Diagnostic Delay in Human Papillomavirus Negative Oropharyngeal Squamous Cell Carcinoma

alexandrossfakianakis shared this article with you from Inoreader Diagnostic Delay in Human Papillomavirus Negative Oropharyngeal Squamous Cell Carcinoma via The Laryngoscope Delays in care related to evaluations by multiple providers and misdiagnosis prolonged time to diagnosis in HPV(−)OPSCC. Improved patient and provider education is necessary to expedite the diagnosis of HPV(−)OPSCC. Objective Failure to recognize symptoms of non-human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV(−)OPSCC) at presentation can delay diagnosis and treatment. We aim to identify patient factors and provider practice patterns that delay presentation and care in HPV(−)OPSCC. Methods Retrospective review at a tertiary care center. Patients with HPV(−)OPSCC receiving treatment from 2006 to 2016. Patients were excluded if their date of symptom onset or diagnosis was unknown after thorough review of the electronic medical record or their tissue was not tested for HPV or p16. Clinical data, workup, and care timelines were abstracted. Univariate and multivariable linear regressions were performed to determine associations between patient and provider factors and delays in care. Results Of 70 included patients, 52 (74%) were male and mean age was 60.5 (SD = 9.0). Median time to diagnosis was 69 days (IQR = 32–127 days), with a median latency of 30 days (IQR = 12–61 days) from symptom onset to first presentation and 19.5 days (IQR = 4–46 days) from the first presentation to diagnosis. Most patients visited at least 2 providers (n = 52, 74%) before diagnosis. Evaluation by 3 or more providers prior to diagnosis was associated with significant delays in diagnosis of nearly a year (357.7 days, p < 0.001) and being treated or prescribed analgesia prior to diagnosis was significantly associated with delays in diagnosis (p = 0.004) on univariate regression analysis. Conclusions Delays in care related to evaluations by multiple providers and misdiagnosis prolonged time to diagnosis in HPV(−)OPSCC. Improved patient and provider education is necessary to expedite the diagnosis of HPV(−)OPSCC. Level of Evidence Level 4 Laryngoscope, 2022 View on Web

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Fatigue resistance and fracture strength of narrow‐diameter one‐piece zirconia implants with angled abutments

alexandrossfakianakis shared this article with you from Inoreader Fatigue resistance and fracture strength of narrow‐diameter one‐piece zirconia implants with angled abutments via Journal of Esthetic and Restorative Dentistry Abstract Objective Zirconia implants are assumed to satisfy the esthetic requirements that titanium implants cannot meet, however, there are not enough studies in the literature about narrow-diameter and angled zirconia implants that can be preferred especially in the anterior region. This in vitro study aimed to evaluate the fatigue resistance and fracture strength of narrow-diameter zirconia implants with angled abutments. Materials and Methods Forty-eight one-piece experimental zirconia implants and monolithic zirconia crowns were produced from 3-YTZP blanks. The implant diameters (3.0 or 3.7 mm) and the restoration types were determined according to three intraoral regions (upper central incisors, lower central incisors, and upper canine), and abutments were designed as straight or 15° angled. The samples were subjected to chewing simulation corresponding to 5 years of clinical performance and then the static loading test. The survival rates of groups were measured by the Kaplan–Meier log-rank test, and the fracture load values were estimated by using Kruskal–Wallis and Mann–Whitney U tests (p < 0.05). Results All 3.0 mm diameter implants failed the fatigue test. The fatigue resistance of the implants with angled abutments was significantly lower than the straight abutments, and different crown designs were found to affect survival rates significantly. The fracture strengths of the surviving groups were above the maximum physiological chewing forces, and the differences were not significant. Conclusions The implant diameter, abutment angle, and restoration type have a significant effect on the fatigue behavior of zirconia implants. Clinical Significance The fracture strengths of the one-piece zirconia implants with a 3.7 mm diameter and a 15° abutment angle are above the chewing forces for the anterior intraoral region. View on Web

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Safety and efficacy of molnupiravir in SARS‐CoV‐2 infected patients: a real‐life experience

