinical Trial of Metastasis Inhibitor NP-G2-044 in Patients With Advanced or Metastatic Solid Tumors (Including Lymphoma)
Conditions: Breast Cancer; Pancreas Cancer; Prostate Cancer; Lung Cancer; Colon Cancer; Esophagus Cancer; Liver Cancer; Ovary Cancer; Lymphoma
Intervention: Drug: NP-G2-044
Sponsors: Novita Pharmaceuticals, Inc.; Translational Drug Development
Not yet recruiting - verified June 2017
http://ift.tt/2tiPivK
Intervention: Drug: NP-G2-044
Sponsors: Novita Pharmaceuticals, Inc.; Translational Drug Development
Not yet recruiting - verified June 2017
http://ift.tt/2tiPivK
Neoadjuvant Anti-PD-1 Antibody SHR-1210 and Radiation in Resectable Esophageal Squamous Cell Carcinoma
Conditions: Esophageal Neoplasms; Esophageal Diseases
Interventions: Radiation: 3-DCRT or IMRT radiation; Drug: anti-PD-1 antibody SHR-1210
Sponsors: Hangzhou Cancer Hospital; Jiangsu HengRui Medicine Co., Ltd.
Recruiting - verified June 2017
http://ift.tt/2tRO6MK
Interventions: Radiation: 3-DCRT or IMRT radiation; Drug: anti-PD-1 antibody SHR-1210
Sponsors: Hangzhou Cancer Hospital; Jiangsu HengRui Medicine Co., Ltd.
Recruiting - verified June 2017
http://ift.tt/2tRO6MK
A Clinical Study of Apatinib in Patients With Local Progressive/Metastalic Refractory Thyroid Cancer
Condition: Refractory Cancer
Intervention: Drug: Apatinib
Sponsor: Chinese Academy of Medical Sciences
Recruiting - verified June 2017
http://ift.tt/2tiKsPb
Intervention: Drug: Apatinib
Sponsor: Chinese Academy of Medical Sciences
Recruiting - verified June 2017
http://ift.tt/2tiKsPb
Multiple Bony Injuries on Bone Scan in a Case of Unsuspected Child Abuse
This case is described of an eleven-month-old infant with lower limbs swelling and the left elbow skeletal malformation following a fall. The radionuclide bone scan was performed to exclude bone infection or congenital skeletal anomaly. The images unexpectedly showed multiple increased radioactive foci throughout the whole body. It was a strong probability of child abuse. All lesions are readily apparent on the following plain film radiographs and MRI.
http://ift.tt/2rXurd1
Do antiplatelet drugs increase the risk of bleeding after tooth extraction? A case-crossover study
Publication date: Available online 26 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): F. Akhlaghi, I. Khaheshi, S. Amirhassani, R. Tabrizi
The aim of this study was to assess the risk of bleeding after tooth extraction in patients taking aspirin or clopidogrel. This case-crossover study evaluated patients taking aspirin (80mg/day) or clopidogrel (75mg/day) and undergoing tooth extraction. In the first session, extraction was performed without discontinuing aspirin (group 1) or clopidogrel (group 2). In the second session, patients ceased using antiplatelet drugs 5days prior to tooth extraction. Bleeding was evaluated using a visual analogue scale (VAS) for 72h after tooth extraction. The platelet function assay (PFA) was performed for group 1 and flow cytometry assessment of vasodilator-stimulated phosphoprotein (VASP) was performed for group 2, in both sessions. Thirty-eight patients were studied: 20 in group 1 and 18 in group 2. Analysis of the data did not demonstrate any difference in bleeding severity between sessions 1 and 2 in either group (P>0.05). There was a significant difference between sessions 1 and 2 in group 1 for the mean collagen/epinephrine membrane closure time (PFA) (P=0.001). A significant difference in platelet reactivity index (flow cytometry for VASP) was noted between sessions 1 and 2 in group 2 (P=0.001). According to this case-crossover study, dental extraction can be performed safely without withdrawal of aspirin or clopidogrel.
