Nivolumab is an immune checkpoint inhibitor that is used in the treatment of a variety of cancers in the adjuvant or metastatic setting. Adverse effects include non-specific activation of T cells, leading to immune-related adverse events in downstream organs. We present a case of a 36-year-old man with unresectable oropharyngeal squamous cell carcinoma who developed nivolumab-induced rheumatoid arthritis. As immune checkpoint inhibitor use is becoming widespread in the medical oncology domain, the purpose of this case report is to increase awareness of an increasingly common cause of rheumatic disease and to alert clinicians to consider immunotherapy in their differential diagnosis of polyarthritis. This case also highlights the importance of working in an interdisciplinary manner to enhance cancer care for the patient as well as to increase awareness of the potential adverse effects of immunotherapy in patients with cancer.
The aim of this case report is to evaluate the efficacy of mesenchymal stem cell (MSC) therapy in the treatment of small joint osteoarthritis (OA). Acromio-clavicular (AC) joint OA is an under-diagnosed and yet frequent source of shoulder pain. MSCs have shown evidence of benefit in the treatment of knee OA. This is the first report to describe the use of MSC therapy in OA of the upper limb. A 43-year-old patient presents with painful AC joint OA and undergoes MSC therapy. The patient reported pain and functional improvement as assessed by the Disability of Arm, Shoulder and Hand Score and Numeric Pain Rating Scale. Imaging at 12 months showed structural improvement with reduction in subchondral oedema, synovitis and subchondral cysts. This case is the first to show the benefit of MSC therapy in the treatment of small joint arthropathy and also of the upper limb.
Trial registration number: Australian New Zealand Clinical Trials Registry (ACTRN12617000638336).
Spinal arachnoid cysts (SAC) are rare in isolation and the exact aetiology is still debated. Primary (congenital) cysts are caused by structural abnormalities in the arachnoid layer and largely affect the thoracic region. Secondary cysts are induced by a multitude of factors, infection, trauma or iatrogenic response, and can affect any level of the spinal cord. While subarachnoid haemorrhage (SAH) is a relatively common condition with significant repercussions, it is extremely uncommonly associated with SAC. When present, it may develop in the months and years after the original bleed, giving rise to new neurological symptoms. Prompt treatment is needed to halt or reverse the worsening of symptoms and questions are still being asked about how best to approach this condition. A 42-year-old man presented with chronic back pain, severe worsening ataxia and numbness below the umbilicus, 7 months after treatment for a World Federation of Neurosurgical Societies grade five (WFNS V) SAH. Imaging revealed a SAC extending from T12 to L4 and causing thecal compression. This was treated with a L3 laminectomy andmarsupialisation. An improvement in neurological function was observed at 6 months. Aetiology of the SAC and its association with SAH are discussed and a review of the relevant literature is provided.
Adenoid cystic carcinoma (ACC) of the head and neck is a rare and highly malignant tumor, characterized by perineural growth and early distant metastases. The composition of immune cells in the peripheral blood and the tumor microenvironment is critical to tumor growth and control. However, little is known about the frequency and function of the relevant immune cell subsets in this entity.
Methods
In ACC patients (n = 11) and matched healthy donors (n = 11), the frequency of peripheral blood T and B cells was measured by flow cytometry at different treatment stages of disease (24 samples). Cells were further characterized by their expression of CCR7, PD-1, CD39 and CD73. Tumor-infiltrating lymphocytes (TIL) were analyzed by immunohistochemistry for ten patients and for three patients by flow cytometry.
Results
CD4+ T cells had significantly lower frequency after radiotherapy (RT). All other cell frequencies, including Treg, were stable through course of the disease. In B cells, CD73 was reduced after RT. CCR7 expression on T and B cells in patients with relapse/metastases (R/M) differed significantly from patients with active disease. PD-1 remained stable. Treg were more present in TIL compared to peripheral blood.
Conclusion
Composition of lymphocyte subgroups behaves similar to squamous cell carcinoma in the head and neck, except for Treg, which remained stable. Nevertheless, the CD4+/Treg ratio was lower after RT, which could stand for an immunosuppressive effect in these patients. Therefore, it could be beneficial treating ACC with combined RT and immunomodulatory drugs.
Allergen-antibody complexes are extremely valuable in describing the detailed molecular features of epitopes. This review summarizes insights gained from recently published co-structures and what obstacles impede the acquisition of further data.
Recent Findings
Structural epitope data helped define the epitopes of two anti-Fel d 1 antibodies undergoing phase I clinical trials, providing a greater level of detail than was possible through hydrogen-deuterium exchange protection studies. Separately, a human camelid-like antibody structure with lysozyme described several unique features in a long variable loop that interacted with the active site cleft of Gal d 4. Finally, a co-structure conclusively demonstrated that Phl p 7 could function as a superantigen and that an antibody could simultaneously recognize two epitopes. These remarkable assertions would not have been possible without visualization of the complex. Only three new complexes have appeared in the last few years, suggesting that there are major impediments to traditional production and crystallization.
Summary
The structural data was extremely valuable in describing epitopes. New techniques like cryo-EM may provide an alternative to crystallography.
The purpose of this article is to review treatment advances in ocular allergy that include the treatment of the various signs and symptoms of the allergic inflammatory response of the ocular surface.
Recent Findings
Recent studies have demonstrated improved pharmacological effect of topical agents with artificial tears and cold compresses; brimonidine, a new ophthalmic decongestant which has demonstrated decreased rebound conjunctivitis; and potential use of contact lens and other novel delivery instruments to increase medication retention time.
Summary
Currently, there have been limited advances in novel ophthalmic treatments. Non-pharmacological interventions have demonstrated in a randomized control study that artificial tears and the use cold compresses alone or in combination with ophthalmic antihistamines can enhance the effectiveness of a traditional pharmacological therapy. The primary advances have been the start of head-to-head studies comparing various agents actively being used in the treatment of ocular allergy. In addition, there has been increasing interest in the development of novel delivery systems to increase residence time of pharmacological agents in the ocular surface such as nanoparticles, microfilms; examining novel pathways of controlling the allergic inflammatory response of the ocular surface such as modulation of cytokines, transcription factors, and immunophilins.
An update on new therapies currently approved or potentially useful in the future for the management of patients suffering moderate-to-severe atopic dermatitis.
Recent Findings
New pathogenic mechanisms involved in atopic dermatitis have permitted to propose novel therapeutic approaches devised to control the inflammatory process observed in involved cutaneous tissues by neutralizing mediators, cytokines, and their receptors.
Summary
Recent research findings have disclosed important and previously unrecognized pathogenic mechanisms that have resulted in innovative targeted therapies, such as dupilumab, and potentially other biologicals and small molecules. Further studies should permit the sub-classification of patients according to the relevance of different mediators and inflammatory cells. It can be concluded that the treatment of atopic dermatitis has entered into the era of personalized/precision medicine.
Allergen-antibody complexes are extremely valuable in describing the detailed molecular features of epitopes. This review summarizes insights gained from recently published co-structures and what obstacles impede the acquisition of further data.
Recent Findings
Structural epitope data helped define the epitopes of two anti-Fel d 1 antibodies undergoing phase I clinical trials, providing a greater level of detail than was possible through hydrogen-deuterium exchange protection studies. Separately, a human camelid-like antibody structure with lysozyme described several unique features in a long variable loop that interacted with the active site cleft of Gal d 4. Finally, a co-structure conclusively demonstrated that Phl p 7 could function as a superantigen and that an antibody could simultaneously recognize two epitopes. These remarkable assertions would not have been possible without visualization of the complex. Only three new complexes have appeared in the last few years, suggesting that there are major impediments to traditional production and crystallization.
Summary
The structural data was extremely valuable in describing epitopes. New techniques like cryo-EM may provide an alternative to crystallography.
The purpose of this article is to review treatment advances in ocular allergy that include the treatment of the various signs and symptoms of the allergic inflammatory response of the ocular surface.
Recent Findings
Recent studies have demonstrated improved pharmacological effect of topical agents with artificial tears and cold compresses; brimonidine, a new ophthalmic decongestant which has demonstrated decreased rebound conjunctivitis; and potential use of contact lens and other novel delivery instruments to increase medication retention time.
Summary
Currently, there have been limited advances in novel ophthalmic treatments. Non-pharmacological interventions have demonstrated in a randomized control study that artificial tears and the use cold compresses alone or in combination with ophthalmic antihistamines can enhance the effectiveness of a traditional pharmacological therapy. The primary advances have been the start of head-to-head studies comparing various agents actively being used in the treatment of ocular allergy. In addition, there has been increasing interest in the development of novel delivery systems to increase residence time of pharmacological agents in the ocular surface such as nanoparticles, microfilms; examining novel pathways of controlling the allergic inflammatory response of the ocular surface such as modulation of cytokines, transcription factors, and immunophilins.
An update on new therapies currently approved or potentially useful in the future for the management of patients suffering moderate-to-severe atopic dermatitis.
Recent Findings
New pathogenic mechanisms involved in atopic dermatitis have permitted to propose novel therapeutic approaches devised to control the inflammatory process observed in involved cutaneous tissues by neutralizing mediators, cytokines, and their receptors.
Summary
Recent research findings have disclosed important and previously unrecognized pathogenic mechanisms that have resulted in innovative targeted therapies, such as dupilumab, and potentially other biologicals and small molecules. Further studies should permit the sub-classification of patients according to the relevance of different mediators and inflammatory cells. It can be concluded that the treatment of atopic dermatitis has entered into the era of personalized/precision medicine.
The cover image is based on the Original Article Dividing neutrophils in subsets reveals a significant role for activated neutrophils in the development of airway hyperreactivity by Sandra Ekstedt et al, https://doi.org/10.1111/cea.13311.
Cochlear implant (CI) biomechanical constraints result in impoverished spectral cues and poor frequency resolution, making it difficult for users to perceive pitch and timbre. There is emerging evidence that music training may improve CI-mediated music perception; however, much of the existing studies involve time-intensive and less readily accessible in-person music training paradigms, without rigorous experimental control paradigms. Online resources for auditory rehabilitation remain an untapped potential resource for CI users. Furthermore, establishing immediate value from an acute music training program may encourage CI users to adhere to post-implantation rehabilitation exercises. In this study, we evaluated the impact of an acute online music training program on pitch discrimination and timbre identification. Via a randomized controlled crossover study design, 20 CI users and 21 normal hearing (NH) adults were assigned to one of two arms. Arm-A underwent 1 month of online self-paced music training (intervention) followed by 1 month of audiobook listening (control). Arm-B underwent 1 month of audiobook listening followed by 1 month of music training. Pitch and timbre sensitivity scores were taken across three visits: (1) baseline, (2) after 1 month of intervention, and (3) after 1 month of control. We found that performance improved in pitch discrimination among CI users and NH listeners, with both online music training and audiobook listening. Music training, however, provided slightly greater benefit for instrument identification than audiobook listening. For both tasks, this improvement appears to be related to both fast stimulus learning as well as procedural learning. In conclusion, auditory training (with either acute participation in an online music training program or audiobook listening) may improve performance on untrained tasks of pitch discrimination and timbre identification. These findings demonstrate a potential role for music training in perceptual auditory appraisal of complex stimuli. Furthermore, this study highlights the importance and the need for more tightly controlled training studies in order to accurately evaluate the impact of rehabilitation training protocols on auditory processing.
