Expansile Sphenoid Mycetoma Presenting With Headache and Galactorrhea

alexandrossfakianakis shared this article with you from Inoreader Expansile Sphenoid Mycetoma Presenting With Headache and Galactorrhea via JAMA Otolaryngology–Head & Neck Surgery Current Issue This case report describes an immunocompetent woman in he r 30s with daily vertex headaches over 13 months duration who developed spontaneous galactorrhea and was diagnosed with noninvasive fungal sinusitis. View on Web

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Osteoradionecrosis of the Jaw Following Proton Radiation Therapy for Head and Neck Cancer

alexandrossfakianakis shared this article with you from Inoreader Osteoradionecrosis of the Jaw Following Proton Radiation Therapy for Head and Neck Cancer via JAMA Otolaryngology–Head & Neck Surgery Current Issue This case series reports the prevalence and clinical char acteristics of osteoradionecrosis of the jaw in patients with oral and oropharyngeal cancer treated with proton radiation therapy. View on Web

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Patterns of Infectious Disease Associated with Injection Drug Use

alexandrossfakianakis shared this article with you from Inoreader Patterns of Infectious Disease Associated with Injection Drug Use in Massachusetts via Clinical Infectious Diseases Advance Access Abstract Background Since 2014, multiple outbreaks of HIV among people who inject drugs (PWID) have occurred across the United States along with hepatitis C (HCV), skin and soft tissue infections (SSTI) and infective endocarditis (IE), creating a converging public health crisis. Methods We analyzed the temporal patterns of infectious disease and overdose (OD) using a hierarchical Bayesian distributed lag logistic regression model examining the probability that a given geographic area experienced at least one HIV case in a given month as a function of the counts/rates of OD, HCV, SSTI, IE and associated medical procedures at different lagged time periods. Results Current-month HIV is associated with increasing HCV cases; abscess incision and drainage, and SSTI cases, in distinct temporal patterns. For example, one additional HCV case occurring 5 and 7 months previously is associated with a 4% increase in the odds of observing at least one current-month HIV case in a given locale (odds ratios: 1.04, 1.04; 90% credible intervals: 1.01-1.10, 1.00-1.09). No such associations were observed for echocardiograms, IE, or OD. Conclusion Lagged associations in other infections preceding rises in current-month HIV counts cannot be described as predictive of HIV outbreaks but may point towards newly discovered epidemics of injection drug use and associated clinical sequalae, prompting clinicians to screen patients more carefully for substance use disorder and associated infections. View on Web

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Study of the inflammatory activating process in the early stage of Fusobacterium nucleatum infected PDLSCs

alexandrossfakianakis shared this article with you from Inoreader Study of the inflammatory activating process in the early stage of <i>Fusobacterium nucleatum</i> infected PDLSCs via International Journal of Oral Science - Issue International Journal of Oral Science, Published online: 08 February 2023; doi:10.1038/s41368-022-00213-0 Study of the inflammatory activating process in the early stage of Fusobacterium nucleatum infected PDLSCs View on Web

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Gaps in Depression Symptom Management for Patients With Head and Neck Cancer

alexandrossfakianakis shared this article with you from Inoreader Gaps in Depression Symptom Management for Patients With Head and Neck Cancer via The Laryngoscope We sought to understand practice patterns and identify care gaps within a large-scale depression screening program for patients with head and neck cancer. A high proportion of head and neck patients report depressive symptoms, though this triggers a referral in a small number of cases. These data highlight areas for improvement in depression screening care pathways. Objective To understand practice patterns and identify care gaps within a large-scale depression screening program for patients with head and neck cancer (HNC). Study Design Retrospective cohort study. Methods This was a population-based study of adults diagnosed with a HNC between January 2007 and October 2020. Each patient was observed from time of first symptom assessment until end of study date, or death. The exposure of interest was a positive depressive symptom screen on the Edmonton Symptom Assessment System (ESAS). Outcomes of interest included psychiatry/psychology assessment, social work referral, or palliative care assessment. Cause specific hazard models with a time-varying exposure were used to investigate the exposure-outcome relationships. Results Of 14,054 patients with HNC, 9016 (64.2%) reported depressive symptoms on at least one ESAS assessment. Within 60 days of first reporting depressive symptoms, 223 (2.7%) received a psychiatry assessment, 646 (7.9%) a social work referral, and 1131 (13.9%) a palliative care assessment. Rates of psychiatry/psychology assessment (HR 3.15 [95% CI 2.67–3.72]), social work referral (HR 1.83 [95% CI 1.64–2.02]), and palliative care assessment (HR 2.34 [95% CI 2.19–2.50]) were higher for those screening positive for depression. Certain patient populations were less likely to receive an assessment including the elderly, rural residents, and those without a prior psychiatric history. Conclusion A high proportion of head and neck patients report depressive symptoms, though this triggers a referral in a small number of cases. These data highlight areas for improvement in depression screening care pathways. Level of Evidence 3 Laryngoscope, 2023 View on Web