http://ift.tt/2ud5Qlc
Intraoral vertico-sagittal ramus osteotomy: modification of the L-shaped osteotomy
Publication date: Available online 26 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Iwanaga, S. Kikuta, M. Nakamura, A. Koba, K. Ogata, S. Toyofuku, R.S. Tubbs, J. Kusukawa
The sagittal split ramus osteotomy and intraoral vertical ramus osteotomy carry the potential risk of postoperative nerve paralysis, bleeding, and fracture and dislocation of the condyle. In 1992, Choung first described the intraoral vertico-sagittal ramus osteotomy for the purpose of avoiding postoperative dislocation of the condyle. However, there is still potential for damaging the inferior alveolar nerve and maxillary artery with this technique. The authors have developed a modified technique to minimize these risks. An evaluation of surgical experience and patient outcomes with the use of this technique is presented herein. One hundred twenty-two sides in 97 Japanese patients diagnosed with a jaw deformity were analyzed. This technique includes a horizontal osteotomy that is performed at a higher position than in the original Choung procedure. Intraoperatively, there was no unexpected bleeding from the operative site. Proximal segment dislocation from the glenoid fossa was observed on one side (0.82%). Non-union of the osteotomy was not observed in any patient. Intraoperative fracture of the coronoid process occurred in 2.46%, but none necessitated treatment of the fracture. Nerve dysfunction was found in 2.46% at the 12-month postoperative follow-up. The modified technique presented herein was developed to reduce postoperative nerve dysfunction and intraoperative hemorrhage.
http://ift.tt/2tfZoMV
The application of a delayed expansion technique for horizontal alveolar ridge augmentation in dental implantation
Publication date: Available online 26 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): X. Li, P. Xu, X. Xu, S. Liu
The aim of this study was to evaluate the application of delayed expansion of the alveolar ridge in dental implantation. This method avoids the need to harvest autogenous bone and the requirement to fix a block with screws, and could help prevent the uncontrolled fracture and avascular necrosis that may result from the traditional alveolar split. Eighteen patients and 43 implants were included in this retrospective study. The width of the alveolar ridge was measured before implantation, immediately after implantation, and after the final restoration. The width increased significantly after the insertion of implants and decreased slightly after bone remodelling. Overall, the width of the alveolar ridge increased by 2.37±1.44mm on average, ranging from −0.20mm to 5.75mm. The results suggest the use of delayed expansion for horizontal alveolar bone augmentation; however, the maxillary premolar area may not be a suitable site.
http://ift.tt/2ud5POa
Antibacterial resistance and the success of tailored triple therapy in Helicobacter pylori strains isolated from Slovenian children
Abstract
Background
Primary Helicobacter pylori (H. pylori) infection occurs predominantly in childhood. Antimicrobial resistance is the leading cause for H. pylori eradication failure. The aims of this study were (i) to establish for the first time the antimicrobial resistance of H. pylori strains in infected Slovenian children not previously treated for H. pylori infection and (ii) to evaluate the effectiveness of tailored triple therapy, assuming that eradication rate with tailored triple therapy will be >90%.
Methods
Data on all treatment-naive children 1-18 years old and treated for H. pylori infection according to susceptibility testing were retrospectively analyzed. All relevant clinical information and demographical information were retrospectively collected from the hospital information systems and/or patients' medical documentation.
Results
The inclusion criteria were met by 107 children (64.5% girls) with a median age of 12.0 years (range 2.0-17.6 years). Primary antimicrobial resistance rates of H. pylori were 1.0% to amoxicillin (AMO), 23.4% to clarithromycin (CLA), 20.2% to metronidazole (MET), 2.8% to levofloxacin (LEV), and 0.0% to tetracycline (TET). Dual resistances were detected to CLA and MET in 11.5% (n=12) of strains, to CLA and LEV in 2.8% (n=3), and to MET and LEV in 2.9% (n=3). Results of treatment success were available for 71 patients (66.2% girls). Eradication of H. pylori was evaluated using the 13C-urea breath test, monoclonal stool antigen test or in some cases with repeated upper GI endoscopy with histology and cultivation/molecular tests. Eradication was achieved in 61 of 71 (85.9%) patients.
