Medicine by Sfakianakis Alexandros: 08/04/17

Παρασκευή 4 Αυγούστου 2017

Surveillance of the use of adrenaline auto-injectors in Japanese children

Publication date: Available online 4 August 2017
Source:Allergology International
Author(s): Komei Ito, Manabu Ono, Naoyuki Kando, Teruaki Matsui, Tomoko Nakagawa, Shiro Sugiura, Motohiro Ebisawa
BackgroundThe appropriate usage of an adrenaline auto-injector (AAI, Epipen^®) is a key aspect of patient and social education in the management of anaphylaxis. However, although AAIs are being prescribed increasingly frequently, there are few reports on their actual use.MethodsThe Anaphylaxis Working Group of the Japanese Society of Pediatric Allergy and Clinical Immunology requested that society members register cases in which AAIs were used. Two hundred and sixty-six cases were collected from March 2014 to March 2016.ResultsThe cases included 240 events of immediate-type food allergies caused by cow's milk (n = 100), hen's egg (n = 42), wheat (n = 40), and peanuts (n = 11). Exercise-related events were reported in 19 cases; however, the diagnosis of food-dependent exercise-induced anaphylaxis with a specific causative food was only made in 4 cases (wheat, n = 2; fish, n = 1; squid, n = 1). The frequent reasons for the causative intake included programmed intake (n = 48), failure to check the food labeling (n = 43), and consuming an inappropriate food (n = 26). AAIs were used at schools or nurseries in 67 cases, with school or nursery staff members administering the AAI in 39 cases (58%). On arriving at the hospital, the symptom grade was improved in 71% of the cases, while grade 4 symptoms remained in 20% of the cases. No lethal cases or sequelae were reported.ConclusionsAAIs were used effectively, even by school teachers. The need to visit a hospital after the use of an AAI should be emphasized because additional treatment might be required.

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Influences of microgap and micromotion of implant–abutment interface on marginal bone loss around implant neck

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Yang Liu, Jiawei Wang
ObjectiveTo review the influences and clinical implications of micro-gap and micro-motion of implant-abutment interface on marginal bone loss around the neck of implant.DesignLiteratures were searched based on the following Keywords: implant-abutment interface/implant-abutment connection/implant-abutment conjunction, microgap, micromotion/micromovement, microleakage, and current control methods available. The papers were then screened through titles, abstracts, and full texts.ResultsA total of 83 studies were included in the literature review. Two-piece implant systems are widely used in clinics. However, the production error and masticatory load result in the presence of microgap and micromotion between the implant and the abutment, which directly or indirectly causes microleakage and mechanical damage. Consequently, the degrees of microgap and micromotion further increase, and marginal bone absorption finally occurs. We summarize the influences of microgap and micromotion at the implant-abutment interface on marginal bone loss around the neck of the implant. We also recommend some feasible methods to reduce their effect.ConclusionsClinicians and patients should pay more attention to the mechanisms as well as the control methods of microgap and micromotion. To reduce the corresponding detriment to the implant marginal bone, suitable Morse taper or hybrid connection implants and platform switching abutments should be selected, as well as other potential methods.

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Relationships between chewing rate, occlusion, cephalometric anatomy, muscle activity, and masticatory performance

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Brent A. Fulks, Kathryn X. Callaghan, Claire D. Tewksbury, Geoffrey E. Gerstner
ObjectiveMastication consists of rhythmic jaw openings and closings. Recent studies suggest that muscle mechanical properties determine the rhythmic rate; however, speed-accuracy tradeoffs may also play a role. This study evaluated how variation in chewing rate affected chewing performance, how masticatory muscle activity varied with chewing rate, and whether morphology and demographics contributed to performance.DesignChewing performance and muscle activity were sampled in 23 healthy, fully-dentate adults, who chewed a standardized test food to a metronome set at 0.5, 0.75, 1, 2 and 3 times their 'natural' chewing rates. Subjects produced ten chews per trial, and five trials for each of the five rates. Surface electromyographic (EMG) activity was sampled from masseter and temporalis muscles bilaterally. Demographic, occlusal, and cephalometric data were also obtained.ResultsChewing performance, defined by median particle size, was inversely related to chewing rate; however, performance was not remarkably improved at rates slower than the natural chewing rate. Above the natural chewing rate, variability in EMG bursts diminished, suggesting a reduction in muscle activity modulation at fast rates. Occlusal contacts and most morphological features appeared to play a limited or no role in performance.ConclusionsResults support the hypothesis that the 'natural' chewing rate is selected to be as fast as possible while providing sufficient time to allow EMG modulation for improved performance. The interplay between EMG modulation and individual variation in skeletal morphology is likely critical for optimal chewing performance.

