Mark your calendars for the McGovern Medical School Department of Otorhinolaryngology-Head and Neck Surgery's two-day CME meeting in the Texas... Read the full article...https://ift.tt/2pzLtif
Σάββατο 24 Μαρτίου 2018
Texas Hill Country ENT Symposium Scheduled for April 2018
Mark your calendars for the McGovern Medical School Department of Otorhinolaryngology-Head and Neck Surgery's two-day CME meeting in the Texas... Read the full article...https://ift.tt/2pzLtif
Branchial Cleft Cyst Resection: A Pediatric Patient Benefits from Texas Medical Center Expertise and the Convenience of Follow-up ENT Care in Southeast Houston
When J. Caleb Simmons, MD, started medical school, he thought he might be a pediatrician. Today as an otolaryngologist, nearly... Read the full article...https://ift.tt/2pCONIu
Dr. Michael Byrd Named 2017 Physician of the Year at Memorial Hermann Southeast Hospital
Otolaryngologist Michael Byrd, MD, has been recognized as 2017 Physician of the Year at Memorial Hermann Southeast Hospital, a 274-bed... Read the full article...https://ift.tt/2pCiWZs
2017 Lone Star Rhinology Course Recap
More than 80 physicians participated in Lone Star Rhinology 2017, an intensive two-day CME program dedicated to the study of... Read the full article...https://ift.tt/2IPlc7m
Modulating ion channel function with antibodies and nanobodies
Catelijne Stortelers | Carolina Pinto-Espinoza | Diane Van Hoorick | Friedrich Koch-Nolte
https://ift.tt/2IQ5gSH
Diffuse Gastric Ganglioneuromatosis: Novel Presentation of PTEN Hamartoma Syndrome—Case Report and Review of Gastric Ganglioneuromatous Proliferations and a Novel PTEN Gene Mutation
Gastrointestinal ganglioneuromatous proliferations are rare, most often found in the colon, and are three types: polypoid ganglioneuromas, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. We present a case of diffuse ganglioneuromatosis in the posterior gastric wall in a nine-year-old female. To our knowledge, this is the first reported case of diffuse ganglioneuromatosis located in the stomach. Only six cases of gastric ganglioneuromatous proliferations have previously been reported, two in English and none were diffuse ganglioneuromatosis. A diagnosis of diffuse ganglioneuromatosis is relevant for patient care because, unlike sporadic polypoid ganglioneuromas or ganglioneuromatous polyposis, most are syndromic. Diffuse ganglioneuromatosis is commonly associated with neurofibromatosis type 1, multiple endocrine neoplasia type 2b, and Cowden Syndrome, one of the phenotypes of PTEN hamartoma tumor syndrome. The patient had the noted gastric diffuse ganglioneuromatosis, as well as other major and minor criteria for Cowden syndrome. Genetic testing revealed a novel frameshift mutation in the PTEN gene in the patient, her father, paternal aunt, and the aunt's son who is a paternal first cousin of the patient.
https://ift.tt/2G4NkpC
Effect of Cathodal Transcranial Direct Current Stimulation on a Child with Involuntary Movement after Hypoxic Encephalopathy
The aim of the study was to investigate the effect of cathodal transcranial direct current stimulation to the supplementary motor area to inhibit involuntary movements of a child. An 8-year-old boy who developed hypoxic encephalopathy after asphyxia at the age of 2 had difficulty in remaining standing without support because of involuntary movements. He was instructed to remain standing with his plastic ankle-foot orthosis for 10 s at three time points by leaning forward with his forearms on a desk. He received cathodal or sham transcranial direct current stimulation to the supplementary motor area at 1 mA for 10 min. Involuntary movements during standing were measured using an accelerometer attached to his forehead. The low-frequency power of involuntary movements during cathodal transcranial direct current stimulation significantly decreased compared with that during sham stimulation. No adverse effects were observed. Involuntary movement reduction by cathodal stimulation to supplementary motor areas suggests that stimulations modulated the corticobasal ganglia motor circuit. Cathodal stimulation to supplementary motor areas may be effective for reducing involuntary movements and may be safely applied to children with movement disorders.
https://ift.tt/2uihHn0
Letter to the Editor referring to the retracted publication entitled “Straticyte demonstrates prognostic value over oral epithelial dysplasia grade for oral potentially malignant lesion assessment” by Hwang et al.
After our article entitled "Straticyte demonstrates prognostic value over oral epithelial dysplasia grade for oral potentially malignant lesion assessment" [1] was published in Oral Oncology, we responded to a reader's query and provided our data at the Editor-in-Chief's request. In reviewing the data, we discovered that a calculation error had occurred which changed the sensitivity from 71% to 48% and negative predictive value from 60% to 36% for the Straticyte assay in the high-risk vs. non-high-risk subgroups.
https://ift.tt/2HYI6Z2
“Tumulus” stabilization of a total ossicular replacement prosthesis
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): T. Mom, C. Caburet, N. Saroul, L. Gilain, M. Gersdorff
Functional failure of total ossicular replacement prostheses (TORP) is often due to secondary displacement, ranging from simple subluxation to prosthesis extrusion following recurrence of severe tympanic membrane retraction. Several surgical techniques have been proposed to stabilize a TORP, mostly using superimposed non-organic or resorbable heterologous materials. We describe a simple so-called "tumulus" surgical technique that limits prosthesis displacement and extrusion, regardless of the type of TORP, by using a few fragments of autologous cartilage that are always available and perfectly tolerated at no cost. Review of 31 cases treated by this technique did not reveal any cases of prosthesis displacement and only one case (3.2%) of prosthesis extrusion with audiometric results comparable to the best results reported in the literature.
https://ift.tt/2DQioU3
In-clinic secondary tracheoesophageal puncture and voice prosthesis placement in laryngectomees
Publication date: Available online 24 March 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Ricci, G. Riva, F. Dagna, E. Seglie, A.L. Cavalot
Secondary tracheoesophageal puncture (TEP) with voice prosthesis placement represents one of the possibility to restore vocal function after total laryngectomy. However, some patients have comorbidities that contraindicate general anesthesia. In our department, an in-clinic TEP procedure for retrograde voice prosthesis placement was developed. It allows the immediate placement of the prosthesis and the avoidance of the use of dilators. We described our technique with advantages and pitfalls. The Provox Vega Puncture Set was used. Our technique for in-clinic secondary TEP without general anesthesia or target controlled infusion was a safe and effective procedure. It allows the use of the traditional TEP set, with possibility of voice prosthesis placement after previous TEP closure.
https://ift.tt/2IRobMy
Mandibular reconstruction with free fibula flaps in the elderly: a retrospective evaluation
The purpose of this study was to evaluate surgical outcomes in elderly patients who had undergone free fibula flap transfer for malignant head and neck tumours. A retrospective chart review was performed to identify patients who had undergone free fibula flap transfer for mandibular reconstruction after malignant tumour resection at Jichi Medical University Hospital between May 2009 and April 2015. Enrolled patients were divided into an elderly group (≥80years old) and a younger group (<80years old).
