Head and Neck Medicine by Alexandros G.Sfakianakis: 05/03/18

Πέμπτη 3 Μαΐου 2018

Management of Post-Traumatic Subglottic Stenosis and Pharyngosubglottic Fistula

Abstract

Injury to the aerodigestive tract following external laryngeal trauma is rare. Reports of acquired laryngopharyngeal fistula are very few. We report a very rare presentation of penetrating neck trauma presenting with fracture of the cricoid cartilage, subglottic stenosis and pharyngosubglottic fistula. The term 'pharyngosubglottic fistula' is used here for the first time to describe a communication tract between hypopharynx and subglottis. The successful surgical management of this case is discussed.

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Spontaneous Medial Cribriform CSF Leak: Endoscopic Surgical Repair with Free Mucosal Graft—Our Experience

Abstract

Cribriform plate is the commonest site of spontaneous CSF leak, the fragility of the plate and juxtaposition of arachnoid's investment to the bone, where the olfactory nerve pierces the skull made this area, a vulnerable site for CSF leak. Transnasal endoscopic approach has gained popularity for CSF leak repair over the years. To describe the 5 year experience of spontaneous medial cribriform CSF leak repair with free mucosal graft in a tertiary medical centre. All patients who underwent transnasal endoscopic repair with free mucosal graft for spontaneous medial cribriform CSF leak in our institution between 2011 and 2016 were reviewed. Twelve patients were identified, all were women with a mean age of 44.5 years. The defect was localised by preoperative computed tomography scans with 1 mm cuts and MR cisternography. Via medial approach, the mucosa surrounding the entire defect was denuded and the defect was closed with free mucosal graft harvested either from the middle turbinate or from the nasal septum and middle turbinate was finally sutured with septum to stabilise the repair. The overall success rate was 100% with the first attempt with no recurrence or postoperative complications. Follow up ranged from 1 to 5 years. The endoscopic transnasal technique with free mucosal graft for the repair of spontaneous medial cribriform CSF rhinorrhoea is associated with a very high success rate and it should be considered for majority of cases.

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Histoplasmosis: An Emerging Endemic Mycosis

A. Pulido Pérez
Actas Dermosifiliogr.2018;109:295

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Risk of Skin Cancer Associated With Narrowband UV-B Phototherapy

J. Aguilera
Actas Dermosifiliogr.2018;109:296

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Improving the Quality of Life of Patients With Actinic Keratosis

N. Blázquez-Sánchez
Actas Dermosifiliogr.2018;109:296-7

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Umbilicated Papules on the Elbows of a Woman With Systemic Vasculitis

C. Lloret-Ruiz, N. Barrado-Solís, E. Quecedo-Estébanez
Actas Dermosifiliogr.2018;109:353-4

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Management of Corticosteroid-Induced Osteoporosis: A Practical Approach for the Dermatologist

C. Vico-Alonso, L. Maroñas-Jiménez, F. Lozano-Morillo
Actas Dermosifiliogr.2018;109:357-8

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Lymphadenectomy After a Positive Sentinel Lymph Node Biopsy in Melanoma: A Paradigm Shift

Á. Pizarro
Actas Dermosifiliogr.2018;109:298-302

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HIV-associated psoriasis

N. Queirós, T. Torres
Actas Dermosifiliogr.2018;109:303-11

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Morphea in Childhood: An Update

B. Aranegui, J. Jiménez-Reyes
Actas Dermosifiliogr.2018;109:312-22

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Dermatology and Immunoglobulin Therapy: Who to Treat and How to Administer Immunoglobulins

F.J. Navarro-Triviño, I. Pérez-López, R. Ruíz-Villaverde
Actas Dermosifiliogr.2018;109:323-30

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Quality of Life, Behaviour and Attitudes towards Actinic Keratosis in Spain: The PIQA Study

I. Longo, C. Serra-Guillén
Actas Dermosifiliogr.2018;109:331-9

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Photocarcinogenic Risk Associated With Narrowband UV-B Phototherapy: An Epidemiologic Study in a Tertiary Care Hospital

J.M. Ortiz-Salvador, D. Subiabre-Ferrer, M. Saneleuterio-Temporal, A.M. Victoria Martínez, A. Pérez-Ferriols, J.J. Vilata Corell, V. Alegre de Miquel
Actas Dermosifiliogr.2018;109:340-5

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Description of patients excluded for Mohs surgery after pre-surgical evaluation: data from the Regesmohs Spanish registry

V. Ruiz-Salas, J.R. Garcés, T. Alonso-Alonso, M.A. Rodríguez-Prieto, A. Toll-Abelló, E. Eusebio Murillo, R. Miñano, J.L. López-Estebaranz, O. Sanmartín-Jiménez, C. Guillén Barona, I. Allende Markixana, A. Alfaro Rubio, Y. Delgado Jiménez, R. Navarro, L. Barchino Ortiz, P. Lázaro Ochaita, E. Vilarasa, C. Ciudad Blanco, H. Vázquez-Veiga, J.L. Artola Igarza, M.L. Alonso, I. García-Doval, M.A. Descalzo, P. Redondo Bellón
Actas Dermosifiliogr.2018;109:346-50

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Electrosurgery for the Treatment of Moderate or Severe Rhinophyma

L.F. González, H. Herrera, A. Motta
Actas Dermosifiliogr.2018;109:e23-6

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Mucocutaneous Manifestations of Infection by Histoplasma capsulatum in HIV-Negative Immunosuppressed Patients

L.V. Gómez-Santana, A.C. Torre, B.A. Hernández, V.I. Volonteri, B. Laura, R. Luis-Galimberti
Actas Dermosifiliogr.2018;109:e27-32

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Painful Ulcer in a Black Man

I. Latour-Álvarez, M. Arteaga-Henriquez, A. de Andrés-del Rosario
Actas Dermosifiliogr.2018;109:351-2

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Ulcerative nodules on the perineum

C.-F. Yen, K.-L. Chen, T.-F. Tsai
Actas Dermosifiliogr.2018;109:355-6

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Proliferating Pilomatricoma Mimicking a Malignant Tumor

P. García-Montero, J.B. Repiso-Jiménez, I. Fernández-Canedo
Actas Dermosifiliogr.2018;109:359

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Evaluation of bone repair after application of a norbixin membrane scaffold with and without laser photobiomodulation (λ 780 nm)

Abstract

Biocompatible membranes are widely used in medicine to stimulate bone repair. Several studies have demonstrated that laser photobiomodulation (PBM) also stimulates osteoblast proliferation and osteogenesis at the fracture site, leading to a greater deposition of bone mass and accelerating the process of bone consolidation. This work assessed the therapeutic effect of 780-nm laser PBM and a polystyrene membrane coated with norbixin and collagen (PSNC) on bone healing in rats with calvarial bone defect. Histological staining, Raman spectroscopy, and scanning electron microscopy (SEM) were used to evaluate the bone repair process. Four experimental treatment groups were compared: C, control; M, membrane only; L, laser PBM only; and ML, membrane + laser PBM. A bone defect was created in the calvaria of each animal, with each group subdivided into two subgroups that underwent euthanasia after 15 and 30 days treatment. The L and ML groups were irradiated (λ = 780 nm, ED = 6 J/cm², P = 60 mW, t = 4 s) postoperatively on alternate days until they were euthanized. The bone concentration of hydroxyapatite (CHA) showed a clear gradation with increasing phosphate area in the order B (normal cortical bone) > L > M > ML > C for both periods. The PSNC membrane was effective in reducing the inflammatory process and served as a scaffold for bone repair. The laser PBM also showed positive effects on the bone repair process with increased deposition and organization of the newly formed bone. However, laser PBM failed to improve the bioactive properties of the membrane scaffold.

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Cutaneous Metastases From Adenocarcinoma of the Prostate

M.Á. Flores-Terry, R. Cruz-Conde de Boom, M. García-Arpa, I.M. de Lara-Simón
Actas Dermosifiliogr.2018;109:360

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Dermatopathic Lymphadenopathy: Is Our Diagnostic Approach Correct?

A. Bueno-Rodriguez, R. Ruiz-Villaverde, M. Caba-Molina, J. Tercedor-Sánchez
Actas Dermosifiliogr.2018;109:361-3

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Folliculitis Decalvans Caused by Bacterial Superinfection Secondary to Erlotinib

A. Sahuquillo-Torralba, B. Escutia-Muñoz, M. Rodríguez-Serna, R. Botella-Estrada
Actas Dermosifiliogr.2018;109:363-4

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Cochlear implants in developing countries: practical and ethical considerations

No abstract available

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Editorial introductions

No abstract available

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Perspectives on voice treatment for unilateral vocal fold paralysis

Purpose of review Unilateral vocal fold paralysis (UVFP) is a common cause of neurogenic dysphonia resulting in glottal insufficiency. To restore glottal sufficiency and reduce the presenting dysphonia, treatment involving either surgical intervention, voice therapy or a combination of the two is typically provided. Currently, there is no consensus for the most effective voice treatment for UVFP. This results in an inability to compare current studies, and a lack of treatment effectiveness for the management of UVFP. This study aims to review the most recent literature for the management of dysphonia due to UVFP to establish the current evidence base for voice treatment options. Recent findings There was found to be a lack of consistency in the rationale, selection and timing of the surgical intervention and/or voice therapy being provided for patients with UVFP. Summary Further consensus is required for the rationale and selection of voice treatment prescriptions for the management of UVFP in order to improve treatment effectiveness and voice outcomes in patients with UVFP.

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A sustainable model for cochlear implantation in the developing world: perspectives from the Indian subcontinent

Purpose of review The overall prevalence of deafness in India is 0.2%, but the prevalence in the southern state of Tamil Nadu is much higher (around 0.6%) because of consanguinity. Especially in India, establishing cochlear implantation as a treatment modality for hearing loss has been a daunting task, but in the last decade, the cochlear implantation program has emerged as an unqualified success in many states, with over 20 000 cochlear implantations done till date. Several states are sponsoring free implants to children under the age of 6 years and below poverty line. Recent findings Nearly 3000 cochlear implantations have been performed in Tamil Nadu under the Chief Minister's Comprehensive Health Insurance Scheme, with the goal to have a 'deafness free Tamil Nadu' by 2025. This scheme covers nearly 40 million people in rural areas. Valuable lessons have been learnt from this social experiment. One of the cornerstones of this scheme is the method to deliver habilitation via satellite centers in rural areas at the doorstep of the patient. The outcomes in peripheral centers were found to be statistically similar to those in the main center and correlated well with duration of habilitation. Summary Opening up satellite centers for habilitation across the state of Tamil Nadu has greatly helped to improve the attendance and outcomes. The Indian model has been hugely successful and has helped start similar cochlear implantation programs in neighboring countries such as Nepal, Sri Lanka and Bangladesh.