The purpose of this study was to compare the effects of different irrigation solutions when used EndoActivator on postoperative pain.
Methodology
A total of 104 subjects with nonvital pulps were selected and randomly assigned to four experimental groups; (G) 1 (n = 26) 2.5% NaOCl + conventional endodontic syringe, (G) 2 (n = 26) 2.5% NaOCl + EndoActivator, (G) 3 (n = 26) 2.5% NaOCl + QMix + conventional endodontic syringe, (G) 4 (n = 26) 2.5% NaOCl + QMix + EndoActivator. All the patients were prescribed ibuprofen 400 mg to be taken every 8 h in case of pain. The patients were asked to rate the severity of the postoperative pain on a visual analog scale (VAS) for 8th, 24th, 48th, and 72nd hours after the visit. The data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Chi-Square tests.
Results
G4 resulted in lesser postoperative pain levels on 8th, 24th, 48th, and 72nd hours than the G2, G3, and G1 did. There was no significant difference between G4 and G2 and between G3 and G1 in terms of the postoperative pain levels at any time interval (P > 0.05).
Conclusion
It was determined that the postoperative values of the groups, in which EA was used, were statistically significantly lower than in the other groups. The combined use of QMix and EA provided the most significant decrease in the postoperative pain values.
Clinical relevance
Successful management of postoperative pain is an important issue for the clinician. The combined use of Qmix and EA can be recommended to the clinicians.
Injection medialization is performed to improve glottic closure, thereby airway protection. Overall objective to determine if unilateral injection medialization changes glottal area with concomitant adjustments in penetration/aspiration scale (PAS) scores and pharyngeal high‐resolution manometry (HRM) parameters.
Methods
Enrolled 17 adults with unilateral vocal fold paralysis/paresis and aspiration/penetration. Fiberoptic endoscopic evaluation of swallowing and pharyngeal HRM completed at (1) baseline (within 1 week before injection), (2) postinjection (within 1 week post injection), and (3) 1‐month postinjection. Comparisons between time points for PAS scores, glottal area, pharyngeal pressure, and timing.
Results
No significant differences in normalized glottal area. No significant differences in PAS scores, for any consistency. Significantly increased rate of mesopharynx pressure rise and maximum pressure at 1 month postinjection (P = .01 and .02, respectively) compared to baseline. Significant decrease in mesopharynx integral from baseline to 1 week postoperative (P = .03).
Conclusion
Findings suggest unilateral vocal fold injection medialization had limited effect on swallow function.
We aimed to investigate BRAF V600E percentage immunohistochemically in ameloblastomas of a single institute cohort. We were interested if age, location, histological properties, or tumor recurrence depend on the BRAF status.
Subjects, Materials and Methods
We had 36 formalin‐fixed, paraffin‐embedded ameloblastoma tissue samples of patients treated at the Helsinki University Hospital between the years 1983‐2016. Tissue sections underwent immunohistochemistry by Ventana BenchMark XT immunostainer using Ms Anti‐Braf V600E (VE1) MAB. We used R 3.4.2 and RSudio1.1.383 to conduct statistical analysis for BRAF positivity and earlier onset as well as tumor location. We used X² ‐tests and 2 by 2 table functions to determine connections between BRAF positivity and recurrence, growth pattern, and type.
Results
BRAF positive tumors occurred in younger patients compared to BRAF negative tumors (p = 0.015) and they located mostly to the mandible (p = <0.001). Growth patterns were limited to two in BRAF negative tumors when BRAF positive tumors presented with one to four growth patterns (p = 0.02). None of the maxillary tumor showed BRAF positivity and of these, 72.2% recurred.
Conclusions
An immunohistochemical BRAF marker could be a beneficial tool to predict the outcome of patients with this aggressive, easily recurring tumor.
This article is protected by copyright. All rights reserved.
An injury of the recurrent laryngeal nerve (RLN) triggers axonal regeneration but results in a poor functional recovery. Netrin‐1 and glial cell‐derived neurotrophic factor (GDNF) expression are up‐regulated in laryngeal muscles during RLN regeneration, but the role of their receptors produced in the nucleus ambiguus is unknown. The aim of this work was to determine the timing of the production of Netrin‐1 and GDNF receptors during RLN regeneration and correlate this with the previously identified timing of up‐regulation of their trophic factors in the laryngeal muscles.
Study Design
Laboratory experiment with rat model.
Methods
The right RLN was transected and dextran amine tracer applied. At 7, 14, and 21 days postinjury (DPI), brainstems were removed and harvested. Immunostaining was performed for Netrin‐1 (deleted in colorectal carcinoma [DCC], UNC5A) and GDNF receptors (rearranged during transfection [Ret], glycosylphosphatidylinositol‐linked cell surface receptors [GFRα1, GFRα2, GFRα3]). The timing and type of receptor production relative to injury as well as their position in the nucleus ambiguus was analyzed.
Results
Netrin‐1 UNC5A receptors were minimal in the nucleus ambiguus during RLN regeneration. DCC, the receptor that plays an attract role, was immunopositive from 7 to 21 DPI. All GDNF receptors, except GFRα2, were clearly positive from 7 to 14 DPI. No differences of production were observed according to the position of the motor neurons in the nucleus ambiguus.
Conclusion
An injury of the RLN leads to a higher production of Netrin‐1 DCC and GDNF receptors in the nucleus ambiguus. The timing of receptor production is similar to up‐regulation of their trophic factors in the laryngeal muscles.
The objective of this study was to report for the first time on the results of submucosal injections of bevacizumab used in conjunction with cyanoacrylate glue sclerotherapy in hereditary hemorrhagic telangiectasia (HHT).
Study Design
Retrospective analytic chart review.
Methods
We performed a chart review that included all patients with HHT treated with intranasal bevacizumab and cyanoacrylate glue for refractory epistaxis at Lariboisiere University Hospital from 2013 with a minimum follow‐up of 6 months. We injected 100 mg (25 mg/mL) of bevacizumab diluted in 2 mL of serum at the base of the telangiectasias, and sclerotherapy with an injection of cyanoacrylate glue was used adjunctively. Treatment efficacy was based on changes in Epistaxis Severity Scores (ESS) and the Bergler‐Sadick Scale. Quality of life and patient satisfaction were evaluated using the Cantril Self‐Anchoring Ladder (CL) and Likert scale, respectively.
Results
Thirty‐one patients were included, with a mean follow‐up of 26.6 months. The average ESS score significantly decreased from 7.82 to 3.89 (P < .05). The Bergler‐Sadick score significantly improved (P < .05) following the treatment, including the frequency (from 2.74 to 1.64) and the quantity (from 2.54 to 1.51) scales. Quality of life was significantly improved (P < .05) using the CL score (from 4.16 to 7.22). The Likert satisfaction scale related to the treatment efficacy was high, with an average of 7.03 out of 10. No complications were noted.
Conclusions
Submucosal injections of bevacizumab in conjunction with cyanoacrylate glue sclerotherapy significantly reduced epistaxis and improved the quality of life in HHT. Prospective comparative studies are needed to further evaluate the significance of this treatment modality.
Cochlear implant (CI) biomechanical constraints result in impoverished spectral cues and poor frequency resolution, making it difficult for users to perceive pitch and timbre. There is emerging evidence that music training may improve CI-mediated music perception; however, much of the existing studies involve time-intensive and less readily accessible in-person music training paradigms, without rigorous experimental control paradigms. Online resources for auditory rehabilitation remain an untapped potential resource for CI users. Furthermore, establishing immediate value from an acute music training program may encourage CI users to adhere to post-implantation rehabilitation exercises. In this study, we evaluated the impact of an acute online music training program on pitch discrimination and timbre identification. Via a randomized controlled crossover study design, 20 CI users and 21 normal hearing (NH) adults were assigned to one of two arms. Arm-A underwent 1 month of online self-paced music training (intervention) followed by 1 month of audiobook listening (control). Arm-B underwent 1 month of audiobook listening followed by 1 month of music training. Pitch and timbre sensitivity scores were taken across three visits: (1) baseline, (2) after 1 month of intervention, and (3) after 1 month of control. We found that performance improved in pitch discrimination among CI users and NH listeners, with both online music training and audiobook listening. Music training, however, provided slightly greater benefit for instrument identification than audiobook listening. For both tasks, this improvement appears to be related to both fast stimulus learning as well as procedural learning. In conclusion, auditory training (with either acute participation in an online music training program or audiobook listening) may improve performance on untrained tasks of pitch discrimination and timbre identification. These findings demonstrate a potential role for music training in perceptual auditory appraisal of complex stimuli. Furthermore, this study highlights the importance and the need for more tightly controlled training studies in order to accurately evaluate the impact of rehabilitation training protocols on auditory processing.
Cutaneous disorders remain a major problem in HIV‐infected patients, even under antiretroviral therapy (ART). Patients at any stage of HIV/AIDS may suffer from skin lesions. Acnes and psoriasis are both common chronic and inflammatory skin diseases, and the treatment becomes more challenging and complex when combined with HIV infection. Whether the incidence and severity of acne and psoriasis are related to HIV infection is still controversial. Here, we report a rare case of an AIDS patient who developed severe acne along with psoriasis. The patient had initially received multiple systemic and topical antipsoriatic and anti‐acne treatments which failed. Ultimately, he achieved dramatic clinical improvement after initiation of ART for main treatment. An 8‐year follow up demonstrated that the patient has been free of symptoms of both psoriasis and acne till now.
The surgical removal of non‐melanoma skin cancers (NMSCs) is guided by the pathologic examination of margins. However, the preparation of histopathology is time consuming, labor‐intensive, and requires separate laboratory infrastructure. Furthermore, when histopathology indicates positive margins, patients must return for re‐excisions. Reflectance confocal microscopy (RCM) with a new video‐mosaicking approach can noninvasively delineate margins directly on patients and potentially guide surgery in real‐time, augmenting the traditional approaches of histopathology.
Objective
To assess a new peri‐operative RCM video‐mosaicking approach for comprehensive delineation of NMSC margins on patients in vivo.