https://ift.tt/2INljjU
Management update of potentially premalignant oral epithelial lesions
Publication date: Available online 23 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Michael Awadallah, Matthew Idle, Ketan Patel, Deepak Kademani
The term oral potentially malignant disorders (OPMD) previously defined at the World Health Organisation (W.H.O) workshop in 2005 has now been redefined as potentially premalignant oral epithelial lesions (PPOELs). It is important to differentiate PPOEL's which are a broad term to define a wide variety of clinical lesions from oral epithelial dysplasia which should be reserved specifically for lesions with biopsy proven foci of dysplasia. Unfortunately, the nomenclature is not consistent and many times both terms PPOEL and dysplasia are used interchangeably which adds to confusion in the literature. PPOEL's encompass lesions that include leukoplakia, erythroplakia, erythroleukoplakia, lichen planus, and submucosal fibrosis. The World Health Organization (W.H.O). definition of a histologically proven oral premalignant lesion that is associated with a significantly increased risk of malignant transformation. The primary goal of management of dysplasia includes the prevention, early detection and treatment prior to malignant transformation. The aim of this paper is to inform the clinician about management of PPOELs.
https://ift.tt/2pzg2Vh
Mandibular reconstruction with free fibula flaps in the elderly: a retrospective evaluation
Publication date: Available online 23 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Y. Sugiura, S. Sarukawa, J. Hayasaka, H. Kamochi, T. Noguchi, Y. Mori
The purpose of this study was to evaluate surgical outcomes in elderly patients who had undergone free fibula flap transfer for malignant head and neck tumours. A retrospective chart review was performed to identify patients who had undergone free fibula flap transfer for mandibular reconstruction after malignant tumour resection at Jichi Medical University Hospital between May 2009 and April 2015. Enrolled patients were divided into an elderly group (≥80years old) and a younger group (<80years old). Seventeen patients met the inclusion criteria and were included in the elderly group. Age at surgery ranged from 80 to 92years. Thirteen patients (76.5%) experienced postoperative complications. Surgical site complications occurred in seven patients. The success rate of free fibula flap transfer was 100%. Systemic complications occurred in nine patients, most commonly delirium (n=6). No perioperative mortality was encountered. The overall 1-year survival rate was 94.1% (16/17). No patient reported gait disturbance as a donor site complication or any other major complication. The incidence of postoperative complications did not differ significantly between the elderly and younger groups. Almost no difference in postoperative course was seen between the groups. Elderly patients appear to tolerate free fibula flap reconstruction just as well as younger patients.
https://ift.tt/2IOuZe1
Association between impaired IL-10 production following exposure to Staphylococcus aureus enterotoxin B and disease severity in eosinophilic chronic rhinosinusitis
Publication date: Available online 23 March 2018
Source:Allergology International
Author(s): Takenori Haruna, Shin Kariya, Tazuko Fujiwara, Takaya Higaki, Seiichiro Makihara, Kengo Kanai, Rumi Fujiwara, Satoshi Iwasaki, Yoshihiro Noguchi, Kazunori Nishizaki, Mitsuhiro Okano
BackgroundIL-10 is a major anti-inflammatory cytokine that prevents inflammation-mediated tissue damage. We characterized the production of IL-10 by sinonasal tissue cells following exposure to Staphylococcus aureus enterotoxin B (SEB), which elicits cellular responses and is associated with the pathogenesis of eosinophilic chronic rhinosinusitis (ECRS).MethodsDispersed nasal polyp (NP) cells and uncinate tissue (UT) cells were prepared from patients with CRS with and without NP, respectively. Cells were incubated with SEB, and then the levels of IL-10 in the cell supernatants were determined. The effect of neutralizing IL-10 on SEB-induced IL-5, IL-13, IFN-γ, and IL-17A production was examined. Expression of IL-10 in NPs was also determined.ResultsIL-10 was expressed in infiltrating inflammatory cells in NPs. NP cells, especially non-adherent NP cells, produced substantial amounts of IL-10 in response to SEB. Although baseline production of IL-10 was significantly higher in NP cells than UT cells, the degree of IL-10 response to SEB was not significantly different between the cell types. The degree of IL-10 production was negatively correlated with the degree of eosinophilia both in tissues and peripheral blood whereas positively correlated with the 1-s forced expiratory volume/forced vital capacity ratio. Patients with severe ECRS displayed a significant decrease in IL-10 production compared with those with non-ECRS. IL-10 neutralization significantly augmented SEB-induced IL-13 and IFN-γ production by NP cells.ConclusionsImpaired IL-10 production in response to SEB in NP may exacerbate the pathophysiology of ECRS including eosinophilia and lower airway obstruction.
https://ift.tt/2pE8X5G
Reduced heart rate variability and increased saliva cortisol in patients with TMD
Source:Archives of Oral Biology
Author(s): Suruedee Chinthakanan, Kittipong Laosuwan, Pattriyaporn Boonyawong, Sirinart Kumfu, Nipon Chattipakorn, Siriporn C. Chattipakorn
Temporomandibular disorders (TMD) are the most common source of non-dental pain. The pathogenesis of TMD is multifactorial, involving biological, psychological and behavioral factors. Those factors are involved with alterations of the autonomic nervous system (ANS) and stressful conditions. Heart rate variability (HRV) has been used as a marker of ANS function. Increased cortisol level (a stress indicator), has been found in chronic pain. Therefore, the present study aimed to compare pain intensity, HRV, psychological factors, and salivary cortisol level between TMD patients and a control group. Twenty-one TMD patients and twenty-three healthy control subjects participated in the study. All participants underwent 24-hour-Holter monitoring to record HRV. Morning unstimulated saliva samples were collected from each participant for cortisol analysis. The pain intensity was assessed using a visual analog scale. The participants were evaluated for anxiety and depression via the Hospital Anxiety and Depression Scales. We found that pain intensity and psychological distress in the TMD group were significantly greater than those of the control (p < 0.01). Pain intensity showed a positive correlation with psychological distress (p < 0.01). HRV parameters in the TMD group were significantly lower than those in the control, suggesting reduced HRV in TMD patients. Pain intensity was negatively associated with HRV. Salivary cortisol level of the TMD group was greater than that of control. Our findings indicate that reduced HRV with higher psychological distress and increased salivary cortisol levels were observed in the TMD group. Therefore, TMD patients may benefit from interventions that can restore ANS function and stress balance.
https://ift.tt/2G3l072
Reduced heart rate variability and increased saliva cortisol in patients with TMD
Source:Archives of Oral Biology
Author(s): Suruedee Chinthakanan, Kittipong Laosuwan, Pattriyaporn Boonyawong, Sirinart Kumfu, Nipon Chattipakorn, Siriporn C. Chattipakorn
Temporomandibular disorders (TMD) are the most common source of non-dental pain. The pathogenesis of TMD is multifactorial, involving biological, psychological and behavioral factors. Those factors are involved with alterations of the autonomic nervous system (ANS) and stressful conditions. Heart rate variability (HRV) has been used as a marker of ANS function. Increased cortisol level (a stress indicator), has been found in chronic pain. Therefore, the present study aimed to compare pain intensity, HRV, psychological factors, and salivary cortisol level between TMD patients and a control group. Twenty-one TMD patients and twenty-three healthy control subjects participated in the study. All participants underwent 24-hour-Holter monitoring to record HRV. Morning unstimulated saliva samples were collected from each participant for cortisol analysis. The pain intensity was assessed using a visual analog scale. The participants were evaluated for anxiety and depression via the Hospital Anxiety and Depression Scales. We found that pain intensity and psychological distress in the TMD group were significantly greater than those of the control (p < 0.01). Pain intensity showed a positive correlation with psychological distress (p < 0.01). HRV parameters in the TMD group were significantly lower than those in the control, suggesting reduced HRV in TMD patients. Pain intensity was negatively associated with HRV. Salivary cortisol level of the TMD group was greater than that of control. Our findings indicate that reduced HRV with higher psychological distress and increased salivary cortisol levels were observed in the TMD group. Therefore, TMD patients may benefit from interventions that can restore ANS function and stress balance.
https://ift.tt/2G3l072
Drug Treatment for Androgenetic Alopecia: First Italian Questionnaire Survey on What Dermatologists Think about Finasteride
Abstract
Introduction
Treatment with finasteride 1 mg/day represents the therapy of choice for androgenetic alopecia (AGA). We investigated how Italian dermatologists approach use of finasteride for treatment of AGA and common side effects reported by patients.
