Introduction Control of cytomegalovirus (CMV) infection after solid organ transplantation (SOT) requires a functional immune system. We assessed the association between quantitation and function of CMV-specific CD8+ T cells and CMV infection in SOT recipients. Methods During a 10-year period, selected kidney, heart, lung, pancreas, liver and composite tissue recipients were tested for CMV-specific CD8+ T cells immune competence (CMV-CD8+), as measured by enumeration, interferon-gamma production and CD107a/b degranulation. Quantitative and functional data were used to assemble T cell immune competence (TIC) score. CMV infection was diagnosed by PCR in blood and other samples, or histopathology. Results Of 130 patients tested, 59 had CMV infection or disease. The median onset to CMV infection was 10.5 months (IQR 5.5-18.7). Gastrointestinal disease (28.8%), pneumonia (20.3%), and CMV syndrome (17%) were most common presentation. An impaired nonspecific or CMV-CD8+ TIC score was associated with tissue-invasive disease (HR 2.84, 95% CI 1.03-11.81; p=.04). Patients with impaired CMV-CD8+ TIC score had longer viremia duration (42.4 vs. 18.8 days, p<.001 patients with impaired nonspecific or cmv-cd8 tic score had higher risk of relapse vs. hr ci p="0.03)." cmv infection disease lower median absolute lymphocyte count cells and cd4 t cell conclusion cmv-specific cd8 function correlated the course after sot measuring these has potential to assist in its clinical management. correspondence: roshini s. abraham ph.d. department laboratory medicine pathology mayo clinic rochester mn abraham.rochini raymund r. razonable m.d. division infectious diseases razonable.raymund authorship page atibordee meesing: participation performance research data collection analysis writing manuscript abraham: reviewing razonable: design approving disclosures: none funding: copyright wolters kluwer health inc. all rights reserved.>
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Τρίτη 7 Αυγούστου 2018
Role of 18F-FDG PET/CT in Restrictive Allograft Syndrome after lung transplantation
Background Differential diagnosis of phenotypes of chronic lung allograft dysfunction (CLAD) remains troublesome. We hypothesized that 18F-FDG PET/CT may help in differential diagnosis of CLAD phenotypes, as it showed promising results regarding diagnosis and prognosis in interstitial lung diseases. Methods A monocentric, retrospective study was performed including all lung transplant recipients suffering from bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS) who underwent 18F-FDG PET/CT scan, in comparison with stable lung transplant recipients. Maximum standardized uptake value (SUVmax) was associated with pulmonary function and survival. Proof-of-concept microCT and glucose transporter-1 (GLUT1) staining served as morphologic validation for regions with different SUVmax. Results SUVmax was higher in RAS (median 2.6, n=29) compared to BOS (median 1.0, n=15) and stable patients (median 0.59, n=8) (p
https://ift.tt/2OOugMO
https://ift.tt/2OOugMO
Patient Functional Status at Transplant and Its Impact on Posttransplant Survival of Adult Deceased-Donor Kidney Recipients
Background Recorded at the time of transplant and reported to the Organ Procurement and Transplantation Network (OPTN), patient's functional status is measured using the Karnofsky Performance Score (KPS), ranging 0-100. Functional status analysis may provide insights on candidate listing and posttransplant survival outcomes for deceased-donor kidney transplants (DDKT). Methods The cohort consisted of adult DDKT recipients transplanted beginning January 2007. One-year and 3-year Cox models for posttransplant survival were fitted with current Scientific Registry of Transplant Recipients (SRTR) variables and KPS. Comparative analyses were performed between the SRTR model without KPS and the augmented model with it. Using the augmented model, we examined the impact of Kidney Donor Profile Index (KDPI) on posttransplant survivals for 5 different KPS strata: 10-30, 40-50, 60-70, 80-90, and 100. Results Comparative analyses showed that KPS was a statistically significant predictor for posttransplant survival: it improved model calibration, discrimination, and predictive accuracy. From the augmented model, the survival curves illustrated that recipients with KPS 40-50 and kidneys with KDPI as high as 99 have expected survival probabilities of above 90% in 1 year and above 80% in 3 years. The expected survival probabilities improve as KPS increases. Recipients with KPS 10-30 have the worst survival probability, even if they received high-quality kidneys. Conclusions Insights from the survival analyses recommend possible inclusion of functional status into SRTR's risk-adjusted models. Moreover, they invite further examination of its use in order to improve current listing and transplantation strategies at transplant centers and potentially reduce deceased-donor kidney discard rate. Corresponding Author: Sanjay Mehrotra, PhD, Professor of Industrial Engineering and Management Sciences, 2145 Sheridan Road, Tech C246, Evanston, IL 60208, Phone: 847-491-3155, Fax: 847-491-8005, E-mail: mehrotra@northwestern.edu Authorship Information Kevin Bui1 MS, Vikram Kilambi2 PhD, James R. Rodrigue3 PhD, Sanjay Mehrotra4 PhD, 1Developed research design, conducted data analysis, and drafted the article; 2Reviewed research design and edited article; 3Reviewed and edited article; 4Developed research design, supervised data analysis, and edited the article; Authors have no conflicts of interest to disclose. This work is funded by National Institutes for Health award 1R21DK108104-01. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2AQOh2y
https://ift.tt/2AQOh2y
Changes in Simultaneous Liver Kidney Transplant Allocation Policy May Impact Post Liver Transplant Outcomes
Background Previous simultaneous liver-kidney transplant (SLK) allocation was based on serum creatinine, a metric that disadvantaged women relative to men. A recent SLK policy change utilizes eGFR, which accounts for sex-based differences in creatinine. Methods To understand the impact of this new policy, we analyzed nonstatus 1 adults listed for liver transplantation (LT) from 5/2007-7/2014, excluding those with exceptions. We defined patients who met the new SLK policy as having an eGFR
https://ift.tt/2AZjQr8
https://ift.tt/2AZjQr8
EFFECT OF DONOR AGE ON OUTCOME OF LUNG TRANSPLANTATION STRATIFIED BY RECIPIENT DIAGNOSIS: A NORDIC MULTICENTER STUDY
Background Organs from older donors are increasingly used in lung transplantation, and studies have demonstrated that this could be safe in selected recipients. However, which recipient groups that have the largest benefit of older organs are unclear. This multicenter study reviews all bilateral lung transplantations (BLTx) from donors ≥55 years stratified by recipient diagnosis, and compares outcomes with transplantations from younger donors. Methods All BLTx recipients (excluding ReTx) at 5 Scandiatransplant centers between 2000 and 2013 were included (n=913). Recipients were stratified to diagnosis groups including cystic fibrosis (CF), Chronic Obstructive Pulmonary Disease (COPD), interstitial lung disease (ILD) and "Other". Intensive care unit (ICU) length of stay (LOS) and survival were assessed. Results Overall, there was no difference in survival among patients transplanted from donors ≥ 55 years compared to younger donors. However, in CF-recipients, donor age ≥55 years was associated with inferior survival (p=0.014), and this remained significant in a multivariate model (HR 5.0, CI 1.8 – 14.1, p=0.002). There was no significant effect of donor age on survival in recipients with COPD, ILD or in the "Other"-group in multivariate models. Utilization of older donors was associated with increased ICU LOS for recipients with CF and ILD, but not in the COPD or "Other"-group. Conclusions BLTx recipients with CF had inferior survival and longer ICU LOS when receiving organs from donors ≥55 years. Recipients with COPD, ILD or in the "Other"-group did not have inferior survival in multivariate models. Authorship information Author-Areas of participation Auråen H-Research design, writing, performance of research, data analysis Durheim MT-Research design, writing, performance of research, data analysis Dellgren G-Writing, performance of research Hämmäinen P-Writing, performance of research Larsson H-Writing, performance of research Geiran O-Writing, performance of research Lawaetz Schultz HH-Writing, performance of research Leuckfeld I-Writing, performance of research Iversen M-Writing, performance of research Fiane AE-Writing, performance of research Holm AM-Research design, writing, performance of research, data analysis Conflict of interest statement: The authors declare no conflicts of interest. Funding: First author Auråen H received funding from The Norwegian Respiratory Society to conduct this research. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2APhTND
https://ift.tt/2APhTND
Effect of institutional case volume on in-hospital mortality after living donor liver transplantation: Analysis of 7073 cases between 2007 and 2016 in Korea
Background The relationship between institutional case volume and clinical outcomes after living donor liver transplantation is not clarified. Methods We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 7073 adult living donor liver transplantations were performed at 50 centers in Korea. Centers were categorized according to the average annual number of liver transplantations: >50, 10 to 50, and 50 liver transplantations/year) had better outcomes after living donor liver transplantation, including in-hospital mortality and long-term mortality, compared to centers with lower case volume (≤50 liver transplantations/year). Seokha Yoo and Eun Jin Jang contributed equally to this work and are co-first authors. Corresponding author: Ho Geol Ryu, MD, PhD, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea, E-mail: hogeol@gmail.com Authorship S.Y.: Study design, Data analysis, First draft of manuscript E.J.J.: Data acquisition, Data analysis, First draft of manuscript N.J.Y.: Revision of manuscript G.H.K.: Data acquisition, Data analysis D.H.K.: Data acquisition, Data analysis H.L.: Study conception, Revision of manuscript C.W.J.: Study design, Revision of manuscript H.G.R.: Study conception, Study design, Revision of manuscript Disclosure The authors declare no conflicts of interest. Funding None. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2vpd88C
https://ift.tt/2vpd88C
Central Odontogenic Fibroma: An Updated Systematic Review of Cases Reported In The Literature With Emphasis On Recurrence Influencing Factors
Publication date: Available online 7 August 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Flavia Sirotheau Correa Pontes, Lucas Lacerda de Souza, Lorena Paula de Paula, Elieser de Melo Galvão Neto, Priscilla Flores Silva Gonçalves, Hélder Antônio Rebelo Pontes
Abstract
Purpose
To integrate the available data published on central odontogenic fibroma (COF) into a comprehensive analysis of its clinical/radiologic/histological features.
Methods
An electronic search was undertaken in September 2017. Eligibility criteria included publications reporting cases of COF having enough clinical, radiological and histological information to confirm the diagnosis. Demographic data, lesion site and size, treatment approach, and recurrence were analysed. The cases included in the analysis presented follow-up time. Concerning recurrence analysis, tumour location, cortical bone perforation, lesion locularity, radiopacities, lesions associated with a tooth, tooth displacement, histological type and treatment used were evaluated.
Results
Eighty-three publications reporting 173 COFs were included. Lesions were slightly more prevalent in men than women (M: F – 1.13: 1); mean age was 31.6 years, with the highest prevalence in the second decade of life. Lesions were more prevalent in the posterior mandible. The difference in recurrence rate (when information about recurrence was provided) presented a statistically significant result for COF for location, cortical bone perforation and locularity of the lesion.
Conclusions
Our paper highlights that patients with COF who present a lesion located in the maxilla with multilocular aspects and cortical bone perforation tend to show a higher recurrence rate.
https://ift.tt/2M1AICC
Teaching a Tracheotomy Handoff Tool to Pediatric First Responders
Publication date: Available online 7 August 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Nicole Murray, Tulio A. Valdez, Amy L. Hughes, Katherine R. Kavanagh
Abstract
Introduction
The Critical Airway Risk Evaluation (CARE) system is an airway classification system we designed to improve handoffs between caregivers by describing the risk of a patient's airway above the tracheotomy tube, and therefore the correct resuscitation maneuvers in the event of an airway emergency. It is designed to quickly communicate 3 categories: 1-easily intubatable; 2-intubatable with specialized techniques or equipment; or 3-not intubatable. We have demonstrated previously that the system is easily taught to and used by pediatric otolaryngologists. For this system to be useful, it must be usable by a broader group, including first responders to a tracheostomy related airway emergency. The objective of this study is to analyze the reliability of teaching and ease of learning the CARE system among practicing otolaryngologists, otolaryngology residents, and pediatric residents.
