Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Σάββατο 30 Ιουνίου 2018

Efficacy of C1Inhibitor concentrate in hereditary angioedema with C1Inhibitor deficiency: analysis in the French Cohort

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Publication date: Available online 30 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Aude Belbézier, Isabelle Boccon-Gibod, Aurélie Du Thanh, Olivier Fain, Laurence Bouillet




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Successful desensitization in a pediatric patient with acetazolamide allergy

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Publication date: Available online 30 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Annette Carlisle, Joshua L. Kennedy, Sheva Chervinskiy, Stacie M. Jones, Robert D Pesek




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Chronic Tearing Induced by Apremilast

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Publication date: Available online 30 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Matthew R. Norris, Leonard Bielory




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Specific-IgE to galactose-alpha-1,3-galactose (alpha-gal) has limited utility in diagnosing meat allergy in a tick-endemic population

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Publication date: Available online 30 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Dr Jamma Li, Mr Richard B. Fulton, RachelO'Connell, Dr Helena S. Jang, Prof. Suran L. Fernando




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Health Literacy and Asthma Among Hispanic and African American Urban Adolescents with Undiagnosed Asthma

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Publication date: Available online 30 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Melissa A. Valerio, Maureen George, Jianfang Liu, Zainab T. Osakwe, Jean-Marie Bruzzese




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Mechanisms of allergen-specific immunotherapy: diverse mechanisms of immune tolerance to allergens

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Publication date: Available online 30 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anna Głobińska, Tadech Boonpiyathad, Pattraporn Satitsuksanoa, Mirelle Kleuskens, Willem van de Veen, Milena Sokołowska, Mübeccel Akdis




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Analysis of blood supply in the hard palate and maxillary tuberosity—clinical implications for flap design and soft tissue graft harvesting (a human cadaver study)

Abstract

Objectives

The aim of the present study is to provide a detailed macroscopic mapping of the palatal and tuberal blood supply applying anatomical methods and studying specific anastomoses to bridge the gap between basic structural and empirical clinical knowledge.

Materials and methods

Ten cadavers (three dentate, seven edentulous) have been prepared for this study in the Department of Anatomy, Semmelweis University, Budapest, Hungary, and in the Department of Anatomy of the Medical University of Graz. All cadavers were fixed with Thiel's solution. For the macroscopic analysis of the blood vessels supplying the palatal mucosa, corrosion casting in four cadavers and latex milk injection in other six cadavers were performed.

Results

We recorded major- and secondary branches of the greater palatine artery (GPA) and its relation to the palatine spine, different anastomoses with the nasopalatine artery (NPA), and lesser palatal artery (LPA) as well as with contralateral branches of the GPA. Penetrating intraosseous branches at the premolar-canine area were also detected. In edentulous patients, the GPA developed a curvy pathway in the premolar area. The blood supply around the maxillary tuberosity was also presented.

Conclusion

The combination of different staining methods has shed light to findings with relevance to palatal blood supply, offering a powerful tool for the design and execution of surgical interventions involving the hard palate.

Clinical relevance

The present study provides clinicians with a good basis to understand the anatomical background of palatal and tuberal blood supply. This might enable clinicians to design optimized incision- and flap designs. As a result, the risk of intraoperative bleeding and postoperative wound healing complications related to impaired blood supply can be minimized.



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Iodonium salt incorporation in dental adhesives and its relation with degree of conversion, ultimate tensile strength, cell viability, and oxidative stress

Abstract

Objective

The aim of this study was to evaluate the degree of conversion, ultimate tensile strength, cell viability, and oxidative stress of two different ternary initiation systems, using two photoinitiation polymerization times.

Methods

The groups investigated were camphorquinone (CQ); CQ and diphenyleneiodonium hexafluorophosphate (DPI); CQ and ethyl 4-dimethylamine benzoate (EDAB); and CQ, EDAB, and DPI, with EDAB in high and low concentration. To assess the degree of conversion (DC) and the ultimate tensile strength (UTS), a real-time Fourier transform infrared spectroscopy and a universal test machine Emic DL-500 were used, respectively. Cell viability and oxidative stress were evaluated by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), superoxide dismutase (SOD), total sulfhydryl (SH) content, and thiobarbituric acid reactive species (TBARS) formation assays.