Methods
A tablet-based survey was conducted from February 2017 to January 2018 in Italy to investigating use of 1 mg/day finasteride in the treatment of AGA. Approximately 1153 Italian dermatologists were surveyed about prescription frequency, therapy duration, treatment practices, and side effects eventually reported.
Results
Dermatologists considered treatment with 1 mg/day finasteride to be the most efficacious treatment for AGA, as reflecting by its long-term (5 years) prescription. Data on sexual side effects from our survey are in line with previous scientific evidence, especially regarding loss of libido, erectile dysfunction, and problems with ejaculation, but also in the psychological sphere and regarding physical impairments such as myalgia and loss of muscle tone.
Conclusions
This is the first preliminary observational study on how Italian dermatologists approach use of finasteride to treat AGA. Although side effects have been reported, especially in the sexual sphere, lack of alternative treatments with the same efficacy leads dermatologists to prescribe 1 mg/day finasteride with a tendency to prolong therapy in the long term.
Funding
Giuliani S.p.A.
https://ift.tt/2ubWdb6
Occupational exposure and asthma
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anh Dao, David I. Bernstein
https://ift.tt/2pFKYCe
Barriers to medication adherence in asthma: the importance of culture and context
Publication date: Available online 23 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Elizabeth L. McQuaid
ObjectiveSignificant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non-minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention.Data SourcesData were gathered from numerous sources, including reports of pharmacy and medical records, observational studies, and trials.Study Selection. Studies analyzed factors contributing to patterns of asthma medication adherence that differ by race and ethnicity.ResultsThere is clear evidence of underuse of asthma controller medications among racial and ethnic minorities in prescription receipt, prescription initiation, and medication use once obtained. Individual factors such as medication beliefs and depressive symptoms play a role. Provider communication is also relevant, including limited discussion of Complementary and Alternative Medicine (CAM) use, difficulties communicating with patients and caregivers with limited English proficiency (LEP), and implicit biases regarding cultural differences. Systems issues (e.g., insurance status, cost) and social context factors (e.g. exposure to violence) also present challenges. Culturally-informed strategies that capitalize on patient strengths and training providers in culturally-informed communication strategies hold promise as intervention approaches.ConclusionDisparities in controller medication use are pervasive. Identifying the sources of these disparities is a critical step toward generating intervention approaches to enhance disease management among the groups that bear the greatest asthma burden.
https://ift.tt/2pAPSkK
Climate Change and the Impact on Respiratory and Allergic Disease: 2018
Abstract
Purpose of Review
The purpose of this paper is to review allergic respiratory disease related to indoor and outdoor exposures and to examine the impact of known and projected changes in climate. The global burden of disease directly attributed to climate change is very difficult to measure and becomes more challenging when the capacity of humans to adapt to these changes is taken into consideration. Allergic respiratory disease, such as asthma, is quite heterogenous, though closely associated with environmental and consequently immunologic interaction. Where is the tipping point?
Recent Findings
Our climate has been measurably changing for the past 100 years. It may indeed be the most significant health threat of the twenty-first century, and consequently tackling climate change may be the greatest health opportunity. The impacts of climate change on human health are varied and coming more into focus. Direct effects, such as heatwaves, severe weather, drought, and flooding, are apparent and frequently in the news. Indirect or secondary effects, such as changes in ecosystems and the impact on health, are less obvious. It is these changes in ecosystems that may have the greatest impact on allergic and respiratory diseases.
Summary
This review will explore some ways that climate change, current and predicted, influences respiratory disease. Discussion will focus on changing pollen patterns, damp buildings with increased mold exposure, air pollution, and heat stress.
https://ift.tt/2HXuv3S
Treatment of Allergic Rhinitis as a Strategy for Preventing Asthma
Abstract
Purpose of Review
To evaluate the impact of allergic rhinitis (AR) on the development of asthma and to update readers on recent literature suggesting that early treatment of allergic subjects with immunotherapy may prevent asthma onset.
Recent Findings
AR is frequently associated with asthma, leading to the concept that these two conditions are different aspects of the same disease. There is increasing evidence that AR precedes the onset of asthmatic symptoms and current treatment strategies are beneficial in symptom control with no impact prevention. There is limited knowledge about the risk factors responsible for the progression of AR to asthma, though recent data supports the notion that it is possible to prevent asthma onset by allergen immunotherapy.
Summary
Despite significant advances in specific immunotherapy (SIT) therapy strengthening its efficacy in AR and possible prevention of progression to asthma, the adoption of this therapeutic strategy is still restricted in comparison to therapies directed towards treatment of AR symptoms. Unlike corticosteroids and other symptomatic therapies, the benefit of SIT treatment in allergic individuals has been shown to prevent the development of allergic conditions. Hence, large well-conducted randomized clinical trials with long-term efficacy of SIT are required to confirm or refute the concept that SIT may abrogate the progression of AR to asthma in patients.
https://ift.tt/2pynYpS
Immigrant Respiratory Health: a Diverse Perspective in Environmental Influences on Respiratory Health
Abstract
Purpose of Review
The aim of this review is to examine the prevalence of and impact of environmental exposures in the workplace and home on immigrant respiratory health in the USA.
Recent Findings
Few studies report levels of workplace and home environmental exposures for immigrant children and adults, and documenting these findings is an important first step to addressing their respiratory health concerns. Rates of respiratory disease are lowest upon first arrival and increase with duration of residency in the USA. Community Health Workers may be an efficacious intervention to reducing exposures and improving lung health among immigrant populations.
Summary
Immigrant children and adults have a high risk of occupational and home environmental exposures that can negatively affect their respiratory health. While limited studies exist, more documentation of these exposures and their impact on immigrant person's respiratory health are needed to begin to tackle these disparities.
https://ift.tt/2pD257J
How Do Storms Affect Asthma?
Abstract
Purpose of Review
There are observations in various geographical areas that thunderstorms occurring during pollen seasons can induce severe asthma attacks in pollinosis patients.
Recent Findings
An accredited hypothesis explaining the association between thunderstorms and asthma suggests that storms can concentrate pollen grains at ground level, which may then release allergenic particles of respirable size in the atmosphere after their imbibition of water and rupture by osmotic shock. During the first 20–30 min of a thunderstorm, patients affected by pollen allergy may inhale a high quantity of the allergenic material that is dispersed into the atmosphere as a bioaerosol of allergenic particles, which can induce asthmatic reactions, often severe. Subjects without asthma symptoms, but affected by seasonal rhinitis can also experience an asthma attack. A key message is that all subjects affected by pollen allergy should be alerted to the danger of being outdoors during a thunderstorm in the pollen season, as such events may be an important cause of severe asthma exacerbations. In light of these observations, it is useful to predict thunderstorms and thus minimize thunderstorm-related events. Patients with respiratory allergy induced by pollens and molds need to be informed about a correct therapeutic approach of bronchial asthma by inhalation, including the use of bronchodilators and inhaled corticosteroids.
