Outcomes of Patients Undergoing Emergency Tracheostomy During COVID 19 Pandemic: Our Experience from a Tertiary Care Centre in North-East India

xlomafota13 shared this article with you from Inoreader Outcomes of Patients Undergoing Emergency Tracheostomy During COVID 19 Pandemic: Our Experience from a Tertiary Care Centre in North-East India Via Otolaryngology Indian Abstract Airway management in the form of tracheostomy may be done as an emergency or elective procedure depending on when the patient presents and it usually involves a multi-disciplinary team including the anesthesiologist and emergency physician. The purpose of this study is to present our experience with emergency tracheostomies carried out for patients presenting with tumors in the aerodigestive tract during this period of covid 19 pandemic and their outcomes. This is a cross sectional observational study. All the patients who underwent emergency tracheostomy at Dr. B. Borooah Cancer Institute, Guwahati, India, during the period 24th March, 2020 to 23rd September, 2020(6 months) are included in this study. A total of 115 patients underwent 117 emergency tracheostomies (two underwent redo tracheostomies). Median age of patients was 55 years. More than 85% of patients were male. The most common initial presenting complaint was dysphagia (40%) followed by dyspnea (25%). Most common site of tumor was pyriform sinus cancer (45.2%). Almost 45% of patients presented with stage IVA. Complications were seen in 10 patients (8.7%). These included stomal stenosis in 4(3.5%), primary hemorrhage in 3(2.6%), subcutaneous emphysema, infection and wound break down each in one patient (0.9% each). Among the eight residents who performed these procedures, five developed covid 19 symptoms subsequently, and were tested covid positive. Emergency tracheostomy is a safe procedure for patients; however it carries a higher risk of covid transmission despite using proper precautions. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A cause‐specific Cox model for second primary tumors in patients with head and neck cancer: A RONCDOC study

xlomafota13 shared this article with you from Inoreader A cause‐specific Cox model for second primary tumors in patients with head and neck cancer: A RONCDOC study Via Head & Neck Abstract Background The aim of this study was to identify risk factors for the development of second primary tumors (SPTs) in the head and neck region, lungs, and esophagus in patients with head and neck cancer. Methods We collected data from 1581 patients. A cause‐specific Cox model for the development of an SPT was fitted, accounting for the competing risks residual/recurrent tumor and mortality. Results Of all patients, 246 (15.6%) developed SPTs. Analysis showed that tobacco and alcohol use, comorbidity, and the oral cavity subsite were risk factors for SPTs. The C‐index, the discriminative accuracy, of the model for SPT was 0.65 (95% confidence interval, 0.61–0.68). Conclusions Our results show that there is potential to identify patients who have an increased risk to develop an SPT. This might increase their survival chances and quality of life. More research is needed to provide head and neck clinicians with definitive recommendations. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Does nutritional treatment in patients with dysphagia affect malnutrition and anxiety?

xlomafota13 shared this article with you from Inoreader Does nutritional treatment in patients with dysphagia affect malnutrition and anxiety? Via swallowing exercises Nutr Hosp. 2021 Mar 4. doi: 10.20960/nh.03430. Online ahead of print. ABSTRACT INTRODUCTION: dysphagia is common in patients with cerebrovascular disease (CVD), with an incidence reported to be 35 %-50 %. Dysphagia can result in malnutrition, dehydration, and death, and negatively affects anxiety levels. OBJECTIVES: this study aimed to evaluate the effects of recommended nutritional treatment (NT) on nutritional status and anxiety levels in patients with dysphagia based on cl inical and fiber-optic endoscopic evaluation of swallowing (FEES) tests. METHODS: seventy-five patients over the age of 50 who were diagnosed with CVD, hospitalized at the Mersin City Research and Training Hospital, Neurology Clinic, from October 2019 to January 2020 were followed up for the study. The FEES test was performed to diagnose dysphagia in CVD patients. Anthropometric measurements of the patients were taken to calculate their body mass index (BMI) values. To determine a patient's daily energy and food intake, 24-h food recalls were taken, and the Nutritional Risk Screening 2002 (NRS 2002) test was used to identify patients at risk of malnutrition. State (SAI)-Trait Anxiety Inventories (TAI) were used to determine instant and general anxiety levels. After patient evaluations NT was provided. All evaluations were repeated 8 weeks after NT. Our study was carried out based on a longitudinal design since we worked with the same units at two different time points. R ESULTS: post-NT SAI scores were significantly lower than pre-NT scores (p < 0.05). A moderate correlation was found between pre- and post-NT SAI scores and daily energy and fluid intake status, and between TAI scores and daily energy, fat, and fluid intake amounts (p < 0.05). Post-NT SAI scores significantly decreased with both NRS 2002 and BMI values (p < 0.05). CONCLUSIONS: this study highlights the importance of NT in improving rehabilitation outcomes of patients with dysphagia. Since exercises such as postural techniques or maneuvers, and muscle strengthening to reduce swallowing difficulties are an important part of NT for dysphagia, a multidisciplinary study is required for the management of dysphagia, and further studies are needed on this subject. PMID:33657826 | DOI:10.20960/nh.03430 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Temporomandibular Joint Arthrocentesis: A Case Series

xlomafota13 shared this article with you from Inoreader Temporomandibular Joint Arthrocentesis: A Case Series Via Otolaryngology Indian Abstract Arthrocentesis is a simple minimally invasive procedure with less risk of complications and significant benefits in patients with internal derangement of temporomandibular joint. Here we report a study on four patients to evaluate the efficacy of arthrocentesis in the treatment of internal derangement of temporomandibular joint. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Medicinal tumor treatment of oropharyngeal cancer

