CBNAAT: A Boon for Early Diagnosis of Tuberculosis-Head and Neck

Abstract

Tuberculosis of head and neck has been an under diagnosed entity due to large number of smear negative cases, which results in missing out the positive cases, further increasing the burden of TB. The role of cartridge- based nucleic acid amplification test (CBNAAT) with a potential to diagnose TB and rifampicin resistance within 2 h is promising. The study highlights the extended implications of CBNAAT in infectious lesions of head and neck, where the pus or aspirate was subjected to this test, along with other investigations which have been routinely used for detection of extra pulmonary tuberculosis. Twelve patients with infective lesions of head and neck were included in this prospective study, conducted in Department of Otorhinolaryngology, Netaji Subhash Chandra Bose Medical College and hospital, Jabalpur from September 2016 to March 2017. They were investigated for pulmonary and extra pulmonary TB. CBNAAT, microscopy, FNAC and HPR from the site of lesion were done. Nine out of twelve patients were diagnosed positive for Tuberculosis. Microscopy (ZN staining) could detect only two such cases, whereas FNAC showed granulomatous lesion in 3 cases (33.3%). CBNAAT was positive in 77.7% of the total positive cases. Histopathological examination showed 100% results but was feasible only in selected number of cases (4 in this study). CBNAAT provides a promising role in early diagnosis of TB in head and neck. Its high sensitivity and less time taking procedure makes it an excellent tool for timely diagnosis of such cases.

https://ift.tt/2JPRNL6

Thyroid Dysfunction Following Management of Non-thyroid Head and Neck Cancers

Abstract

Head and neck cancers are one of the commonest malignancies in India. Majority of cases of head and neck malignancy undergo chemoradiation with or without surgery. Thyroid bears the brunt in terms of either excision or the gland tends to get irradiated and fibrosed. In either scenario the functionality of gland is lost leading to hypothyroidism and other clinical manifestations. It tends to get subclinical and goes unnoticed. To identify the occurrence of clinical and subclinical hypothyroidism among head and neck cancer patients receiving radiation to the neck and to justify routine use of thyroid function tests during follow up. It was a prospective non randomized control study of 100 patients of head and neck cancer receiving radiotherapy for duration of 1 year. Thyroid stimulating hormone and T3 and T4 estimations were done at baseline and at 3 and 9 months following radiotherapy. Out of 100 patients, 72 (72%) were males and 28 (28%) were females. All the patients received radiation to the neck to a dose of > 30 Gy. 35 patients received concurrent chemotherapy. 11 patients were found to have subclinical hypothyroidism while 32 patients developed significant clinical hypothyroidism (P value of 0.001). Thus a total of 43 patients developed radiation induced hypothyroidism. 20 of the 32 patients who developed clinical hypothyroidism were in the age group of 41–50 years. 11 of 32 patients who developed clinical hypothyroidism received chemoradiation while rest 21 received radiotherapy alone. Mean period for developing radiation induced hypothyroidism was 4.5 months. Hypothyrodism (clinical or subclinical) is an under recognised morbidity of external radiation to the neck which is seen following a minimum dose of 30 Gy to the neck. Recognising hypothyroidism (clinical or subclinical) early and treating it prevents thyroid dysfunction related complications. Hence, thyroid function tests should be made routine during follow up in all patients undergoing radiotherapy.

https://ift.tt/2EMHX8Y

The Reliability of Polyvinylidene Fluoride Sensor for Intra- and Intersession Measurements

Abstract

A new nasal sensor has been designed using Polyvinylidene fluoride (PVDF) film using its piezoelectric property to measure nasal patency. The aim of this study is to determine the intra- and intersession reliability of the new PVDF nasal sensor measurement of unilateral and combined nasal parameters in a group of healthy subjects. Two identical nasal sensors: for right nostril (RN) and left nostril (LN) were designed using piezoelectric natured PVDF films. Twenty subjects were studied. To evaluate the repeatability, total three sets of PVDF sensor measurements were recorded, two sets were taken 5 min apart during same session without repositioning the PVDF nasal sensors and two more sets were taken during 1 h apart successively, by repositioning the PVDF nasal sensor. Intraclass correlation coefficients (ICC) of PVDF sensor measurements for intra- and intersession showed a high and greater repeatability over time for all the combined (mean) and unilateral (RN and LN) values. In both healthy and patients, ICC values for both intra- and intersession measurements were ≥ 0.80 confirming strong reliability and also almost all of the coefficients of variation for the same parameters were low (below 10%). PVDF sensor measurements showed good intra- and intersession repeatability and can be recommended for the objective monitoring of nasal patency during diagnosis and follow-up of conditions.

