International Forum of Allergy &Rhinology, Volume 8, Issue 4, Page 453-455, April 2018.
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Τρίτη 3 Απριλίου 2018
Issue Information
International Forum of Allergy &Rhinology, Volume 8, Issue 4, Page 553-553, April 2018.
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Distinct and complementary roles of CD4 T cells in protective immunity to influenza virus
Andrea J Sant | Katherine A Richards | Jennifer Nayak
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Transcriptional programming of tissue-resident memory CD8+ T cells
J Justin Milner | Ananda W Goldrath
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Cutis laxa in a patient with 1p36 deletion syndrome
The Journal of Dermatology, EarlyView.
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Herpes vegetans accompanied by Good's syndrome
The Journal of Dermatology, EarlyView.
https://ift.tt/2uNg7ts
Pigmented dermatofibrosarcoma protuberans associated with dermal melanocytosis
The Journal of Dermatology, EarlyView.
https://ift.tt/2q1EYoA
Relationship between environmental factors, age of onset and familial history in Japanese patients with psoriasis
The Journal of Dermatology, EarlyView.
https://ift.tt/2q05RIG
Improving detection of patient deterioration in the general hospital ward environment
Patient monitoring on low acuity general hospital wards is currently based largely on intermittent observations and measurements of simple variables, such as blood pressure and temperature, by nursing staff. Often several hours can pass between such measurements and patient deterioration can go unnoticed. Moreover, the integration and interpretation of the information gleaned through these measurements remains highly dependent on clinical judgement. More intensive monitoring, which is commonly used in peri-operative and intensive care settings, is more likely to lead to the early identification of patients who are developing complications than is intermittent monitoring. Early identification can trigger appropriate management, thereby reducing the need for higher acuity care, reducing hospital lengths of stay and admission costs and even, at times, improving survival. However, this degree of monitoring has thus far been considered largely inappropriate for general hospital ward settings due to device costs and the need for staff expertise in data interpretation. In this review, we discuss some developing options to improve patient monitoring and thus detection of deterioration in low acuity general hospital wards.https://ift.tt/2H5XkvO
Postoperative nausea and vomiting after unrestricted clear fluids before day surgery: A retrospective analysis
BACKGROUND Guidance on pre-operative fluids fasting policy continues to evolve. Current European guidelines encourage the intake of oral fluids up to 2 h before the induction of general anaesthesia. From October 2014, Torbay Hospital Day Surgery Unit commenced an unrestricted fluid policy, encouraging patients to drink clear fluids up until the time of transfer to theatre. OBJECTIVE The aim of this study was to assess the incidence of postoperative nausea and vomiting before and after the change to the unrestricted pre-operative clear oral fluids. DESIGN Retrospective, before and after study. SETTING Single district general hospital between November 2013 and February 2016. PATIENTS A total of 11 500 patients on the day case pathway who were receiving either sedation, general anaesthesia, regional anaesthesia or their combination. The data from these patients were collected routinely. This number of patients represents approximately 78% of all patients before the change in fluids policy and 74% after the change. Exclusions were patients undergoing a termination of pregnancy, or patients undergoing community dental procedures, from whom patient experience data are not collected. INTERVENTION Introduction of a change to the day surgery pathway policy permitting unrestricted clear oral fluids preoperatively until transfer to theatre (from October 2014). MAIN OUTCOME MEASURES Incidence of postoperative nausea and vomiting. RESULTS The rates of nausea within 24 h postoperatively were 270/5192 (5.2%) when patients could not drink within 2 h of surgery, and 179/4724 (3.8%) when patients could drink up until surgery, a relative rate (95% confidence interval) of 0.73 (0.61 to 0.88), P = 0.00074. The corresponding rates of vomiting were 146/5186 (2.8%) and 104/4716 (2.2%), a relative rate (95% confidence interval) of 0.78 (0.61 to 1.00), P = 0.053. CONCLUSION Our data suggest that the liberal consumption of clear fluids before the induction of scheduled day case anaesthesia reduced the rates of postoperative nausea and vomiting.https://ift.tt/2EgM2lu
Comparison of double intravenous vasopressor automated system using nexfin versus manual vasopressor bolus administration for maintenance of haemodynamic stability during spinal anaesthesia for caesarean delivery: A randomised double-blind controlled trial
BACKGROUND Hypotension is a common side effect of spinal anaesthesia during caesarean delivery and is associated with maternal and foetal adverse effects. We developed an updated double intravenous vasopressor automated (DIVA) system that administers phenylephrine or ephedrine based on continuous noninvasive haemodynamic monitoring using the Nexfin device. OBJECTIVE The aim of our present study is to compare the performance and reliability of the DIVA system against Manual Vasopressor Bolus administration. DESIGN A randomised, double-blind controlled trial. SETTING Single-centre, KK Women's and Children's Hospital, Singapore. PATIENTS Two hundred and thirty-six healthy women undergoing elective caesarean delivery under spinal anaesthesia. MAIN OUTCOME MEASURES The primary outcome was the incidence of maternal hypotension. The secondary outcome measures were reactive hypertension, total vasopressor requirement and maternal and neonatal outcomes. RESULTS The DIVA group had a significantly lower incidence of maternal hypotension, with 39.3% (46 of 117) patients having any SBP reading less than 80% of baseline compared with 57.5% (65 of 113) in the manual vasopressor bolus group (P = 0.008). The DIVA group also had fewer hypotensive episodes than the manual vasopressor bolus group (4.67 versus 7.77%; P https://ift.tt/2GOCV0N
Intra-operative lidocaine in the prevention of vomiting after elective tonsillectomy in children: A randomised controlled trial
BACKGROUND Postoperative vomiting (POV) is a frequent complication of tonsillectomy in children. In adult patients undergoing abdominal surgeries, the use of intravenous lidocaine infusion can prevent POV. OBJECTIVE To evaluate the anti-emetic effect of an intravenous lidocaine infusion used as an adjuvant to general anaesthesia, in children undergoing elective ear, nose and throat surgery. DESIGN Double-blind, randomised, controlled study. SETTING Hospital-based, single-centre study in Chile. PATIENTS ASA I-II children, aged 2 to 12 years, scheduled for elective tonsillectomy. INTERVENTION We standardised the induction and maintenance of anaesthesia. Patients were randomly allocated to lidocaine (1.5 mg kg−1 intravenous lidocaine over 5 min followed by 2 mg kg−1 h−1) or 0.9% saline (at the same rate and volume). Infusions were continued until the end of the surgery. MAIN OUTCOME MEASURES Presence of at least one episode of vomiting, retching or both in the first 24 h postoperatively (POV). SECONDARY OUTCOMES Plasma concentrations of lidocaine and postoperative pain. RESULTS Ninety-two children were enrolled. Primary outcome data were available for 91. In the Lidocaine group, 28 of 46 patients (60.8%) experienced POV, compared with 37 of 45 patients (82.2%) in the Saline group [difference in proportions 21.3% (95% confidence interval (CI) 2.8 to 38.8), P = 0.024]. The intention-to-treat analysis showed that when we assumed that the patient in the Saline group lost to follow-up did not have POV, the difference in proportions decreased to 19.6% (95% CI, 0.9 to 37.2), with an unadjusted odds ratio of 0.38 (95% CI, 0.15 to 0.97, P = 0.044). The odds of having POV were 62% less likely in those patients receiving lidocaine compared with patients in the Saline group. The mean lidocaine plasma concentration was 3.91 μg ml−1 (range: 0.87 to 4.88). CONCLUSION Using an intravenous lidocaine infusion as an adjuvant to general anaesthesia decreased POV in children undergoing elective tonsillectomy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01986309.https://ift.tt/2EguUMP
