Restoration of an academic historical gross pathology collection—refreshed impact on current medical teaching?

Abstract

The declaration of Leiden pronounces the demand to conserve pathological-anatomical collections as cultural heritage. Likewise, the Institute of Pathology of the Friedrich-Alexander-University Erlangen-Nuremberg owns macroscopic pathological-anatomical specimens reaching back over 150 years. The purpose of this work is to examine the impact, meaning, and perception of such historical preparations during the current medical curriculum. Additionally, the experiences from the renovation process can be used as a template for other institutes. All preparations were documented, photographed, and catalogued in an electronic database. During a restoration period, a series of didactically suitable specimens were professionally restored. Hereby, the help of a special course of interested students was admitted. In a second step, the specimens were integrated into the regular teaching of students in macroscopic pathology. An evaluation was carried out on two student cohorts with and without historical specimens by means of a questionnaire with 23 items and two free text fields. In total, 1261 specimens were registered covering diseases from almost the complete human body with a strong representation of the cardiovascular, urinary, gastrointestinal, and central nervous systems. Hereby, exceptional rare and untreated cases with medical relevance could be found and stepwise implemented into the curriculum. The student evaluation positively addressed that the courses became livelier and interactive. Furthermore, a more comprehensive overview and a better understanding of the macroscopic pathology were appreciated. However, more self-study time with the specimen was demanded. The authenticity of historical specimens contrasts with the tendency to carry out virtual "online" didactic methods. The stereoscopic view on often untreated and, therefore, unbiased cases enhances a skill-oriented deeper understanding of diseases. In conclusion, historical specimens regain interest and even didactic value, especially in an era of declining autopsy rates.

https://ift.tt/2wsa7XY

Bond strength of adhesive systems to sound and demineralized dentin treated with bioactive glass ceramic suspension

Abstract

Objective

The objective of this study was to evaluate the effect of a Biosilicate®, associated with dentin adhesive system, on microtensile bond strength (μTBS) to sound and demineralized dentin.

Materials and methods

Eighty sound-extracted molars had their middle occlusal dentin exposed. In forty teeth, dentin was artificially demineralized (pH cycling). Sound and demineralized dentin teeth were separated into four groups (n = 10), according to the substrate treatment before restoration: Group 1—total-etching adhesive Adper TM Single bond 2 (ASB) + Biosilicate®, Group 2—ASB (without Biosilicate®), Group 3—AdheSE self-etching adhesive system (AdSE) + Biosilicate®, and Group 4—AdSE (without Biosilicate®). Each tooth was restored with a hybrid composite and stored in water at 37 °C for 6 months. After water aging, teeth were cut in sticks (≈ 1 mm² cross-sectional area) and all samples were submitted to μTBS test. The fracture modes of the samples were analyzed by stereomicroscopy. The representatively fractured samples were observed by scanning electron microscopy. Representative samples of each group were analyzed on energy dispersive X-ray spectrometry (EDX). The μTBS and Ca-P ratio values were analyzed by 2-way ANOVA, Bonferroni, and Tukey test, respectively, p < .05.

Results

ASB + Biosilicate® presented the highest μTBS values (p < .05), and lowest μTBS values (p < .05) were found in AdSE Group. There was no statistical difference (p < .05) on μTBS when substrates were compared, except for Group 2. The fracture pattern analysis showed prevalence of adhesive fractures in all groups.

Conclusion

Biosilicate® enhanced bond strength of self-etching and etch-and-rinse adhesives to sound and demineralized dentin.

Clinical relevance

Bioactive glass ceramic suspension could be recommended to be used to improve the dentin bond strengths of the total-etching and self-etching adhesives after acid-etching and priming.

https://ift.tt/2IryrOw

Gingival crevicular fluid levels of human beta-defensin-1 in type 2 diabetes mellitus and periodontitis

Abstract

Objectives

Human β-defensin (hBD)-1 is an important gatekeeper of the gingiva against constant bacterial challenge, and glucose levels are involved in its optimal expression. The aims of the study were to investigate hBD-1 levels in gingival crevicular fluid (GCF) and to compare these levels between type 2 diabetics with or without periodontitis and healthy individuals.

Materials and methods

Altogether, 81 subjects were included in the study: 21 subjects with type 2 diabetes mellitus (T2DM) suffering from generalized periodontitis (T2DM + GP), 18 systemically healthy generalized periodontitis patients (GP), 18 periodontally healthy T2DM subjects (T2DM + H), and 24 systemically and periodontally healthy subjects (control). Plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded, and GCF samples were collected. hBD-1 levels in GCF were measured using ELISA.

Results

hBD-1 levels were significantly reduced in the T2DM + GP and GP groups. Although PI and GI scores were similar in both periodontally healthy groups, hBD-1 levels were lower in the T2DM + H group. In the whole population, hBD-1 levels correlated negatively with all periodontal parameters.

Conclusions

Both diabetes and periodontitis affect hBD-1 levels in GCF.

Clinical relevance

The altered levels of hBD-1 in GCF of diabetics might be associated with the susceptibility of diabetics to periodontitis.

https://ift.tt/2wuvWpF

Cost assessment of a new oral care program in the intensive care unit to prevent ventilator-associated pneumonia

Abstract

Objectives

Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP.

Materials and methods

In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital's point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…).

Results

A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program.

Conclusion and clinical relevance

Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable.

Trial registration

NCT02400294

https://ift.tt/2ItRU0R

Evaluation of implant screw loosening by resonance frequency analysis with triaxial piezoelectric pick-up: in vitro model and in vivo animal study

Abstract

Objective

The aim of this study was to evaluate implant screw loosening using resonance frequency (RF) analysis with triaxial piezoelectric pick-up in vitro and in vivo.

Methods

For the in vitro experiment, a titanium implant was inserted into a mandibular model. The abutment screws were tightened to 10 N torque and loosened from 0 to 90° for RF measurement using 13 different screw conditions. In the in vivo experiment, three titanium implants were installed in each tibia of a New Zealand white rabbit, and the RF values were recorded after 8 weeks. For the RF analyses, a small 3D accelerometer was mounted rigidly onto the implant abutment, and impulsive vibration was directly applied to the abutment to vibrate the implant in a direction perpendicular to the tibia and implant (x-axis). The y-axis was defined as parallel to the tibia. The RF values of the x- and y-axis directions (RF-X and RF-Y) were used for evaluation.

Results

The RF values significantly decreased according to the degree of screw loosening (p < 0.05, ANOVA). In the in vitro model, RF-Y with x- and y-axis vibrations (RF-Yx and RF-Yy) significantly differed from the initial value at 10 and 15°, respectively (p < 0.05, Dunnett's test). In the in vivo experiment, the RF-Yy significantly differed from the initial value between 5 and 20° (p < 0.05).

Conclusion

The results suggest that RF analysis with triaxial piezoelectric pick-up can be used to detect implant screw loosening.

Clinical relevance

RF analysis with the triaxial piezoelectric pick-up can be used to detect screw loosening after mounting the superstructure.

https://ift.tt/2G1xdnS

Placement of an antibiotic oral pack on the hard palate after primary cleft palatoplasty: a randomized controlled trial into the effect on fistula rates

Abstract

Objective

The objective of this study is to determine whether placement of an antibiotic oral pack on the hard palate reduces fistula rates after primary cleft palatoplasty.

Subjects and methods

This study was a parallel blocked randomized controlled trial. The study consisted of two groups of 100 patients each with non-syndromic unilateral complete cleft lip, alveolus, and hard and soft palate that underwent primary palatoplasty. Group A had an oral pack placed on the hard palate for 5 days postoperatively while group B did not. Occurrence of fistulae between both groups was tested using odds ratios (OR).

Results

In 2% of the patients in group A, a fistula was found 6 months after palatal surgery. In contrast, in 21% of the patients in group B, a palatal fistula could be confirmed. The fistula occurrence in group A was statistically significantly lower than that in group B (OR = 0.0768, CI = [0.02 … 0.34], p < 0.001).

Conclusion

The findings of this study provide evidence that the rate of fistula formation after primary palatoplasty is significantly reduced if a pack soaked with antibiotic cream is placed on the palate postoperatively for 5 days.

Clinical relevance

The use of an antibiotic pack after cleft palate repair can be recommended to prevent occurrence of oronasal fistulae.

https://ift.tt/2jKB9R6

Micro-CT evaluation of voids using two root filling techniques in the placement of MTA in mesial root canals of Vertucci type II configuration

Abstract

Objective

The present study aims to compare two mineral trioxide aggregate (MTA) placement techniques, manual compaction and ultrasonic activation of manually compacted MTA, with warm vertical compaction (WVC) for orthograde obturation of mesial root canals of mandibular first molars showing Vertucci type II root canal configuration.

Materials and methods

Thirty roots were selected according to their micro-CT scanned images. Root canals were chemomechanically prepared using Reciproc R25 and NaOCl using EndoVac. The specimens were divided into three groups according to the root canal filling technique, as manual compaction of MTA, ultrasonic activation of manually compacted MTA and WVC using gutta-percha and AH Plus (Denstply Sirona, Ballaigues, Switzerland). Percentages of voids located in apical 3 mm and remaining coronal half until the level where separate root canals re-join within filling were calculated. Data were analyzed using the Kruskal-Wallis and Dunn's tests, and significance was set at 5%.

Results

No significant difference was found among the filling techniques regarding the percentage volume of voids at apical 3 mm (P > 0.05). At the coronal half of the isthmus, WVC produced significantly less percentage volume of voids than manual compaction of MTA (P < 0.05) and similar to ultrasonic activation group did (P > 0.05). There was no significant difference between two MTA placement techniques at the coronal half of the isthmus (P > 0.05).

Conclusions

No filling technique produced void-free fillings. The percentage of void volume was similar among groups at apical 3 mm but was different at the coronal half of the isthmus.

Clinical relevance

Warm vertical compaction and ultrasonically activated MTA fillings revealed similar quality at the isthmus area, which was superior to manually compacted MTA.

https://ift.tt/2G22rLA

Orofacial manifestations in outpatients with anorexia nervosa and bulimia nervosa focusing on the vomiting behavior

Abstract

Objective

This case-control study aims to evaluate the oral health status and orofacial problems in a group of outpatients with eating disorders (ED)—either anorexia nervosa (AN) or bulimia nervosa (BN)—further focusing on the influence of vomit.

Materials and methods

Fifty-five women outpatients with AN or BN diagnosis were invited to participate, of which 33 agreed. ED outpatients and matched controls were submitted to a questionnaire and clinical oral examination.