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Developing competent videofluoroscopic swallowing study analysts

Purpose of review This review examines the recent literature concerning the development of VFSS analysts. Recent findings Face-to-face and blended methods of training improve reliability and accuracy of VFSS analysis. However, with the exception of the literature describing the MBSImP training, most studies investigate relatively brief training for specific VFSS rating tools. The influence of training mode and trainee factors has received limited attention. Summary There is a lack of controlled studies investigating the influences of training methods for VFSS analysis. Pilot data is emerging concerning VFSS analysis training 'packages' but without information about the relative influence of training mode, it is difficult to determine the most efficient and cost-effective way of training VFSS analysts. Future research should investigate the contribution of trainee-related factors to succeed in VFSS analysis training, and the relative benefits and disadvantages of online, peer, independent, and blended modes of training.

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Managing the late effects of chemoradiation on swallowing: bolstering the beginning, minding the middle, and cocreating the end

Purpose of review Late dysphagia has a profound impact on quality of life in patients treated with chemoradiation therapy for advanced head and neck cancer and the number of survivors is growing. Traditional treatment methods are not uniformly successful in reducing the swallow impairment in these patients. Recent findings Manifestations of late dysphagia are complex and do not follow a uniform trajectory. Patient's experience of eating and engagement in treatment is critical given the complex, variable nature of late dysphagia. Novel swallow treatment methods target respiratory function including coordination and strength as well as patient adherence. Summary Head and neck cancer survivors deserve routine and fastidious surveillance beyond the 5-year survival point with respect to swallow function if the enormous biopsychosocial burden of late dysphagia is to be addressed.

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A comparison of neuromuscular electrical stimulation and traditional therapy, versus traditional therapy in patients with longstanding dysphagia

Purpose of review Dysphagia in adults arises from a range of causes including acquired neurological disorders and some cancers. Previous research has suggested that treatment using neuromuscular electrical stimulation (NMES) when used in conjunction with conventional therapy is effective. This review describes the recent literature and a small prospective case series carried out in the United Kingdom. This study contributed to support National Institute of Clinical Excellence (NICE) guidance for clinicians who wish to include NMES in a rehabilitation programme for dysphagic patients, specifically with reference to safety and the impact on swallowing function of this intervention. Recent findings In 2014, the UK NICE issued guidelines enabling UK therapists to trial the use of NMES, but the guidelines also sought additional evidence on the impact on swallowing function of NMES and the incidence of side effects. This small prospective case series investigated both of these aspects with a group of patients with dysphagia of neurological origin who had not achieved adequate swallowing function with traditional therapy alone. This study recruited 10 adult patients with dysphagia of neurological origin. All had previously received traditional swallowing therapy for at least 6 months but only achieved a Functional Oral Intake Scale of 4 or less (a scale for amounts and types of oral intake). The total study period was 10 weeks for each subject comprising 5 weeks of traditional therapy delivered three times a week followed by 5 weeks of NMES concurrent with traditional therapy (NMES + traditional therapy) delivered three times a week using the VitalStim stimulator (VitalStim Therapy, UK). In addition, the Quality of Life in Swallowing and Eating Assessment Tool 10 (quality of life scales) were determined to allow comparison between studies. Nine subjects achieved an improvement in swallowing function after NMES + traditional therapy was measured using the Functional Oral Intake Scale, giving a statistically significant improvement (P

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Cost-effectiveness of CI in developing countries

Purpose of review Cost-effectiveness of cochlear implants is a major concern for expanding these services to low-income and middle-income developing countries. Recent findings Recent studies have applied appropriate methodology to make determination of cost-effectiveness for cochlear implants in developing countries. In addition, important parameters that effect cost-effectiveness have been reviewed in a systematic way. The combination of these new studies along with existing reports of cochlear implant programmes in developing countries allows for a discussion of cost and outcomes determinants that drive cost-effectiveness in these environments. Summary Cochlear implants are a very cost-effective treatment for profound hearing loss in all high-resource countries and in many low-income and middle-income developing countries. A number of cost considerations affect cost-effectiveness of cochlear implants in developing countries including device cost and device-related expenses such as power consumption and reliability, but also including rehabilitation and access-related expenses. Large-scale programmes confer an advantage for cost-effectiveness, primarily through device-related savings.

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Clinical presentation, assessment, and management of inducible laryngeal obstruction

Purpose of review Many aspects of inducible laryngeal obstruction (ILO) are still poorly understood. However, in recent years there have been advances made and an international consensus has achieved a standardized taxonomy. This review will synthesize recent research; specifically, relating to clinical presentation, assessment, and therapeutic interventions. Recent findings The evidence base is growing but still limited for ILO and mostly comprises retrospective reviews, case studies, and anecdotal reports. The proposed relationship between ILO and other manifestations of laryngeal dysfunction via laryngeal hypersensitivity and hyperresponsiveness warrants further investigation. Progress has been made with guidelines published on laryngoscopy reporting procedures and validated symptom questionnaires produced for clinical use, although diagnostic algorithms are yet to be established. Emerging conservative and surgical interventions show promise, although as yet there are no randomized controlled trials investigating treatment efficacy. Summary The field is in an embryonic state and key research priorities, acknowledged in the current literature, need to be addressed to positively impact patient care.

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Overcoming developing-world challenges in cochlear implantation: a South American perspective

Purpose of review Effective hearing rehabilitation with cochlear implantation is challenging in developing countries, and this review focuses on strategies for childhood profound sensorineural hearing loss care in South America. Recent findings Most global hearing loss exists in developing countries; optimal cost-effective management strategies are essential in these environments. This review aims to assess and discuss the challenges of cochlear implantation effectiveness in South America. The authors searched electronic databases, bibliographies, and references for published and unpublished studies. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and failure rate. Costs were obtained from experts in South America using known costs and estimations whenever necessary. Recent studies reported several challenges in unilateral or bilateral cochlear implants: cochlear implant costs, deaf education costs, increasing need for cochlear implant capacity, and training and increasing longevity. Summary Cochlear implantation was very cost-effective in all South American countries. Despite inconsistencies in the quality of available evidence, the robustness of systematic review methods substantiates the positive findings of the included studies, demonstrating that unilateral cochlear implantation is clinically effective and likely to be cost-effective in developing countries.

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Sound source localization

Publication date: Available online 3 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Risoud, J.-N. Hanson, F. Gauvrit, C. Renard, P.-E. Lemesre, N.-X. Bonne, C. Vincent
Sound source localization is paramount for comfort of life, determining the position of a sound source in 3 dimensions: azimuth, height and distance. It is based on 3 types of cue: 2 binaural (interaural time difference and interaural level difference) and 1 monaural spectral cue (head-related transfer function). These are complementary and vary according to the acoustic characteristics of the incident sound. The objective of this report is to update the current state of knowledge on the physical basis of spatial sound localization.

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French Society of ENT (SFORL) guidelines (short version) on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome

Publication date: Available online 3 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): B. Pateron, R. Marianowski, P.-J. Monteyrol, V. Couloigner, M. Akkari, F. Chalumeau, P. Fayoux, N. Leboulanger, P. Franco, M. Mondain
ObjectiveThe authors present the guidelines of the French Society of ENT and Head & Neck Surgery (SFORL) on the role of the ENT physician in childhood obstructive sleep apnea-hypopnea syndrome (OSAHS). This section of the guidelines concerns the roles of the various medical and surgical treatment options.MethodA multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Based on the retrieved articles and the group members' own experience, guidelines were drawn up, then read over by a reading group independent of the work-group. An editorial meeting then produced the final text.ResultsAdenotonsillectomy is the reference treatment for childhood OSAHS with adenotonsillar hypertrophy. Respiratory assistance is recommended in children with severe OSAHS without nasal and/or oropharyngeal obstacle, after surgery in case of persistent OSAHS, in case of contraindications to surgery, in complex obstruction related to pharyngolaryngeal or laryngeal pathology or comorbidity, or as an alternative to tracheotomy. Nasal route corticosteroids may be used in childhood OSAHS in with associated nasal obstruction.

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Expansive renal osteitis fibrosa: a case report

Abstract

Hyperparathyroidism (HPT) is an endocrine metabolic disorder characterized by increased secretion of parathyroid hormone. Untreated secondary HPT leads to renal osteodystrophy (ROD). Facial skeletal abnormalities in patients with ROD are rare. The purpose of this paper is to report a conservative surgical approach of exuberant osteitis fibrosa lesions in patient with chronic kidney disease. A 24-year-old female was referred to maxillofacial surgery department with giants ROD affecting palate, maxilla, and mandible, resulting in esthetic and functional impairment. The pathogeneses and multidisciplinary management of ROD are discussed with a brief literature review. Eight years after the conservative treatment of exuberant jaw lesions, no noticeable bone changes were observed in the patient. A multidisciplinary therapy is essential for correct diagnosis of ROD and optimal multimodality treatment. The conservative management was an efficient alternative for the success of the case reported.

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Elucidation of the TMab-6 Monoclonal Antibody Epitope Against Telomerase Reverse Transcriptase

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.

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Expansive renal osteitis fibrosa: a case report

Abstract

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Custom designing laryngoplasty implant using actual size CT scan images on a mobile device

Clinical Otolaryngology, EarlyView.