Results

Slight lower cell viability was shown when DPI was associated with high concentrations of EDAB; this reduction seemed to be attenuated when lower concentrations of EDAB were used. When EDAB and DPI were associated, no oxidative damage was shown. The degree of conversion was increased in the ternary systems (CQ + EDAB lower concentration + DPI) group, which did not affect the UTS, cytotoxicity, and oxidative stress parameters. The polymerization time did not affect cell viability, total SH, and TBARS; however, a slight increase was shown in SOD levels.

Clinical relevance

Our study emphasizes the relevance of incorporating the third element—iodonium salt—in a binary adhesive systems composed exclusively of CQ and EDAB.



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Oral lichenoid reactions may possibly be associated with abatacept: A case report and literature update

Publication date: Available online 30 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Bethany Zembiec-Wheeler, Abberly Lott-Limbach, Hans Malmström, Sharon Elad
Oral Lichenoid Reactions (OLRs) are a group of conditions, with a common clinical appearance and histopathologic pattern that may be induced by several conditions or medications. This report describes an OLR possibly induced by a biologic agent. A 69-year-old woman with rheumatoid arthritis (RA) presented with a chief complaint of oral pain. The patient retroactively reported of skin lesions as well. Clinically, she had mixed red-white mucosal lesions and ulcers suggestive of an OLR. This diagnosis was supported by the histopathologic findings. Withholding the putative etiologic agent, abatacept, resulted in an immediate improvement of both oral and skin lesions.Abatacept and other biologics are thought to help treat inflammation and are becoming more commonly prescribed to treat RA. However, the clinicians should explore these medications as a causative factor for OLR.



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Can Platelet-Rich Fibrin Improve Healing After Surgical Treatment of Medication-Related Osteonecrosis of the Jaw? A Pilot Study

Publication date: Available online 30 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Amerigo Giudice, Selene Barone, Carmen Giudice, Francesco Bennardo, Leonzio Fortunato
ObjectiveThe aim of this study was to evaluate the efficacy of platelet-rich fibrin (PRF) after bone surgery compared to surgery alone in the treatment of medication-related osteonecrosis of the jaw (MRONJ).Study designA total of 47 patients with diagnosis of stage II or III of MRONJ were recruited at the Academic Hospital of Magna Graecia University of Catanzaro and allocated to 2 groups: in the first, patients were treated with PRF in addition to surgery (PRF group), in the other, only bone surgery was performed (non-PRF group). Fisher's exact and Student t tests were used to evaluate differences between the 2 surgical protocols in terms of mucosal integrity, absence of infection, and pain evaluation at scheduled follow-ups of 1 month (T1), 6 months (T2), and 1 year (T3).ResultsAnalysis of mucosal integrity, absence of infection, and pain evaluation showed a significant difference between the 2 groups in favor of PRF only at T1 (p<0.05), while no differences were determined at T2 and T3 (p>0.05).ConclusionOur results suggested that local application of PRF after bone surgery may improve the quality of life limited to the short-term follow-up and reduce pain and post-operative infections.



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Bifid variations of the mandibular canal: cone beam computed tomographic evaluation of 1000 Northern Chinese patients