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Salivary microbiome in non-oral disease: A summary of evidence and commentary

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Aneesha Acharya, Yuki Chan, Supriya Kheur, Li Jian Jin, Rory M. Watt, Nikos Mattheos
ObjectiveThe advent of high-throughput sequencing and 'omic' technologies is facilitating an 'open-ended' understanding of the human microbial community and its interplay with health. This commentary aims to present key perspectives and summarize current evidence from metagenomic studies of salivary microbiota in relation to general health and systemic diseases.DesignA narrative review of studies that described salivary microbiome composition in relation to various general health conditions was conducted and the main results were summarized.ResultsCurrently available evidence shows salivary microbial patterns and fingerprints as related to a range of metabolic, autoimmune and immunodeficiency associated conditions, similar to albeit at a far lower scale than similar studies in the gut microbiome.ConclusionsConsidering the relative ease of collection, emerging evidence of association with non-oral diseases may imply that saliva microbiome research may have potential diagnostic or prognostic value.

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Characterization of the clustered regularly interspaced short palindromic repeats sites in Streptococcus mutans isolated from early childhood caries patients

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Jing Chen, Tiancheng Li, Xuedong Zhou, Lei Cheng, Yuanyuan Huo, Jing Zou, Yuqing Li
ObjectiveThe aim of this study was to analyze the characteristics of the clustered regularly interspaced short palindromic repeats (CRISPR) sites in 45 clinical Streptococcus mutans strains and their relationship to the clinical manifestations of early childhood caries (ECC).MethodsForty-five S. mutans strains were isolated from the plaque samples taken from sixty-three children. CRISPR sites were sequenced and BLAST was used to compare these sites to those in the CRISPRTarget database. The association between the distribution of CRISPR sites and the manifestation of caries was analyzed by Chi-Square test. Further, biofilm formation (by crystal violet staining) and the synthesis of polysaccharide (by anthrone-sulfuric method) of all clinical isolated S. mutans strains with both CRISPR sites and no CRISPR site were comapared. Finally, acidogenicity and acidurity of two typical strains were determined using pH drop and acid tolerance assays. Biofilm formation and EPS synthesis by two typical strains were compared by 3D CLSM (Confocal Laser Scanning Microscope) assays and the expression of gtf genes were evaluated using qPCR.ResultsWe found that most of the spacers in the clinical S. mutans strains were derived from Streptococcus phages APCM01 and M102. The number of CRISPR sites in these strains was associated with the clinical manifestations of ECC. Moreover, we found that the biofilm formation and EPS synthesis ability of the S. mutans strains with both CRISPR sites was significant improved.ConclusionsAn association was found between the distribution of CRISPR sites and the clinical manifestations of caries. The CRISPR sites might contribute to the cariogenic potential of S. mutans.

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Extracellular HSP72 induces proinflammatory cytokines in human periodontal ligament fibroblast cells through the TLR4/NFκB pathway in vitro

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Chihiro Arai, Yoshiaki Nomura, Masazumi Matsuzawa, Nobuhiro Hanada, Yoshiki Nakamura
ObjectiveThe aim of the present study was to examine the effect of extracellular heat shock protein (HSP) 72 on human periodontal ligament fibroblast cells (hPDLFs) in vitro.DesignhPDLFs were stimulated by recombinant human HSP72 (rhHSP72). TAK-242 was used to inhibit toll-like receptor 4 (TLR4) activity. Interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-α mRNA levels were analyzed by real-time PCR and protein levels were analyzed by enzyme-linked immunosorbent assay. p65/RelA phosphorylation was analyzed by western blot.ResultsIL-6, IL-8 and TNF-α mRNA and protein levels were significantly increased by rhHSP72 stimulation. These effects were inhibited by TAK-242 treatment. Additionally, p65/RelA phosphorylation was increased after 5-min rhHSP72 stimulation, which was inhibited by TAK-242 treatment.ConclusionExtracellular HSP72 induces proinflammatory cytokines through TLR4/NF-κB in hPDLFs.