Results

Multivariate analysis identified a significantly higher incidence of teeth-related complications (i.e., tooth decay, dental erosion, and self-reported dentin hypersensitivity), periodontal disease, salivary alterations (i.e., hyposalivation and xerostomia), and oral mucosa-related complications in ED outpatients. Dental erosion, self-reported dentin hypersensitivity, hyposalivation, xerostomia, and angular cheilitis were found to be highly correlated with the vomiting behavior.

Conclusions

ED outpatients were found to present a higher incidence of oral-related complications and an inferior oral health status, compared to gender- and age-matched controls. Alterations verified within outpatients were acknowledged to be quite similar to those previously reported within inpatients, in both of nature and severity, thus sustaining that the cranio-maxillofacial region is significantly affected by ED, even in the early/milder forms of the condition, as expectedly verified within outpatients.

https://ift.tt/2KPJWxv

Bisphosphonates hinder osteoblastic/osteoclastic differentiation in the maxillary sinus mucosa-derived stem cells

Abstract

Objectives

Although bisphosphonates (BPs) are known to be associated with osteonecrosis of the maxilla, the precise effects of BPs on bone metabolism in human maxillary sinus mucosal cells (HMSMCs) are not yet known. The purposes of this study were to examine the effects of the BPs zoledronate (ZOL) and alendronate (ALN) on osteoblastic and osteoclastic differentiation in HMSMCs and to investigate the signaling pathways involved.

Materials and methods

The effects of ZOL and ALN were assessed for osteoblast differentiation by alkaline phosphatase (ALP) activity, alizarin red staining, and RT-PCR for genes encoding Runx2 and osterix. Receptor activator of nuclear factor-κB ligand (RANKL)-mediated osteoclast differentiation in bone marrow macrophages (BMMs) was also examined.

Results

ZOL and ALN both suppressed osteoblastic differentiation, as evidenced by their effects on ALP activity, mineralization nodule formation, and the mRNA expression levels of osteoblastic transcript factors. The RANKL/osteoprotegerin ratio in HMSMCs was increased by ALN, whereas ZOL had the opposite effect. Conditioned medium obtained from ALN-treated HMSMCs stimulated osteoclast formation and upregulated NFATc1 expression, whereas conditioned medium from ZOL-treated cells did not. ALN was more cytotoxic and stimulated apoptosis more strongly than ZOL. BPs decreased the protein levels of the non-canonical Wnt signaling protein Wnt5a and calmodulin-dependent kinase II. Moreover, recombinant human Wnt5a reversed the effects of BPs on osteoblastic and osteoclastic differentiation.

Conclusion

This study is the first demonstration that BPs exert negative effects on osteoblastic and osteoclastic processes via the non-canonical Wnt pathway in HMSMSCs.

Clinical relevance

It suggests that patients taking BPs during the period of maxillary sinus lifting and amentation should be given special attention.

https://ift.tt/2G0m0UD

23-valent pneumococcal polysaccharide vaccine elicits hierarchical antibody and cellular responses in healthy and tuberculosis-cured elderly, and HIV-1-infected subjects

Publication date: Available online 9 May 2018
Source:Clinical Immunology
Author(s): Huichang Huang, Xiaohua Qian, Rong Pan, Ling Shen, Shanshan Liang, Feifei Wang, Peng Zhang, Hongbo Shen, Zheng W. Chen
The PPV23 immunizes healthy elderly and other high-risk populations against pneumococcal disease. Immune mechanisms whereby these populations differently mount antibody(Ab) and cellular responses to PPV23 vaccination remain unknown. Here, healthy elderly, those elderly with prior tuberculosis-cured history (TB-cured), and HIV-infected humans were vaccinated with PPV23, and assessed for opsonophagocytic Ab responses and potential cellular mechanisms. PPV23 vaccination elicited hierarchical responses of opsonophagocytic Ab. PPV23-elicited Ab titers were highest in healthy elderly, significantly lower in TB-cured elderly and lowest in HIV-infected subjects. Mechanistically, high PPV23-elicited Ab titers in healthy elderly were associated with increases in CD19 + CD69+ cells and CD19 + CD138 + plasma cells. Surprisingly, TB-cured elderly failed to show PPV23-induced increases in these cells. While HIV-infected subjects showed a depressed CD19 + CD69+ cellular response, PPV23 vaccination uncovered HIV-related over-reactive increases in CD19 + CD138 + cells. For the first time, we demonstrate that PPV23-elicted opsonophagocytic Ab titers correlate with different cellular responses in healthy, TB-cured and HIV statuses.



https://ift.tt/2KSGxOe

Subgingivally delivered coenzyme Q10 in the treatment of chronic periodontitis among smokers: a randomized, controlled clinical study

Publication date: Available online 9 May 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Chetan P. Raut, Kunal S. Sethi, Bhagyashree Kohale, Alefiya Mamajiwala, Ayushya Warang
BackgroundCoenzyme Q10 is an antioxidant whose efficacy in periodontal diseases is well known. However studies regarding its efficacy in smokers with periodontitis are few. Coenzyme Q10 serves as an endogenous antioxidant and its increased concentration in the diseased gingiva effectively suppresses advanced periodontal inflammation.ObjectivesThe aim of this study is to evaluate the efficacy of coenzyme Q10 as an adjunct to scaling and root planing in smokers with chronic periodontitis.MethodsTotal of 40 patients were enrolled for the study. The subjects were divided into control (Scaling and root planing only) and test group ( Coenzyme Q10 plus Scaling and root planing). Clinical parameters such as plaque index, modified sulcular bleeding index, probing pocket depth and clinical attachment level. These were assessed at baseline, at 1 month and 3 month. The results were subjected to appropriate statistical analysis.ResultsThere was a significant improvement in all clinical parameters in the test sites seen at the end of the 1 month and 3 month period.ConclusionsCoenzyme Q10 can be said to have a beneficial effect on smokers with periodontitis when used as an adjunct to scaling and root planing.



https://ift.tt/2G0fSLW

Chronic stress and temporalis muscle activity in TMD patients and controls during sleep: a pilot study in females

Abstract

Objectives

The aim of this study was to assess the correlation between chronic stress and temporalis muscle activity during four nights.

Material and methods

Forty-four female subjects were recruited in five dental practices located in different areas of the federal state of Saarland, Germany (dental practice network in Saarland). The following inclusion criteria were used: female, aged between 18 and 65, no somatization or depression, and no pain medication, graded chronic pain status < 3. Both subjects reporting about sleep bruxism and subjects negating sleep bruxism during anamnesis were included. Anamnestic issues, sleep bruxism, anxiety, and chronic stress were assessed using validated questionnaires. Temporalis muscle activity was measured for four nights using a portable electromyographic device. Correlation coefficient was used to assess the correlation (Spearman-correlation) between chronic stress and number of temporalis muscle episodes/hour and between anxiety and the number of episodes/hour.

Results

The analysis showed that the factors "work overload" (adulthood chronic stress because of too many demands at work) and "pressure to perform" (necessity to be successful at work) were significantly correlated with the number of temporalis muscle episodes per hour. In contrast, anxiety was not correlated with temporalis muscle episodes per hour.

Conclusions

Work-related chronic stress seems to be associated with an increased level of temporalis muscle activity during sleep.

Clinical relevance

During anamnesis, work-related aspects should be assessed in females presenting with sleep-bruxism.

https://ift.tt/2KKvSFz

Comparative evaluation of three obturation techniques in primary incisors using digital intra-oral receptor and C.B.C.T—an in vitro study

Abstract

Objectives

Successful pulpectomy in primary teeth depends on quality of obturation. It can be evaluated using digital intra-oral receptor (D.I.O.R) and cone beam computed tomography (C.B.C.T). The purposes of this study were to compare 3 different obturation techniques such as lentulospiral, insulin syringe, and endodontic plugger in primary incisors and to evaluate its quality of obturation using D.I.O.R and C.B.C.T technique.

Materials and methods

Thirty-three extracted primary incisors were biomechanically prepared and obturated with zinc oxide eugenol cement by 3 different obturation techniques. The obturation was evaluated for length of obturation and voids using D.I.O.R and C.B.C.T methods.

Results

There was a statistically significant difference between all the groups in length of obturation (P = 0.02) in both D.I.O.R and C.B.C.T. Significant differences (P = 0.03) were present in number of voids among 3 obturation techniques in C.B.C.T. Statistically more voids were observed with D.I.O.R in lentulospiral (P = 0.04) group and in insulin syringe (P = 0.02) group.

Conclusions

Acceptable result was obtained with lentulospiral in length of obturation compared to insulin syringe and endodontic plugger technique. Insulin syringe technique resulted in increased underfilling with least number of voids. More number of voids were seen in middle one-third and least number of voids were observed at apical one third of the root among all the 3 techniques of obturation. The study concluded that void identification is improved with D.I.O.R compared to C.B.C.T.

Clinical relevance

Lentulospiral reported effective length of obturation, while insulin syringe with least number of voids. D.I.O.R (2-Dimensional) is efficient in detecting voids compared to C.B.C.T (3-Dimensional) in obturated primary teeth.

https://ift.tt/2KMEUlk

Micro-CT evaluation of different final irrigation protocols on the removal of hard-tissue debris from isthmus-containing mesial root of mandibular molars

Abstract

Objectives

This study aimed to compare four final irrigation protocols (passive ultrasonic irrigation [PUI], EndoVac, Self-Adjusting File [SAF] and EasyClean) on the removal of accumulated hard-tissue debris (AHTD) from mesial canals of mandibular molars through microcomputed tomographic (micro-CT) analysis.

Materials and methods

Forty mesial roots of mandibular molars presenting isthmuses type I or III were scanned in a micro-CT device and instrumented up to Reciproc R40 instrument. After the completion of canal preparations, root canals of each group were submitted to a final rinse using 20 mL of solution (16 mL of 5.25% NaOCl and 4 mL of 17% EDTA) in a total time of 5 min according to one of the four final irrigation protocols (n = 10): PUI, EndoVac, SAF and EasyClean operated at reciprocating motion. The sample was scanned again after canal preparation and after the use of the final irrigation protocols, and the registered data sets were examined to evaluate the percentage of AHTD. Data were statistically compared using the Tukey test with a significance level set at 5%.

Results

All groups presented a decrease on the accumulation of hard-tissue debris after the use of the final irrigation protocols (P < 0.05). No significant differences in the removal of AHTD were observed among the final irrigation protocols (P > 0.05).

Conclusions

All final irrigation protocols showed the same effectiveness in the removal of AHTD. None of them was able to render mesial canals of mandibular molars completely free from packed debris.