xlomafota13 shared this article with you from Inoreader Medicinal tumor treatment of oropharyngeal cancer Via hno HNO. 2021 Mar 3. doi: 10.1007/s00106-021-01011-6. Online ahead of print. ABSTRACT BACKGROUND: The number of patients suffering from human papillomavirus (HPV)-associated oropharyngeal cancer has increased in recent decades. To date, the role of medical therapy in patients with squamous cell carcinoma of the head and neck region has only been established in the refractory or metastatic setting (r/m HNSCC). OBJECTIVE: What are the current treatment options for patients w ith r/m HNSCC or r/m oropharyngeal cancer? MATERIALS AND METHODS: A literature search was conducted on systemic treatment of oropharyngeal cancer and r/m HNSCC. RESULTS: There is currently no standard treatment for patients with oropharyngeal cancer in refractory or metastatic stages. Since 2017, immunotherapy with checkpoint inhibitors has become increasingly important in the treatment of r/m HNSCC patients. First-line therapy was recently adapted based on the results of the KEYNOTE-48 (KN048) study. For selected patients with r/m HNSCC, there now exists a chemotherapy-free treatment option. Use of immunotherapy also in earlier stages of HNSCC can be expected in the near future. CONCLUSION: Medical therapy of r/m HNSCC patients is in a period of great change. Treatment is increasingly based on combination therapy with checkpoint inhibitors. PMID:33660085 | DOI:10.1007/s00106-021-01011-6 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bilateral multifocality, a marker for aggressive disease, is not an independent prognostic factor for papillary thyroid microcarcinoma: A propensity score matching analysis

xlomafota13 shared this article with you from Inoreader Bilateral multifocality, a marker for aggressive disease, is not an independent prognostic factor for papillary thyroid microcarcinoma: A propensity score matching analysis Via radioactive iodine Clin Endocrinol (Oxf). 2021 Mar 4. doi: 10.1111/cen.14455. Online ahead of print. ABSTRACT CONTEXT: Multifocality and bilaterality are common in patients with papillary thyroid microcarcinoma (PTMC). However, their clinical behaviors and prognostic implications remain controversial. OBJECTIVE: To investigate the relationship between multifocality and classically aggressive characteristics and outcomes in patients with PTMC. METHODS: Clinical data of 3005 patients with P TMC were retrospectively reviewed at a tertiary medical center. The role of unilateral and bilateral multifocality in aggressive characteristics and clinical outcomes of PTMC was evaluated using propensity score matching (PSM). RESULTS: A total of 573 patients had bilateral multifocal disease (B-MFD), 272 had unilateral multifocal disease (U-MFD), and 2160 had unifocal disease (UFD). Univariate analysis showed that patients in the multifocal disease (MFD) groups showed significantly different characteristics compared to patients in the UFD group in terms of age, chronic lymphocytic thyroiditis (CLT), follicular variant PTMC, tumor diameter, aggressive growth including extrathyroidal extension (ETE), central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM), TNM stage, and underwent radioactive iodine (RAI) therapy. Further stratified analysis revealed that patients in the B-MFD group reflected the differences between the MFD and UFD groups. However, those in the U-MFD group showed slight differences only in sex, CLT, and cell subtypes, compared to the UFD group. In addition, PSM indicated differences in ETE, CLNM, and LLNM between the B-MFD and UFD groups (P<0.001), while only ETE differed between the U-MFD and UFD groups (P<0.001). After a median follow-up period of 60 months, no difference was observed in recurrence-free survival between the UFD and B-MFD (P=0.294) or U-MFD (P=0.603) groups using PSM. CONCLUSION: This propensity score matching analysis provides strong evidence that bilateral multifocality, rather than unilateral multifocality, should be considered as an aggressive marker at presentation, and neither is an independent prognostic factor for clinical outcome in PTMC. PMID:33660317 | DOI:10.1111/cen.14455 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laryngeal Manifestations of Crohn's Disease in a Toddler with Very Early Onset-IBD

xlomafota13 shared this article with you from Inoreader Laryngeal Manifestations of Crohn's Disease in a Toddler with Very Early Onset-IBD Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Mar 4:3489421998214. doi: 10.1177/0003489421998214. Online ahead of print. ABSTRACT OBJECTIVES: We report obstructing laryngeal manifestations of Crohn's disease in a toddler with very early onset-IBD (VEO-IBD) who required tracheotomy tube placement at 27 months of age for relief of recalcitrant airway obstruction unresponsive to maximal medical therapy. We review the literature for the frequency of extra-intestinal laryngeal manifestations of Crohn's disease in adults and children. METHODS: Case report and literature review of laryngeal manifestations of Crohn's disease. RESULTS: Laryngeal involvement of Crohn's disease is very rare with only 14 other cases reported. Most cases appear in adults, with the supraglottis most commonly affected. This case marks the youngest report and only the second report of a patient requiring a tracheotomy for supraglottic obstruction when intensive medical management, including use of steroids and biologics, failed to relieve obstructing laryngeal inflammation. Despite ongoing Crohn's disease, laryngeal manifestations improved permitting decannulation the following year. CONCLUSIONS: Laryngeal manifestations of Crohn's disease are rare and usually affect adults. Most cases are managed with medical therapy, however surgical excision of obstructing lesions or tracheotomy placement is sometimes required for temporary relief of airway obstruction. PMID:33657845 | DOI:10.1177/0003489421998214 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.