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„Ökonomische Kennziffern verdrängen unsere ethischen Grundsätze“

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Nicht mehr Blutungen durch Ibuprofen nach Tonsillektomie

Die postoperative Schmerzkontrolle mit Ibuprofen nach einer Tonsillektomie steigert bei pädiatrischen Patienten nicht das Risiko für Blutungen. Wenn es allerdings blutet, fallen die Hämorrhagien oft heftiger aus, wie eine US-Studie ergeben hat.

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Kooperation bietet allen mehr Chancen als Nachteile

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Verschmäht und weggepackt

Nicht sehen trennt von den Dingen, nicht hören trennt von den Menschen — dieser Satz wird oft zitiert, wenn es um die Schwächen der menschlichen Sinne geht. Da verwundert es, wie unterschiedlich beliebt Seh- und Hörhilfen bei Menschen sind, die sie benötigen. Denn während die Brille als modisches Accessoire durchgeht, fristet das Hörgerät nicht selten ein verschämtes Dasein im Verborgenen.

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Rezidiv bei Kopf-Hals-Tumoren: SBRT mit Langzeitschäden?

Bei lokal rezidivierten, zuvor bestrahlten Kopf-Hals-Tumoren, die für eine Salvage-Operation ungeeignet sind, hat sich die Körperstereotaxie (SBRT) als effizient erwiesen. Doch wie steht es mit der Langzeittoxizität?

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Sensibilisierung gegen Katze und Hund erhöht Asthmarisiko deutlich

Wie stark sind Sensibilisierungen gegen Katzen- und Hunde-Epithelien mit Asthmasymptomen assoziiert? Bisher konnte der Zusammenhang nicht quantifiziert werden. Eine Studie aus einer milben- und schimmelpilzfreien Gegend liefert jetzt Daten.

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Gesundheitspolitik im Wahlkampf: Alles wie gehabt

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Hörstörung und kognitiver Abbau im Alter

Mit zunehmendem Alter treten zum einen vermehrt Hörstörungen auf, zum anderen unterliegen auch verschiedene kognitive Funktionen einem altersassoziierten Abbau. Aktuelle wissenschaftliche Studien untersuchen mögliche Zusammenhänge zwischen Hörvermögen und kognitiven Fähigkeiten und Konsequenzen für die lautsprachliche Kommunikation im Alter.

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So viel verdienen niedergelassene Ärzte

Trotz steigender Betriebskosten: Die wirtschaftliche Lage in den Vertragsarztpraxen hat sich zwischen den Jahren 2011 und 2014 merklich verbessert. Die Einnahmen je Inhaber stiegen um 10,2 %, der Jahresüberschuss — also der Gewinn — um 6,7 %, während die Praxiskosten um 8,9 % zulegten. Das zeigen die Daten des Zi-Praxis-Panels (ZiPP), die aus über 5.000 Praxen generiert wurden.

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Haben Sie auch eine fachliche Frage?

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Chronische Rhinosinusitis: erhöhte Revisionsrate nach Sinus-Op bei Polypennachweis

Kanadische Ärzte um Dr. Luke Rudmik von der Universität von Calgary sind in einer retrospektiven Studie der Frage nachgegangen, wie sich bei Patienten mit chronischer Rhinosinusitis die Ergebnisse einer endoskopischen Sinus-Chirurgie (ESS, endoscopic sinus surgery) durch Ärzte an Kliniken in Alberta unterscheiden. Primärer Studienendpunkt war die Revisionsrate fünf Jahre nach dem Eingriff.