Conclusions
The primary resistance rates of H. pylori to CLA and MET in Slovenia are high. Our data strongly support the fact that in countries with high prevalence of resistant H. pylori strains susceptibility testing and tailored therapy is essential.
http://ift.tt/2rXuF3E
Synchronous parotid and nasopharyngeal Warthin's tumor: case report and literature review
Publication date: Available online 27 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Tom Ben-Dov, Evgeny Edelstein, Ben I. Nageris, Firas Kassem
http://ift.tt/2scxDFS
Short-term evaluation of tegumentary changes of the nose in oral breathers undergoing rapid maxillary expansion
Publication date: Available online 26 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fauze Ramez Badreddine, Reginaldo Raimundo Fujita, Mario Cappellette
IntroductionRapid maxillary expansion (RME) is an orthodontic and orthopedic procedure that can change the form and function of the nose. The soft tissue of the nose and its changes can influence the esthetics and the stability of the results obtained by the RME.ObjectiveThe objective of this study was to assess the changes in nose dimensions after rapid maxillary expansion (RME) in oral breathers with maxillary atresia, using a reliable and reproducible methodology through computed tomography.MethodsA total of 30 mouth-breathing patients with maxillary atresia were analyzed and divided into a Treatment Group (TG) who underwent RME (20 patients, 10 of which were male and 10 female, with a MA of 8.9 years and a SD of 2.16, ranging from 6.5 to 12.5 years) and a Control Group (CG) (10 patients, 5 of which were male and 5 female, with a MA of 9.2 years, SD of 2.17, ranging from 6.11 to 13.7 years). In the TG, multislice computed tomography (CT) scans were obtained at the start of the treatment (T1) and 3 months after expansion (T2). The patients of the CG were submitted to the same exams at the same intervals of time. Four variables related to soft tissue structures of the nose were analyzed (alar base width, alar width, height of soft tissue of the nose and length of soft tissue of the nose), and the outcomes between T1 and T2 were compared using Osirix MD software.ResultsIn the TG, the soft tissues of the nose exhibited significant increases in all variables studied (p<0.05), whereas, changes did not occur in the CG (p>0.05). In the TG, mean alar base width increased by 4.87% (p=0.004), mean alar width increased by 4.04% (p=0.004), mean height of the soft tissues of the nose increased by 4.84% (p=0.003) and mean length of the soft tissues of the nose increased by 4.29% (p=0.012).ConclusionIn short-term, RME provided a statistically significant increase in the dimensions of the soft tissues of the nose.
http://ift.tt/2sWlbaw
IRF6 rs2235375 single nucleotide polymorphism is associated with non-syndromic cleft palate only but not cleft lip with or without palate in south Indian population
Publication date: Available online 26 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Venkatesh Babu Gurramkonda, Altaf Hussain Syed, Jyotsna Murthy, Bhaskar V.K.S. Lakkakula
IntroductionTranscription factors are very diverse family of proteins involved in activating or repressing the transcription of a gene at a given time. Several studies using animal models demonstrated the role of transcription factor genes in craniofacial development.ObjectiveWe aimed to investigate the association of IRF6 intron-6 polymorphism in the non-syndromic cleft lip with or without Palate (NSCL/P) in a south Indian population.Methods173 unrelated NSCL/P patients and 176 controls without clefts patients were genotyped for IRF6 rs2235375 variant by allele-specific amplification using the KASPar single nucleotide polymorphism (SNP) genotyping system. The association between interferon regulatory factor-6 (IRF6) intron-6 dbSNP208032210:g.G>C (rs2235375) SNP and NSCL/P risk was investigated by chi-square test.ResultsThere were significant differences in genotype or allele frequencies of rs2235375 SNP between controls and cases with NSCL/P. IRF6 rs2235375 variant was significantly associated with increased risk of NSCL/P in co-dominant, dominant (OR: 1.19; 95% CI 1.03–2.51; p=0.034) and allelic models (OR: 1.40; 95% CI 1.04–1.90; p=0.028). When subset analysis was applied significantly increased risk was observed in cleft palate only (CPO) group (OR dominant: 4.33; 95% CI 1.44–12.97; p=0.005).ConclusionThese results suggest that IRF6 rs2235375 SNP play a major role in the pathogenesis and risk of developing NSCL/P.