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The application of Mir-183 family and mesenchymal stem cells: A possibility for restoring hearing loss

Mohammad Reza Mahmoudian-Sani, Ameneh Mehri-Ghahfarrokhi, Ghollam Reza Poorshahbazi, Majid Asadi-Samani

Indian Journal of Otology 2017 23(4):217-221

Hearing loss as one of the most common disabilities approximately over 5% of the world's population – 360 million people – has disabling hearing loss (328 million adults and 32 million children). Recent developments in stem cell technology provide new opportunities for the treatment of deafness. miRNAs are essential factors of an extensively conserved posttranscriptional process controlling gene expression at mRNA level. Various biological processes such as growth and differentiation are regulated by miRNAs. In this review paper we have discussed about the application of miR-183 family and mesenchymal stem cells as a possibility for restoring hearing loss. In this regards, the web of Science and PubMed databases were searched using the Endnote software for the publications about the application of miR-183 family and mesenchymal stem cells (MSCs) to study hearing loss published from 2000 to 2016. The miR-183 family (miR-183, miR-96, and miR-182) is expressed abundantly in sensory cells in inner ear. miR-183 family is significant for the development and persistence of auditory neurons and hair cell. These four genes, i.e. Sox2, Notch1, Jag1, and Hes1, are potentially the targets of miR-183 family. In studies on animal models such as mouse and zebrafish, the time of Atoh1 expression in the hair cells was found to be the E12/5-E14/5 day, and miR-183 family was reported to begin to express on the E14/5 day. Use of human MSCs in differentiating into hair cells has been investigated, demonstrating that MSCs have neuroregenerative capacity. Cell therapy-targeting regeneration of the auditory neurons and hair cell may therefore be a powerful strategy to cure hearing loss that cannot be reversed by current therapies. A combination of the MSCs, specific growth factors and miR-183 cluster (96-182-183) can increase the potential to differentiate into the auditory neurons and hair cell.

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Glass ionomer cement: An attractive alternative for the reconstruction of incudostapedial joint discontinuity

BS Yogeesha, K Rohit, Nagaraj Maradi

Indian Journal of Otology 2017 23(4):222-225

Background: Chronic suppurative otitis media (CSOM) is a rampant clinical entity in India, and hearing loss is a very debilitating condition which is treatable. Hence, ossiculoplasty is a frequently combined operation with myringoplasty to reconstruct the hearing apparatus of a CSOM patient. Ossiculoplasty can be accomplished through autograft, homograft, and allograft materials. The glass ionomer cement (GIC) included under bone cement is biocompatible and easily available, for restoring the ossicular continuity, more specifically, the incudostapedial joint. Objective: The purpose of this study is to evaluate hearing improvement after repair of ossicular discontinuity between the incus and stapes with GIC. Materials and Methods: This prospective clinical study was conducted in a tertiary care hospital. CSOM patients found to have incudostapedial joint discontinuity intraoperative underwent ossiculoplasty with GIC. Postoperatively, hearing was evaluated at 1 month and 3 months. Audiometric pure-tone threshold by air conduction (AC) was recorded at 0.5, 1, 2, 3, 4, 6, and 8 kHz and by bone conduction at 0.5, 1, 2, 3, and 4 kHz. As per the AAO-CHE guidelines, thresholds at 0.5, 1, 2, and 3 kHz were used to calculate the Pure Tone Average (PTA). The air-bone gap (ABG) was calculated for each patient and the results were tabulated. Results: At the end of each predesignated PTA evaluation, postoperatively, the patients showed improvement in AC thresholds and narrowing of ABG, which was statistically significant. In our study, after applying GIC, the mean AC was 30.89 dB at the end of 3rd month which was significant improvement. Eighteen patients (66.67%) had closure of ABG <20 dB. Interpretation and Conclusion: The current study reveals that tympano-ossicular reconstruction using GIC is a simple, cost-effective method which gives definite good postoperative hearing improvement. Other advantages are more physiological continuity between the incus and stapes, technically easier application, nonextrusion.

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Tuberculous otomastoiditis: A therapeutic and diagnostic challenge

Rohit Verma

Indian Journal of Otology 2017 23(4):260-263

Context and Aims: Tuberculosis (TB) has affected mankind since time immemorial. Extrapulmonary TB poses special diagnostic and therapeutic challenges. Temporal bone is an extremely rare target organ for tuberculous infection. It constitutes just 0.05%–0.9% of all chronic middle ear otitis cases. However, because of its rarity, it is often missed as a diagnosis, and thus there is a significant delay in initiating the treatment. The aim of this study was to identify the cases of tuberculous otomastoiditis (TOM) in patients undergoing middle ear surgery in a tertiary care hospital. Settings and Design: This was a retrospective chart review carried out in a tertiary care hospital. Materials and Methods: Nine hundred and fifty charts of patients undergoing middle ear surgery were studied. Three cases of TOM were identified. Results: All the patients had painless otorrhea and hearing loss as the presenting feature. Only one patient had facial nerve palsy. During the initial phase of management, TB was not suspected in any of the patients. Histopathological examination (HPE) of the tissue obtained at surgery provided the diagnosis in all the cases. The response to antitubercular treatment (ATT) was satisfactory in all three cases. Conclusions: TB should always be kept as a differential diagnosis in case of chronic middle ear infection, especially if there is a poor response to antibacterial treatment. HPE of the tissue and specific microbiological testing are the gold standard for diagnosis. The primary treatment in these cases is ATT with a limited role of surgery.

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Hyperuricemia effects auditory functions

Amit Saini, Jagdeep S Thakur, Gaveshna Saini, Dev Raj Sharma, Narinder K Mohindroo

Indian Journal of Otology 2017 23(4):226-229

Aim: The aim of this article is to study the effect of hyperuricemia on auditory functions. Materials and Methods: This was an academic institution (Indira Gandhi Medical College, Shimla, HP, India)-based, prospective, observational case–control study with 25 hyperuricemic individuals. Individuals with any confounding factor were excluded from the study. Cochlear functions were evaluated using pure tone audiometry, transient evoked otoacoustic emission (TEOAE), and distortion product otoacoustic emission (DPOAE). Results: This study found reduced responses at higher frequencies on DPOAE and TEOAE in the case group. On TEOAE, statistically significant difference was observed in the signal-noise ratio at 4 and 3 KHz with P < 0.001. Signal-noise ratio of DPOAE was also found statistically significant at 5 and 6 KHz. Conclusions: This study found association of asymptomatic hyperuricemia and hearing loss, especially at high frequencies. In our opinion, hyperuricemia causes cochlear damage through crystal formation and minor vessel atherosclerosis.

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Bacteriology and drug susceptibility in chronic suppurative otitis media in Ear, Nose, and Throat outpatient and inpatient department of tertiary care Hospital, Bhavnagar

TU Samanth, Sushil G Jha, Vikas Sinha, Swati Dadhich

Indian Journal of Otology 2017 23(4):252-255

Background: The diagnosis of Chronic Suppurative otitis media (CSOM) implies a permanent abnormality of the pars tensa or flaccida, most likely a result of earlier acute otitis media or negative middle ear pressure. Changes in the microbiological flora following the advent of sophisticated synthetic antibiotics increase the relevance of antibiotic sensitivity to plan a general outline of treatment for a patient with a chronically discharging ear. Aim: To evaluate the bacteriological causes of CSOM. To know their antibiotic sensitivity pattern to commonly used antibiotics. Study Design: Prospective Observational Study. Materials and Methods: Sixty patients of Suppurative otitis media both unilateral and bilateral who present with active purulent discharge for to Ear, Nose and Throat (ENT) Department will be prospectively studied. Patients were of all age group, both sexes and had symptoms of active ear discharge for more than 6 weeks. Patients suffering from SOM who are on systemic antibiotics and on topical medications to the ear were not included in the study. Results: Of the 60 patients 64% were males with maximum incidence in 26-50 y age group.55% of patients were from lower Socio Economic Status.Of the organisms isolated Staph. Aureus(35%) was most predominant followed by Pseudomonas(31%).All gram positive organisms were susceptible to Co-trimoxazole, Vancomycin , Gentamycin and all Gram negative to Meropenam, Aztreonam, Piperacillin. Conclusion: The patients should also be advised to take the drugs for the complete prescribed duration. This will not only help in minimizing the complications, but also help in preventing the emergence of resistant strains.

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Effect of practicing yoga on functioning of efferent auditory system

Shubhaganga Dhrruva Kumar, Tejaswini Shambhu, Prashanth Prabhu

Indian Journal of Otology 2017 23(4):230-232

Introduction: The present study attempted to determine the effect of practicing Yoga on the functioning of the efferent auditory system using contralateral suppression of otoacoustic emissions (OAE). Method: The efferent suppression of transient evoked OAE (TEOAE), and distortion product OAE (DPOAE) was recorded from 40 participants (20 who practice Yoga regularly and 20 who do not practice yoga regularly). Results: The results of this study showed that there was an increase in the amount of suppression of both TEOAE and DPOAE in individuals who practice Yoga. The result suggests that Yoga enhances the sensory perception and improves auditory attention. The constant practice of Yoga could have led to the plasticity of the efferent auditory system. Conclusions: Thus, the practice of Yoga may be used to strengthen the efferent auditory system. However, further studies on a larger group of the population are essential for better clinical applicability of the results.

https://ift.tt/2I9R614

When to operate facial nerve schwannomas?

Rajeshwary Aroor, Deepika Pratap, Marina Saldanha, Vijay Pai, U Raguraj

Indian Journal of Otology 2017 23(4):267-269

Facial nerve schwannomas are rare, benign slow-growing tumors arising from the Schwann cell sheath of the facial nerve. A 60-year-old female presented with a mass in the left parotid region for 6 months. It was associated with Grade 6 left lower motor neuron facial palsy. Malignancy of the parotid gland associated with facial nerve involvement was suspected. However, high-resolution computed tomography temporal bone and magnetic resonance imaging done showed a soft-tissue density along the vertical portion of the facial nerve and into the parotid gland. The lesion was eroding the skull base and was found to be in direct contact with the jugular bulb. She underwent excision of the tumor by a modified Blair incision along with a cortical mastoidectomy. Tumor abutting the jugular bulb was removed through transmastoid approach. Facial nerve was transected during tumor excision. Postoperatively, gold implant was inserted. Facial schwannomas can arise from any segment of the nerve, from the cerebellopontine angle to the extratemporal peripheral portion. About 650 cases have been reported in the world literature. The best timing for surgery depends on facial and hearing function, size, and intracranial mass effect.