The trapezius plane block: a technique for regional anaesthesia of the superficial posterior thorax
No abstract availablehttps://ift.tt/2GPZxhf
Oesophageal or transgastric views for estimating mean pulmonary artery pressure with transoesophageal echocardiography: A prospective observational study
BACKGROUND Recent data suggest that in cardiac surgical patients, the pulmonary artery acceleration time (PAT) is useful for estimating mean pulmonary artery pressure (MPAP) noninvasively with transoesophageal echocardiography (TOE). The pulmonary valve can be visualised from multiple echocardiographic windows, but it is unclear which, if any, view correlates best with MPAP. OBJECTIVE(S) To compare the PAT measured with TOE from oesophageal and transgastric views with MPAP obtained invasively with a pulmonary artery catheter. DESIGN A prospective observational study. SETTING St. Vincent's Hospital, Melbourne, a university tertiary referral centre in Australia. PATIENTS Sixty-three patients having cardiac surgery were included in our study. All patients had insertion of both a TOE probe and pulmonary artery catheter; this is the routine standard of care in our centre. INTERVENTION(S) Nil. MAIN OUTCOME MEASURES During a period of haemodynamic stability, the PAT was measured first from an oesophageal view and then immediately after from a transgastric view. The results were then compared with the invasively measured MPAP. RESULTS Simultaneous measurements of MPAP and PAT were taken in 63 patients. In two patients, these measurements were not possible in the transgastric position due to an inability to visualise the right ventricular outflow tract and pulmonary valve. A Bland–Altman analysis of the PAT measured from the upper oesophageal and transgastric views showed a mean difference of 1 ms and limits of agreement of −18 to 16 ms. The area under the receiver operating curves for predicting pulmonary hypertension with PAT were upper oesophageal view 0.99 [95% confidence interval (CI), 0.98 to 1.00] and transgastric view 0.99 (95% CI, 0.97 to 1.00). The agreement between the results from these two views in the diagnosis of pulmonary hypertension (defined as PAT 25 mmHg) with a sensitivity of 94.7% and specificity of 97.6%. The transgastric view predicted pulmonary hypertension with a sensitivity of 89.4% and specificity of 95.2%. CONCLUSION Oesophageal and transgastric measurements of PAT have close agreement and a similar high ability to discriminate between people with and without pulmonary hypertension. The transgastric measurement was unobtainable in a small percentage of patients and required more probe manipulation. We would recommend PAT measurement in the upper oesophageal view.https://ift.tt/2EijVSS
Ultrasound examination of the antrum to predict gastric content volume in the third trimester of pregnancy as assessed by MRI: A prospective cohort study
BACKGROUND Ultrasound examination of the gastric antrum allows reliable pre-operative assessment of gastric contents and volume in adult patients. However, during pregnancy, the change in the anatomical position of the stomach due to the gravid uterus leads to a change in the measured value of the antral area. Therefore, current mathematical models predicting gastric content volume (GCV) in the adult may not apply in term pregnant women. OBJECTIVE To propose a mathematical model which is predictive of GCV in pregnant women and to assess the performance of an ultrasound qualitative grading scale (0 to 2) for the diagnosis of clear fluid volumes more than 0.8 and 1.5 ml kg−1. DESIGN Prospective cohort study. SETTING Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon and Assistance Publique – Hôpitaux de Marseille, Hôpital Nord, Marseille, France. PATIENTS Pregnant women in the third trimester of pregnancy. MAIN OUTCOME MEASURES Comparison of the GCV as measured by MRI and the ultrasound measured antral cross-sectional area, and an assessment of gastric contents according to a 0 to 2 qualitative grading scale. RESULTS Data from 34 women were analysed. A linear model predictive of GCV was constructed with a 95% agreement band of ±95 ml, with a mean polar angle of −8.7°. Performance of the qualitative grading scale to detect fluid volumes >0.8 and >1.5 ml kg−1 was improved when used in a composite scale including a 505 mm2 antral area cut-off value in the semirecumbent supine position. CONCLUSION We report a new mathematical model predictive of GCV in women in the third trimester of pregnancy. Furthermore, the combination of the qualitative and the quantitative ultrasound examination of the gastric antrum might be useful to assess gastric fluid volume in pregnant women. TRIAL REGISTRATION ANSM Register N°2015-A00800-49https://ift.tt/2GVigIB
Microvascular reactivity, assessed by near-infrared spectroscopy and a vascular occlusion test, is associated with patient outcomes following cardiac surgery: A prospective observational study
BACKGROUND Microvascular dysfunction in patients admitted to the ICU following cardiac surgery may be related to perioperative complications and increased resource utilisation even in the presence of acceptable systemic haemodynamic variables. OBJECTIVES To assess the relationship between microvascular impairment using peripheral near-infrared spectroscopy at ICU admission and 6 h postadmission and the duration of mechanical ventilatory support, length of stay in ICU and in hospital. DESIGN Prospective, observational cohort study. SETTING Single-centre, tertiary-level cardiac ICU. PATIENTS Sixty-nine adult patients following elective cardiac surgery excluding patients with on-going extracorporeal support or in whom tissue haemoglobin oxygen saturation (StO2) measurements were not feasible. MAIN OUTCOME MEASURES Thenar and forearm StO2 in response to a vascular occlusion test to calculate desaturation and reperfusion slopes. A logistic regression model was used to ascertain the associations between StO2, desaturation and reperfusion slopes as well as cardiac index, mean arterial pressure, arterial lactate concentrations and prolonged (≥75th percentile) duration of mechanical ventilation, ICU length of stay and hospital length of stay. RESULTS A reduced reperfusion slope at ICU admission was associated independently with prolonged mechanical ventilation at thenar (OR 0.08; 95% CI [0.02 to 0.47], P = 0.003) and forearm [OR 0.2 (0.04 to 0.59), P = 0.006] sites. Similarly, a reduced Rres was associated with prolonged ICU LOS at both thenar [OR 0.3 (0.13 to 0.77), P = 0.007] and forearm [OR 0.2 (0.05 to 0.62), P = 0.007] sites at ICU0 h, as well as ICU6 h [OR 0.2 (0.05 to 0.66), P = 0.004 and OR 0.05 (0.008 to 0.34), P = 0.002]. An increased Rdes was associated with prolonged hospital LOS at the thenar eminence at ICU0 h [OR 1.9 (1.4 to 2.3), P = 0.004] and ICU6 h [OR 6.7 (2.0 to 23), P = 0.002] as well as the forearm at ICU0 h [OR 1.5 (1.3 to 1.9), P = 0.004] and ICU6 h [OR 1.6 (1.3 to 2.1), P = 0.004]. CONCLUSION In the early postoperative period following cardiac surgery, changes in thenar and forearm tissue oxygenation variables are associated with patient resource utilisation outcomes.https://ift.tt/2EhOGr7
Prediction of bilateral cerebral oxygen desaturations from a single sensor in adult cardiac surgery: A prospective observational study