http://ift.tt/2scH9sl
First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP)
Publication date: Available online 27 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Melissa A.G. Avelino, Rebecca Maunsell, Fabiana Cardoso Pereira Valera, José Faibes Lubianca Neto, Cláudia Schweiger, Carolina Sponchiado Miura, Vitor Guo Chein, Dayse Manrique, Raquel Oliveira, Fabiano Gavazzoni, Isabela Furtado de Mendonça Picinin, Paulo Bittencourt, Paulo Camargos, Fernanda Peixoto, Marcelo Luiz Brandão, Tania Maria Sih, Wilma Terezinha Anselmo-Lima
IntroductionTracheostomy is a procedure that can be performed in any age group, including children under 1-year of age. Unfortunately, in Brazil huge difficulty exists for health professionals to deal with this condition, as well as lack of care standardization.ObjectiveThis clinical consensus carried out by ABOPe and SBP aims to generate national recommendations on the care and conducts concerning tracheostomized children.MethodsA group of experts experienced in childhood tracheostomy (otorhinolaryngologists, intensive care pediatricians, endoscopists, and pneumopediatricians) and proven practical practice in the subject were selected, also considering the different regions of Brazil, according to the inclusion and exclusion criteria.ResultsThe results generated from this document were based on the agreement of most participants regarding the indications, type of cannula, surgical techniques, care, and general guidelines and decannulation.ConclusionThese guidelines can be used as directives for a wide range of health professionals across the country who deal with the difficulties of tracheostomized children.
http://ift.tt/2sWmXs1
Examining the importance of laboratory and diagnostic testing when treating and diagnosing onychomycosis
Abstract
Onychomycosis is a fungal nail infection caused primarily by dermatophytes. Several other nail disorders, including psoriasis, can simulate onychomycosis. Accurate diagnosis is therefore vital for the ongoing treatment and management of onychomycosis and to avoid misdiagnosis and treatment delay, which can be both lengthy and costly. Often, a combination of histologic and laboratory techniques is used to obtain an accurate diagnosis. The potential diagnostic challenges associated with the differential diagnosis of onychomycosis caused by dermatophytes and the most common techniques used to confirm the diagnosis are discussed.
http://ift.tt/2sWrNp0
Proteases, actinidin, papain and trypsin reduce oral biofilm on the tongue in elderly subjects and in vitro
Source:Archives of Oral Biology, Volume 82
Author(s): Naho Mugita, Takayuki Nambu, Kazuya Takahashi, Pao-Li Wang, Yutaka Komasa
ObjectiveDental plaque is a causative factor for oral disease and a potential reservoir for respiratory infection in the elderly. Therefore, there is a critical need for the development of effective methods to remove oral biofilm. The objective of this study was to investigate the effect of proteases on oral biofilm formation andremoval.DesignThe in vivo effect of actinidin, a cysteine protease, on the removal of tongue coating was assessed after orally taking a protease tablet. Effects of the proteases trypsin, papain and actinidin on Actinomyces monospecies biofilm and multispecies biofilm that was reconstructed using a plaque sample from the tongue coating were investigated using the microtiter plate method. Antimicrobial tests and limited proteolysis of fimbrial shaft proteins were also performed to clarify underlying mechanisms of oral biofilm removal.ResultsTablets containing actinidin removed tongue coating in elderly subjects. Oral Actinomyces biofilm was significantly reduced by the proteases papain, actinidin and trypsin. Papain and trypsin effectively digested the major fimbrial proteins, FimP and FimA, from Actinomyces. Actinidin, papain and trypsin reduced multispecies biofilm that was reconstructed in vitro. Papain and trypsin inhibited formation of multispecies biofilm in vitro.ConclusionsThis study shows that proteases reduced oral biofilm in vivo in elderly subjects and in vitro, and suggests that protease digests fimbriae and inhibits biofilm formation.
http://ift.tt/2sMnm1D
Proteases, actinidin, papain and trypsin reduce oral biofilm on the tongue in elderly subjects and in vitro
Source:Archives of Oral Biology, Volume 82
Author(s): Naho Mugita, Takayuki Nambu, Kazuya Takahashi, Pao-Li Wang, Yutaka Komasa
ObjectiveDental plaque is a causative factor for oral disease and a potential reservoir for respiratory infection in the elderly. Therefore, there is a critical need for the development of effective methods to remove oral biofilm. The objective of this study was to investigate the effect of proteases on oral biofilm formation andremoval.DesignThe in vivo effect of actinidin, a cysteine protease, on the removal of tongue coating was assessed after orally taking a protease tablet. Effects of the proteases trypsin, papain and actinidin on Actinomyces monospecies biofilm and multispecies biofilm that was reconstructed using a plaque sample from the tongue coating were investigated using the microtiter plate method. Antimicrobial tests and limited proteolysis of fimbrial shaft proteins were also performed to clarify underlying mechanisms of oral biofilm removal.ResultsTablets containing actinidin removed tongue coating in elderly subjects. Oral Actinomyces biofilm was significantly reduced by the proteases papain, actinidin and trypsin. Papain and trypsin effectively digested the major fimbrial proteins, FimP and FimA, from Actinomyces. Actinidin, papain and trypsin reduced multispecies biofilm that was reconstructed in vitro. Papain and trypsin inhibited formation of multispecies biofilm in vitro.ConclusionsThis study shows that proteases reduced oral biofilm in vivo in elderly subjects and in vitro, and suggests that protease digests fimbriae and inhibits biofilm formation.
