Postextubation dysphagia in intensive care patients : Current findings and clinical recommendations

xlomafota13 shared this article with you from Inoreader Postextubation dysphagia in intensive care patients : Current findings and clinical recommendations Via swallowing exercises Anaesthesist. 2022 Feb 15. doi: 10.1007/s00101-022-01092-0. Online ahead of print. ABSTRACT BACKGROUND: A considerable number of critically ill and mechanically ventilated intensive care patients show pronounced dysphagia after extubation. Many studies have shown that postextubation dysphagia (PED) leads to a significant decline of outcome. The awareness, timely diagnostic procedures and integration of suitable treatment methods in intensive care units are therefore of great import ance. OBJECTIVE: Current basic findings on PED, diagnostic possibilities, therapeutic methods as well as the development of concrete recommendations for clinical practice. METHODS: A selective literature search was performed in PubMed, Medline and Cochrane using keywords. RESULTS: In the literature the incidence PED is reported very heterogeneous but is probably at least 10% in intensive care patients after mechanical ventilation. The duration of intubation plays a critical role here. A multifactorial interaction of several factors is assumed to be the cause, whereby the impairment of laryngeal structures is of particular relevance. A PED leads to longer hospital stays, higher mortality, more reintubation and a higher number of patients with tube feeding. With respect to diagnostics, screening by trained nurses, clinical swallowing examinations and, in particular, the use of instrumental examinations by flexible endoscopic evaluation of swallowing (FEES) are recomm ended. The treatment should include adaptive measures in the sense of an adapted diet but also functional exercises. Innovative approaches, such as electrical stimulation are also conceivable. The aim is primarily to avoid penetration and aspiration in order to counteract respiratory complications. CONCLUSION: In many intensive care units the clinical picture of PED is still neglected despite clear evidence. A simple algorithm in the treatment of intensive care patients can contribute to early detection and initiation of further steps. These should be integrated into clinical treatment standards. PMID:35166868 | DOI:10.1007/s00101-022-01092-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Systematic construction and external validation of an immune‐related prognostic model for nasopharyngeal carcinoma

xlomafota13 shared this article with you from Inoreader Systematic construction and external validation of an immune‐related prognostic model for nasopharyngeal carcinoma Via Head & Neck Abstract Background We attempted to identify the most reliable immune-related index for predicting nasopharyngeal carcinoma (NPC) prognosis and to reveal its precise and integrated relationship with NPC progression. Method One thousand seven hundred and six patients with newly diagnosed NPC (1320 from the primary cohort and 386 from the validated cohort) from January 2010 to March 2014 were enrolled. Clinical features and 12 immune-related variables were analyzed. Results A high absolute lymphocyte count (ALC; >3.2 × 109/L) correlated with a poor prognosis of patients with NPC. Significant OS differences were discovered between patients with high ALC and no ALC elevation (p < 0.05, in primary cohort), showing similar prognostic risk to patients with advanced NPC (p > 0.05, in validated cohort). ALC improved the predictive performance of the basic tumor-node-metastasis prognostic model (p = 0.025), which was reliably validated in the external independent cohort. Conclusion High ALC is a surrogate marker for improved prognostic risk stratification in NPC. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Immediate or interval abscess tonsillectomy? A systematic review and meta-analysis

xlomafota13 shared this article with you from Inoreader Immediate or interval abscess tonsillectomy? A systematic review and meta-analysis Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2022 Feb 15. doi: 10.1007/s00405-022-07294-x. Online ahead of print. ABSTRACT OBJECTIVES: Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore, this study aimed to compare clinical outcomes of immediate and interval abscess tonsillectomy. METHODS: The databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for completed studies published until the 1st of November 2021. Comparative studies assessing intraoperative and postoperative outcomes of immediate and interval abscess tonsillectomy were considered, with the primary outcome being postoperative hemorrhage. Operative time, intraoperative blood loss, postoperative pain, and duration of hospital stay were classed as secondary outcomes. A random-effects pairwise meta-analysis of both randomized a nd non-randomized trials was conducted. Subgroup analysis linked to the randomization of trials was executed. Quality assessment was performed, utilizing the Cochrane risk of bias tool and ROBINS-I tool for randomized and non-randomized trials, respectively. RESULTS: Data from 265 cases stemming from six trials were pooled together. For postoperative bleeding rates, no statistically significant difference between immediate and interval tonsillectomy was detected (OR = 1.26; 95% CI 0.27, 5.86; p = 0.77). By contrast, longer hospital stay was observed for patients subjected to interval tonsillectomy (SMD = - 0.78; CI - 1.39 to- 0.17; p = 0.01). For operative time and intraoperative blood loss, no statistically significant difference was noticed between immediate and interval tonsillectomy (SMD = 1.10; 95% CI - 0.13, 2.33; p = 0.08; and SMD = 0.04; 95% CI - 0.49, 0.57; p = 0.88; respectively). CONCLUSIONS: This study shows that quinsy tonsillectomy appears to be a safe meth od, providing full abscess drainage and instant relief of the symptoms. Moreover, quinsy tonsillectomy was not associated with a statistically higher postoperative hemorrhage incidence rate than immediate tonsillectomy. PMID:35169892 | DOI:10.1007/s00405-022-07294-x View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extension of HPV vaccination to boys