https://ift.tt/2JRvoMC

Role of antivirals in treatment of vertigo due to vestibulopathies

Zafarullah Beigh, Tabish Maqbool, Rauf Ahmad

Indian Journal of Otology 2017 23(4):233-236

Objective: The objective of this study is to study the role of antiviral medication on treatment of recurrent vertigo due to various vestibulopathies. Materials and Methods: Sixty-six adult patients of vestibular neuronitis (VN), Meniere's disease (MD), and benign paroxysmal positional vertigo were enrolled in this study, patients in each disorder where distributed randomly in two groups, Group A (antiviral) and Group B (nonantiviral). All Patients were assessed on the basis of reduction in dose of vestibular sedative drugs needed for control of vertigo on 1st, 3rd, and 5th day of treatment. Results: Statistically significant reduction in dose of labyrinthine sedatives was found to control vertigo in Group A patients as compared to Group B patients in both VN and MD. This reduction in dose of labyrinthine sedatives was seen on day 3 as well as on day 5 of treatment. Conclusion: This study shows that use of antiviral drugs significantly reduces the dose of vestibular sedatives needed for control of vertigo in MD and VN and hence should be used on a regular basis to treat these ailments.

https://ift.tt/2rjOHr0

Efficacy of vestibulo-ocular reflex gain and refixation saccades of video head impulse test in identifying vestibular pathologies

Niraj Kumar Singh, Rajeshwari Govindaswamy, Nirmala Jagadish

Indian Journal of Otology 2017 23(4):247-251

Aim: Video head impulse test is a clinical tool found useful for assessment of each of the 6 semicircular canals independent of each other. However there is little known about relative efficacy of the two measures, vestibulo-ocular reflex gain and refixation saccade, in identifying the presence of a vestibular pathology. The present study therefore aimed at investigating the utility of each of these measures in identifying vestibular pathology. Materials and Methods: Twenty subjects with normal audio-vestibular system and 20 subjects with vestibulopathies underwent video head impulse testing. Results: The VOR gain was significantly higher in lateral and posterior canals and presence of refixation saccades was in significantly higher proportion of individuals with vestibulopathies than the controls (p < 0.05). When presence of either refixation saccades or reduced VOR gain was considered an abnormal result, the sensitivity was ~71% and ~43% and specificity was ~92% and ~82% for lateral and posterior canals respectively. When presence of either refixation saccades or reduced VOR gain for either of the two canals was considered an abnormal result, the sensitivity shot up to reach ~86% whereas the specificity plummeted slightly to drop to75%. Conclusion: The video head impulse test can differentiate vestibulopathies from normal individuals and hence a clinically useful tool.

https://ift.tt/2JRoc2Y

GSTP1 levels in cisplatin-induced rat cochlea after alpha lipoic acid and oxytocin treatment

Sedat Aydin, Mehmet Gökhan Demir, Serpil Oguztüzün, Niyazi Altintoprak, Eda Bekmez Bilmez, Aylin Ege Gül, Arzu Kaya Kocdogan

Indian Journal of Otology 2017 23(4):237-240

Introduction: Cisplatin is a well-known chemotherapeutic agent used in many cancer treatments. Several antioxidant agents are used for diminishing the toxic side effects of the cisplatin therapy. Alpha-lipoic acid (α-LA) and oxytocin (OT) are antioxidant agents that can be used in toxicity. Our aim is to investigate the effect of these antioxidants in cisplatin-induced ototoxicity in tissue level. Materials and Methods: Forty Wistar albino rats divided into five groups as control, cisplatin, cisplatin + intraperitoneal (IP) OT, cisplatin + intratympanic (IT) OT, and cisplatin + IT α-LA. The drug administration is applied for 4 days, and at the end of the procedure, the cochleas are harvested. After tissue preparation, GSTP1 levels are investigated and the intensity of the reaction is scored as negative (−), weak (1+), moderate (2+), or strong (3+). Results: Group 4 has a moderate staining which can be interpreted as high immunoreaction. When we compare with Group 1, this staining difference is statistically significant (P < 0.02). When we observe the Group 3, we cannot detect any difference with Group 1 in immunoreactivity. Conclusion: α-LA and OT are antioxidants effective against cisplatin ototoxicity. The expression of GSTP1 isozyme is increased in antioxidant-treated groups. Increased levels of these isozymes proved the increased healing response in tissue levels. Antioxidant agents can be used for adverse effects during cisplatin treatment. IT route is effective as IP systemic route.

https://ift.tt/2IfaycP

Inflammation-Based prognostic factor in different forms of chronic suppurative otitis media

Hatice Terzi, Kasım Durmuş, Tuba Doğan Karataş, Mehmet Şencan, Emine Elif Altuntaş

Indian Journal of Otology 2017 23(4):256-259

Objective: The aim of the present study was to investigate whether several blood tests could be used as inflammatory indicators in active or inactive chronic suppurative otitis media patients. Methods: Between 2007 to 2014, this study was conducted in 358 consecutive patients having chronic suppurative otitis media were included in the present retrospective clinical study. Patients were divided into two groups based on the clinical history, otologic examination, audiological evaluation and intraoperative finding. Group 1 consisted of 163 patients who had inactive chronic suppurative otitis media, while group 2 was comprised of 195 patients who had active chronic suppurative otitis media and cholesteatomatous otitis media. Results: With respect to the neutrophil-lymphocyte ratio (P = 0 .001), the platelet-lymphocyte ratio (P = 0 .001), absolute lymphocytes (P = 0.001), absolute neutrophil (P = 0.001), platelet (P = 0,001) and white blood cell (P = 0,02), Group 1 and Group 2 showed statistically significant differences. Conclusion: The results we obtained showed that markers such as neutrophil-lymphocyte ratio, the platelet-lymphocyte ratio, platelet, absolute neutrophil and white blood cell could be used as guide in evaluation of the prognosis of chronic suppurative otitis media.

https://ift.tt/2JRaGMQ

Risk factors and identifiable causes of hearing impairment among pediatric age group in Kaduna, Nigeria

Musa Thomas Samdi, Abdullahi Musa Kirfi, Umaru Sambo Grema, Alfred Nicholas Bemu

Indian Journal of Otology 2017 23(4):241-243

Background: Most of the cases of pediatric hearing loss are avoidable through primary prevention. This study aims to identify the common risk factors/identifiable causes and type of hearing loss among the pediatric age group in the study location. Methods: A retrospective study of pediatric patients diagnosed with hearing loss. The clinical records of these patients seen at the study center from 2009 to 2012 were reviewed. Demography, histories of risk factors, and type of hearing loss were obtained from the record. The data collected were analyzed using IBM SPSS version 16. Results: Three hundred and twenty-one (10.33%) children were diagnosed with hearing loss with a male-to-female ratio 1.8:1. Average age at diagnosis was 2.65 and 3.35 years for bilateral and unilateral hearing losses, respectively, bilateral hearing loss, 304 (94.70%), and unilateral hearing loss, 17 (5.29%). Furthermore, 235 (73.20%) children had predisposing risk factors while 86 (26.79%) had no identifiable risk factor. The most common risk factor was febrile illness and its treatment in 163 (50.7%), followed by middle ear infections in 29 (9.03%). A family history of hearing loss, prematurity, or complicated perinatal course was found in 17 (5.29%) patients. Seven (2.18%) cases had sickle cell disease. Sensorineural hearing loss was observed in 228 (71.0%) on the right ear and 222 (69.2%) on the left ear while conductive hearing loss accounted for 21 (6.54%) and 25 (7.78%), respectively, while mixed hearing loss was 9 (3.1%). Conclusion: Hearing loss constitutes about 10.33% of all pediatric ear, nose, and throat diseases within the period under review. There were more males than females. Febrile illnesses and their treatment are the most common risk factors. The most common cause of these fevers was meningitis, measles, malaria, mumps, and sepsis. Sensorineural hearing loss is also the most common type of hearing loss.

https://ift.tt/2I9QRDc

A rare complication of tuning fork test

Rajinder Singh Hardyal Singh, Hasme Zam Hashim, Irfan Mohamad

Indian Journal of Otology 2017 23(4):264-266

Incidence of tuning fork-related complication is extremely rare. Here, we report a case of an 18-year-old gentleman who presented with a recurrent left ear discharge with a central perforation for the past 7-year duration. Left myringoplasty was performed after the ear condition was permissible. One week after surgery, he presented with an erythematous lesion over his forehead secondary to a tuning fork test which was done prior discharge.

https://ift.tt/2JRkpCy

Optimizing outcomes in pediatric cochlear implant recipients with coexisting attention deficit hyperactive disorder

Ruchika Mittal, Poonam Raj

Indian Journal of Otology 2017 23(4):244-246

Introduction: Speech language outcomes are often variable in hearing impaired children managed with cochlear Implantation. Co-existing Attention Deficit Hyperactive Disorder may be responsible in some cases. Active management of these cases may result in improved outcomes in terms of better speech language acquisition. This study compared the progress in speech language acquisition in paediatric cochlear implant recipients with coexisting ADHD before and after intervention with Behaviour Modification Therapy (BMT) and /or pharmacological treatment. Materials and Methods: The study group was of 20 hearing impaired children post cochlear implant with co-existing ADHD who did not show expected results with regular AVT for 3 months post implant. Management of ADHD was instituted as per laid down protocol and CAP scores were compared at 0, 3, 6, 9 and 12 months post implantation. The scores obtained were subjected to a Wilcoxon sign rank test and P value derived. Results: The CAP scores after the inclusion of treatment for ADHD showed a definite improvement with a highly significant P value. Conclusions: Variables such as co-existent ADHD must be actively looked for in hearing impaired children prior to surgery and. Appropriate treatment in the form of BMT and / or medication should be instituted to improve the performance.

https://ift.tt/2rleMG7

Aural melanocytic nevi presented as polypoidal mass

Jeyasakthy Saniasiaya, Mohd Khairi Md Daud, Ramiza Ramza Ramli, Hilma Hazmi, Hasnan Jaafar

Indian Journal of Otology 2017 23(4):270-272

Nevus is a benign melanocytic tumor which occurs anywhere in the skin and is considered to be the most common type of skin tumor. Albeit rare, its manifestation over the external auditory canal has been reported. Herein, we present a case of a previously healthy middle-aged female who presented with insidious onset of left-sided aural fullness and tinnitus. Otoscopic finding revealed a peculiar-looking blackish polypoidal mass occupying left ear canal. Histopathological examination of the excised polypoidal mass turned out to be intradermal melanocytic nevi. Melanocytic nevi in the ear canal may presents as polypoidal mass in a long-standing case. Any suspicious mass over the external auditory canal warrants excision along with histopathological examination of the excised mass as to exclude the possibility of malignancy.

https://ift.tt/2JPV7ot

Infant and childhood diet at the passage tomb of Alto de la Huesera (north‐central Iberia) from bone collagen and sequential dentine isotope composition

International Journal of Osteoarchaeology, EarlyView.