Clinical relevance

This study highlighted that all final irrigation protocols (PUI, EndoVac, SAF, and EasyClean) promoted a similar removal of AHTD. However, none of the final irrigation protocols was able to render mesial canals of mandibular molars completely free from packed debris.

https://ift.tt/2G0bLQ0

From human antibody structure and function towards the design of a novel Plasmodium falciparum circumsporozoite protein malaria vaccine

Hedda Wardemann | Rajagopal Murugan

https://ift.tt/2K6CU6m

Sustainable vaccine development: a vaccine manufacturer's perspective

Rino Rappuoli | Emmanuel Hanon

https://ift.tt/2wsQDCj

Less is more: similar efficacy in three sessions and seven sessions of pulsed dye laser treatment in infantile port-wine stain patients

Abstract

Port-wine stains (PWS) affect 0.3 to 0.5% of newborns and pulsed dye laser (PDL) remains the treatment of choice. However, no reliable study regarding the benefits of more frequent has been conducted. We designed the present study to evaluate whether more frequent PDL treatments in infantile patients would achieve further lightening of erythema. We prospectively investigated 20 infants with PWS. Two adjacent sites were both treated for a 12-week duration and randomly allocated to be treated for seven sessions at 2-week intervals or three sessions at 6-week intervals. The efficacy outcome 2 months after the final treatment was determined by visual and chromameter evaluation. Sixteen patients completed the study with a total of 54 treatment sites. Similar results were observed in the two groups. The average blanching rates were 42.93% (SD = 27.92%) and 43.81% (SD = 32.80%) for PDL treatments with seven and three sessions, respectively (p = 0.374). Partial recovery from the laser treatment was more frequently observed and side effects were significantly higher at 2-week follow-ups (p < 0.001), resulting in a total of 3–13 weeks for skin recovery. More frequent PDL treatments do not necessarily increase efficacy in infantile PWS patients. Considering the potential risks and added costs, this practice may not be of benefit. (Clinical trial registration number: ChiCTR-ONC-17010857)

https://ift.tt/2K6MOET

CONTRA: Postoperative Epiduralanalgesie – der Goldstandard?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 246-251
DOI: 10.1055/s-0043-104667

Die Epiduralanalgesie (EDA) kann nicht für alle Eingriffe mit mittelstarkem bis starkem Schmerzniveau der Goldstandard der Therapie sein. Die EDA ist der PCA (patientenkontrollierte Analgesie) und den oralen Analgetika in Bezug auf Reduktion der postoperativen Schmerzintensität überlegen [1]. Mögliche schwerwiegende Komplikationen sowie die höheren Kosten der EDA erfordern aber eine sorgfältige, evidenzbasierte operationsspezifische Abwägung.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Spinalanästhesie bei Sectio: hyperbares oder isobares Bupivacain?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 230-231
DOI: 10.1055/a-0588-2078

Georg Thieme Verlag KG Stuttgart · New York

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Die Bedeutung der Hämolyse in Anästhesie und Intensivmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 296-305
DOI: 10.1055/s-0043-121622

Die intravasale Hämolyse mit erhöhten Plasmakonzentrationen von zellfreiem Hämoglobin tritt nicht nur bei hämolytischen Erkrankungen auf – sie ist auch bei der Transfusion von Blutkonserven sowie bei Patienten mit ARDS, Sepsis oder kardiopulmonalem Bypass für den Krankheitsverlauf von Bedeutung. Dieser Beitrag möchte den klinisch tätigen Anästhesisten für die Relevanz der Hämolyse sowie deren Prävention und Früherkennung sensibilisieren.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Intensivmedizin: Dysphagie nach Intensivbeatmung

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 231-232
DOI: 10.1055/a-0589-4882

Georg Thieme Verlag KG Stuttgart · New York

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Patientenkontrollierte Analgesie: Methoden, Handhabung und Ausbaufähigkeit

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 270-280
DOI: 10.1055/s-0043-104665

Eine nebenwirkungsarme und patientenadaptierte Schmerztherapie ist integraler Bestandteil aller multimodalen Behandlungskonzepte, die eine schnelle und komplikationsfreie Erholung nach operativen Eingriffen ermöglichen sollen. Die patientenkontrollierte Analgesie (PCA) bietet dabei eine etablierte und sichere Option für eine individuell angepasste Schmerztherapie, die – richtig genutzt – ein hohes Maß an Patientenzufriedenheit garantiert.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Opioid-Missbrauch bei chronischen Schmerzen: Messinstrumente zur Risikoeinschätzung

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 232-234
DOI: 10.1055/a-0588-2062

Georg Thieme Verlag KG Stuttgart · New York

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Neurologisches Defizit nach intraoperativem anaphylaktischen Schock

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 314-316
DOI: 10.1055/a-0592-8364

Schlichtungsstellen für Arzthaftpflichtfragen bieten Patienten, Ärzten und Versicherern eine Möglichkeit, Arzthaftungsstreitigkeiten außergerichtlich zu klären. In der Rubrik „Fälle der Schlichtungsstelle" stellen wir abgeschlossene Fälle aus der Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern vor.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Intraoperative Anaphylaxie: Nach Behandlung kann die OP meist weitergehen

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 234-234
DOI: 10.1055/a-0588-2034

Georg Thieme Verlag KG Stuttgart · New York

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Periphere Regionalanästhesie ohne Komplikationen – Ein Traum wird wahr?!

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 252-268
DOI: 10.1055/s-0043-104664

Periphere Regionalanästhesieverfahren sind relativ sichere Verfahren der klinischen Anästhesie – dennoch können typische, meist transiente und selten sogar persistierende Komplikationen auftreten. Neben allgemeinen Komplikationen und Strategien zur Risikoreduktion widmet sich dieser Artikel akzidentellen Mitblockaden anderer nervaler Strukturen am Beispiel des Plexus brachialis. Ein Ausblick in die Zukunft informiert über selektivere Blockaden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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https://ift.tt/2rwfArS

Postoperative Schmerztherapie: Wie gehtʼs uns denn heute?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 235-236
DOI: 10.1055/a-0588-5760

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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https://ift.tt/2wsIr51

Organisation der perioperativen Schmerztherapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 282-294
DOI: 10.1055/s-0043-104671

Organisatorische Aspekte der postoperativen Schmerztherapie werden oft vernachlässigt – dabei sind sie ebenso wichtig wie Details zu pharmakologischen oder regionalanalgetischen Verfahren. Anhand virtueller Fragen und Erfahrungen eines Assistenzarztes beleuchten wir in diesem Artikel die „Organisation der perioperativen Schmerztherapie": Schmerzerfassung und Dokumentation, Patienteninformation und -edukation, Aufgaben eines Akutschmerzdienstes.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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PRO: Epiduralanalgesie – Goldstandard bei abdominalen und thorakalen Eingriffen

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 237-244
DOI: 10.1055/s-0043-104668

Die Kombination aus thorakaler Epiduralanalgesie (TEA) und Allgemeinanästhesie hat sich bei großen abdominellen und thorakalen Operationen aufgrund der ausgezeichneten Analgesiequalität bewährt 1. Komplikationen sind selten, aber potenziell schwerwiegend – sie müssen rasch erkannt und therapiert werden. Daher sollte die TEA in ein den gesamten perioperativen Verlauf umfassendes Konzept integriert sein, wie es in diesem Beitrag vorgestellt wird.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Transfusion in der Herzchirurgie: liberal oder restriktiv?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 229-230
DOI: 10.1055/a-0589-4915

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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https://ift.tt/2ru9Kr4

Kasuistik: Opioidtherapie bei chronischem Rückenschmerz

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 306-313
DOI: 10.1055/s-0043-115205

Ein 76-jähriger stellt sich mit chronischen lumbalen Rückenschmerzen vor, die trotz hochdosierter Opioidtherapie nicht suffizient behandelt sind. Nach Ausschluss spezifischer Ursachen konnte im Rahmen eines multimodalen tagesklinischen Behandlungsprogramms für Senioren die Opioidtagesdosis von 480 mg auf 28 mg Morphinäquivalent und die initiale hohe Schmerzintensität von 7 auf 4 Punkte auf einer numerischen Rangskala erfolgreich reduziert werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Ausgedehnte Raumforderung des Parapharyngealraums

Laryngo-Rhino-Otol
DOI: 10.1055/a-0601-6954

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

https://ift.tt/2I7unzf

Sinonasal adenoid cystic carcinoma-role of on-site FNAC: a case report

Abstract

Background

Adenoid cystic carcinoma (ACC), a rare tumor of epithelial cell origin, commonly arises from the major salivary glands. Uncommonly it may be found outside the salivary glands and it's especially rare in the nasal cavity.

Case presentation

A 71-year female had complaints of swelling at the base of nose, Fine needle aspiration (FNA) from the swelling revealed features of adenoid cystic carcinoma; cell block & IHC for CD-117 was positive.

Conclusions

Sino-nasal ACC (SNACC) continues to pose diagnostic and therapeutic challenges to clinicians. Due to its rarity & vague presentation, early diagnosis requires a high index of suspicion. FNA can be used as an invaluable diagnostic tool in the evaluation of these lesions. Since it's incidence in sinonasal region is rare; our attempt to report this case will heighten the physician's awareness of this disease, helping further treatment.

https://ift.tt/2jJaxjh

The evaluation of MTA and Biodentine as a pulpotomy materials for carious exposures in primary teeth

Abstract

Objective

This study examined the effects of MTA and Biodentine on the clinical and radiographic success rates of pulpotomies performed on primary teeth with carious pulp exposures.

Materials and methods

This study was conducted with 44 mandibular primary molars requiring vital pulpotomy. Carious dentin surrounding the exposure site was used as the inclusion criteria for all teeth, which were randomly divided into two groups according to pulpotomy material [MTA group (n = 24), Biodentine group (n = 20)]. Treatment was followed up clinically and radiologically for 24 months. Pulp canal obliteration was not regarded as a failure.

Results

Clinical and radiographic success rates at the end of 24 months were 100% for the MTA group and 89.4% for the Biodentine group. Success rates did not vary significantly between the groups (p = 0.646). Pulp canal obliteration was observed in two teeth (8.3%) in the MTA group at 6 months, but the teeth were found to be stabilized by 24 months.

Conclusion

The long-term clinical and radiographic success rates obtained in this study indicate that both MTA and Biodentine are appropriate options for pulpotomy treatment of primary teeth with carious exposure in patients whose teeth should be retained for long periods of time.