BACKGROUND Monitoring regional cerebral oxygen saturation (rcSO2) with near-infrared spectroscopy is increasingly being performed in patients scheduled for cardiac surgery. It is sometimes difficult to monitor both frontal lobes due to anatomical or space compromises. However, it remains unclear whether the use of only one lateral or medial probe can provide adequate bilateral monitoring. OBJECTIVE To evaluate the efficacy of using a single lateral or medial probe to detect substantial desaturations on both sides. DESIGN A prospective observational study. SETTING Tertiary university teaching hospital. PATIENTS Seventeen adult patients undergoing elective cardiac surgery monitored with three near-infrared spectroscopy probes (two lateral and one medial) using an INVOS 5100C monitor. INTERVENTIONS The value of rcSO2 was recorded up to 19 times during each procedure. Substantial desaturation was defined as an absolute rcSO2 value of 50% or less or a decrease of more than 20% compared with baseline values on spontaneous ventilation with 21% oxygen. MAIN OUTCOME MEASURES The level of agreement between the three pairs of probes using the Bland–Altman method for repeated measures, and the grade of concordant and discordant results between the three pairs of probes by means of contingency tables and the κ coefficient. RESULTS We obtained 244 records per probe. Greater agreement was observed between the two lateral probes (mean ± SD of the differences between recordings was -0.9 ± 5.5); mean difference between left and medial, and right and medial probes was 2.4 ± 7.3 and 3.3 ± 6.7, respectively. The rate of discordant results between the two lateral probes was 5.7%, κ coefficient of 0.6 with 95% confidence interval (95% CI 0.4 to 0.8), and between the left and medial, and right and medial of 8.2 and 7.4%, with κ coefficients of 0.57 (95% CI 0.38 to 0.76) and 0.5 (95% CI 0.29 to 0.71), respectively. CONCLUSION In cardiac surgery patients in whom there is difficulty in accommodating two rcSO2 probes, a single lateral probe can effectively measure bilateral rcSO2 in specific scenarios.https://ift.tt/2EgusOD
Dexmedetomidine as a part of general anaesthesia for caesarean delivery in patients with pre-eclampsia: A randomised double-blinded trial
BACKGROUND During general anaesthesia, endotracheal intubation of patients with pre-eclampsia causes stimulation of the sympathetic nervous system and catecholamine release, which may lead to maternal and neonatal complications. OBJECTIVE To attenuate both the stress response and the haemodynamic response to tracheal intubation in patients with pre-eclampsia. DESIGN A randomised, double-blind, controlled study. SETTING Single University Hospital. PATIENTS Sixty patients aged 18 to 45 years with pre-eclampsia receiving general anaesthesia for caesarean section. INTERVENTIONS The patients were randomly allocated to three groups. Groups D1and D2 received an infusion of dexmedetomidine 1 μg kg−1 over the 10 min before induction of general anaesthesia, then 0.4 and 0.6 μg kg−1 h−1 dexmedetomidine, respectively. Group C received equivalent volumes of 0.9% saline. MAIN OUTCOME MEASURES The primary outcome was the effect of dexmedetomidine on mean arterial blood pressure measured before induction of general anaesthesia at 1 and 5 min after intubation, and then every 5 min until 10 min after extubation. The secondary outcomes were blood glucose and serum cortisol (measured before induction of general anaesthesia, and at 1 and 5 min after intubation), postoperative visual analogue pain scores, time to first request for analgesia, the total consumption of analgesia, Ramsay sedation score, maternal and placental vein blood serum levels of dexmedetomidine and neonatal Apgar score at 1 and 5 min. RESULTS At all assessment times, the mean arterial pressures were significantly lower in the dexmedetomidine groups than in the control group. Compared with group C, the heart rate was significantly lower in both groups D1 and D2. In group D2, the heart rate was lower than in group D1. Serum glucose and cortisol were significantly higher in the controls than in either group D1 or D2. Group D2 patients were significantly more sedated on arrival in the recovery room followed by D1. Time to first analgesia was significantly longer in groups D2 and D1 than in group C, and the visual analogue pain scores were significantly lower in groups D1 and D2 than in group C at 1, 2, 3 and 5 h. Total morphine consumption was significantly lower in groups D1 and D2 than in the control group. There was no difference in Apgar scores across the three groups despite significantly higher dexmedetomidine concentrations in group D2 (both maternal and placental vein) than in group D1. CONCLUSION Administration of dexmedetomidine in doses 0.4 and 0.6 μg kg−1 h−1 was associated with haemodynamic and hormonal stability, without causing significant adverse neonatal outcome. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR201706002303170), (www.pactr.org).https://ift.tt/2Egumqf
Economic evaluation of bilateral sternal local anaesthetic infusions via multi-hole catheters after cardiac surgery
No abstract availablehttps://ift.tt/2H6W0Jk
Financial outcomes of transoral robotic surgery: A narrative review
To determine the current cost impact and financial outcomes of transoral robotic surgery in Otolaryngology.
https://ift.tt/2EhShp1
The Cochleural Alternating Acoustic Beam Therapy (CAABT): A pre-clinical trial
We intend to assess the effectiveness of a novel tinnitus treatment therapy, the Cochleural Alternating Acoustic Beam Therapy (CAABT) using the psychoacoustic measures, the questionnaires and rs-fMRI.
https://ift.tt/2H5LtOp
Bicycle helmets are protective against facial injuries, including facial fractures: a meta-analysis
Publication date: Available online 3 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): D.G. Fitzpatrick, M. Goh, D.C. Howlett, M. Williams
Cycling is a popular activity. However there are risks associated with cycling, including facial injury. Helmets are often worn to prevent head injury. Evidence for their protection against facial injury is limited. This meta-analysis investigated the effect of bicycle helmets on the incidence of facial injury. The PubMed/MEDLINE, Google Scholar, and Cochrane Library databases were searched. Studies included were observational and involved adult participants. Paediatric studies, studies on helmet legislation, and those combining facial injuries with other injury types were excluded. The studies were evaluated by two reviewers. Risk of bias was assessed using the RevMan bias assessment tool. Odds ratios (OR) were extracted for facial injuries and facial fractures. Two meta-analyses were performed using these categories. Nine of the 102 studies identified were included. Helmets were protective against facial injury (OR 0.69, 95% confidence interval 0.63–0.75, P<0.0001). Five studies reported facial fracture rates; helmets were protective against these also (OR 0.79 95% confidence interval 0.70–0.90, P=0.0003). There are no randomized controlled trials on this topic and the number of studies available is small. Bicycle helmets offer protection against facial injuries and this should be considered by cyclists when deciding whether or not to use one.
https://ift.tt/2JftDcA
Clefts of the lip and palate: is the Internet a trustworthy source of information for patients?
Publication date: Available online 3 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): G.A. Karamitros, N.A. Kitsos
Great numbers of patients use the Internet to obtain information and familiarize themselves with medical conditions. However, the quality of Internet-based information on clefts of the lip and palate has not yet been examined. The goal of this study was to assess the quality of Internet-based patient information on orofacial clefts. Websites were evaluated based on the modified Ensuring Quality Information for Patients (EQIP) instrument (36 items). Three hundred websites were identified using the most popular search engines. Of these, 146 were assessed after the exclusion of duplicates, irrelevant sites, and web pages in languages other than English. Thirty-four (23.2%) web pages, designed mostly by academic centres and hospitals, covered more than 22 items and were classified as high-score websites. The EQIP score achieved by websites ranged between 4 and 30, out of a total possible 36 points; the median score was 19 points. The top five high-scoring web pages are highlighted. The overall quality of Internet-based patient information on orofacial clefts is low. Also, the majority of web pages created by medical practitioners have a marketing perspective and in order to attract more patients/customers avoid mentioning the risks of the reconstructive procedures needed.
https://ift.tt/2IsO6cr
Endocytoscopy for in situ real-time histology of oral mucosal lesions
This study investigated the utility of endocytoscopy, a novel emerging endoscopic system, for in situ real-time histology of oral mucosal lesions. Endocytoscopy involves the use of a contact light microscopy system with 380-fold magnification. With the development of endoscopic instruments, it has become possible to observe the abnormal microvascular and capillary patterns of tumour cells. The resolution of the endoscopic image is improved in situ, and a more detailed diagnosis is possible. In this study, endocytoscopy along with other diagnostic modalities was used in nine patients.
