Orbital Exenteration in Rhino-Orbito-Cerebral Mucormycosis: A Prospective Analytical Study with Scoring System

Abstract

Mucormycosis is an uncommon, rapidly progressive, angio-invasive, commonly fatal, opportunistic fungal infection. The most critical decision in the management of rhinoorbital mucormycosis is whether the orbit should be exenterated. (1) To layout the indications of orbital exenteration in patients with rhino-orbito-cerebral mucormycosis. (2) To devise a scoring system that predicts the stage at which the exenteration needs to be carried out. A scoring system was devised by a team of experienced Otorhinolaryngologists and Ophthalmologists from prior experience in managing mucormycosis. All patients of mucormycosis visiting our hospital were admitted and included in the study. A total of 15 patients were included. The scoring system is based on 3 main criteria, namely: (1) clinical signs and symptoms. (2) Direct and Indirect Ophthalmoscopy. (3) Imaging. The Sion Hospital Scoring System is an accurate and promising measure to solve the dilemma that is associated with orbital exenteration in orbito-rhino-cerebral mucormycosis.

http://ift.tt/2IjneMW

Post Earthquake Equilibrium Disturbance: A Study After Nepal–India Earthquake 2015

Abstract

Nepal and adjoining areas of India suffered a series of massive earthquakes in April–May 2015. This was followed by a remarkable increase in the patient presenting with vague dizziness like features which could not be attributed to any defined variant of vestibular disorder. Extensive search of literature revealed only scarce information about ambiguous post-earthquake vestibular symptoms and their management. We performed a detailed epidemiological analysis of these patients to analyse the presentation, underlying mechanism and optimal management. The results were scrutinised in light of existing international literature. We observed that earthquake precipitated a psychological stress like event that provoked features of disequilibrium and the neuroanatomical basis of the proposition was explored. We renounce the hypothesis of Secondary BPPV precipitated by earthquake leading to symptoms. The results were interpreted from the perspective of Indian scenario and its utility in post-earthquake disaster management in our country has been highlighted.

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Comparison between the efficacy of microneedling combined with 5-fluorouracil vs microneedling with tacrolimus in the treatment of vitiligo

Summary

Background

Several treatment modalities had been used for the treatment of vitiligo, but the optimal treatment has not yet been identified.

Objectives

To study the efficacy of microneedling with 5-flurouracil vs its efficacy with tacrolimus in the treatment of vitiligo.

Patients and methods

Twenty-five patients with vitiligo were subjected to microneedling of 2 patches of vitiligo with dermapen, then application of 5-fluorouracil to 1 patch and tacrolimus on the other patch. This procedure was repeated every 2 weeks for every patient for maximum 6 months (12 sessions). The patients were followed up for 3 months after the last session.

Results

The overall repigmentation was significantly higher in 5-fluorouracil-treated patches compared with tacrolimus. Excellent improvement occurred in 48% of 5- flurouracil-treated patches while only in 16% of tacrolimus-treated patches. In the acral parts, 40% of the patches treated with 5-fluorouracil achieved excellent improvement (repigmentation >75%), while no patch in the acral parts achieved excellent improvement with tacrolimus. However, there was significant difference between the 2 drugs,regarding inflammation, ulceration, and hyperpigmentation which occurred with 5-fluorouracil.

Conclusion

Microneedling combined with 5-fluorouracil or tacrolimus is safe and effective treatment of vitiligo. However, 5-fluorouracil achieved a greater percentage of repigmentation than tacrolimus particularly in the acral parts.

http://ift.tt/2HvJYYR

Orbital Exenteration in Rhino-Orbito-Cerebral Mucormycosis: A Prospective Analytical Study with Scoring System

Abstract

Mucormycosis is an uncommon, rapidly progressive, angio-invasive, commonly fatal, opportunistic fungal infection. The most critical decision in the management of rhinoorbital mucormycosis is whether the orbit should be exenterated. (1) To layout the indications of orbital exenteration in patients with rhino-orbito-cerebral mucormycosis. (2) To devise a scoring system that predicts the stage at which the exenteration needs to be carried out. A scoring system was devised by a team of experienced Otorhinolaryngologists and Ophthalmologists from prior experience in managing mucormycosis. All patients of mucormycosis visiting our hospital were admitted and included in the study. A total of 15 patients were included. The scoring system is based on 3 main criteria, namely: (1) clinical signs and symptoms. (2) Direct and Indirect Ophthalmoscopy. (3) Imaging. The Sion Hospital Scoring System is an accurate and promising measure to solve the dilemma that is associated with orbital exenteration in orbito-rhino-cerebral mucormycosis.

http://ift.tt/2IjneMW

Post Earthquake Equilibrium Disturbance: A Study After Nepal–India Earthquake 2015

Abstract

Nepal and adjoining areas of India suffered a series of massive earthquakes in April–May 2015. This was followed by a remarkable increase in the patient presenting with vague dizziness like features which could not be attributed to any defined variant of vestibular disorder. Extensive search of literature revealed only scarce information about ambiguous post-earthquake vestibular symptoms and their management. We performed a detailed epidemiological analysis of these patients to analyse the presentation, underlying mechanism and optimal management. The results were scrutinised in light of existing international literature. We observed that earthquake precipitated a psychological stress like event that provoked features of disequilibrium and the neuroanatomical basis of the proposition was explored. We renounce the hypothesis of Secondary BPPV precipitated by earthquake leading to symptoms. The results were interpreted from the perspective of Indian scenario and its utility in post-earthquake disaster management in our country has been highlighted.

http://ift.tt/2paxKx5

Cover Image

The cover image, by Matthias Leonhard et al., is based on the Original Article In vitro biofilm growth on modern voice prostheses, DOI: 10.1002/hed.25053.

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Issue Information

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NKG2D and its ligands in cancer

Payal Dhar | Jennifer D Wu

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Metabolites, genome organization, and cellular differentiation gene programs

Danielle A Chisolm | Amy S Weinmann

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Demodex mites modulate sebocyte immune reaction: Possible role in the pathogenesis of rosacea

Abstract

Rosacea is a common facial skin disorder affecting middle-aged adults. Its aetiology is unknown and pathogenesis uncertain. Activation of the host innate immune response has been identified as important. The Demodex mite population in the skin of these patients is significantly higher than in subjects with normal skin suggesting they may be of etiological importance in this disorder. Little is known of the role of these mites in human skin and their potential to interact with the host immune system has not been elucidated.

Live Demodex mites were extracted from normal facial skin of control subjects and used in cell stimulation experiments with the immortalised SZ95 sebocyte line. Time and mite dose dependent experiments were performed. Direct Demodex effects and the effects of medium in which Demodex had been cultured were evaluated on the TLR-signalling pathway on both a gene and protein expression level.

Mites modulated TLR signalling events on both mRNA and protein levels in SZ95 sebocytes. An initial trend towards down modulation of genes in this pathway was observed. A subsequent switch to positive gene up-regulation was recorded after 48 hours of co-culture. Demodex secreted bioactive molecules that affected TLR2 receptor expression by sebocytes. High numbers of Demodex induced pro-inflammatory cytokine secretion whereas lower numbers did not.

Demodex mites have the capacity to modulate the TLR signalling pathway of an immortalised human sebocyte line. Mites have the capacity to secrete bioactive molecules that affect the immune reactivity of sebocytes. Increasing mite numbers influenced IL8 secretion by these cells.

This article is protected by copyright. All rights reserved.

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Workforce Considerations, Training, and Diseases in the Middle East

Evaluating and providing global health assistance, humanitarian aid, and medical missions to Middle Eastern countries can be rewarding and challenging. A broad spectrum of financial capabilities supports effective health care delivery and infrastructure. Middle East tension can make obtaining a visa difficult. Personal safety considerations may hinder efforts to develop and carry out clinical and educational programs. Several Middle East countries have sophisticated and modern health care systems. Medical education and specialty training compares with that of Western medicine. The Middle East has a proud heritage as the foundation of many fundamental and modern medical and surgical principles.

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Response letter to the editor about the editorial by oppenheimer and greenberger “baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO” (2017;119:474-5)

In our editorial "Baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO1 regarding the observational study,2 we stated that "the clinician must consider the great cost associated with these agents " referring to omalizumab. A supporting reference3 didn't include indirect costs (absenteeism from school or work, psychologic harms and economic hardships of uncontrolled asthma) although we did mention them. Luskin et al point out that there are indirect benefits from omalizumab that would improve its value (benefits/costs) also known as cost effectiveness ratio.

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A randomized, double-blind, placebo-controlled study of the use of viscous oral cromolyn sodium for the treatment of eosinophilic esophagitis

There is a need for effective, non-steroid pharmacologic therapies for eosinophilic esophagitis (EoE). Cromolyn sodium offers an option as mast cells have been implicated in the symptomatology of EoE and cromolyn has also been shown to have some anti-eosinophilic properties.

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Bioimpedance measurement as an assessment of margin positivity in Mohs surgical specimens of non-melanoma skin cancer: Management implications

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High neutrophil-to-lymphocyte ratio before starting anti-PD1 immunotherapy predicts poor outcome in patients with metastatic melanoma

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Increased Topical Generic Prices by Manufacturers: An Isolated Trend or Worrisome Future?

There is limited data regarding generic medication prices. Recent studies have shown price changes at the retail level, but much is not known about the pharmaceutical supply chain or price changes at the manufacturer level.

http://ift.tt/2FDqgKf

Clinical, dermoscopic and trichoscopic analysis of frontal fibrosing alopecia associated with acquired dermal macular hyperpigmentation: A cross sectional observational case-control study

http://ift.tt/2FLJEYN

Gordon Fordyce 1925–2018

Gordon Fordyce, a former Consultant Oral Surgeon and President of the British Association of Oral Surgeons, passed away on February 18th.