Methods
A brief tutorial was designed to introduce the scale and was presented to practicing otolaryngologists, otolaryngology residents, and pediatrics residents. A 30-point questionnaire was administered in which patient's airways and airway management techniques were described. Participants were asked to classify each example according to the CARE system. Statistical analysis was performed using Student's t test and Fleiss' kappa reliability.
Results
A total of 66 physicians participated in the study. The pediatric residents correctly identified the patients' airway class 89% of the time (26.6/30 +/- SD=2.9). Otolaryngology attendings and residents answered correctly 92% of the time (27.7/30 +/- SD=2.9), which was not statistically different (p=0.23). Inter-rater reliability was also substantial among all groups, with a Fleiss' kappa greater than 0.7 for all groups.
Conclusions
This study demonstrates that the system can be taught to pediatrics residents as effectively as it can be taught to otolaryngology residents and practicing otolaryngologists and, therefore, can be effectively utilized in inter-disciplinary handoffs to facilitate information transfer to potential first responders.
https://ift.tt/2ORoQRe
Rural and Urban Food Allergy Prevalence from the South African Food Allergy Study (Saffa)
Publication date: Available online 7 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Maresa Botha, Wisdom Basera, Heidi E. Facey-Thomas, Ben Gaunt, Claudia L. Gray, Jordache Ramjith, Alexandra Watkins, Michael E. Levin
Abstract
Background
Food sensitization and challenge proven food allergy has not been compared in urban and rural settings.
Objective
To determine and compare the prevalence of food sensitization and challenge-proven IgE-mediated food allergy in urban and rural South African toddlers aged 12-36 months.
Methods
This cross-sectional study of unselected children included 1185 participants in urban Cape Town and 398 in the rural Eastern Cape. All participants completed a questionnaire and underwent skin prick tests to egg, peanut, cow's milk, fish, soya, wheat, and hazelnut. Participants with SPT≥ 1mm to one or more foods and not tolerant on history underwent an open oral food challenge.
Result
The prevalence of food allergy was 2.5% (CI 1.6-3.3) in urban children - most commonly to raw egg white (1.9%), followed by cooked egg (0.8%), peanut (0.8%), cow's milk (0.1%) and fish (0.1%). Urban sensitization (≥1mm SPT) to any food was 11.4% (CI 9.6%-13.3%) and 9.0% (CI 7.5%-10.8%) at ≥3mm SPT. Sensitization in the rural cohorts was significantly lower than the urban cohort (1mm SPT 4.5%, CI 2.5-6.6; 3mm SPT 2.8%, CI 1.4-4.9: p<0.01).
In the rural black African cohort 0.5% (CI 0.1%-1.8%) of children were food allergic - all to egg. This is significantly lower than the prevalence of urban cohort overall (2.5%) and urban black African participants (2.9%; CI 1.5%-4.3%)(p=0.006).
Conclusion
Food allergy prevalence in Cape Town is comparable to rates in industrialised middle-income countries and is significantly higher than in rural areas. Further analysis will describe and compare environmental exposures and other risk factors in this cohort.
https://ift.tt/2AR7Tnj
Education-dependent activation of glycolysis promotes the cytolytic potency of licensed human natural killer cells
Publication date: Available online 7 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Jolie R. Schafer, Travis C. Salzillo, Nitin Chakravarti, Meisam Naeimi Kararoudi, Prashant Trikha, Jennifer A. Foltz, Ruoning Wang, Shulin Li, Dean A. Lee
Abstract
The mechanism by which natural killer (NK) cell education results in licensed NK cells with heightened effector function against missing-self targets is not known. We found that licensed human NK cells are higher in number in peripheral blood and proliferate more in vitro than unlicensed NK cells. Using high-throughput protein analysis, we found that unstimulated licensed NK cells have increased expression of the glycolytic enzyme PKM2, and after KIR crosslinking have increased phosphorylation of the metabolic modulators p38-α and AMPKα. Following cytokine expansion and activation, unlicensed NK cells solely depended on mitochondrial respiration for cytolytic function, whereas licensed NK cells demonstrated metabolic reprogramming toward glycolysis and mitochondrial-dependent glutaminolysis, leading to accumulation of glycolytic metabolites and depletion of glutamate. As such, blocking both glycolysis and mitochondrial-dependent respiration was required to suppress cytotoxicity of licensed NK cells. Collectively, our data support an arming model of education in which enhanced glycolysis in licensed NK cells supports proliferative and cytotoxic capacity.
https://ift.tt/2OShq0k
Blimp-1 controls Th9 cell development, IL-9 production and allergic inflammation
Publication date: Available online 7 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Luciana Benevides, Renata Sesti Costa, Lucas Alves Tavares, Momtchilo Russo, Gislâine A. Martins, Luis Lamberti P. da Silva, Luiza Karla de P. Arruda, Fernando Q. Cunha, Vanessa Carregaro, João Santana Silva
Abstract
Background
The transcriptional repressor Blimp-1 has a key role in terminal differentiation in various T cell subtypes. However, whether Blimp-1 regulates Th9 differentiation and its role in allergic inflammation are unknown.
Objective
We aimed to investigate the role of Blimp-1 in Th9 differentiation and in the pathogenesis of allergic airway inflammation.
Methods
In vitro Th9 differentiation, flow cytometry, ELISA and real-time PCR were used to investigate the effects of Blimp-1 on Th9 polarization. T cell-specific Blimp-1-deficient mice (CKO), a model of allergic airway inflammation, and T cell adoptive transfer to Rag-1-/- mice were used to address the role of Blimp-1 in the pathogenesis of allergic inflammation.
Results
We found that Blimp-1 regulates Th9 differentiation, as deleting Blimp-1 increased IL-9 production in CD4+ T cells in vitro. In addition, we showed that in CKO mice, deletion of Blimp-1 in T cells worsened airway disease, and this worsening was inhibited by the neutralization of IL-9. In asthmatic patients, CD4+ T cells in response to TGF-β plus IL-4 increased IL-9 expression and down-regulated Blimp-1 expression compared to those of healthy controls. Blimp-1 overexpression in human Th9 cells inhibited IL-9 expression. Conclusion: Blimp-1 is a pivotal negative regulator of Th9 differentiation and controls allergic inflammation.
Graphical abstract
https://ift.tt/2ARCCR7
Tertiary lymphoid organs: A novel target in chronic rhinosinusitis
Publication date: Available online 7 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Sathish Paramasivan, Susan Lester, Aden Lau, Judy Ou, Alkis Psaltis, Peter-John Wormald, Sarah Vreugde
https://ift.tt/2ORL9WV
Investigating innate immune mechanisms in the early-life development and outcomes of food allergy
Publication date: Available online 7 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Andrew Dang, Stephanie Logsdon, Simon P. Hogan
https://ift.tt/2AORdwq
Central Odontogenic Fibroma: An Updated Systematic Review of Cases Reported In The Literature With Emphasis On Recurrence Influencing Factors
To integrate the available data published on central odontogenic fibroma (COF) into a comprehensive analysis of its clinical/radiologic/histological features.
https://ift.tt/2OOwiNf
Risk Factors for Cervical Spine Injury in Patients with Mandibular fractures
Publication date: Available online 7 August 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Esa M. Färkkilä, Zachary S. Peacock, R.John Tannyhill, Laurie Petrovick, Alice Gervasini, George C. Velmahos, Leonard B. Kaban
Abstract
Purpose
Patients with mandibular fractures are known to be at risk for concomitant cervical spine injuries (CSI). The purpose of this study was to determine the incidence and risk factors for CSI in these patients.
Patients and Methods
We conducted a retrospective cohort study of adult trauma patients with mandibular fractures from June 1, 2007 through June 30, 2017. Patients were identified through the Massachusetts General Hospital Trauma Registry and were included as subjects if they had a mandibular fracture and computed tomography (CT) or magnetic resonance imaging (MRI) of the cervical spine. Primary predictor variable was site of mandibular fracture; outcome variables were presence of CSI and mortality. Other variables were: Demographic (age, gender, alcohol and drug use, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), presence of mid-face and extra-craniofacial injuries and etiology. Data analysis consisted of univariate correlations and construction of a multivariate model to determine independent risk factors for CSI.
Results
Of 23,394 patients, in the Trauma Registry, 3950 (17%) had craniomaxillofacial fractures (CMF) and 1822 (7.7%) CSI. The frequency of CSI in the overall cohort of mandibular fracture patients (n=1147) was 4.4% and for admitted patients (n=495) 10%. Mean age of patients with mandibular fractures + CSI was 40 years (19-93); 84% were male. Subjects with a ramus-condyle unit fracture, mandible + any mid-face fracture, non-CMF injuries and motor vehicle crash (MVC) etiology had the highest frequency of CSI. Ramus-condyle unit fracture and chest injury were independent risk factors for CSI in the multivariate model (p=0.0334 and 0.0013, respectively). Mortality was four-fold higher in subjects with CSI versus those without CSI.
Conclusion
The presence of ramus-condyle unit fractures and chest injury were independent risk factors for CSI. Oral and maxillofacial surgeons should be diligent in ruling out CSI in mandibular fracture patients.
https://ift.tt/2LZJJMd
Implant-retained overdenture for a patient with severe lichen planus: A case report with 3 years’ follow-up and a systematic review
Publication date: Available online 7 August 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Li Fu, Yan Liu, Jing Zhou, Yanmin Zhou
Abstract
Purpose
To describe a new case of implant-retained overdenture in a patient with severe oral lichen planus (OLP) and to perform a literature review to evaluate the effectiveness and safety of implant rehabilitation in OLP patients.
Materials and Methods
A patient with erosive OLP was restored with implant-retained overdenture using the Locator attachment system. A literature search was performed in the PubMed/Medline, Embase and Cochrane databases for articles published between 1990 and 2018 using the key terms "oral lichen planus" and "implant".
Results
The present case revealed favorable restorative results and excellent implant osseointegration with acceptable marginal bone resorption during the follow-up of 3 years. The literature search identified 13 publications, including 9 single case reports or case series and 4 small-scale controlled studies. A total of 86 OLP patients and 259 dental implants were analyzed. The survival rate of implants was 95.8% during a follow-up period ranging from 1 to 13 years.
