Treatment of pruritus in a palliative care patient with low-dose paroxetine: a case report

Pruritus is a distressing symptom seen in palliative care. There is limited high-quality evidence of pharmaceutical treatments for pruritus in palliative care, including the use of paroxetine.

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How to write a Critically Appraised Topic: evidence to underpin routine clinical practice

Summary

Critically appraised topics (CATs) are essential tools for busy clinicians who wish to ensure that their daily clinical practice is underpinned by evidence-based medicine. CATs are short summaries of the most up-to-date, high-quality available evidence that is found using thorough structured methods. They can be used to answer specific, patient-orientated questions that arise recurrently in real-life practice. This article provides readers with a detailed guide to performing their own CATs. It is split into four main sections reflecting the four main steps involved in performing a CAT: formulation of a focused question, a search for the most relevant and highest-quality evidence, critical appraisal of the evidence and application of the results back to the patient scenario. As well as helping to improve patient care on an individual basis by answering specific clinical questions that arise, CATs can help spread and share knowledge with colleagues on an international level through publication in the evidence-based dermatology section of the British Journal of Dermatology.

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The meta‐analysis

Fernando de Andrade Quintanilha Ribeiro
Braz J Otorhinolaryngol 2017;83:497

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First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP)

Melissa A.G. Avelino, Rebecca Maunsell, Fabiana Cardoso Pereira Valera, José Faibes Lubianca Neto, Cláudia Schweiger, Carolina Sponchiado Miura, Vitor Guo Chen, Dayse Manrique, Raquel Oliveira, Fabiano Gavazzoni, Isabela Furtado de Mendonça Picinin, Paulo Bittencourt, Paulo Camargos, Fernanda Peixoto, Marcelo Barciela Brandão, Tania Maria Sih, Wilma Terezinha Anselmo‐Lima
Braz J Otorhinolaryngol 2017;83:498-506

Resumo - Texto Completo - PDF

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Impact of cartilage graft size on success of tympanoplasty

Waleed Abdelhameed, Ibrahim Rezk, Alhussein Awad
Braz J Otorhinolaryngol 2017;83:507-11

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Encoding of speech sounds at auditory brainstem level in good and poor hearing aid performers

Hemanth Narayan Shetty, Manjula Puttabasappa
Braz J Otorhinolaryngol 2017;83:512-22

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Profile and prevalence of hearing complaints in the elderly

Magda Aline Bauer, Ângela Kemel Zanella, Irênio Gomes Filho, Geraldo de Carli, Adriane Ribeiro Teixeira, Ângelo José Gonçalves Bós
Braz J Otorhinolaryngol 2017;83:523-9

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Preoperative vestibular assessment protocol of cochlear implant surgery: an analytical descriptive study

Roseli Saraiva Moreira Bittar, Eduardo Setsuo Sato, Douglas Jósimo Silva Ribeiro, Robinson Koji Tsuji
Braz J Otorhinolaryngol 2017;83:530-5

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Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings

Ibrahim Erdim, Ali Ahmet Sirin, Bahadir Baykal, Fatih Oghan, Ali Guvey, Fatma Tulin Kayhan
Braz J Otorhinolaryngol 2017;83:536-40

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The effect of melatonin and vitamin C treatment on the experimentally induced tympanosclerosis: study in rats

Sema Koc, Halil Kıyıcı, Aysun Toker, Harun Soyalıç, Huseyin Aslan, Hakan Kesici, Zafer I. Karaca
Braz J Otorhinolaryngol 2017;83:541-5

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Efficacy of syringe‐irrigation topical therapy and the influence of the middle turbinate in sinus penetration of solutions

Guilherme Henrique Wawginiak, Leonardo Balsalobre, Eduardo Macoto Kosugi, João Paulo Mangussi‐Gomes, Raul Ernesto Samaniego, Aldo Cassol Stamm
Braz J Otorhinolaryngol 2017;83:546-51

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Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study

Sara Sena Esteves, Miguel Gonçalves Ferreira, João Carvalho Almeida, José Abrunhosa, Cecília Almeida e Sousa
Braz J Otorhinolaryngol 2017;83:552-7

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Medical adherence to intranasal corticosteroids in adult patients

Emre Ocak, Baran Acar, Deniz Kocaöz
Braz J Otorhinolaryngol 2017;83:558-62

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An often neglected area in crooked nose: middle turbinate pneumatization

Fatih Özdoğan, Halil Erdem Özel, Erkan Esen, Erdem Altıparmak, Selahattin Genç, Adin Selçuk
Braz J Otorhinolaryngol 2017;83:563-7

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Does stapes surgery improve tinnitus in patients with otosclerosis?