https://ift.tt/2rjwVEp

Time-course transcriptome analysis of medullary thymic epithelial cells in the early phase of thymic involution

Publication date: July 2018
Source:Molecular Immunology, Volume 99
Author(s): Haoming Wu, Xiaodan Qin, Hui Dai, Yu Zhang
Degeneration of the thymic epithelium is believed to be the primary cause of age-associated thymic involution. In order to investigate the molecular events during the early phase of thymic involution, RNA-seq was performed to gain the transcriptional profiles of medullary thymic epithelial cells (mTEC) from mice of 2, 6 and 10 weeks of age. We confirmed and extended the previous observation of declined expression of cell cycle-related genes and diminished E2F3 activity during thymic involution, showing that it occurred as early as 2–6 weeks after birth. Moreover, we demonstrated that mTEC aging was coupled with augmented expression of inflammatory chemokines and cytokines, reminiscent of the senescence-associated secretory phenotype. Impaired cell cycling and proinflammatoty response therefore represent two predominant transcriptional signatures during the very early phase of thymic involution. Taken together, the present study provides not only complimentary information about, but also new insight into the molecular mechanisms underlying age-related degeneration of thymic epithelial cells.

https://ift.tt/2I8voKX

Increased plasmatic soluble HLA-G levels in endometrial cancer

Publication date: July 2018
Source:Molecular Immunology, Volume 99
Author(s): Hamza Ben Yahia, Wafa Babay, Daria Bortolotti, Nadia Boujelbene, Ahmed Baligh Laaribi, Nour Zidi, Mehdi Kehila, Hanène Chelbi, Abdellatif Boudabous, Karima Mrad, Amel Mezlini, Dario Di Luca, Hadda-Imene Ouzari, Roberta Rizzo, Inès Zidi
Human Leukocyte Antigen-G (HLA-G) is known as an immune suppressive molecule; it interacts with several immune cells and inhibits their functions. HLA-G molecule is highly represented in pathological conditions including malignant transformation. To the best of our knowledge this is the first study that focuses on the expression of soluble HLA-G (sHLA-G) in endometrial cancer (EC). We aimed at exploring sHLA-G plasma levels and its prognostic value in EC.We examined total sHLA-G expression as well as the sHLA-G1 and HLA-G5 isoforms expression in plasma samples from 40 patients with EC and 45 healthy controls by a specific sandwich ELISA. Immunoprecipitation and Coomassie blue staining were performed to explore the presence of plasmatic sHLA-G monomers and dimers.sHLA-G plasma level was significantly enhanced in patients with EC compared to healthy controls (p = 0.028). Additionally, HLA-G5 molecules were highly represented than sHLA-G1 molecules in EC, at the borderline of significance (p = 0.061). Interestingly, sHLA-G has been shown to be increased in early stages (Stages I and II) as well as in high grade EC (Grade 3) that is associated with rapid spread of the disease (p = 0.057). sHLA-G ^positive EC plasma were majorly in monomeric form (75%). Clinically, all the HLA-G dimers were detected in early stages and in high grade of EC.Our data strengthen the implication of HLA-G molecules in EC etiology and especially in progression.

https://ift.tt/2HRGZKW

Insect (food) allergy and allergens

Publication date: Available online 3 May 2018
Source:Molecular Immunology
Author(s): Steffie de Gier, Kitty Verhoeckx
Insects represent an alternative for meat and fish in satisfying the increasing demand for sustainable sources of nutrition. Approximately two billion people globally consume insects. They are particularly popular in Asia, Latin America, and Africa. Most research on insect allergy has focussed on occupational or inhalation allergy. Research on insect food safety, including allergenicity, is therefore of great importance. The objective of this review is to provide an overview of cases reporting allergy following insect ingestion, studies on food allergy to insects, proteins involved in insect allergy including cross-reactive proteins, and the possibility to alter the allergenic potential of insects by food processing and digestion. Food allergy to insects has been described for silkworm, mealworm, caterpillars, Bruchus lentis, sago worm, locust, grasshopper, cicada, bee, Clanis bilineata, and the food additive carmine, which is derived from female Dactylopius coccus insects. For cockroaches, which are also edible insects, only studies on inhalation allergy have been described. Various insect allergens have been identified including tropomyosin and arginine kinase, which are both pan-allergens known for their cross-reactivity with homologous proteins in crustaceans and house dust mite. Cross-reactivity and/or co-sensitization of insect tropomyosin and arginine kinase has been demonstrated in house dust mite and seafood (e.g. prawn, shrimp) allergic patients. In addition, many other (allergenic) species (various non-edible insects, arachnids, mites, seafoods, mammals, nematoda, trematoda, plants, and fungi) have been identified with sequence alignment analysis to show potential cross-reactivity with allergens of edible insects. It was also shown that thermal processing and digestion did not eliminate insect protein allergenicity. Although purified natural allergens are scarce and yields are low, recombinant allergens from cockroach, silkworm, and Indian mealmoth are readily available, giving opportunities for future research on diagnostic allergy tests and vaccine candidates.

https://ift.tt/2HMxzEv

Spectrophotometric photodynamic diagnosis of prostate cancer cells excreted in voided urine using 5-aminolevulinic acid

Abstract

To evaluate the feasibility of photodynamic diagnosis using 5-aminolevulinic acid (PDD-ALA) for detection of prostate cancer (PCa) cells in urine samples after prostate massage in patients who were suspected to have PCa. One hundred and eighty-nine patients with abnormal digital rectal examination and/or an elevated prostate-specific antigen (PSA) level who underwent initial prostate biopsy were recruited. After prostate massage, the first 60 mL of voided urine was collected. For PDD-ALA, 50 mL was used. The rest of collected urine was used for polymerase chain reaction (PCR) of PSA and glyceraldehyde 3-phosphate dehydrogenase (GAPDH). After incubation for 2 h, the intensity was measured at 635 nm under a 405-nm wavelength excitation. The results of PDD-ALA were compared with those of an initial transrectal ultrasound (TRUS)–guided prostate biopsy. Overall, 126/189 (67%) samples that showed bands of both PSA and GAPDH on PCR in urine samples were analyzed. The area under the curve, sensitivity, and specificity of PDD-ALA were 0.74, 77, and 67%, respectively. The value of PDD-ALA was significantly higher in patients with Gleason scores of 6 (p = 0.03), 7 (p = 0.005), and 8–10 (p = 0.0002) than in those with negative biopsy results. In the multivariate analysis, high PSA density, abnormal findings on TRUS, and a high value of PDD-ALA were significant markers for prediction of positive biopsy results. PDD-ALA was useful to predict positive biopsy results in patients who underwent initial prostate biopsy with suspected PCa. This PCa-detection method has potential for clinical use.

https://ift.tt/2FFHPIW

Adoptive T cell therapy: points to consider

Cassian Yee

https://ift.tt/2wbWThJ

The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer

Abstract

Background:

Despite significant advances in the screening, detection, and treatment of preinvasive cervical lesions, invasive cervical cancer is the fifth most common cancer in European women. There are large disparities in Europe and worldwide in the incidence, management, and mortality of cervical cancer.

Objective:

The European Society of Gynecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) jointly develop clinically relevant and evidence-based guidelines in order to improve the quality of care for women with cervical cancer across Europe and worldwide.

Methods:

The ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of cervical cancer (23 experts across Europe). To ensure that the guidelines are evidence based, the current literature identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 159 international reviewers, selected through ESGO/ESTRO/ESP and including patient representatives.

Results:

The guidelines cover comprehensively staging, management, and follow-up for patients with cervical cancer. Management includes fertility sparing treatment; stage T1a, T1b1/T2a1, clinically occult cervical cancer diagnosed after simple hysterectomy; early and locally advanced cervical cancer; primary distant metastatic disease; cervical cancer in pregnancy; and recurrent disease. Principles of radiotherapy and pathological evaluation are defined.

https://ift.tt/2Ibnws1

Stability of fumonisin B 1 , deoxynivalenol, zearalenone, and T-2 toxin during processing of traditional Nigerian beer and spices

Abstract

The stability of the Fusarium mycotoxins fumonisin B₁, deoxynivalenol, T-2 toxin, and zearalenone during processing of Nigerian traditional spices (dawadawa, okpehe, and ogiri) and beer (burukutu) using artificially contaminated raw materials was investigated. Results revealed the reduction of these toxins in all the final products. Boiling played a significant role (p < 0.05) in Fusarium mycotoxin reduction in the traditional spices. The highest percentage reduction of deoxynivalenol (76%) and zearalenone (74%) was observed during okpehe processing (boiled for 12 h). Dehulling and fermentation further demonstrated a positive influence on the reduction of these toxins with a total reduction ranging from 85 to 98% for dawadawa, 86 to 100% for okpehe, and 57 to 81% for ogiri. This trend was also observed during the production of traditional beer (burukutu), with malting and brewing playing a major impact in observed reduction. In addition, other metabolites including deoxynivalenol-3-glucoside, 15-acetyl-deoxynivalenol, α-zearalenol, and β-zearalenol which were initially not present in the raw sorghum were detected in the final beer product at the following concentrations 26 ± 11, 16 ± 7.7, 22 ± 18, and 31 ± 16 μg/kg, respectively. HT-2 toxin was also detected at a concentration of 36 ± 13 μg/kg along the processing chain (milled malted fraction) of the traditional beer. For the traditional spices, HT-2 toxin was detected (12 μg/kg) in ogiri. Although there was a reduction of mycotoxins during processing, appreciable concentrations of these toxins were still detected in the final products. Thus, the use of good quality raw materials significantly reduces mycotoxin contamination in final products.

https://ift.tt/2riwcDc

To compare the effectiveness of different mouthrinses on Streptococcus mutans count in caries active children

Publication date: Available online 2 May 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Sharma Aakansha, Nidhi Agarwal, Ashish Anand, Zohra Jabin
IntroductionStreptococcus mutans is the prime microbe responsible for caries. Mouthwashes represent an effective means for decreasing their count. To ascertain this, three commercially available mouthrinses were evaluated for their antimicrobial activity.Materials and methodChlorhexidine, Sodium fluoride and Herbal mouth rinse were evaluated for their efficacy against S. mutans in 60 children aged 6–12 years old. Plain water acted as the control groupResultsThe values obtained were subjected to statistical analysis. ANOVA test, student-t test and paired t-test were used for evaluation. Chlorhexidine and fluoride showed statistically significant reduction in S. mutans count as compared to herbal rinse.ConclusionAll the mouthrinses used in the present study have shown a definite decline in S. mutans count.