Publication date: Available online 30 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ya-Qiong Zhang, Ya-Ning Zhao, Deng-Gao Liu, Yuan Meng, Xu-Chen Ma
ObjectivesTo evaluate and quantify variations of bifid mandibular canals (BMCs) in a population of Northern China by using cone beam computed tomography (CBCT).Study designCBCT images of 1000 consecutive patients were analyzed using the NewTom proprietary software. BMCs were identified and classified based on Naitoh's classification. Linear and angular measurements of BMCs were performed. Statistical analyses were conducted using chi-squared and Wilcoxon tests.ResultsBMCs were observed in 13.2% of 1000 patients and 8.4% of 2000 sides. The prevalence of BMCs was significantly lower in patients in the first two decades and in cases with a Class II molar relationship. The retromolar canal (68.4%) was the most common type of BMC observed. No buccolingual canals were identified; however, two special canals were detected. A classification system of three subtypes of retromolar canals was suggested. On average, the beginning site of the branches from the opening of the main canal was at a distance of 8.1 mm. The mean diameter and length of BMCs were 2.1 mm and 12.6 mm, respectively.ConclusionThis study underlined the prevalence and characteristics of BMCs in a population of Northern China. Preoperative identification of BMCs with CBCT may help prevent postoperative complications.



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Agenesis of dorsal pancreas associated with pancreatic neuroendocrine tumor: a case report and review of the literature

Agenesis of the dorsal pancreas is very rare. Less than 70 cases have been reported to date. Some of these cases had an association with a tumor. The literature of agenesis of the dorsal pancreas and agenesis ...

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Common polymorphism in the glycine N-methyltransferase gene as a novel risk factor for cleft lip with or without cleft palate

Publication date: Available online 30 June 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Karas Kuželički, A. Šmid, T. Kek, A. Eberlinc, K. Geršak, I. Mlinarič-Raščan
The objective of this study was to identify new environmental and genetic risk factors for orofacial clefts that arise during early foetal development. In this retrospective, case–control, mother–child pair study, 172 orofacial clefts cases and 199 healthy controls, and their respective mothers, were genotyped for common variants in relevant genes obtained by text and database mining using STRING 10.0. Exposure to environmental risk factors was evaluated using questionnaires. Variant glycine N-methyltransferase (odds ratio (OR) 2.1, 95% confidence interval (95% CI) 1.0–4.4) and dihydrofolate reductase (OR 2.4, 95% CI 1.3–4.5) genotypes were identified as risk factors for cleft lip with or without cleft palate formation. Furthermore, synergy was detected between variant glycine N-methyltransferase and dihydrofolate reductase genotypes in promoting cleft lip with or without cleft palate formation (OR 7, 95% CI 2–23). This study is novel in finding that common glycine N-methyltransferase variant genotypes increase the risk of cleft lip with or without cleft palate.



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Complete spontaneous regression of a metastatic melanoma of the mandible: a case report and follow-up recommendations

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Publication date: Available online 30 June 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Schlabe, K.A. Shah, F. Sheerin, M.J. Payne, A.A. Fasanmade
Regression of metastatic melanoma is very rare and occurs in only 0.23% of cases. Metastasis to the oral cavity is particularly uncommon and accounts for only 1–3% of all oral malignancies. This report presents a case of spontaneous and complete regression of a metastatic melanoma in the mandibular ramus. The patient remains asymptomatic more than 2 years after diagnosis. The patient was followed up regularly. It is recommended that further surveillance imaging be performed in asymptomatic patients following discussion with the surgical and oncological teams. This type of surveillance, together with new systemic treatments, is advocated due to its potential to increase long-term survival even after relapse.



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Novel vaccines: Technology and development

Publication date: Available online 30 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Sarita U. Patil, Wayne G. Shreffler
The development and widespread use of vaccines, which are defined by the World Health Organization as "biological preparations that improve immunity to a particular disease," represents one of the most significant strides in medicine. Vaccination was first applied to reduce mortality and morbidity from infectious diseases. The World Health Organization estimates that vaccines prevent 2 to 3 million human deaths annually, and these numbers would increase by at least 6 million if all children received the recommended vaccination schedule. However, the origins of allergen immunotherapy share the same intellectual paradigm, and subsequent innovations in vaccine technology have been applied beyond the prevention of infection, including in the treatment of cancer and allergic diseases. This review will focus on how new and more rational approaches to vaccine development use novel biotechnology, target new mechanisms, and shape the immune system response, with an emphasis on discoveries that have direct translational relevance to the treatment of allergic diseases.