https://ift.tt/2JNzztz

A Study on Neck Nodes in Oral Cancers, with Special Reference to Skip Metastasis

Abstract

To analyse the distribution of Neck metastases (NM) and to study frequency of skip metastases in oral squamous cell carcinoma (SCC) of oral cavity. From September 2012 to April 2013, 30 previously untreated patients with SCC of oral cavity underwent primary surgical treatment in our institution. From pathological report of Neck dissection specimen prevalence and distribution of NM were ascertained. All patients were classified according to American Joint Committee on Cancer 2005 TNM classification. Overall frequency of NM was 36.7%. Frequency of occult metastases was 33.3%. N+ metastases found in 37% cases. The overall frequency of NM in level IV and V was 9.5%. Isolated level III involvement was found in 3.3%. No isolated level IV and V involvement was found. Skip metastases to level III LN was 6.7%. We did not find any skip metastases to level IV in our study. Neck nodes at greater risk for metastases were level I and II (50 and 28.6%). Level III (11.9%), IV (7.14%), V (2.38%). The risk of skip metastases to level IV was nil in our study.

https://ift.tt/2viqQMz

Effect of photobiomodulation therapy on postoperative pain after endodontic treatment: a randomized, controlled, clinical study

Abstract

Objective

The aim of this prospective, randomized, clinical study was to assess the effect of photobiomodulation therapy (PBM) with low-level laser irradiation (LLLI) on postoperative pain after endodontic treatment.

Materials and methods

Sixty patients, diagnosed with irreversible pulpitis in lower molar teeth, participated in the study. All treatments were performed by a single operator. Participants were randomly divided into two groups: in the experimental group (EG), endodontic treatment was performed with a reciprocating system, immediately followed by PBM with LLLI; and only endodontic treatment was performed in the control group (CG). Postoperative pain was assessed by a second examiner, who was blinded, using two scales: verbal rating scale (VRS) and numerical rating scale (NRS). Assessment was carried out at 6, 12, and 24 h after treatment. Data were analyzed using chi-squared, Fisher's exact, Mann-Whitney tests, ordinal, and non-parametric regression analyses.

Results

For the prevalence of pain, the difference between the groups was significant for the evaluations performed after 6 h (p = 0.04) and 24 h (p = 0.02). The difference after 24 h remained significant after stratification by sex and extrusion of filling material. Increased pain intensity was associated with extrusion of root canal filling material to the periapical region in the two scales used.

Conclusion

The effect of PBM therapy after endodontic treatment showed a significant decreasein prevalence of postoperative pain.

Clinical relevance

The PBM reduces the prevalence of postoperative pain and may benefit patients who need endodontic treatment.

https://ift.tt/2JPg6Zl

Nine prophylactic polishing pastes: impact on discoloration, gloss, and surface properties of a CAD/CAM resin composite

Abstract

Objectives

To investigate discoloration reduction and changes of surface properties of a CAD/CAM resin composite after 14 days´ storage in red wine and polishing with nine different prophylactic polishing pastes (PPPs).

Materials and methods

Rectangular discs (N = 172) were fabricated and polished (P4000) using GC Cerasmart (GC Europe) to investigate different polishing protocols with 1–4 related descending PPPs (22 in total): Cleanic/CLE-Kerr, CleanJoy/CLJ-Voco, Clean Polish/Super Polish/SPO-Kerr, Clinpro Prophy Paste/CPP-3M, Détartrine/DET-Septodont, Nupro/NUP-Dentsply Sirona, Prophy Paste CCS/CCS-Directa, Proxyt/PXT-Ivoclar Vivadent, and Zircate/ZIR Prophy Paste-Dentsply Sirona. Surface properties (roughness values (RV)/Ra, Rz, Rv, surface free energy (SFE), surface gloss (G), and discoloration (ΔE)) were analyzed before and after storage and additional polishing. Data were examined using Kolmogorov-Smirnov test, three-way ANOVA followed by Tukey-B post hoc, Mann-Whitney U, and Kruskal-Wallis H tests (α < 0.05).