Summary
The purpose of this review is to focalize epidemiological, etiopathogenetic, and clinical aspects of thunderstorm-related asthma.
https://ift.tt/2pynU9C
Severe Cutaneous Adverse Drug Reactions: Presentation, Risk Factors, and Management
Abstract
Purpose of Study
Immune-mediated adverse drug reactions occur commonly in clinical practice and include mild, self-limited cutaneous eruptions, IgE-mediated hypersensitivity, and severe cutaneous adverse drug reactions (SCAR). SCARs represent an uncommon but potentially life-threatening form of delayed T cell-mediated reaction. The spectrum of illness ranges from acute generalized exanthematous pustulosis (AGEP) to drug reaction with eosinophilia with systemic symptoms (DRESS), to the most severe form of illness, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
Recent Findings
There is emerging literature on the efficacy of cyclosporine in decreasing mortality in SJS/TEN.
Summary
The purpose of our review is to discuss the typical presentations of these conditions, with a special focus on identifying the culprit medication. We review risk factors for developing SCAR, including HLA alleles strongly associated with drug hypersensitivity. We conclude by discussing current strategies for the management of these conditions.
https://ift.tt/2I37i0p
Precision Medicine in Chronic Rhinosinusitis with Nasal Polyps
Abstract
Purpose of Review
Chronic rhinosinusitis is a disease with high prevalence, significant impact on health-related quality of life (HRQoL) and it is associated with substantial healthcare and productivity costs. We face an urgent need to improve the level of disease control and achieve higher patient satisfaction and disease prevention. Precision medicine is increasingly recognized as the way forward in optimal patient care. The combination of personalized care, prevention of disease, prediction of success of treatment, and participation of the patient in the elaboration of the treatment plan is expected to guarantee the best possible therapeutic approach for individuals suffering from a chronic disabling condition.
Recent Findings
This is a narrative review on the current state of endotypes, biomarkers, and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses. Different phenotypes of rhinitis and chronic rhinosinusitis (CRS) have been described based on symptom severity and duration, atopy status, level of control, comorbidities, and presence or absence of nasal polyps in CRS. The underlying pathophysiological mechanisms are diverse, with different endotypes being recognized. Novel emerging therapies are targeting specific pathophysiological pathways or endotypes. This endotype-driven treatment approach requires careful selection of the patient population who might benefit from a specific treatment.
Summary
This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.
https://ift.tt/2pBHHEZ
Erythroderma and extensive poikiloderma – a rare initial presentation of dermatomyositis: a case report
Dermatomyositis is a humoral-mediated inflammatory myopathy with symmetrical proximal muscle weakness and dermatological manifestations such as Gottron's papules, heliotrope rash, periungual abnormalities, and...
https://ift.tt/2IR9bP6
Climate Change and the Impact on Respiratory and Allergic Disease: 2018
Abstract
Purpose of Review
The purpose of this paper is to review allergic respiratory disease related to indoor and outdoor exposures and to examine the impact of known and projected changes in climate. The global burden of disease directly attributed to climate change is very difficult to measure and becomes more challenging when the capacity of humans to adapt to these changes is taken into consideration. Allergic respiratory disease, such as asthma, is quite heterogenous, though closely associated with environmental and consequently immunologic interaction. Where is the tipping point?
Recent Findings
Our climate has been measurably changing for the past 100 years. It may indeed be the most significant health threat of the twenty-first century, and consequently tackling climate change may be the greatest health opportunity. The impacts of climate change on human health are varied and coming more into focus. Direct effects, such as heatwaves, severe weather, drought, and flooding, are apparent and frequently in the news. Indirect or secondary effects, such as changes in ecosystems and the impact on health, are less obvious. It is these changes in ecosystems that may have the greatest impact on allergic and respiratory diseases.
Summary
This review will explore some ways that climate change, current and predicted, influences respiratory disease. Discussion will focus on changing pollen patterns, damp buildings with increased mold exposure, air pollution, and heat stress.
https://ift.tt/2HXuv3S
Treatment of Allergic Rhinitis as a Strategy for Preventing Asthma
Abstract
Purpose of Review
To evaluate the impact of allergic rhinitis (AR) on the development of asthma and to update readers on recent literature suggesting that early treatment of allergic subjects with immunotherapy may prevent asthma onset.
Recent Findings
AR is frequently associated with asthma, leading to the concept that these two conditions are different aspects of the same disease. There is increasing evidence that AR precedes the onset of asthmatic symptoms and current treatment strategies are beneficial in symptom control with no impact prevention. There is limited knowledge about the risk factors responsible for the progression of AR to asthma, though recent data supports the notion that it is possible to prevent asthma onset by allergen immunotherapy.
Summary
Despite significant advances in specific immunotherapy (SIT) therapy strengthening its efficacy in AR and possible prevention of progression to asthma, the adoption of this therapeutic strategy is still restricted in comparison to therapies directed towards treatment of AR symptoms. Unlike corticosteroids and other symptomatic therapies, the benefit of SIT treatment in allergic individuals has been shown to prevent the development of allergic conditions. Hence, large well-conducted randomized clinical trials with long-term efficacy of SIT are required to confirm or refute the concept that SIT may abrogate the progression of AR to asthma in patients.
https://ift.tt/2pynYpS
Immigrant Respiratory Health: a Diverse Perspective in Environmental Influences on Respiratory Health
Abstract
Purpose of Review
The aim of this review is to examine the prevalence of and impact of environmental exposures in the workplace and home on immigrant respiratory health in the USA.
Recent Findings
Few studies report levels of workplace and home environmental exposures for immigrant children and adults, and documenting these findings is an important first step to addressing their respiratory health concerns. Rates of respiratory disease are lowest upon first arrival and increase with duration of residency in the USA. Community Health Workers may be an efficacious intervention to reducing exposures and improving lung health among immigrant populations.
Summary
Immigrant children and adults have a high risk of occupational and home environmental exposures that can negatively affect their respiratory health. While limited studies exist, more documentation of these exposures and their impact on immigrant person's respiratory health are needed to begin to tackle these disparities.
https://ift.tt/2pD257J
How Do Storms Affect Asthma?
Abstract
Purpose of Review
There are observations in various geographical areas that thunderstorms occurring during pollen seasons can induce severe asthma attacks in pollinosis patients.
Recent Findings
An accredited hypothesis explaining the association between thunderstorms and asthma suggests that storms can concentrate pollen grains at ground level, which may then release allergenic particles of respirable size in the atmosphere after their imbibition of water and rupture by osmotic shock. During the first 20–30 min of a thunderstorm, patients affected by pollen allergy may inhale a high quantity of the allergenic material that is dispersed into the atmosphere as a bioaerosol of allergenic particles, which can induce asthmatic reactions, often severe. Subjects without asthma symptoms, but affected by seasonal rhinitis can also experience an asthma attack. A key message is that all subjects affected by pollen allergy should be alerted to the danger of being outdoors during a thunderstorm in the pollen season, as such events may be an important cause of severe asthma exacerbations. In light of these observations, it is useful to predict thunderstorms and thus minimize thunderstorm-related events. Patients with respiratory allergy induced by pollens and molds need to be informed about a correct therapeutic approach of bronchial asthma by inhalation, including the use of bronchodilators and inhaled corticosteroids.