Onur Ismi, Osman Erdogan, Mesut Yesilova, Cengiz Ozcan, Didem Ovla, Kemal Gorur
Braz J Otorhinolaryngol 2017;83:568-73

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Speech perception performance of subjects with type I diabetes mellitus of noise

Bárbara Cristiane Sordi Silva, Erika Barioni Mantello, Maria Cristina Foss Freitas, Milton César Foss, Myriam de Lima Isaac, Adriana Ribeiro Tavares Anastasio
Braz J Otorhinolaryngol 2017;83:574-9

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Hearing handicap in patients with chronic kidney disease: a study of the different classifications of the degree of hearing loss

Klinger Vagner Teixeira da Costa, Sonia Maria Soares Ferreira, Pedro de Lemos Menezes
Braz J Otorhinolaryngol 2017;83:580-4

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Proliferative verrucous leukoplakia: diagnosis, management and current advances

Diogo Lenzi Capella, Jussara Maria Gonçalves, Adelino Antônio Artur Abrantes, Liliane Janete Grando, Filipe Ivan Daniel
Braz J Otorhinolaryngol 2017;83:585-93

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Canine fossa puncture in endoscopic sinus surgery: report of two cases

Federico Sireci, Matteo Nicolotti, Paolo Battaglia, Raffaele Sorrentino, Paolo Castelnuovo, Frank Rikki Canevari
Braz J Otorhinolaryngol 2017;83:594-9

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Postauricular neurofibroma – a rare occurrence

Tan Shi Nee, Mazita Ami, Kong Min Han, Primuharsa Putra Sabir Husin Athar
Braz J Otorhinolaryngol 2017;83:600-1

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Thyroid compressive mass, a metastasis of femur chondrosarcoma after 14 years: case report and literature review

François Simon, Marion Classe, Pierre Vironneau, Michel Wassef, Philippe Herman, Nicolas Le Clerc
Braz J Otorhinolaryngol 2017;83:602-4

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Oral manifestations of dengue viral infection

Beuy Joob, Viroj Wiwanitkit
Braz J Otorhinolaryngol 2017;83:605

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Endotracheal intubation: ultrasound-guided versus fiberscope in patients with cervical spine immobilization

Abstract

Background

Ultrasound has growing applications in airway management during anesthesia. The aim of the present study was to evaluate the feasibility of real-time ultrasound-guided tracheal intubation in patients with cervical spine immobilization relative to fiberscope-guided tracheal intubation.

Patients and methods

This randomized controlled study was carried out on 266 adult patients who have a rigid neck collar in place for cervical spine immobilization and were randomly allocated into two equal groups. All patients were subjected to the same anesthetic protocol. After full neuromuscular blockade, neck collar was removed and tracheal intubation was done in the neutral position. In group A, the trachea was intubated guided by a 5–12-MHz linear ultrasound probe attached to a Sonoscape A5 ultrasound machine. In group B, the trachea was intubated by an endotracheal tube mounted over a fiberscope (Karl Storz, working length 65 cm, distal tip diameter 5.6 mm). Hemodynamic measurements and oxygen saturation were recorded. Tracheal intubation criteria for both groups including duration of the intubation procedure, number of intubation attempts, success rate at each attempt, and the lowest oxygen saturation recorded during tracheal intubation were recorded.

Results

Ultrasound and fiberscope achieved comparable time for tracheal intubation (57 ± 12 vs. 55 ± 10 s), respectively. Success rate of tracheal intubation at the first attempt was higher in the fiberscope group than the ultrasound group, with a P value of 0.032. The overall success rate was not significantly different between the two groups.

Conclusions

Ultrasound-guided tracheal intubation showed a lower first attempt success rate in patients with cervical spine immobilization compared to fiberscope-guided tracheal intubation but the overall success rates were comparable. Ultrasound can be an alternative technique for guiding tracheal intubation in patients with cervical spine immobilization.

Registry number

PACTR201602001476292.

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Preoperative flurbiprofen axetil administration for acute postoperative pain: a meta-analysis of randomized controlled trials

Abstract

Objective

Non-steroidal anti-inflammatory drugs have been shown to effectively decrease postoperative pain and reduce opioid requirements. Flurbiprofen axetil is an injectable non-selective cyclooxygenase inhibitor that has a high affinity for inflammatory tissues to achieve targeted drug therapy and prolonged duration of action. This meta-analysis examined the use of preoperative flurbiprofen axetil and its impact on postoperative analgesia.

Methods

An electronic literature search of the Library of PubMed, Cochrane CENTRAL, and EMBASE databases was conducted in Feb 2016. Searches were limited to randomized controlled trials. The primary outcome was pain scores. The secondary outcomes included cumulative postoperative opioid consumption and opioid-related adverse effects.

Results

A total of nine RCT studies involving 457 patients were included in this study. Compared to patients without perioperative flurbiprofen axetil, patients treated with preoperative flurbiprofen axetil had lower pain scores at 2 h (SMD −1.00; 95% CI −1.57 to −0.43, P = 0.0006), 6 h (SMD −1.22; 95% CI −2.01 to −0.43; P = 0.002), 12 h (SMD −1.19; 95% CI −2.10 to −0.28; P = 0.01), and 24 h (SMD −0.79; 95% CI −1.31 to −0.27; P = 0.003) following surgery. Preoperative flurbiprofen axetil had no significant effect on postoperative opioid consumption (SMD −13.11; 95% CI −34.56 to 8.33; P = 0.23). There was no significant difference between the groups with regard to adverse effects. Compared to patients with postoperative flurbiprofen axetil, however, preoperative flurbiprofen axetil resulted in decreased pain score only at 2 h after operation.