Clinical relevance

The etiology of exposure determines pulpal response, making it crucial to distinguish between mechanical and carious exposures. The carious exposure is presumed to be accompanied by severe inflammation, which makes the prognosis of treatment unpredictable. Biomaterials can be used especially in cases with carious pulp exposures.

https://ift.tt/2G23tHi

Gelfoam haemostatic agent with or without autologous bone marrow-derived stem cells for the regeneration of critical-size mandibular defects in the rabbit

This study evaluated the effect of Gelfoam sponge with and without autologous bone marrow-derived stem cells (BMSCs) on bone regeneration in critical-size mandibular defects. The study involved 56 New Zealand rabbits assigned to four groups (14 in each). The osseous defects in group I were irrigated with normal saline, those in group II were grafted with autogenous tibial bone, and those in group III were filled with Gelfoam sponge. Group IV defects were treated as for group III, but the interface between the Gelfoam sponge and bone surface was injected with BMSCs.

https://ift.tt/2woX8WM

Surgical management of patients with Eagle syndrome

Eagle syndrome, a spectrum of disease resulting from an elongated styloid process and/or calcified stylohyoid ligament, lacks standardized recommendations regarding indications for surgical intervention and approach.

https://ift.tt/2I6kNAI

A hybrid technique to address exposure keratopathy secondary to facial nerve paresis: A combination of a lateral tarsorrhaphy and lateral wedge resection

To present the results of treating combined lower eyelid laxity, retraction and midface descent secondary to facial nerve weakness with a hybrid surgical procedure.

https://ift.tt/2rwO64E

Factors Affecting Speech Reception in Background Noise with a Vocoder Implementation of the FAST Algorithm

Abstract

Speech segregation in background noise remains a difficult task for individuals with hearing loss. Several signal processing strategies have been developed to improve the efficacy of hearing assistive technologies in complex listening environments. The present study measured speech reception thresholds in normal-hearing listeners attending to a vocoder based on the Fundamental Asynchronous Stimulus Timing algorithm (FAST: Smith et al. 2014), which triggers pulses based on the amplitudes of channel magnitudes in order to preserve envelope timing cues, with two different reconstruction bandwidths (narrowband and broadband) to control the degree of spectrotemporal resolution. Five types of background noise were used including same male talker, female talker, time-reversed male talker, time-reversed female talker, and speech-shaped noise to probe the contributions of different types of speech segregation cues and to elucidate how degradation affects speech reception across these conditions. Maskers were spatialized using head-related transfer functions in order to create co-located and spatially separated conditions. Results indicate that benefits arising from voicing and spatial cues can be preserved using the FAST algorithm but are reduced with a reduction in spectral resolution.

https://ift.tt/2I3u3WD

The Validity of Pyoderma Gangrenosum ICD9-CM Coding in Hospital Administrative Datasets

https://ift.tt/2wqUU9r

Transforming acne care by pediatricians: An interventional cohort study

https://ift.tt/2ryymyL

Knowledge of melanoma and non-melanoma skin cancer among general dermatology patients

https://ift.tt/2KbcT62

Reply to: Comment on “Vitamin D deficiency in patients with alopecia areata: A systematic review and meta-analysis”

https://ift.tt/2ru36B8

Comparison of long term cosmetic outcomes for different treatments of superficial basal cell carcinoma

https://ift.tt/2wqUQGJ

Psoriatic patients with chronic viral hepatitis do not have an increased risk of liver cirrhosis despite long-term methotrexate use: real-world data from a nationwide cohort study in Taiwan.

Prior studies have shown that methotrexate may lead to liver cirrhosis in psoriatic patients. Real-world data show that long-term methotrexate use is not associated with an increased risk of liver cirrhosis among psoriatic patients with chronic viral hepatitis. Methotrexate may be a treatment option in psoriatic patients with chronic viral hepatitis.

https://ift.tt/2rxuQ7G

Serum vitamin D level and disease severity of alopecia areata: a meta-regression analysis

https://ift.tt/2K4LXVp

The Challenges of Big Data in Dermatology

https://ift.tt/2ryynTl

Title: Benzoyl Peroxide Gel Stains Synthetic Fabrics less than Cotton

https://ift.tt/2K5kJy0

Store and Forward Teledermatology Improves Dermatology Knowledge Among Referring Primary Care Providers: A Survey-Based Cohort Study

https://ift.tt/2rwL80N

Research letter: Changes in melanoma diagnosis after pre-surgical tertiary care center review

https://ift.tt/2K4LTF9

Histomorphologic spectrum of germline-related and sporadic BAP-1 Inactivated Melanocytic Tumors

The histomorphology of BAP-1 inactivated melanocytic tumors (BIMTs) includes cases with spitzoid cytomorphology and cases with smaller epithelioid cells without spitzoid features. Approximately 12% of patients with BIMTs have germline BAP-1 mutations. BIMT patients with extensive junctional involvement of BAP-1 inactivated melanocytes, prior melanoma or BIMT may be considered for germline testing.

https://ift.tt/2rvF5cN

The association between thyroid dysfunction, thyroid autoimmunity, and clinical features of alopecia areata: a retrospective study

https://ift.tt/2wqUIad

Cavernous sinus involvement in human papillomavirus associated oropharyngeal squamous cell carcinoma: case report of an atypical site of distant metastasis

HPV-associated OSCC (HPV-OSCC) has been determined to be a distinct disease entity from non-HPV associated OSCC. Patients affected by HPV-OSCC generally have a more favourable prognosis, with improved rates of...

https://ift.tt/2wuyzry

An evaluation of in-office flexible fiber-optic biopsies for laryngopharyngeal lesions

Operative endoscopy and flexible fiber-optic in-office tissue biopsy are common techniques to assess suspicious laryngopharyngeal lesions.

https://ift.tt/2rwLvIx

Temporomandibular joint anomalies in pediatric craniofacial Gorham-Stout disease

Gorham-Stout disease (GS) is a rare and little understood bone disease that leads to the progressive replacement of the affected bone by fibrous tissues. The mandible is the most commonly affected craniofacial bone, but there is no report to date of temporomandibular joint (TMJ) lesions in this condition. We aimed to characterize the involvement of the TMJ in this uncommon bone disorder.

https://ift.tt/2rxyWw1

Predictive value of comorbidity and anemia on outcome in patients with sinonasal carcinoma

To evaluate the influence of comorbidities and anemia on outcome and survival in patients with sinonasal carcinomas.

https://ift.tt/2I3VcIH

Non-syndromic cleft lip and/or cleft palate: Epidemiology and risk factors in Lubumbashi (DR Congo), a case-control study

To determine the incidence and risk factors of occurrence of non-syndromic cleft lip and/or cleft palate (NSCLP) in Lubumbashi.

https://ift.tt/2rxewTE

Pyoderma gangrenosum on the nose

Pyoderma gangrenosum is a rare ulcerative condition associated with various systemic diseases. Lesions on the lower extremities and the trunk are common, but lesions on the nose are rare. Here we report a case of pyoderma gangrenosum on the nose. A 33-year-old woman presented with fever, nasal obstruction, and painful swelling on the nasal bridge. Physical examination revealed swellings on the nasal septal mucosa bilaterally. Computed tomography showed a septal abscess and a subcutaneous abscess on the nasal bridge.

https://ift.tt/2FZYNS8

A novel fluoroscopic method for multidimensional evaluation of swallowing function

Dynamic videofluoroscopic swallow study (VFSS) is used to investigate swallowing movements. However, it requires prolonged radiation exposure and mainly provides qualitative information. Herein, we present a multi-dimensional method for analyzing swallowing based on a pulsed, low-dose fluoroscopy technique that uses serial-shot images and evaluates the size, position, and temporal profile of the bolus to obtain a more comprehensive and realistic analysis of swallowing movements.

https://ift.tt/2KJK4i5

Factors Affecting Speech Reception in Background Noise with a Vocoder Implementation of the FAST Algorithm

Abstract

Speech segregation in background noise remains a difficult task for individuals with hearing loss. Several signal processing strategies have been developed to improve the efficacy of hearing assistive technologies in complex listening environments. The present study measured speech reception thresholds in normal-hearing listeners attending to a vocoder based on the Fundamental Asynchronous Stimulus Timing algorithm (FAST: Smith et al. 2014), which triggers pulses based on the amplitudes of channel magnitudes in order to preserve envelope timing cues, with two different reconstruction bandwidths (narrowband and broadband) to control the degree of spectrotemporal resolution. Five types of background noise were used including same male talker, female talker, time-reversed male talker, time-reversed female talker, and speech-shaped noise to probe the contributions of different types of speech segregation cues and to elucidate how degradation affects speech reception across these conditions. Maskers were spatialized using head-related transfer functions in order to create co-located and spatially separated conditions. Results indicate that benefits arising from voicing and spatial cues can be preserved using the FAST algorithm but are reduced with a reduction in spectral resolution.

https://ift.tt/2I3u3WD

The effect of transcutaneous neuromuscular electrical stimulation on laryngeal vestibule closure timing in swallowing

The purpose of this study was to investigate the effect of transcutaneous neuromuscular electrical stimulation (NMES) on the timing of laryngeal vestibule closure during the pharyngeal stage of swallowing in h...

https://ift.tt/2ryvLE4

Utility of Baseline Transaminase Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis

To the Editor We applaud the important research findings by Patel et al regarding pediatric onychomycosis. In this study, the authors appropriately conclude that routine laboratory monitoring of children during treatment with terbinafine may be unnecessary, considering (1) the low incidence of clinically significant adverse effects; (2) the costs of laboratory tests; (3) workup of spurious laboratory abnormalities; and (4) patient discomfort.

https://ift.tt/2puIDuZ

Hair Loss Associated With Cucurbit Poisoning

This case report describes a patient experiencing hair loss following cucurbit poisoning.

https://ift.tt/2GiEssx

Catalyzing Future Drug, Device, and Information Technology Breakthroughs in Dermatology

This Viewpoint announces the creation of the Advancing Innovation in Dermatology Accelerator Fund and describes its aims.

https://ift.tt/2ILIzOC

Paraffin Prosthesis

To remedy the inevitable changes that accompany the aging body, fillers have been used since the early 19th century in efforts to enhance appearance. With goals of rejuvenating and restructuring both real and perceived bodily imperfections, the development of fillers was not without its share of blunders. The story of fillers begins with the discovery of paraffin in 1830 by a German chemist named Baron Karl Ludwig von Reichenbach. He was able to create the material through the dry distillation of beechwood tar. Noting that the substance was extremely unreactive, he thought paraffin could be used as a lubricant or perhaps as a replacement for beeswax in candles. The name paraffin comes from the Latin words parum and affinis, meaning barely and affinity, respectively. In the years to follow, paraffin would take the medical community by storm.

https://ift.tt/2wqR9B0

The Potential of Behavioral Counseling to Prevent Skin Cancer

Skin cancers, ie, melanoma and keratinocyte skin cancer, are the most common cancers. The number of melanomas is expected to nearly double by 2030, tripling annual treatment costs in the United States. Because skin cancer is strongly associated with UV radiation (UVR) exposure, the Centers for Disease Control and Prevention recommend reducing unprotected exposure to UVR. The US Surgeon General issued a Call to Action to Prevent Skin Cancer, appealing for efforts to identify effective skin cancer prevention interventions.