Summary
The purpose of this review is to focalize epidemiological, etiopathogenetic, and clinical aspects of thunderstorm-related asthma.
https://ift.tt/2pynU9C
Severe Cutaneous Adverse Drug Reactions: Presentation, Risk Factors, and Management
Abstract
Purpose of Study
Immune-mediated adverse drug reactions occur commonly in clinical practice and include mild, self-limited cutaneous eruptions, IgE-mediated hypersensitivity, and severe cutaneous adverse drug reactions (SCAR). SCARs represent an uncommon but potentially life-threatening form of delayed T cell-mediated reaction. The spectrum of illness ranges from acute generalized exanthematous pustulosis (AGEP) to drug reaction with eosinophilia with systemic symptoms (DRESS), to the most severe form of illness, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
Recent Findings
There is emerging literature on the efficacy of cyclosporine in decreasing mortality in SJS/TEN.
Summary
The purpose of our review is to discuss the typical presentations of these conditions, with a special focus on identifying the culprit medication. We review risk factors for developing SCAR, including HLA alleles strongly associated with drug hypersensitivity. We conclude by discussing current strategies for the management of these conditions.
https://ift.tt/2I37i0p
Precision Medicine in Chronic Rhinosinusitis with Nasal Polyps
Abstract
Purpose of Review
Chronic rhinosinusitis is a disease with high prevalence, significant impact on health-related quality of life (HRQoL) and it is associated with substantial healthcare and productivity costs. We face an urgent need to improve the level of disease control and achieve higher patient satisfaction and disease prevention. Precision medicine is increasingly recognized as the way forward in optimal patient care. The combination of personalized care, prevention of disease, prediction of success of treatment, and participation of the patient in the elaboration of the treatment plan is expected to guarantee the best possible therapeutic approach for individuals suffering from a chronic disabling condition.
Recent Findings
This is a narrative review on the current state of endotypes, biomarkers, and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses. Different phenotypes of rhinitis and chronic rhinosinusitis (CRS) have been described based on symptom severity and duration, atopy status, level of control, comorbidities, and presence or absence of nasal polyps in CRS. The underlying pathophysiological mechanisms are diverse, with different endotypes being recognized. Novel emerging therapies are targeting specific pathophysiological pathways or endotypes. This endotype-driven treatment approach requires careful selection of the patient population who might benefit from a specific treatment.
Summary
This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.
https://ift.tt/2pBHHEZ
Letter to the Editor referring to the retracted publication entitled “Straticyte demonstrates prognostic value over oral epithelial dysplasia grade for oral potentially malignant lesion assessment” by Hwang et al.
Source:Oral Oncology
Author(s): Jason T.K. Hwang, Ying R. Gu, Benjamin J. Dickson, Mi Shen, Ranju Ralhan, Paul G. Walfish, David Mock, Kenneth P.H. Pritzker
https://ift.tt/2IKW2H8
Patrón olfativo en lesiones cerebrales no psiquiátricas ni traumáticas
Publication date: Available online 23 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): Josep de Haro-Licer, Adela González-Fernández, Albert Planas-Comes, Josep Antón González-Ares
IntroducciónLas etiologías más frecuente de las patologías olfativas dentro de la otorrinolaringología suelen ser las producidas por resfriados, inflamaciones nasosinusales, alergias y traumatismos craneo-faciales, fuera de estas etiologías tenemos, con menor frecuencia, las enfermedades neurológicas, psiquiátricas, metabólicas. Nuestro servicio ha podido atender a pacientes con alteraciones neurológicas que presentan patologías olfativas.ObjetivoEste trabajo tiene por finalidad verificar qué tipo de alteraciones olfativas se hallan en las personas que padecen lesiones del sistema nervioso central excluidos los traumatismos craneales, las enfermedades psiquiátricas, las epilepsias, las enfermedades de Parkinson y Alzheimer y las sinestesias.Material metodosSe trata de un estudio descriptivo basado en un grupo de 61 pacientes diagnosticados de diversas lesiones neurológicas y de un grupo control. Ambos grupos fueron valorados por medio del olfatómetro BAST-24. Se comparan los resultados con un grupo control de 120 personas.ResultadosLos resultados muestran que las personas con estos tipos de lesiones neurológicas tienen una capacidad de percibir olores que oscila entre el 60 y el 77% mientras que el grupo control se sitúa entre el 98 y el 100%. Respecto a la capacidad de reconocer correctamente los olores, los paciente neurológicos no superan el 32% de aciertos, mientras que el grupo control se sitúa entre el 59 y el 75% de aciertos, siendo las diferencias olor a olor presentado estadísticamente significativas (p<0,05) tanto para la detección como para el acierto.Conclusionesa) Las alteraciones neurológicas no causadas por traumatismos craneales ni por alteraciones psiquiátricas pueden presentar una pérdida olfativa que oscila entre el 68 y el 89%. b) En este tipo de lesiones debe tenerse en cuenta la presencia de alteraciones olfativas. c) Hay alteraciones olfativas por afectación de otras áreas cerebrales distintas a las clásicas olfativas. d) Debe establecerse una colaboración entre los servicios de ORL y Neurología para poder atender dichas alteraciones.IntroductionThe most common cause of olfactory ENT disorders are colds and flu, chronic sinusitis, allergies and traumatic brain injury. Rarer aetiologies include certain neurological, psychiatric and metabolic injuries.TargetThe aim of this paper was to check the sort of olfactory disorders found in people who have suffered a brain injury, excluding: cranial traumas, psychiatric diseases, epilepsy, Parkinson's and Alzheimer's disease, and synaesthesia.Material and methodsA descriptive study based on 61 patients with diagnoses of various neurological injuries, which were tested by BAST-24 olfactometer. The results were compared with those of a control group (n= 120).ResultsThe results show major impairment in these patients' olfactory sense. The neurological injury patients were able to detect from 60-77% of the odours, while the control group were able to detect between 98-100%. The neurological patients were able, at best, to identify, 11-32% of the odours correctly, while the control group were able to correctly detect between 59 -75%. The differences between odour detection and correct identification were statistically significant (p<.05).ConclusionsWe concluded: a) Neurological injury, not caused by traumatic brain injury, psychiatric disorders or ENT diseases, ranged from 68-89% of the olfactory failures. b) We must bear in mind that these sorts of injuries can cause olfactory disorders. c) ENT and Neurologists should collaborate in the treatment of these disorders.