https://ift.tt/2GRd0FO
Septal anchoring suture: a key suture to improve the nasolabial symmetry in unilateral cheiloplasty
Since 2008, a septal anchoring suture has been used in unilateral cleft lip repair at Chang Gung Memorial Hospital in order to stabilize the lateral lip centrally. This study compared the symmetry of two groups of patients: those treated with and without an anchoring suture. Multiple standardized direct and photographic facial measurements were performed on the faces of all patients pre-cheiloplasty and at 5 years post-cheiloplasty. The degree of nasolabial symmetry was evaluated by comparing the ratios of measurements of the cleft vs.
https://ift.tt/2EhPmwJ
The Cochleural Alternating Acoustic Beam Therapy (CAABT): A pre-clinical trial
Publication date: Available online 3 April 2018
Source:American Journal of Otolaryngology
Author(s): Chunli Liu, Han Lv, Tao Jiang, Jing Xie, Lu He, Guopeng Wang, Jiao Liu, Zhenchang Wang, Shusheng Gong
PurposeWe intend to assess the effectiveness of a novel tinnitus treatment therapy, the Cochleural Alternating Acoustic Beam Therapy (CAABT) using the psychoacoustic measures, the questionnaires and rs-fMRI.Materials and methodsIn this study, we enrolled 11 older than 18 years old Chinese patients with normal hearing who had unilateral, chronic (longer than 6 months), sensorineural tinnitus, of frequencies between 125–8000 Hz, and an average loudness of 31 dB. The patients underwent the treatment with the CAABT method for 12 weeks and the outcomes were evaluated with tinnitus questionnaire scores, a set of psychoacoustic measures, and rs-fMRI testing before treatment and at 3 months. This was an earlier study of the controlled randomized clinical trial which was registered with ClinicalTrials.gov, number NCT02774122.ResultsAlmost all the patients reported reduced tinnitus annoyance after the three-month treatment. The THI and VAS scores showed decreased tinnitus severity. The rs-fMRI results indicated that the right middle frontal gyrus and the right superior temporal gyrus displayed noticeable decreases of the ReHo values for the subjects between the before and after treatment, supporting the clinical evidence of significant tinnitus reduction.ConclusionThe therapy seemed effective in patients of varying severities, and no side effects were observed in this trial. The CAABT can be an alternative for those who are suitable for sound therapy once a large scale of and better controlled clinical studies have validated the findings of this experiment.
https://ift.tt/2GuRlDL
Financial outcomes of transoral robotic surgery: A narrative review
Publication date: Available online 3 April 2018
Source:American Journal of Otolaryngology
Author(s): Sammy Othman, Brian J. McKinnon
ObjectiveTo determine the current cost impact and financial outcomes of transoral robotic surgery in Otolaryngology.Data sourcesA narrative review of the literature with a defined search strategy using Pubmed, MEDLINE, CINAHL, and Web of Science.Review methodsUsing keywords ENT or otolaryngology, cost or economic, transoral robotic surgery or TORs, searches were performed in Pubmed, MEDLINE, CINAHL, and Web of Science and reviewed by the authors for inclusion and analysis.ResultsSix total papers were deemed appropriate for analysis. All addressed cost impact of transoral robotic surgery (TORs) as compared to open surgical methods in treating oropharyngeal cancer and/or the identification of the primary tumor within unknown primary squamous cell carcinoma. Results showed TORs to be cost-effective.ConclusionTransoral robotic surgery is currently largely cost effective for both treatment and diagnostic procedures. However, further studies are needed to qualify long-term data.
https://ift.tt/2Iq9e3c
Effect of vowel context on test–retest nasalance score variability in children with and without cleft palate
Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Seunghee Ha, Seungeun Jung, Kyung S. Koh
ObjectiveThe purpose of this study was to determine whether test–retest nasalance score variability differs between Korean children with and without cleft palate (CP) and vowel context influences variability in nasalance score.ParticipantsThirty-four 3-to-5-year-old children with and without CP participated in the study.MethodsThree 8-syllable speech stimuli devoid of nasal consonants were used for data collection. Each stimulus was loaded with high, low, or mixed vowels, respectively. All participants were asked to repeat the speech stimuli twice after the examiner, and an immediate test–retest nasalance score was assessed with no headgear change.ResultsChildren with CP exhibited significantly greater absolute difference in nasalance scores than children without CP. Variability in nasalance scores was significantly different for the vowel context, and the high vowel sentence showed a significantly larger difference in nasalance scores than the low vowel sentence. The cumulative frequencies indicated that, for children with CP in the high vowel sentence, only 8 of 17 (47%) repeated nasalance scores were within 5 points.ConclusionsTest–retest nasalance score variability was greater for children with CP than children without CP, and there was greater variability for the high vowel sentence(s) for both groups.
https://ift.tt/2IseK5d
Factors predicting health practitioners' awareness of UNHS program in Malaysian non-public hospitals
Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Abdussalaam Iyanda Ismail, Abdul Halim Abdul Majid, Mohd Normani Zakaria, Nor Azimah Chew Abdullah, Sulaiman Hamzah, Siti Zamratol-Mai Sarah Mukari
ObjectiveThe current study aims to examine the effects of human resource (measured with the perception of health workers' perception towards UNHS), screening equipment, program layout and screening techniques on healthcare practitioners' awareness (measured with knowledge) of universal newborn hearing screening (UNHS) in Malaysian non-public hospitals.MethodsVia cross sectional approach, the current study collected data using a validated questionnaire to obtain information on the awareness of UNHS program among the health practitioners and to test the formulated hypotheses. 51, representing 81% response rate, out of 63 questionnaires distributed to the health professionals were returned and usable for statistical analysis. The survey instruments involving healthcare practitioners' awareness, human resource, program layout, screening instrument, and screening techniques instruments were adapted and scaled with 7-point Likert scale ranging from 1 (little) to 7 (many). Partial Least Squares (PLS) algorithm and bootstrapping techniques were employed to test the hypotheses of the study.ResultsWith the result involving beta values, t-values and p-values (i.e. β=0.478, t=1.904, p<0.10; β=0.809, t=3.921, p<0.01; β= -0.436, t=1.870, p<0.10), human resource, measured with training, functional equipment and program layout, are held to be significant predictors of enhanced knowledge of health practitioners. Likewise, program layout, human resource, screening technique and screening instrument explain 71% variance in health practitioners' awareness. Health practitioners' awareness is explained by program layout, human resource, and screening instrument with effect size (f2) of 0.065, 0.621, and 0.211 respectively, indicating that program layout, human resource, and screening instrument have small, large and medium effect size on health practitioners' awareness respectively. However, screening technique has zero effect on health practitioners' awareness, indicating the reason why T-statistics is not significant.ConclusionHaving started the UNHS program in 2003, non-public hospitals have more experienced and well-trained employees dealing with the screening tools and instrument, and the program layout is well structured in the hospitals. Yet, the issue of homogeneity exists. Non-public hospitals charge for the service they render, and, in turn, they would ensure quality service, given that they are profit-driven and/or profit-making establishments, and that they would have no option other than provision of value-added and innovative services. The employees in the non-public hospitals have less screening to carry out, given the low number of babies delivered in the private hospitals. In addition, non-significant relationship between screening techniques and healthcare practitioners' awareness of UNHS program is connected with the fact that the techniques that are practiced among public and non-public hospital are similar and standardized. Limitations and suggestions were discussed.