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M. Menière: intratympanale Gabe von Methylprednisolon so wirksam wie Gentamicin

Ein klassischer Therapieansatz bei Morbus Menière ist die intratympanale Gabe von Gentamicin. Dies führt dosisabhängig zu einem Untergang der vestibulären Rezeptoren und damit zu einem Ausfall der vestibulären Funktionen. Bei etwa 20 % der so behandelten Patienten kommt es auch zu einer Hörminderung oder sogar zu einem Hörverlust. Daher ist es dringend notwendig, andere Therapien zu entwickeln, bei denen die vestibulären Funktionen intakt bleiben und insbesondere kein Risiko für eine Hörminderung besteht.

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Hilft Kortison gegen die ototoxische Wirkung von Cisplatin?

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Wege zu einer barrierefreien Kommunikation

Barrierefreiheit ist nicht nur wichtig für Personen mit körperlichen Einschränkungen, sondern auch für Menschen mit Sinneseinschränkungen wie z.B. beim Vorliegen einer Schwerhörigkeit. Im Folgenden wird aufgezeigt, warum Hörassistenzsysteme notwendig sind und wie eine barrierefreie Kommunikation mit technischen Hörassistenzsystemen erschlossen werden kann.

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Inhaltsverzeichnis

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Todmüde ans Steuer?

Wer an Schlafapnoe leidet, hat nicht nur ein erhöhtes Risiko für Herz-Kreislauf-Erkrankungen, sondern auch ein höheres Unfallrisiko. Denn schwere Tagesschläfrigkeit und der berühmte Sekundenschlaf am Steuer sind Ursache vieler schwerer Verkehrsunfälle. Wie steht es also um die Fahreignung bei schlafbezogenen Atmungsstörungen?

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Viele Ärzte reagieren allergisch auf „Dr. Google“

Erst die Symptome googeln, dann zum Doktor: Immer mehr Patienten kommen derart vorinformiert in die Praxis. Viele Ärzte erachten diese Selbstdiagnostik aber als problematisch.

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Ärztebashing 130 Jahre vor Jameda & Co.

„Nun merkt auf, wie eine simple Geschichte Euch zu nichte macht". Dieses Zitat aus Shakespeares Heinrich IV hat Morell Mackenzie 1888 seiner Verteidigungsschrift zu seiner Rolle bei der Behandlung von Kaiser Friederich III vorangestellt. Er war tief gekränkt von den Unterstellungen und Verleumdungen in der Presse. Wäre Mackenzie heute ein Fall im Bewertungsportal Jameda? Dass auch ein gutmeinender Arzt an der Kritik in den Medien zerbrechen kann, galt gestern wie heute.

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Finanzielle Fördermittel sollen motivieren

Der Ausbau einer reibungslosen sektorübergreifenden Versorgung dürfte eines der großen Themen für das Gesundheitswesen in der nächsten Legislaturperiode werden. Niedergelassene Ärzte profitieren, wenn sie sich schon heute auf mögliche Änderungen einstellen.

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Einfach mal skypen ist nicht erlaubt

Seit April können Ärzte Videosprechstunden als EBM-Leistung über ihre KV abrechnen. Allerdings nur, wenn die Kommunikationsdienste, die sie hierfür nutzen, strenge technische Voraussetzungen erfüllen. Und genau das hat noch einen Haken: Noch gibt es auf dem Markt nur eine überschaubare Zahl von Videodiensten, die das leisten.

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The theory of autoimmunity in Meniere’s disease is lacking evidence

The role of immunological factors in the pathophysiology of Meniere's disease (MD) has been hypothesized. In order to evaluate the current level of evidence on autoimmunity in MD, original articles relevant to the matter (1970–2016) were reviewed. The following has been considered to support the theory of autoimmunity in MD (1) the increased prevalence of autoimmune diseases among MD patients, (2) the elevated levels of antibodies and immunocomplexes in MD patients, (3) the association of MD with HLA-types and genetic polymorphisms and (4) the positive corticosteroid-responsiveness detected in some MD patients.

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Trends in dermatology practices and the implications for the workforce

The American Academy of Dermatology (AAD) practice profile surveys have been conducted for more than a decade to gauge trends in our workforce supply and demand.