xlomafota13 shared this article with you from Inoreader Extension of HPV vaccination to boys: Survey of families and general practitioners Via Association française pour l'étude du cancer Bull Cancer. 2022 Feb 12:S0007-4551(22)00036-4. doi: 10.1016/j.bulcan.2022.01.005. Online ahead of print. ABSTRACT INTRODUCTION: As part of an analysis on the extension of the HPV vaccination to French boys, the French National Cancer Institute (INCa) and the French National Authority for Health (HAS) have conducted in collaboration a survey on HPV vaccine acceptance in July 2019. This survey was completed by parents of children aged 11-19 and general practitioners (GPs). Questions focused on their representations, practices and intentions in the context of the future policy change allowing boys to get vaccinated against HPV. METHODS: The survey was conducted between June 20 and July 12, 2019. It focused on two populations: a nationally representative sample of parents with at least one girl aged 11-19 and/or one boy aged 11-14 (n=1984) and a representative sample of GPs in mainland France. Data were collected through a web-based questionnaire with a mean completion time of 10minutes for parents and GPs. The quota method was applied to ensure the representative nature of the samples based on (i) gender, age, children (girl aged 11-14 and/or boy aged 11-14) of the household, socio-professional category of the "head of the household", size of urban area and region for the parents' sample and based on (ii) gender, age, region and type of practice for the GPs' sample. RESULTS: Although most GPs were very favourable towards HPV vaccination (94%), they considered it one of the most challenging vaccinations to get parents to adhere to (82%). A notable percentage of parents have unfavourable opinions towards HPV vaccination (25%). The three main barriers cited by parents of non-vaccinated girls were: the fear of adverse effects, the lack of information, and the fact that the GP did not propose it. Regarding the extension of HPV vaccination to boys, 84 % of GPs would recommend this vaccination to boys if it wa s included in the vaccination schedule, and 88 % of those who did not routinely recommend HPV vaccination to girls would be more likely to offer it to girls if the extension was recommended. PMID:35168764 | DOI:10.1016/j.bulcan.2022.01.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Successful outcomes with flaps for recurrent cerebrospinal fluid leaks: A systematic review of the literature

xlomafota13 shared this article with you from Inoreader Successful outcomes with flaps for recurrent cerebrospinal fluid leaks: A systematic review of the literature Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2022 Jan 22:S1748-6815(22)00036-5. doi: 10.1016/j.bjps.2022.01.022. Online ahead of print. ABSTRACT Complex back wounds with cerebrospinal fluid (CSF) leak constitute a challenge for surgeons in clinical practice. While repair of complex back wounds with various flaps is well described in the literature, there is a paucity of reviews and articles regarding optimal treatment for refractory CSF leaks. The aim of this systematic review was to present the different flap techniques proposed in the literature for CSF leaks fistulas and pseudo-meningoceles. A systematic review of the literature was conducted using the PubMed, Medline, Embase, and Cochrane databases. Studies tackling different flap techniques used for spinal or skull base CSF leak were included in the studies. The main outcomes were complications and recurrences after previous failed treatments. Fifteen studies were included in the study, constit uting a cohort of 42 patients (mean age 45 years; F/M ratio 1.15:1). A previous unsuccessful non-flap procedure was proposed in 88.1% of patients for their CSF leak. Only 16.7% had a recurrence of their CSF leak after the flap procedure. Free radial forearm flap and regional muscle flaps were more frequently used in the skull base region. Pedicled omental flaps and reverse turnover latissimus dorsi were the most commonly used flaps in the thoracolumbar region. No statistically significant differences were found between these flaps regarding rates of complications and recurrence. Flaps should be considered as a safe and effective treatment option for complex back wounds with CSF leaks. All proposed flaps in the literature seem to provide an equivalent cure rate for recurrent and refractory leaks. PMID:35168923 | DOI:10.1016/j.bjps.2022.01.022 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Vax1 rs7078160 polymorphisms and non-syndromic cleft lip