https://ift.tt/2GSYRYs
Treatment of an obstructive, recurrent, syncytial myoepithelioma of the trachea with tracheal resection and reconstruction
Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Michael Pfeiffer, Jason E. Cohn, Judy Mae Pascasio, Sri K. Chennupati
Myoepithelioma is a rare occurrence in the trachea and respiratory tract with only 11 cases reported in the literature. We present a case report of a 10-year-old female who was found to have an anterior tracheal mass causing near total obstruction of the airway on bronchoscopy. Characteristics of the mass were consistent with syncytial myoepithelioma. The patient experienced multiple recurrences requiring tracheal resection with end-to-end reanastomosis. To date there have not been any reported cases of myoepithelioma of the trachea in a child and no reports of syncytial myoepithelioma in the trachea or respiratory tract.
https://ift.tt/2Ehu0zs
Selective IgM deficiency associated with adult-onset Still disease
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Jessica Oh, David McGarry, Brian Peppers, Robert Hostoffer
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Table of Contents
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
https://ift.tt/2q1chaD
Information for Authors
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
https://ift.tt/2Jhtt4o
Is there a link between nasal polyposis and increased risk for sinonasal malignancy?
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Deena Pourang, Michael Batech, Kian Karimi, Javed Sheikh, Shefali Samant
https://ift.tt/2q1c731
Editorial Board
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
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Do we need to keep playing this tune?
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Miles Weinberger
https://ift.tt/2uEvF2s
Choosing wisely in the era of biologics for asthma
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): M. Diane Lougheed
https://ift.tt/2JhtiWM
Information for Readers
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
https://ift.tt/2Gyxd3y
Anaphylaxis and severe immune hemolytic anemia during the course of desensitization with carboplatin
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Diana Pérez-Alzate, Natalia Blanca-López, María Luisa Somoza, Francisco Javier Ruano, Gloria Serrano Montero, María José Penalva, Carmen Gimeno, Miguel Blanca, Gabriela Canto
https://ift.tt/2q3hD5c
Biologics
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Chitra Dinakar, David A. Khan, Stanley M. Fineman, David Michael Lang, Stephen A. Tilles
https://ift.tt/2Jht95G
Challenges in the treatment of asthma in children and adolescents
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Stanley J. Szefler, Bradley Chipps
ObjectiveDespite the availability of effective treatments, asthma control in children and adolescents remains inadequate and rates of health care use are high. This follow-up to a recent review (O'Byrne et al, Eur Respir J. 2017;50[3]) examines a number of challenges in current pediatric asthma management compared with that of an adult perspective and discusses possible alternative strategies that might improve pediatric asthma management and control.Data SourcesThe evidence base for this review is limited because, historically, much of the research has been performed in adults.Study SelectionsNot applicable.ResultsPediatric asthma management is complicated by variability in asthma severity and control and difficulty in measuring pulmonary function and airway inflammation. Current challenges in pediatric asthma management include the recommended initial therapy treating only the symptoms rather than the underlying inflammation and switching to controller therapy only when asthma subsequently worsens.ConclusionAlternative strategies that might improve pediatric asthma management and control include replacement of short-acting β2-agonist relievers by an inhaled corticosteroid plus a fast-acting β2-agonist (short-acting β2-agonist or fast- and long-acting β2-agonist) combination at Global Initiative for Asthma step 1 or 2 to ensure that patients receive an inhaled corticosteroid whenever they feel the need for symptomatic relief. Such an approach could eliminate the problem of learned overuse or over-reliance on short-acting β2-agonist reliever medication and address the other challenges in current pediatric asthma management. Clinical studies in pediatric patients or large studies involving a proportion of pediatric patients are required to provide the supporting evidence needed to help advance such new approaches and improve asthma control from a pediatric perspective.
https://ift.tt/2pZ6jXE
Skin testing and desensitization outcomes among platinum-sensitive oncology patients
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Stephanie L. Mawhirt, Luz S. Fonacier, Rose Calixte, Mark Davis-Lorton, Marcella R. Aquino
https://ift.tt/2JbMl4R
Outpatient penicillin skin testing has greater value in targeted patient populations
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Viviana M. Temiño, Timothy P. Gauthier, Paola Lichtenberger
https://ift.tt/2pZ64vI
Common variable immunodeficiency associated with stiff-person syndrome
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Jason Schend, Dave McGarry, John Johnson, Robert Hostoffer
https://ift.tt/2Jh1YYS
Food allergy management and anaphylaxis preparedness in a suburban school district varies by school level
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): S. Shahzad Mustafa, Jonathan Bress
https://ift.tt/2q27eXg
Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions
Publication date: April 2018
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Nicola A. Hanania, Marc Massanari, Neal Jain
BackgroundAssessment of asthma using clinical measures alone often fails to detect underlying airway inflammation. Fractional exhaled nitric oxide (FeNO) is a recognized biomarker of type 2 airway inflammation in asthma. Measurement of FeNO is instrumental in the assessment and management of patients with corticosteroid-sensitive asthma.ObjectiveTo determine the impact of measuring FeNO on asthma management in real-world clinical practices.MethodsClinicians from 337 US practices performed a clinical assessment and recorded treatment plans before and after measuring FeNO in 7,901 patients with asthma. Airway inflammation was classified as low, intermediate, or high according to the clinician's usual procedures, including clinical examination, spirometry, and symptoms. Clinicians recorded asthma medication plans, indicating medications to be initiated, continued, or stopped. FeNO measurement was performed, followed by documentation of any change(s) in the treatment plans based on the FeNO value (eg, initiating new medications or changing the dose of or discontinuing existing medications).ResultsClinical assessment was concordant with FeNO measurement in only 56% of cases, matching FeNO more frequently in patients with low inflammation (64%) vs high inflammation (34%). After FeNO measurement, clinicians modified their treatment plan in 31% and altered prescriptions for inhaled corticosteroids in 90% of cases. Inhaled corticosteroids were initiated or their dose increased in 66% of patients with high inflammation but discontinued or their dose decreased in only 9% of patients with low inflammation.ConclusionMeasurement of FeNO enabled clinicians to assess underlying airway inflammation, leading to a significant revision of their treatment plans compared with real-world clinical assessment of asthma alone.
https://ift.tt/2GuYggb
Changes in emergency department concordance with guidelines for the management of stinging insect-induced anaphylaxis
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Sunday Clark, Krislyn M. Boggs, Diana S. Balekian, Kohei Hasegawa, Phuong Vo, Brian H. Rowe, Carlos A. Camargo
BackgroundChanges in emergency department (ED) concordance with guidelines for the management of stinging insect-induced anaphylaxis (SIIA) are not known.ObjectiveTo describe temporal changes in ED concordance with guidelines for the management of SIIAs.MethodsWe analyzed data from 2 multicenter retrospective studies of patients with stinging insect-related acute allergic reactions seen in 1 of 14 North American EDs during 2 periods: 1999 through 2001 and 2013 through 2015. Visits were identified similarly across studies (eg, using International Classification of Diseases, Ninth Revision, Clinical Modification codes 989.5, 995.0, and 995.3). Anaphylaxis was defined as an acute allergic reaction with involvement of at least 2 organ systems or hypotension. We compared concordance between periods with 4 guideline recommendations: (1) treatment with epinephrine, (2) discharge prescription for epinephrine auto-injector, (3) referral to an allergist/immunologist, and (4) instructions to avoid the offending allergen.ResultsWe compared 182 patients with SIIA during 1999 to 2001 with 204 during 2013 to 2015. Any treatment with epinephrine (before arrival to the ED or in the ED) increased over time (30% vs 49%; P < .001). Prescriptions for epinephrine auto-injector at discharge increased significantly (34% vs 57%; P < .001), whereas documentation of referral to an allergist/immunologist decreased (28% vs 12%; P = .002), and instructions to avoid the offending allergen did not change (23% vs 24%; P = .94). Receipt of at least 3 guideline recommendations increased over time; however, the comparison was not statistically significant (10% vs 16%; P = .15).ConclusionDuring the nearly 15-year study interval, we observed increased ED concordance with epinephrine-related guideline recommendations for the management of SIIA. Reasons for the decrease in allergy/immunology referrals merit further study.