Conclusions
Dental implant seems to be an acceptable and reliable treatment option in patients with OLP. Nevertheless, clinical information on this topic is still scarce, and more well-designed randomized studies are needed to define the benefits and risks of implant rehabilitation in OLP patients.
https://ift.tt/2vLnCys
Mycosis fungoides in Puerto Rico
Mycosis fungoides (MF) and Sezary syndrome compromise about 53% of cutaneous lymphomas. Disease stage depends on involved body surface area, clinical presentation and the presence or absence systemic involvement, which will determine treatment. MF is generally diagnosed at early stages and carries a chronic and indolent disease course. In 2007, 30 MF cases in Puerto Rico were described from 1983 to 2002. We performed a retrospective chart review of MF cases (1999-2016) to compare these populations and identify any changes in disease prognosis and treatment response given different and new treatment modalities are now available.
https://ift.tt/2Mrt40s
Real-world use of secukinumab for the treatment of plaque psoriasis and psoriatic arthritis: Experience of four dermatology units in Spain
Introduction: Worldwide, there is an increasing trend to use real-world data to inform decision making in health care. The data regarding appropriate drug use, effectiveness, and cost-effectiveness in real-world clinical practice is intended to complement the findings from clinical trials, and to evaluate a drug's real-world value. Secukinumab is a fully humanized anti–interleukin (IL) 17A antibody that specifically binds to IL-17A receptors. In recent years, IL-17A has been recognized to play an important role in the disease pathology.
https://ift.tt/2M8PeYy
Comorbid conditions in lichen planopilaris: A retrospective data analysis of 334 patients
Background: Lichen planopilaris (LPP) is a rare cicatricial, lymphocyte mediated alopecia. It is thought to have an autoimmune pathogenesis, and possibly related to other autoimmune diseases; however, data are limited. In addition, studies examining comorbid conditions are lacking.
https://ift.tt/2MrsXSA
Small molecule inhibitor of the Wnt pathway (SM04755) as a potential topical treatment for psoriasis
Background: Psoriasis (PSO) is an autoimmune disease causing patches of thick, inflamed, scaly skin due to excessive proliferation of skin cells. Wnt signaling plays an important role in PSO, regulating inflammation and keratinocyte proliferation. SM04755, a novel, topical small-molecule Wnt pathway inhibitor was previously shown to inhibit inflammation and keratinocyte proliferation in vitro and in an IMQ-induced mouse PSO model. In this study, the effects of SM04755 on inflammation and skin health were evaluated in a model using reconstitution of ICR scid mice with minor histocompatibility mismatched naive CD4+ T lymphocytes, which more closely resembles human PSO pathophysiology.
https://ift.tt/2M9AM2p
Time to tumor response and planned subgroup analyses from the BOLT trial for sonidegib in advanced basal cell carcinoma
Background: Sonidegib 200 mg once daily (qd) was approved in the United States for patients with locally advanced basal cell carcinoma (laBCC) not amenable to curative surgery or radiotherapy based on results of the phase 2 BOLT study (NCT01327053). Here we report time to tumor response and planned subgroup analyses from the 30-month efficacy data from BOLT.
https://ift.tt/2MscNrW
Teledermatology in rural and remote British Columbia: A survey of primary care providers
Teledermatology, defined as the delivery of dermatology care at a distance through telecommunication technologies, has been proposed as a strategy to improve dermatology access to underserved populations. One such population is in rural and remote British Columbia, an area where there are currently no regularly practicing dermatologists. To gain an understanding of teledermatology utilization, attitudes and experiences in this area, we distributed a 14-question survey containing 10 questions related to the study objective.
https://ift.tt/2KxrHLW
Retrospective comparison of the clinical effects of programmed death protein 1 inhibitors to treat melanoma versus nonmelanoma skin cancer
Background: Programmed death protein (PD) 1 inhibitors have revolutionized treatment for cancers such as melanoma. However, clinical benefits and risks of PD-1 inhibitors among nonmelanoma skin cancers (NMSCs) are less well known, although off-label usage has been reported in the medical literature.
https://ift.tt/2OOlvmd
Two cases of cutaneous endometriosis
Cutaneous endometriosis (CEM) is a rare cutaneous manifestation of a common gynecological disease. More than 70% of CEM lesions are seen at sites of previous surgical scars, however primary lesions can arise de-novo in previously normal epithelium. The clinical presentation can vary and mimic other common dermatologic conditions. We present 1 primary and 1 secondary case of young healthy African American women with umbilical CEM. A 30-year-old woman presented with 2 umbilical lesions present for 1 year, associated with intermittent pain, swelling, and bleeding with menstrual cycles.
https://ift.tt/2MscLjO
The importance of early implementation of laser treatment in facial scars: A single-institution retrospective study
Background: Interest in minimizing scars especially on face has been rising recently.
https://ift.tt/2OTmDFc
Subject satisfaction demonstrated for two on-label injection volumes of abobotulinumtoxinA when used to treat moderate to severe glabellar lines
Introduction: In the U.S., glabellar lines (GLs) are most often treated with botulinum toxin type A (BoNT-A) and satisfaction with treatment is typically measured using patient-reported outcomes. Dysport (abobotulinumtoxinA [ABO]) is approved in the U.S. for the treatment of GLs and can be injected at 2 different injection volumes, 0.05 mL and 0.08 mL. In this study, we evaluated both on-label injection volumes in subjects with moderate to severe GLs at maximum frown and asked them to complete questionnaires before and after treatment to assess treatment satisfaction and health-related quality of life subject-reported outcomes, which is the focus of this report.
https://ift.tt/2MobGtl
Secondary localized cutaneous amyloidosis in mycosis fungoides
Secondary localized cutaneous amyloidosis is often not clinically apparent, but may be seen histologically. It is associated with several skin tumors, and has been reported with PUVA use. To date, there are three reported cases of secondary localized cutaneous amyloidosis associated with mycosis fungoides before any treatment. We present a case of a 39-year-old woman who presented to the dermatology clinic for evaluation of facial acne. During the exam, several 5-10 mm hypopigmented patches were noted on the bilateral ventral forearms.
https://ift.tt/2OOlizr
Ustekinumab an alternative therapeutic option for refractory erytroderma pytiriasis rubra pilaris disease
Introduction: Pityriasis rubra pilaris (PRP) is a rare, chronic erythematous squamous disorder. PRP is divided into six subtypes, type 1 being the most common and classic form in adults. PRP erytroderma may be a therapeutic challenge because standard therapies are lacking due to its unclear pathogenesis. Ustekinumab is a monoclonal antibody that is approved for the treatment of psoriasis, but has been shown to be effective as an off-label use treatment for PRP. We report a case of refractory erythroderma type 1 PRP with complete resolution with ustekinumab therapy.
https://ift.tt/2KxrisU
Treating to target: Exploration of Investigator Global Assessment and body surface area (IGA×BSA) as a practical minimal disease activity goal
Objective: Psoriasis Area Severity Index (PASI) is typically used in clinical trials, but may not be pragmatic for use in clinical practice. The Investigator Global Assessment (IGA) and percentage of affected body surface area (BSA) are measures of psoriasis disease activity that are easily performed in routine clinical practice. This retrospective pooled analysis explored cutoff values of the product of IGA and BSA (IGA×BSA) that correlate with minimal disease activity (MDA) and would allow for a treat-to-target approach that may be feasible in clinical practice.
https://ift.tt/2Mc9dWe
The sun and your health: Targeting teenagers and adolescents in British Columbia
Introduction: Skin cancer is one of the most preventable forms of cancer. Approximately 85% of skin cancer cases could be avoided by reducing ultraviolet (UV) exposure, especially during childhood and adolescence. We conducted a pilot study to evaluate UV exposure and sun safety behaviors in this age group. In addition, the effectiveness in changing sun protection knowledge, attitudes, and behaviors using an innovative intervention was compared with the strategy of using education alone.
https://ift.tt/2Kxr7he
The effect of topical sunscreen plus antioxidant against the visible light biologic effects
Background: Visible light (VL) has been shown to induce erythema, pigmentation, and photodamage. Sunscreens effective against VL contain inorganic filters, but are often cosmetically unacceptable in darker skin tones. Antioxidants possess photoprotective properties and may serve as an alternative.
https://ift.tt/2Mc984S
Sparing the use of steroids in the treatment of Sweet syndrome: A case report
Sweet syndrome is an acute febrile neutrophilic dermatosis first decribed in 1964. It is an uncommon disease, with no racial predisposition, that affects mostly women 30-60 years of age. Its physiopathology is unknown and 20% of the cases are linked to malignant tumors. It can also be associated with autoimmune diseases, drug intake, pregnancy and 60% are idiopathic. It can present with papules, nodules, and erythematous plaques, most of the times painful. Edema is associated, and can lead to vesicules, bullae, and/or pustules.
https://ift.tt/2MsoC1B
Spontaneous regression of Merkel cell carcinoma is associated with clonal T-cell expansion
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin tumor. MCC is immunogenic and highly responsive to immune checkpoint inhibitors. There are at least 45 reported cases of spontaneous regression of both local and metastatic MCC following biopsies, excisions, fine needle aspirations, and in 1 case after allergic contact dermatitis. Spontaneous tumor regression has also been observed in other tumor types, however the mechanism is poorly understood. There has been speculation that trauma-induced antigen shedding and subsequent recruitment of a host immune response drives tumor regression.
https://ift.tt/2Mc9U1A
Serratia pyoderma mimicking acne vulgaris
A 17-year-old woman with no significant medical history presented complaining of acne. She reported that three days before her "acne" started she applied tea tree oil (TTO) for a few pimples. Photos on the patient's phone before TTO application revealed completely clear facial skin. Within a few days of TTO use she developed a facial eruption. She was evaluated by her pediatrician who prescribed minocycline for 10 days along with adapalene and benzoyl peroxide. She did not improve and was referred to dermatology.
https://ift.tt/2KzM1fK
Safety and efficacy of microfocused ultrasound with visualization for the correction of moderate-to-severe atrophic acne scars
Background and objective: Microfocused ultrasound with visualization (MFU-V; Ulthera) has been shown to induce collagen production and remodeling of tissue layers in the skin. The purpose of this study was to assess the efficacy and safety of MFU-V for improving the appearance of atrophic acne scars.
https://ift.tt/2OSUy0m
Mast cell activation syndrome: High frequency of skin manifestations and anaphylactic shock
Publication date: Available online 7 August 2018
Source: Allergology International
Author(s): Eline A. Casassa, Claire Mailhol, Emilie Tournier, Camille Laurent, Yannick Degboe, Marine Eischen, Natalia Kirsten, Jacques Moreau, Solène M. Evrard, Véronique Mansat-De Mas, Laurence Lamant, Patrice Dubreuil, Pol André Apoil, Olivier Hermine, Carle Paul, Cristinai Bulai Livideanu
https://ift.tt/2AN26PB
Interventions for dry mouth and hyposalivation in Sjögren's syndrome: a systematic review and meta‐analysis
Oral Diseases, Volume 0, Issue ja, -Not available-.
https://ift.tt/2MrNwhL
Putative neuromycotoxicoses in an adult male following ingestion of moldy walnuts
Abstract
A tremorgenic syndrome occurs in dogs following ingestion of moldy walnuts, and Penicillium crustosum has been implicated as the offending fungus. This is the first report of suspected moldy walnut toxicosis in man. An adult male ingested approximately eight fungal-infected walnut kernels and after 12 h experienced tremors, generalized pain, incoordination, confusion, anxiety, and diaphoresis. Following symptomatic and supportive treatment at a local hospital, the man made an uneventful recovery. A batch of walnuts (approximately 20) was submitted for mycological culturing and identification as well as for mycotoxin analysis. Penicillium crustosum Thom was the most abundant fungus present on walnut samples, often occurring as monocultures on isolation plates. Identifications were confirmed with DNA sequences. The kernels and shells of the moldy walnuts as well as P. crustosum isolates plated on yeast extract sucrose (YES) and Czapek yeast autolysate (CYA) agars and incubated in the dark at 25 °C for 7 days were screened for tremorgenic mycotoxins and known P. crustosum metabolites using a liquid chromatography-tandem mass spectrometric (LC-MS/MS) method. A relatively low penitrem A concentration of only 1.9 ng/g was detected on the walnut kernels when compared to roquefortine C concentrations of 21.7 μg/g. A similar result was obtained from P. crustosum isolates cultured on YES and CYA, with penitrem A concentrations much lower (0.6–6.4 μg per g mycelium/agar) compared to roquefortine C concentrations (172–1225 μg/g). The authors surmised that besides penitrem A, roquefortine C might also play an additive or synergistic role in intoxication of man.