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Relation between globus pharyngeus and OSA in patients examined simultaneously by PSG and pH monitor: A cross sectional study

This was a first cross-sectional single-center study to research the relation between globus pharyngeus, OSA and GERD. Since previous clinical studies have demonstrated a relationship between globus phayrngeus and GERD, however, no reported study on the relation between globus pharyngeus, sleep disorders including OSA, and GERD.

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Gordon Fordyce 1925–2018

Publication date: Available online 12 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Andrew Sadler




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Diagnostic Tools to Use When We Suspect an Allergic Reaction to a Tattoo: A Proposal Based on Cases at Our Hospital

I. González-Villanueva, J.F. Silvestre Salvador
Actas Dermosifiliogr 2018;109:162-72

Abstract - Full text - PDF

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Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1625965

Orbital trapdoor fractures (OTFs) entail entrapment of intraorbital soft tissues with minimal or no displacement of the affected bones and are almost exclusively seen in children. This article aimed to report the diagnosis and treatment of an OTF of the floor in an adult patient and to critically review the literature regarding the management aspects of this specific subset of orbital blowout fractures in adults. A 29-year-old man presented with limitations of vertical right eye movements owing to blunt orbital trauma. The patient mainly complained of double vision in upper gazes and some episodes of nausea. Neither floor defect nor significant bone displacement found on orbital computed tomography, while edema of inferior rectus muscle was apparent. The patient underwent surgical repair 5 days later; a linear minimally displaced fracture of the floor was recognized and complete release of the entrapped perimuscular tissues was followed. Within the first week postoperatively, full range of ocular motility was restored, without residual diplopia. This case was the only identified pure OTF over a 6-year period in our department (0.6% of 159 orbital fractures in patients >18 years). By reviewing the literature indexed in PubMed, a very limited number of either of isolated case reports or retrospective case series of pure OTFs has been reported in adults. Contrary to the typical white-eyed blowout fractures, the literature indicates that OTFs in adults seem to not always constitute absolute emergency conditions. Although such fractures need to be emergently/ immediately treated in children, in the absence of true muscle incarceration, adults may undergo successful treatment within a wider but either early or urgent frame of time. Adults frequently exhibit vagal manifestations and marked signs of local soft tissues injury.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Role of integrins in wound repair and its periodontal implications

Publication date: Available online 14 February 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Harpal Jakhu, Gurveen Gill, Amarjot Singh
Wound healing in human periodontium is a complex process which involves both cell-cell and cell-matrix interactions. Integrins play a major role in regulation of these cell-cell, cell-matrix interaction. Wound healing involves two major events i.e. re-epithelialization and connective tissue repair. In this concise review, we will discuss the role of integrins in these major events as well as their impIications in periodontal wound repair. Integrins are differentially expressed in both of these major events. In re-epithelialization, keratinocytes express novel integrins receptors αvβ1, α5β1and αvβ6 which are not expressed in normal healthy epithelium. Re-epithelialization also involves interaction of integrins with TGF-β and fibronectin. Similarly, in connective tissue repair, the activation of fibroblast as well as the expression of integrins α5β1 and α3β1 is upregulated. In healthy periodontium, integrin αvβ6 is normally expressed in junctional epithelium which is generally expressed only at wound sites in other parts of the body. The epithelialization at implant surface has not been yet fully explored with respect to interactions among integrins and other extra-cellular matrix molecules.



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Conservative versus Surgical Therapy in Managing Patients with Facial Nerve Palsy Due to the Temporal Bone Fracture

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1625966

Facial nerve paralysis is classified into immediate or delayed-onset palsy, and affected patients should be treated through conservative or surgical therapy. Appropriate treatment is somewhat debated as well as proper time for performing surgery. This study aimed to assess treatment outcome between conservatively and surgically treated groups and to determine the appropriate time of surgery in selected patients for surgery. Twenty-four patients from April 2008 to July 2015 were included. Performing decompression surgery within the first 2 months following the trauma accompanies a better prognosis (p-value < 0.05). Eleven patients were managed conservatively, and 4 of them demonstrated immediate onset and 7 indicated delayed onset. Nine patients obtained normal nerve function, one patient had partial palsy, and one of them had complete palsy. There was no significant difference in the rate of recovery between types of the treatment (p-value > 0.05). Decompression surgery is recommended in the first 2 months after the trauma for immediate onset and also complete degeneration on electroneuronography.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Clinical Research at Territorial Section Meetings of the Spanish Academy of Dermatology and Venereology (AEDV)

Á. Iglesias-Puzas, A. Batalla, Á. Flórez
Actas Dermosifiliogr 2018;109:148-54

Abstract - Full text - PDF

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Cutaneous Leiomyosarcoma: On the Importance of Histologic Location

B. Llombart
Actas Dermosifiliogr 2018;109:98

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Clinical Research at the Heart of the Spanish Academy of Dermatology and Venereology

M.A. Descalzo
Actas Dermosifiliogr 2018;109:99

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The Future of Treatment for Capillary Malformations

R. del Río
Actas Dermosifiliogr 2018;109:99

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Use of Transgingival Lag Screw Osteosynthesis in the Management of Alveolar Process Fracture

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1629906

The purpose of this study is to check the efficacy of transgingival lag screw osteosynthesis in alveolar process fractures of maxilla and mandible. A single-arm nonrandomized observational study was performed for the treatment of alveolar process fractures of maxilla and mandible. In this study, 20 mixed age group patients with alveolar process fracture were included. All the patients were treated by a 2.0-mm transgingival screw fixation under local or general anesthesia. All the patients were evaluated for fracture stability, anatomical reduction, bone loss and bone resorption of alveolar process, tooth loss, and wound infection at 3 months of follow-up. A simple descriptive statistical analysis was done to evaluate the parameters and it was shown that the treatment of alveolar process fracture with two or three lag screws provides adequate fracture stability and anatomical reduction with no signs of bone loss and tooth loss, and wound infections were noted post lag screw fixation. The study concludes that transgingival lag screw fixation is a suitable alternative for alveolar process fractures in all the age groups and two to three lag screws are generally sufficient to fix fractured alveolar process either under local anesthesia or general anesthesia.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Allergic Reactions to Tattoo Inks: A New Diagnostic Challenge

D. Muñoz Borrás
Actas Dermosifiliogr 2018;109:100

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Psoriasis-Arthritis Units: Three Years On

A. López-Ferrer, A. Láiz-Alonso
Actas Dermosifiliogr 2018;109:101-3

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The Role of Postoperative Imaging after Orbital Floor Fracture Repair

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1625949

Obtaining postoperative images of maxillofacial fractures does not affect the clinical management of asymptomatic patients; however, few studies have evaluated the role of postoperative imaging in the context of orbital floor fractures. In this study, we evaluate current practice techniques and the role of postoperative imaging in the management of orbital floor fractures in isolation and with concomitant facial fractures. Retrospective review of patients who underwent open reduction and internal fixation of orbital floor fractures between 2005 and 2015 at a single medical institution. Operative and perioperative records were reviewed to characterize postoperative imaging as routine or as indicated by concerning clinical symptoms, and to correlate clinical outcomes to postoperative imaging patterns across all identified orbital floor fractures. A total of 139 patients underwent open reduction and internal fixation of orbital floor fractures. Of these, 75 (54%) had zygomaticomaxillary (ZMC) involvement. The remaining 64 (46%) were isolated orbital floor fractures. Overall, 54 (39%) patients underwent postoperative imaging. Of these, 38 (70%) had postoperative imaging in the absence of concerning clinical symptoms. There was no observed difference in complication rates in those who underwent postoperative imaging, and those who did not. Patients with orbital + ZMC fractures underwent a significantly higher number of postoperative imaging studies (p < 0.001); however, there was no observed difference in complications between isolated orbital and orbital + ZMC fractures. Routine postoperative imaging is not warranted in the absence of persistent clinical symptoms following open reduction and internal fixation of orbital floor fractures.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Genetic Diagnosis of Epidermolysis Bullosa: Recommendations From an Expert Spanish Research Group

C. Sánchez-Jimeno, M.J. Escámez, C. Ayuso, M.J. Trujillo-Tiebas, M. del Río
Actas Dermosifiliogr 2018;109:104-22

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Melanoma Arising in a Melanocytic Nevus

A. Martín-Gorgojo, E. Nagore
Actas Dermosifiliogr 2018;109:123-32

Abstract - Full text - PDF

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A systematic review of biomarkers of gingival crevicular fluid: Their predictive role in diagnosis of periodontal disease status

Publication date: Available online 10 February 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Stuti Gupta, Shivjot Chhina, Sachit Anand Arora
The objective of the study was to conduct a systematic review of the literature so as to evaluate and summarize the diagnostic and prognostic potential of GCF. Included studies were systematically analyzed based on PRISMA (Preferred Reporting Items For Systematic Reviews and Meta Analyses) and studies were identified based on the-PICO (Glossary of evidence based terms 2007):1) Patients with chronic periodontitis.2) Intervention- NSPT (Non-SurgicalPeriodontal therapy); NSPT+Chemotherapeutics.3) Comparison between treated v/s non treated sites.4) Outcomes measured: Analysis of variation in constituents of GCF.Electronic database search of Pubmed, Medline, Google Scholar and Scopus was performed using (MeSH) terms- Gingival Crevicular fluid and Cytokines, MMP's, NE, PGE-2, A2M, B2M, ALP, AST, Osteocalcin and Calprotectin. Articles published between year 2000-2016 were reviewed and were included based on inclusion and exclusion criteria.Based on this systematic review of literature, it can be concluded that analysis of constituents of GCF can be used as an effective and efficient diagnostic tool of periodontal diseases. These biomarkers in turn with their prognostic significance could act as a valuable tool in the combat of periodontal disease.