https://ift.tt/2q4IVYH
Subcutaneous venom immunotherapy in children
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Pınar Gür Çetinkaya, Saliha Esenboğa, Özge Uysal Soyer, Ayfer Tuncer, Bülent Enis Şekerel, Ümit Murat Şahiner
BackgroundVenom immunotherapy (VIT) is safe in children, although adverse effects can occur.ObjectiveTo document adverse effects and to determine re-sting reactions and the efficacy of VIT in childhood.MethodsWe retrospectively analyzed data from children who had taken VIT from 2002 through 2015. These patients were queried by telephone to determine reactions after re-stings during or after VIT.ResultsIn total 107 children with a systemic reaction after Hymenoptera sting and with proved immunoglobulin E-mediated sensitization were enrolled. Participants had a median age of 10.0 years (7.2–12.4 years) at the beginning of immunotherapy. Fifty-two participants had allergic reactions during VIT; 40 of these reactions were local (37.4%), 5 were large local (4.7%), and 7 were systemic (6.5%). Of the 52 patients with adverse reactions, most reactions were local (n = 40, 89%) and were observed mainly in dose-increase periods (n = 25, 60%; P < .001). Although local reactions were more frequently seen with Vespula treatment (P = .047), systemic reactions were common with Apis treatment (P = .031). Sixty-eight patients (63.5%) were queried for re-sting, 33 (48.5%) had a re-sting and 24 (72.7%) of these 33 patients developed allergic reactions. The reactions were local (n = 19), large local (n = 1), and systemic (n = 4). Risk analysis for local and systemic reactions during VIT showed pre-existing asthma as an independent risk factor (odds ratio 4.1, 95% confidence interval 1.3–12.7, P = .016).ConclusionIn children, VIT appears to be safe and protective against severe reactions after re-sting. However, pre-existing asthma was identified as a risk factor for systemic and large local reactions during VIT in children.
https://ift.tt/2JhtyVC
Late presentation of subtotal C6 deficiency in a patient with recurrent Neisseria meningitides infections
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Lana Rosenfield, Anna Cvetkovic, Kevin Woodward, Jaclyn Quirt
https://ift.tt/2q3prUB
Antigen 5–spiked Vespula and Polistes venom extracts for Vespid allergy diagnostics: A French multicenter study
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 4
Author(s): Claude Lambert, Joëlle Birnbaum, Charles Dzviga, Nicolas Hutt, Pol-André Apoil, Françoise Bienvenu, Martine Drouet, Céline Beauvillain, Séverine Brabant, Laurence Guilloux, Delphine Mariotte, François Lavaud, Pascale Nicaise-Roland, Thierry Tabary, Anne Sarrat, Joana Vitte
https://ift.tt/2JdVOsg
Extracellular vesicles and their immunomodulatory functions in pregnancy
Abstract
Extracellular vesicles (EVs) are membrane-bound vesicles released into the extracellular space by almost all types of cells. EVs can cross the physiological barriers, and a variety of biological fluids are enriched in them. EVs are a heterogeneous population of vesicles, including exosomes, microvesicles, and apoptotic bodies. The different subpopulations of vesicles can be differentiated by size and origin, in which exosomes (~100 nm and from endocytic origin) are the most studied so far. EVs have essential roles in cell-to-cell communication and are critical modulators of immune response under normal and pathological conditions. Pregnancy is a unique situation of immune-modulation in which the maternal immune system protects the fetus from allogenic rejection and maintains the immunosurveillance. The placenta is a vital organ that performs a multitude of functions to support the pregnancy. The EVs derived from the human placenta have crucial roles in regulating the maternal immune response for successful pregnancy outcome. Placenta-derived vesicles perform a myriad of functions like suppression of immune reaction to the developing fetus and establishment and maintenance of a systemic inflammatory response to combat infectious intruders. A fine-tuning of these mechanisms is quintessential for successful completion of pregnancy and healthy outcome for mother and fetus. Dysregulation in the mechanisms mentioned above can lead to several pregnancy disorders. In this review, we summarize the current literature regarding the critical roles played by the EVs in immunomodulation during pregnancy with particular attention to the placenta-derived exosomes.
https://ift.tt/2GNc3OJ
The role of extracellular vesicles when innate meets adaptive
Abstract
Innate immune cells are recognized for their rapid and critical contribution to the body's first line of defense against invading pathogens and harmful agents. These actions can be further amplified by specific adaptive immune responses adapted to the activating stimulus. Recently, the awareness has grown that virtually all innate immune cells, i.e., mast cells, neutrophils, macrophages, eosinophils, basophils, and NK cells, are able to communicate with dendritic cells (DCs) and/or T and B cells, and thereby significantly contribute to the orchestration of adaptive immune responses. The means of communication that are thus far primarily associated with this function are cell-cell contacts and the release of a broad range of soluble mediators. Moreover, the possible contribution of innate immune cell-derived extracellular vesicles (EVs) to the modulation of adaptive immunity will be outlined in this review. EVs are submicron particles composed of a lipid bilayer, proteins, and nucleic acids released by cells in a regulated fashion. EVs are involved in intercellular communication between multiple cell types, including those of the immune system. A good understanding of the mechanisms by which innate immune cell-derived EVs influence adaptive immune responses, or vice versa, may reveal novel insights in the regulation of the immune system and can open up new possibilities for EVs (or their components) in controlling immune responses, either as a therapy, target, or as an adjuvant in future immune modulating treatments.
https://ift.tt/2Iq9mjk
A historical perspective on the role of sensory nerves in neurogenic inflammation
Abstract
The term 'neurogenic inflammation' is commonly used, especially with respect to the role of sensory nerves within inflammatory disease. However, despite over a century of research, we remain unclear about the role of these nerves in the vascular biology of inflammation, as compared with their interacting role in pain processing and of their potential for therapeutic manipulation. This chapter attempts to discuss the progress in understanding, from the initial discovery of sensory nerves until the present day. This covers pioneering findings that these nerves exist, are involved in vascular events and act as important sensors of environmental changes, including injury and infection. This is followed by discovery of the contents they release such as the established vasoactive neuropeptides substance P and CGRP as well as anti-inflammatory peptides such as the opioids and somatostatin. The more recent emergence of the importance of the transient receptor potential (TRP) channels has revealed some of the mechanisms by which these nerves sense environmental stimuli. This knowledge enables a platform from which to learn of the potential role of neurogenic inflammation in disease and in turn of novel therapeutic targets.
https://ift.tt/2H7NUjA
16p11.2 microdeletion syndrome: a case report
The recurrent ∼ 600 kb 16p11.2 microdeletion is among the most commonly known genetic etiologies of autism spectrum disorder, overweightness, and related neurodevelopmental disorders.
https://ift.tt/2Ip8rQ2
Immediate type hypersensitivity and late phase reaction occurred consecutively in a patient receiving ethambutol and levofloxacin
We experienced a rare case of immediate type hypersensitivity and late phase reaction to anti-tubercular therapy consisting of ethambutol and levofloxacin, which occurred in close succession, giving the appear...