https://ift.tt/2vobMe4
An integrated deep sequencing analysis of microRNAs in transplanted corneas
Publication date: September 2018
Source: Molecular Immunology, Volume 101
Author(s): Xiaoli Lu, Jing Wu, Ming Ma, Xiaosong Wu, Jing Wen, Jian Yu
Abstract
Illumina Hiseq 2500 deep sequencing was used to screen for differentially expressed genes (DEGs) in matched pairs of isograft corneas and normal corneas, allograft corneas and isograft corneas. Our results showed that 22 miRNAs were significantly upregulated and 4 were significantly downregulated in the isograft group when compared with the control group (P < 0.01), while 17 miRNAs were significantly upregulated and 3 were significantly downregulated in the allograft group when compared with the isograft group (P < 0.01). Among the miRNAs with altered expression levels, miR-155-5p, miR-142-3p, miR-142-5p, and miR-223-3p displayed simultaneous changes in the above two comparisons. Potential target genes among the DEGs were predicted using target prediction software (TargetScan, Miranda, miRDB, and CLIP), and the overlay portion was analyzed using the Gene Ontology (GO) database and the Kyoto Encyclopedia of Genes and Genomes (KEGG). GO and KEGG analyses showed that the DEGs were mainly involved in metabolic pathways, cytokine secretion, and tumor immunity functions. An analysis of the interactions between DEG proteins (PPI analysis) and a MetaCore software analysis of 4 key DEGs revealed that the genes regulated by miR-155-5p played important roles in the miRNA-mRNA regulatory network. Furthermore, the MetaCore analysis identified C/EBP beta, p53, and sp1 as key transcription factors in that network. Our study identified transplanted corneas-specific miRNA in matched pairs of isograft corneas and normal corneas, allograft corneas and isograft corneas. Furthermore, bioinformatics analysis of the key miRNA regulatory network revealed the molecular mechanisms, which suggests miRNAs may as new molecular targets for treating corneal injuries and corneal transplant rejection.
https://ift.tt/2APOdQv
The effectiveness of eugenol against cisplatin-induced ototoxicity
Publication date: Available online 7 August 2018
Source: Brazilian Journal of Otorhinolaryngology
Author(s): Muhammed Sedat Sakat, Korhan Kilic, Fazile Nur Ekinci Akdemir, Serkan Yildirim, Gizem Eser, Ahmet Kiziltunc
Abstract
Introduction
Ototoxicity refers to cellular damage or function impairment developing in the inner ear in association with any therapeutic agent or chemical substance, and still represents the principal side-effect restricting the use of cisplatin.
Objective
The aim of this study was to perform a biochemical, functional and histopathological investigation of the potential protective effect of eugenol against cisplatin-induced ototoxicity.
Methods
The study was performed with 24 female Sprague Dawley rats. Distortion product otoacoustic emissions tests were performed on all animals, which were randomized into four equal groups. A single intraperitoneal dose of 15 mg/kg cisplatin was administered to cisplatin group, while the eugenol group received 100 mg/kg eugenol intraperitoneal for five consecutive days. 100 mg/kg eugenol was administered to cisplatin + eugenol group for 5 days. On the third day, these rats were received a single dose of 15 mg/kg cisplatin. The control group was given 8 mL/kg/day intraperitoneal saline solution for five days. The distortion product otoacoustic emissions test was repeated 24 h after the final drug administration. All animals were sacrificed, and the cochleas were subsequently used for biochemical and histopathological examinations.
Results
Cisplatin caused oxidative stress in the cochlea, impaired the cochlear structure and significantly reduced signal noise ratio levels. Administration of eugenol together with cisplatin reversed these effects and provided functional, biochemical and histopathological protection.
Conclusion
The study findings represent the first indication in the literature that eugenol may protect against ototoxicity by raising levels of antioxidant enzymes and lowering those of oxidant parameters.
Resumo
Introdução
A ototoxicidade refere-se ao dano celular ou comprometimento da função da orelha interna interna associado a qualquer agente terapêutico ou substância química, e ainda representa o principal efeito colateral que restringe o uso da cisplatina.
Objetivo
O objetivo deste estudo foi realizar uma investigação bioquímica, funcional e histopatológica do potencial efeito protetor do eugenol contra a ototoxicidade induzida pela cisplatina.
Método
O estudo foi realizado com 24 ratos fêmeas Sprague Dawley. Testes de emissões otoacústicas por produto de distorção foram realizados em todos os animais, os quais foram randomizados em quatro grupos iguais. Uma única dose intraperitoneal de 15 mg/kg de cisplatina foi administrada ao grupo cisplatina, enquanto o grupo eugenol recebeu 100 mg/kg de eugenol intraperitoneal por cinco dias consecutivos. Foram administrados 100 mg/kg de eugenol ao grupo cisplatina + eugenol durante 5 dias. No terceiro dia, estes ratos receberam uma dose única de 15 mg/kg de cisplatina. O grupo controle recebeu 8 mL/kg/dia de solução salina intraperitoneal por cinco dias. O teste de emissões otoacústicas por produto de distorção foi repetido 24 horas após a administração final do medicamento. Todos os animais foram sacrificados e as cócleas foram posteriormente utilizadas para exames bioquímicos e histopatológicos.
Resultados
A cisplatina causou estresse oxidativo na cóclea, prejudicou a estrutura coclear e reduziu significativamente os níveis da relação sinal/ruído. A administração de eugenol juntamente com a cisplatina reverteu esses efeitos e forneceu proteção funcional, bioquímica e histopatológica.
Conclusão
Os achados do estudo representam a primeira indicação na literatura de que o eugenol pode proteger contra a ototoxicidade, elevando os níveis de enzimas antioxidantes e diminuindo os níveis dos parâmetros oxidantes.
https://ift.tt/2ORmrWP
Diagnosis by Comprehensive Cardiovascular Imaging for Stroke and TIA
Conditions: Stroke; Transient Ischaemic Attack
Intervention: Diagnostic Test: CCI scanning (CTA, cardiac CT), and MRI scanning
Sponsors: NHS Greater Glasgow and Clyde; University of Glasgow
Not yet recruiting
https://ift.tt/2KCLnhs
Intervention: Diagnostic Test: CCI scanning (CTA, cardiac CT), and MRI scanning
Sponsors: NHS Greater Glasgow and Clyde; University of Glasgow
Not yet recruiting
https://ift.tt/2KCLnhs
Stereotactic Body Radiation Therapy and Durvalumab With or Without Tremelimumab Before Surgery in Treating Participants With Human Papillomavirus Positive Oropharyngeal Squamous Cell Caner
Conditions: Clinical Stage I HPV-Mediated (p16-Positive) Oropharyngeal Carcinoma AJCC (American Joint Committee on Cancer) v8; Clinical Stage II HPV-Mediated (p16-Positive) Oropharyngeal Carcinoma AJCC v8; Clinical Stage III HPV-Mediated (p16-Positive) Oropharyngeal Carcinoma AJCC v8; Human Papillomavirus Positive; Oropharyngeal Squamous Cell Carcinoma; p16 Positive Neoplastic Cells Present; Pathologic Stage I HPV-Mediated (p16-Positive) Oropharyngeal Carcinoma AJCC v8; Pathologic Stage II HPV-Mediated (p16-Positive) Oropharyngeal Carcinoma AJCC v8; Pathologic Stage III HPV-Mediated (p16-Positive) Oropharyngeal Carcinoma AJCC v8
Interventions: Biological: Durvalumab; Procedure: Modified Radical Neck Dissection; Other: Quality-of-Life Assessment; Other: Questionnaire Administration; Radiation: Stereotactic Body Radiation Therapy; Procedure: Transoral Robotic Surgery; Biological: Tremelimumab
Sponsors: Jonsson Comprehensive Cancer Center; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2LZmKBg
Interventions: Biological: Durvalumab; Procedure: Modified Radical Neck Dissection; Other: Quality-of-Life Assessment; Other: Questionnaire Administration; Radiation: Stereotactic Body Radiation Therapy; Procedure: Transoral Robotic Surgery; Biological: Tremelimumab
Sponsors: Jonsson Comprehensive Cancer Center; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2LZmKBg
Impact of Cancer Therapy on Myocardial Function in Patients With Esophagus Cancer
Condition: Cancer of Esophagus
Intervention:
Sponsors: Aarhus University Hospital Skejby; Danish Cancer Society
Recruiting
https://ift.tt/2KzVmUw
Intervention:
Sponsors: Aarhus University Hospital Skejby; Danish Cancer Society
Recruiting
https://ift.tt/2KzVmUw
Durvalumab With or Without Metformin in Treating Participants With Head and Neck Squamous Cell Carcinoma
Conditions: Larynx; Lip, Oral Cavity and Pharynx
Interventions: Drug: Metformin; Biological: Durvalumab
Sponsor: Sidney Kimmel Cancer Center at Thomas Jefferson University
Not yet recruiting
https://ift.tt/2M1ZmmE
Interventions: Drug: Metformin; Biological: Durvalumab
Sponsor: Sidney Kimmel Cancer Center at Thomas Jefferson University
Not yet recruiting
https://ift.tt/2M1ZmmE
Soil exposure modifies the gut microbiota and supports immune tolerance in a mouse model
Publication date: Available online 7 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Noora Ottman, Lasse Ruokolainen, Alina Suomalainen, Hanna Sinkko, Piia Karisola, Jenni Lehtimäki, Maili Lehto, Ilkka Hanski, Harri Alenius, Nanna Fyhrquist
Background
Sufficient exposure to natural environments, in particular soil and its microbes, has been suggested to be protective against allergies.
Objective
We aim at gaining more direct evidence of the environment-microbiota-health axis by studying the colonization of gut microbiota in mice after exposure to soil and by examining immune status in both a steady-state situation and during allergic inflammation.
Methods
The gastrointestinal microbiota of mice housed on clean bedding or in contact with soil was analyzed by using 16S rRNA gene sequencing, and the data were combined with immune parameters measured in the gut mucosa, lung tissue, and serum samples.
Results
We observed marked differences in the small intestinal and fecal microbiota composition between mice housed on clean bedding or in contact with soil, with a higher proportion of Bacteroidetes relative to Firmicutes in the soil group. The housing environment also influenced mouse intestinal gene expression, as shown by upregulated expression of the immunoregulatory markers IL-10, forkhead box P3, and cytotoxic T lymphocyte–associated protein 4 in the soil group. Importantly, using the murine asthma model, we found that exposure to soil polarizes the immune system toward TH1 and a higher level of anti-inflammatory signaling, alleviating TH2-type allergic responses. The inflammatory status of the mice had a marked influence on the composition of the gut microbiota, suggesting bidirectional communication along the gut-lung axis.
Conclusion
Our results provide evidence of the role of environmentally acquired microbes in alleviating against TH2-driven inflammation, which relates to allergic diseases.