https://ift.tt/2KvKSH0

Preventive orthodontic approach for functional mandibular shift in early mixed dentition: A Case Report

Publication date: Available online 3 May 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Divya S. Sharma, Samiksha Srivastava, Shobha Tandon
The case reported here highlights the importance of examination of functional occlusion along with static occlusion. Any undetected malocclusion during early mixed dentition has potency to alter the growth and function of stomatognathic system. Premature contacts in primary canine region is the most prevalent cause of functional mandibular shift and can lead to TMJ problems for the prevalence of self correction of such malocclusion is very low if not intervened. A case of functional mandibular shift due to faulty canine guidance because of premature contacts is discussed here. Selective grinding of premature contacts and myofunctional exercise resulted in well balanced centric occlusion coinciding with centric relation.

https://ift.tt/2FF7VvD

Suspected severe acute food protein-induced enterocolitis syndrome caused by cow's milk through breast milk

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated gastrointestinal food hypersensitivity, characterized by profuse vomiting, frequently associated to pallor or/and lethargy that appears within 1 to 3 hours after ingestion of the offending food. Severe cases with protracted emesis develop dehydration, hypotension and acidosis.

https://ift.tt/2FFDnda

Angioedema: systemic activation process during prodromes

The present observation sheds new light on the pathogenesis of bradykinin-mediated angioedema by showing that local involvement occurs hours after systemic kallikrein-kinin activation. Therefore, biological diagnostic workup is of greatest value when performed at the very early phase of the attack.

https://ift.tt/2KzKHdJ

The impact of patient autonomy on older adults with asthma

Understanding patient preferences and desire for involvement in making medical decisions is important when managing chronic conditions. Previous studies have utilized the Autonomy Preference Index (API) in younger asthmatic patients to evaluate these preferences.

https://ift.tt/2FFzTag

Three-dimensional evaluation of the posterior airway space: differences in computed tomography and cone beam computed tomography

Abstract

Objectives

Obstructive sleep apnea syndrome (OSAS) becomes increasingly important. For diagnosis and surgery, computed tomography (CT), and cone beam computed tomography (CB-CT) are used equally, although in most of cases, patient positioning differs between supine positioning (CT) and upright seating positioning (CB-CT). We measured volumetric and anatomical changes in the posterior airway space (PAS) between upright and supine positioning in a three-dimensional set up.

Materials and methods

Coherent CT and CB-CT scans of 55 patients were included in the study. Using Brainlab ENT 3.0, image data was superimposed, and three-dimensional models were segmented. PAS height, cross-sectional area, vertical and horizontal position of the mandible and hyoid, and volumetric analyses of the three-dimensional models were measured.

Results

PAS height and cross-sectional area were significantly higher in CB-CT compared to CT scans (p < 0.001). In the vertical dimension, the mandible and hyoid were localized more caudally in CB-CT in contrast to CT scans (p < 0.04; p < 0.001). Three-dimensional evaluation showed a greater volume of the PAS in CB-CT (p < 0.0001). Pearson correlation coefficient showed a correlation between vertical positioning of the mandible and hyoid compared to the positioning of the patient.

Conclusions

Patient positioning during CT and CB-CT has an effect on the location of anatomical structures like the mandible and hyoid and changes the dimensions and volume of the posterior airway space significantly.

Clinical relevance

The radiological technique used and the positioning of the patient should be taken into account when considering further surgical therapy.

https://ift.tt/2rjVFvW

Effect of implant macrogeometry on peri-implant healing outcomes: a randomized clinical trial

Abstract

Objectives

This randomized split-mouth clinical trial investigated the influence of implant macrogeometry on bone properties and peri-implant health parameters during the healing process.

Material and methods

Ninety-nine implants were placed bilaterally in posterior mandibles of 23 patients that received at least four dental implant macrogeometries: standard geometry, Integra (IN) and three geometries inducing "healing chamber": Duo (D), Compact (C), and Infra (IF). Insertion torque (IT) and implant stability quotient (ISQ) were measured. Peri-implant health were monitored by visible plaque index (VPI), peri-implant inflammation (PI), and presence of calculus (CC). Data were collected during 90 days. Data were assessed for normality using the asymmetry and kurtosis coefficients followed by the Shapiro-Wilk test. A one-way ANOVA was used to investigate differences in IT and linear bone dimensions between the macrogeometry groups. The repeated measurements ANOVA test or ANOVA-R was used for analysis of ISQ, VPI, and PI. Tukey-Kramer test or Student's t test was used for comparisons between the groups or within each macrogeometry.

Results

Macrogeometry did not significantly influence IT and ISQ values. The minimum ISQ was recorded after 7 days (71.95 ± 12.04, p = 0.0001). Intermediate ISQ was found after 14 days, when the ISQ reached values that are statistically identical to primary stability. The VPI showed significantly higher scores for the D (0.88 ± 1.03) and IN (0.72 ± 0.94) implants after 7 days. The PI was only influenced by the healing time significantly decreasing from 7 (1.07 ± 0.89) to 21 days (0.18 ± 0.18).

Conclusion

Implant macrogeometry did not influence IT nor ISQ values. The relationship between IT and SS was more evident for the Duo implant, but only in the final stage of healing process.

Clinical relevance

Show to the clinician that the macrogeometry and drilling protocols did not interfere in the clinical behavior of the implants during the healing process. However, the IT, primary and secondary stability, is quite dependent of the surgeon experience.

https://ift.tt/2JSJ0H9

Anthropometric and Anthroposcopic Analysis of Periorbital Features in Malaysian Population: An Inter-racial Study

Facial plast Surg
DOI: 10.1055/s-0038-1648224

In oculoplastic operations, knowledge of the dimensions of periorbital features based on age, gender, and race is essential for achieving better aesthetic result. This article seeks to determine the racial and gender differences of periorbital features among Malaysian Malay (MM), Malaysian Indian (MI), and Malaysian Chinese (MI) subjects. Evaluation of periorbital features was done on photographs of 200 MM, 200 MI, and 200 MC subjects, aged 18 to 26 years. The measured values were evaluated by an independent t-test. A significant difference was found between MM and MI in all measurements except interbrow distance in males, eyebrow thickness in females, and apex to lateral limbus distance in both sexes. Between MI and MC the difference was insignificant for interbrow distance in male groups, apex to lateral limbus distance in females, and palpebral fissure inclination and eyebrow apex angle in both sexes. Between MM and MC, significant differences were found for eyebrow thickness and medial canthus tilt in female group. Male groups showed significant difference for apex to lateral limbus and lateral canthus distance and eyebrow apex angle. Eyebrow height, palpebral fissure width, and intercanthal distance were significantly different in both sexes. Sexual dimorphism was found for all measurements in MI, but MM and MC showed insignificant difference for eyebrow apex angle. Four types of epicanthus were observed in MM and MC and three types in MI. Eyebrow apex between lateral limbus and lateral canthus was the most common position in all racial groups. Significant racial and gender differences exist for certain periorbital measurements. The knowledge of these differences is expected to influence the surgical outcome.
[...]

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

Article in Thieme eJournals:
Table of contents | Abstract | Full text

https://ift.tt/2rlMmef

Deep circumflex iliac artery perforator flap with iliac crest for oromandibular reconstruction

Mandibular reconstruction after tumor ablation is one of the challenging tasks for oral and maxillofacial surgeons because of the mandible's esthetic importance and its primary role in speech, swallowing, and chewing with the help of dentures (Farwell and Futran, 2000; Baker et al., 2001; Schimmele, 2001). Nowadays, vascularized bone grafting is a favorable option for such reconstructions.

https://ift.tt/2riMVpi

Mandibular Advancement for Pediatric Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Mandibular distraction osteogenesis and mandibular advancement, collectively referred to as mandibular advancement surgeries (MAS), have been used to treat children with mandibular insufficiency and obstructive sleep apnea (OSA). The objective is to perform a systematic review and meta-analysis for MAS as treatment for obstructive sleep apnea.

https://ift.tt/2Kwszl8

Maintenance of therapeutic response over one year using apremilast combination therapy compared to monotherapy for the treatment of plaque psoriasis: a multicenter, retrospective study

https://ift.tt/2jsYiau

Color Atlas of Oral Diseases, 4th Edition

https://ift.tt/2w5mXLs

Thirty years of submental intubation: a review

Submental intubation has been used as an alternative to conventional intubation in the field of oral and maxillofacial surgery since its introduction by Francisco Hernández Altemir in 1986. A review of submental intubation was performed using data from all case reports, case-series, and prospective and retrospective studies published between 1986 and 2016. The indications, variations in incision length, incision sites, types of endotracheal tube used, methods of exteriorization, and complications were recorded and analyzed.

https://ift.tt/2HPo4EN

Laterally positioned flap along with acellular dermal matrix graft in the management of maxillary localized recessions

Abstract

Objectives

The aim of this study was to evaluate acellular dermal matrix graft (ADM) combination with laterally positioned flap (LPF) and to compare the results with LPF alone in terms of root coverage, esthetics, and patient perspectives in gingival recessions.

Materials and methods

Twenty-two patients with localized Miller Class I/II recessions ≥ 3 mm with gingival thickness (GT) < 0.8 mm were included. Outcome parameters such as recession height and width, keratinized tissue (KT) height, GT, mean and complete defect coverage, patient satisfaction, and root coverage esthetic score (RES) were re-evaluated at 12 months postoperatively.

Results

Mean and complete defect coverage were 94.80 and 72.73% in LPF+ADM group and 77.25 and 45.45% in LPF group, respectively. Significant differences were observed for KT and GT gain, patient satisfaction, and RES in favor of LPF group (p < 0.05). A significant positive correlation was established between GT and mean defect coverage (r = 0.448; p < 0.05).

Conclusion

LPF is a successful approach in the treatment of localized Miller I/II gingival recessions. On the other hand, when thin donor tissue was thickened with an allogenic graft, more successful results regarding complete defect coverage, patient satisfaction, and RES were obtained.