Methods
Thirty‐five patients undergoing Mohs micrographic surgery (MMS) in the Mohs surgery unit at Memorial Sloan Kettering Cancer Center, New York, NY were included in the study. RCM imaging was performed before and after the first staged excision by acquiring videos along the surgical margins (epidermal, peripheral and deep dermal) of each wound, which were subsequently processed into video‐mosaics. Two RCM evaluators read and assessed video‐mosaics, and subsequently compared to the corresponding Mohs frozen histopathology.
Results
RCM videos and video‐mosaics displayed acceptable imaging quality (resolution and contrast), pre‐operatively in 32/35 (91%) NMSC lesions, and intra‐operatively in 29/35 lesions (83%). Pre‐operative delineation of margins correlated with the histopathology in 32/35(91%) lesions. Intra‐operative delineation correlated in 10/14 (71%) lesions for the presence of residual tumor and in 18/21 (86%) lesions for absence. Sensitivity/specificity were 71%/86% and 86%/81% for two RCM video‐mosaic evaluators, and overall agreement was 80% and 83% with histopathology, with moderate inter‐evaluator agreement (k=0.59, p≤0.0002).
Conclusions
Peri‐operative RCM video‐mosaicking of NMSC margins directly on patients may potentially guide surgery in real‐time, serve as an adjunct to histopathology, reduce time spent in clinic and reduce the need for re‐excisions. Further testing in larger studies is needed.
This article is protected by copyright. All rights reserved.
Although exposure to indoor tanning has been established as a clear risk factor for skin cancer, sunbeds are still commonly used in Europe. Understanding the determinants of sunbed use in Europe is key to plan educational interventions, behavioural strategies and legislative measures, which should be tailored to subgroups with different risk profiles. Evidences show that the typical sunbed users in Europe are young‐adult women, with intermediate skin type, a current employment and a medium/high socio‐economic status. Typical users display sun‐seeking behaviours and other risky behaviours such as smoking. Indoor tanning seems more common in northern than southern Europe. However, sunbed use remains common in fair‐skinned individuals and among adolescents/pre‐adolescents. Commonly reported reasons for sunbed use in Europe include aesthetic motives (i.e. looking attractive), the pursue of a prevacation tan, the influence of peers/parents engaging in the same habit, and the treatment of health conditions. The most commonly reported places to get an artificial tan in Europe are tanning studios and beauty salons. However, sunbeds are also available in sport venues, such as swimming pools and gyms, hotels and private houses. All these factors should be taken into account when planning educational, behavioural and legislative interventions to reduce the popularity of artificial tanning in Europe.
Vitamin D seems to be associated with a protective effect in a vast range of diseases, including cardiovascular, autoimmune and oncologic conditions. Since ultraviolet (UV) B light is the most important prerequisite for the cutaneous synthesis of vitamin D, sunbeds are able to increase serum vitamin D levels, although only transiently in most cases. In this scenario, the artificial tanning industry relentlessly tries to promote the use of sunbeds as a 'safe' therapeutic measure to achieve an adequate serum vitamin D status. The World Health Organization classified UV‐emitting tanning devices, as well as the whole UV spectrum, as group‐1 carcinogens, as they significantly increase the risk of melanoma and non‐melanoma skin cancer. In case of vitamin D deficiency or insufficiency, the current risk‐benefit ratio is therefore in favour of vitamin D supplementation instead of sunbed use. Artificial tanning devices should never be considered as an option to achieve an appropriate vitamin D status. Their supposedly beneficial effects, vastly publicised by the artificial tanning industry, are not worth the carcinogenic risk associated with sunbed use.
Sunbed use has been significantly associated with increased risk of melanoma and non‐melanoma skin cancer (NMSC), but its relationship with melanoma's risk factors such as high nevus count, atypical nevi and lentigines is poorly studied. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once‐a‐year screening during which participants' data, including sunbed use and phenotype, are collected via questionnaires.
Objectives
To investigate the association of sunbed use with nevus count, atypical nevi, lentigines and suspicion of skin cancer.
Methods
To ensure reliability of the data, we defined inclusion and exclusion criteria for countries' eligibility for the risk analysis. Multivariate logistic regression models (including age, gender, education, skin type, family history of melanoma, personal history of skin cancer, any sun exposure and any sunscreen use) were used to calculate summary odds ratios (SORs) of each clinical endpoint for ever sunbed use.
Results
Overall, 227 888 individuals from 30 countries completed the Euromelanoma questionnaire. After the data quality check, 16 countries were eligible for the multivariate analysis, for a total of 145 980 participants (64.8% females; median age 43 years; 62.3% highly educated; 28.5% skin type I–II; 11.0% ever sunbed use). Ever sunbed use was independently associated with nevus count >50 [SOR = 1.05 (1.01–1.10)], atypical nevi [SOR = 1.04 (1.00–1.09)], lentigines [SOR = 1.16 (1.04–1.29)] and suspicion of melanoma [SOR = 1.13 (1.00–1.27)]. Conversely, no significant association was found between ever sunbed use and suspicion of NMSC [SOR = 1.00 (0.91–1.10)].
Conclusions
Indoor tanning is significantly associated with well‐recognized risk factors for melanoma (including high nevus count, presence of atypical nevi and lentigines) as well as suspicion of melanoma within the Euromelanoma screenees. In order to reduce the prevalence of melanoma risk factors, avoidance/discontinuation of sunbed use should always be encouraged, especially but not exclusively for individuals with high‐risk phenotypes.
Malignant melanoma is accounting for the vast majority of skin cancer death. The treatment and productivity loss due to morbidity or premature mortality are associated with costs for society. There are few cost‐of‐illness (COI) studies on malignant melanoma in European countries from societal perspective and currently there is no publication analysing the COI in all European countries.
Objectives
The objective of the present study was to comparatively estimate COI of malignant melanoma in the European countries based on an identical approach.
Methods
Cost information was obtained from results of a systematic literature research. For countries with no available cost information, a model for imputation of cost data was developed. Country‐specific costs were modelled on the national gross domestic product, health expenditures, gross national income and epidemiological data. The adjustment for purchasing power parity allowed a comparison across countries.
Results
Crude national costs of malignant melanoma ranged between € 1.1 million in Iceland and € 543.8 million in Germany and resulted in € 2.7 billion for all EU/EFTA states. Estimated crude costs per patient were lowest in Bulgaria (€ 6422) and highest in Luxembourg (€ 50 734). The share of direct costs varied from 3% to 26% across countries. After adjustment for the purchasing power parity costs per patient ranged between € 14 420 in Bulgaria and € 50 961 in Cyprus. Treatment expenses and morbidity costs were markedly lower for countries that entered the EU since 2004. By contrast, mortality costs were lower in countries with a high gross domestic product per capita.
Conclusion
In this first estimation, malignant melanoma induces relevant COI in Europe. There was large variation in the costs per patient due to different health care systems and expenses. Beyond decreasing patient burden, early intervention and prevention of melanoma could have a relevant potential to save costs across Europe.
The use of UV‐emitting tanning devices for cosmetic purposes is associated with an increased risk of melanoma and non‐melanoma skin cancer. Young women are the most frequent users, therefore, there is an increasing concern about the regulation of sunbed use.
Objective
The primary objective is to assess the current legislation on sunbed use among European countries.
Methods
We developed a 30‐item questionnaire to gather the most relevant information about sunbed use legislation. The questionnaire was sent to Euromelanoma coordinators and to designated coordinators out of the Euromelanoma network.
Results
We obtained a response rate of 64%. More than 25% of the countries did not report any specific legislation. Roughly one‐third of the countries does not have a restriction for minors. Even in countries with a specific legislation, a lack or insufficient enforcement of age limit was observed in up to 100% of the inspections based on the PROSAFE report from 2012. Self‐tanning devices were reported in 50%, and almost 40% of countries do not require supervision of use. Although a warning display is required in 77% of cases, a signed informed consent is not required in 80%. In the vast majority of cases, the number of licensed or closed tanning centres is unknown.
Conclusions
Despite the evidence of its harmful effects, and its frequent use by young people, many of whom are at high risk of skin cancer because of fair skin, a significant number of European countries lack a specific legislation on tanning devices. In order to limit the access of young people to sunbeds, a more strictly enforced regulation is needed, as well as regulation regarding advertisement, and location of tanning centres, in addition to health promotion campaigns that target the vulnerable population of young women seeking its use for improved cosmesis.
Experimental investigations have definitely assessed that ultraviolet A (UVA) as well as ultraviolet B (UVB) radiation induce mutagenic DNA photoproducts and other cell damages with a carcinogenic potential. Artificial tanning increases significantly the lifetime risk for basal cell carcinoma, squamous cell carcinoma and melanoma particularly in subjects with fair skin type, subjects with a history of skin cancer or frequent childhood sunburn or if exposures took place at an age younger than 18 years. In addition, experimental and clinical evidence indicate that UVA exposure promotes skin photoageing. Therefore we are dealing with a recreational activity (for customers) and a profitable business (for the tanning industry) with human costs, i.e. an increase in morbidity and mortality by skin cancer, and health and social costs leading to an increased expenditure by the European national health systems. In a few European countries, legislation has recently prohibited the use of sunbeds for minors, pregnant women, people with skin cancer or a history of skin cancer and individuals who do not tan or who burn easily from sun exposure. However, this legislation seems to be insufficient from a photobiological perspective, and importantly, it is largely disregarded by consumers and tanning industry. Therefore the Euromelanoma group proposes a new, more stringent regulation for the tanning industry and restrictions for customers, particularly for those individuals with constitutional and anamnestic risk factors. Finally, we ask for an enhanced commitment to increase the awareness of the general population on the risk of artificial tanning.
The incidence of non‐melanoma and melanoma skin cancer has been rising in Europe. Although the World Health Organization's International Agency for Research on Cancer has since 2009 classified sunbeds as a Group 1 carcinogen, sunbed use, especially by those under the age of 18, continues to be a concern. As the only platform for cancer leagues in Europe, the Association of European Cancer Leagues decided to explore interest and actions by its member leagues at the national level against sunbed use, to share experiences and to provide background information on possible future collective actions at the EU level.
The safety of sunbed, especially when it comes to protecting young and vulnerable consumers, is a key concern that the Directorate‐General for Health and Consumers has been trying to address in various ways. This document presents a brief overview of activities undertaken at European level to address the main concerns related to the use of this product.
Although considered as a first‐group carcinogen, indoor tanning is a common practice in Europe. Euromelanoma is a pan‐European skin cancer prevention campaign.
Objectives
To compare several European countries in terms of the prevalence and determinants of sunbed use.