https://ift.tt/2GzqVN5
Urodynamics and Clinical Factors That Are Associated With Bladder Over-sensitivity
Conditions: Overactive Bladder Syndrome; Bladder Outlet Obstruction; Benign Prostate Enlargement; Stress Incontinence (Female) (Male); Bladder Disease
Intervention: Other: IPSS questionnaire
Sponsor: Assaf-Harofeh Medical Center
Recruiting
https://ift.tt/2q1E0YM
Intervention: Other: IPSS questionnaire
Sponsor: Assaf-Harofeh Medical Center
Recruiting
https://ift.tt/2q1E0YM
Novel Pharmacological Nonopioid Therapies in Chronic Pain
Abstract
Purpose of Review
Opioid use and abuse has led to a worldwide opioid epidemic. And while opioids are clinically useful when appropriately indicated, they are associated with a wide range of dangerous side effects and whether they are effective at treating or eliminating chronic pain is controversial. There has long been a need for the development of nonopioid alternative treatments for patients that live in pain, and until recently, only a few effective treatments were available. Today, there are a wide range of nonopioid treatments available including NSAIDs, acetaminophen, corticosteroids, nerve blocks, SSRIs, neurostimulators, and anticonvulsants. However, these treatments are still not entirely effective at treating pain, which has sparked a new exploration of novel nonopioid pharmacotherapies.
Recent Findings
This manuscript will outline the most recent trends in novel nonopioid pharmacotherapy development including tramadol/dexketoprofen, TrkA inhibitors, tapentadol, opioid agonists, Nektar 181, TRV 130, ßarrestin2, bisphosphonates, antibodies, sodium channel blockers, NMDA antagonists, TRP receptors, transdermal vitamin D, AAK1 kinase inhibition, calcitonin gene-related peptide (CGRP), TRPV4 antagonists, cholecystokinin, delta opioid receptor, neurokinin, and gene therapy.
Summary
The pharmacotherapies discussed in this manuscript outline promising opioid alternatives which can change the future of chronic pain treatment.
https://ift.tt/2GUcXc2
Tyrosine kinase inhibitor induced rapidly progressive vasculopathy after intracranial stent placement
Tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia (CML) has been associated with progressive peripheral arterial disease and, more recently, rare cases of intracranial vascular stenosis have been reported. We report the fourth case of TKI treatment associated intracranial vasculopathy and rapid progression of intracranial vascular stenosis following intracranial stent placement. This was a 49-year-old woman who developed right-sided weakness, paresthesias, numbness, and speech difficulties 7 years following TKI treatment for CML. Cerebral catheter angiography demonstrated 90% stenosis of the left supraclinoid internal carotid artery, for which the patient underwent intracranial stent placement with no residual stenosis and improved distal blood flow. Approximately 1 month following the procedure, the patient returned with similar symptoms. Catheter angiography demonstrated 70% and 50% stenosis just distal and proximal to the stent construct, respectively. Rapid disease progression and non-atherosclerotic vasculopathy may argue against endovascular therapy.
https://ift.tt/2uI2rQv
Dilemmas in Current Management of Complicated Chronic Otitis Media
Abstract
To evaluate the distribution of complications of chronic otitis media, dilemma of how soon to operate a seriously ill patient with CSOM and treatment outcomes. A retrospective study was done in a tertiary care centre. Clinical data from 2013 to 2015 was compiled, surgical management with outcome was analysed. A total of 425 patients with chronic otitis media were evaluated. Single/multiple complications were seen in 147 (34.5%) patients. Majority of the complications were seen in active squamosal type of chronic otitis media i.e. 137 (59.5%) cases out of the 147. Meningitis (3.3%) was the most common intracranial complication. Patients with intracranial complications were referred from other departments and did not primarily present to ENT, indicating a major fact that treatment was sort for the complication and not for chronic otitis media. Headache with or without ear discharge was the most common presenting complaint. Fever and pain were not prominent indicators of complications, posing a diagnostic dilemma as patients were already receiving antibiotics and analgesics before reaching tertiary care centre. The patients with severe intracranial complications were promptly taken up (within 3–5 days) for canal wall down mastoidectomy with intravenous broad spectrum antibiotic (vancomycin) and mannitol with high risk consent. However ill the patients were, especially children with very poor general conditions, there was dramatic recovery as soon as the mastoidectomy was done. There were no deaths due to the complications of chronic otitis media in our 3 years study period. Delay in resorting to surgical management of chronic otitis media was the main reason for patients going into complications. Timely mastoidectomy in patients with poor general condition with high risk of mortality, the surgery actually had a major role in reducing the morbidity and mortality. Lack of awareness that chronic otitis media is a condition that can lead to life threatening complications resulted in procrastination of surgery. Chronic otitis media requires speedy surgical management i.e. as soon as patient is fit to tolerate anaesthesia: Tympanoplasty and Canal wall up or down Mastoidectomy to prevent complications from arising or to resolve the present complication.
https://ift.tt/2Gtce2i
Appendiceal intussusception in the setting of ulcerative colitis
Abstract
Appendiceal intussusception is a very rare condition with an estimated incidence of 0.01%. Most cases present in adults with chronic waxing and waning of symptoms over a period of weeks to months. We report a case of a 39-year-old Caucasian female with a 5-week history of worsening right-sided abdominal pain. Computed tomography revealed cecal thickening without visualization of the appendix. A colonoscopy revealed mild diffuse erythema and edema in the ascending colon as well as a mass within the lumen of the cecum. Biopsies of the colon were suggestive of mild ulcerative colitis (UC). The patient's symptoms continued and laparoscopic assisted ileocecectomy was performed revealing an inverted appendix protruding into the cecal lumen. The patient was discharged without any complications and began mesalamine therapy for her UC.https://ift.tt/2Ip1632
Calcific tendonitis of the quadriceps tendon
Abstract
A 61-year-old woman presented with chronic anterior pain and stiffness in the distal left thigh. Examination revealed swelling and tenderness immediately proximal to the patella. Radiographs showed opacities in the distal anterior thigh whilst MRI identified enlargement of the distal quadriceps tendon with splayed fibres separated by solid conglomerates. Dystrophic calcification of the quadriceps tendon was diagnosed. Blood tests revealed no systemic abnormalities in calcium handling. Arthroscopy of the left knee identified calcific deposits in the supra-patella pouch with surrounding synovitis. An open debridement of the tendon was performed; biopsy of the excised tendon showed chronic tenosynovitis with dystrophic calcification without evidence of malignancy. Post-operatively her knee was braced in extension enabling progressive flexion over 4 weeks. Anterior knee pain diminished post-operatively and 10 months following surgery the patient was pain free, able to walk normally and scored 99/100 on the Fulkerson modification of the Lysholm score.https://ift.tt/2H32I2N
Pulmonary paraganglioma in a 10-year-old: a case report and review of the literature
Abstract
Paraganglioma is a rare extra-adrenal tumor of the paraganglia often found in association with sympathetic and parasympathetic nerves. The case presented is of a 10-year-old boy with hemoptysis who was found to have an obstructive bronchial mass. He underwent surgical resection and biopsy confirmed primary pulmonary paraganglioma. He was subsequently found to have an associated genetic syndrome. This is the first case report describing a primary pulmonary paraganglioma in a child.https://ift.tt/2EftKRM
Optimizing the use of topical retinoids in Asian acne patients
The Journal of Dermatology, EarlyView.
https://ift.tt/2JgxvK7
Subcutaneous venom immunotherapy in children
Venom immunotherapy (VIT) is safe in children, although adverse effects can occur.
https://ift.tt/2GurQTg
Do we need to keep playing this tune?