https://ift.tt/2GNG7r9

Chronic Urticaria Associated With Methylisothiazolinone Type IV Hypersensitivity

This case report describes a patient with chronic urticaria associated with methylisothiazolinone type IV hypersensitivity.

https://ift.tt/2ptpyJh

Indoor Tanners as a Priority Population for Skin Cancer Screening

The study by Heckman et al published in this issue of JAMA Dermatology makes a significant contribution to our understanding of skin cancer screening for indoor tanners. The literature contains only a handful of studies that examined skin screening prevalence and factors that may be associated with this practice among indoor tanners. The National Health Interview Survey (NHIS), a national probability survey of the US adult population, collects data on skin screening and indoor tanning and provides a valuable opportunity to examine potential factors associated with these practices in a large sample. Results of previous studies of skin screening and indoor tanning using NHIS data have been mixed, possibly because of differences in methods and sampling. One study of 2010 NHIS data found a positive association between indoor tanning in the past year and ever having had a skin examination, whereas another study of a subsample of the 2015 NHIS data found no association.

https://ift.tt/2GxkEBH

Thyroid Function Screening in Children With Alopecia Areata

To the Editor In their recent article in JAMA Dermatology, Patel et al describe the prevalence of thyroid disorders among subgroups of children with alopecia areata (eg, those with Down syndrome), and interpret the findings as justification for screening such children. Unfortunately, the authors did not attempt to exclude children presenting with symptoms of thyroid dysfunction (eg, heat or cold intolerance, fatigue, growth abnormalities). Indeed, a category of thyroid dysfunction among the 59 patients with abnormal results was "subclinical thyroid dysfunction," implying that the other patients may have had clinical signs or symptoms of thyroid disease. Since screening, by definition, is conducted among asymptomatic individuals, the results reported by Patel et al cannot be interpreted to support or refute screening guidelines. Children with symptoms of thyroid dysfunction are more likely to receive thyroid function tests and are also more likely to have thyroid dysfunction; therefore, the true prevalence of thyroid disorders among asymptomatic children with alopecia areata who receive thyroid screening is expected to be lower than the estimates in this study. Whether the true prevalence is high enough in certain subgroups to justify screening cannot be determined from the data presented.

https://ift.tt/2v3OBId

Inpatient Dermatologists—Crucial for the Management of Skin Diseases in Hospitalized Patients

Inpatient dermatology is an emerging subspecialty focused on the care of skin diseases in hospitalized patients. Inpatient dermatologists provide expertise that the primary team and other consultative services lack. The cases encountered in hospital dermatology are often different from those seen in the traditional dermatology outpatient clinic and therefore require dermatologists with specific expertise.

https://ift.tt/2ByiFxa

Inspection—A Fine Art

https://ift.tt/2I2tegK

The Effect of Dermatology Consultation on Outcomes of Patients With Presumed Cellulitis

This randomized clinical trial examines the association of dermatologic consultation with duration of hospital stay and intravenous antibiotic treatment in patients with suspected cellulitis.

https://ift.tt/2BxYbop

Facial Neutrophilic Dermatosis Mimicking Iododerma Associated With IBD

This case report describes a patient with facial neutrophilic dermatosis mimicking iododerma and associated with inflammatory bowel disease.

https://ift.tt/2oWBOBe

Outcomes of Early Dermatology Consultation for Inpatients Diagnosed With Cellulitis

This cohort study examines the effects of dermatology consultation on misdiagnosis of cellulitis in patients admitted to emergency departments.

https://ift.tt/2C15RR2

Death by Gun Violence—Guns Are Not the Problem

To the Editor I read with interest the editorial by Bauchner et al regarding gun violence and wish to offer a different opinion. My family and I live on a farm in a rural area near Nashville, Tennessee. Crime, including violent crime, is essentially unheard of in our part of the county. I believe that this stems, in part, from the well-known fact that those of us living here are armed. We have rifles and shotguns in our homes and pistols in our vehicles and/or on our persons.

https://ift.tt/2I8LhOE

Skin Examination Patterns and Thinner Nodular vs Superficial Spreading Melanoma at Diagnosis

This cross-sectional pooled analysis analyzes the association between skin examination practices and diagnosis with thin nodular or superficial spreading melanoma.

https://ift.tt/2HKPoRh

Task Shifting in Dermatology—A Call to Action

To the Editor In response to the Evidence Synopsis by Brown et al on the practice of task shifting, we would like to highlight how task shifting is currently being successfully implemented in health programs in India, with emphasis on National Leprosy Eradication Program.

https://ift.tt/2q5q0Oq

Skin Cancer Screening Among Indoor Tanners and Nontanners

This survey study of 30 352 participants investigates the association between indoor tanning and skin cancer screening.

https://ift.tt/2GDApY0

Depression Screening in Dermatology—Think Isotretinoin

To the Editor We applaud McDonald et al for publishing "The PHQ-2 in Dermatology—Standardized Screening for Depression and Suicidal Ideation." The importance of this work cannot be overemphasized. We agree that dermatologists are uniquely situated to identify psychiatric concerns related to skin disease, and the PHQ-2 (Patient Health Questionnaire-2) is a great screening tool for this. Since we published on the use of the PHQ-2 in the context of isotretinoin, we have had positive feedback on its use and wish to reemphasize the importance in association with the article by McDonald et al. Additionally, we believe that their algorithmic approach warrants an expansion.

https://ift.tt/2pLWxsG

Sun Protection Use and Sunburn Among US Adults

This cross-sectional study using National Health Interview Survey data examined the prevalence of sun protection use and sunburn and the association between sunburn and demographic characteristics and health behaviors in the US population.

https://ift.tt/2FAdwIu

Haldi Ceremony—Historical Use of Turmeric

Long before golden lattes and turmeric face creams became popular in the West, ancient South Asian civilizations were using the native golden root as a panacea to treat everything from arthritis to indigestion to various skin conditions. Its active ingredient, curcumin, has been shown to have anti-inflammatory, antioxidant, and wound-healing properties and also influences multiple downstream signaling pathways. In addition to medicinal uses, turmeric has played an important role in South Asian cuisine and cultural practices.

https://ift.tt/2I2GrGe

Frank's Sign

Publication date: Available online 9 May 2018
Source:Acta Otorrinolaringológica Española
Author(s): Satvinder Singh Bakshi




https://ift.tt/2rri3DV

Solitary chemosensory cells producing interleukin‐25 and group‐2 innate lymphoid cells are enriched in chronic rhinosinusitis with nasal polyps

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2rxGgrp

Supra-Threshold Hearing and Fluctuation Profiles: Implications for Sensorineural and Hidden Hearing Loss

Abstract

An important topic in contemporary auditory science is supra-threshold hearing. Difficulty hearing at conversational speech levels in background noise has long been recognized as a problem of sensorineural hearing loss, including that associated with aging (presbyacusis). Such difficulty in listeners with normal thresholds has received more attention recently, especially associated with descriptions of synaptopathy, the loss of auditory nerve (AN) fibers as a result of noise exposure or aging. Synaptopathy has been reported to cause a disproportionate loss of low- and medium-spontaneous rate (L/MSR) AN fibers. Several studies of synaptopathy have assumed that the wide dynamic ranges of L/MSR AN fiber rates are critical for coding supra-threshold sounds. First, this review will present data from the literature that argues against a direct role for average discharge rates of L/MSR AN fibers in coding sounds at moderate to high sound levels. Second, the encoding of sounds at supra-threshold levels is examined. A key assumption in many studies is that saturation of AN fiber discharge rates limits neural encoding, even though the majority of AN fibers, high-spontaneous rate (HSR) fibers, have saturated average rates at conversational sound levels. It is argued here that the cross-frequency profile of low-frequency neural fluctuation amplitudes, not average rates, encodes complex sounds. As described below, this fluctuation-profile coding mechanism benefits from both saturation of inner hair cell (IHC) transduction and average rate saturation associated with the IHC-AN synapse. Third, the role of the auditory efferent system, which receives inputs from L/MSR fibers, is revisited in the context of fluctuation-profile coding. The auditory efferent system is hypothesized to maintain and enhance neural fluctuation profiles. Lastly, central mechanisms sensitive to neural fluctuations are reviewed. Low-frequency fluctuations in AN responses are accentuated by cochlear nucleus neurons which, either directly or via other brainstem nuclei, relay fluctuation profiles to the inferior colliculus (IC). IC neurons are sensitive to the frequency and amplitude of low-frequency fluctuations and convert fluctuation profiles from the periphery into a phase-locked rate profile that is robust across a wide range of sound levels and in background noise. The descending projection from the midbrain (IC) to the efferent system completes a functional loop that, combined with inputs from the L/MSR pathway, is hypothesized to maintain "sharp" supra-threshold hearing, reminiscent of visual mechanisms that regulate optical accommodation. Examples from speech coding and detection in noise are reviewed. Implications for the effects of synaptopathy on control mechanisms hypothesized to influence supra-threshold hearing are discussed. This framework for understanding neural coding and control mechanisms for supra-threshold hearing suggests strategies for the design of novel hearing aid signal-processing and electrical stimulation patterns for cochlear implants.

https://ift.tt/2FWwm7T

Persistent Auditory Nerve Damage Following Kainic Acid Excitotoxicity in the Budgerigar ( Melopsittacus undulatus )

Abstract

Permanent loss of auditory nerve (AN) fibers occurs with increasing age and sound overexposure, sometimes without hair cell damage or associated audiometric threshold elevation. Rodent studies suggest effects of AN damage on central processing and behavior, but these species have limited capacity to discriminate low-frequency speech-like sounds. Here, we introduce a new animal model of AN damage in an avian communication specialist, the budgerigar (Melopsittacus undulatus). The budgerigar is a vocal learner and speech mimic with sensitive low-frequency hearing and human-like behavioral sensitivity to many complex signals including speech components. Excitotoxic AN damage was induced through bilateral cochlear infusions of kainic acid (KA). Acute KA effects on cochlear function were assessed using AN compound action potentials (CAPs) and hair cell cochlear microphonics (CMs). Long-term KA effects were assessed using auditory brainstem response (ABR) measurements for up to 31 weeks post-KA exposure. KA infusion immediately abolished AN CAPs while having mild impact on the CM. ABR wave I, the far-field AN response, showed a pronounced 40–75 % amplitude reduction at moderate-to-high sound levels that persisted for the duration of the study. In contrast, wave I latency and the amplitude of wave V were nearly unaffected by KA, and waves II–IV were less reduced than wave I. ABR thresholds, calculated based on complete response waveforms, showed no impairment following KA. These results demonstrate that KA exposure in the budgerigar causes irreversible AN damage, most likely through excitotoxic injury to afferent fibers or synapses as in other species, while sparing ABR thresholds. Normal wave V amplitude, assumed to originate centrally, may persist through compensatory mechanisms that restore central response amplitude by downregulating inhibition. Future studies in this new animal model of AN damage can explore effects of this neural lesion, in isolation from hair cell trauma and threshold elevation, on central processing and perception of complex sounds.