Methods
Participants in the Euromelanoma campaigns filled in questionnaires containing demographics and risk factors, including type/duration of sunbed use. Multivariate analyses adjusted for age, gender, education, skin type and year of survey were employed to assess factors independently associated with sunbed use in each country.
Results
In total, 227 888 individuals (67.4% females, median age 44, 63.4% highly educated, 71.9% skin types III–VI) from 30 countries participated. Overall, the prevalence of sunbed ever use was 10.6% (≤19‐year‐olds: 5.9%; 20 to 35‐year‐olds: 17.0%; >35‐year‐olds: 8.3%). Females displayed a higher prevalence than males in all countries. Balkan countries displayed the highest female/male ratios (≥4). Sunbed use was significantly more prevalent among skin type III–VI (14/30 countries) and highly educated participants (11/30 countries). Significant correlations were found between sunbed use prevalence and countries' latitude (P < 0.001) and sunshine (P = 0.002); Italy and Spain represented exceptions towards excessive exposure. Very different prevalence rates were found for Spain (19.3%) and Portugal (2.0%). Scandinavian countries ranked highest in sunbed use among ≤19‐year‐olds, Baltic countries among 20 to 35‐year‐olds.
Conclusions
Sunbed use prevalence was higher in northern, sun‐deprived countries, with the exception of Italy and Spain. The main determinants of sunbed use were age (young adults) and gender (females), whereas education and skin type had a less relevant effect. Geographic particularities were found in four regions: Iberian (prevalence ten times higher in Spain than Portugal), Balkan (prevalence disproportionately higher among women), Baltic (highest prevalence among young adults) and Scandinavian (highest prevalence among adolescents). These data have public health relevance for future interventions aimed at reducing sunbed use in Europe.
The International Agency for Research on Cancer classified, in July 2009, exposure to artificial tanning devices (sunbeds) as carcinogenic to humans. This classification was based on evidence from epidemiological and experimental animal studies. The present chapter will review these epidemiological evidences. The summary risk estimates from 27 epidemiological studies obtained through a meta‐analysis showed an increased risk of melanoma: summary relative risk (SRR) = 1.20 [95% confidence interval (CI) 1.08–1.34]. The risk was higher when exposure took place at younger age (SRR = 1.59; 95% CI 1.36–1.85). The risk was independent of skin sensitivity or population and a dose response was evident. A meta‐analysis of 12 studies was conducted for non‐melanoma skin cancers and showed a significantly increased risk for basal cell carcinoma (SRR = 1.29; 95% CI 1.08–1.53) and for squamous cell carcinoma (SRR = 1.67; 95% CI 1.29–2.17). As for melanoma, the risk for other skin cancers increased for first exposures at young age. Epidemiological studies have gradually strengthened the evidence for a causal relationship between indoor tanning and skin cancer and they fit with prior knowledge on relationship between UV exposure and skin cancer. Additionally, several case–control studies provided consistent evidence of a positive association between use of sunbed and ocular melanoma, also with greater risk for first exposures at younger age. Preventive measures based on information on risk or by requiring parental authorization for young users proved to be inefficient in several studies. The significant impact of strong actions or total ban, such as performed in Iceland, or a total ban of sunbed use, as in Brazil or Australian states, needs to be further assessed.
The incidence of melanoma has been increasing worldwide. Extended UV exposure during childhood or adolescence significantly increases the probability of skin cancer in adulthood.
Objective
The objective of this study was to analyse knowledge, attitudes and behaviour regarding exposure to natural and artificial UV radiation among Belgrade high school students.
Methods
The study was conducted using a questionnaire among 549 students of 3rd and 4th grade (17 and 18 years of age) in four Belgrade high schools. The questionnaire had 32 questions: questions about gender, date and month of birth and parents' education, nine questions regarding sunbed use, nine questions regarding behaviour in the sun during summer months, four questions regarding personal and family history and skin phototype and seven questions regarding attitude and general knowledge about effects of UV radiation. Assessment of frequency rate and relative numbers was used as methods of descriptive statistics.
Results
As many as 39% of participants had used a sunbed at least once, 38% plan on using it in the future. One quarter spends more than 3 hours in the sun on the beach during summer without any protection, and only one‐third of participants had not experienced sunburn during last summer. Only one‐half of students know what melanoma is, while 37% stated that they do not know.
Conclusion
General awareness of risk factors regarding sun exposure as well as general knowledge about melanoma is not on a high level among Belgrade high school students. Therefore, besides legislative measures, it is extremely important to conduct adequate education programmes in high schools.
Many pediatric psoriasis patients suffer from nail involvement and psoriatic arthritis. In adults, biologic agents have demonstrated success in treating refractory nail psoriasis and arthritis, but studies are limited in children. In this report, we present a pediatric patient with severe, recalcitrant nail and joint psoriasis, successfully treated with secukinumab.
Dermoscopic findings in umbilical granuloma are vascular polymorphism comprised of linear irregular and arborizing vessels with structureless areas distributed over a milky‐red background. The increase of angiogenesis and neovascularization is represented by the linear irregular and arborizing vessels. Structureless areas over an irregularly milky‐red background are originated by the proliferation of vascular endothelial cells and fibroblasts, with capillary and granulation tissue formation.
Severe atopic dermatitis (AD) may require systemic immunomodulatory agents to control symptoms. A lack of evidence and guidelines for systemic AD therapy in children has led to variability in agents selected and uncertainty in their comparative efficacy and safety. Evaluation of the efficacy of methotrexate in children with severe AD was performed.
Methods
We performed a retrospective chart review of 55 pediatric patients seen at Children's Hospital of Philadelphia that measured improvement using the Investigator's Global Assessment (IGA), a scale that rates AD symptoms from 0 to 5.
Results
About 76% of patients showed improvement with methotrexate. Mean baseline IGA of all patients was 4.18. After 6‐9 months of treatment, this improved to 2.94. There was additional improvement to a mean IGA score of 2.39 after 12‐15 months of treatment. At the final visit before each patient stopped methotrexate, the mean IGA score was 2.71. Approximately 50% of patients experienced minor side effects with gastrointestinal side effects the most common.
Conclusions
In a diverse patient population, safety and efficacy of methotrexate was demonstrated. Significant improvement in IGA was noted for the majority after 6‐9 months of therapy with further improvement when continuing treatment to 12‐15 months. Methotrexate remains an important option for long‐term symptom control with a favorable side effect profile and low cost.
Both medallion‐like dermal dendrocyte hamartoma and fibroblastic connective tissue nevus are rare benign dermal lesions composed of CD34‐positive spindle cells. Although regarded as different diseases, it is sometimes difficult to distinguish between them due to their clinical and pathological similarities. We present a case of medallion‐like dermal dendrocyte hamartoma that could also be diagnosed as fibroblastic connective tissue nevus and propose the possibility of overlap in these diseases.
Cognitive dysfunction in chronic rhinosinusitis (CRS) is often overlooked despite potentially broad implications. Earlier work has demonstrated decreased cognitive function in CRS patients at baseline. In this study we sought to prospectively evaluate the impact of initial, appropriate medical therapy on subjective and objective cognitive function, fatigue, and workplace productivity.
Methods
Adult patients with CRS were prospectively enrolled and completed a robust battery of pretreatment quality‐of‐life and neurocognitive testing, before undergoing appropriate medical therapy with follow‐up testing at 6 weeks. Patient‐reported cognitive function was assessed using the Cognitive Failures Questionnaire (CFQ), whereas fatigue was measured with the Fatigue Severity Scale (FSS). Objective cognitive function was assessed using the Automated Neuropsychological Assessment Metrics (ANAM) platform and workplace productivity using the Clinical Trials version of the World Health Organization Health and Work Performance Questionnaire (ctHPQ).
Results
Twenty‐seven patients were enrolled. Patients demonstrated posttreatment improvement scores on the FSS (4.32 ± 1.78 to 3.28 ± 1.65; p = 0.003), Pittsburgh Sleep Quality Index (8.62 ± 5.06 to 6.85 ± 4.11; p = 0.014), and CFQ (38.56 ± 16.40 to 33.04 ± 14.35; p = 0.046). Objective neurocognitive tests of mathematical processing and Stroop Reaction Test Block 3 improved after medical therapy (19.79 ± 5.61 to 21.3 ± 6.87; p = 0.029 and 43.06 ± 15.66 to 50.42 ± 19.34; p = 0.002, respectively). Measures of workplace productivity did not change significantly.
Conclusion
Appropriate medical therapy improves several measures of cognitive dysfunction in patients with CRS. Sustainability of results should be evaluated with larger, prolonged studies.
The distribution of Pooideae species varies across Europe. Especially, Timothy is less represented in Southern than in Northern Europe. Since allergenic cross-reactivity between pollens from different grasses ...
Pedicle ossification is thought to arise from the residual perieosteum left along the pedicle during the fibula free flap (FFF) harvesting. Pedicle ossification in head and neck reconstruction can cause trismus, pain on mastication/turning the neck, or neck swelling.
Methods
Two patients reported in this article developed severe trismus within 6 months after mandibular reconstruction with FFF. CT scans revealed ossification along the vascular pedicle interfering with mouth opening. Both patients underwent surgical debridement of the heterotopic bone.
Results
Surgical debridement of the heterotopic bone led to the resolution of trismus in both patients with pedicle ossification.
Conclusions
Pedicle ossification is a complication of FFF that can be effectively managed by removal of heterotopic bone. However, it is best prevented at the time of initial surgery. In this article, a new modified FFF harvesting technique is introduced to prevent pedicle ossification and reduce the ischemia time.
Drug Reaction with Eosinophilia and Systemic Symptoms syndrome (DRESS) is a severe Cutaneous Adverse drug Reaction, for which allergological explorations are poorly codified.
Patch tests are usually well tolerated, and their sensitivity depends on the tested drug. Due to a potential risk of relapse during the tests, intradermal tests (IDTs) are contra‐indicated in severe cutaneous drug adverse reactions 1. Consequently, results of IDTs in DRESS allergological work‐up have been rarely reported.
The objective of this retrospective monocentric study was to assess the value and tolerance of drug IDTs in patients who had a DRESS and negative patch tests with the same drugs.
This article is protected by copyright. All rights reserved.
To evaluate the current evidence regarding the effectiveness of non‐opioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy.
Materials and Methods
A literature search was conducted which included randomized controlled trials that assessed patient‐related outcome of pain in patients with oral mucositis associated with radiation therapy only or chemoradiotherapy. Literature searches were conducted in MEDLINE via Pubmed, Embase, Scopus and CINAHL.
Results
The electronic searches identified 846 articles. Screening revealed that 6 articles met all eligibility inclusion criteria. Interventions showing statistically significant benefits to reduce oral mucositis associated pain compared to placebo included doxepin (P<0.001, 95% CI ‐6.7 to ‐2.1), amitriptyline (p=0.04), diclofenac (p<0.01), and benzydamine (p=0.014).