Results

Regarding RV, CLE, followed by CCS, and CPP showed the highest values; the lowest presented SPO and DET (p < 0.001). No impact of PPP was observed on ΔE values (p = 0.160). The lowest SFE presented DET, followed by SPO; highest showed CCS followed by NUP and CPP (p < 0.001). Within G, lowest values were observed for CLE and NUP, followed by CCS, ZIP, and CLJ (p < 0.001); the highest presented SPO (p < 0.001). Polishing showed generally a positive impact on SFE values (p < 0.001–p = 0.007), except ZIP (p = 0.322) and CLE (p = 0.083). G increased and RV decreased after polishing (p < 0.001), except SPO, with no significant change for G (p = 0.786).

Conclusions

Polishing with PPPs improves the surface properties and is generally recommended. The choice of PPP has a minor role in removing discolorations. Multi-step systems should be carried out conscientiously.

Clinical relevance

The proper selection of PPP is essential for the clinical outcome of surface properties of prosthetic restorations. Not every polishing paste leads to the same final surface quality.

https://ift.tt/2EPhsj9

CBNAAT: A Boon for Early Diagnosis of Tuberculosis-Head and Neck

Abstract

Tuberculosis of head and neck has been an under diagnosed entity due to large number of smear negative cases, which results in missing out the positive cases, further increasing the burden of TB. The role of cartridge- based nucleic acid amplification test (CBNAAT) with a potential to diagnose TB and rifampicin resistance within 2 h is promising. The study highlights the extended implications of CBNAAT in infectious lesions of head and neck, where the pus or aspirate was subjected to this test, along with other investigations which have been routinely used for detection of extra pulmonary tuberculosis. Twelve patients with infective lesions of head and neck were included in this prospective study, conducted in Department of Otorhinolaryngology, Netaji Subhash Chandra Bose Medical College and hospital, Jabalpur from September 2016 to March 2017. They were investigated for pulmonary and extra pulmonary TB. CBNAAT, microscopy, FNAC and HPR from the site of lesion were done. Nine out of twelve patients were diagnosed positive for Tuberculosis. Microscopy (ZN staining) could detect only two such cases, whereas FNAC showed granulomatous lesion in 3 cases (33.3%). CBNAAT was positive in 77.7% of the total positive cases. Histopathological examination showed 100% results but was feasible only in selected number of cases (4 in this study). CBNAAT provides a promising role in early diagnosis of TB in head and neck. Its high sensitivity and less time taking procedure makes it an excellent tool for timely diagnosis of such cases.

https://ift.tt/2JPRNL6

Thyroid Dysfunction Following Management of Non-thyroid Head and Neck Cancers

Abstract

Head and neck cancers are one of the commonest malignancies in India. Majority of cases of head and neck malignancy undergo chemoradiation with or without surgery. Thyroid bears the brunt in terms of either excision or the gland tends to get irradiated and fibrosed. In either scenario the functionality of gland is lost leading to hypothyroidism and other clinical manifestations. It tends to get subclinical and goes unnoticed. To identify the occurrence of clinical and subclinical hypothyroidism among head and neck cancer patients receiving radiation to the neck and to justify routine use of thyroid function tests during follow up. It was a prospective non randomized control study of 100 patients of head and neck cancer receiving radiotherapy for duration of 1 year. Thyroid stimulating hormone and T3 and T4 estimations were done at baseline and at 3 and 9 months following radiotherapy. Out of 100 patients, 72 (72%) were males and 28 (28%) were females. All the patients received radiation to the neck to a dose of > 30 Gy. 35 patients received concurrent chemotherapy. 11 patients were found to have subclinical hypothyroidism while 32 patients developed significant clinical hypothyroidism (P value of 0.001). Thus a total of 43 patients developed radiation induced hypothyroidism. 20 of the 32 patients who developed clinical hypothyroidism were in the age group of 41–50 years. 11 of 32 patients who developed clinical hypothyroidism received chemoradiation while rest 21 received radiotherapy alone. Mean period for developing radiation induced hypothyroidism was 4.5 months. Hypothyrodism (clinical or subclinical) is an under recognised morbidity of external radiation to the neck which is seen following a minimum dose of 30 Gy to the neck. Recognising hypothyroidism (clinical or subclinical) early and treating it prevents thyroid dysfunction related complications. Hence, thyroid function tests should be made routine during follow up in all patients undergoing radiotherapy.