https://ift.tt/2jKAkYn

Correction to: Aminoglycoside Damage and Hair Cell Regeneration in the Chicken Utricle

This article was updated to correct a formatting error in Table 1.

https://ift.tt/2FZ7BYM

Interest and Uptake of MC1R Testing for Melanoma Risk in a Diverse Primary Care Population

This randomized clinical trial examines the prevalence of interest in and uptake of MC1R testing in the general population and examines patterns across demographic and skin cancer risk factors.

https://ift.tt/2rwXQLX

Demographic, Academic, and Publication Factors Associated With Academic Dermatology Career Selection

This cohort study examines associations between demographic, academic, and publication factors and dermatology trainees' initial choice of academic vs private practice careers.

https://ift.tt/2KPiwYn

Recurrent Unilateral Periorbital Edema Associated With Subcutaneous Cysticercosis

This case report describes a patient with recurrent unilateral periorbital edema caused by subcutaneous cysticercosis.

https://ift.tt/2rwXO6N

Cost-effectiveness of Skin Cancer Referral and Consultation Using Teledermoscopy in Australia

This study uses a decision-analytic model to assess the cost-effectiveness of teledermoscopy as a referral mechanism for skin cancer diagnosis and management in Australia.

https://ift.tt/2KNLS9C

Firm Papules and Nodules on Face, Neck, and Thorax

A man in his early 40s who had been injured in a land mine explosion 15 years earlier presents with a 6-month history of asymptomatic, erythematous nodules. What is your diagnosis?

https://ift.tt/2rxVigz

Supra-Threshold Hearing and Fluctuation Profiles: Implications for Sensorineural and Hidden Hearing Loss

Abstract

An important topic in contemporary auditory science is supra-threshold hearing. Difficulty hearing at conversational speech levels in background noise has long been recognized as a problem of sensorineural hearing loss, including that associated with aging (presbyacusis). Such difficulty in listeners with normal thresholds has received more attention recently, especially associated with descriptions of synaptopathy, the loss of auditory nerve (AN) fibers as a result of noise exposure or aging. Synaptopathy has been reported to cause a disproportionate loss of low- and medium-spontaneous rate (L/MSR) AN fibers. Several studies of synaptopathy have assumed that the wide dynamic ranges of L/MSR AN fiber rates are critical for coding supra-threshold sounds. First, this review will present data from the literature that argues against a direct role for average discharge rates of L/MSR AN fibers in coding sounds at moderate to high sound levels. Second, the encoding of sounds at supra-threshold levels is examined. A key assumption in many studies is that saturation of AN fiber discharge rates limits neural encoding, even though the majority of AN fibers, high-spontaneous rate (HSR) fibers, have saturated average rates at conversational sound levels. It is argued here that the cross-frequency profile of low-frequency neural fluctuation amplitudes, not average rates, encodes complex sounds. As described below, this fluctuation-profile coding mechanism benefits from both saturation of inner hair cell (IHC) transduction and average rate saturation associated with the IHC-AN synapse. Third, the role of the auditory efferent system, which receives inputs from L/MSR fibers, is revisited in the context of fluctuation-profile coding. The auditory efferent system is hypothesized to maintain and enhance neural fluctuation profiles. Lastly, central mechanisms sensitive to neural fluctuations are reviewed. Low-frequency fluctuations in AN responses are accentuated by cochlear nucleus neurons which, either directly or via other brainstem nuclei, relay fluctuation profiles to the inferior colliculus (IC). IC neurons are sensitive to the frequency and amplitude of low-frequency fluctuations and convert fluctuation profiles from the periphery into a phase-locked rate profile that is robust across a wide range of sound levels and in background noise. The descending projection from the midbrain (IC) to the efferent system completes a functional loop that, combined with inputs from the L/MSR pathway, is hypothesized to maintain "sharp" supra-threshold hearing, reminiscent of visual mechanisms that regulate optical accommodation. Examples from speech coding and detection in noise are reviewed. Implications for the effects of synaptopathy on control mechanisms hypothesized to influence supra-threshold hearing are discussed. This framework for understanding neural coding and control mechanisms for supra-threshold hearing suggests strategies for the design of novel hearing aid signal-processing and electrical stimulation patterns for cochlear implants.

https://ift.tt/2FWwm7T

Persistent Auditory Nerve Damage Following Kainic Acid Excitotoxicity in the Budgerigar ( Melopsittacus undulatus )

Abstract

Permanent loss of auditory nerve (AN) fibers occurs with increasing age and sound overexposure, sometimes without hair cell damage or associated audiometric threshold elevation. Rodent studies suggest effects of AN damage on central processing and behavior, but these species have limited capacity to discriminate low-frequency speech-like sounds. Here, we introduce a new animal model of AN damage in an avian communication specialist, the budgerigar (Melopsittacus undulatus). The budgerigar is a vocal learner and speech mimic with sensitive low-frequency hearing and human-like behavioral sensitivity to many complex signals including speech components. Excitotoxic AN damage was induced through bilateral cochlear infusions of kainic acid (KA). Acute KA effects on cochlear function were assessed using AN compound action potentials (CAPs) and hair cell cochlear microphonics (CMs). Long-term KA effects were assessed using auditory brainstem response (ABR) measurements for up to 31 weeks post-KA exposure. KA infusion immediately abolished AN CAPs while having mild impact on the CM. ABR wave I, the far-field AN response, showed a pronounced 40–75 % amplitude reduction at moderate-to-high sound levels that persisted for the duration of the study. In contrast, wave I latency and the amplitude of wave V were nearly unaffected by KA, and waves II–IV were less reduced than wave I. ABR thresholds, calculated based on complete response waveforms, showed no impairment following KA. These results demonstrate that KA exposure in the budgerigar causes irreversible AN damage, most likely through excitotoxic injury to afferent fibers or synapses as in other species, while sparing ABR thresholds. Normal wave V amplitude, assumed to originate centrally, may persist through compensatory mechanisms that restore central response amplitude by downregulating inhibition. Future studies in this new animal model of AN damage can explore effects of this neural lesion, in isolation from hair cell trauma and threshold elevation, on central processing and perception of complex sounds.

https://ift.tt/2jKAkYn

Correction to: Aminoglycoside Damage and Hair Cell Regeneration in the Chicken Utricle

This article was updated to correct a formatting error in Table 1.

https://ift.tt/2FZ7BYM

Effects of “trigeminal training” on trigeminal sensitivity and self-rated nasal patency

Abstract

Purpose

Patients with the feeling of a congested nose not always suffer from an anatomical obstruction but might just have a low trigeminal sensibility, which prevents them from perceiving the nasal airstream. We examined whether intermittent trigeminal stimulation increases sensitivity of the nasal trigeminal nerve and whether this effect is accompanied by subjective improvement of nasal breathing.

Method

Thirty-five patients (M_age = 58.4 years; SD = 14.8; Min_age = 21 years; Max_age = 79 years; 43% females) and 30 healthy controls (M_age = 36.7 years, SD = 14.5; Min_age = 20 years; Max_age = 73 years; 60% females) participated in a study comprised of two sessions separated by "trigeminal training". During each session, trigeminal sensitivity towards CO₂, trigeminal lateralization abilities and ratings of nasal patency were assessed. Age and training compliance were controlled.

Results

"Trigeminal training" had a positive effect on trigeminal sensitivity in both groups, (p = .027) and this effect depended on the training compliance (p < .001). "Trigeminal training" had no effect on lateralization abilities of the subjects (p > .05). Ratings of nasal patency increased in patients (p = .03), but not in controls.

Conclusions

"Trigeminal training" consisting of intermittent presentation of diverse stimulants leads to an increase of trigeminal sensitivity, but this effect depended on the training compliance. Importantly, in patients, this training is also associated with an increase in self-rated nasal patency.

https://ift.tt/2rrRcXs

Immature teratoma mimicking pulmonary stenosis: a case report

Immature teratoma in a mediastinal location is a rare disease that might present as a valve pathology. Germ cell tumors with mediastinal locations account for up to 6% of immature teratoma cases. We present a ...

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Making a Difference in Low-Resource Settings

By Nathan Douthit

In February, 1999, the World Health Organization partnered with more than 20 non-governmental organizations involved in eye care to launch VISION2020: The Right to Sight. The goal of this initiative is to eliminate the main preventable and treatable causes of blindness by the year 2020. The threefold strategy involves disease control, human resource development, and infrastructure and appropriate technology development. Despite major improvements, there is still work to be done.^[1]

In "Management of a rhegmatogenous retinal detachment in a low-resource setting: treatment options when there is no vitreoretinal surgeon," Emsley et all highlight the difficulty in management of opthalmological problems in low resource settings, where no subspecialists are present. The patient presented with a treatable retinal detachment and retinal tear, but, "Unfortunately, no access to any vitreoretinal trained personnel or vitrectomy equipment currently exists in Sierra Leone…. [T]he nearest facility in Ghana is 2018 km away and beyond the financial means of the patient." Despite presenting with vision acuity of 20/30 bilaterally, "At review 8 months later, the visual acuity had dropped to 6/36 and the retina had completely detached.

In the discussion, the authors present the incidence of rhegmatogenous retinal detachment in sub-Saharan Africa and Sierra Leone. Despite the growing prevalence of this disease and the "late presentation with advanced disease and secondary complications" in the developing world, only 15 subspecialty trained vitreoretinal surgeons practice in the region of Senegal to Kenya and Ethiopia to Tanzania. The lack of equipment and continued training for opthalmologic specialties is a well documented problem.^[2] The need to develop a system for screening, referring and transporting patients to well-equipped tertiary care centers is also well-described.^[3]

Despite steps in these directions, however, there are still countless patients suffering with no access to the necessary specialties—in this case, a vitreoretinal surgeon. Rather than forgoing any care, healthcare professionals with appropriate training can optimize the treatment with the resources they have available to them. Emsley et al excellently describe several interventions in there article that would have helped this patient without the need for a vitreoretinal surgeon. They focus on pneumatic retinopexy, "[T]he ideal treatment option for the case described above in this setting."

BMJ Case Reports invites authors to submit global health case reports that describe feasible interventions that could alleviate disease in low-resource settings. These cases could focus on:

•  Interventions that have been successfully instituted in a low-resource area
•  Potential interventions to help a vulnerable population
•  Challenges to instituting an intervention in a low-resource setting
•  Low-resource interventions that have aided individual patients

Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports via the submission system. For more information, review our guidance on how to write a global health case report and look through our online collection.