http://ift.tt/2sMnm1D
Names and phenotypes of CD163 positive macrophages in oral precancerous lesions
Source:Oral Oncology
Author(s): Xianghe Qiao, Longjiang Li, Chunjie Li
http://ift.tt/2sh78KC
Neighborhood deprivation and risk of head and neck cancer: A multilevel analysis from France
Source:Oral Oncology, Volume 71
Author(s): Joséphine Bryere, Gwenn Menvielle, Olivier Dejardin, Ludivine Launay, Florence Molinie, Isabelle Stucker, Daniele Luce, Guy Launoy
BackgroundWhile it is known that cancer risk is related to area-level socioeconomic status, the extent to which these inequalities are explained by contextual effects is poorly documented especially for head and neck cancer.MethodsA case-control study, ICARE, included 2415 head and neck cancer cases and 3555 controls recruited between 2001 and 2007 from 10 French regions retrieved from a general cancer registry. Individual socioeconomic status was assessed using marital status, highest educational level and occupational social class. Area-level socioeconomic status was assessed using the French version of the European Deprivation Index (EDI). The relationship between both individual and area-based socioeconomic level and the risk of head and neck cancer was assessed by multilevel analyses.ResultsA higher risk for head and neck cancer was found in divorced compared with married individuals (OR=2.14, 95% CI=1.78–2.57), for individuals with a basic school-leaving qualification compared with those with higher education (OR=4.55 95% CI=3.72–5.57), for manual workers compared with managers (OR=4.91, 95% CI=3.92–6.15) and for individuals living in the most deprived areas compared with those living in the most affluent ones (OR=1.98, 95% CI=1.64–2.41). The influence of area-level socioeconomic status measured by EDI remained after controlling for individual socioeconomic characteristics (OR=1.51; 95% confidence interval: 1.23–1.85, p-value=0.0003).ConclusionsThe role of individual socioeconomic status in the risk of head and neck cancer is undeniable, although contextual effects of deprived areas also increase the susceptibility of individuals developing the disease.
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Predictive and prognostic value of CT based radiomics signature in locally advanced head and neck cancers patients treated with concurrent chemoradiotherapy or bioradiotherapy and its added value to Human Papillomavirus status
Source:Oral Oncology, Volume 71
Author(s): Dan Ou, Pierre Blanchard, Silvia Rosellini, Antonin Levy, France Nguyen, Ralph T.H. Leijenaar, Ingrid Garberis, Philippe Gorphe, François Bidault, Charles Ferté, Charlotte Robert, Odile Casiraghi, Jean-Yves Scoazec, Philippe Lambin, Stephane Temam, Eric Deutsch, Yungan Tao
ObjectivesTo explore prognostic and predictive value of radiomics in patients with locally advanced head and neck squamous cell carcinomas (LAHNSCC) treated with concurrent chemoradiotherapy (CRT) or bioradiotherapy (BRT).Materials and MethodsData of 120 patients (CRT vs. BRT matched 2:1) were retrospectively analyzed. A total of 544 radiomics features of the primary tumor were extracted from radiotherapy planning computed tomography scans. Cox proportional hazards models were used to examine the association between survival and radiomics features with false discovery rate correction. The discriminatory performance was evaluated using receiver operating characteristic curve analysis.ResultsMultivariate analysis showed a 24-feature based signature significantly predicted for OS (HR=0.3, P=0.02) and progression-free survival (PFS) (HR=0.3, P=0.01). Combining the radiomics signature with p16 status showed a significant improvement of prognostic performance compared with p16 (AUC=0.78vs. AUC=0.64 at 5years, P=0.01) or radiomics signature (AUC=0.78vs. AUC=0.67, P=0.01) alone. When patients were stratified according to this combination, OS and PFS were significantly different according to the 4 sub-types (p16+ with low/high signature score; p16− with low/high signature score) (P<0.001). Patients with high signature score significantly benefited from CRT (vs. BRT) in terms of OS (P=0.004), while no benefit from CRT in patients with low signature score.ConclusionOur analysis suggests an added value of radiomics features as prognostic and predictive biomarker in HNSCC treated with CRT/BRT. Moreover, the radiomics signature provided additional information to HPV/p16 status to further stratify patients. External validation of such findings is mandatory given the risk of overfitting.