Graphical abstract
https://ift.tt/2vT7Y4b
Issue Information
Journal of Oral Pathology &Medicine, Volume 47, Issue 7, Page ii-v, August 2018.
https://ift.tt/2vPWiiC
Cover Image
Journal of Oral Pathology &Medicine, Volume 47, Issue 7, Page i-i, August 2018.
https://ift.tt/2ni0uU9
Mandibular war injuries caused by bullets and shell fragments: a comparative study
Abstract
Purpose
Is to compare the patterns, severity, and management of the high- and low-velocity mandibular war injuries managed at Al Shaheed Gazi Al-Hariri Hospital in Baghdad Medical City, Iraq, during a 2-year period.
Methods
Forty-one patients with a history of mandibular war injuries treated by our maxillofacial team were reviewed during a period of 2 years (2015–2017). All patients were treated in the Maxillofacial Unit of the Hospital of Specialized Surgeries in Baghdad Medical City.
Results
A 2-year retrospective study evaluated 41 patients with mandibular war injuries with a total of 94 fractures (comminution represents 79.06% of the bullet injuries, while it is only 62.74% with IED injuries). Management of these injuries was varied according to the severity of the injuries and resources available. Close reduction was used in 72.72% of the linear fracture cases, whereas open technique was used in 56.6% of the comminuted fractures.
Conclusions
Bullet injuries were associated with a higher number of mandibular comminuted fractures, in addition to more extensive bone loss. While shell injuries of IED (improvised explosive devices), on the other hand, were associated with higher infection rate and more postoperative complication.
https://ift.tt/2nkRvBW
Mandibular war injuries caused by bullets and shell fragments: a comparative study
Abstract
Purpose
Is to compare the patterns, severity, and management of the high- and low-velocity mandibular war injuries managed at Al Shaheed Gazi Al-Hariri Hospital in Baghdad Medical City, Iraq, during a 2-year period.
Methods
Forty-one patients with a history of mandibular war injuries treated by our maxillofacial team were reviewed during a period of 2 years (2015–2017). All patients were treated in the Maxillofacial Unit of the Hospital of Specialized Surgeries in Baghdad Medical City.
Results
A 2-year retrospective study evaluated 41 patients with mandibular war injuries with a total of 94 fractures (comminution represents 79.06% of the bullet injuries, while it is only 62.74% with IED injuries). Management of these injuries was varied according to the severity of the injuries and resources available. Close reduction was used in 72.72% of the linear fracture cases, whereas open technique was used in 56.6% of the comminuted fractures.
Conclusions
Bullet injuries were associated with a higher number of mandibular comminuted fractures, in addition to more extensive bone loss. While shell injuries of IED (improvised explosive devices), on the other hand, were associated with higher infection rate and more postoperative complication.
https://ift.tt/2nkRvBW
Caracterización de la enfermedad por reflujo faringolaríngeo en pacientes de edad avanzada y ancianos
Publication date: Available online 7 August 2018
Source: Acta Otorrinolaringológica Española
Author(s): Francisco J. Cervera-Paz, Marta Jordano-Cabrera
Resumen
Objetivos
Caracterizar la enfermedad por reflujo faringolaríngeo en pacientes de edad avanzada y ancianos.
Métodos
Estudio retrospectivo de pacientes mayores de 60 años, con sintomatología sugestiva de enfermedad por reflujo faringolaríngeo, vistos entre 2005 y 2014 en el Departamento de Otorrinolaringología de un hospital universitario. Se seleccionaron 85 pacientes (54 mujeres y 31 hombres) sometidos a una pH-metría de 24 h con doble sensor («gold standard» en el diagnóstico del reflujo).
Se calculó el índice de masa corporal. Se revisó la información clínica y evaluaron las pH-metrías según los criterios de DeMeester y Johnson. Se revisó el cuestionario «Reflux Symptoms Index» (RSI), considerado patológico cuando fue ≥13. Se evaluaron los hallazgos endoscópicos faringolaríngeos del «Reflux Finding Score» (RFS), considerado patológico cuando fue ≥7.
Resultados
La edad media fue 67 años. En 70 pacientes (82%) la pH-metría fue patológica. El índice de masa corporal fue patológico en 50 pacientes (59%), de los que casi el 90% tenían pH-metría patológica. El RSI medio fue 9,8, con resultados anormales en 24 pacientes (28%). En 20 pacientes (23%) con RSI anormal tenían una pH-metría positiva. El hallazgo endoscópico más común (90%) fue la hipertrofia de comisura posterior. El RFS medio fue 9,07, con resultados anormales en 69 pacientes (70%). En 61 pacientes (70%) con RFS anormal tenían una pH-metría patológica. Solo 18 pacientes con RSI y RFS patológicos tenían una pH-metría patológica.
Conclusiones
En pacientes mayores, los valores patológicos de índice de masa corporal se asocian altamente con pH-metrías patológicas. El RSI es un indicador de poco valor, mientras que el RFS es de valor moderado.
Abstract
Objectives
To characterize laryngo-pharyngeal reflux (LPR) in patients over 60 years of age.
Methods
Retrospective review of patients over 60 years of age with symptoms suspicious of LPR, seen from 2005 to 2014 at an ENT Department of an academic hospital. Eighty-five consecutive patients (54 females, 31 males) who had completed a dual-sensor 24-hour pH-metry were included (considered "gold-standard" in LPR diagnosis).
Body mass index, and reflux information and interventions were revised. pH-metries were evaluated according to DeMeester & Johnson's criteria. Symptoms were assessed according to the Reflux Symptom Index (RSI) and classified as abnormal if score was ≥13. A naso-fibro-laryngoscopy enabled findings to be documented according to the Reflux Finding Score (RFS), and they were classified as abnormal if the score was ≥7.
Results
The patients' mean age was 67 years. A positive pH-metry was present in 70 patients (82.5%). Fifty patients (59%) had abnormal body mass index, and almost 90% of them had an abnormal pH-metry. Mean RSI score was 9.8, with abnormal results in 24 patients (28%). Only 20 patients (23%) with abnormal RSI had a positive pH-metry. Posterior commissure hypertrophy was the most common finding (90% of patients). Mean RFS score was 9.07, with abnormal results in 69 patients (81%). Sixty-one patients (70%) with abnormal RFS had a positive pH-metry. Only 18 patients (20%) had coincidental abnormal pH-metry, RSI, and RFS.
Conclusions
In ageing patients, abnormal body mass index is strongly associated with abnormal pH-metry. RSI is a weak indicator of LPR, whereas RFS has a moderate value.
https://ift.tt/2nkILLK
Validez de las medidas del pico cepstral para la valoración objetiva de la disfonía en sujetos de habla hispana
Publication date: Available online 7 August 2018
Source: Acta Otorrinolaringológica Española
Author(s): Faustino Núñez-Batalla, Noelia Cartón-Corona, Gabriela Vasile, Patricia García-Cabo, Laura Fernández-Vañes, José Luis Llorente-Pendás
Resumen
Introducción y objetivos
La fiabilidad de las calificaciones perceptuales de la calidad global de la voz y sus dimensiones específicas es difícil de alcanzar, por cuanto estos juicios dependen de la subjetividad del examinador. De este modo, la búsqueda de unas medidas clínicas que sean objetivas, válidas y accesibles es una prioridad para incluirlas en los protocolos de evaluación de la voz.
El propósito del presente estudio fue: 1) determinar la exactitud diagnóstica de un único parámetro acústico, la prominencia del pico cepstral suavizado (CPPS), para predecir la presencia y severidad de una disfonía en vocales sostenidas y habla conectada utilizando el programa Praat; 2) determinar la relación entre las medidas del CPPS y las calificaciones perceptuales de la calidad vocal; y 3) describir los valores normativos del CPPS.
Método
Se obtuvo el valor del CPPS de muestras vocales sostenidas y de habla conectada de 72 sujetos hispanohablantes con trastornos vocales y de 52 sujetos hispanohablantes sanos utilizando el programa Praat. Se llevó a cabo un estudio estadístico completo utilizando el programa SPSS de IBM versión 23.
Resultados
Se encontró una sensibilidad de un 70% y una especificidad de un 85%. La severidad estimada de la voz, tanto en vocal sostenida como en habla conectada, se correlacionó de forma importante con las calificaciones perceptuales de severidad global de la disfonía.
Conclusiones
Un parámetro acústico único, el CPPS calculado mediante el programa Praat, predice de forma importante el estatus de un trastorno vocal. Se considera la incorporación del CPPS para complementar la valoración clínica de la voz.
Abstract
Introduction and objectives
Perceptual rating of overall voice quality and other more specific perceptual dimensions is difficult, as such judgments depend on the listener's subjectivity. Thus, finding objective, valid, and accessible clinical measures to include in comprehensive voice evaluation protocols is a priority.
The purposes of this study were to 1) determine the diagnostic accuracy of a single acoustic measure, smoothed cepstral peak prominence (CPPS), to predict voice disorder status from sustained vowels and connected speech samples using the software Praat; 2) to determine the relationship between measures of CPPS and perceptual ratings of vocal quality; and 3) describe the normative values of CPPS.
Method
Measures of CPPS were obtained from connected speech and sustained vowel recordings of 72 Spanish-speaking subjects with voice disorders and 52 nondysphonic Spanish-speaking subjects with no vocal disorders using freely downloadable Praat software. IBM SPSS Statistics software version 23 was used to complete the statistical analyses.
Results
results revealed a 70% sensitivity rate, a specificity rate of 85%. Estimated severity for sustained vowels and connected speech were strongly correlated and significantly associated with listener ratings of dysphonia severity.
Conclusions
A single acoustic measure of CPPS was highly predictive of voice disorder status using Praat software. Clinicians may consider using CPPS to complement clinical voice evaluation and screening protocols.
https://ift.tt/2vMeIAN
Use of a Non-Crosslinked Collagen Membrane During Guided Bone Regeneration Does Not Interfere With the Bone Regenerative Capacity of the Periosteum
Publication date: Available online 7 August 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Felipe Eduardo Pinotti, Guilherme José Pimentel Lopes de Oliveira, Cássio Rocha Scardueli, Marcell Costa de Medeiros, Andreas Stavropoulos, Rosemary Adriana Chiérici Marcantonio
Purpose
To assess whether the use of a non-crosslinked porcine collagen type I and III bi-layered membrane inter-positioned between the periosteum and a bone defect would interfere with the bone regenerative capacity of the periosteum.
Materials and Methods
Sixty rats, each with 1 critical-size calvarial defect (CSD; diameter, 5 mm) in the parietal bone, were randomly allocated to 1 of 3 equal-size groups after CSD creation: 1) the periosteum was excised and the flap was repositioned without interposition of a membrane (no-periosteum [NP] group); 2) the flap including the periosteum was repositioned (periosteum [P] group); and 3) a non-crosslinked collagen membrane was inter-positioned between the flap, including the periosteum, and the bone defect (membrane [M] group). Micro-computed tomography, qualitative histology, immunohistochemistry, and real-time quantitative polymerase chain reaction were performed at 3, 7, 15, and 30 days postoperatively.
Results
A markedly increased radiographic residual defect length was observed in the NP group compared with the P group at 30 days. The NP group also presented a smaller radiographic bone fill area than the P group at 15 and 30 days and then the M group at 30 days. The P and M groups exhibited considerably greater expression of bone morphogenetic protein-2 and osteocalcin than the NP group at 7 days; expression of transforming growth factor-β1 was considerably greater in the NP group at 15 days. Further, the P group presented considerably higher gene expression levels of Runx2 and Jagged1 at 7 days and of alkaline phosphatase at 3 and 15 days compared with the M and NP groups.