To read more about interventions in low resource settings at BMJ Case Reports, please review:

•  Treatment of complex infantile hemangioma a in a resource-poor setting
•  Management of paediatric head injury in remote Nepal
•  Penetrating cardiac injury: sustaining health by building team resilience in growing civilian violence

To read more about opthalmologic care in the developing world, please review:

^[1] World Health Organization. What is VISION 2020? [internet] Prevention of Blindness and Visual Impairment. WHO 2018. Accessed from: http://www.who.int/blindness/partnerships/vision2020/en/ on 3 May 2018

^[2] Courtright P, Ndegwa L, Msosa J, Banzi J. Use of our existing eye care human resources: assessment of the productivity of cataract surgeons trained in eastern Africa. Archives of ophthalmology. 2007 May 1;125(5):684-7.

^[3] Sommer A, Taylor HR, Ravilla TD, West S, Lietman TM, Keenan JD, Chiang MF, Robin AL, Mills RP. Challenges of ophthalmic care in the developing world. JAMA ophthalmology. 2014 May 1;132(5):640-4.

Competing Interests

None Declared

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Prävalenz von Dermatomykosen bei Profifußballspielern

Zusammenfassung

Hintergrund

Die Prävention, frühzeitige Diagnose und Behandlung von Onychomykosen ist für Profisportler von großer Bedeutung, um körperliche Einschränkungen durch Komplikationen vermeiden zu können. Bislang gibt es wenige Daten zur Prävalenz von Hautmykosen bei Profisportlern.

Ziel der Arbeit

Vor diesem Hintergrund war das Ziel, die Prävalenz von Dermatomykosen bei professionellen Fußballspielern im Vergleich zur altersentsprechenden Normalbevölkerung zu erheben.

Material und Methoden

Die prospektive, nichtinterventionelle, kontrollierte Studie zur Prävalenz von Dermatomykosen wurde bei Fußballspielern eines deutschen Bundesliga-Erstligisten durchgeführt und mit einer zuvor untersuchten Kohorte altersentsprechender Beschäftigter aus unterschiedlichen Industriezweigen verglichen. Es erfolgten eine strukturierte Fragebogenerhebung, eine dermatologische Ganzkörperuntersuchung und ein mikrobiologischer Erregernachweis bei klinischem Verdacht.

Ergebnisse

Insgesamt wurden Daten von 84 Fußballspielern, n = 45 2013 sowie n = 39 2015, erhoben und mit n = 8186 zuvor untersuchten männlichen Beschäftigten zwischen 17 und 35 Jahren verglichen. Klinisch zeigte sich in der Gruppe der Sportler bei 60,7 % eine Onychomykose, bei 36,9 % eine Tinea pedis und bei 17,8 % eine Pityriasis versicolor. In der altersentsprechenden Normalbevölkerung lag die Prävalenz einer Onychomykose bei 3,3 %, einer Tinea pedis bei 3,2 % sowie einer Pityriasis versicolor bei 1,4 %.

Diskussion

Unsere Studie zeigt ein deutlich erhöhtes Risiko für Pilzinfektion der Haut, insbesondere der Füße bei professionellen Fußballspielern. Die Ergebnisse zeigen die Notwendigkeit für eine Aufklärung im Rahmen von Prävention und die Etablierung einer leitliniengerechten Therapie von Dermatomykosen bei professionellen Fußballspielern.

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Mitteilungen der DDL

https://ift.tt/2K9qj2l

Panorama Dermatologische Praxis

https://ift.tt/2rv3zTk

Mitteilungen der DSTIG

https://ift.tt/2K7540S

Adult-Type Rhabdomyoma of the Larynx in Birt–Hogg–Dubé Syndrome: Evidence for a Real Association

Abstract

The autosomal dominant Birt–Hogg–Dubé syndrome is known to be associated with skin, lung and kidney lesions. It is caused by heterozygous germline mutations in the folliculin gene and has a high penetrance. We report the case of a 51 year old woman with Birt–Hogg–Dubé syndrome who presented with a laryngeal mass. Imaging confirmed a mass centered on the piriform sinus and following excision histological examination confirmed the lesion was composed of polygonal cells with abundant eosinophilic cytoplasm consistent with a rhabdomyoma. Laryngeal rhabdomyoma is rare condition and has not been previously described in association with Birt–Hogg–Dubé. In patients with Birt–Hogg–Dubé syndrome who develop upper aerodigestive tract symptoms secondary to mass lesion an adult-type rhabdomyoma might be considered as a differential, with endoscopic excision being the treatment of choice.

https://ift.tt/2KMQBsh

Adult-Type Rhabdomyoma of the Larynx in Birt–Hogg–Dubé Syndrome: Evidence for a Real Association

Abstract

The autosomal dominant Birt–Hogg–Dubé syndrome is known to be associated with skin, lung and kidney lesions. It is caused by heterozygous germline mutations in the folliculin gene and has a high penetrance. We report the case of a 51 year old woman with Birt–Hogg–Dubé syndrome who presented with a laryngeal mass. Imaging confirmed a mass centered on the piriform sinus and following excision histological examination confirmed the lesion was composed of polygonal cells with abundant eosinophilic cytoplasm consistent with a rhabdomyoma. Laryngeal rhabdomyoma is rare condition and has not been previously described in association with Birt–Hogg–Dubé. In patients with Birt–Hogg–Dubé syndrome who develop upper aerodigestive tract symptoms secondary to mass lesion an adult-type rhabdomyoma might be considered as a differential, with endoscopic excision being the treatment of choice.

https://ift.tt/2KMQBsh

Update on Omalizumab for Urticaria: What’s New in the Literature from Mechanisms to Clinic

Abstract

Purpose of Review

Since omalizumab has been approved for urticaria, numerous randomized and real-life observational trials have been published. We reviewed the period January 2017–February 2018.

Recent Findings

Omalizumab is effective for the control of urticaria recalcitrant to antihistamines in different populations globally. The ratio of total serum IgE 4-week/baseline ≥2 can predict response with a high likelihood. In observational real-life trials, doses have been adjusted on an individual basis: in some populations, up to two-thirds of the patients can be controlled with 150 mg/month; however, others are still not controlled with 300 mg/month. In these, 150 mg bimonthly could be tried, before up-dosing to 450 mg/month. On the long run (up to 3 years) omalizumab kept its efficacy. In many patients, dosing intervals could be augmented (6–8 weeks, some even more). After a 12-month treatment, about 20% showed long-term remission without relapse.

Summary

Some biomarkers are being detected. Adjusting omalizumab doses in urticaria patients could enhance efficacy (shortening dosing interval and/or augmenting dose) and save costs (after 12 months: extending dosing interval and/or reducing dose).

https://ift.tt/2I28V2W

Preschool hearing screening in Sweden. An evaluation of current practices and a presentation of new national guidelines

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Karin Stenfeldt
ObjectivesAs the various regional authorities responsible for health care in Sweden operate independently, no knowledge was available on pre-school hearing screening available to children living in different parts of the country. The aim of this study was to carry out a survey to ascertain how preschool hearing screening was performed in the various regions of Sweden. An objective of the present paper was also to present the uniform national guidelines for pre-school hearing screening that were launched by health authorities and were based on this study. A follow-up investigation was performed to ascertain whether the new guidelines were well accepted and followed throughout the country.MethodsA questionnaire was sent to 25 physicians responsible for child health care centers in all 21 regions throughout the whole country. The questionnaire included detailed questions on hearing screening in preschool children. New national guidelines were introduced in cooperation with health authorities and providers of preventive child health care. After two and four years, questionnaires were sent to the same recipients to determine whether changes in practice in pre-school hearing screening had been implemented, and to obtain information about experiences with the new guidelines.ResultsSixteen of 21 regions practiced universal hearing screening of 4-yearolds. Many different protocols were used. Professionals at child health care centers expressed a need for national guidelines for pre-school hearing screening. At the two and four-year follow-ups, one more region had introduced universal hearing screening of 4-year-olds, while two regions were planning to introduce it in 2019. The new national guidelines were well accepted and used throughout the country.ConclusionThere was a great variability in how pre-school hearing screening was performed in Sweden. Efforts are being made to provide uniform pre-school hearing screening. Cooperation between professionals in hearing health and health authorities is needed in order to broaden the use of universal pre-school hearing screening and to implement the new national guidelines.



https://ift.tt/2rsS1jK

Indocyanine green-mediated photobiomodulation on human osteoblast cells

Abstract

Photobiomodulation (PBM) and photodynamic therapy (PDT) share similar mechanisms but have opposite aims. Increased levels of reactive oxygen species (ROS) in the target tissue in response to light combined photosensitizer (PS) application may lead to cell proliferation or oxidative damage depending on the ROS amount. The purpose of the present study is to investigate the effect of indocyanine green (ICG)-mediated PBM on osteoblast cells by measuring cell viability, proliferation, alkaline phosphatase (ALP) activity, mineralization, and gene expressions of three phenotypic osteoblast markers. A diode laser irradiating at 809 nm (10 W output power, 50 mW/cm² power density) was used at 0.5, 1, and 2 J/cm² energy densities (10, 20, and 40 s respectively) was applied following ICG incubation. No inhibitory effect was observed in cell viability and proliferation according to the (4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and Alamar Blue assays. ICG-mediated PBM did not alter cell viability but increased ALP activity and enhanced mineralization of existing osteoblasts. These results were also confirmed by real-time polymerase chain reaction (RT-PCR) analysis of osteoblastic markers. PS can be combined to PBM not only to damage the malignant cells as aimed in PDT studies, but also to promote cellular activity. The findings of this in vitro study may contribute to in vivo studies and ICG-mediated PBM can have promising outcomes in bone healing and regeneration therapies in future.

https://ift.tt/2K5SYVL

Update on Omalizumab for Urticaria: What’s New in the Literature from Mechanisms to Clinic

Abstract

Purpose of Review

Since omalizumab has been approved for urticaria, numerous randomized and real-life observational trials have been published. We reviewed the period January 2017–February 2018.

Recent Findings

Omalizumab is effective for the control of urticaria recalcitrant to antihistamines in different populations globally. The ratio of total serum IgE 4-week/baseline ≥2 can predict response with a high likelihood. In observational real-life trials, doses have been adjusted on an individual basis: in some populations, up to two-thirds of the patients can be controlled with 150 mg/month; however, others are still not controlled with 300 mg/month. In these, 150 mg bimonthly could be tried, before up-dosing to 450 mg/month. On the long run (up to 3 years) omalizumab kept its efficacy. In many patients, dosing intervals could be augmented (6–8 weeks, some even more). After a 12-month treatment, about 20% showed long-term remission without relapse.