Clinical relevance

Increase in gingival thickness and keratinized tissue height represents critical improvements in the prognosis of the advanced localized recessions and will be beneficial for patient's periodontal health and esthetics. Both approaches can be used successfully as an alternative for soft tissue root coverage in specific localized cases with a limited amount of keratinized tissue apical to the defect.

https://ift.tt/2IbJn2n

Measuring Knowledge of Disease Management in Adolescents with Cystic Fibrosis: Initial Psychometric Evaluation

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.

https://ift.tt/2FGScvN

NLRP3: A promising therapeutic target for autoimmune diseases

Publication date: Available online 3 May 2018
Source:Autoimmunity Reviews
Author(s): Hui-Hui Shen, Yue-Xin Yang, Xiang Meng, Xiao-Yun Luo, Xiao-Mei Li, Zong-Wen Shuai, Dong-Qing Ye, Hai-Feng Pan
NLRP3, a member of nucleotide-binding domain-(NOD)like receptor family, can be found in large varieties of immune and non-immune cells. Upon activation, the NLRP3, apoptosis-associated speck-like protein (ASC) and pro-caspase-1 would assemble into a multimeric protein, called the NLRP3 inflammasome. Then the inflammasome promotes inflammation (through specific cleavage and production of bioactive IL-1β and IL-18) and pyroptotic cell death. Previous studies have indicated the importance of NLRP3 in regulating innate immunity. Recently, numerous studies have begun to reveal their significance in autoimmune diseases, such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc) and inflammatory bowel disease (IBD). In this review, we will briefly discuss the biological features of NLRP3 and summarize the recent progression of the involvement of NLRP3 in the development and pathogenesis of autoimmune diseases, as well as its clinical implications and therapeutic potential.

https://ift.tt/2JQB8pA

Hearing loss in autoimmune disorders: Prevalence and therapeutic options

Publication date: Available online 3 May 2018
Source:Autoimmunity Reviews
Author(s): Patrizia Mancini, Francesca Atturo, Alessia Di Mario, Portanova Ginevra, Massimo Ralli, Armando De Virgilio, Marco de Vincentiis, Antonio Greco
The objective of this study was to review our current knowledge relative to the correlation between sensorineural hearing loss (SNHL) and autoimmune diseases, focusing on the prevalence of hearing loss in different pathologies and possible therapeutic approaches. A review of the literature on hearing loss in different forms of autoimmune disease has been carried out, with emphasis on incidence and prevalence of SNHL. Therapeutic protocols have been assessed including both conservative medical and rehabilitative methods. Cochlear implant outcomes have been investigated. The prevalence of hearing loss in autoimmune and immune-mediated inner ear diseases, as referred by case reports or single-center statistics, is widely variable. More difficult is the evaluation of severe/profound SNHL, usually reported in relation to cochlear implantation. Though these patients represent ideal candidates for cochlear implantation, as they become deaf after years of hearing; the associated systemic disease, the specific damage on inner ear structures and the medication taken may influence the result of cochlear implantation. The main problem is the cochlear fibrosis or ossification that has been found to affect 50% of implanted ears in patients suffering from autoimmune and immune-mediated SNHL. Hence, in the presence of severe/profound SNHL earlier implantation may be indicated before post-inflammatory obliterative changes to the cochlea.

https://ift.tt/2riJmAh

Cytokine markers of B lymphocytes in minor salivary gland infiltrates in Sjögren's syndrome

Publication date: Available online 3 May 2018
Source:Autoimmunity Reviews
Author(s): Erika P. Navarro-Mendoza, David Aguirre-Valencia, Iván Posso-Osorio, Shirley Vanessa Correa-Forero, Daniel-Felipe Torres-Cutiva, Diana Loaiza, Gabriel J. Tobón
Sjögren's syndrome (SS) is a chronic autoimmune disorder characterised by the clinical presence of sicca syndrome. SS compromises the dysfunction of exocrine glands due to the presence of focal, mononuclear cell infiltrates that surround the ducts and replace the secretory units. Abnormal expression of different cytokines and chemokines such as B-cell activating factor, CXC Motif Chemokine Ligand 13, interleukin 6 (IL-6), IL-22, and FMS-like tyrosine kinase 3 ligand as well as that of their corresponding receptors has been implicated in the inflammatory process. The severity of glandular infiltration has been suggested to be associated with the presence of extra-glandular systemic manifestations, contributing to a clinical spectrum of the most severe disease. This review describes several cytokines and chemokines associated with B lymphocytes expressed in the minor salivary gland, their chemical structures, and their roles in SS as possible early predictors of lymphoma development and disease progression.

https://ift.tt/2JR1GqZ

Mortality in systemic necrotizing vasculitides: A retrospective analysis of the French Vasculitis Study Group registry

Publication date: Available online 3 May 2018
Source:Autoimmunity Reviews
Author(s): Sabine Jardel, Xavier Puéchal, Alain Le Quellec, Christian Pagnoux, Mohamed Hamidou, François Maurier, Olivier Aumaitre, Achille Aouba, Thomas Quemeneur, Jean-François Subra, Vincent Cottin, Jean Sibilia, Pascal Godmer, Patrice Cacoub, Anne Laure Fauchais, Eric Hachulla, Delphine Maucort-Boulch, Loïc Guillevin, Jean-Christophe Lega
ObjectiveThe aim of the study was to describe the evolution of mortality and cause-specific mortality over time in patients with systemic necrotizing vasculitides (SNV), including polyarteritis nodosa (PAN), granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA).MethodsPatients with SNV from the French Vasculitis Study Group registry were divided into 5 groups according to the date of diagnosis: <1980, 1980–1989, 1990–1999, 2000–2010, and ≥ 2010. The causes of death were classified as vasculitis, infection, cardiovascular, malignancy, miscellaneous, or unknown.ResultsAmong the 2217 patients included (PAN 16.1%, GPA 41.7%, EGPA 22.6%, MPA 19.6%), overall incidence of death was 2.26 per 100 person-years. The overall survival improved during each period considered. The 5-year survival rate increased from 72.2% (95% confidence interval [CI] 59.7–87.2) for patients diagnosed before 1980 to 94.5% (95% CI 90.4–98.8) after 2010 (p < 0.001). Periods of diagnosis, age, and male gender were independently associated with a poor survival with a non-significant difference between vasculitis. The incidence of mortality between the 1980s and after 2010 significantly decreased for vasculitis-related (p = 0.03) and cardiovascular-related deaths (p = 0.04). Incidence of death by infection remained stable between the 1980s and the 2000s but no death by infection occurred after 2010. The incidence of death by malignancy remained stable over time.ConclusionOverall survival of SNV patients has improved since the 1980s with the decrease of vasculitis- and cardiovascular-related deaths, but cancer-related mortality remained stable. These results highlight malignancy as the current target to improve the overall prognosis.

https://ift.tt/2rjCXoc

Inflammation and atherosclerosis: Cardiovascular evaluation in patients with autoimmune diseases

Publication date: Available online 3 May 2018
Source:Autoimmunity Reviews
Author(s): Ricardo O. Escárcega, Michael J. Lipinski, Mario García-Carrasco, Claudia Mendoza-Pinto, Jose Luis Galvez-Romero, Ricard Cervera
Evidence now indicates that inflammation contributes considerably to the initiation and progression of atherosclerosis and active inflammatory processes may trigger plaque rupture and enhance the risk of coronary thrombosis leading to a clinical ischemic event. Interest in characterizing inflammatory markers that predict clinical events have dominated clinical investigation. Such markers include C-reactive protein, Fibrinogen and a number of interleukins.Human macrophages avidly phagocytize cholesterol crystals. These cholesterol crystals induce a dose-dependent secretion of mature Interleukin 1-beta (IL-1β) from human monocytes and macrophages (an NLRP3 inflammasome-mediated pathway). Since IL-1β production leads to increased levels of IL-6 and C-reactive protein, this could be a mechanistic link between early deposition of cholesterol crystals within the vessel wall to the macrophage–monocyte interactions that initiate fatty streaks and promote local atherosclerotic progression. We have entered a time where a pure anti-inflammatory drug without significant effects on lipids or any other traditional cardiovascular risk factor decreased cardiovascular events. Patients with autoimmune diseases are at increase cardiovascular risk. In this review we describe the link between inflammation and atherosclerosis. Furthermore we explore the data regarding primary prevention, cardiac imaging for risk stratification and the implications of targeting inflammation in patients with autoimmune disease.

https://ift.tt/2JQK5Q2

The SLAM family receptors: Potential therapeutic targets for inflammatory and autoimmune diseases

Publication date: Available online 3 May 2018
Source:Autoimmunity Reviews
Author(s): Matthew Dragovich, Adam Mor
The signaling lymphocytic activation molecule (SLAM) family is comprised of nine distinct receptors (SLAMF1 through SLAMF9) that are expressed on hematopoietic cells. All of these receptors, with the exception of SLAMF4, are homotypic by nature as downstream signaling occurs when hematopoietic cells that express the same SLAM receptor interact. The SLAM family receptor function is largely controlled via SLAM associated protein (SAP) family adaptors. The SAP family adaptors consist of SAP, Ewing sarcoma associated transcript (EAT)-2, and EAT-2-related transducer (ERT). These adaptors associate with the cytoplasmic domain of the SLAM family receptors through phosphorylated tyrosines. Defects in SLAM family members and SAP adaptors have been implicated in causing immune deficiencies. This is exemplified in patients with X-linked lymphoproliferative (XLP) disease, where SAP undergoes a loss of function mutation. Furthermore, evidence has been accumulating that SLAM family members are potential targets for inflammatory and autoimmune diseases. This review will discuss the structure and function of the SLAM family receptors and SAP family adaptors, their role in immune regulation, and potential approaches to target this family of receptors therapeutically.