Conclusions
Non‐opioid interventions, including topical doxepin, amitriptyline, diclofenac and benzydamine were found to provide relief of pain due to mucositis, and when effective may allow for reduction in the use of opioids in pain management.
This article is protected by copyright. All rights reserved.
The aim of this study was to investigate the effects of epigallocatechin‐3‐gallate on the proliferation and apoptosis of odontogenic keratocyst keratinocytes in vitro.
Materials and Methods
Keratinocytes isolated from the epithelial lining of the odontogenic keratocyst were cultured in keratinocyte serum‐free medium and identified by CK10, CK14, pan‐cytokeratin, and vimentin immunofluorescence staining. The cells were exposed to EGCG at different concentrations, and proliferation inhibition was measured by CCK‐8 assay. Cell cycle and apoptosis were assessed by flow cytometry, and expression of the WNT signalling pathway‐related proteins FZD3 and JNK3 was detected by quantitative real‐time PCR and western blotting. Human oral keratinocytes were used as the control.
Results
The odontogenic keratocyst keratinocytes were successfully cultured. The primary cells were tile‐like and expressed the epithelial biomarkers CK10, CK14, and pan‐cytokeratin. Epigallocatechin‐3‐gallate inhibited cell proliferation in a dose‐ and time‐dependent manner, arrested cell cycle in the G1 phase, and induced apoptosis of odontogenic keratocyst keratinocytes. FZD3 and JNK3 were overexpressed in odontogenic keratocyst keratinocytes compared with human oral keratinocytes and were downregulated by epigallocatechin‐3‐gallate treatment.
Conclusion
Epigallocatechin‐3‐gallate inhibited proliferation and induced apoptosis in odontogenic keratocyst keratinocytes, possibly by suppressing the WNT/JNK signalling pathway. It may thus be potentially used for odontogenic keratocyst treatment.
This article is protected by copyright. All rights reserved.
This survey study examines responses from 675 individuals with alopecia areata and analyzes the out-of-pocket financial burden for this patient population.
This nationally weighted cohort analysis assesses the association of hospitalization for treatment of cellulitis with readmission among patients in the US National Readmissions Database.
In Reply We thank Mollanazar for the interest in our study and agree that the existing requirements by the US Food and Drug Administration (FDA) may deter the entrance of generic manufacturers for topical dermatology drugs. Specifically, the author references the considerable financial resources and time required for in vivo bioequivalence studies prior to drug approval, while noting recent and incremental progress in which the FDA allowed in vitro testing for acyclovir. Among topical medications, in vitro testing to establish bioavailability and bioequivalence usually requires the tested drug to be qualitatively and quantitively similar to the reference listed drug, in addition to possessing comparable physicochemical properties, release rates, and permeation characteristics.
This case report describes a woman with acquired pili torti and a history of Roux-en-Y gastric bypass, alcohol abuse, and malnutrition who was admitted to the hospital for hepatic encephalopathy secondary to nonalcoholic steatohepatitis.
To the Editor In a recent issue of JAMA Dermatology, Li et al reported on the inverse association between change in drug price and the median number of manufacturers of generic topical dermatologic drugs. The authors discuss the importance of policy changes aimed at destabilizing existing drug monopolies and duopolies. While the authors discuss some of the barriers of entry faced by manufacturers, they fail to discuss the impact of US Food and Drug Administration (FDA) policies surrounding generic topical medications.
This multi-institutional cohort study reports survival outcomes in patients with cutaneous squamous cell cancer of the head and neck after disease recurrence after surgery and postoperative radiotherapy and investigates the association of immune status with disease-related outcomes.
In the article titled "Sex and Racial/Ethnic Diversity of US Medical Students and Their Exposure to Dermatology Programs," errors were present in Figures 1 and 2 on initial publication. "Year" has been deleted from the x-axis of both figures, and the orange box in the key of Figure 2 has been updated to "3." This article has been corrected online.
Publication date: Available online 26 February 2019
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): Y. Zheng, N. Yin, Z. Zhao, Y. Wang, D. Wu, H. Li, C. Jiang, H. Tong, T. Song
Abstract
Rigid external distraction is currently used to correct severe maxillary hypoplasia. The purpose of this retrospective study was to present the clinical results and complications of a two-stage surgical approach using a modified external distraction system that consists of maxillary distraction and then maxillary fixation. We treated eight patients with cleft lip and palate in this way from 2016 to 2018. Lateral cephalograms taken before the first operation, after distraction, two weeks after the second operation, and one year after treatment were used to examine maxillofacial morphology. Velopharyngeal function was evaluated by a speech therapist. The mean movements of the maxilla forwards and downwards at Point A were 12.0 mm and 8.0 mm at the completion of distraction and those at Point B were 5.0 mm backwards and 9.7 mm downwards. Mouth opening was limited at this time, and was relieved after maxillary fixation. The mean relapse one year postoperatively was 24.3% horizontally and 52.5% vertically. Velopharyngeal function was unchanged by the operation. We conclude that the method has advantages that include the short duration of wearing distractors and increased acceptance by patients. The modified external device advanced the midface sufficiently.
Publication date: Available online 27 February 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Patrick Scheffler, Nikolaus E. Wolter, Evan J. Propst, Yvonne Chan
Abstract
Objectives
To describe the type and frequency of sports related pediatric head and neck trauma.
Methods
The National Electronic Injury Surveillance System (NEISS) was searched for football, basketball, soccer, lacrosse and ice hockey related facial injuries. Cross-sectional analysis of incidence, age, and sex and specific injury diagnoses, mechanisms, and facial locations were performed. We focused on craniofacial and soft tissue injuries and excluded patients with concussion or other neurological injuries.
Results
A total of 24,905 cases were identified in the NEISS database, corresponding to an estimated, 764,293 emergency department visits. The most hazardous sports were basketball, accounting for 356,188 visits (46.6%), football with 249,633 visits (32.6%), and soccer with 128,113 (14.7%) visits. Lacrosse and ice hockey accounted for 16,869 (1.9%) and 13,490 (1.5%) visits, respectively. There has been a decrease in injuries over the past 10 years, particularly for football (53%), ice hockey (46%), and lacrosse (41%). Soccer (13%) and basketball (9%) noticed the smallest decreases.
Conclusion
Children who play basketball, football and soccer are especially prone to emergency department visits related to the head and neck. Overall, there has been an improvement in number of injuries across the five sports investigated. Sports amenable to head and neck protective equipment saw the largest improvement (football, ice hockey, lacrosse), whereas only small decreases were noted in basketball and soccer. Changes in regulations for sports not amenable to more protective equipment may help decrease adverse events.
Publication date: Available online 26 February 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Anahita Nourmahnad, Fouzi Benboujja, Christopher J. Hartnick
Abstract
Objectives
Unilateral vocal fold paralysis (UVFP) impairs communication and reduces academic performance and social interactions in children. Deciding between temporary, permanent, or potentially destructive surgical interventions can be challenging, as there currently exists no reliable means of predicting vocal fold recovery or assessing the presence of vocal fold atrophy. Regarding vocal fold atrophy, optical coherence tomography (OCT) has been shown to be an appealing non-invasive alternative for accessing vocal fold structures. This study describes UVFP microanatomy and identifies possible vocal fold atrophy using OCT.
Methods
Three UVFP patients (ages 1, 11, and 17 years) underwent bilateral OCT imaging using a handheld probe while under general anesthesia for direct laryngoscopy, and the laryngoscopic images were compared with images obtained from OCT. Structural morphological features were extracted and compared to a healthy patients' cohort.
Results
While endoscopy showed no evidence of vocal fold atrophy in two of three cases, OCT images revealed distinct differences between the lamina propria of the paralyzed and functional vocal folds in all patients. In two cases, the paralyzed vocal fold morphology was similar to a healthy patient at the age of nerve injury. The third case exhibited extensive scarring in the lamina propria of the paralyzed vocal fold.
Conclusion
This pilot study characterizes and compares vocal fold microanatomy in three UVFP patients. In most cases, lamina propria development halted at the age of paralysis, suggesting that lamina propria maturation may be dependent on vocal fold functionality. OCT shows potential to aid UVFP assessment and treatment decisions by evaluating the presence of atrophy.
Complications during or after cochlear implantation are relatively rare. They occur more frequently in patients who partake in activities that can potentially lead to local trauma. No formal recommendations exist for participation in self‐contained underwater breathing apparatus (SCUBA) activities. We describe three patients with a combined five cochlear implants and extensive diving experience, the largest case series to date, and highlight some of the difficulties faced. We also review the literature on previously described SCUBA‐diving patients with cochlear implants.
Study Design
Retrospective case series and literature review.
Methods
A review of the known SCUBA divers in the National Hearing Implant and Research Centre in Ireland was conducted, and a review of the literature was carried out using PubMed and Google Scholar.
Results
Of the three SCUBA divers with cochlear implants, two required reimplantation, the first due to nonauditory stimulation, and the second due to extrusion of the electrode through the tympanic membrane following repetitive SCUBA dives. The third patient remains without complications after 80 dives.
Conclusions
Patients with cochlear implants can have complications relating to the implant itself, with device failure a theoretical risk. The cochleostomy can lead to perilymphatic extravasation, as well as inner ear barotrauma, decompression sickness, and formation of air bubbles along the electrode. A combination of deafness, vestibulopathy with abrupt perilymph leak, and loss of proprioception can lead to disorientation and blue dome syndrome. Based on our experience with cochlear implants in SCUBA divers, along with those reported in the literature, we recommend caution in patients with cochlear implants who SCUBA dive regularly and strict adherence to the recommended safety limits.
Unilateral vocal fold paralysis (UVFP) induces hoarseness due to progressive atrophy of the denervated thyroarytenoid (TA) muscle. Therefore, treatments aimed at regenerating the atrophied TA muscle are required. Basic fibroblast growth factor (bFGF) is involved in muscle development and regeneration. This study aimed to elucidate the effects of bFGF injection on atrophied TA muscle.
Study Design
Animal research.
Methods
A recurrent laryngeal nerve–paralysis rat model was established, and low‐ (200 ng) or high‐dose (2,000 ng) bFGF or saline (control) was injected into the TA muscle 28 days later. The larynges were excised on day 1, 3, 7, 14, and 28 after treatment. The cross‐sectional area of the TA muscle in normal and paralyzed sides was compared, and the Ki67‐positive (Ki67+) dividing cells, paired box 7–positive (Pax7+) satellite cells (SCs), and myogenic differentiation–positive (MyoD+) myoblasts were counted.