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Empowerment in Dermatology

J.J. Domínguez-Cruz, J.J. Pereyra-Rodríguez, R. Ruiz-Villaverde
Actas Dermosifiliogr 2018;109:133-9

Abstract - Full text - PDF

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Widely disseminated sporadic Burkitt lymphoma initially presented as oral manifestations in a 6-year-old boy

Publication date: Available online 10 February 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Bong-Hae Cho, Dong-Hoon Shin, Yun-Hoa Jung, Hae-Ryoun Park
Burkitt lymphoma, a subtype of non-Hodgkin's lymphoma, is an aggressive neoplasm with three variants that are endemic, sporadic, and immunodeficiency associated. We present an unusual case of sporadic Burkitt lymphoma in a 6-year-old boy who initially presented with hypermobile teeth and no other specific signs or symptoms. On dental radiography, the patient was found to have alveolar bone resorption adjacent to the maxillary first molars, with the appearance of floating teeth. In addition, magnetic resonance imaging (MRI) showed extensive soft tissue masses involving four quadrants of the jaws. A definitive diagnosis of Burkitt lymphoma was made based on tissue and bone marrow biopsy. Subsequent images, including abdominal computed tomography (CT) and bone scan, revealed wide dissemination of the lymphoma into the abdominal cavity, pancreas, and numerous bones. This case suggests the possibility of dental complaints as an initial clinical manifestation of sporadic Burkitt lymphoma and emphasizes the role of dentists in early detection of the disease to improve prognosis.



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Clinical and Histopathologic Findings of Cutaneous Leiomyosarcoma: Correlation With Prognosis in 12 Patients

E. Rodríguez-Lomba, I. Molina-López, V. Parra-Blanco, R. Suárez-Fernández, A. Pulido-Pérez
Actas Dermosifiliogr 2018;109:140-7

Abstract - Full text - PDF

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Focal dermal hypoplasia: A novel finding in disguise

Publication date: Available online 1 February 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): S. Nathwani, K. Martin, R. Bunyan
Focal Dermal Hypoplasia (FDH) or Goltz-Gorlin syndrome is an unusual X-linked dominant syndrome characterised by anomalies of both ectodermal and mesodermal structures.We present a case report on the management of a 58year old Caucasian male with Focal Dermal Hypoplasia. This report describes an additional clinical manifestation of an intraosseous mandibular lipoma, which has not been previously described in cases of FDH. Intraosseous lipomas in the head and neck region are reported in only seventeen cases in isolation of any associated syndrome.Diagnosis was hindered due to similitude with Nevoid Basal Cell Carcinoma Syndrome (Gorlin-Goltz Syndrome) which despite similar nomenclature, is an exclusively separate conditionThis novel finding encourages clinicians to consider unusual differential diagnoses in such cases and highlights the importance of avoiding eponyms to prevent confusion with similar conditions



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Expression of Ki-67, p53, α-SMA and COX-2 in lichen planus and related lesions: A pilot study

Publication date: Available online 19 February 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): D.S. Sanketh, Karuna Kumari, Roopa S. Rao, Vanishree C. Haragannavar, Sachin C. Sarode, Gargi S. Sarode, A. Thirumal Raj, Shankargouda Patil
BackgroundResearchers have struggled to understand the natural history of lesions presenting with both lichenoid features and epithelial dysplasia. Thus the present study was designed to differentiate between OLP, OLP with dysplasia, epithelial dysplasia and epithelial dysplasia with lichenoid features based on the expressions of ki-67, p53, COX-2, and α-SMA.Materials and methodsFormalin-fixed paraffin-embedded archival specimens of OLP, OLP with dysplasia, epithelial dysplasia and epithelial dysplasia with lichenoid features were subjected to immunohistochemical staining with ki-67, p53, COX-2, and α-SMA.ResultsKi-67 exhibited strong positivity in 100% (6/6) of epithelial dysplasia cases, 71.4% (5/7) of lichenoid dysplasia cases, 57.1% (4/7) of OLP cases and 60% (3/5) of OLP with dysplasia cases. Strong p53 staining was evident in more cases of lichenoid dysplasia [42.8% (3/7)], while moderate staining was more frequent in OLP cases [42.8% (3/7)] and OLP with dysplasia cases [42.8% (3/7)] and mild intensity was more frequent in epithelial dysplasia cases [50% (3/6)] followed by lichenoid dysplasia cases [42.8% (3/7)], OLP cases [28.5 (2/7)] and OLP with dysplasia cases [40% (2/5)]. COX-2 strong positivity was more frequent in cases of epithelial dysplasia cases [57.1% (4/7)] and OLP [50% (3/6)]. Strong α- SMA staining was noted more frequently in lichenoid dysplasia cases [71.4 (5/7)], followed by OLP cases [42.8% (3/7)] and OLP with dysplasia cases [60% (3/5)].ConclusionsKi-67, p53, α-SMA and COX-2 expression do not differentiate between OLP, LP with dysplasia and epithelial dysplasia with lichenoid features.



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Capillary Malformations Treated With Sequential Pulsed Dye and Nd:YAG Laser Therapy: A Retrospective Study

J. Alcántara-González, P. Boixeda, M.T. Truchuelo-Díez, N. Jiménez-Gómez, B. Pérez-García, L. Pérez-Carmona, P. Jaén Olasolo
Actas Dermosifiliogr 2018;109:155-61

Abstract - Full text - PDF

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Soft-Tissue Anthropometric Norms of Iranians with Proper Occlusion and Inter-Ethnic Norm Comparisons

Abstract

Background

Photographic soft-tissue norms of Iranian race are not reported previously, nor are they compared with other ethnicities. Besides, sex dimorphism is assessed in only very few studies on soft-tissue profile. The aim of this study was to assess the soft-tissue measurements of Iranians with good occlusion and the existing sex dimorphism and to compare the Iranian norms with other ethnicities.

Materials and Methods

Twelve anthropometric variables were measured by a dentist in 100 Iranian subjects with good occlusions. The subjects included 50 males and 50 females. The differences between the two genders, as well as the differences between Iranian norms and the norms in all other ethnicities available in the literature were statistically analyzed using a t test (α = 0.05).

Results

There were significant differences between males and females regarding frontonasal angle (P = 0.0000), mentolabial sulcus (P = 0.0000), vertical height ratio (P = 0.0000), vertical lip–chin ratio (P = 0.0013), nasolabial angle (P = 0.0019), lower vertical height–depth ratio (P = 0.0029), maxillary prognathism (P = 0.0045), and mandibular prognathism (P = 0.0118). The difference in facial convexity was marginally significant (P = 0.0543). Protrusions of both lips and horizontal distance between the lips were not significantly different between sexes (P > 0.2).

Conclusions

Unlike Americans and Brazilians but similar to Koreans, there was considerable sex dimorphism in Iranians. Compared to Iranian men, women might have more convex profiles, more advanced mandibles (unlike all other races studied), more protruded maxillae, lips closer to the middle of nose-chin vertical distance, deeper mentolabial sulci, less protruded noses with higher nose tips, and smaller lower faces.

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Buccal Fat Pad: A Useful Adjunct Flap in Cleft Palate Repair

Abstract

Aim

The aim of the study is to describe the technique and also the outcome of using buccal fat pad (BFP) as an adjunct flap in cleft palate repair and to report the surgical outcome.

Materials and Methods

All the surgical repairs with BFP were done under general anaesthesia. The use of BFP was indicated in patients who needed a secondary palatal cleft repair, those with wide palatal clefts or patients whose primary palatal cleft repair was complicated intraoperatively by inadvertent tearing of the nasal mucosa. The raw wound surfaces were dressed with Vaseline gauze instilled with Framycetin. All subjects 4 years of age and below had oral toileting with warm saline-soaked gauze after each meal. The other patients had oral toileting with warm saline mouth bath in addition to conventional toothbrushing.

Results

Eight patients were included in this study with an age range of 1–26 years (mean ± SD = 6.1 ± 8.6 years). Three patients presented with wide palatal clefts, another three presented with dehiscence after a primary repair which necessitated a secondary repair, while the remaining two patients had inadvertent iatrogenic tear of the nasal mucosa during the primary surgical repair. For the latter set of patients, repair was completed by the use of BFP as an adjunct at the same surgery. Post-operative evaluation was satisfactory in all cases, with healing of the flaps and complete epithelialization of the BFP in 1 month. All the patients experienced post-operative cheek swelling, signifying the post-operative oedema due to BFP harvest. However, this was usually resolved within 48 h. Healing was satisfactory with full epithelialization, and no complications were observed.

Conclusions

Successful application of BFP as an adjunct flap in palatal cleft closure is demonstrated in these series. It is recommended that cleft surgeons add this technique to their armamentarium in difficult cases, especially in wide palatal cleft repair, secondary palatal cleft repair and in cases of inadvertent tearing of nasal mucosa during primary cleft palate repair.