Summary

Some biomarkers are being detected. Adjusting omalizumab doses in urticaria patients could enhance efficacy (shortening dosing interval and/or augmenting dose) and save costs (after 12 months: extending dosing interval and/or reducing dose).

https://ift.tt/2I28V2W

Cancer stage and pack-years, but not p16 or HPV, are relevant for survival in hypopharyngeal and laryngeal squamous cell carcinomas

Abstract

Purpose

Recently, p16 has been included in the TNM guideline for oropharyngeal carcinomas. The role of HPV and p16 in hypopharyngeal and laryngeal carcinomas has not yet been established sufficiently.

Methods

Hundred and thirty-four patients with hypopharyngeal and laryngeal carcinomas were included in this retrospective analysis. Only patients with known HPV status were eligible for the investigation. Survival probabilities were estimated for different risk factors.

Results

Eighty-five patients presented with laryngeal carcinoma and 49 patients with hypopharyngeal carcinoma. 8% were HPV positive (10.6% laryngeal, 4.1% hypopharyngeal carcinoma). Median follow-up time was 58 months. We observed a significantly better overall survival for patients with an early tumor stage compared to advanced carcinoma. One of the hypopharyngeal HPV positive carcinomas was also p16 positive and one was p16 negative. Of the nine HPV positive laryngeal carcinomas, four were p16 positive and five p16 negative. Neither patients who were HPV positive nor patients positive for p16 showed a significantly better outcome than HPV or p16 negative patients. In contrast, nicotine pack-years showed a highly significant correlation with survival in our patient collective.

Conclusions

The data suggest that tumor stage and nicotine exposure seem to have the highest impact on survival in hypopharyngeal and laryngeal squamous cell carcinoma patients. There is no evidence for a better survival for p16 positive or HPV positive patients with hypopharyngeal or laryngeal squamous cell carcinoma. HPV seems to play a minor role in these entities of head and neck carcinoma.

https://ift.tt/2wp9huS

Adult-Type Rhabdomyoma of the Larynx in Birt–Hogg–Dubé Syndrome: Evidence for a Real Association

Abstract

The autosomal dominant Birt–Hogg–Dubé syndrome is known to be associated with skin, lung and kidney lesions. It is caused by heterozygous germline mutations in the folliculin gene and has a high penetrance. We report the case of a 51 year old woman with Birt–Hogg–Dubé syndrome who presented with a laryngeal mass. Imaging confirmed a mass centered on the piriform sinus and following excision histological examination confirmed the lesion was composed of polygonal cells with abundant eosinophilic cytoplasm consistent with a rhabdomyoma. Laryngeal rhabdomyoma is rare condition and has not been previously described in association with Birt–Hogg–Dubé. In patients with Birt–Hogg–Dubé syndrome who develop upper aerodigestive tract symptoms secondary to mass lesion an adult-type rhabdomyoma might be considered as a differential, with endoscopic excision being the treatment of choice.

https://ift.tt/2KMQBsh

Nivolumab und Ipilimumab beim Nierenzellkarzinom

https://ift.tt/2KNXUzW

Delayed recurrent pleuropericardial effusions following atrial septal defect closure with Amplatzer septal occluder device: a case of postpericardiotomy syndrome?

The authors present the case of a 41-year-old woman, who presented with moderate pericardial effusion and bilateral pleural effusion 11 months following a secundum atrial septal defect closure with an Amplatzer septal occluder (ASO) device. The acute presentation responded well to diuretics and a short course of corticosteroid therapy. The patient, however, continued to experience pleuritic chest pain and a recurrence of pericardial effusion a month later. The patient showed significant symptomatic improvement with a 2-month course of down-titrating prednisolone. Six months later, the echocardiogram showed complete remission of pleural and pericardial effusion. The possibility of cardiac erosion following ASO implantation has been excluded. The aetiology of the reoccurrence of steroid-responsive pleuropericarditis remains unknown.

https://ift.tt/2I8vX4e

Iatrogenic immunosuppression may favour Alternaria skin lesion flares

Alternaria spp may cause opportunistic mycoses in the skin after cutaneous inoculation or through blood dissemination in immune-suppressed patients. Here, we describe a case of cutaneous infection with Alternaria spp in a 62-year-old man, presenting with multifocal papules and erythematous nodules involving distal limbs bilaterally. The absence of inflammatory bowel disease was confirmed by a gastroenterologist. The patient was under treatment for uveitis of unknown origin with immunosuppressive doses of cyclosporin and prednisolone for approximately 3 months. The diagnosis was based on clinical signs, demonstration of fungal elements in skin biopsies and deep fungal culture. Complete clinical remission was achieved by oral and systemic treatment with antifungal drugs. However, because cessation of the immunosuppressive medication was not possible, his clinical history was characterised by multiple flares requiring each time oral and intravenous antifungal treatment.

https://ift.tt/2jJHRGT

Long-lasting remission in a case of Cronkhite-Canada syndrome

Cronkhite-Canada syndrome is a rare disease characterised by diffuse gastrointestinal polyposis, diarrhoea, weight loss, skin hyperpigmentation, onychodystrophy and alopecia. More than 500 cases have been described in the medical literature so far. The disease is probably caused by immune-mediated inflammatory mechanisms, and the diagnosis is based on clinical history, physical examination, endoscopic findings and histology. Differentiating this condition from other clinical entities presenting with similar signs and symptoms may be challenging. We present here the case of a 70-year-old Sardinian man where apparently the syndrome was induced by a mental strain triggered by a work-related accident. Continuous treatment with low-dose of antidepressant, anti-inflammatory and immunosuppressive medications in addition to nutritional support was remarkably effective and resulted in sustained (longer than 8 years) disappearance of clinical manifestations as well as the persistence of physical and psychological well-being. This case argues against the poor prognosis previously ascribed to patients with this syndrome.

https://ift.tt/2I6x2JC

Primary meningococcal septic arthritis with multiple native joint involvement

A previously healthy 18-year-old woman presented with an acutely painful, swollen right ankle joint, with similar symptoms subsequently developing in the right hip and right wrist. Microbiological samples from the ankle aspirate grew Neisseria meningitidis. She had had no preceding clinical symptoms of meningitis or previous contact with a patient with meningitis. She was treated with intravenous antibiotics and surgical drainage.

On follow-up, her symptoms had resolved, inflammatory markers had returned to normal and she has no long-term sequelae of septic arthritis. Primary meningococcal septic arthritis in the adult population is extremely uncommon, and makes up approximately 1% of all cases of primary septic arthritis.

https://ift.tt/2ruxScT

Left-sided omental infarction: a rare cause of abdominal pain, discovered by CT scan

Omental infarction in adults is a rarely occurring phenomenon, with left-sided omental infarction being even more seldom. The importance of this case report lies in raising awareness of the diagnosis omental infarction as a cause of acute abdomen among doctors who work in the emergency department, in order to prevent unnecessary surgical interventions as conservative treatment generally solves the problem. Omental infarction is the result of vascular obstruction and ends in tissue ischaemia. Because of the rich vasculature of the greater omentum, anastomoses reorganise the vascularisation, which explains the mostly benign course of omental infarction. By adding omental infarction to the list of differential diagnoses in patients who present with acute abdominal pain, future management of patients with an acute abdomen can be adjusted for the optimal approach to not overlook any surgery-requiring diagnosis as well as to prevent overtreatment.

https://ift.tt/2I6PzWd

Reflex anoxic seizures (RAS) in an adult patient: a separate entity from epilepsy

Reflex anoxic seizures (RAS) are essential in the differential diagnosis of non-epileptic paroxysmal seizures. They are precipitated by vagally mediated brief cardiac asystole, which in turn leads to transient cerebral ischaemia. RAS are usually seen in infants and preschool children, but in this case happened in a middle-aged man. Our patient is a 61-year-old man who presented with sudden, repeated contractions of his left upper arm and urine incontinence, followed by loss of consciousness for about 30 s. He reported a similar episode occurred 2 years earlier. He did indicate episodic confusion pointing towards possibility of more occurrences. In the emergency department, he developed a similar seizure, during which telemetry revealed sinus arrest lasted for 4–6 s that was followed by junctional escape. Implantation of a pacemaker resulted in total cessation of sinus arrest and seizure activity during the admission. On 1-year follow-up, patient and family members did not report episodic confusion or any seizure-like activity. RAS constitute a particular entity of seizures and need careful interpretation and management. They have a similar pathophysiology to cardiac syncope. Successful prevention of cerebral hypoperfusion with a cardiac pacemaker usually leads to complete resolution of symptoms in patients with RAS as demonstrated in this case

https://ift.tt/2rtV37a

Cavernous sinus involvement in human papillomavirus associated oropharyngeal squamous cell carcinoma: case report of an atypical site of distant metastasis

Abstract

Background

HPV-associated OSCC (HPV-OSCC) has been determined to be a distinct disease entity from non-HPV associated OSCC. Patients affected by HPV-OSCC generally have a more favourable prognosis, with improved rates of locoregional control and survival compared with their non-HPV counterparts. Despite this, HPV-OSCC has a similar rate of distant metastases. Interestingly, recent evidence has emerged that demonstrates more frequent atypical metastasis patterns when compared to non-HPV associated disease. To the best of our knowledge, this report describes the first case of a confirmed HPV-OSCC with distant metastasis to the cavernous sinus.

Case Presentation

A 62-year-old non-smoking male presented to the head and neck oncology clinic with a five-month history of enlarging right neck mass causing neck pain, dysphagia, and dysphonia. HPV-associated base of tongue squamous cell carcinoma (cT4aN2c) was diagnosed, and he was treated with primary chemoradiation. Shortly after treatment, he presented with progressive bilateral cranial nerve palsies including left cranial nerve III and right cranial nerve VI involvement. Imaging identified masses in the left cavernous sinus with extension of tumor into the sella and in the right cavernous sinus at the level of Dorello's canal. Endoscopic Image Guided Transsphenoidal biopsy of the left sellar mass confirmed distant metastases from the previously treated HPV-OSCC primary to the cavernous sinus. The patient was palliated with carboplatin and paclitaxel.

Conclusion

The presented report is the first documented case of confirmed HPV-associated oropharyngeal squamous cell carcinoma metastasizing to the cavernous sinus, and the only HPV confirmed head and neck cancer case to present with metastasis to the cavernous sinus and limited extracranial disease. This case demonstrates the importance of recognizing presentations of atypical metastasis that are possible in HPV-associated oropharyngeal cancer. Given the rarity of metastasis to this region, vigilance in follow up is instrumental in early identification and treatment for these patients.

https://ift.tt/2I7Z7QI