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Disease course and long-term outcome of juvenile localized scleroderma: Experience from a single pediatric rheumatology Centre and literature review

Publication date: Available online 3 May 2018
Source:Autoimmunity Reviews
Author(s): Giorgia Martini, Gloria Fadanelli, Anna Agazzi, Fabio Vittadello, Alessandra Meneghel, Francesco Zulian
Juvenile Localized Scleroderma (JLS) is a rare disorder that may cause severe aesthetic sequelae and functional disability. To date, data on natural history and long-term outcome are discordant and difficult to compare due to the heterogeneity of clinical subtypes, treatments and methods to evaluate activity and outcome in previous studies.A retrospective and cross-sectional study including 133 patients followed between January 1991 and December 2016 was conducted at our Pediatric Rheumatology Centre. Disease course was drawn by retrospective analysis of patients' clinical features, treatment, disease course and outcome at the last evaluation. Disease activity and severity of tissue damage were assessed by using parameters derived from the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) and thermography. Most patients achieved complete remission, as only 12.5%, all with the linear subtype, had still active disease after over 10 years of follow-up. At least one disease relapse occurred in 22.2% of patients and first flare was observed 20 months after first treatment discontinuation. Mild tissue damage was observed in more than half of patients, in 25.4% was moderate and in 23.0% severe; 19.8% presented a functional limitation. The entity of skin and subcutaneous fat loss established at the early stages of the disease as 27.8% of patients with shorter disease duration had severe damage and the rates remained constant in patients with longer follow-up. The delay in start of systemic treatment was associated with longer disease activity and higher relapse rate. Patients with linear scleroderma (LS), pansclerotic morphea (PM) and mixed subtype (MS) presented more severe aesthetic and functional damage but did not differ from other subtypes as for rate of complete remission.JLS in some patients can be a very aggressive disease with persistent activity after >10 years and/or several disease relapses. As tissue damage establishes early in disease course a prompt diagnosis and start of appropriate treatment is crucial to control inflammation, to limit and stabilize damage, before it become irreversible. Clinicians must be aware that children with JLS may present disease reactivation so it is important to closely follow-up patients, particularly in the first 2 years after discontinuation of treatment when disease relapses may occur more frequently.

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Emerging role of IL-35 in inflammatory autoimmune diseases

Publication date: Available online 3 May 2018
Source:Autoimmunity Reviews
Author(s): Lin-Chong Su, Xiao-Yan Liu, An-Fang Huang, Wang-Dong Xu
Interleukin 35 (IL-35) is the recently identified member of the IL-12 family of cytokines and provides the possibility to be a target for new therapies for autoimmune, inflammatory diseases. It is composed of an α chain (p35) and a β chain (EBI3). IL-35 mediates signaling by binding to its receptors, activates subsequent signaling pathways, and therefore, regulates the differentiation, function of T, B cells, macrophages, dendritic cells. Recent findings have shown abnormal expression of IL-35 in inflammatory autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, type 1 diabetes, psoriasis, multiple sclerosis, autoimmune hepatitis, experimental autoimmune uveitis. In addition, functional analysis suggested that IL-35 is critical in the onset and development of these diseases. Therefore, the present study will systematically review what had been occurred regarding IL-35 in inflammatory autoimmune disease. The information collected will help to understand the biologic role of IL-35 in immune cells, and give information about the therapeutic potential of IL-35 in these diseases.

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Positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging of macrophages in large vessel vasculitis: Current status and future prospects

Publication date: Available online 3 May 2018
Source:Autoimmunity Reviews
Author(s): William Febry Jiemy, Peter Heeringa, Jan A.A.M. Kamps, Conny J. van der Laken, Riemer H.J.A. Slart, Elisabeth Brouwer
Macrophages are key players in the pathogenesis of large-vessel vasculitis (LVV) and may serve as a target for diagnostic imaging of LVV. The radiotracer, ¹⁸F-FDG has proven to be useful in the diagnosis of giant cell arteritis (GCA), a form of LVV. Although uptake of ¹⁸F-FDG is high in activated macrophages, it is not a specific radiotracer as its uptake is high in any proliferating cell and other activated immune cells resulting in high non-specific background radioactivity especially in aging and atherosclerotic vessels which dramatically lowers the diagnostic accuracy. Evidence also exists that the sensitivity of ¹⁸F-FDG PET drops in patients upon glucocorticoid treatment. Therefore, there is a clinical need for more specific radiotracers in imaging GCA to improve diagnostic accuracy. Numerous clinically established and newly developed macrophage targeted radiotracers for oncological and inflammatory diseases can potentially be utilized for LVV imaging. These tracers are more target specific and therefore may provide lower background radioactivity, higher diagnostic accuracy and the ability to assess treatment effectiveness. However, current knowledge regarding macrophage subsets in LVV lesions is limited. Further understanding regarding macrophage subsets in vasculitis lesion is needed for better selection of tracers and new targets for tracer development. This review summarizes the development of macrophage targeted tracers in the last decade and the potential application of macrophage targeted tracers currently used in other inflammatory diseases in imaging LVV.

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Non-glucocorticoid drugs for the treatment of Takayasu's arteritis: A systematic review and meta-analysis

Publication date: Available online 2 May 2018
Source:Autoimmunity Reviews
Author(s): Lillian Barra, Grace Yang, Christian Pagnoux
BackgroundTakayasu's Arteritis (TAK) affects mostly young women and causes significant morbidity. Most patients are refractory to glucocorticoids (GC) or relapse when GC doses are reduced. The objective of this study is to summarize the literature pertaining to the effectiveness of non-GC drugs for the treatment of TAK.MethodsMEDLINE and Embase were searched for English-language studies of TAK patients with a sample size >5. Studies were included if the effectiveness of non-GC drugs for the treatment of TAK was reported. Random effects meta-analyses of various effect measures were performed.ResultsOf the 915 studies identified by the search, 14 of small molecule immunosuppressants (IS) and 25 of biologic therapies were included. Studies had a high risk of bias. Pooled remission rates were similar for both categories of non-GC drugs: 58% (95% CI: 40–74%) and 64% (95% CI: 56–72%), respectively. The relapse rate was 54% (95% CI: 39–68%) for IS therapies and 31% (95% CI: 22–41%) for biologics. Both significantly decreased GC doses and acute phase reactants. Observational studies suggested that anti-TNF agents were more effective than IS at maintaining remission. Randomized-controlled trials (RCTs) of biologics were of small sample size: abatacept was not effective and the trial of tocilizumab was underpowered to detect a difference in time to relapse versus placebo. Serious adverse events were uncommon.ConclusionsNon-GC agents were moderately effective in inducing remission in TAK, but relapse rates were high. Larger, better designed studies are required to determine the optimal treatment regimen for TAK.

https://ift.tt/2JOELwm

Association of Obstructive Sleep Apnea With Calvarial and Skull Base Thinning

This cohort study examines the association of obstructive sleep apnea in adults with intracranial bone (calvaria and skull base) thickness.

https://ift.tt/2JM8q9m

Blood Pressure Changes After Adenotonsillectomy in Children With Obstructive Sleep Apnea—Reply

In Reply We appreciate Dr Ghadami for his well advised comments. We are obliged for the keen interest taken in our study that compared the association of adenotonsillectomy with blood pressure (BP) in nonhypertensive vs hypertensive children with obstructive sleep apnea (OSA). We demonstrated that after adenotonsillectomy children with OSA showed improvement in diastolic BP, and our subgroup analysis revealed that hypertensive children with OSA had significant improvement in all BP measurements. Increasing evidence suggests that childhood OSA correlates with hypertension and sequential cardiovascular morbidities. Our results highlight the importance of screening children with OSA and appropriately treating these children to ease their OSA symptoms and potentially prevent future adverse cardiovascular outcomes.

https://ift.tt/2IaYhWN

Response Time to Nurse Triage Phone Calls in a Tertiary Care Pediatric Otolaryngology Practice

This quality-improvement study analyzes a collaborative team approach to determine the optimal time for triage callback to families and attempts to define an optimal process that would allow more rapid response time for calls needed to escalate to the patient's managing surgeon.

https://ift.tt/2JNREH8

Proton Pump Inhibitor Use and Outcomes in Children With Respiratory Symptoms

This Viewpoint discusses proton pump inhibitor use and outcomes among children without gastroesophageal reflux in light of the growing body of adult and pediatric literature highlighting the association of proton pump inhibitor use with the risk of fractures, infections, renal disease, cardiac disease, and even death.

https://ift.tt/2rgSzZM

Blood Pressure Changes After Adenotonsillectomy in Children With Obstructive Sleep Apnea

To the Editor Obstructive sleep apnea (OSA), which is mainly characterized by repetitive airway obstructions, intermittent hypoxia and arousals, occurs in 1% to 4% of children. Whereas OSA in adults is predominantly attributed to obesity, in children airway obstruction is mainly associated with adenotonsillar hypertrophy. Growing evidence has demonstrated that children with OSA, similar to adults, are affected by cardiovascular diseases, with cumulative reports on association between pediatric OSA and the development of hypertension and impaired nocturnal blood pressure (BP) dipping and BP variability. Treatment of OSA in children by adenotonsillectomy is associated with gradual improvement in elevated BP.

https://ift.tt/2JPfr9v

7th International Symposium on Molecular Allergology (ISMA 2017)

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Folgen für Kinder nach zytotoxischer Therapie in der Schwangerschaft

Zusammenfassung

Hintergrund

Eine bösartige Erkrankung in der Schwangerschaft ist selten, tritt jedoch zunehmend häufiger auf, da das Alter von Erstgebärenden zunimmt. Mit einer notwendigen Therapie soll nicht bis zum Ende der Schwangerschaft gewartet werden. Das Wissen über die Folgen einer Chemotherapie in der Schwangerschaft basiert allerdings lediglich auf Fallberichten, kleinen Serien und relativ kurzen Nachbeobachtungszeiträumen.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed sowie einer Auswertung von Expertenempfehlungen.

Ziel

Der Beitrag fasst die vorhandene Evidenz bezüglich Kurz- und Langzeitfolgen für Kinder nach Chemotherapieexposition in utero zusammen.

Schlussfolgerungen

Eine Chemotherapie in der Schwangerschaft hat nach Abschluss des ersten Trimesters geringe Folgen für die Kinder. Frühgeburten sind häufiger, jedoch meist iatrogen bedingt und sollten auf Grund der erhöhten neonatalen Morbidität möglichst vermieden werden. In den vorhandenen Daten zeigt sich kein negativer Einfluss einer Chemotherapie auf die neurologische und kognitive Entwicklung der Kinder. Auch zeigen vorhandene Langzeitdaten keine erhöhten kardialen Risiken. Zusätzliche Studien sind jedoch notwendig, um die Risiken einer Chemotherapie während der Schwangerschaft weiter einzuschätzen, iatrogene Frühgeburten zu vermeiden und die Langzeitfolgen im Erwachsenenalter, insbesondere für neu entwickelte Chemotherapeutika, dessen Einsatz in der Schwangerschaft noch nicht untersucht wurde, zu verstehen.

https://ift.tt/2jvy1sp

Αρχειοθήκη ιστολογίου

Πέμπτη 3 Μαΐου 2018

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