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Oral corticosteroids in preschool children with severe episodes of virus-associated wheeze: to treat or not to treat?

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Publication date: Available online 30 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Avraham Beigelman, Leonard B. Bacharier




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Surgical Retrieval of Parotid Stones

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Publication date: Available online 30 June 2018
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Fernando Pozzi Semeghini Guastaldi, Jose Sandro Pereira da Silva, Maria J. Troulis, Edward Lahey




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Preface

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Publication date: Available online 30 June 2018
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Michael D. Turner, Maria J. Troulis




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Survival impact and toxicity of metformin in head and neck cancer: An analysis of the SEER-Medicare dataset

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Publication date: September 2018
Source:Oral Oncology, Volume 84
Author(s): William A. Stokes, Megan Eguchi, Arya Amini, Mohammad K. Hararah, Ding Ding, Jessica D. McDermott, Cathy J. Bradley, Sana D. Karam
ObjectivesRecent preclinical research has renewed interest in the interplay between glucose dysregulation and cancer. Metformin holds promise as an adjunctive antineoplastic agent in head and neck cancer (HNC). We aimed to explore the impact of metformin in HNC patients from a population-based dataset.Patients & MethodsPatients diagnosed with HNC from 2008 to 2011 were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset and categorized into three groups: non-diabetics (nD), diabetics not taking metformin (DnM), and diabetics taking metformin (D + M). Overall survival (OS) and cancer-specific survival (CSS) were compared between groups using Kaplan-Meier and Cox regression controlling for sociodemographic, clinical, and treatment covariates. The incidence of toxicities associated with HNC therapy was compared among groups using χ2 analysis.ResultsAmong 1646 patients, there were 1144 nD, 378 DnM, and 124 D + M. 2-year OS rates was 65.6% for nD, 57.7% for DnM, and 73.4% for D + M by Kaplan-Meier (p < 0.01), and corresponding rates of 2-year CSS were 73.7%, 66.1%, and 88.8% (p < 0.01), respectively. On Cox multivariable analysis, OS among the three groups did not significantly differ; however, CSS was significantly worse among both nD versus DnM as compared to D + M. Toxicity rates were not significantly increased among D + M.ConclusionHNC patients with diabetes taking metformin experience improved CSS. Prospective investigation of the addition of metformin to standard-of-care HNC therapy is warranted.



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Oral tongue carcinoma among young patients: An analysis of risk factors and survival

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Publication date: September 2018
Source:Oral Oncology, Volume 84
Author(s): Douglas R. Farquhar, April M. Tanner, Maheer M. Masood, Sagar R. Patel, Trevor G. Hackman, Andrew F. Olshan, Angela L. Mazul, Jose P. Zevallos
IntroductionThe incidence of oral tongue squamous cell carcinoma (OTSCC) in younger adults has rapidly increased over the past two decades. While tobacco and alcohol use may be less likely to cause these tumors, it remains controversial whether differences also exist in their prognosis. Our aim is to examine the risk factors for cancer among young (<45 years old) OTSCC patients at our institution, and to compare their recurrence and survival with older patients in a matched cohort.Materials and methodsAll OTSCC patients seen at our institution between 2000 and 2015 were reviewed. Patients under 45 who with sufficient treatment information were matched 1:1 on race, T-stage, and N-stage with patients 45 and older. Three-year recurrence and survival were determined in stratified and adjusted Cox regression models.ResultsOf 397 OTSCC patients were seen at our institution, 117 (29%) were less than 45 years old. Younger patients were significantly more likely to be female, (50% vs. 39%; p = 0.04) and to abstain from tobacco (51% vs. 39%; p < 0.01). Young patients in the matched cohort were significantly more likely to have a recurrence (HR 3.9 95% CI 1.4–10.5). There was no difference in overall survival.ConclusionYounger OTSCC patients in a matched cohort were more likely to recur within 3 years, although there was no difference in overall mortality. Differences in risk factors and recurrence between older and younger patients suggest that some cancer among younger patients may be distinct from traditional OTSCC.