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Vasculitis With Lesions on the Scalp as the Only Cutaneous Manifestation

F.C. Benavente Villegas, J.M. Sánchez Motilla, N. Rausell Fontestad
Actas Dermosifiliogr 2018;109:175-6

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Ultrasound as an Assessment Method in Predicting Difficult Intubation: A Prospective Clinical Study

Abstract

Objective

Aim of the study is to predict the difficulty in intubation preoperatively using ultrasonography.

Methods

One hundred and thirty-seven patients underwent ultrasound followed by surgery under general anesthesia. A experienced radiologist examined the airway and performed measurements of specific airway parameters: visualization of hyoid bone, visualization of vocal cords through thyroid cartilage, visualization of epiglottis, distance from base of tongue to hyoid bone, distance of hyomental region distance of thyrohyoid region, distance between skin and fat pad thickness to thyroid cartilage, thickness of submental region, distance from epiglottis to skin (above hyoid), and visualization of cricothyroid membrane. After performing ultrasound, patient was presented for surgery. An experienced anesthesiologist who is associated with this study did all the laryngoscopy and intubation.

Results

We were able to visualize all relevant anatomical structures in all the participants using ultrasound. The receiver operating characteristic curve analysis results showed that hyomental is ≤ 1.09 (P value < 0.01) to classify difficult in intubation.

Conclusion

The study shows that ultrasound can reliably image all the airway structures. This study suggests that hyomental distance is a more valid criterion in predicting difficult intubation. Further, case control study is needed for assessing the ease of intubation.

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Confluent and Reticulated Papillomatosis With Linear Pseudo-striae: A Description of 20 Cases

C.A. Morales-Cardona, C. Tejada-Figueroa, D.M. Méndez-Velasco
Actas Dermosifiliogr 2018;109:e7-e11

Abstract - Full text - PDF

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Comparative Study Between Oral Lorazepam and Diazepam as Sedation in Oral and Maxillofacial Surgery

Abstract

Purpose

The aim of the study was to compare the efficacy of oral lorazepam as night sedation and premedication with diazepam.

Methods

A prospective, randomized, and double-blind study was done in 50 healthy patients in each drug group. The impacted third molar impaction was taken as the study model. Study was carried out after giving bioequivalent doses of respective drugs for either side. All the patients were assessed for quality of sleep, sedation, recall of visual stimuli, cooperation shown by patient and recovery postoperatively.

Results

The study concluded that lorazepam showed more advantages than diazepam as well as patient's preference and satisfaction. However, postoperative recovery with lorazepam was longer than diazepam.

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Erythematous Lesion on the Nose

D. González Fernández, S. Requena López, F. Valdés Pineda
Actas Dermosifiliogr 2018;109:173-4

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Hemangiopericytoma of Gingiva in a 4-Year-Old Child: A Rare Case Report

Abstract

A hemangiopericytoma is a type of soft tissue sarcoma that originates in the pericytes in the walls of capillaries which was characterized in 1942. It is commonly seen in the age group of 5th–6th decades of adults and only 5–10% of cases occur in children with extreme rare occurrence in head and neck region (16%). A rare case of hemangiopericytoma in a 4-year-old female patient is presented here and its clinical, histopathological and immunohistochemically features are discussed. Though surgical resection remains the mainstay, excisional biopsy was primarily performed to reach the final diagnosis. Even in the follow-up phase of 1 year, no recurrence or no metastatic changes were observed.

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Low-dose methotrexate in rheumatoid arthritis: a potential risk factor for bisphosphonate-induced osteonecrosis of the jaw

Abstract

Bisphosphonate-induced osteonecrosis of the jaw [BIONJ] is a relatively new pathological condition which was first described in the year 2003. The prevalence of BIONJ in patients on oral formulations is around 0.05% within the first 3 years and increases up to 0.2% after 4 years of consumption. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases [e.g., high doses of methotrexate up to 30 mg daily] significantly increase the chances of acquiring BIONJ. We present three patients with osteoporosis and rheumatoid arthritis [RA] who consumed oral bisphosphonates [alendronate] for less than 1 year and developed BIONJ within 2 to 5 months of undergoing a traumatic dental procedure. The patients also gave a history of consuming low doses of methotrexate [disease-modifying anti-rheumatic drugs] up to 20 mg weekly for 4 to 10 years. No history of steroid consumption was given by any of the patients. This case series highlights the possibility of rheumatoid arthritis and low-dose methotrexate being potential risk factors for BIONJ. This may be on account of the synergistic effect of methotrexate and bisphosphonates and the pro-inflammatory state created by RA which increased the risk of acquiring BIONJ.

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Rituximab: Revolutionizing the Treatment of Pemphigus

D. Morgado-Carrasco, P. Giavedoni, X. Fustà-Novell, P. Iranzo
Actas Dermosifiliogr 2018;109:177-8

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Letter to the editor: “Considerations in computer-aided design for inlay cranioplasty: technical note”

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Prosthetic versus surgical rehabilitation in patients with maxillary defect regarding the quality of life: systematic review

Abstract

Purpose

To assess the ability of prosthetic rehabilitation versus surgical rehabilitation in improving the QOL for patients with maxillary defects.

Material and methods

A systematic search of PubMed, Scopus data base, Cochrane database, Ovid database, and Latin America & Caribbean database for articles published before September 2017 was performed by two independent reviewers. A manual search of articles published from January 2000 to September 2017 was also conducted. Only English studies were included which evaluate the QoL in patients with head and neck cancers. Any confusion between the two independent reviewers was resolved by means of a moderated discussion between the reviewers.

Results

Five studies fulfilled the inclusion criteria for this study. Many parameters were used regarding evaluation of QOL as the EORTC Head and Neck 35 assessment, UW-QOL, OHIP-14, VAS, OFS, MHI, HAD, Body Satisfaction Scale, Oral symptom check list, Swallowing, Diet consist, Pain control, Postoperative complication, and Speech. Two studies supported the surgical line of treatment for improving the QOL as compared to the prosthetic one; another two studies showed a statistically insignificant improvement in the patients' QOL with the surgical line, while only one revealed insignificant difference in QoL with both lines of treatment.

Conclusions

Surgical rehabilitation provides a better line of treatment in improving the QOL for patients with maxillary defects. On the other hand, prosthetic has proved effectiveness in the immediate post-surgical times as temporary strategy, and it has represented a good alternative when the surgical obturation is compromised.

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Viscerocutaneous Loxoscelism

R. Cullen, P. Hasbún, M.P. Piquer
Actas Dermosifiliogr 2018;109:179

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Use of ultrasonic scalpel and monopolar electrocautery for skin incisions in neck dissection: a prospective randomized trial

Abstract

Purpose

Ultrasonic scalpel (UC) and monopolar electrocautery (ME) are standard equipment for soft tissue surgery. The aim of the present study was to compare intraoperative and postoperative patterns of patients using either UC or ME for skin incisions in neck dissection.

Material and methods

In a prospective randomized study of 30 patients, the thermal effects of UC (n = 15) and ME (n = 15) were examined using real-time infrared thermographic imaging. Additionally, tissue damage was evaluated histopathologically. The other measured variables were operation and bleeding time, postoperative pain score (only neck incision area), in-patient time, and complications.

Results

UC significantly reduces the thermal effects, compared to ME (p < 0.001). The mean depth of tissue damage (i.e., necrosis) was 272.7 μm for UC and 284.7 μm for ME with no significant difference (p = 0.285). From the third postoperative day, patients treated using UC had noticeably less pain in the neck incision area (t3 p = 0.010; t4 p < 0.001; t5 p < 0.005). Cutting time was reduced for ME by 36.1 s (p < 0.001) and the bleeding time was decreased by 40.9 s for UC (p < 0.001). The total preparation time was the same (p = 0.402). When comparing in-patient time (p = 0.723), as well as complications, no significant differences were seen.

Conclusion

UC results in less postoperative pain and less bleeding in the neck incision area. Accordingly, UC is superior to ME for skin incisions in neck dissection.

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Síndrome de CLAPO

M.Á. Flores-Terry, P. Zamberk-Majlis, M.P. Cortina-de la Calle, M. García-Arpa
Actas Dermosifiliogr 2018;109:180

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Malignant Blue Nevus: A Challenge for Dermatologists and Dermatopathologists

T. Toledo-Pastrana, I. Rodríguez Pérez, P. Eguino Gorrochategui
Actas Dermosifiliogr 2018;109:181-3

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Cutaneous Solitary Fibrous Tumor: A Spindle Cell Neoplasm With Distinctive Immunohistochemical Features

J. Santos-Juanes, B. García-García, Y. Hidalgo, B. Vivanco
Actas Dermosifiliogr 2018;109:183-5

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Allergic diseases: A collection of interactive immunologic disorders at the crossroads of genetics, environment, and immunity

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Association between urticaria and nematode infections

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Association of alopecia areata with atopic dermatitis and chronic spontaneous urticaria

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Association between psoriasis and asthma risk: A meta-analysis

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Safety of a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in children: A randomized clinical trial

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Randomized trial to assess the efficacy and safety of beclomethasone dipropionate breath-actuated inhaler in patients with asthma

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VideoEndocrinology™ High-Impact Videos

VideoEndocrinology™
The Official Journal of: American Thyroid Association

FREE ACCESS through March 12, 2018.
Watch now:

Delphian Lymph Node Dissection: Surgical Dissection Technique as Illustrated by the Johns Hopkins Head and Neck Endocrine Surgery Division
Vaninder K. Dhillon, Jonathon O. Russell, Ralph P. Tufano 