Results
The TA muscle area of animals administered high‐dose bFGF increased with time and was significantly larger than that of the saline‐injected controls 28 days after treatment (P < .05). The counts of Ki67+ and Pax7+ cells were the highest on day 1, whereas the MyoD+ myoblast count was highest on day 7. These results suggest that bFGF administration into the denervated TA muscles compensated for the atrophied TA muscles by inducing proliferation of SCs and their differentiation to myoblasts.
Conclusions
A single injection of high‐dose bFGF augmented regeneration and differentiation of the atrophied TA muscle by enhancing proliferation and differentiation of muscle SCs, suggesting its possible clinical application in humans with UVFP.
Longitudinal studies in laryngeal cancer can provide clinicians information about short-term and long-term functional outcomes, like quality of life (QoL) and voice outcome. This information is important when counseling patients or choosing a primary treatment modality. The present study assessed long-term (2 years) QoL and voice outcome in patients with extended T1 and limited T2 glottic carcinoma treated with transoral CO2 laser microsurgery (TLM) (unilateral type III or bilateral type II resections).
Methods
Three questionnaires were administered: the Voice Handicap Index (VHI), the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ)-C30, the EORTC QLQ-HN35. A perceptual voice evaluation at six different time points was conducted: preoperatively, and postoperatively at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Fluctuations over time were investigated.
Results
Sixty-one patients were included in the analysis. Patients reported high-level functioning and low symptom scores 2 years postoperatively. Gender significantly affected the VHI scores at 2 years (mean VHI scores: female 8.7 vs. male, 23.9; p = 0.023). The major improvement in VHI scores was observed within the first 6 months. The tumor stage (T1a, T1b, and T2) significantly impacted the grade (mean scores at 2 years: 1.0, 1.9, and 1.7; p = 0.001). These scores stabilized at 6 months.
Conclusions
Patients show good long-term QoL with low symptom scores, a low voice handicap, and mild to moderate dysphonia, 2 years postoperatively. Scores stabilize at 6 months and provide a clear indication of status at 1 and 2 years.
Orbital cavernous hemangiomas (OCH) are the most common adult orbital tumor and represent an ideal index lesion for endonasal orbital tumor surgery. In order to standardize outcomes reporting, an anatomic‐based staging system was developed.
Methods
An international, multidisciplinary panel of 23 experts in orbital tumor surgery was formed. A modified Delphi method was used to develop the cavernous hemangioma exclusively endonasal resection (CHEER) staging system with a total of 2 rounds being completed.
Results
Tumors medial to a plane along the long axis of the optic nerve may be considered amenable for an exclusively endonasal resection. In select cases, tumors may extend inferolaterally if the tumor remains below a plane from the contralateral naris through the long axis of the optic nerve (ie, plane of resectability [POR]). This definition reached consensus with 91.3% of panelists in agreement. Five stages were designed based on increasing technical resection difficulty and potential for morbidity. Stages were based on the relationship of the tumor to the extraocular muscles, the inferomedial muscular trunk of the ophthalmic artery (IMT), and orbital foramina. Staging by anatomic location also reached consensus with 87.0% of panelists in agreement. Size was not included in the staging system due to the lack of agreement on the contribution of size to resection difficulty.
Conclusion
Endoscopic orbital tumor surgery is a nascent field with a growing, yet heterogeneous, body of literature. The CHEER staging system is designed to facilitate international, high‐quality, standardized studies establishing the safety, efficacy, and outcomes of endonasal resection of OCH.
Gastric pharmacobezoars are a rare entity that can induce mechanical gastric outlet obstructions and sometimes prolong toxic pharmacological effects. Certain medications, such as sustained-release forms, conta...
This study aimed to systematically review the efficacy of direct optical fluorescence imaging as an adjunct to comprehensive oral examination in the clinical evaluation, risk assessment and surgical management of oral cancer and potentially malignant disorders.
Methods
Studies adopting autofluorescence devices, evaluating the efficacy of comprehensive oral examination and optical fluorescence imaging in detection, visualisation or management of oral squamous cell carcinoma or oral potentially malignant disorders, as well as discriminating oral epithelial dysplasia from other mucosal lesions, were included in the literature search across bibliographic databases until October 2018.
Results
28 studies were found to be eligible for inclusion in qualitative analysis. Of these, only six studies demonstrated a low risk of bias across all domains of the methodological assessment tool (QUADAS‐2). Optical fluorescence imaging demonstrated positive results, with higher sensitivity scores, increased lesion detection and visualisation than comprehensive oral examination alone in the clinical evaluation of oral squamous cell carcinoma and oral potentially malignant disorders.
Conclusions
This review provides promising evidence for the utilisation of optical fluorescence imaging as an adjunct to comprehensive oral examination in varying clinical settings. It is important that devices utilising optical fluorescence imaging are viewed strictly as clinical adjuncts and not specifically as diagnostic devices.
This article is protected by copyright. All rights reserved.
Role of insulin resistance in essential hypertensive patients in Qena Governorate, Egypt
p. 99
Mohamed Alsenbsey, Basem Asham, Sanaa Shaker Aly, Samar Sayed Ahmed, Ahmed Boghdady DOI:10.4103/AZMJ.AZMJ_56_17
Introduction Essential hypertension is associated with multiple metabolic abnormalities; one of the most important is hyperinsulinemia. On the contrary, euglycemic state has been elicited in hypertensive patients. Aim To explore the pathogenic role of hyperinsulinemia in essential hypertensive patients even with euglycemia. Patients and methods A total of 60 euglycemic patients (30 hypertensive patients and 30 normotensive controls) were recruited in a case–control study. Blood pressure, insulin level, lipid profiles, BMI, and waist circumference (WC) were estimated for both groups. In addition, the severity of hypertension was classified according to the European hypertension guidelines. Results Significant increases of fasting insulin level, BMI, WC, and dyslipidemia (increase total cholesterol, triglycerides, and low-density lipoprotein-cholesterol) and a significant decrease of high-density lipoprotein-cholesterol in hypertensive patients than the controls were found. Moreover, a highly significant correlation was detected between the severity of hypertension and the parameters of fasting insulin level, BMI, WC, and triglycerides level. Conclusion The study showed a significant increase in fasting insulin level in hypertensive patients than the control group. Besides, there was a highly significant increase of fasting insulin level with hypertension severity; therefore, this supports a possible pathogenic role of hyperinsulinemia (through insulin resistance) in the onset of hypertension even when the fasting blood sugar is within the normal limits (euglycemic).
Angioplasty and drug-eluting stent for vertebral artery stenosis
p. 105
Nabil A Metwally, Khalid M Sobh, Mahmoud M Hassan, Ali F El Hadad, Shoukry Abd Al Aziz DOI:10.4103/AZMJ.AZMJ_27_18
Objective To study the efficacy, safety, and feasibility of angioplasty and drug-eluting stents (DESs) in the treatment of vertebral artery stenosis. Patients and methods The study was carried out on 20 patients (17 patients with vertebral artery endovascular stenting and three patients with angioplasty alone). The success rate, perioperative complications, and long-term effectiveness were evaluated.Results A total of 17 DESs were implanted and three patients with angioplasty alone. The success rate was 100%. The degree of stenosis decreased from 78.25±10.17 to 11.50±7.45% (P<0.01). Complications were absent during the perioperative period. Follow-up was performed for 6 months. Two patients developed transient ischemic attack and one of them developed stroke and no cerebral ischemic events were noted in the remaining patients, suggesting a favorable outcome. ConclusionAngioplasty and DESs is a safe and effective strategy for the treatment of symptomatic vertebral artery stenosis.
Toxoplasmosis prevalence in Egyptian diabetic patients
p. 113
Mahmoud H Hemida, Samir A Shahat, Ahmed M.S Bayoumy, Khairy A Mohamed, Shady M Hassan DOI:10.4103/AZMJ.AZMJ_53_18
Background Infection with Toxoplasma gondii is one of the most common parasitic infections in humans worldwide. Nearly one-third of individuals worldwide have been exposed to this parasite. Diabetes mellitus is an important factor that increases the susceptibility and risk of various infestations in the host.Objective This study aimed to shed light on and evaluate the seroprevalence of T. gondii infection in diabetic patients. Patients and methods T. gondii antibodies were tested serologically in 50 patients with diabetes mellitus and 50 apparently healthy individuals as controls using the enzyme-linked immunosorbent assay technique. Results The seropositivity for anti-Toxoplasma immunoglobulin (Ig)G antibodies in the study groups was 46% in diabetic patients (group I) and 24% in the control group (group II), with P value of 0.03 indicating a statistically significant difference between the two groups. Only one patient in the diabetic group (group I) was positive for anti-Toxoplasma IgM, with P value of 0.98, showing no statistically significant difference between the two groups. Conclusion The seropositivity for anti-Toxoplasma antibodies in diabetic patients was found to be higher than that in nondiabetic patients. Anti-Toxoplasma IgG antibodies 46 versus 24% (P=0.03).
Studying Tenascin-C in systemic lupus erythematosus as a new biomarker for disease activity
p. 117
Farag Khalil, Nabil M Rafat, Mohammad S Nada, Mohammad Magdy, Hassan A Abdelaziz DOI:10.4103/AZMJ.AZMJ_58_18
Background The precise etiology and pathogenesis of systemic lupus erythematosus (SLE) remain unclear. Unpredictable flares and remissions and diverse serological and clinical manifestations are observed among patients with SLE and the challenge for the evaluation of disease activity and administration of appropriate treatment. Assessment of Tenascin-C (TNC) may reflect disease activity and/or early tissue damage in SLE. Aim The aim of this study was to examine whether TNC levels are useful as a predictive biomarker in SLE and to reflect their activity. Patients and methods In all, 50 patients with SLE (25 patients with active SLE, 25 patients with inactive SLE), and 25 age-matched and sex-matched healthy controls were enrolled in the study. Patients undergo clinical and laboratory assessment. Serum TNC was assessed by enzyme-linked immunosorbent assay. Our results The results have shown that patients with active SLE had a higher TNC level compared with inactive patients and healthy volunteers. Also the study showed a statistically significant positive correlation between TNC level and Systemic Lupus Erythematosus Disease Activity Index score. On the other hand, the TNC level correlated negatively with white blood cells, platelet counts, C3 and C4 levels, hemoglobin level, and disease status. Conclusion The increased serum tenascin level was found in patients with SLE and was correlated with certain clinical and laboratory immunoinflammatory parameters. So the estimation of serum Tenascin levels seems beneficial in the assessment of disease activity and progress in SLE patients as well as in the assessment of the efficacy of various treatment regimens used.