https://ift.tt/2EMHX8Y

The Reliability of Polyvinylidene Fluoride Sensor for Intra- and Intersession Measurements

Abstract

A new nasal sensor has been designed using Polyvinylidene fluoride (PVDF) film using its piezoelectric property to measure nasal patency. The aim of this study is to determine the intra- and intersession reliability of the new PVDF nasal sensor measurement of unilateral and combined nasal parameters in a group of healthy subjects. Two identical nasal sensors: for right nostril (RN) and left nostril (LN) were designed using piezoelectric natured PVDF films. Twenty subjects were studied. To evaluate the repeatability, total three sets of PVDF sensor measurements were recorded, two sets were taken 5 min apart during same session without repositioning the PVDF nasal sensors and two more sets were taken during 1 h apart successively, by repositioning the PVDF nasal sensor. Intraclass correlation coefficients (ICC) of PVDF sensor measurements for intra- and intersession showed a high and greater repeatability over time for all the combined (mean) and unilateral (RN and LN) values. In both healthy and patients, ICC values for both intra- and intersession measurements were ≥ 0.80 confirming strong reliability and also almost all of the coefficients of variation for the same parameters were low (below 10%). PVDF sensor measurements showed good intra- and intersession repeatability and can be recommended for the objective monitoring of nasal patency during diagnosis and follow-up of conditions.

https://ift.tt/2JNzztz

A Study on Neck Nodes in Oral Cancers, with Special Reference to Skip Metastasis

Abstract

To analyse the distribution of Neck metastases (NM) and to study frequency of skip metastases in oral squamous cell carcinoma (SCC) of oral cavity. From September 2012 to April 2013, 30 previously untreated patients with SCC of oral cavity underwent primary surgical treatment in our institution. From pathological report of Neck dissection specimen prevalence and distribution of NM were ascertained. All patients were classified according to American Joint Committee on Cancer 2005 TNM classification. Overall frequency of NM was 36.7%. Frequency of occult metastases was 33.3%. N+ metastases found in 37% cases. The overall frequency of NM in level IV and V was 9.5%. Isolated level III involvement was found in 3.3%. No isolated level IV and V involvement was found. Skip metastases to level III LN was 6.7%. We did not find any skip metastases to level IV in our study. Neck nodes at greater risk for metastases were level I and II (50 and 28.6%). Level III (11.9%), IV (7.14%), V (2.38%). The risk of skip metastases to level IV was nil in our study.

https://ift.tt/2viqQMz

Role of intralesional bleomycin and intralesional triamcinolone therapy in residual haemangioma following propranolol

Publication date: Available online 14 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): V. Pandey, P. Tiwari, S.P. Sharma, R. Kumar, O.P. Singh
With the emergence of propranolol as the first choice of treatment for problematic infantile haemangioma at many centres, the number of patients with a partial or non-response to propranolol has also been growing. This study investigated the role of intralesional bleomycin and triamcinolone in patients with residual disease following propranolol therapy for infantile haemangioma. Sixty-seven patients with residual haemangioma were assigned randomly to receive either intralesional bleomycin (group A, n=36) or intralesional triamcinolone (group B, n=31). The response to treatment and adverse effects were assessed in both groups. All patients received at least four doses and a maximum of six doses of the assigned drug. In group A (mean follow-up 9.38months), 47.2% had an excellent response and 44.4% a good response. In group B (mean follow-up 7.42months), 25.8% had an excellent response and 48.4% a good response. There was no difference in overall response between the groups (P=0.074). Among patients who were initially non-responders to propranolol, bleomycin showed a better response than triamcinolone (P=0.037). This may be due to an overlap in the mechanism of action of propranolol and triamcinolone. Thus, intralesional bleomycin should be preferred in patients with no initial response to propranolol therapy, while bleomycin or triamcinolone can be used in patients with a partial response to propranolol therapy, as they have equal efficacy.