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Exposure to air pollution and risk of prevalence of childhood allergic rhinitis: A meta-analysis

Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Qi-Yuan Zou, Yang Shen, Xia Ke, Su-Ling Hong, Hou-Yong Kang
ObjectivesAllergic rhinitis (AR), a common chronic inflammatory disease in the upper airways. The prevalence of AR in children seems to be increasing recently, and the most significant causes of the increase are thought to be changes in environmental factors, especially air pollution. However, we could not find any meta-analysis on the risk of air pollution exposure on the prevalence of AR in childhood. The aim of this research was to carry out a meta-analysis on the results of recent studies (21 s t century) to present valid information about exposure to air pollution and risk of prevalence of childhood AR.MethodsPubMed, Science, Google Scholar, Elsevier and MDPI web database were searched up to January 1, 2000 to February 28, 2018. Including of air pollution and AR in childhood related to the observation of literature. Meta-analysis, study quality assessment, heterogeneity analysis and publication bias test were using Stata-MP 14.1 and Review Manager version 5.3 software.Results13 studies will be included in the meta-analysis (8 cross-sectional studies, 5 cohort studies). Exposure to NO2 (OREurope = 1.031, 95%CI [1.002,1.060], P = 0.033; ORAsia = 1.236, 95%CI [1.099,1.390], P = 0.000; ORoverall = 1.138, 95%CI [1.052,1.231], P = 0.001); Exposure to SO2 (OREurope = 1.148, 95%CI [1.030,1.279], P = 0.012; ORAsia = 1.044, 95%CI [0.954,1.142], P = 0.352; ORoverall = 1.085, 95%CI [1.013,1.163], P = 0.020); Exposure to PM10 (OREurope = 1.190, 95%CI [1.092,1.297], P = 0.000; ORAsia = 1.075, 95%CI [0.995,1.161], P = 0.066; ORoverall = 1.125, 95%CI [1.062,1.191], P = 0.000); Exposure to PM2.5 (OREurope = 1.195, 95%CI [1.050,1.360], P = 0.007; ORAsia = 1.163, 95%CI [1.074,1.260], P = 0.000; ORoverall = 1.172, 95%CI [1.095,1.254], P = 0.000).ConclusionsExposed to air pollution probable is a risk of prevalence of childhood AR. And the prevalence of AR will be increase when exposed to NO2, SO2, PM10 and PM2.5, but maybe the relationship between SO2/PM10 and prevalence of AR are not closely in Asia.



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Comparison of click auditory brainstem response and chirp auditory steady-state response thresholds in children

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Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Konstantinos Mourtzouchos, Maria Riga, Mario Cebulla, Vasilios Danielides, Stefanos Naxakis
ObjectivesDuring the last twenty years, auditory steady-state responses (ASSRs) are being used as an alternative and adjunct to the auditory brainstem response (ABR) for threshold estimation. This study aims at comparing and finding correlations between air-conduction thresholds using the traditional click ABR and the relatively recently used chirp ASSR test methods, for a large pediatric population.MethodsOne hundred and thirty children referred to our Clinic from Hospitals and Clinics of Western Greece ranging in age from 5 to 79 months (mean age = 32.7 ± 14.0 months) participated prospectively.ResultsStrong and statistically significant correlations were found between the average of the 1000, 2000 and 4000 Hz chirp ASSR thresholds and click ABR thresholds (rs = .826, p < .001), and the average of the 2000 and 4000 Hz chirp ASSR and click ABR thresholds (rs = .824, p < .001). Additionally, there have been measurements for some children with hearing loss in the severe-to-profound range during the ASSR test, but no ABR at the upper limits of the equipment. Click ABR and chirp ASSR thresholds averaged at 2000 and 4000 Hz were within 20 dB in 90% of the ears tested.ConclusionsThe results of this study support the inclusion of chirp ASSRs into the pediatric test battery and indicate that they may provide an essential adjunct to the click ABR, especially in the management of very young children with severe-to-profound hearing loss.