https://ift.tt/2pAVPxu
Parálisis bilateral de cuerdas vocales en pediatría: nuestra experiencia
Publication date: Available online 23 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): María Laura Scatolini, Hugo A. Rodriguez, Cinthia G. Pérez, Alejandro Cocciaglia, Hugo A. Botto, Mary Nieto, Lucas Bordino
La parálisis bilateral de cuerdas vocales (PBCV) es la segunda causa más frecuente de estridor neonatal. Nuestro objetivo es describir la demografía, etiología, comorbilidades y tratamientos instaurados.Materiales y métodosRevisión retrospectiva de las historias clínicas de pacientes con diagnóstico de PBCV de 2011 a 2015.ResultadosSe incluyeron 47 pacientes. La edad media de diagnóstico fue un mes de vida, con predominio de sexo masculino (63%). El 59% fue por causa congénita y el 41% adquirida, por lo general idiopática y postoperatoria, respectivamente. Se realizó traqueostomía (TQT) en 42 pacientes (89%), sin diferencias significativas en relación con la causa. La recuperación de la movilidad cordal fue del 39% en toda la muestra, 44% en la congénita, 31% en la adquirida y 62,5% en la idiopática. A 5 pacientes se les realizó laringotraqueoplastia con injerto costal posterior y a un paciente cordectomía posterior. Todos fueron decanulados. A un paciente se le realizó lateralización cordal, evitando la TQT.ConclusiónLas causas congénitas fueron las más frecuentes, en su mayoría idiopáticas. Se registró una leve predilección por el sexo masculino. Un alto porcentaje de pacientes requirieron de TQT. La tasa de recuperación de la movilidad es mayor en causas idiopáticas. Se decanularon todos los pacientes operados, pero se requieren trabajos con mayor número de participantes, comparación de técnicas y evaluación de la deglución y la fonación de forma objetiva.Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The aim of this study was to describe the demographic features, aetiology, comorbidities, and management of our patients with BVCP.Material and methodsWe conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP seen at the Department of Respiratory Endoscopy between 2011 and 2015.Results47 patients were included. Mean age at diagnosis was 1 month and male sex predominated (63%). The aetiology was congenital in 59% and acquired in 41% of the infants. The cause was most frequently idiopathic in the former group and secondary to postoperative injury in the latter. Overall, 42 patients (89%) required tracheostomy, without statistically significant differences between the causes. Of all the patients, 39% regained vocal-cord mobility; 44% of those with congenital BVCP, 31% of those with acquired BVCP and 62.5% with idiopathic BVCP. In five patients a laryngotracheoplasty was performed with a posterior costal cartilage graft and one underwent posterior cordectomy. All were decannulated. In one patient vocal-cord lateralization was performed, avoiding tracheostomy.ConclusionBVCP was most commonly of congenital cause and was mainly idiopathic within this group of patients, with a slight male preponderance. A high percentage of patients required tracheostomy. A higher recovery rate of vocal-cord mobility was observed in idiopathic BVCP, which allowed for successful decannulation. In this series, decannulation was possible in all patients that underwent surgery; however, further studies with comparison of techniques and objective assessment of swallowing and phonation are necessary.
https://ift.tt/2GkeCaw
Clinical evaluation of coronally advanced flap with or without platelet-rich fibrin for the treatment of multiple gingival recessions
Abstract
Objectives
The aim of this randomized, controlled study was to assess the clinical effect of platelet-rich fibrin (PRF) in combination with coronally advanced flap (CAF) on root coverage, esthetics, and patient satisfaction when compared to CAF alone for the treatment of multiple Miller class I recessions.
Materials and methods
A total of 24 patients with 52 Miller class I multiple recessions ≥ 3 mm were included and divided into CAF + PRF and CAF groups. At baseline and 12 months after surgery, recession height (RH), keratinized tissue height, gingival thickness (GT), and mean and complete defect coverage were evaluated. Patient satisfaction and root coverage esthetic scores were also assessed.
Results
Baseline RH in CAF + PRF and CAF groups was 3.15 ± 0.24 and 3.36 ± 0.34 mm, respectively. Intragroup comparisons revealed significant differences at 12 months for all parameters (p < 0.05). RH reduction was 2.75 ± 0.33 and 2.51 ± 0.33 mm (mean root coverage of 88.36 and 74.63%) in the CAF + PRF and CAF groups, respectively. Intergroup differences were found to be significant for GT gain (p < 0.05).
Conclusions
The additional use of PRF membrane did not provide additional benefits in terms of root coverage outcomes compared with CAF alone. The use of PRF membranes increased tissue thickness significantly.
https://ift.tt/2pB1pAO
Extraction of mandibular premolars and molars: comparison between local infiltration via pressure syringe and inferior alveolar nerve block anesthesia
Abstract
Objectives
The purpose of this study was to evaluate the anesthetic efficiency of local infiltration anesthesia administered with a pressure syringe (P-INF) via a special technique versus direct block anesthesia of the inferior alveolar nerve (IANB) for tooth extraction in the posterior mandible.
Materials and methods
In a prospective randomized study, 101 teeth in 101 patients were extracted in the posterior mandible under local anesthesia whereby two different administration techniques were used (P-INF n = 48; IANB n = 53). Primary objectives were comparisons of anesthetic success rate (yes/no) and efficacy (full/sufficient vs. insufficient). Secondary objectives were patients' pain perception during treatment, pain of injection (numerical rating scale), need for second injections (always IANB), time until onset of anesthetic action (min), and duration of local numbness (min).
Results
IANB was successful in all cases, whereas initial P-INF achieved 35% of success only. Furthermore, IANB reached significant higher values of anesthetic efficacy compared to P-INF (P < 0.001). Concerning pain of injection, patients rated IANB to be more painful (P = 0.039). Second injections were significantly more often necessary for P-INF (P = 0.006) whereas duration until onset of action as well as the duration of local numbness were found to be equal.
Conclusions
For anesthetic efficacy as well as anesthetic success, block anesthesia of the inferior alveolar nerve (IANB) turned out to be more proficient to local infiltration via special delivering system with a special technique.
Clinical relevance
Infiltration, even when performed with 4% articaine and a pressure syringe system, is not a suitable method of anesthesia in the posterior mandible.
https://ift.tt/2G8w8eV
Effect of different endodontic sealers and time of cementation on push-out bond strength of fiber posts
Abstract
Objectives
This study aims to evaluate the effect of different endodontic sealers (epoxy resin, eugenol, and bioceramic/calcium silicate-based) and the time of cementation (immediately or 7 days after canal obturation) on the bond strength of a fiberglass post cemented with RelyX™ ARC.
Material and methods
Eighty-four premolars were instrumented and divided into groups (n = 12) according to the sealer and the time of post cementation: Endofill (EN), Endosequence BC Sealer (BC), and AH Plus (AH) had immediately fiber post cementation; EN7, BC7, and AH7 had post cementation after 7 days; and control group (C) had fiber post cementation without endodontic sealer. Each post space of the root was cut into slices and submitted to push-out test. Failure mode was assessed. Two-way ANOVA, Tukey's, and Dunnett's tests were used for statistical analysis (α = 5%).
Results
The type of endodontic sealer (p < 0.001), the time of post cementation (p = 0.038), and the interaction sealer time (p = 0.002) had negative influence on bond strength of fiberglass posts cemented with RelyX™ ARC. AH promoted the highest bond strength mean values (21.20 MPa immediately and 15.54 MPa at 7 days). EN (9.75 MPa immediately and 13.15 MPa at 7 days) and BC (10.43 MPa immediately and 5.73 MPa at 7 days) had lower bond strength than AH, regardless the time of cementation.
Conclusions
AH was the best sealer to obturate the root canal when fiberglass cementation with resin-based cement is planned.
Clinical relevance
The correct choice of an endodontic sealer and the adequate time of post cementation may avoid post dislocation caused by low bond strength to dentin.
https://ift.tt/2pAWLTf
Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial
Abstract
Objective
This multicenter randomized controlled clinical trial aimed to compare the outcomes of stepwise excavation (SW) and partial caries removal (PCR) regarding the maintenance of pulp vitality in deep caries lesions over 5 years.
Methods
At baseline, 299 permanent molars with deep caries lesions were randomly assigned to control or test groups. The control group received the stepwise excavation treatment (SW), while the test group received partial caries removal from the pulpal wall followed by restoration in a single session (PCR). Treatments were conducted in two centers located in the cities of Porto Alegre (South Brazil) and Brasília (Midwest Brazil). Survival analysis was performed to compare PCR and SW over time (Weibull regression models). The primary outcome of this study was pulp vitality, determined by the combination of the following characteristics: positive response to cold test, negative response to percussion, absence of spontaneous pain, and absence of periapical lesion (radiographic examination).