http://ift.tt/2sh6ay0
Single Triangular Suture: A Modified Technique for Hyoid Suspension as a Treatment for Obstructive Sleep Apnea: our experience with twenty four patients
Abstract
1 Hyoid suspension is a part of a multilevel surgery concept that is often combined with other procedures as uvulopalatopharyngoplasty to treat obstructive sleep apnea.
2 Between February 2012 and November 2016, twenty- four patients underwent the single triangular suture technique for hyoid suspension as a treatment for obstructive sleep apnea.
3.Successful outcome was reported in 12 patients, while 9 patients were responders (reduced cardiovascular risk).
4.Postoperatively, the mean AHI dropped significantly and the mean lowest oxygen saturation level increased significantly.
5.The procedure is safe, well-tolerated by patients and has a readily progressive learning curve. It is an economic and less traumatic maneuver.
This article is protected by copyright. All rights reserved.
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Cutaneous implantation of papillary thyroid carcinoma secondary to percutaneous ethanol injection into nodal metastasis
Papillary thyroid carcinoma is the most common malignant neoplasm of the thyroid gland, accounting for 50-89% of the cases. It usually presents as a well-differentiated, slow-growing, malignant disease with common spread to locoregional lymph nodes and high recurrence rates. In patients with limited cervical lymph node metastases who are not candidates for surgery or radioiodine therapy, percutaneous ethanol injection (PEI) guided by ultrasonography has proven to be a valuable treatment alternative.
This article is protected by copyright. All rights reserved.
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Hailey-Hailey disease due to ATP2C1 splice-site mutation, successfully treated with minocycline hydrochloride
Hailey-Hailey disease (HHD) is an autosomal dominant disease characterized by acantholysis and caused by ATP2C1.1 Here, we report the first case of HHD successfully treated with minocycline alone in which the diagnosis was confirmed by gene analysis.
This article is protected by copyright. All rights reserved.
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Dual anti-inflammatory and antiparasitic action of topical ivermectin 1% in papulopustular rosacea
Abstract
Background
Recently, therapy of rosacea with inflammatory lesions (papulopustular) has improved substantially with the approval of topical ivermectin 1% cream. It is assumed to have a dual mode of action with anti-inflammatory capacities and anti-parasitic effect against Demodex, which however has not yet been demonstrated in vivo.
Aim
To find scientific rationale for the dual anti-inflammatory and anti-parasitic mode of action of topical ivermectin 1% cream in patients with rosacea.
Methods
A monocentric pilot study was performed including 20 Caucasian patients with moderate to severe rosacea, as assessed by investigator global assessment (IGA score ≥ 3) and a demodex density ≥ 15/cm2. Patients were treated with topical ivermectin 1% cream once daily (Soolantra®) for ≥12 weeks. The density of Demodex mites was assessed with skin surface biopsies. Expression of inflammatory and immune markers were evaluated with RT-PCR and by immunofluorescence staining.
Results
The mean density of mites was significantly decreased at week 6 and week 12 (p<0.001). The gene expression levels of IL-8, LL-37, HBD3, TLR4 and TNF-α were downregulated at both time points. Reductions in gene expression were significant for LL-37, HBD3 and TNF-α at both follow up time points and at week 12 for TLR4 (all p<0.05). Reduced LL-37 (p<0.05) and IL-8 expression was confirmed on the protein level by immunofluorescence staining. All patients improved clinically and 16 out of 20 patients reached therapeutic success defined as IGA score ≤ 1.
Conclusion
Topical ivermectin 1% cream acts by a dual, anti-inflammatory and anti-parasitic mode of action against rosacea by killing Demodex spp. in vivo, in addition to significantly improving clinical signs and symptoms in the skin.
This article is protected by copyright. All rights reserved.
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Dermatitis caused by arthropods in domestic environment: an Italian multicentre study
Abstract
Background
Skin diseases caused by mites and insects living in domestic environments have been rarely systematically studied.