Conclusions

Preoperative use of flurbiprofen axetil will result in significantly lower postoperative pain scores, but no difference in nausea, vomiting, and opioid consumption compared to those who did not receive flurbiprofen axetil. However, more homogeneous and well-designed clinical studies are necessary to determine whether preoperative flurbiprofen axetil administration has more efficacy than that given at the end of surgery.

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Foreign Body Aspiration in Northern Ghana: A Review of Pediatric Patients

Background. Foreign body (FB) aspiration requires a high index of suspicion for diagnosis and prompt management to avoid morbidity and mortality. This retrospective study was conducted to review pediatric foreign body aspiration at the Ear, Nose and Throat (ENT) Unit of the Tamale Teaching Hospital (TTH). Materials and Methods. The theater records of children managed for foreign body aspiration from January 2010 to December 2016 at the ENT Unit of TTH were retrieved and data summarized with respect to age, gender, indications for bronchoscopy, nature of foreign body, location of foreign body, and outcome of the bronchoscopy procedure. Results. A total of 33 children were managed within the five-year study period and comprised 16 (48.5%) males and 17 (51.5%) females. The commonly aspirated FBs were groundnuts (13, 39.4%) and metallic objects (7, 21.1%). The peak incidence occurred in children aged ≤ 3 years. The foreign bodies (FBs) were commonly localized to the right (24.2%) and left (24.2%) main bronchi, respectively. One patient had emergency tracheostomy for failed bronchoscopy. Conclusion. Groundnuts were the most commonly aspirated foreign body with most of the FBs localized in the bronchi.

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Late Onset Streptococcus agalactiae Meningitis following Early Onset Septicemia: A Preventable Disease?

We report a neonate who presented with early onset Streptococcus agalactiae or group B streptococcus (GBS) septicemia within 24 hours of birth. After discharge at day 14, she went on to develop late onset GBS meningitis at 36 days of age. The infant was treated with intravenous antibiotics on both occasions and eventually discharged home with no apparent sequelae. We address issues associated with GBS infection in infancy including the demographics, risk factors, and the risk of late onset GBS meningitis following an early onset GBS infection. The major source of GBS in early onset GBS disease is maternal birth canal GBS colonization. On the other hand, nosocomial cross-infection is an important source of GBS in late onset disease. Penicillin remains the current treatment of choice for GBS infection. Given the rapid onset and progression within hours of birth and lack of an effective solution for preventing late onset GBS, administration of an effective GBS vaccine in pregnancy could provide a sensible and cost-effective solution in all settings.

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A novel PAX9 mutation causing oligodontia

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Eiman Mohammed Daw, Christian Saliba, Godfrey Grech, Simon Camilleri
IntroductionAn extended family presenting with several members affected by developmentally missing teeth was investigated by analysis of the MSX1 and PAX9 genes.Materials and methodsSaliva samples were collected and DNA extracted. Primers were designed to span the exons and intron-exon junctions of the MSX1 and PAX9 genes. These primers were optimised using gradient Polymerase Chain Reaction. The amplified fragments were sent for Sanger sequencingResultsa novel heterozygote missense mutation in exon 3 of PAX9 (c.296G > C, p.A99P), was found in two severely affected members of the family as well as a potentially pathogenic heterozygote variant (c.119C > G, p.A40G) in exon 1 of the MSX1 gene.ConclusionThe PAX9 A99P mutation is in the DNA binding domain and is predicted to be pathogenic.



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A novel PAX9 mutation causing oligodontia

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Eiman Mohammed Daw, Christian Saliba, Godfrey Grech, Simon Camilleri
IntroductionAn extended family presenting with several members affected by developmentally missing teeth was investigated by analysis of the MSX1 and PAX9 genes.Materials and methodsSaliva samples were collected and DNA extracted. Primers were designed to span the exons and intron-exon junctions of the MSX1 and PAX9 genes. These primers were optimised using gradient Polymerase Chain Reaction. The amplified fragments were sent for Sanger sequencingResultsa novel heterozygote missense mutation in exon 3 of PAX9 (c.296G > C, p.A99P), was found in two severely affected members of the family as well as a potentially pathogenic heterozygote variant (c.119C > G, p.A40G) in exon 1 of the MSX1 gene.ConclusionThe PAX9 A99P mutation is in the DNA binding domain and is predicted to be pathogenic.



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Diagnostic Challenges of Antrochoanal Polyps: A Review of Sixty One Cases

Abstract

Antrochoanal polyps (ACP) are benign, large, inflammatory polyps which originate from within the maxillary sinus and extend through the natural or accessory ostia, into the nasal cavity, with extension into the choana. They are relatively uncommon, accounting for just 3 – 6% of all nasal polyps, although they are much more frequently encountered in children, affecting upto 35% of the paediatric population ¹. Even among adults, they usually present at a younger age, as compared with usual nasal polyps with a mean age at diagnosis of 27 and 50 years respectively ².

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