Results
This 5-year study includes data pertaining to 229 teeth: 121 teeth actually examined at the 5-year appointment, and 108 teeth contributed with data collected in previous follow-ups (18 months or 3 years). Survival analysis showed success rates of 80% in PCR group and 56% in SW group (p < 0.001). Failure was significantly associated with treatment [PCR, HR=0.38; 95%CI=0.23–0.63)] and region [South, HR=2.22; 95%CI=1.21–4.08].
Conclusion
PCR significantly reduced the occurrence of pulp necrosis when compared with SW.
Clinical relevance
This study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth.
https://ift.tt/2G8PekZ
Efficacy of resin infiltration of proximal caries in primary molars: 1-year follow-up of a split-mouth randomized controlled clinical trial
Abstract
Objective
The main purpose of this split month, randomized, controlled clinical trial was evaluate the efficacy of caries infiltration in controlling the progression of non-cavitated proximal lesions in primary molars. Anxiety and time required for the caries infiltration was also evaluated.
Materials and methods
Fifty healthy children, 5 to 9 years, presenting two primary molars with proximal caries lesions (1/2 of the enamel or outer 1/3 of dentin), were included. Lesions were randomly allocated to the test group (fluoridated toothpaste + flossing + infiltration) or to the control group (fluoridated toothpaste + flossing). Caries risk was based on the Cariogram model. The main outcome after 1-year radiographic follow up was assessed by an independent blinded examiner A facial image scale (FIS) was applied to assess dental anxiety and time required to perform the infiltration was recorded.
Results
Of the sample, 92.9% corresponded to high or medium caries risk. In 42 patients (1-year follow up), caries progression was observed in 11.9% (5/42) of the test lesions compared with 33.3% (14/42) of the control lesions (p < 0.05). Five control and three test lesions progressed to the middle 1/3 of dentin and were restored. No side effects were observed. Anxiety was both low before and after the treatment, and mean time required for the infiltration was 11.29 min (± 1.16 min).
Conclusions
Caries infiltration of proximal caries lesions in primary molars is significantly more efficacious than standard therapy alone (fluoride toothpaste + flossing).
Clinical relevance
Caries infiltration is an applicable and well-accepted method be used in children, representing a promising micro-invasive approach.
https://ift.tt/2G8PdgV
Risk factors associated with new caries lesions in permanent first molars in children: a 5-year historical cohort follow-up study
Abstract
Objective
The objective of this study is to analyze the factors associated with the occurrence of caries in the permanent teeth (PT) and in the permanent first molar (PFM) 5 years after their eruption.
Material and methods
Children born in 2005 and enrolled in a community dental program were included. The inclusion criteria were: age 10 years in 2015; the availability of clinical dental history (CDH) data from before eruption of the PT and a follow-up period of 5 years after eruption of the PT. A total of 206 children were enrolled. Risk factors evaluated were: caries experience in the mother, educational level of the mother, frequent drug use, systemic diseases, eating habits, brushing frequency, presence of molar incisor hypomineralization (MIH) in PT, and caries in deciduous teeth (DT). Associations between explanatory factors and the DMF-T (decayed, missing, filled teeth in PT) and DMFT-M (DMF in PFM) indexes, independently considering cavitated or cavitated and non-cavitated caries as outcomes, were evaluated by poisson regression with robust variance analysis.
Results
In the multivariate analysis, a cariogenic diet, especially soft drinks, was associated to high DMF-T and DMFT-M scores when both cavitated and non-cavitated caries were considered. A brushing frequency < 1 a day was significantly associated to high DMF-T scores. The presence of df-t (decayed and filled temporary teeth) score > 0 and MIH conditioned high DMF-T or DMFT-M values, considering cavitated or cavitated and non-cavitated caries.
Conclusions
The intake of sweets and soft drinks, brushing frequency, caries in DT, and MIH in PT were the best predictors of caries in PT.
Clinical relevance
Control of risk factors in early childhood is important for preventing caries in PT.
https://ift.tt/2pDjHRO
Dental prevention and disease awareness in children with congenital heart disease
Abstract
Objectives
The importance of excellent oral health is known to be crucial in children with congenital heart diseases (CHD). Data about dental health and disease awareness is limited. This study aims to assess preventive measures taken to improve dental health in children with CHD and to gain insight into disease awareness and knowledge about the importance of oral health in children with CHD and to propose measures that could be taken.
Material and methods
Parents of 150 children with CHD were asked to complete a questionnaire containing specific questions about the preventive measures taken by the parents and dental and medical practitioners and their knowledge about underlying disease and the importance of oral health.
Results
Our results show an absence of information in parents concerning preventive measures and oral hygiene. Knowledge of the indications for antibiotic prophylaxis and for actually given medications was lacking. Preventive dental measures were not performed according to current guidelines.
Conclusions
Knowledge of parents about the importance of oral health in children with CHD could be improved. However, specialized centers involving pediatric cardiologists and pediatric dentists could coordinate the education of parents at an early stage. Moreover, general dentists should be trained more frequently concerning the indications for antibiotic prophylaxis, in particular, and the dental care of children with chronic diseases, in general. Warning cards such as the heart pass should be issued to parents of children with CHD.
Clinical relevance
The current study reveals the need for the structured training of medical and dental practitioners to support parents of children with CHD.
https://ift.tt/2pAIrJR
Push-out bond strength of three different calcium silicate-based root-end filling materials after ultrasonic retrograde cavity preparation
Abstract
Objective
The aim of this study was to evaluate the bond strength of three calcium silicate-based root-end filling materials.
Materials and methods
The root canals of 30 single-rooted teeth were endodontically treated; their root ends were resected and root-end cavities were prepared using ultrasonic tip. The teeth were randomly divided into three groups according to the material: (1) Micro-Mega mineral trioxide aggregate (MM-MTA), (2) Biodentine, and (3) TotalFill root repair material (RRM). Push-out test was performed using universal testing machine, and failure mode was analyzed by stereomicroscope. The data were statistically analyzed using Kruskal-Wallis and Man-Whitney post hoc tests. All p values < 0.05 were considered significant.
Results
TotalFill RRM exhibited significantly higher bond strength (12.69 MPa) than Biodentine (9.34 MPa, p = 0.023) and MM-MTA (7.89 MPa, p = 0.002). The difference between Biodentine and MM-MTA was not significant (p = 0.447). Mixed failures were the most noted in all three groups. MM-MTA had more adhesive failures than Biodentine and TotalFill, and no cohesive failures, but without statistical significance (p = 0.591).
Conclusion
The bond strength was the highest for TotalFill RRM.
Clinical relevance
In order to provide a persistent apical seal, root-end filling materials should resist dislodgement under static conditions, during function and operative procedures. TotalFill RRM exhibited higher bond strength to dentin than MM-MTA and Biodentine.
https://ift.tt/2pAG7D9
Differences in maxillomandibular morphology among patients with mucopolysaccharidoses I, II, III, IV and VI: a retrospective MRI study
Abstract
Objective
The aims of this study were to analyze the maxillomandibular morphology of patients with mucopolysaccharidosis (MPS) type I, II, III, IVa and VI and to evaluate the craniofacial effect of hematopoietic stem cell transplantation (HCST) in MPS I.
