Novel Use of a Disposable Syringe Barrel as a Mouth Prop in Emergency Maxillofacial Trauma Cases to Access Intraoral Soft Tissue Injuries

Abstract

Oral and maxillofacial surgeons are often called in emergency situations during odd hours to manage facial trauma cases. While addressing these patients, many a times the surgeon might require to keep the patients mouth open for long time while accessing intraoral injuries. This can become difficult for a surgeon if in case regular dental mouth props/mouth gags are not available at a particular surgical setup. The author here describes a technique of using a standard disposable syringe as a mouth prop in emergency cases to access and repair any intraoral injury in absentia of a regular mouth prop/mouth gag.

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Comparative Evaluation of Intranasal Butorphanol and Oral Diclofenac Sodium for Analgesia After Surgical Removal of Impacted Mandibular Third Molars: Split-Mouth Prospective Controlled Clinical Study

Abstract

Aim

The study intended to compare the analgesic effect and patient satisfaction of intranasal butorphanol with oral diclofenac sodium after surgical removal of impacted mandibular third molars.

Materials and Methods

This split-mouth prospective controlled clinical study included 50 patients with bilateral symmetrically impacted mandibular third molars with the same difficulty on the Pederson Index. All patients had two appointments of surgery. In the first, the molar on one side was surgically removed and depending upon the chit selected by the patient, either intranasal butorphanol or oral diclofenac sodium was prescribed postoperatively for pain relief. Two weeks later, the impacted mandibular third molar on the other side was surgically removed and if butorphanol was selected for the first side, then oral diclofenac sodium was prescribed for the other side and vice versa. Pain relief was recorded on the Facial Visual Analogue Scale at 1, 2, 3, 4 and 5 h postoperatively and on postoperative day 1 and 2 at the same time for both the drugs.

Results

Intensity of pain was less with intranasal butorphanol as compared to oral diclofenac sodium at all the time intervals and especially in the 1st postoperative hour. Overall acceptance (88%) to butorphanol nasal formulation was statistically similar to diclofenac sodium tablets.

Conclusion

Intranasal butorphanol at the very acceptable 1 mg dose after the surgical removal of impacted mandibular third molars provides a profound degree of analgesia. It is a well-tolerated drug with a high acceptance rate if administered correctly.

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Improved resin‐to‐dentin bond strength and durability via non‐thermal atmospheric pressure plasma drying of etched dentin

This study aimed to evaluate the improvement in strength and durability of the bond between dentin and composite resins following plasma drying of the etched dentin surface using non‐thermal atmospheric pressure plasma. Plasma drying was applied to the etched dentin before applying adhesive. Conventional wet‐bonding and helium (He) gas‐dried bonding schemes were used as control groups. The bond strength of the composite resin to dentin was measured as the microtensile bond strength at 24 h after bonding and after 10,000 cycles of thermocycling. Hybrid layer formation was observed using micro‐Raman spectroscopy and scanning electron microscopy. Although the bond‐strength values were not statistically different either at 24 h after bonding or after thermocycling, the bond strength of the plasma‐dried bonding group was significantly higher than the conventional wet‐bonding group and He gas‐dried bonding group. Micro‐Raman spectral analysis revealed effective penetration of the adhesive and an improved polymerization rate of the adhesive after plasma drying. Plasma drying increased the penetration of hydrophobic resin into the collagen mesh structure, which improved mechanical bonding and long‐term durability between dentin and composite resin.

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Superior detection of metastatic cystic lymphadenopathy in patients with papillary thyroid cancer by utilization of thyroglobulin washout

Abstract

Background

Fine‐needle aspiration (FNA) cytology has been the standard of care in the workup of cervical lymph nodes (LNs) in patients with recurrent papillary thyroid cancer (PTC) and suspicious cervical LNs. Recently, FNA thyroglobulin (TG) washout measurement has been proposed as an adjunct in the management of these patients. We hypothesize that using FNA‐TG washout for suspicious cervical LNs would increase the accuracy of diagnosing metastatic disease especially in cystic and highly vascular cervical LN in patients with recurrent PTC.

Methods

This is a retrospective study of a prospectively collected database for patients with thyroid cancer who underwent preoperative FNA followed by selective neck dissection by one surgeon at an academic institution. FNA‐cytology and FNA‐TG washout were performed simultaneously. A total of 138 patients were included in our study, of which 92 (66.7%) had undergone surgical intervention. Results of both methods were then correlated with the final surgical pathology.