Transversus abdominis plane block for postoperative analgesia after abdominal surgeries in morbidly obese
p. 134
Mofeed A Abdelmaboud DOI:10.4103/AZMJ.AZMJ_30_18
Background Pain is a significant problem for many patients after major surgery. The transversus abdominis plane (TAP) block is a new technique that provides analgesia following abdominal surgery. TAP block can be done blindly or by using ultrasound that include posterior and subcostal approach.Aim The primary aim was to study the clinical utility of TAP block as analgesia after lower abdominal surgeries in morbidly obese. The secondary aim was to assess the advantages and disadvantages of the same. Patients and methods A total of 60 patients fulfilling inclusion criteria who were undergoing elective lower abdominal surgeries were divided into two equal groups. Group T (TAP group), which received bilateral ultrasound-guided subcostal TAP block at the end of the surgery before emergence, and group C (control group) that received general anesthesia, with no further narcotic administration. Postoperative mean arterial pressure, heart rate, respiratory rate, visual analog scale, and visual analog scale on cough, PaCO2, time to first request of analgesia, average frequency of analgesia, average total analgesics consumption, average total local anesthetic (bupivacaine) consumption, postoperative complications, and frequency of antiemetic were recorded. Bromage score was assessed at 20 min postoperatively. Results There were significant decrease in mean arterial pressure, heart rate, respiratory rate, visual analog scale, and visual analog scale on cough in group T than group C at 10, 20 min. There wasa high significant decrease in peak expiratory flow rate and significant increase in PaCO2 in group C than group T at 2, 6 h postoperatively. There was a high significant increase in the time to first request of analgesia, and a high significant decrease of both frequency of analgesia and average total consumption of analgesia. A high significant increase was observed in local anesthetic consumption in the first 24 h postoperatively in group T than group C. There were significant differences in nausea, vomiting, and frequency of antiemetic, whereas they did not occur in group T. There were no significant differences in the grade of motor block between two groups at 20 min or any other time.Conclusion TAP block was safe, and easy to perform, and more effective in the early postoperative period with significant reductions in opioid requirement, pain score, and complications, and did not produce motor block.
Effect of strabismus surgery on refractive power of the eye
p. 141
Hanan S Hegazy, Nashwa M Lamie, Rasha H Abd El Salam DOI:10.4103/AZMJ.AZMJ_40_18
Background The aim was to evaluate the refractive and corneal topographic changes occurring in the eyes after horizontal rectus muscle surgery, either unilateral recess–resect procedure or bilateral rectus muscle recession. Patients and methods A total of 31 eyes of 20 patients were included in this study. The patients underwent strabismus surgery for concomitant horizontal strabismus (exotropia). The patients were divided into two groups. Group A included nine patients (nine eyes), who were subjected to lateral rectus muscle recession and medial rectus resection in the same eye (R&R group). Group B included 11 patients (22 eyes) who were subjected to lateral rectus recession in both eyes (bilateral lateral rectus recession group). A full ophthalmic examination including cycloplegic automated refraction was carried out. Refraction and keratometry were assessed at 1–2 weeks preoperatively and 1 week, 1 month, and 3 months postoperatively. Corneal topography was performed before and 3 months after the operation. Preoperative and postoperative refraction was compared in terms of spherical equivalent (SE) and cylindrical power. Results The SE showed a transient statistically insignificant change toward the myopic side in the first week in both groups; these changes persisted for 2 months postoperatively and stabilized at the third month. However, the difference in SE from the preoperative values was statistically insignificant in both groups. Also, the changes in the refractive status that occurred when two muscles were operated in the same eye (R&R group) were greater than when only one muscle was operated.Conclusion Refractive status changed postoperatively, but this change was small and reversible.
Clinicopathological and immunohistochemical study of recurrent basal cell carcinoma in Egyptian patients
p. 148
Maha Sultan, Inass Mohamed, Sameh Fawzy, Mohamed El-Khalawany DOI:10.4103/AZMJ.AZMJ_94_18
Background Although recurrence of basal cell carcinoma (BCC) is uncommon, it may pose a prognostic problem that cannot be fully predicted. Aim The aim was to assess the clinical, histologic, and immunohistochemical features of recurrent BCC among Egyptian patients. Materials and methods A retrospective study that included 18 patients who had recurrent BCC during the period from 2010 to 2015 was carried out. Clinical data and histological features were analyzed, and an immunohistochemical study was carried out for primary and recurrent lesions. Results The study included 11 (61.1%) women and seven (38.9%) men with a mean age of 53±8.3 years. Most of the lesions were located on the scalp (33.3%) and cheeks (27.8%). The mean duration of the lesions was 4.1±1.7 years and the mean size of the lesions was 10.6±3.4 mm. Recurrence time ranged from 13 to 47 months, with a mean of 25.3±9.9 months. Out of 18 cases, only three (16.7%) were surgically excised, whereas 15 (83.3%) were treated by nonsurgical methods. Histological examination of recurrent lesions showed a change in histological type in 38.9%, whereas in 61.1% of cases, it was similar to the primary lesion. Immunostaining showed significant changes with Ki-67, whereas other markers (p53, bcl-2, CD10, and CD34) showed no significant differences between primary and recurrent lesions.Conclusions Our results proposed an increased risk of BCC recurrence after nonsurgical treatment and still surgical treatment is the best therapeutic method associated with low recurrence rates. We believe that increased awareness of clinical, histological, and molecular risk factors help in minimizing recurrence of BCC.
Magdy M.A Sakr, Mohammad I Abdel-Aal, Tarek M Emran, Mohammad H.M Al-Emam DOI:10.4103/AZMJ.AZMJ_82_18
Background Febrile seizures (FS) are the single most common type of seizures seen in children between 6 and 60 months of age. There has been a conflict about the role of zinc in FS. Aim The aim of this study was to determine whether there are any changes in serum zinc level in children with FS.Patients and methods This study included 100 infants and children aged between 6 and 60 months who were divided into two groups: group I included 50 patients with FS as a case group (study group) and group II included 50 patients with fever without seizures as a control group. Both groups were age and sex matched. Serum zinc level was estimated in all patients by colorimetric test kit. Statistical analysis Data were analyzed using the statistical package for social sciences, version 17. P value less than 0.05 was significant. Results FS levels were significantly reduced in case group when compared with control group (76.72±10.99 vs. 133.80±33.44 μg/dl, respectively). P value was less than 0.001.Conclusion Serum zinc level was significantly reduced among children with FS compared with febrile children without seizures. Zinc deficiency can be considered as a risk factor for FS and expected to have a role in the pathogenesis of FS.
The role of ultrasonography in the diagnosis of painful shoulder syndrome in rheumatoid arthritis
p. 160
Samia Abd El Hamid Abd El Megid, Mohammed T Abdel-Hak, Marwa M.A Abd El Rahim, Ibtesam H Abdel-Whab Hassan DOI:10.4103/AZMJ.AZMJ_29_18
Aim of the work To identify the role of ultrasonography in diagnosis of painful shoulder syndrome in rheumatoid arthritis (RA). Patients and methods A total of 45 patients with RA who fulfilled the ACR/EULAR 2010 criteria for RA were included, involving 65 shoulders. There were seven male and 38 female patients, and their mean age was 48.02±15.41 years. Their mean disease duration was 15.5±11.25 years. They were subjected to full history taking, thorough clinical examination, laboratory investigations, plain radiography, and shoulder ultrasonography. Results The 65 RA shoulders were divided according to the disease activity score 28 (DAS28) into group A (with high DAS28), which included 15 (23%) shoulder joints, and group B (with moderate DAS28), which included 50 (77%) shoulder joints. Ultrasound findings of groups A and B revealed bicipital tenosynovitis in 47 and 22%, rotator cuff (RC) tendinopathy in 66.7 and 24%, humeral head erosions in 80 and 48%, effusion in 66.7 and 18%, subacromial/subdeltoid (SA/SD) bursitis in 66.7 and 28%, and positive power Doppler signals (PDS) in 60 and 14%, respectively. There was a highly significant difference in effusion and a significant difference in RC tendinopathy and SA/SD bursitis between both groups. There was a significant to highly significant difference in SA/SD bursitis, RC tendinopathy, and bicipital tenosynovitis between patients with positive and negative PDS. Conclusion Ultrasonography is a useful tool in the diagnosis of shoulder pain in RA that can distinguish between various causes, helping in proper decision making regarding the treatment strategy. Bicipital tenosynovitis, SA/SD bursitis, glenohumeral joint effusion, humeral head erosions, and positive PDS were significant predictors of inflammatory nature of the painful shoulder syndrome.
Seroprevalence of leptospirosis among people in Shabramant Village, Egypt
p. 168
Amgad A Elzahaby, Samy Zaky, Nawal A Hafez Hassanain, El-Sayed R Hassan, Mohey A Hafez Hassanain, Mohamed Hegazy, Ahmed M Maher DOI:????
Background Leptospirosis is considered as the most common zoonosis in the world. Leptospirosis has a multiorgan affection that can affect nearly any organ in a classical, rare or unusual presentation and complications. This may include hepatic, renal, pulmonary, meninges and cardiac affections. Aim The purposes of this study were estimating leptospiral infection prevalence among people living in Shabramant village at El-Giza Governorate and identifying associated environmental and behavioral risk factors for the infection. Patients and methods This study was designed to be a cross-sectional study conducted during the period from June 2013 to May 2014. Our study included 100 participants based on history taking and laboratory investigations; a structured questionnaire was administered to collect information on individuals' potential risk factors for leptospiral infection. Microagglutination test was performed using five Leptospira serovars: Leptospira int. icterohaemorrhagiae, Leptospira int. canicola, Leptospira int. pomona, Leptospira int. grippotyphosa and Leptospira int. wolffi to determine the presence of leptospiral antibodies and their titers in the sera of investigated patients. Results Our study found leptospirosis disease to be common among studied cases (44%), and L. icterohemorrhagiae was the only serovar detected among the studied cases. Middle-aged female patients were predominantly affected (52.6%); hence, age and sex can be regarded as risk factors of leptospirosis. Coinfections by other pathogens were also noted in this study; 22.2% of the 44 cases included had positivity for hepatitis C virus antibodies, which can be regarded as a risk factor for acquiring this disease. Also, living close to places inhabited by rodents and animals was considered as an important risk factor for exposure to such infections, and measures should be developed to minimize exposure to these animals. Conclusion It can be concluded that leptospirosis is an important neglected zoonotic disease despite its high prevalence. We recommend adding Leptospira infection to the list of possible diseases among febrile patients and increasing the awareness of the fever hospital clinicians about leptospirosis.