alexandrossfakianakis shared this article with you from Inoreader Safety and efficacy of molnupiravir in SARS‐CoV‐2 infected patients: a real‐life experience via Journal of Medical Virology Abstract Introduction Since the start of the SARS-CoV-2 pandemic, several treatments have been proposed to cure Coronavirus Disease 2019 (COVID-19) and prevent it. Molnupiravir is a ribonucleoside prodrug of N-hydroxycytidine with an in vitro e in vivo activity against SARS-CoV-2. Methods We conducted a retrospective cohort study including all people treated with Molnupiravir between the 10th of January and the 31th of March 2022 at the University Hospital of Sassari. Molnupiravir was prescribed, according to the Italian Agency of Drug indications, in patients with recent symptoms onset (≤5five days), no need of oxygen supplementation, and with a high risk of disease progression for the presence chronic diseases. Results We included 192 people with a mean age of 70.4±15.4 years; 144 (75%) patients were over 60 years. During the follow-up, 20 (10.4%) patients showed a disease progression. At the multivariate analysis, older age, having neurological dis ease, and having dyspnea at the onset of the symptoms, and acquiring SARS-CoV-2 infeciton during an hospital admission were associated with an increased risk of progression. On the contrary, early start of treatment was associated with a reduced risk of disease progression. Molnupiravir was also extremely safe since 13 (6.8%) adverse events were reported, with only one interruption. Conclusion Our study shows that Monlupiravir confirmed its efficacy and safety in a real-life cohort that included a high percentage of elderly people with a high comorbidity burden. This article is protected by copyright. All rights reserved. View on Web

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Understanding spatio-temporal human mobility patterns for malaria control using a multi-agent mobility simulation model

alexandrossfakianakis shared this article with you from Inoreader Understanding spatio-temporal human mobility patterns for malaria control using a multi-agent mobility simulation model via Clinical Infectious Diseases Advance Access ABSTRACT Background More details about human movement patterns are needed to evaluate relationships between daily travel and malaria risk at finer scales. A multi-agent mobility simulation model was built to simulate the movements of villagers between home and their workplaces in two townships in Myanmar. Methods An agent-based model (ABM) was built to simulate daily travel to and from work based on responses to a travel survey. Key elements for the ABM were lan dcover, travel time, travel mode, occupation, malaria prevalence, and a detailed road network. Most visited network segments (MVS) for different occupations and for malaria-positive cases were extracted and compared. Data from a separate survey was used to validate the simulation. Results Mobility characteristics for different occupation groups showed that while certain patterns were shared among some groups, there were also patterns that were unique to an occupation group. Forest workers were estimated to be the most mobile occupation group, and also had the highest potential malaria exposure associated with their daily travel in Ann Township. In Singu Township, forest workers were not the most mobile group; however, they were estimated to visit regions that had higher prevalence of malaria infection over other occupation groups. Conclusions Using an ABM to simulate daily travel generated mobility patterns for different occupation groups. These spatial patterns va ried by occupation. Our simulation identified occupations at a higher risk of being exposed to malaria and where these exposures were more likely to occur. View on Web

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Differential survival of potentially pathogenic, septicemia- and meningitis-causing E. coli across the wastewater treatment train

alexandrossfakianakis shared this article with you from Inoreader Differential survival of potentially pathogenic, septicemia- and meningitis-causing E. coli across the wastewater treatment train via Earth and environmental sciences : nature.com subject feeds View on Web

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Pediatric hematology providers’ contraceptive practices for female adolescents and young adults with sickle cell disease: A national survey

alexandrossfakianakis shared this article with you from Inoreader Pediatric hematology providers' contraceptive practices for female adolescents and young adults with sickle cell disease: A national survey via Pediatric Blood & Cancer Abstract Background Adolescent and young adult (AYA) women with sickle cell disease (SCD) have increased pregnancy-related health risks and are prescribed potentially teratogenic medications, yet limited data are available regarding pediatric SCD provider contraceptive practices. We aimed to assess pediatric hematology providers' beliefs, practices, motivators, and barriers for providing contraceptive care to female AYAs with SCD. Methods Guided by the Health Belief Model (HBM), we developed a 25-question, web-based survey to assess practices. Survey links were distributed nationwide to pediatric SCD and/or general hematology providers through their publicly available emails and by request to directors of U.S.-accredited Pediatric Hematology-Oncology fellowship programs for distribution to their SCD providers. Data analysis included descriptive statistics, chi-square analysis, and logistic regression. Results Of 177 respondents, 160 surveys meeting inclusion criteria were analyzed. Most providers reported counseling (77.5%) and referring female AYA patients for contraception (90.8%), but fewer reported prescribing contraception (41.8%). Proportionally fewer trainees provided counseling compared with established providers (54% vs. 85%, p < .001), with a similar trend for prescribing (p = .05). Prescription practices did not differ significantly by provider beliefs regarding potential teratogenicity of hydroxyurea. Key motivators included patient request and disclosure of sexual activity. Key barriers included inadequate provider training, limited visit time, and perceived patient/parent interest. Conclusion Provider contraceptive practices for female AYAs with SCD varied, especially by provider status. Health beliefs regarding teratogenic potential of hydroxyurea did not correlate with contraceptive practices. Clinical guidelines, provider training, and patient/parent decision-making tools may be tested to assess whether provider contraceptive practices could be improved. View on Web

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