Conclusion
Interposition of this specific non-crosslinked collagen membrane between the periosteum and the bone defect during guided bone regeneration interferes only slightly, if at all, with the bone regenerative capacity of the periosteum.
https://ift.tt/2APSlQx
What do Vitiligo Impact Scale (VIS)‐22 scores mean? Studying the clinical interpretation of scores using an anchor‐based approach
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2APL7w5
Comparison of the effect of the lidocaine, tetracaine, and articaine application into nasal packs on pain and hemorrhage after septoplasty
Abstract
Objective
We purposed to compare the effects of certain local anesthetics soaked Merocel nasal packs on hemorrhage and pain after septoplasty.
Materials and methods
This study is a prospective double-blind study that was done in patients undergoing septoplasty. The study was created with 90 patients. All patients were divided into four groups. The each group was applied 2% lidocaine plus adrenaline, 2% tetracaine, 4% articaine plus adrenaline as study groups or 0.9% sodium chloride (NaCl) as control group in their Merocel packs after septoplasty. Verbal analog scale (VAS) was applied to all patients and the amount of postoperative hemorrhage was noted during postoperative period. The statistical analysis was performed using Student's t test and Chi-square test on each patient group at each time point.
Results
The study groups (2% lidocaine plus adrenaline, 2% tetracaine and 4% articaine plus adrenaline groups) had significantly better pain scores versus control group in the 1st, 4th, 8th, 16th and 24th postoperative hours (p < 0.05). The articaine plus adrenaline group had better pain scores than the lidocaine plus adrenaline group, and the lidocaine plus adrenaline group had better pain scores than the tetracaine group in the postoperative first day. Also articaine plus adrenaline group had less postoperative bleeding rate than the lidocaine plus adrenaline, tetracaine and control groups (p < 0.05). There was no statistically significant difference between the lidocaine plus adrenaline, tetracaine and control groups in terms of postoperative hemorrhage (p > 0.05).
Conclusion
Topical articaine plus adrenaline application in the nasal packs can be safely used for less pain and bleeding following septoplasty.
https://ift.tt/2AOgI14
Serum Leukotriene B4 Levels, Tonsillar Hypertrophy and Sleep-Disordered Breathing in Childhood
Publication date: Available online 7 August 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Emmanouel Ι. Alexopoulos, George Haritos, Christina Befani, Georgia Malakasioti, Vassilis A. Lachanas, Panagiotis Liakos, Konstantinos Gourgoulianis, Athanasios G. Kaditis
Abstract
Objectives
In children with snoring, increased production of leukotriene B4 (LTB4) may promote tonsillar hypertrophy and sleep-disordered breathing (SDB) or conversely SDB may enhance LTB4 synthesis. We explored whether: i) high LTB4 serum levels predict tonsillar hypertrophy; and ii) SDB severity correlates with LTB4 serum concentration.
Methods
Normal-weight children with SDB or controls underwent polysomnography and measurement of LTB4 serum concentration. Tonsillar hypertrophy was the main outcome measure and high LTB4 serum level (>75 t h percentile value in controls) was the primary explanatory variable. Odds ratio (OR) and the corresponding 95% confidence intervals (CI) for tonsillar hypertrophy in children with versus without high LTB4 level were calculated. The control subgroup and subgroups of subjects with increasing SDB severity were compared regarding LTB4 concentration by Kruskal-Wallis test. Spearman's correlation co-efficient was applied to assess the association of LTB4 concentration with SDB severity.
Results
A total of 104 children with SDB and mean obstructive apnea-hypopnea index-AHI of 4.8 ± 5.3 episodes/h (primary snoring: n=19; mild SDB: n=49; moderate/severe SDB: n=36) and 13 controls (no snoring; AHI: 0.4 ± 0.2 episodes/h) were recruited. The four study subgroups were similar regarding LTB4 serum concentration (P=0.64). High LTB4 (>170.3 pg/mL) was a significant predictor of tonsillar hypertrophy after adjustment for age and gender (OR 3.0 [1.2-7.2]; P=0.01). There was no association between AHI or desaturation index and LTB4 serum concentration (r=-0.08; P=0.37 and r=-0.1; P=0.30, respectively).
Conclusion
No association was identified between SDB severity and LTB4 levels, but high LTB4 concentration predicted tonsillar hypertrophy.
https://ift.tt/2vIzBN7
Prevalence of ear disease and associated hearing loss among primary school students in the Solomon Islands: otitis media still a major public health issue
Publication date: Available online 7 August 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Annette Kaspar, Obiga Newton, Joseph Kei, Carlie Driscoll, De Wet Swanepoel, Helen Goulios
https://ift.tt/2M05I5J
Submental flap donor site morbidity in pediatric patients
Publication date: Available online 7 August 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Amin Rahpeyma, Saeedeh khajehahmadi
https://ift.tt/2vGk2W0
Melasma in a transgender woman
Publication date: Available online 7 August 2018
Source: American Journal of Otolaryngology
Author(s): Laura Garcia-Rodriguez, Jeffrey Spiegel
https://ift.tt/2vt4mGo
Soluble CD14 concentration in human breast milk and its potential role in child atopic dermatitis: results of the Ulm Birth Cohort Studies
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2KvQAHS
Cholesteatoma vs granulation tissue: a differential diagnosis by DWI-MRI apparent diffusion coefficient
Abstract
Purpose
To diagnose cholesteatoma when it is not visible through tympanic perforation, imaging techniques are necessary. Recently, the combination of computed tomography and magnetic resonance imaging has proven effective to diagnose middle ear cholesteatoma. In particular, diffusion weighted images have integrated the conventional imaging for the qualitative assessment of cholesteatoma. Accordingly, the aim of this study was to obtain a quantitative analysis of cholesteatoma calculating the apparent diffusion coefficient value. So, we investigated whether it could differentiate cholesteatoma from other inflammatory tissues both in a preoperative and in a postoperative study.
Methods
This study included 109 patients with clinical suspicion of primary or residual/recurrent cholesteatoma. All patients underwent preoperative computed tomography and magnetic resonance imaging with diffusion sequences before primary or second-look surgery to calculate the apparent diffusion coefficient value.
Results
We found that the apparent diffusion coefficient values of cholesteatoma were significantly lower than those of non cholesteatoma. In particular, the apparent diffusion coefficient median value of the cholesteatoma group (0.84 × 10− 3 mm2/s) differed from the inflammatory granulation tissue (2.21 × 10− 3 mm2/s) group (p < 2.2 × 10− 16). Furthermore, we modeled the probability of cholesteatoma by means of a logistic regression and we determined an optimal cut-off probability value of ~ 0.86 (specificity = 1.0, sensitivity = 0.97), corresponding to an apparent diffusion coefficient cut-off value of 1.37 × 10− 3 mm2/s.
Conclusions
Our study has demonstrated that apparent diffusion coefficient values constitute a valuable quantitative parameter for preoperative differentiation of cholesteatomas from other middle ear inflammatory diseases and for postoperative diagnosis of recurrent/residual cholesteatomas.
https://ift.tt/2AO5OZ6
Accuracy of Virtual Surgical Planning in Treatment of Temporomandibular Joint Ankylosis Using Distraction Osteogenesis: Comparison of Planned and Actual Results
Publication date: Available online 7 August 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Kan Chen, Di Xiao, Bassam Abotaleb, Haozhe Chen, Yunfeng Li, Songsong Zhu
Purpose
This study evaluated the accuracy of virtual surgical planning and 3-dimensional (3D) printed templates to guide osteotomy and distraction osteogenesis (DO) in the treatment of temporomandibular joint (TMJ) ankylosis and secondary mandibular deformity.
Patients and Methods
Seven consecutive patients diagnosed with TMJ ankylosis and mandibular deformities were included. A composite skull model was obtained with data from spiral computed tomography (CT) and laser scanning of the dental arch. A virtual surgical simulation was performed using Dolphin Imaging 11.7 Premium (Dolphin Imaging and Management Solutions, Chatsworth, CA). Then, the virtual plan was transferred to the operation using 2 surgical templates. These templates were designed by 3D printing using data from the virtual surgical simulation for guiding the osteotomy and the DO, respectively. The preoperative measurement and differences between the actual mandibular position and the virtual plan were analyzed.
Results
Postoperative radiographs, CT images, and quantitative analysis showed a clinically acceptable precision for the position of the mandible. The mean length of the mandible and the vertical height of the DO were 79.1 and 14.9 mm, respectively. With the 3D superimposition and linear measurement, the mean difference between the virtual plan and the actual results ranged from 0.64 ± 0.20 to 1.90 ± 0.85 mm. All patients obtained satisfactory changes in the facial profile and marked improvement in postoperative pharyngeal airway space and mouth opening.
Conclusion
The results of this study showed that virtual surgical planning and 3D printed guiding templates facilitated treatment planning, an accurate osteotomy, repositioning of bony segments, and contouring of the mandibular border in the treatment of TMJ ankylosis and secondary mandibular deformity.
https://ift.tt/2vIzfpB
AAOM CLINICAL PRACTICE STATEMENT LEUKOPLAKIA
Publication date: Available online 6 August 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ivan J. Stojanov, Sook-Bin Woo
https://ift.tt/2vKWqQa
E-Services von Ärzten erwartet
Das Thema Fernbehandlung spaltet die Ärzteschaft. Die Mehrheit der Patienten hingegen scheint sich Onlinekontakt zu Ärzten zu wünschen. Das geht aus einer Patientenbefragung der apoBank hervor.
https://ift.tt/2OiXa6D
Was taugt Medizin nach Noten?
Glaubt man den einschlägigen Statistiken, schauen sich die weitaus meisten Patienten, die nach einem Arzt suchen, im Internet um. An Portalen, in denen Ärzte gelistet und auch bewertet werden, herrscht dort kein Mangel. Eher schon fehlt es an einer Antwort auf die Frage, was die dort verzeichneten Informationen tatsächlich wert sind.
https://ift.tt/2MoXFMa
Probiotika unterstützen Toleranzinduktion
Die Entwicklung weiterer Allergien bei primär kuhmilchallergischen Kindern beruht wahrscheinlich auch auf einer intestinalen Dysbiose. Was bringt die Zugabe von Probiotika zu einem Casein-Hydrolysat in der Prävention atopischer Sekundärmanifestationen?