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Spontaneous posterior rectus sheath hernia: a case report

Hernias of the posterior rectus sheath are very rare abdominal wall hernias with only a handful of cases reported in the literature to date. As an uncommon disease, it is important to recognize and report this...

https://ift.tt/2qzKluK

A Novel Technique of Ultrasound-Guided Selective Mandibular Nerve Block With a Lateral Pterygoid Plate Approach: A Cadaveric Study

Background and Objectives We aimed to describe a novel technique of ultrasound-guided selective mandibular nerve block with a lateral pterygoid plate (LPP) approach and to assess its feasibility and accuracy in a soft cadaver model. Methods Ten soft cadavers were studied. A curved array ultrasound transducer was applied over 1 side of the face of the cadaver, in an open-mouth position. The transducer was placed transversely below the zygomatic arch and tilted in the caudal-to-cranial direction to identify the boundary of the LPP. The needle was inserted in-plane, in an anterior-to-posterior direction, into the posterior border of the uppermost part of the LPP, and 3 mL of methylene blue was injected. Results Mandibular nerve block was successfully performed in all 10 cadavers using an LPP approach under ultrasound guidance. The mandibular nerve and its branches were seen to be stained with methylene blue in all cadaveric specimens. No accidental injection into the facial nerve or maxillary artery was observed. Conclusions This cadaveric study suggests that this novel technique, using an LPP approach under ultrasound guidance, is helpful for selective mandibular nerve block, with high accuracy and feasibility. Further studies are required to establish its safety and efficacy for clinical application. Clinical Trial Registration This study was registered at the Thai Clinical Trials Registry (ClinicalTrials.in.th), identifier TCTR20160601004. Accepted for publication November 20, 2017. Address correspondence to: Wirinaree Kampitak, MD, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, 1873, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand (e-mail: nutong127@yahoo.com). No external funding was received. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

https://ift.tt/2HF7DHK

The Impact of Spinal Needle Selection on Postdural Puncture Headache: A Meta-Analysis and Metaregression of Randomized Studies

Background and Objectives Potentially broadened indications for spinal anesthesia require increased understanding of the risk factors and prevention measures associated with postdural puncture headache (PDPH). This review is designed to examine the association between spinal needle characteristics and incidence of PDPH. Methods Meta-analysis and metaregression was performed on randomized controlled trials to determine the effect of needle design and gauge on the incidence of PDPH after controlling for patient confounders such as age, sex, and year of publication. Results Fifty-seven randomized controlled trials (n = 16416) were included in our analysis, of which 32 compared pencil-point design with cutting-needle design and 25 compared individual gauges of similar design. Pencil-point design was associated with a statistically significant reduction in incidence of PDPH (risk ratio, 0.41; 95% confidence interval, 0.31–0.54; P

https://ift.tt/2GZpdVG

Selective Suprascapular and Axillary Nerve Block Versus Interscalene Plexus Block for Pain Control After Arthroscopic Shoulder Surgery: A Noninferiority Randomized Parallel-Controlled Clinical Trial