Postoperative Continuous Pressure Monitoring in Thyroid Surgery: Pathophysiology of Post-Thyroidectomy Hemorrhage
Ulrich Wirth, Thomas von Ahnen, Stefan Schopf, Hans Martin Schardey 

An Elusive Parathyroid: Interesting Case Presentation
Anton F. Engelsman, Robert F. Parkyn, Andrew Carter, James Christie, Leigh W. Delbridge 

Transaxillary Robotic Parathyroidectomy: Huge Parathyroid Adenoma
Patrick Aidan, Maroun Bechara

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Asthma control, lung function, symptoms, and corticosteroid sparing after omalizumab initiation in patients with allergic asthma

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Thyroid® High-Impact Articles

FREE ACCESS through March 9, 2018.
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Latest Impact Factor: 5.515
The Official Journal of: American Thyroid Association^®

Gene Fusions in Thyroid Cancer
Valentina D. Yakushina, Larisa V. Lerner, Alexander V. Lavrov

Alterations of the Gut Microbiota in Hashimoto's Thyroiditis Patients
Fuya Zhao, Jing Feng, Jun Li, Lei Zhao, Yang Liu, Huinan Chen, Ye Jin, Biqiang Zhu, Yunwei Wei 

Cancer Risk Associated with Nuclear Atypia in Cytologically Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis
Pablo Valderrabano, Laila Khazai, Zachary J. Thompson, Susan C. Sharpe, Valentina D. Tarasova, Kristen J. Otto, Julie E. Hallanger-Johnson, J. Trad Wadsworth, Bruce M. Wenig, Christine H. Chung, Barbara A. Centeno, Bryan McIver 

Maternal Thyrotropin Receptor Antibody Concentration and the Risk of Fetal and Neonatal Thyrotoxicosis: A Systematic Review
Naomi Kiyota, Bruce Robinson, Manisha Shah, Ana O. Hoff, Matthew H. Taylor, Di Li, Corina E. Dutcus, Eun Kyung Lee, Sung-Bae Kim, Makoto Tahara

 

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The age-related characteristics of adults with asthma who visited emergency departments in Korea from 2007 to 2012

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Clinical Thyroidology®High-Impact Articles

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Editorial: What's Ahead for Clinical Thyroidology in 2018
Jerome M. Hershman 

Patient Age Is Associated with Papillary Thyroid Cancer Mortality Only in Patients with BRAF V600E Mutation
Masha J. Livhits, Michael W. Yeh

Current ATA Thyroid Cancer Guidelines Are Poor Predictors of the Extent of Thyroidectomy
Tracy S. Wang

A Low-Iodine Diet During Methimazole Treatment Worsens Graves' Disease Outcomes
Elizabeth N. Pearce

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In vitro induction of T regulatory cells by a methylated CpG DNA sequence in humans: Potential therapeutic applications in allergic and autoimmune diseases

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Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Many clinicians and laboratories check TSH alone as the initial test for thyroid problems and then only add a Free T4 measurement if the TSH is abnormal, referred to as "reflex" testing. Read More….

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

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Interleukin 33 and interleukin 4 regulate interleukin 31 gene expression and secretion from human laboratory of allergic diseases 2 mast cells stimulated by substance P and/or immunoglobulin E

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ATA® Thyroid Cancer Patient Survey

DIAGNOSED AND TREATED FOR THYROID CANCER?
ATA^® INVITES YOUR FEEDBACK ON THIS SURVEY:

https://www.surveymonkey.com/r/thyroidcancerpatientsurvey

The American Thyroid Association^® (ATA) is collecting information and opinions from patients about their experience with thyroid cancer to better inform medical providers about how patients experience the challenge of thyroid cancer diagnosis and treatment. ATA^® encourages anyone with a history of thyroid cancer to take this survey, feel free to disseminate this survey link broadly, and encourage others to take the survey. We also encourage all thyroid healthcare professionals to share this survey with their patients. Survey results will be compiled and discussed by thyroid leaders at the American Thyroid Association Satellite Symposium: The Spectrum of Thyroid Cancer, from Surveillance to Systemic Therapy on Friday, March 16, 2018 from 11:15 AM – 5:30 PM at McCormick Place West in Chicago, IL. Subsequently, survey results will be posted online with free access to the public as well as made available through publication. Your responses are anonymous and should only take a few minutes to complete.

For more information regarding the ATA Spring Satellite Symposium, visit the ATA website at www.thyroid.org or  https://www.thyroid.org/2018-ata-spring-satellite/.

We again appreciate your continued support of ATA^® and its initiatives.

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Guidance for compassionate restraint of small children to prevent injuries with epinephrine autoinjectors

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For the Patient

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Clinical Thyroidology®High-Impact Articles

FREE ACCESS through February 13, 2018
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Should a Young Patient in Whom a Multinodular Goiter Develops Be Assessed for DICER1 Mutations?
Stephen W. Spaulding

Levothyroxine Treatment Does Not Reduce Risk for Premature Delivery Among TPO-Negative Pregnant Women with a TSH of 2.5 to 10.0 mIU/L
Elizabeth N. Pearce

Adding the Immunosuppressant Mycophenolate Mofetil to Medium-Dose Infusions of Methylprednisolone Improves the Treatment of Graves' Orbitopathy
Jacques Orgiazzi

Surgery for Hyperthyroidism Lowers Cardiovascular Mortality Compared with Radioactive Iodine
Andrew J. Day, Michael W. Yeh, Masha J. Livhits

 

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Characterization and expression of DEC205 in the cDC1 and cDC2 subsets of porcine dendritic cells from spleen, tonsil, and submaxillary and mesenteric lymph nodes

Publication date: April 2018
Source:Molecular Immunology, Volume 96
Author(s): Héctor Parra-Sánchez, Lucinda Puebla-Clark, Mónica Reséndiz, Olivia Valenzuela, Jesús Hernández
Conventional dendritic cells (cDCs) are divided into the following different subtypes: cDC1, which promotes a Th1 response, and cDC2, which stimulates a Th2 and Th17 response. These cells have not been characterized in porcine lymphoid tissues. DEC205 is a receptor that increases antigen presentation and allows DCs to cross-present antigens. The objectives of this work were to characterize cDCs subsets in the tonsil, submaxillary and mesenteric lymph nodes and spleen lymphoid tissues and to determine their expression of DEC205 by flow cytometry. The cDC1 (MHCII^highCADM1^highCD172a^−/low) and cDC2 (MHCII^highCADM1^highCD172a⁺) phenotypes were confirmed by the expression of characteristic cDC1 and cDC2 transcripts (FLT3, XCR1 and FCER1α). Among all lymphoid tissues, the spleen had the highest frequency of total cDCs. The cDC1:cDC2 ratio showed that all lymph tissues had higher levels of cDC1 than levels of cDC2. DEC205⁺ cDCs were found in all analyzed tissues, albeit with different frequencies. Our research will facilitate the study on the function of these cells and the investigation of the strategies for DEC205 targeting and functional studies.



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Contact allergy to benzalkonium chloride in patients using a steroid nasal spray: A report of 3 cases

Jerome Rene Lechien, MD, PhD, MS; Pedro Costa de Araujo, MD; Lisa G. De Marrez, BSc; Jean-Luc Halloy, MD; Mohamad Khalife, MD; Sven Saussez, MD, PhD

Abstract

Benzalkonium chloride (BAC) is a bactericidal preservative excipient commonly found in steroid nasal sprays used to treat allergic rhinitis and nasal polyposis. In rare cases, BAC can be responsible for type I and type IV hypersensitivity reactions that can manifest as rhinorrhea, which a clinician might misinterpret as a lack of response to nasal spray therapy rather than a complication of it. We report 3 cases of type IV hypersensitivity reactions in patients who were being treated with mometasone nasal spray. We describe the epidemiology, clinical features, diagnosis, and treatment of these reactions.

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Recent advances in the selection and identification of antigen-specific nanobodies

Publication date: April 2018
Source:Molecular Immunology, Volume 96
Author(s): Wenshuai Liu, Haipeng Song, Quan Chen, Jianli Yu, Mo Xian, Rui Nian, Dongxiao Feng
Nanobodies represent the next-generation antibody-derived biologics with significant advances over conventional antibodies. Several rapid and robust techniques for isolating highly specific nanobodies have been developed. Antigen specific nanobodies are selected from constructed nanobody libraries, which can be classified into 3 main types: immune library, naïve library, and semisynthetic/synthetic library. The immune library is the most widely used strategy for nanobody screening. Target specific nanobodies are highly enriched in immune libraries than in non-immune libraries; however, it is largely limited by the natural antigenicity of antigens. The naïve library is thus developed. Despite the lack of somatic maturation, protein engineering can be employed to significantly increase the affinities of selected binders. However, a substantial amount of blood samples collected from a large number of individual animals is a prerequisite to ensure the diversity of the naïve library. With this issue considered, the semisynthetic/synthetic library may be a promising path toward obtaining a limitless source of nanobodies against a variety of antigens without the need of animals. In this review, we summarize the state-of-the-art screening technologies with different libraries. The approaches presented here can further boost the diverse applications of nanobodies in biomedicine and biotechnology.



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A South African first: Congenital absence of the cartilaginous nasal septum

Yahya Atiya, MBBCh, MMed (ORL), FCORL

Abstract

Congenital absence of the cartilaginous nasal septum has been reported just once in the literature. We present a case of a young child, diagnosed by exclusion, with complete agenesis of the cartilaginous septum. We believe it is only the second case worldwide, and the first in South Africa, to be reported.