xlomafota13 shared this article with you from Inoreader Vax1 rs7078160 polymorphisms and non-syndromic cleft lip: correspondence Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2022 Jan 29:S1808-8694(22)00003-9. doi: 10.1016/j.bjorl.2022.01.002. Online ahead of print. NO ABSTRACT PMID:35168926 | DOI:10.1016/j.bjorl.2022.01.002 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Early death in supraglottic laryngeal squamous cell carcinoma: A population-based study

xlomafota13 shared this article with you from Inoreader Early death in supraglottic laryngeal squamous cell carcinoma: A population-based study Via ear nose throat Ear Nose Throat J. 2022 Feb 16:1455613221078184. doi: 10.1177/01455613221078184. Online ahead of print. ABSTRACT BACKGROUND: Supraglottic laryngeal squamous cell carcinoma (LSCC) is the second most common type of laryngeal cancer with a poor prognosis. Current population-based estimates of the early death rate and associated factors for early death of supraglottic LSCC are lacking. The purpose of this study was to assess the early death rate and related factors for early dea th in patients with supraglottic LSCC. METHODS: We identified 3733 adult patients diagnosed with supraglottic LSCC between 2010 and 2017 for whom the vital status at 3 months was known from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were staged according to the seventh edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. The early death (survival time ≤ 3 months) rate was calculated. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with the early death rate. RESULTS: 313 (8.38%) of the 3733 patients died within 3 months of diagnosis of supraglottic LSCC. Of these, 225 patients died from cancer-specific causes. Multivariate logistic regression analyses confirmed that advanced age, male sex, advanced T stage, advanced N stage, advanced M stage, and not undergoing treatment (surgery, radiotherapy, and chemotherapy) had significant c orrelations with all-cause early death in supraglottic LSCC. In addition, advanced age, advanced T stage, advanced N stage, advanced M stage, and not undergoing treatment (surgery, radiotherapy, and chemotherapy) were significantly correlated with cancer specificity in supraglottic LSCC. CONCLUSION: When a tumor is newly diagnosed, we should pay close attention to sex, age, unmarried status and AJCC TNM staging to quickly detect supraglottic LSCC patients with a tendency toward early death. These findings have implications for precise prognosis prediction and individualized and personalized patient counseling and therapy. PMID:35171058 | DOI:10.1177/01455613221078184 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bilateral Pulsatile Tinnitus Caused by Bilateral Dilated Mastoid Emissary Vein

xlomafota13 shared this article with you from Inoreader Bilateral Pulsatile Tinnitus Caused by Bilateral Dilated Mastoid Emissary Vein Via ear nose throat Ear Nose Throat J. 2022 Feb 16:1455613221077597. doi: 10.1177/01455613221077597. Online ahead of print. ABSTRACT Pulsatile tinnitus is a rhythmic type of tinnitus. Most cases are caused by vascular disorders and present as synchronous with the patient's heartbeat. A dilated mastoid emissary vein may cause pulsatile tinnitus. Here, we report the first case of bilateral pulsatile tinnitus caused by dilated bilateral mastoid emissary vein. The patient suffered from bilateral pu lsatile tinnitus for 2 years. His bilateral tinnitus disappeared temporarily when the bilateral mastoid processes were compressed. Temporal bone computed tomographic (CT) showed the bilateral dilated mastoid emissary canals. Cranial Magnetic resonance venograms (MRV) showed the bilateral dilated mastoid emissary veins. We explained the risk of surgery to the patient. Because the patient could tolerate his tinnitus and did not have a hemangioma or tumor, he did not choose to undergo surgery. PMID:35171065 | DOI:10.1177/01455613221077597 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.