Background and Objectives This randomized trial aimed to assess if a combined suprascapular-axillary nerve block (SSB) is noninferior (margin = 1.3 on a 0- to 10-point scale) to interscalene block (ISB) in treating pain after arthroscopic shoulder surgery. Secondary end points included opioid consumption, dyspnea, discomfort associated with muscle weakness, and patient satisfaction. Methods One hundred patients undergoing arthroscopic shoulder surgery were randomized to receive ultrasound-guided ISB (n = 50) or SSB (n = 50). Pain intensity at rest, dyspnea, and discomfort were recorded upon arrival in the recovery room, discharge to the ward, and at 4, 8, and 24 hours after surgery. Piritramide consumption was recorded for the first 24 hours. Patient satisfaction was assessed on the second postoperative day. Results During the first 4 hours after surgery, the difference in mean pain score between SSB and ISB was higher than 2.5 (±0.8). The difference gradually decreased to 1.1 (±1.0) at 8 hours before resulting in noninferiority during the night and at 24 hours. Piritramide consumption was significantly higher in the SSB group in the first 8 hours. The incidence of dyspnea and discomfort was higher after ISB. Treatment satisfaction was similar in both groups. Conclusions Suprascapular-axillary nerve block is inferior to ISB in terms of analgesia and opioid requirement in the immediate period after arthroscopic shoulder surgery but is associated with a lower incidence of dyspnea and discomfort. The difference in pain and opioid consumption gradually decreases as the blocks wear off in order to reach similar pain scores during the first postoperative night and at 24 hours. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02415088. Accepted for publication December 30, 2017. Address correspondence to: Björn Stessel, MD, PhD, Department of Anesthesiology and Pain Treatment, Jessa Hospital, Virga-Jesse Campus, Stadsomvaart 11, 3500 Hasselt, Belgium (e-mail: bjornstessel@hotmail.com). This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, Province of Limburg, Flemish Government, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. The authors declare no conflict of interest. Authors' contributions: A.N. was responsible for the study design, data collection, and writing of the paper. B.S. was responsible for the study design, data interpretation, table creation, and writing of the paper. P.F.W. was responsible for the data interpretation and writing of the paper. C.D. was responsible for the study design and the writing of the paper. W.C. provided statistical expertise and was responsible for the statistical analyses and figure creation. J.-P.O., I.A., L.J., and J.D. were responsible for the writing of the paper. D.S. conceived of the study and was responsible for the study design, the literature search, execution of all regional blocks, and writing of the paper. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Clotting-Factor Concentrations 5 Days After Discontinuation of Warfarin

Background The American Society of Regional Anesthesia and Pain Medicine guidelines recommend discontinuation of warfarin and an international normalized ratio (INR) of 1.2 or less before a neuraxial injection. The European and Scandinavian guidelines accept an INR of 1.4 or less. We evaluated INR and levels of clotting factors (CFs) II, VII, IX, and X 5 days after discontinuation of warfarin. Methods Patients who discontinued warfarin for 5 days and had an INR of 1.4 or less had activities of factors II, VII, IX, and X measured. The primary outcome was the frequency of subjects with CF activities of less than 40%. Results Twenty-three patients were studied; 21 (91%) had an INR of 1.2 or less. In these 21 patients, the median (interquartile range) activities of factors II, VII, IX, and X were 66% (52%–80%), 114% (95%–132%), 101% (84%–121%), and 55% (46%–63%), respectively. Ninety-five percent (99% confidence interval, 69%–99%) had CF activities of greater than 40%. The patient who did not CF activities greater than 40% had end-stage renal disease. Two subjects had an INR of greater than 1.2; the activities of factor II, VII, IX, and X were 37% and 46%, 89% and 105%, 66% and 78%, and 20% and 36%, respectively. Neither patient had CF activities of greater than 40%. Conclusions Based on 40% activity of CFs, patients with INRs of 1.2 or less can be considered to have adequate CFs to undergo neuraxial injections. The number of patients with an INR of 1.3 and 1.4 is too small to make conclusions. Accepted for publication January 30, 2018. Address correspondence to: Honorio T. Benzon, MD, Department of Anesthesiology, 251 E. Huron, St, Feinberg Pavilion, 5–704, Chicago, IL 60611 (e-mail: h-benzon@northwestern.edu). L.V. is retired. This work is attributed to the Departments of Anesthesiology and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Funding support for this study was provided by the Department of Anesthesiology, Northwestern University Feinberg School of Medicine (departmental sources only). The study was presented at Anesthesiology 2016, the annual meeting of the American Society of Anesthesiologists, October 22 to 25, 2016, Chicago, IL. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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