Seghezzo and colleagues1 add to the many other studies that report that 2 doses of dexamethasone and 5 to 7 days of prednisone or prednisolone therapy are associated with no detected difference in relapse or readmission. The implication of that study is that 2 doses of 0.6 mg/kg of dexamethasone (equivalent to 3 mg/kg of prednisolone from standard corticosteroid equivalency tables) matches the efficacy of 5 to 7 days of 1 or 2 mg/kg of prednisone or prednisolone. However, the absence of a placebo in this and other studies cannot distinguish equal efficacy from equal inefficacy.
https://ift.tt/2pZkgEQ
Antigen 5–spiked Vespula and Polistes venom extracts for Vespid allergy diagnostics: A French multicenter study
Vespula and Polistes spp venom extracts (VEs) for ImmunoCAP (Thermo Fisher Scientific, Uppsala, Sweden) platforms have been spiked, that is, enriched, with group 5 allergens since 2012. Limited information was available from the manufacturer, but small cohorts have reported altered performance for in vitro diagnostics.1,2 Herein we present the results of a French multicenter study on antigen 5–spiked Vespula and Polistes VEs compared with nonspiked VEs.
https://ift.tt/2GurLyW
Changes in emergency department concordance with guidelines for the management of stinging insect-induced anaphylaxis
Changes in emergency department (ED) concordance with guidelines for the management of stinging insect-induced anaphylaxis (SIIA) are not known.
https://ift.tt/2q2n7gx
Biologics
A new Annals feature in 2018, "From the pages of AllergyWatch" is devoted to publishing synopses of Allergy and Asthma literature relevant to a topic of emphasis. These unbiased synopses and comments by our Editors have been previously printed in the AllergyWatch bimonthly newsletter, and it is our hope that presenting carefully selected article summaries and comments in the Annals will serve as a valuable educational resource for practicing allergists.
https://ift.tt/2q2iy5E
Anaphylaxis and severe immune hemolytic anemia during the course of desensitization with carboplatin
Platinum salts are one of the most frequent cytostatic agents involved in drug hypersensitivity.1 Drug desensitization may enable continuation of therapy for disease control.2 The approach consists of giving incremental doses of the drug by the intravenous route until the therapeutic dose is reached. A transitory desensitization is induced, although release of mast-cell mediators may still occur and require the administration of antihistamines and other drugs.3
https://ift.tt/2q2mQdv
Choosing wisely in the era of biologics for asthma
In the era of biologics for asthma, clinicians, researchers, and guideline developers face an increasingly important challenge. In addition to critically appraising the evidence for efficacy of novel therapies for specific asthma phenotypes, we must consider the real-life cost and effectiveness of increasingly personalized medicine. Put simply, we must consider health economics and prescribe wisely.
https://ift.tt/2Gvbfi0
Selective IgM deficiency associated with adult-onset Still disease
Selective immunoglobulin M (IgM) deficiency is a rare immunodeficiency disorder characterized by decreased serum levels of IgM. Those with IgM deficiency may present with recurrent infections and have an increased predisposition to allergic and autoimmune diseases.1 Adult-onset Still disease (AOSD) is a rare autoinflammatory disease characterized by high-spiking fevers, evanescent salmon-colored rash, and multiorgan involvement. It is a diagnosis based on clinical criteria and age of onset.2 A case of selective IgM deficiency associated with AOSD has not been reported previously.
https://ift.tt/2q2mH9X
Outpatient penicillin skin testing has greater value in targeted patient populations
β-Lactam allergy is a major component of antimicrobial stewardship today due to its reported associations with increased healthcare costs, drug toxicity, infections with drug-resistant bacteria, and use of less-preferred antibiotic therapies.1,2 It remains the most common reported medication allergy in the United States, with an estimated prevalence of 10%.1 The US Centers for Disease Control and Prevention and the Infectious Disease Society of America, among other institutions, recommend the performance of penicillin skin testing (PST) as part of antimicrobial stewardship.
https://ift.tt/2JcDKyV
Food allergy management and anaphylaxis preparedness in a suburban school district varies by school level
Food allergy (FA) affects up to 8% of school-age children,1 and management of FA in schools has become a major public health issue. Although there are few proven strategies for improving FA safety in schools, consensus guidelines recommend that all students at risk for anaphylaxis due to FA have an individualized emergency action plan (EAP), as well as an epinephrine auto-injector (EAI) available at all times.2,3 Few studies have evaluated the percentage of children with FA with an EAP and an EAI available at school and, to our knowledge, none have evaluated for differences between school levels.
https://ift.tt/2q1tAYR
Common variable immunodeficiency associated with stiff-person syndrome
Common variable immunodeficiency (CVID) is a primary immunodeficiency.1,2 The autoimmune diseases associated with CVID commonly affect the hematologic, dermatologic, and gastrointestinal systems.3–6 Neurologic autoimmune disorders associated with CVID are seen infrequently.7 We describe the first case of CVID associated with stiff-person syndrome (SPS), a neurologic autoimmune disorder. SPS is an extremely rare autoimmune neuromuscular disorder with a prevalence of 1–2 per million and an incidence of 1 case per million per year.
https://ift.tt/2GsAv8O
Challenges in the treatment of asthma in children and adolescents
Despite the availability of effective treatments, asthma control in children and adolescents remains inadequate and rates of health care use are high. This follow-up to a recent review (O'Byrne et al, Eur Respir J. 2017;50[3]) examines a number of challenges in current pediatric asthma management compared with that of an adult perspective and discusses possible alternative strategies that might improve pediatric asthma management and control.
https://ift.tt/2q1tqRf
Skin testing and desensitization outcomes among platinum-sensitive oncology patients
Platinum-based, immediate hypersensitivity reactions (HSRs) are relatively common, with incidences ranging from 6.5% to 44% for carboplatin and from 10% to 19% for oxaliplatin.1 Platinum hypersensitivity potentially leads to patient anxiety, delayed chemotherapy administration, or switches to less-preferred regimens. Platinum skin tests (STs) confirm immediate-type reactions in upward of 66%–98% of patients.2–5 False-negative results may occur if ST is performed shortly after a platinum-based HSR.
https://ift.tt/2JfJW9p
Is there a link between nasal polyposis and increased risk for sinonasal malignancy?
Sinonasal polyposis is a condition that can be present in both allergic and nonallergic clinical settings. The specific relationship between sinonasal polyps and sinonasal malignancies has not been well described. With regard to allergic etiologies, there is some suggestion that those individuals with atopy in general may be at higher risk of lymphoma.1,2 One population-based study demonstrated an association with allergic rhinitis and nasopharyngeal carcinoma.3 Another study evaluated 22 patients with newly diagnosed nasopharyngeal carcinoma, 4.5% of whom had allergic rhinitis.
https://ift.tt/2q1l9gl
Late presentation of subtotal C6 deficiency in a patient with recurrent Neisseria meningitides infections
The complement system is important in fighting meningococcal disease. Recurrent meningococcal infections are a significant feature of terminal complement deficiency.1 The terminal complement system produces a membrane attack complex (MAC), which creates pores in bacteria, leading to lysis of microorganisms. Most invasive meningococcal infections are caused by Neisseria serotypes A, B, C, W-135, and Y, all of which are targeted with commercially available vaccines. Infections with less common serotypes are seen in patients with terminal complement deficiencies.
https://ift.tt/2JfJLef
Recognition of early melanoma: a monocentric dermoscopy follow‐up study comparing de novo melanoma with nevus‐associated melanoma
International Journal of Dermatology, EarlyView.
https://ift.tt/2uKQglU
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