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miR-330-5p/Tim-3 axis regulates macrophage M2 polarization and insulin resistance in diabetes mice

Publication date: March 2018
Source:Molecular Immunology, Volume 95
Author(s): Jiling Sun, Qiujing Huang, Shufa Li, Fanqing Meng, Xunhua Li, Xiaoyun Gong
Obesity is associated with a state of low-grade inflammatory response in adipose tissue, and contributes to the development of type 2 diabetes.Immune cells such as macrophages can infiltrate adipose tissue and are responsible for the majority of inflammatory cytokine production. Therefore, adipose tissue promotes macrophage infiltration, resulting in local inflammation and insulin resistance. Tim-3 negatively regulates IFN-γ secretion and influences the ability to induce T cell tolerance in diabetes. MicroRNA contributes to the development of immunological tolerance and involves in macrophage polarization. However, the potential of Tim-3 to regulate macrophage polarization and the related microRNA has not been reported. In this experiment, 8-week-old C57BL/6 mice were fed a high-fat diet for 8 weeks. The adipose tissue macrophages were isolated, miR-330-5p and Tim-3 levels, and M1/M2 polarization were analyzed. In addition, insulin tolerance tests was detected. The results demonstrated that miR-330-5p levels increased but Tim-3 levels decreased, leading to M1 polarization and insulin tolerance in diabetes mice. In addition, inhibition of miR-330-5p enhanced Tim-3 levels, leading to M2 polarization and insulin tolerance attenuation in diabetes mice. Furthermore, we detected the inverse relationship between miR-330-5p and Tim-3. We found that Tim-3 mRNA contained conserved miR-330-5p binding sites in its 3′UTR, and miR-330-5p could directly regulate Tim-3 expression through these 3′UTR sites. Our study demonstrated that miR-330-5p served as a regulator of the M2 polarization and miR-330-5p/Tim-3 axis potentially down-regulated insulin resistance in diabetes, probably through enhancing the M2 polarization of macrophage.



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Use of the microdebrider in the surgical management of rhinophyma

Winsion Chow, MD, MSc; Goran Jeremic, MD, FRCSC; Leigh Sowerby, MD, FRCSC

Abstract

Rhinophyma is a disfiguring end-stage manifestation of acne rosacea. It is characterized by a painless hyperplasia of the sebaceous glands and connective tissues of the nose. Numerous surgical modalities-including scalpel surgery, dermabrasion, CO2 laser ablation, and electrocautery-have been reported with varying results. We describe our experience with using a microdebrider to treat 2 patients-a 65-year-old man and a 74-year-old man-who presented with rhinophyma. The instrument we used was the Medtronic Straightshot M4 Microdebrider. Using a low revolution speed, we easily excised the bulky superficial tissue. At higher revolution speeds with the use of a small shaver tip, we were able to achieve delicate contouring of the nasal tip and ala without causing scarring. Postoperatively, both patients exhibited an excellent cosmetic outcome and expressed a high degree of patient satisfaction. We conclude that the microdebrider is an excellent surgical tool for treating rhinophyma lesions. Its ease of use and its availability at most surgical centers makes it a favorable surgical option.

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Emodin attenuates titanium particle-induced osteolysis and RANKL-mediated osteoclastogenesis through the suppression of IKK phosphorylation

Publication date: April 2018
Source:Molecular Immunology, Volume 96
Author(s): Juehong Li, Yamin Li, Xiaochun Peng, Bin Li, Xiangwei Yuan, Yunsu chen
Aseptic loosening due to wear particles is a serious challenge for orthopedic surgeons, sabotaging the long-term success of total joint arthroplasty. The existing treatments for aseptic loosening are still far from satisfactory, necessitating more aggressive drug exploration. Here, we examined the effect of emodin on titanium particle-induced osteolysis and further investigated its underlying mechanism in vivo and in vitro. Thirty-two C57BL/6 mice were randomly assigned into four groups: the Sham group (sham operation with vehicle injection), Vehicle group (titanium particle treatment with vehicle injections), Low group (titanium particle treatment with injections of 10 mg/kg/day emodin) and High group (titanium particle treatment with injections of 50 mg/kg/day emodin). Micro-CT scanning and histological analysis revealed that after emodin injections, the inflammatory response and bone destruction were markedly ameliorated. TRAP staining showed that osteoclast numbers were also dramatically reduced. Throughout the in vitro culture period, emodin significantly decreased the bone resorption area, number of osteoclasts and formation of F-actin rings. Mechanistic studies suggested that reduced NF-κB signaling might be mediating the inhibitory effects of emodin. Collectively, our findings suggest that emodin, a natural product extracted from Rheum palmatum, may be developed as a promising candidate for the treatment of wear particle-induced osteolysis and subsequent aseptic loosening.



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A case of squamous cell carcinoma of the nasal cavity in a patient with granulomatosis with polyangiitis (Wegener granulomatosis)

Edward C. Kuan, MD, MBA; Kevin A. Peng, MD; Lyndon O. Gonzalez, MD; Joel A. Sercarz, MD

Abstract

We report a rare case of squamous cell carcinoma (SCC) of the nasal cavity arising in a patient with granulomatosis with polyangiitis (GPA). The patient was a 35-year-old man who had been diagnosed 15 years earlier with GPA and treated medically for sinonasal, pulmonary, and renal involvement. He presented to us with left-sided orbital and cheek pain and nasal obstruction. Endoscopy detected a friable, exophytic mass that involved the left lateral nasal wall and septum. Biopsy analysis identified the mass as an SCC. A definitive endoscopic resection was performed, followed by chemoradiation, but the patient exhibited progression of disease 2 months after the cessation of therapy. He then underwent an open craniofacial resection and a second round of chemoradiation. At 7 months of follow-up, he remained disease-free. Sinonasal symptoms in GPA are consistent with those in chronic rhinosinusitis, but the presence of unilateral symptoms may suggest a neoplastic process. Immunosuppressants are implicated in the pathophysiology of this malignancy, but equally plausible is the oncogenic role of chronic inflammation.

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Variations of T and B lymphocytes of flounder (Paralichthys olivaceus) after Hirame novirhabdovirus infection and immunization

Publication date: April 2018
Source:Molecular Immunology, Volume 96
Author(s): Jing Xing, Lei Wang, Mengxiao Zhen, Xiaoqian Tang, Wenbin Zhan
T and B lymphocytes are closely related to immunization and pathogen infection. Our previous study confirmed the CD3⁺, CD4-1⁺, CD4-2⁺, CD8β⁺ T lymphocytes and IgM⁺ B lymphocytes presented in the peripheral blood leukocytes (PBLs) of flounder (Paralichthys olivaceus), in this paper, the variations of T and B lymphocytes of flounder after Hirame novirhabdovirus (HIRRV) infection or immunization were investigated. The flounders were injected with live or inactivated HIRRV, then the percentages of T and B lymphocytes in PBLs were analyzed by Flow cytometry (FCM), total antibodies and HIRRV-specific antibodies in serum were detected by Enzyme-linked immunosorbent assay (ELISA), and expression of twelve immune-related genes in the head kidneys were determined using q-PCR. The results showed that the percentages of CD3⁺, CD4-1⁺, CD4-2⁺, CD8β⁺ T lymphocytes and IgM⁺ B lymphocytes significantly increased in both infection and immunization groups, in infection group they decreased rapidly after the peak and significantly lower than control levels at the end of infection, in immunization group they went down steadily to the control levels at the end of immunization. The total antibodies and HIRRV-specific antibodies increased first and peaked on the 7^th day post infection and on the 14^th day post immunization, respectively, then gradually decreased to the control levels. Additionally, twelve immune-related genes were up-regulated in both groups. These results demonstrated that the HIRRV induced both humoral and cellular immunity of flounder, the lymphocytes varied more sharply in infection group than those in immunization group and CD8⁺ T lymphocytes responded much more than CD4⁺ T lymphocytes to HIRRV antigen.



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Silicone granuloma formation associated with dermal injection

Leo L. Wang, MS; William W. Thomas, MD; Cherie M. Ditre, MD; Oren Friedman, MD

Silicone fillers, for all their advantages, are associated with significant long-term risks.

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Immunological network analysis in HPV associated head and neck squamous cancer and implications for disease prognosis

Publication date: April 2018
Source:Molecular Immunology, Volume 96
Author(s): Xiaohang Chen, Bingqing Yan, Huihuang Lou, Zhenji Shen, Fangjia Tong, Aixia Zhai, Lanlan Wei, Fengmin Zhang
Human papillomavirus-positive (HPV+) head and neck squamous cell cancer (HNSCC) exhibits a better prognosis than HPV-negative (HPV−) HNSCC. This difference may in part be due to enhanced immune activation in the HPV+ HNSCC tumor microenvironment. To characterize differences in immune activation between HPV+ and HPV− HNSCC tumors, we identified and annotated differentially expressed genes based upon mRNA expression data from The Cancer Genome Atlas (TCGA). Immune network between immune cells and cytokines was constructed by using single sample Gene Set Enrichment Analysis and conditional mutual information. Multivariate Cox regression analysis was used to determine the prognostic value of immune microenvironment characterization. A total of 1673 differentially expressed genes were functionally annotated. We found that genes upregulated in HPV+ HNSCC are enriched in immune-associated processes. And the up-regulated gene sets were validated by Gene Set Enrichment Analysis. The microenvironment of HPV+ HNSCC exhibited greater numbers of infiltrating B and T cells and fewer neutrophils than HPV− HNSCC. These findings were validated by two independent datasets in the Gene Expression Omnibus (GEO) database. Further analyses of T cell subtypes revealed that cytotoxic T cell subtypes predominated in HPV+ HNSCC. In addition, the ratio of M1/M2 macrophages was much higher in HPV+ HNSCC. The infiltration of these immune cells was correlated with differentially expressed cytokine-associated genes. Enhanced infiltration of B cells and CD8+ T cells were identified as independent protective factors, while high neutrophil infiltration was a risk enhancing factor for HPV+ HNSCC patients. A schematic model of immunological network was established for HPV+ HNSCC to summarize our findings.