Materials and methods
One hundred head magnetic resonance images were retrospectively analyzed from 41 MPS and 27 control individuals. The width, height and length of the maxilla and mandible were plotted against age and the means of controls, MPS I, MPS II and MPS III were statistically compared. To determine the effect of HSCT in MPS I, jaw morphology was compared between MPS I patients with full donor chimerism versus patients with mixed/no donor chimerism.
Results
Maxillary dimensions were not statistically different between the MPS types. The height and length of the mandible were clearly smaller in MPS I as compared to those in controls, MPS II and MPS III. This was associated with progressive resorption of the mandibular condyles in MPS I, which was also observed in MPS II and VI, but not in MPS III or IVa. Whereas the success of HCST did not affect these changes, mandibular width was significantly smaller in MPS I individuals with full donor chimerism.
Conclusion
MPS I individuals have a smaller mandible as compared to control, MPS II and MPS III individuals due to progressive condylar degeneration. These abnormalities are also evident following successful HSCT.
Clinical relevance
Clinicians should be aware of specific differences in mandibular morphology and condylar involvement among the MPS subtypes.
https://ift.tt/2pCegBX
Color adjustment potential of resin composites
Abstract
Objectives
The purpose of this study was to evaluate color adjustment potential (CAP) of resin composites.
Materials and methods
Two shades of each of eight commercial resin composites and one control shade were evaluated. Visual (color competent observers, controlled conditions) and instrumental color evaluations (spectroradiometer, spectrophotometer) were performed. The data were analyzed by analysis of variance, Fisher's PLSD intervals for comparison of means, and Spearman's rank order correlation.
Results
Instrumental color adjustment potential (CAP-I) ranged from − 0.51 to 0.74, and corresponding Fisher's PLSD intervals were 0.1 and 0.05, respectively (p < 0.0001, power 1.0). Visual color adjustment potential (CAP-V) ranged from 0.10 to 0.78, and corresponding Fisher's PLSD intervals were 0.2 and 0.1, respectively (p < 0.0001, power 1.0). The greatest overall color shifting between test shades in isolation and the same shades surrounded by control shade were recorded for HRi ENA enamel, followed by Clearfil Majesty ES2. The highest visual CAP (blending) was recorded for Herculite Ultra, HRi ENA enamel, and Clearfil Majesty ES2.
Conclusion
Within the limitation of the study, it was found that color adjustment potential (CAP) was composite and shade-dependent. Positive CAP was recorded both instrumentally and visually for majority of composites and shades. Overall, the measured color difference reduction associated with positive CAP was 31%, while the average visual CAP was 43%.
Clinical relevance
Resin composites with pronounced color adjustment potential interact with surrounding dental restorations. Introduced CAP-V and CAP-I were indirect measurements of blending (optical illusion).
https://ift.tt/2pBcuSf
Melanom: Erfolg moderner Therapien trotz Hirnmetastasen
Ein Team aus internationalen Onkoligen untersuchte in einer retrospektiven Kohortenstudien das Risiko für Hirnmetastasen und die Überlebendauer nach Beginn der systemischen Therapie bei Melanompatienten im nicht resezierbaren AJCC-Stadium (American Joint Committee on Cancer) III/IV.
https://ift.tt/2pAurk6
Plattenepithelkarzinom: Fluorouracil als Prophylaxe
Forscher aus den USA sind der Frage nachgegangen, ob eine topische Fluorouracil-Behandlung Hochrisikopatienten vor weiteren Basalzell- oder Plattenepithelkarzinomen der Haut schützen kann.
https://ift.tt/2DRo8N8
Besenreiser: Vorteile durch Polidocanol in 70%iger Glukoselösung
Die Sklerotherapie setzt zum Veröden kleinkalibriger Varizen unterschiedliche Substanzen ein. Dermatologen aus Brasilien verglichen die Wirksamkeit des nicht ionischen Detergens Polidocanol (Lauromacrogol) in Glukoselösung und der hypertonen Lösung allein.
https://ift.tt/2DQMnuX
Dornwarzen: Needling nicht besser als Kürettage
Was Needling bei Plantarwarzen bringt, hat ein Team aus Großbritannien in einer randomisierten Studie untersucht.
https://ift.tt/2pAuo7U
Psoriasis: Höheres Suizidrisiko unter Brodalumab?
Psoriasispatienten sind im Vergleich zur Allgemeinbevölkerung stärker suizidgefährdet. Ist das die Erklärung für die während der Entwicklungsphase des monoklonalen Antikörpers Brodalumab beobachteten Selbsttötungen?
https://ift.tt/2HZHu5k
Stelarc: Zwischen Biologie und Technik
Im Jahr 1984 demonstrierte der Film Terminator das ungeheure Faszinationspotenzial des Cyborg, des Mensch-Maschine-Hybriden. Längst wird aus Science-Fiction Wirklichkeit. Der Medien- und Performance-Künstler Stelarc nutzt Robotik, Prothetik und Virtual-Reality-Systeme, um die Beziehung zwischen Körper und Technologie neu zu konfigurieren.
https://ift.tt/2I2oqmV
Melanom: Welche Folgen hat ein Immuntherapieabbruch?
Etwa 40 % der Melanompatienten brechen eine Kombinationstherapie mit den Checkpointhemmern Ipilimumab und Nivolumab aufgrund der Nebenwirkungen ab. Wie sicher ist ein solcher Immuntherapieabbruch?
https://ift.tt/2pAulce
Molekulare Schnelldiagnose beschleunigt Therapie von metastasierten Melanomen
„New generation sequencing" und mutationsspezifische Immunhistochemie sind in der Diagnostik von BRAF- und NRAS-Mutationen metastasierter Melanome durchaus hilfreich. Doch bis ein Ergebnis vorliegt, kann es dauern. Es geht aber auch schneller.
https://ift.tt/2I2VefD
Viele Muttermale im Kindesalter — Hautkrebsrisiko erhöht?
Gibt es einen Zusammenhang zwischen der Anzahl von Muttermalen und dem Risiko später gehäuft (atypische) Nävi zu entwickeln? Dieser Frage gingen Forscher aus den USA in einer prospektiven Longitudinalstudie nach.
https://ift.tt/2DRrShM
Chronische Urtikaria bei Kindern: Marker für die Krankheitsdauer entdeckt
Eine chronische Urtikaria bei Kindern ist sehr hartnäckig. In einer kanadischen Studie zeigte sich, dass zwei Biomarker Anhaltspunkte für die voraussichtliche Dauer der Plage mit den juckenden Quaddeln liefern können.
https://ift.tt/2DQpubf
Offenheit zwischen Arzt und Patient hilft weiter
Das Internet macht die Beziehung zwischen Arzt und Patient kompliziert. Das Problem: Der Arzt weiß nicht, wie gut sein Patient über das Netz informiert ist. Und der Patient fürchtet oft, der Arzt könnte seine Recherchen missbilligen. Eine Studie hat versucht, Licht ins Dunkel zu bringen.
https://ift.tt/2pBfoGG
Praxiswebsites oft juristisch angreifbar
Die meisten Praxiswebsites erfüllen nicht die gesetzlichen Anforderungen. Das lassen zumindest die Ergebnisse einer aktuellen Studie vermuten, in der 400 Homepages von Ärzten untersucht wurden. Sie zeigt, wo am häufigsten Fehler passieren.
https://ift.tt/2DQFdqI
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