Studying the effects of granisetron, ketamine, and pethidine on prevention of shivering induced by spinal anesthesia
p. 176
Alaa El-Deen M Sayed DOI:10.4103/AZMJ.AZMJ_38_17
Background Spinal anesthesia avoids the hazards of airway management during general anesthesia. Shivering is a frequent risk factor in patients undergoing lower half operations under spinal anesthesia. Premedication with intravenous serotonin receptor antagonists such as granisetron has been used to overcome this problem. Ketamine increases arterial pressure and heart rate and may decrease core-to-peripheral redistribution of heat. Moreover, pethidine which is considered as a time-tested drug for control of shivering can be of value for shivering prophylaxis. Objective This study evaluates the efficacy of granisetron, ketamine, and pethidine on shivering in patients undergoing lower half operation under spinal anesthesia. Patients and methods A total of 60 patients were assigned to three equal groups: group G received 3 mg granisetron, group K received 25 mg ketamine, and group P received 25 mg pethidine 5 min before spinal anesthesia. The incidence of shivering episodes was recorded at baseline monitoring, intraoperatively, and postoperatively. Moreover, propagation and regression of motor and sensory block were assessed. Results Regarding mean arterial blood pressure, there was significant decrease in group P in comparison with groups G and K. Regarding decreased incidence of shivering, there was no significant difference between the study groups. Regarding incidence of nausea and vomiting, there was significant decrease incidence in group G compared with groups K and P. Moreover, there was significant difference regarding faster time to regression of sensory block in group G in comparison with groups K and P. Conclusion In patients undergoing lower half surgery under spinal anesthesia, prophylactic intravenous administration of 3 mg granisetron, 25 mg ketamine, or 25 mg pethidine 5 min before induction of spinal anesthesia significantly reduced the severity of shivering. Regression of sensory block was faster with granisetron than ketamine and pethidine. Moreover, prophylactic granisetron also reduces nausea and vomiting and the need of antiemetics.
Surgical results and outcome of sphenoid wing en plaque meningioma
p. 184
Mohamed Shaban, Mostafa Abdelsamie, Ahmed Taha DOI:10.4103/AZMJ.AZMJ_54_17
Background Sphenoid wing en plaque meningioma is a subgroup of meningiomas defined by its particular sheet-like dural involvement and its disproportionately large bone hyperostosis. Sphenoid wing en plaque meningiomas are also called spheno-orbital meningiomas and pterioneal meningiomas en plaque. It represents 2–9% of all meningiomas and they are mainly located in the sphenoid wing.Objective The aim of this study was to analyze the outcome, surgical results, and recurrence rate in a series of 20 patents. Patients and methods This respective descriptive analytical study includes 20 patients with sphenoid wing en plaque meningiomas, who were surgically treated between 2010 and 2014. Results There were 14 women and 6 men, the mean age was 45 years (range: 20 and 70 years), six patients presented by extension of the dural component into the orbit, seven patients with cavernous sinus infiltration, adjuvant radiation therapy was performed for five patients after the surgery. After follow-up at 4 years, seven patients developed tumor recurrence, three patients submitted to surgical treatment, and four patients to radiation therapy. Patients without tumor extension to the orbit or cavernous sinus had the best prognosis, while patients with tumor extension, the recurrent rate was high. Conclusion Postoperative radiation therapy is indicated in cases with residual tumor in cavernous sinus and superior orbital fissure involvement is frequent and should be considered within surgical limits.
Evaluation of the effect of elective percutaneous intervention to left coronary artery disease on left ventricular functions: an echocardiography and tissue Doppler study
p. 189
Mohamed Mahmoud, Mahmoud A Abd Elbaset, Waleed Yousof DOI:10.4103/AZMJ.AZMJ_50_18
Background and Aim Coronary artery disease (CAD) is the leading cause of death worldwide. After acute myocardial infarction (AMI), CAD is a serious and common ailment that can influence a patient's prognosis and quality of life. Aim of the study The aim of this study was to assess the effect of elective percutaneous coronary intervention (PCI) on left ventricular (LV) functions after 3 months in patient with significant chronic left coronary system lesions by echo and tissue doppler imaging (TDI). Patients and methods The study was conducted on 30 patients with chronic significant (more than 70%) left coronary system stenosis as proved by diagnostic coronary angiography with or without other coronary artery affections. Resuts Left ventricular ejection fraction (EF) was statistically significant different between the patient's pre-& post-PCI (mean ± SD was = 0.4893 ± 0.06963 pre-PCI, 0.4550 ± 0.05158 post-PCI with P value of 0.0341. twenty two of patients (73.3%) were males and 8 (26.7%) were females, with age ranged from 40 to 67 years and mean age or 55.92 years. Conclusion PCI for a significant coronary lesion has a beneficial effect on LV functions, improvement in regional and global LV functions & myocardial contractility after revascularization that can be predicted by conventional echo and TDI.
Retrospective study of hepatitis c virus relapse after treatment with sofosbuvir and daclatasvir with or without ribavirin
p. 197
Mohamed DA Abd Alla, Amer AA Gomaa, Galal A Abou Farrag, Mohamed G Shikhroho, Walid M Mousa, Osama AM Mahmoud DOI:10.4103/AZMJ.AZMJ_22_18
Background and aims The highest prevalence of chronic hepatitis C virus (HCV) genotype 4 infection is reported in Egypt. Fortunately, the oral anti-HCV therapy (OAT) has been available with more than 95% reported 12-week sustained virologic response (SVR) after treatment for 84 days. The current study goals included evaluation of 12-week SVR after treatment with sofosbuvir (SOF) plus daclatasvir (DCV) with or without ribavirin for 12 weeks. An additional goal was to study the correlation between post-OAT HCV serologic relapse and diabetes mellitus, liver fibrosis, and pretreatment viral loads.Patients and methods Patients with chronic HCV infection (n=590) were retrospectively enrolled in the current study. They were subjected to OAT for 12 weeks. Single daily dose of SOF (400 mg) plus DCV (60 mg) constituted the baseline therapy in all study cases, and ribavirin (RBV) was coadministered in 262 patients. Responses to OAT were assessed 12 weeks after end of treatment by single-step reverse transcription polymerase chain reaction (SRT-PCR). Results We found that overall 12-week SVR was 98% (579/590), which showed insignificant advantages on adding ribavirin (99%) compared with solitary directly acting antivirals regimen (97%) (P>0.05). The SVR in normoglycemic and/or none or early hepatic fibrosis (F0–F2) (>99.0%) was significantly higher compared with diabetic and/or late fibrotic (F3–F4) (94%) patients (P<0.05). Pretreatment detection of HCV loads by SRT-PCR was significantly lower in F0 compared with F4 hepatic fibrosis (P<0.001), with insignificant changes when compared with F1–F3 (P>0.05). Conclusion SOF plus DCV with or without ribavirin regimens achieved 12-week SVR in 98% of the patients with chronic HCV infection. Hepatic fibrosis and diabetes mellitus have negative effects on 12-week SVR. Despite F4 hepatic fibrosis being associated with the highest pre-treatment HCV-SRT-PCR values, baseline viral loads do not affect anti-HCV oral therapy outcomes.
The role of serum S100A12 (calgranulin C) as a diagnostic marker in Egyptian patients with irritable bowel syndrome and ulcerative colitis
p. 205
Yousry Hashem, Elsayed M Mahmoud, Diaa Eltiby, Ahmed Ghazy, Mohammed Rashed, Sayed Abd-Alraheem DOI:10.4103/AZMJ.AZMJ_52_18
Background S100A12, a proinflammatory protein secreted by granulocytes, is known to be elevated in different diseases of inflammatory origin, including inflammatory bowel disease. Aims To evaluate the role of serum S100A12 as a diagnostic marker in patients with irritable bowel syndrome (IBS) and inflammatory bowel disease. Patients and methods A cross-sectional study was conducted on 70 persons who fulfilled the designed inclusion criteria and were classified into four groups: group I included 10 healthy persons; group II included 20 patients known to have IBS; group III included 20 patients known to have ulcerative colitis (UC) in remission; and group IV included 20 patients known to have UC in active state. Serum S100A12 level was measured in all patients using a highly sensitive enzyme-linked immunosorbent assay. Results The mean serum S100A12 level for UC patients in exacerbation was 83.93±30.78 pg/ml, UC patients in remission 64.03±19.87 pg/ml, the mean value of serum S100A12 was 47.73±11.15 pg/ml in the IBS group, and the mean value for the control group was 45.32±8.60 pg/ml. So, there is a significant high level of serum S100A12 in UC groups compared with the IBS group and the control group. Serum S100A12 levels were significantly higher in active UC patients compared with IBS/healthy controls (P<0.01). Serum S100A12 levels were significantly higher in UC in remission compared with the IBS and control groups (P<0.05). Serum S100A12 levels were significantly higher in active UC compared with UC in remission (P<0.05). There is no significant difference between the IBS group and the control group regarding serum S100A12 levels (P>0.05). The performed analysis also focused on the determination of a cutoff for UC prediction that would exhibit the highest possible sensitivity and specificity. This optimal cutoff was estimated at 52.8 pg/ml with a sensitivity and a specificity of 80 and 75%, respectively. Conclusions Serum S100A12 can be used as a noninvasive marker to distinguish UC from IBS.
Comparative study between radiofrequency coblation and traditional adenoidectomy
p. 211
Ali Abd Allah Abd El Rahman, Ayman Abd El Aziz El Shehaly, Yehia M Dawood, Mohammed A El Sharkawy, Ibrahim T Shalaby DOI:10.4103/AZMJ.AZMJ_20_18
Background Adenoid hypertrophy is known to be the most common cause of nasal obstruction in children; thus, adenoidectomy with or without tonsillectomy is one of the most commonly performed surgical procedures in the pediatric population. The widely used conventional curette adenoidectomy was first described. Dissatisfaction with this technique led to the use of other methods, including powered-shaver adenoidectomy, bipolar electrocautery, coblation, and LASER. Aim This study aimed to compare the endoscopic-assisted coblation adenoidectomy to conventional adenoidectomy (by cold instruments) in terms of safety, efficacy, results, and complications. Patients and methods Eighty patients were diagnosed depending on history, clinical examination, and radiology. The patients were operated on by either conventional or coblation adenoidectomy and divided into two groups: the patients in group A underwent conventional adenoidectomy, whereas the patients in group B underwent coblation adenoidectomy. The intraoperative parameters studied were operative time, intraoperative bleeding, and completeness of removal of adenoid. Postoperative parameters included assessment of postoperative pain, resolution time, and complications. Results It was found that although coblation has a longer operative time, it is a safe and effective alternative to curette adenoidectomy, it is more complete and accurate, there is less intraoperative blood loss, less postoperative pain, and fast resolution time, and fewer complications. Conclusion Coblation adenoidectomy proved to be safe and effective; however, reducing the cost is mandatory before considering it as the modality of choice for adenoidectomy.