Objectives
To study patients with dermatitis induced by arthropods in domestic environment describing their clinical features, isolating culprit arthropods and relating the clinical features to the parasitological data.
Methods
The study was performed in 105 subjects with clinical and anamnestic data compatible with the differential diagnosis of ectoparasitoses in domestic environments. Clinical data and arthropods findings obtained by indoor dust direct examination were studied.
Results
Indoor dust direct examination demonstrated possible arthropods infestation in 98 subjects (93.3%), more frequently mites (56.1%) (mainly Pyemotes ventricosus and Glycyphagus domesticus) than insects (43.9%) (mainly Formicidae and Bethylidae). Strophulus (46.9%) and urticaria-like eruption (36.7%) in upper limbs and trunk with severe extent were prevalent. Itch was mostly severe (66.3%) and continuous (55.1%). Ectoparasitoses occurred frequently with acute course in summer (44.9%) and spring (30.6%).
Conclusions
Possible correlation between clinical and aetiological diagnosis of arthropods ectoparasitoses in domestic environments needs the close cooperation between dermatologist and parasitologist. This is crucial to successfully and definitely resolve skin lesions by eradicating the factors favouring infestation.
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Paederus dermatitis outbreak in Luanda City, Angola
Paederus dermatitis (PD), dermatitis linearis or "ferro em brasa" is an inflammatory skin reaction against pederin, a vesicant non-proteinaceous toxin present in the hemolymph of Paederus spp. The beetle distributes along tropical and subtropical climates; it inhabits crop fields (rice), marshes and riverbanks to avoid desiccation. Paederus is more active during the earliest hours after sunset and it is attracted by artificial lights, so humans are usually exposed at night in urban and suburban areas.
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Intraepidermal neutrophilic dermatosis type of IgA pemphigus with circulating linear IgA disease antibodies associated with ulcerative colitis
A 42-year-old woman with ulcerative colitis previously well controlled on mesalazine presented with blistering, crusts and severe itching on her upper body and legs together with painful erosions on her conjunctivae and oral mucous membranes in addition to active bowel symptoms for two weeks. Clinical examination revealed multiple lesions consisting of vesiculopustules with circinate distribution and central crusts in sunflower-like configuration on her flanks and legs, a typical characteristic of intraepidermal neutrophilic dermatosis (IEN)-type of IgA pemphigus (Figure 1A and 1C) [1]. Lips, nasolabial folds and eyelids were affected by yellow crusts and erosions on erythematous base (Figure 1B).
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A Familial Mediterranean Fever flare induced by a Drug Reaction with Eosinophilia and Systemic Symptoms
Familial Mediterranean Fever (FMF) is an autosomal recessive inherited auto-inflammatory disease revealed by flare episodes characterized by systemic symptoms (pleural, joint serositis, abdominal pain…) that are triggered by infections, cold or menstruations. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe cutaneous adverse reaction characterized by visceral involvement and viral reactivation including HHV6, HHV7, EBV, CMV… and may be associated with certain HLA alleles.
This article is protected by copyright. All rights reserved.
http://ift.tt/2sWczQY
The Role of IL-23 and the IL-23/TH17 Immune Axis in the Pathogenesis and Treatment of Psoriasis
Abstract
Psoriasis is a chronic, immune-mediated disease affecting more than 100 million people worldwide and up to 2.2% of the UK population. The etiology of psoriasis is thought to originate from an interplay of genetic, environmental, infectious, and lifestyle factors. The manner in which genetic and environmental factors interact to contribute to the molecular disease mechanisms has remained elusive. However, the interleukin 23 (IL-23)/T-helper 17 (TH17) immune axis has been identified as a major immune pathway in psoriasis disease pathogenesis. Central to this pathway is the cytokine IL-23, a heterodimer composed of a p40 subunit also found in IL-12 and a p19 subunit exclusive to IL-23. IL-23 is important for maintaining TH17 responses, and levels of IL-23 are elevated in psoriatic skin compared with non-lesional skin. A number of agents that specifically inhibit IL-23p19 are currently in development for the treatment of moderate to severe plaque psoriasis, with recent clinical trials demonstrating efficacy with a good safety and tolerability profile. These data support the role of this cytokine in the pathogenesis of psoriasis. A better understanding of the IL-23/TH17 immune axis is vital and will promote the development of additional targets for psoriasis and other inflammatory diseases that share similar genetic etiology and pathogenetic pathways.