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Temporal bone anomalies associated with unbalanced 9;13 chromosome translocation depicted on CT and MRI

Daniel Thomas Ginat, MD, MS

The presence of microtia in conjunction with inner ear anomalies is uncommon.

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Absence of a neutralizing antibody response to humanized cobra venom factor in mice

Publication date: May 2018
Source:Molecular Immunology, Volume 97
Author(s): Mathieu Ing, Brian E. Hew, David C. Fritzinger, Sandrine Delignat, Sébastien Lacroix-Desmazes, Carl-Wilhelm Vogel, Julie Rayes
Cobra venom factor (CVF) is the complement-activating protein in cobra venom. Humanized CVF (hCVF) is a human C3 derivative where the C-terminal 168 amino acid residues were replaced with the homologous sequence from CVF. hCVF has been shown in multiple models of disease with complement pathology to be a promising therapeutic agent, with no observed adverse effects. Here we describe the antibody response to hCVF in two different strains of mice. hCVF was able to repeatedly decomplement the mice after four injections in weekly intervals, demonstrating the absence of a neutralizing antibody response. In contrast, natural CVF caused decomplementation in all mice only after the first administration. After two additional administrations of natural CVF, decomplementation was inconsistent and varied tremendously from mouse to mouse. After the fourth administration, natural CVF was essentially unable to deplete complement, consistent with the known generation of a neutralizing antibody response. We also analyzed the IgG antibody response to hCVF. There was great variation, with approximately one quarter of the mice exhibiting non-detectable levels of anti-hCVF IgG, and another quarter very low levels. The levels of anti-hCVF IgG did not correlate with the levels of remaining C3. The anti-hCVF antibodies cross-reacted with natural CVF, recombinant CVF, and human C3. Whereas overall the level of anti-hCVF IgG cross-reacting with human C3 was lower compared to rCVF or nCVF, mice with higher levels of anti-hCVF IgG exhibited higher binding to CVF and human C3, excluding the possibility that higher antibody levels reflect preferential immunogenicity of CVF-specific or human C3-specific epitopes.



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Langerhans cell histiocytosis presenting as a scalp mass in a child

Omar Hariri, BBA; Seckin Ulualp, MD; Ron B. Mitchell, MD

The clinical presentation and course of Langerhans cell histiocytosis can range from a single benign lesion to life-threatening disseminated disease affecting multiple organs.

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Bacterially activated B-cells drive T cell differentiation towards Tr1 through PD-1/PD-L1 expression

Publication date: April 2018
Source:Molecular Immunology, Volume 96
Author(s): Sawsan Sudqi Said, Guliz Tuba Barut, Nesteren Mansur, Asli Korkmaz, Ayca Sayi-Yazgan
Regulatory B cells (Bregs) play a crucial role in immunological tolerance primarily through the production of IL-10 in many diseases including autoimmune disorders, allergy, infectious diseases, and cancer. To date, various Breg subsets with overlapping phenotypes have been identified. However, the roles of Bregs in Helicobacter infection are largely unknown. In the present study, we investigate the phenotype and function of Helicobacter −stimulated B cells. Our results demonstrate that Helicobacter felis −stimulated IL-10- producing B cells (Hfstim- IL-10⁺ B) are composed of B10 and Transitional 2 Marginal Zone Precursor (T2-MZP) cells with expression of CD9, Tim-1, and programmed death 1 (PD-1). On the other hand, Helicobacter felis −stimulated IL-10- nonproducing B (Hfstim- IL-10⁻ B) cells are mainly marginal zone (MZ) B cells that express PD-L1 and secrete TGF-β, IL-6, and TNF-α, and IgM and IgG2b. Furthermore, we show that both Hfstim- IL-10⁺ B cells and Hfstim- IL-10⁻ B cells induce CD49b⁺LAG-3⁺ Tr1 cells. Here, we describe a novel mechanism for PD-1/PD-L1- driven B cell-dependent Tr1 cell differentiation. Finally, we explore the capability of Hfstim- IL-10⁻ B cells to induce Th17 cell differentiation, which we find to be dependent on TGF-β. Taken together, the current study demonstrates that Hfstim- B cells induce Tr1 cells through the PD-1/PD-L1 axis and Th17 cells by secreting TGF-β.



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Microbial flora and antibiotic resistance in odontogenic abscesses in Upstate New York

Ann W. Plum, MD; Anthony J. Mortelliti, MD; Ronald E. Walsh, NP

Abstract

Abscesses in the head and neck frequently have odontogenic sources. As bacterial pathogens and antibiotic resistance patterns may change over time and based on location, we describe the current common bacteria found in odontogenic abscesses, the prevalence of antibiotic resistance, and differences in each between pediatric and adult patients in Upstate New York. This is a retrospective review of patients who underwent drainage of odontogenic abscesses (n = 131) from 2002 to 2012 at an academic institution. The medical records were reviewed for results of abscess cultures, comorbidities, and drainage procedures. Polymicrobial sources were identified in 60.3% and monomicrobial in 33.6%. Overall, the most common bacteria were alpha hemolytic Streptococci (33.6%), Streptococcus milleri (32.1%), Prevotella (16.8%), and coagulase-negative Staphylococcus (14.5%). Candida and Morganella spp were more common in children than in adults. Overall, antibiotic resistance was observed in seven different pathogens. The most common antibiotic resistances were to clindamycin and erythromycin, which should be considered when deciding initial antibiotic therapy, especially in adult patients, who trended in this study toward having pathogens with higher rates of resistance.

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Endoscopic view of a mucocele obstructing a middle meatal antrostomy

Eiji Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, MBA, FACS

Mucoceles can occur naturally as mucus retention cysts or after sinus surgery, by ostial obstruction and formation of a lesion lined by low columnar epithelium.

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The head impulse test as a predictor of videonystagmography caloric test lateralization according to the level of examiner experience: A prospective open-label study

Ashraf Awadie, MD; Yehuda Holdstein, MD; Margalit Kaminer, MSc; Avi Shupak, MD

Abstract

We conducted a study to compare how well the head impulse test (HIT), without and with eye-movement recordings, would predict videonystagmographic (VNG) caloric test lateralization when performed by a resident and an experienced otoneurologist. This prospective, open-label, blinded study was conducted in an ambulatory tertiary care referral center. Our study population was made up of 60 patients-29 men and 31 women, aged 20 to 82 years (mean: 56.4 ± 11.4)-with peripheral vestibulopathy who underwent HIT and VNG caloric testing. The HIT was conducted in two protocols: HIT0 and HIT1. The HIT0 was performed with passive brisk movements of the patient's head from the 0° null position to 20° sideways, and the HIT1 was performed toward the center while the null position was a 20° head rotation to the right and to the left. Each protocol was carried out without video eye-movement recordings (HIT0 and HIT1) and with such recordings (rHIT0 and rHIT1). The primary outcome measures were (1) a comparison of the HIT's sensitivity and specificity when performed by the resident and by the experienced otoneurologist and (2) the ability of video-recorded HIT to predict VNG caloric test lateralization. The sensitivity and specificity obtained by the resident were 41 and 81%, respectively, for HIT0 and 41 and 90% for HIT1. The sensitivity and specificity obtained by the experienced otoneurologist were 18 and 89% for HIT0 and 32 and 85% for HIT1. Analysis of the recorded eye-movement clips of the HIT0 and HIT1 obtained by a second experienced otoneurologist found a sensitivity and specificity of 32 and 63% for rHIT0 and 33 and 82% for rHIT1. We conclude that the HIT yields high false-negative rates in predicting significant caloric lateralization. Analysis of the eye-movement recordings was no better than normal testing alone for detecting saccades. The experience of the examining physician had no impact on test performance characteristics.

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Fiberoptic Endoscopic Evaluation of Swallow (FEES) in Intensive Care Unit Patients Post Extubation

Abstract

Intensive care unit patients frequently require prolonged intubation and ventilator support. Swallowing dysfunction often occurs in patients who receive prolonged mechanical ventilation. Intubation can cause transient injury to the larynx with a subsequent reduction in protective mechanism and increased incidence of oropharyngeal secretions once patient is extubated. Aim of this study was to evaluate the anatomical damage caused by intubation and the occurrence of aspiration/silent aspiration in patients following extubation, using fiberoptic endoscopic evaluation of swallow (FEES) as diagnostic and therapeutic tool. Participants in the study included all adult ICU patients who were intubated for ≥ 48 h. Head injury patients, patients with abnormal neurological status, completely disoriented patients were excluded. We performed FEES in 41 patients. Duration of intubation was in the range of 2–9 days. We studied 41 patients, among them 19(44%) patients had laryngeal injury and 6 (14%) had aspiration. we noticed that all patients who had aspiration had some laryngeal injury. All 6 patients who had aspiration initially recovered their swallowing function fully as noticed during repeat FEES done after swallow therapy. There is a significant impact of intubation on occurrence of aspiration (14%) and laryngeal abnormality (44%). We found in our study that there is a significant correlation to duration of intubation and occurrence of laryngeal injury.