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Bescheinigungen: Viele Ärzte verschenken hier Geld
Oft werden Ärzte im Praxisalltag gebeten, zwischen Tür und Angel „schnell mal" ein Formular auszufüllen oder ein Attest auszustellen. Dabei übersehen Arzt und Praxisteam häufig, dass solche vermeintlichen Bagatellen durchaus auch relevant für die Abrechnung sind.
https://ift.tt/2MqsCzB
Oftmals von Dauer: Schluckbeschwerden nach Thyreoidektomie
Anders als bislang angenommen, beschränken sich Schluckbeschwerden nach einer Thyreoidektomie nicht auf die unmittelbar postoperative Phase. Selbst ein halbes Jahr später fühlt sich ein Teil der Patienten beim Schlucken noch beeinträchtigt, wobei ein objektivierbares Korrelat meist fehlt.
https://ift.tt/2M5QMT0
Forschung heute — Zukunft morgen
Die 89. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie fand dieses Jahr vom 9. bis. 12 Mai in Lübeck statt. Der Kongress mit rund 2.500 Teilnehmern aus 40 Nationen stand unter dem Motto „Forschung heute — Zukunft morgen".
https://ift.tt/2MpZYOQ
Mundmikrobiom kann Risiko für Kopf-Hals-Tumoren beeinflussen
Das Risiko, an einem Plattenepithelkarzinom im Kopf-Hals-Bereich zu erkranken, scheint auch von der bakteriellen Besiedlung der Mundhöhle abzuhängen. Bestimmte Bakteriengattungen könnten protektiv wirken.
https://ift.tt/2OjgaSM
Wann Datenschutzbeauftragte in Arztpraxen jetzt Pflicht sind
Am 25. Mai 2018 ist die neue EU-Datenschutz-Grundverordnung in Kraft getreten. Damit gelten nun in allen Staaten der Europäischen Union grundsätzlich die gleichen Standards für den Datenschutz. Ziel des Europäischen Rats und des Europäischen Parlaments war es dabei, die schon bestehenden Prinzipien des grundrechtsorientierten Datenschutzrechts mit einer stärkeren Harmonisierung und einer maßvollen Modernisierung zu verknüpfen.
https://ift.tt/2MprPyR
Effect of preoperative pregabalin versus gabapentin on postoperative pain control after laparoscopic gastric bypass surgery
Ain-Shams Journal of Anaesthesiology 2017 10(1):195-200
Background Perioperative gabapentin helps produce a significant opioid-sparing effect and probably also improves postoperative pain scores. Pregabalin is a novel drug with a heightened research interest in the analgesic, sedative, anxiolytic, and opioid-sparing effects, in various pain settings, including postoperative pain. We investigated pregabalin analgesic efficacy in morbid obese patients experiencing acute pain after laparoscopic gastric bypass surgery and compared it with gabapentin and placebo. Patients and methods A randomized, placebo-controlled study was conducted on 90 morbidly obese patients undergoing laparoscopic gastric bypass surgery. Patients were allocated into one of the three groups; the pregabalin group in which the patients received 300 mg pregabalin, the gabapentin group in which the patients received 1200 mg gabapentin, or the control group in which the patients received placebo 2 h prior to surgery. Postoperative pain was controlled with intravenous fentanyl via patient controlled analgesia (PCA). Fentanyl consumption over 24 h and pain intensity measured by visual analogue score at rest (static) and during cough (dynamic) at recovery time, 1, 2, 6, 12, and 24 h were recorded. Also sedation status, somnolence, dizziness, headache, nausea, and vomiting were monitored. Results Postoperative 24 h fentanyl consumption was significantly higher in the control group compared with both pregabalin and gabapentin groups (P<0.001). Pain intensity on visual analogue score (static and dynamic) was significantly higher in the control group compared with both pregabalin and gabapentin groups at time of recovery, 1, 2, 6, 12, and 24 h postoperatively. Numeric sedation score was significantly lower in the control group compared with pregabalin and gabapentin groups at time of recovery, 1, 2, and 6 h postoperatively. No significant differences were found among the three groups as regards somnolence, dizziness, headache, nausea, and vomiting. Conclusion A single dose of 300 mg pregabalin or 1200 mg gabapentin given 2 h before surgery is better than placebo for postoperative pain control for laparoscopic gastric bypass surgery without significant side effects.
https://ift.tt/2vGaOcw
Optimum target in percutaneous upper thoracic thermocoagulation in primary hyperhidrosis
Ain-Shams Journal of Anaesthesiology 2017 10(1):293-296
Introduction Primary palmar hyperhidrosis is a disabling problem that affects young age groups and usually continues for years without an effective treatment. It is usually accompanied by plantar hyperhidrosis and to a lesser extent by axillary affection. We have tried to improve the efficacy of percutaneous radiofrequency ablation of upper thoracic sympathetic ganglia via imitating what thoracoscopic surgeons do in endoscopic thoracic sympathectomy. Patients and methods A total of 40 patients with primary hyperhidrosis were randomly classified into two groups. Group Tb (n=20) underwent thermocoagulation of sympathetic chain on vertebral body. Group Th (n=20) underwent thermocoagulation of sympathetic chain on the head and neck of ribs. Hand temperature and dryness were followed up during the procedure and on the following intervals: 1 week, 1 month, 3 months, 6 months, 9 months, and 12 months after the procedure. Results During the procedure, the hands of 50% of patients became warm and dry in group Tb and only 40% remained so till 12 months, whereas in group Th, the hands of 100% of the patients became warm and dry during the procedure till 12 months. Conclusion Thermocoagulation of upper thoracic sympathetic chain on the head and neck of the second and third ribs is more effective than attacking the chain on vertebral bodies in patients with primary hyperhidrosis with no recorded complications.
https://ift.tt/2ngN2QD
Effectiveness of minimal acute normovolemic hemodilution to minimize allogenic blood transfusion and re-exploration in elective adult coronary artery bypass graft surgery using colloid as a replacement solution
Ain-Shams Journal of Anaesthesiology 2017 10(1):3-9
Background and aim Various studies have questioned the efficacy of intraoperative acute normovolemic hemodilution (ANH) in reducing bleeding, the need for allogenic transfusion, and the incidence of re-exploration in cardiac surgery. The aim of the present study was to evaluate the effectiveness of the use of minimal ANH for blood transfusion requirements and re-opening in elective adult coronary artery bypass graft surgery using cardiopulmonary bypass. Patients and methods This prospective, randomized controlled study was conducted on 100 consecutive adult patients who underwent elective coronary artery bypass graft. Patients were randomly divided into two equal groups: the ANH group (n=50) and the control group (n=50). In the ANH group, 5–8 ml/kg of autologous blood was withdrawn after administering anesthesia and before systemic heparinization. Simultaneously, colloid solution (6% hydroxyethyl starch 130/0.4; Voluven) was infused in a ratio of 1:1, and then the blood was re-infused after bypass. Hemodilation was not carried out for the control group. Total amount of allogenic-packed red blood cell, fresh frozen plasma, platelet concentrate transfusion, and the number of patients undergoing re-opening because of excessive bleeding were calculated for the two groups. Results A significant decrease was observed in the number of red blood cell units and fresh frozen plasma transfusion per patient in the ANH group compared with the control group. Conversely, chest tube output, representing postoperative bleeding and platelet count, did not differ between the two groups. Conclusion In this study, the use of the minimal ANH technique reduced the consumption of allogenic red blood cells and fresh frozen plasma in adult cardiac surgery patients. However, this technique had no effect on postoperative bleeding, incidence of re-exploration, and platelet count.
https://ift.tt/2vEnGQm
Comparison of butorphanol and tramadol as an adjuvant to local anesthetic drug in axillary brachial plexus block
Ain-Shams Journal of Anaesthesiology 2017 10(1):242-246
Background With the advent of opioid receptors, a variety of opioid agents are added to local anesthetic mixtures used in peripheral blocks to improve the quality and duration of block. In this study, we compared the effect of butorphanol and tramadol as adjuvant agents for orthopedic upper extremity surgery. Patients and methods This study was carried out on 50 patients aged between 18 and 60 years, of American Society of Anesthesiologists grades I and II, of either sexes in each group, undergoing orthopedic upper limb surgeries through axillary brachial plexus block. An injection of butorphanol 2 mg (group B) and that of tramadol 100 mg (group T) were added to local anesthetic mixture. Onset of sensory and motor blockade, extent of blockade, and occurrence of any complications were studied in both groups. All patients were observed for analgesia postoperatively by visual analog scale pain score. Results In our study, the onset time (minutes) of sensory and motor blockade was delayed in group B (8.76±1.0 and 5.86±0.71, respectively) as compared with group T (7.54±0.88 and 4.6±0.73, respectively). In group B, the duration of sensory block (291.24±48.51 min) was longer than group T (160.42±12.66 min). Duration of analgesia postoperatively (first rescue analgesic) was 619.96±26.96 min in group B, whereas it was 290.2±20.38 min in group T. Conclusion Butorphanol is more potent and produces longer duration of postoperative analgesia than tramadol, with an extra advantage of sedation and calmness.
https://ift.tt/2M2Bnnq
The effect of perioperative use of dexmedetomidine on pediatric patients with pulmonary hypertension undergoing congenital cardiac surgery
Ain-Shams Journal of Anaesthesiology 2017 10(1):10-14
Background Anesthetic management of a pediatric patient with pulmonary arterial hypertension (PAH) poses an enormous challenge. The objective of this study was to evaluate the ability of dexmedetomidine to reduce the pulmonary artery pressure in pediatric patients with PAH undergoing cardiac surgery. Patients and method Seventy patients diagnosed with PAH were enrolled in this study. The patients were randomized into two groups: group D received dexmedetomidine infusion of 1 μg/kg/h for one hour, which was reduced to 0.5 μg/kg/h throughout the surgery until extubation in the post anesthesia care unit (PACU), and group C received 0.9% normal saline in the same volume. Pulmonary artery systolic pressure (PASP) and systemic systolic blood pressure (SSBP) were recorded throughout surgery and postoperatively in the PACU. The need for vasodilator and sedative drugs and the time of extubation and ICU stay were recorded for all patients. Results The patients in the dexmedetomidine group showed a significant decrease in PASP and PASP/SSBP ratio during surgery and throughout the first 24 h in the PACU (P<0.001). The dexmedetomidine group required a significantly lower amount of vasodilator drugs than the control group (P<0.001), as well as a lower amount of sedatives (P<0.001). Conclusion We concluded that perioperative use of dexmedetomidine in pediatric patients with pulmonary hypertension reduces the PASP throughout the operative and postoperative period.
https://ift.tt/2vKWTlx
Perioperative terlipressin infusion in living donor liver transplantation: effects on sodium and water balance
Ain-Shams Journal of Anaesthesiology 2017 10(1):173-176
Background Although terlipressin is being used perioperatively in recipients of liver transplantation to improve splanchnic hemodynamics and postoperative renal functions, its associated antidiuretic effect has not been specifically investigated in this group of patients. The aim of this study is to assess the effect of terlipressin infusion started intraoperatively and continued for 48 h postoperatively in recipients of living donor liver transplantation on serum sodium and water/sodium excretion. Materials and methods Thirty patients with end-stage liver disease and portal hypertension scheduled for living donor liver transplantation were randomized into two groups including 15 patients each. Group 1 (control): patients did not receive terlipressin. Group 2: terlipressin was administered as an infusion at a rate of 2 µg/kg/h continued for 48 h after postoperative ICU admission. Comparisons were performed between both groups in terms of serum sodium, urine sodium, urine osmolarity, and the urine : sodium osmolarity ratio. Results There were no significant changes between the control group and the terlipressin group in serum sodium, urine sodium, urine osmolarity, and the urine : sodium osmolarity ratio. Conclusion Terlipressin infusion started intraoperatively at a rate of 2 µg/kg/h and continued for 48 h postoperatively in recipients of living donor liver transplantation did not result in significant changes in serum sodium and sodium/water excretion.
https://ift.tt/2nhuyPP
Postoperative analgesic effect of dexmedetomidine in patients undergoing cardiac surgery
Ain-Shams Journal of Anaesthesiology 2017 10(1):15-19
Aim Open heart surgeries are painful procedures that require a large dose of analgesics. The aim of this study was to investigate the effect of postoperative dexmedetomidine (DEX) on the analgesic requirements in postcardiac surgery patients. Settings and design This prospective, randomized, double-blind study was conducted on 60 patients scheduled for elective coronary artery bypass graft surgery at the Cardiothoracic Surgery Unit, Ain Shams University Hospital. Patients and methods this study, group D (n=30) received DEX diluted to 4 μg/ml and infused at a rate of 0.1–0.2 μg/kg/h, whereas group C (n=30) received an equal volume of saline at an infusion rate of 0.1–0.2 μg/kg/h immediately from the end of surgery and postoperatively in the ICU thereafter. Postoperative analgesia was assessed using the Numeric Pain Intensity Scale, and sedation was assessed using the Modified Ramsay Score at T1, T2, T3, T4, T5, and T6 for the first 24 h, as well as postoperative rescue morphine analgesic requirements. Statistical analysis Analysis of data was performed using the Student t-test for independent samples for parametric data and using the χ2-tests for categorical data. Results There was a significant decrease in the pain scores in group D compared with group C (P<0.001). Morphine rescue analgesia was needed in 10% of patients in group D and in 95% of patients in group C, with a significant reduction in time to extubation and ICU length of stay in group D. The incidence of postoperative nausea and vomiting was lower in group D compared with group C but did not reach statistical significance. Conclusion Adding DEX after coronary artery bypass graft decreased both postoperative analgesic requirement and pain score without hemodynamic effects.