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http://ift.tt/2scjrMX
Cutaneous Leishmania tropica in children: report of three imported cases successfully treated with liposomal amphotericin B
Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis, being endemic in more than 90 countries around the world. The increasing number of international travelers to endemic areas has favored the expanding number of imported cases, making CL a mayor health issue.1,2 Herein, we report three immunocompetent children with multifocal CL caused by Leishmania tropica who received systemic therapy with liposomal amphotericin B (L-AmB).
This article is protected by copyright. All rights reserved.
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Do antiplatelet drugs increase the risk of bleeding after tooth extraction? A case-crossover study
The aim of this study was to assess the risk of bleeding after tooth extraction in patients taking aspirin or clopidogrel. This case-crossover study evaluated patients taking aspirin (80mg/day) or clopidogrel (75mg/day) and undergoing tooth extraction. In the first session, extraction was performed without discontinuing aspirin (group 1) or clopidogrel (group 2). In the second session, patients ceased using antiplatelet drugs 5days prior to tooth extraction. Bleeding was evaluated using a visual analogue scale (VAS) for 72h after tooth extraction.
http://ift.tt/2schnEF
The application of a delayed expansion technique for horizontal alveolar ridge augmentation in dental implantation
The aim of this study was to evaluate the application of delayed expansion of the alveolar ridge in dental implantation. This method avoids the need to harvest autogenous bone and the requirement to fix a block with screws, and could help prevent the uncontrolled fracture and avascular necrosis that may result from the traditional alveolar split. Eighteen patients and 43 implants were included in this retrospective study. The width of the alveolar ridge was measured before implantation, immediately after implantation, and after the final restoration.
http://ift.tt/2sVZ8k1
Intraoral vertico-sagittal ramus osteotomy: modification of the L-shaped osteotomy
The sagittal split ramus osteotomy and intraoral vertical ramus osteotomy carry the potential risk of postoperative nerve paralysis, bleeding, and fracture and dislocation of the condyle. In 1992, Choung first described the intraoral vertico-sagittal ramus osteotomy for the purpose of avoiding postoperative dislocation of the condyle. However, there is still potential for damaging the inferior alveolar nerve and maxillary artery with this technique. The authors have developed a modified technique to minimize these risks.
http://ift.tt/2sbZBla
The EVerT2 (Effective Verruca Treatments) Trial: a randomised controlled trial of needling versus nonsurgical debridement for the treatment of plantar verrucae
Abstract
Background
Verrucae are a common foot skin pathology which can in some cases persist for many years. Plantar verrucae can be unsightly and painful. There are a range of treatment options including needling.
Objectives
The EVerT2 trial aimed to evaluate the clinical and cost effectiveness of the needling procedure for the treatment of plantar verrucae, relative to callus debridement.
Methods
This single centre randomised controlled trial recruited 60 participants (aged 18 years and over with a plantar verruca). Participants were randomised 1:1 to the intervention group (needling) or the control group (debridement of the overlying callus). The primary outcome was clearance of the index verruca at 12 weeks after randomisation. Secondary outcomes include recurrence of the verruca; clearance of all verrucae; number of verrucae; size of the index verruca; pain; and participant satisfaction at 12 and 24 weeks. A cost-effectiveness analysis was carried out from the NHS perspective over 12 weeks.
Results
Sixty eligible patients were randomised (needling group n=29, 48.3%; debridement group n=31, 51.7%) and 53 were included in the primary analysis (needling n=28, 96.6%; debridement n=25, 80.7%). Clearance of the index verruca occurred in 8 (15.1%) participants (needling n=4, 14.3%; debridement n=4, 16.0%, p=0.86). The needling intervention costs were on average £14.33 (95% CI 5.32 to 23.35) more per patient than debridement.
Conclusions
There is no evidence that the needling technique is more clinically or cost effective than callus debridement. The results show a significant improvement in pain outcomes after needling compared to the debridement treatment alone.
This article is protected by copyright. All rights reserved.
http://ift.tt/2thlgIE
AHNS Series – Do you know your guidelines? Principles of treatment for glottic cancer: A review of the National Comprehensive Cancer Network guidelines
Abstract
This article is a continuation of the "Do You Know Your Guidelines" series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network (NCCN) guidelines for primary and adjuvant treatment of cancer of the glottic larynx are reviewed here in a systematic fashion according to stage.
http://ift.tt/2rWAjTH
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