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Comparative Study of Management of BPPV (Benign Paroxysmal Positional Vertigo) with only Drugs Versus Drugs Plus Epley Manoeuvre

Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, accounting for 20% of all vertigo cases. Idiopathic BPPV is most common between the ages of 50 and 70, although the condition is found in all age groups. The importance of early diagnosis and treatment can lead to a much improved quality of life for patients afflicted by this ailment. It is presently common for physicians to treat these patients mainly with benzodiazepines, antihistamines, and anticholinergic medications, especially if the history and physical is consistent with BPPV. This method of treatment has had questionable success. Several reviews of the management of vertigo have shown that no medication in current use has well established curative or prophylactic value or is suitable for long-term treatment. Epleys manoeuvre is also used in the treatment of BPPV. This manoeuvre relocates free floating particles from the affected semi-circular canals back into utricle, thus relieving the symptoms of vertigo. The purpose of this study is to compare the efficacy of Epleys manoeuvre with conventional drug therapy versus conventional therapy alone in patients who present with vertigo. The purpose of this study to evaluate and examine two methods of treatment.

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Physical Activity, Body Mass Index, and Clustered Metabolic Risk in U.S. Adolescents: 2007–2012 Nhanes

Metabolic Syndrome and Related Disorders, Volume 16, Issue 2, Page 97-103, March 2018.


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Hemodynamic, airway pressure, and capnometric changes and perioperative outcome in pediatric laparoscopic inguinal herniorrhaphy: A comparison with open inguinal herniorrhaphy

Jyoti Garg, Suniti Kale, Nikki Sabharwal, Deepak Bagga, Anoop Raj Gogia

Anesthesia: Essays and Researches 2018 12(1):165-169

Background: Laparoscopic procedures which are now established in pediatric population as well exposes the child to supplemental cardiorespiratory changes due to increase in intraabdominal pressure (IAP) and hypercarbia. Aims: This study aims to analyze the effects of pneumoperitoneum and postural modifications on cardiorespiratory system (primary outcome) during pediatric laparoscopic herniorrhaphy (LH) and its comparison with open herniorrhaphy (OH) and assessment of overall perioperative outcome (secondary outcome). Settings and Design: A prospective, observational study conducted in a tertiary care hospital. Materials and Methods: Fifty children undergoing either LH (n = 25) or OH (n = 25) were included in the study. Anesthetic procedure was standardized. Parameters monitored were heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressures (MAP), electrocardiogram lead-II, end-tidal CO2(ETCO2), airway pressures PPeak, PPlateau, PMean, pulse oximetry, IAP, minute ventilation/respiratory rate alterations. Statistical Analysis Used: Student's t-test and Chi-square test were applied to compare different variables between the two groups. Intragroup analysis was done using the analysis of variance test. Results: The HR was comparable in both groups. The rise in SBP, DBP, and MAP was 9% (102.88 ± 6.91–121.32 ± 6.63), 19% (60.88 ± 4.94–77.00 ± 9.75), and 14.8% (73.92 ± 4.65–90.40 ± 8.42), respectively, in group LH. The rise in peak, plateau, and mean airway pressures was 19.4% (14.20 ± 2.00–18.00 ± 2.54), 20.1% (13.32 ± 1.89–16.89 ± 2.60), and 16.1% (6.20 ± 1.00–7.47 ± 0.96), respectively, in group LH. ETCO2showed a maximum rise of 19.4% (34.52 ± 3.61–41.21 ± 3.99) in group LH. In laparoscopic group, recurrence was seen in 3 patients. Conclusions: We found significant hemodynamic, airway pressure, and capnometric changes during pediatric LH with comparable perioperative outcome among the two groups.

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Relationship Between Paraoxonase-1 and Butyrylcholinesterase Activities and Nutritional Status in Mexican Children

Metabolic Syndrome and Related Disorders, Volume 16, Issue 2, Page 90-96, March 2018.


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The role of nonpharmacological methods in attenuation of pain due to peripheral venous cannulation: A randomized controlled study

Archana Shivashankar, KB Nalini, Prapti Rath

Anesthesia: Essays and Researches 2018 12(1):7-10

Background: Establishing an intravenous access is indispensable for safe administration of anesthesia. Most of the times, it is executed without any analgesia although the pain associated with this procedure is quite agonizing to the patients. Aims: This study aims to evaluate the role of 3 different nonpharmacological measures such as Valsalva maneuver, flash of light, and distraction method in attenuation of pain during venous cannulation. Design: A clinical randomized controlled study. Materials and Methods: Two hundred patients of either sex, aged between 18 and 65 years, posted for elective surgery were enrolled in this study. Patients were randomly allocated into four groups, Group C-control, Group V (valsalva) - blew into sphygmomanometer raising the mercury column up to 30 mm of Hg, Group D (distraction) - pressed a rubber ball and Group L (light) - photographed with a flash of light before venous cannulation. During the process of cannulation, patients were observed and questioned, and pain was graded using a 4- point scale. After the cannulation, pain during the procedure was also assessed using visual analog scale (VAS) score. Data analysis was done using SPSS statistical package version 17. Results: A significant reduction in the incidence of pain was noted in distraction group 36% as compared to 44% in Group L, 46% in Group V, and 100% in the control group. The severity of pain as assessed by 4-point score was significantly lowest in Group D (0.26 ± 0.53) as compared to other three groups (Group V and L = 0.54 ± 0.16, Group C = 1.64 ± 0.6, P < 0.001). Mean VAS score was significantly low in Group D (0.6 ± 1.11) and Group L (0.54 ± 1.06) as compared to Group V (1.26 ± 1.76) and Group C (5.0 ± 1.21, P < 0.001). Conclusion: We conclude that distraction can be considered as a diligent, reasonable, and simple method to attenuate procedural pain during peripheral venous cannulation.

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Vaspin and Omentin-1 in Obese Children with Metabolic Syndrome: Two New Kids on the Block?

Metabolic Syndrome and Related Disorders, Volume 16, Issue 2, Page 73-75, March 2018.


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Comparison of levobupivacaine and levobupivacaine with dexmedetomidine in infraumbilical surgeries under spinal anesthesia

Amar Parkash Kataria, Vishal Jarewal, Rajan Kumar, Ankush Kashyap

Anesthesia: Essays and Researches 2018 12(1):251-255

Introduction: Spinal anesthesia is a widely used technique providing faster onset with effective and uniformly distributed sensory and motor block. Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia. Dexmedetomidine when used intrathecally is associated with prolonged motor and sensory block, hemodynamic stability, and less requirement of rescue analgesia in 24 h. Materials and Methods: A prospective, randomized study was carried out which included 60 adult patients between the age group of 20 and 65 years of physical status American Society of Anesthesiologists Classes I and II who underwent infraumbilical surgeries. Group L patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml normal saline while Group LD patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml (3 μg) dexmedetomidine. The two groups were compared with respect to the onset and duration of sensory and motor block and hemodynamic stability. Results: The mean duration of sensory block in Group L was 199.50 ± 7.96 min while in Group LD was 340.20 ± 11.78 min. All the differences were statistically highly significant between the two groups (P < 0.001). Mean duration of motor block in Group L and LD was 150.83 ± 9.17 min and 190.20 ± 9.61 min, respectively. Both the differences were highly significant (P < 0.001). Conclusion: It is concluded that Group LD has early-onset and prolonged duration of sensory and motor block and longer duration of postoperative analgesia than Group L.

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Dietary Fiber, C-Reactive Protein, and Leisure-Time Physical Activity Among U.S. Adults

Metabolic Syndrome and Related Disorders, Volume 16, Issue 2, Page 104-109, March 2018.


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Hemodynamic responses and safety of sedation following premedication with dexmedetomidine and fentanyl during fiberoptic-assisted intubation in patients with predicted difficult airway

Sunil Rajan, Rittick Talukdar, Pulak Tosh, Jerry Paul, Bindu K Vasu, Lakshmi Kumar

Anesthesia: Essays and Researches 2018 12(1):11-15

Background: Awake fiberoptic intubation (AFOI) is the gold standard for the management of predicted difficult airway, and inappropriate sedation is a major cause leading to its failure. Aims: The primary objective was to compare the heart rate (HR) changes that accompany AFOI following sedation with dexmedetomidine and fentanyl. Secondary objectives included comparison of changes in blood pressure, patient comfort, ease of intubation, and degree of sedation. Settings and Designs: This prospective double-blinded randomized study was conducted in a tertiary care institution. Subjects and Methods: Forty patients with anticipated difficult airway requiring AFOI were included in the study. Group A received dexmedetomidine 1 μg/kg whereas Group B received fentanyl 2 μg/kg. After topical anesthesia of the airway, AFOI was performed. Statistical Analysis Used: Fisher's exact test, independent two-sample t-test, and Mann–Whitney U-test were used as applicable. Results: The hemodynamic parameters were comparable in both the groups except at 1 min postintubation when fentanyl group had significantly higher HR. There were lower alertness and muscle tone scores in dexmedetomidine group. Total comfort score was significantly higher in fentanyl group. Though more patients in dexmedetomidine group showed that no reaction to intubation and more patients in fentanyl had slight grimacing, the difference was insignificant. The ease of intubation was similar in both the groups. Conclusion: Though dexmedetomidine1 μg/kg and fentanyl 2 μg/kg premedication results in comparable hemodynamics and ease of intubation, in view of enhanced patient comfort, dexmedetomidine premedication is advantageous in patients with anticipated difficult airway undergoing AFOI.

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