Results

FNA‐cytology alone showed a sensitivity of 80.0%, specificity of 100.0% with a negative predictive value (NPV) of 60.0%. By contrast, FNA‐TG washout had a sensitivity of 95.8%, specificity of 90.5% with a NPV of 86.4%. Combination of the FNA‐cytology with FNA‐TG washout of cystic/highly vascular LN increased the accuracy of diagnosis with a sensitivity of 98.2%, specificity of 100.00% with a NPV of 95.0%. All 14 malignant cervical LNs with false‐negative FNA‐cytology showed elevated FNA‐TG washout, 10 (71.4%) of which were cystic in nature and 4 were highly vascular on ultrasonography.

Conclusion

FNA‐TG washout increases the diagnostic accuracy in detecting metastatic disease in patients with recurrent thyroid cancer. FNA‐TG washout may be of special diagnostic importance in cystic or highly vascular LNs, which might have falsely negative cytology.

Level of Evidence

2B

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The impact of human herpesvirus detection in pemphigus vulgaris

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Dermatitis and alopecia in a patient treated with dupilumab: a new adverse effect?

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Nasal function and CPAP compliance

Publication date: Available online 8 December 2018

Source: Auris Nasus Larynx

Author(s): Akiko Inoue, Shintaro Chiba, Kentaro Matsuura, Hiroshi Osafune, Robson Capasso, Kota Wada

Abstract

Objective

Continuous positive airway pressure (CPAP) is the mainstay therapy for patients with obstructive sleep apnea (OSA) however compliance with CPAP is variable. Nasal ailments, such as nasal congestion are frequently mentioned as a cause for CPAP non-compliance, and potentially could be addressed prior to CPAP initiation, however, no specific criteria or recommendations for the evaluation and management of these patients exist. The aim of this retrospective study is to evaluate the effects of nasal anatomic features and disease on adherence to CPAP therapy for patients with OSA and determine the indications for pre-CPAP nasal treatment by using data obtained at clinical examination.

Methods

In total, 711 adult patients with initial diagnosis of OSA and an apnea–hypopnea index of ≥20 who were amenable to CPAP were included. We analyzed nasal parameters, past history of nasal disease, subjective symptoms, and disease severity in addition to whether CPAP therapy had been initiated, rate of CPAP therapy use (initial and 1 year), treatment continuation rate at 2 months and 1 year, and nasal treatments for all patients.

Results

CPAP therapy was initiated in 543 of 711 patients. Nasal resistance was significantly higher in patients who discontinued therapy soon after CPAP initiation. Nasal disease and nasal parameters were not found to be predictors of treatment adherence at 1 year.

Allergic rhinitis, moderate to severe nasal congestion at bedtime, slight or extensive sinus opacification, and a high nasal septum deviation score were found to be independent predictors of nasal treatment, while strong awareness of nasal congestion, a past history of sinusitis, and a total nasal resistance (supine position) of ≥0.35 Pa/cm³/s were independent predictors of surgical treatment.

Conclusion

Long-term CPAP therapy adherence in patients with OSA can be predicted from initial CPAP adherence. Nasal disease and nasal parameters are important factors for early CPAP therapy discontinuation and should be adequately treated before therapy initiation to ensure long-term adherence. Indications for pre-CPAP nasal treatment and nasal surgery for patients with OSA can be predicted from the data obtained at the first examination, and these patients should be treated differently from those without OSA.

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Seizure and Acute Vision Loss in a Filipino Lupus Patient: A Case of Posterior Reversible Encephalopathy Syndrome with Intraparenchymal Hemorrhage

Posterior reversible encephalopathy syndrome (PRES) is a rare and poorly understood neurologic condition that has been described in some patients with systemic lupus erythematosus (SLE). Intracerebral hemorrhage is a unique and atypical presentation of PRES and has been described only in a small number of patients with SLE. We present the case of a 33-year-old female, diagnosed with SLE and active nephritis, who was admitted for seizures. She had acute-onset headache, confusion, and bilateral vision loss associated with severe hypertension. CT scan revealed right occipital and parietal lobe hemorrhage. MRI showed vasogenic edema and hyperintense foci in bilateral cortical and subcortical regions of the occipital and posterior parietal lobes which are consistent with posterior reversible encephalopathy syndrome (PRES). Strict blood pressure control and medical ICP-lowering treatment were immediately instituted, while maintaining her on anticonvulsants, high-dose steroids, and mycophenolate mofetil. The patient was discharged with improvement in vision and resolution of headache. On follow-up, she had gained her premorbid visual acuity and reported no recurrence of headache or seizures. Despite its name, reversibility remains to be conditional in PRES. A high index of suspicion is important, especially among those who present with seizure, headache, and visual loss. Early diagnosis and timely initiation of therapy is recommended, as clinical symptoms are potentially reversible and delayed therapy may result in life-threatening complications, such as coma or death.