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Transcanal incision and drainage of a parapharyngeal abscess in a pediatric patient: A novel technique

Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Tyler R. Schwartz, Miranda D. Colletta, Michael E. McCormick
The disease of parapharyngeal abscess is well known to the otolaryngologist and is commonly managed via transoral, transcervical, or combined incision and drainage. We report a novel approach to an abscess that was drained through the external auditory canal (EAC). An otherwise healthy 2-year-old female presented with a 4-day history of fevers, decreased oral intake, neck stiffness, and voice changes. CT neck with contrast revealed a deep abscess in the left neck extending from the peritonsillar space into the parapharyngeal space in close proximity to the anterior aspect of the EAC. Because the EAC was the closest surface to the abscess collection, we elected to attempt drainage through this route. Successful incision and drainage was performed via transcanal approach. She received intravenous antibiotics and steroids post-operatively and surgical packing was removed. She was discharged home on post-operative day 5 afebrile and tolerating a regular diet and continued to do well at most recent outpatient follow-up.



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Evaluation of clinical approaches and physician adherence to guidelines for otitis media with effusion

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Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Nisa Eda Cullas Ilarslan, Fatih Gunay, Seda Topcu, Ergin Ciftci
ObjectivesOtitis media with effusion (OME) is an important clinical entity because of its high prevalence, difficulties in diagnosis, complications and diversities in management. Herein, we aimed to evaluate current physician approaches on OME and determine clinical adherence to current guidelines.Methods and materialsA total of 370 physicians [Group 1: pediatricians (n = 256, 69.2%), Group 2: otorhinolarynologists (n = 114, 30.8%)] completed a survey instrument addressing demographic data and clinical practice parameters on OME in children. We also compared clinical approaches of Group 1 and Group 2. In addition, multiple logistic regression analysis was performed to evaluate factors which may effect correct approaches.ResultsThe mean period of clinical experience was 9.30 ± 8.35 [median 6 (1–40)] years. A total of 311 (84%) respondents reported satisfactory level of self-confidence as regards of clinical approaches to OME. Reduced mobility of the tympanic membrane and preference of pneumatic otoscopy was signified by 107 (28.9%) and 64 (17.3%) respondents, respectively. Fifty-six (15.1%) physicians identified "watchful waiting" for 3 months for children who are not at risk while 314 (84.9%) reported preference of medications, with antibiotics the most preferred prescription (n = 223, 63%). Comparison of Group 1 and Group 2 indicated similar results except better, yet insufficient, characterization of physical examination findings of OME by Group 2 (p < 0.001, for each parameter). Group 2 preferred tympanometry more in uncertain cases (p < 0.001) and handled chronic cases better (p < 0.001). Multiple logistic regression analysis revealed lower signification of reduced mobility of the tympanic membrane for respondents who denoted depending on personal experience ([OR] = 3.077 [95% CI 1.042–9.09]) or following clinical guidelines ([OR] = 3.365 [95% CI 1.38–8.20]) rather than combining them both. Rate of antibiotic avoidance was lowest in physicians with a period of clinical experience<5 years ([OR] = 2.14 [95% CI 1.32–3.48]).ConclusionsDespite notifying high self-confidence and adherence to current guidelines on OME, both pediatricians and otorhinolaryngologists lacked to exhibit proper approaches. Further research is warranted to evaluate the causes of poor adherence to current guidelines and bring suggestions for the maintenance of consistent and correct clinical approaches to OME.



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Quality Management in Healthcare: The Pivotal Desideratum

Publication date: Available online 30 June 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Anubha Aggarwal, Himanshu Aeran, Manu Rathee
Health care is very complex sector and delivery of service is the fragmented care. Quality can be a common paradigm to address the need of all groups in health care. Quality improvement is the process approach to the organization's operational challenges. The initiative to address the quality in health care has become a global phenomenon. A quality revolution for delivery of service with patient at the center and services around it is the demand of the time. This article comprehensively reviews the quality management in health care service and aims to sensitize the health care professionals towards achieving total quality.



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