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Density of antibiotic use and infectious complications in pediatric allogeneic hematopoietic cell transplantationa

alexandrossfakianakis shared this article with you from Inoreader Density of antibiotic use and infectious complications in pediatric allogeneic hematopoietic cell transplantationa via Transplant Infectious Disease Abstract Background : Antibiotics, while an essential component of supportive care in allogeneic hematopoietic cell transplant (allo-HCT), can have adverse effects and select for antibiotic resistance. Understanding of patterns of use will inform antimicrobial stewardship (AMS) interventions. Methods : Retrospective, single center cohort of children undergoing first allo-HCT (n = 125). Antibiotic prescription and infection data were included from the date conditioning was commenced until 30 days post allo-HCT. Antibiotic use was reported as length of therapy (LOT) (number days a patient received an antibiotic) and days of therapy (DOT (aggregating all antibiotics prescribed per day). Infections were classified as microbiologically documented (MDI) or clinically documented infections (CDI). Results : At least one course of antibiotics was administered to 124 (99%) patients. The LOT was 636 per 1000 patient days and DOT was 959 per 1000 patient days. The median duration of cumulative antibiotic exposure per patient was 24 days (inter-quartile range (IQR) 20 – 30 days). There were 131 days of fever per 1000 patient days with patients febrile for a median of four days (IQR 1–7 days). Piperacillin-tazobactam was used for 116 (94%) of patients with a LOT of 532 per 1000 patient days. A total of 119 MDI episodes occurred in 74 (59%) patients, including blood stream infection in 30 (24%) and a proven/probable invasive fungal infection in four (3%). Conclusion : Pediatric HCT patients receive prolonged courses of broad-spectrum antibiotics relative to the frequency of fever and bacterial infections. This study has identified opportunities for AMS intervention to improve outcomes for our HCT patients. This article is protected by copyright. All rights reserved View on Web

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Features of cytomegalovirus DNAemia and virus‐specific T‐cell responses in allogeneic hematopoietic stem‐cell transplant recipients during prophylaxis with letermovir

alexandrossfakianakis shared this article with you from Inoreader Features of cytomegalovirus DNAemia and virus‐specific T‐cell responses in allogeneic hematopoietic stem‐cell transplant recipients during prophylaxis with letermovir via Transplant Infectious Disease Abstract Background There is scarce information on the natural kinetics of cytomegalovirus (CMV) DNAemia and dynamics of CMV-specific T-cell reconstitution in allogeneic hematopoietic transplant recipients (allo-HSCT) undergoing letermovir (LMV) prophylaxis. Methods Twelve adult CMV-seropositive high-risk recipients (median age, 53 years; 9 males/3 females) undergoing LMV prophylaxis and 13 non-LMV allo-HSCT controls (median age, 58 years; 7 males/6 females) were included. CMV DNAemia in plasma was monitored by real-time polymerase chain reaction. Preemptive antiviral therapy (PET) was administered upon detection of ≥1500 IU/ml. CMV-specific interferon-gamma (IFN-γ)-producing CD8+ and CD4+ T cells were enumerated by flow cytometry around days +30, +60, and +90 after allo-HSCT. Ex vivo experiments assessing of the potential effect of LMV on CMV-specific T-cell expansion in a single CMV-seropositive donor were also conducted. Results Five LMV patients (41.6%) developed CMV DNAemia that cleared spontaneously. Four patients (33.3%) developed CMV DNAemia after LMV cessation, of which two required PET. Nine non-LMV patients (69.2%) developed CMV DNAemia (five required PET). The percentage of LMV and non-LMV patients exhibiting detectable CMV-specific T-cell responses was comparable (7/10 vs. 10/13; p = .71). Nevertheless, median CMV-specific CD4+ and CD8+ T-cell counts were lower in LMV patients by days +60 (p = .006 and .02, respectively) and +90 (p = .08 and .02). Ex vivo, CMV-specific CD8+ T cells expanded to the same level either in the presence (19.8%) or in the absence of LMV (20.6%). Conclusions In our series, episodes of CMV DNAemia in LMV patients cleared spontaneously. A diminished degree of CMV-specific T-cell reconstitution in LMV patients compared to non-LMV patients was observed. View on Web

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