https://ift.tt/2vHnU9r
The efficacy of rectus sheath block for pain management following laparoscopic orchiopexy surgery
Ain-Shams Journal of Anaesthesiology 2017 10(1):219-223
Background Ultrasound (U/S)-guided rectus sheath block is an effective analgesic technique in elective pediatric laparoscopic surgical procedures. The aim of the study was to evaluate the efficacy of rectus sheath block for pain management following laparoscopic orchiopexy surgery. Patients and methods A total of 50 patients undergoing elective laparoscopic orchiopexy were allocated randomly into two groups: the U/S-guided rectus sheath block group (the REC group) and the general anesthesia-only group (the GA group), in which no rectus sheath block was performed. All patients received the same general anesthetic technique. In the REC group, patients received bilateral U/S-guided rectus sheath block, using 0.4 ml/kg of 0.25% bupivacaine, and morphine (0.1 mg/kg) was administered for rescue analgesia postoperatively and its total dose was recorded. Pain was measured by means of Children's Hospital of Eastern Ontario Pain Scale score. Hospital stay and the incidence of respiratory depression or vomiting were recorded. Results In all, 50 patients completed the study. The total dose of morphine used over 24 h was significantly lower in the REC group. Children's Hospital of Eastern Ontario Pain Scale scores were significantly lower in the REC group during the first 3 h postoperatively, and the incidence of vomiting, respiratory depression, and oxygen saturation in the postanesthesia care unit showed no significant difference between the study groups. Hospital stay was significantly shorter in the REC group compared with the GA group. Conclusion U/S-guided rectus sheath block is an effective analgesic technique with morphine-sparing effect after laparoscopic orchiopexy surgery.
https://ift.tt/2M14sQ0
Efficacy and safety of single versus repeated stepwise cycling recruitment maneuver during one-lung ventilation in patients with normal pulmonary function undergoing video-assisted thoracoscopic lung surgery: a randomized, controlled trial
Ain-Shams Journal of Anaesthesiology 2017 10(1):20-27
Background One-lung ventilation (OLV)-associated hypoxemia is a major concern and a challenge for the anesthesiologist. Lung recruitment maneuvers (RMs) are ventilator strategies in which the main goal is to restore the functional residual capacity and improve arterial oxygenation. Hemodynamic side effects are mainly associated with 'fast' RM not with 'slow' cycling RM and their effects are self-limited; therefore, they must be performed repetitively. Aim The aim of this study was to evaluate the efficacy and safety of single versus repeated stepwise cycling RMs during OLV in patients with normal lung function. Settings and design The study design is a randomized, double-blinded, controlled one. Patients and methods Sixty adult patients of ASA I–II who were scheduled for elective thoracoscopic lung surgery were randomized into groups C, single recruitment maneuver (SRM), and repeated recruitment maneuver (RRM) comprising 20 patients each. Group C patients received standard ventilation protocol: volume-controlled ventilation mode, VT 6 ml/kg, I : E ratio 1 : 2, positive end expiratory pressure (PEEP) 5 cmH2O, and respiratory rate 10–12 breaths/min. SRM patients received standard ventilation protocol with one alveolar RM 10 min after initiation of OLV with a PEEP of 10 cmH2O until end of surgery. RRM patients received standard ventilation protocol with first RM 10 min after initiation of OLV and then repeated every 30 min during OLV and a PEEP of 10 cmH2O until end of surgery. The following were assessed: hemodynamic parameters – heart rate, mean arterial blood pressure, and central venous pressure; respiratory mechanical parameters – peak airway pressure (Paw-peak), plateau pressure (Paw-plat), and static lung compliance; and oxygenation parameters – partial arterial oxygen tension (PaO2), PaO2/FiO2, and oxygen saturation (SpO2). Results PaO2 and PaO2/FiO2 ratio increased in the SRM and RRM groups after RM from T2 (10 min after first RM) to T4 (45 min from first RM), with a significant difference compared with group C (P<0.05). Peak and plateau airway pressures declined in the SRM and RRM groups after RM from T2 to T4, with a significant difference when compared with group C (P<0.05). Static lung compliance increased in the SRM and RRM groups after RM, with a significant difference among the groups (P<0.05). Conclusion Single or repeated cycling RM was considered effective with high safety profile in patients with normal pulmonary function undergoing thoracoscopic lung surgery using OLV.
https://ift.tt/2vHnyzD
Dexmedetomidine as adjuvant to hyperbaric bupivacaine in spinal anesthesia for inguinoscrotal surgery
Ain-Shams Journal of Anaesthesiology 2017 10(1):264-271
Background and aim The purpose of this study was to evaluate the anesthetic and analgesic effects of dexmedetomidine as adjuvant in spinal anesthesia for patients undergoing inguinoscrotal surgery. Patients and methods A total of 70 adult male patients (American Society of Anesthesiologists I or II) scheduled for inguinoscrotal surgery were randomized into two equal groups using a computer-generated randomization table and received 3 ml plain hyperbaric bupivacaine 0.5% diluted in 0.5 ml normal saline in group C or plus dexmedetomidine (5 µg) in group D. Anesthesia, analgesia, and sedation qualities; hemodynamic changes; and adverse effects were recorded. Results The studied groups showed no significant difference regarding demographic data. The highest sensory level (T8) was the same in both groups, but there were statistically significant differences between the two groups (P<0.05) regarding quality of anesthesia, times of onset, and duration and regressions of sensory and motor blocks (rapid onset and delayed offset of sensory and motor blocks in group D). Postoperative pain score (visual analog scale) and rescue analgesic requirements were lower in group D compared with group C, and excellent analgesic quality was higher in group D. Sedation score intraoperatively and up to 60 min postoperatively was significantly higher in group D compared with group C. Regarding hemodynamics, mean arterial blood pressure and heart rate showed a statistically significant difference intraoperatively and till discharge to ward (P<0.05). Regarding adverse effects, two patients in group C compared with three patients in group D had incidence of hypotension (mean arterial blood pressure˂55 mmHg). Conclusion Dexmedetomidine as an adjuvant to hyperbaric bupivacaine in spinal anesthesia seems to be a profound intrathecal anesthetic, analgesic, and sedative agent, with preservation of hemodynamic stability and minimal adverse effects.
https://ift.tt/2LZ4isb
Perioperative magnesium sulfate: an adjuvant to patients undergoing video-assisted thoracoscopic surgery
Ain-Shams Journal of Anaesthesiology 2017 10(1):28-33
Background This randomized, prospective, double-blind, placebo-controlled study was designed to assess perioperative magnesium sulfate, an N-methyl-d-aspartate receptor blocker, as an anesthetic adjuvant reducing intraoperative anesthetic requirement, with a decrease in postoperative analgesic requirement and less adverse events. Patients and methods A total of 24 patients undergoing video-assisted thoracoscopic surgery were included in two parallel groups − the magnesium group (group M, n=12) received magnesium sulfate 40 mg/kg intravenously before induction of anesthesia followed by 15 mg/kg/h continuous intravenous infusion during the operation. The same volume of isotonic solution was administered to the control group (group C, n=12). Primary outcome measures were postoperative analgesic requirement (doses of morphine and ketorolac). Secondary outcomes included intraoperative anesthetic requirements (fentanyl, sevoflurane, and vecuronium), postoperative visual analog score, Ramsay sedation score, and postoperative adverse events. Results In the magnesium group, there was a reduction in intraoperative fentanyl (P=0.01), sevoflurane (P=0.02), and vecuronium (P=0.008), with a significant reduction in the postoperative dose of morphine (P=0.02), the need for rescue ketorolac (P=0.02), and a significant reduction in visual analog score and Ramsay sedation score compared with group C at 2, 3, 4, 6, and 8 h. There was a significant reduction in the number of patients who suffered an episode of tachyarrhythmia (P=0.03) with a decrease in nausea (P=0.06), vomiting (P=0.06), and pruritus (P=0.3), but did not reach statistical significance in group M compared with group C. Conclusion Magnesium sulfate as an anesthetic adjuvant decreased postoperative analgesic requirement with a decrease in intraoperative anesthetic doses, with less adverse events.
https://ift.tt/2vJqkEC
Comparative study between dexamethasone and dexmedetomidine as an adjuvant to ondansetron for the prevention of postoperative nausea and vomiting following functional endoscopic sinus surgery operation
Ain-Shams Journal of Anaesthesiology 2017 10(1):156-163
Background Postoperative nausea and vomiting (PONV) are the most common annoying events and complications following general anesthesia and surgery. Emetic incidents can lead to aspiration of gastric contents, wound unsealing, psychological distress, and delayed recovery from anesthesia and discharge times. Aim This study was designed to compare the effects of a single dose of dexmedetomidine or dexamethasone as an adjuvant to ondansetron for reducing PONV after functional endoscopic sinus surgery operation and to assess if there is any advantage of one drug over the other. Patients and methods This study is a prospective randomized single-blind study. The study involved 60 patients with American Society of Anesthesiologists physical status I and II, of both sexes, between 18 and 50 years of age, undergoing elective functional endoscopic sinus surgery operation. At the end of surgery, patients were randomly allocated to receive an intravenous single dose of either 0.1 mg/kg of ondansetron as a control group, or 8 mg of dexamethasone following 0.1 mg/kg of ondansetron, or dexmedetomidine 0.1 μ/kg following 0.1 mg/kg ondansetron. Postoperatively, all the incidents of nausea, retching and/or vomiting were recorded and patients were asked if vomiting had occurred or if the patients felt nauseated with only two possible answers (yes or no). Results There was no significant differences among the three groups regarding the incidence of PONV during the first 24 h postoperatively, with a slight difference in the ondansetron–dexmedetomidine (ondan–dexmed) group, which was less in frequency in relation to the other groups (P<0.211). Regarding the PONV incidence in relation to intraoperative and postoperative medications, there was a highly significant difference among the three groups regarding the severity of PONV. The PONV severity was lower in the ondan–dexmed group in relation to the other groups (P<0.001). The metoclopramide dose during the following 24 h was significantly low in ondan–dexmed group in relation to the other groups (P<0.001). The tramadol dose during the following 24 h was significantly low in ondan–dexmed group in relation to the other groups (P<0.001). The intraoperative fentanyl requirements was significantly lower in ondan–dexmed group in relation to the other groups (P<0.001). Regarding the first analgesic request, it was significantly delayed in ondan–dexmed group in relation to the other groups (P<0.021). Conclusion A single dose of dexmedetomidine combined with ondansetron is superior to ondansetron alone or ondansetron combined with dexamethazone for preventing PONV in patients undergoing functional endoscopic sinus surgery under general anesthesia.
https://ift.tt/2M1WR3P
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