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Stereophotogrammetric analysis of labial morphology in a young adult Middle-Eastern population

Publication date: Available online 8 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Fouad Ayoub, Maria Saadeh, Hassan Kazan-Fayad, Ramzi Haddad

Abstract

Introduction

The majority of previous research delineating the morphological characteristics of the orolabial region has been on Caucasian populations, with very minor research on Mediterranean populations, and none on the Lebanese population.

Aim

The primary aim was to collect information on the gender-specific 3D morphology of the mouth and lips in young Middle Eastern adults. The secondary aim was to explore the presence of associations between orolabial morphology and age and body mass index (BMI), and to assess correlations between linear orolabial dimensions and area/volume measures.Methods. The study used non-invasive stereophotogrammetry to collect information on gender-specific 3D labial morphology (linear distances, areas, and volumes) for 122 adult Lebanese subjects, aged 18– 30 years (47 males, 75 females). Associations between labial morphology and age and body mass index were assessed, in addition to correlations between linear orolabial dimensions and area/volume measures.

Results

All linear, angular, area, and volume lip measurements displayed significant variability. Both lip area and volume were smaller in the upper than in the lower lip. Eighteen out of the 20 linear measurements were significantly larger in males. The ratio, area, and volume measurements mostly displayed no statistically significant gender dimorphism.

Conclusions

Alongside presenting the first documented report on anthropometric labial measurements of a young Lebanese adult population, this research highlights the presence of gender dimorphism in linear and angular measurements, but not in area and volume measurements, and a strong association between certain linear labial measurements and lip area and volume. In addition, it presents pilot data on the association between labial anthropometry and body mass index.

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Serious Asthma Events with Mometasone Furoate Plus Formoterol Compared With Mometasone Furoate

Publication date: Available online 8 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Cindy L.J. Weinstein, Nicholas Ryan, Tulin Shekar, Davis Gates, Stephen J. Lane, Ioana Agache, Robert A. Nathan, SPIRO Investigators

Abstract

Background

The safety of long-acting beta agonists added to inhaled corticosteroids for the treatment of persistent asthma has been controversial.

Objective

To determine whether administering formoterol in combination with mometasone furoate increases the risk of serious asthma outcomes compared to mometasone furoate alone.

Methods

We conducted a 26-week, randomized, double-blind trial in adolescent and adult patients (≥12 years) with persistent asthma in 35 countries with the primary objective of evaluating whether mometasone furoate-formoterol increases the risk of serious asthma outcomes (adjudicated hospitalization, intubation, or death) compared to mometasone furoate alone. The key efficacy endpoint was asthma exacerbation (composite of hospitalizations ≥24 h, emergency visits <24 h requiring systemic corticosteroid, or systemic corticosteroid for ≥3 consecutive days).

Results

Among 11,729 patients (mometasone furoate-formoterol, n=5868; mometasone furoate, n=5861), a total of 81 serious asthma outcomes, all asthma-related hospitalizations, were observed in 71 patients; 45 events from 39 patients on mometasone furoate-formoterol and 36 events from 32 patients on mometasone furoate. The hazard ratio for the first serious asthma outcome in the mometasone furoate-formoterol versus mometasone furoate group was 1.22 (95% CI: 0.76 to 1.94, p=0.411). Asthma exacerbation occurred in 1487 patients; 708 on mometasone furoate-formoterol and 779 on mometasone furoate. The hazard ratio for the first asthma exacerbation in the mometasone furoate-formoterol versus mometasone furoate group was 0.89 (95% CI: 0.80 to 0.98, p=0.021).

Conclusions

The addition of formoterol to mometasone maintenance therapy did not increase the risk of serious asthma-related events and reduced the risk of asthma exacerbation.

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Identification of novel allergic diathesis genes: are we closer to novel therapeutic targets?

Publication date: Available online 8 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Michelle Daya, Kathleen C. Barnes

https://ift.tt/2E7StuS