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Cleaved kininogen as a biomarker for bradykinin release in hereditary angioedema

Publication date: Available online 4 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Zonne L.M. Hofman, Steven de Maat, Chiara Suffritti, Andrea Zanichelli, Cassandra van Doorn, Silvie A.E. Sebastian, Nora Veszeli, Dorottya Csuka, Thomas Renné, Gerard Pasterkamp, Marco Cicardi, Henriette Farkas, C. Erik Hack, Coen Maas

Teaser

Cleaved high-molecular weight kininogen (cHK) in plasma is a biomarker for bradykinin formation. We developed an immuno-assay to detect cHK in plasma. cHK plasma levels are increased in asymptomatic C1-INH-HAE patients, and increase further during angioedema attacks.

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A new allergen family involved in pollen food associated syndrome: snakin/gibberellin regulated proteins

Publication date: Available online 4 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hélène Sénéchal, Jiří Šantrůček, Magdalena Melčová, Petr Svoboda, Jarmila Zídková, Denis Charpin, Laurence Guilloux, Youcef Shahali, Marie-Ange Selva, Rémy Couderc, Tomoyasu Aizawa, Pascal Poncet

Teaser

At least two pollen food associated syndromes were described with cypress pollen allergy involving peach and citrus. Snakin/gibberellin regulated proteins are described herein to be the cross-reactive allergens between Cupressus sempervirens pollen and fruit/vegetables.

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Plasma cell deficiency in humans with heterozygous mutations in SEC61A1

Publication date: Available online 4 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Desirée Schubert, Marie-Christine Klein, Sarah Hassdenteufel, Andrés Caballero-Oteyza, Linlin Yang, Michele Proietti, Alla Bulashevska, Janine Kemming, Johannes Kühn, Sandra Winzer, Stephan Rusch, Manfred Fliegauf, Alejandro A. Schäffer, Stefan Pfeffer, Roger Geiger, Adolfo Cavalié, Hongzhi Cao, Fang Yang, Yong Li, Marta Rizzi, Hermann Eibel, Robin Kobbe, Amy L. Marks, Brian P. Peppers, Robert W. Hostoffer, Jennifer M. Puck, Richard Zimmermann, Bodo Grimbacher
BackgroundPrimary antibody deficiencies (PAD) are the most frequent primary immunodeficiencies in humans. The genetic causes for PADs are largely unknown. Sec61 translocon alpha 1 subunit (SEC61A1) is the major subunit of the Sec61 complex, which is the main polypeptide-conducting channel in the endoplasmic reticulum (ER) membrane. SEC61A1 is a target gene of XBP1s and strongly induced during plasma cell differentiation.ObjectiveCharacterization of a novel genetic defect and its pathological mechanism in eleven patients from two unrelated families with PAD.MethodsWhole exome sequencing (WES) and targeted sequencing were conducted to identify novel genetic mutations. Functional studies were carried out ex vivo in primary cells of patients and in vitro in different cell lines to assess the effect of SEC61A1 mutations on B cell differentiation and survival.ResultsWe investigated two families with patients suffering from hypogammaglobulinemia, severe recurrent respiratory tract infections and normal peripheral B- and T cell subpopulations. Upon in vitro stimulation, B cells showed an intrinsic deficiency to develop into plasma cells (PCs). Genetic analysis and targeted sequencing identified novel heterozygous missense (c.254T>A, p.V85D) and nonsense (c.1325G>T, p.E381*) mutations in SEC61A1, segregating with the disease phenotype. SEC61A1-V85D was deficient in co-translational protein translocation and it disturbed the cellular calcium homeostasis in HeLa cells. Moreover, SEC61A1-V85D triggered the terminal unfolded protein response (UPR) in multiple myeloma (MM) cell lines.ConclusionWe describe a monogenic defect leading to a specific plasma cell deficiency in humans, expanding our knowledge about the pathogenesis of antibody deficiencies.

Teaser

Heterozygous mutations in SEC61A1 are associated with plasma cell deficiency in patients with early-onset hypogammaglobulinemia and severe, recurrent respiratory tract infections but with normal B cell subpopulations in the peripheral blood.

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CDHR3 gene variation and childhood bronchiolitis

Publication date: Available online 4 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): A. Husby, A. Pasanen, J. Waage, A. Sevelsted, H. Hodemaekers, R. Janssen, M.K. Karjalainen, J. Stokholm, B.L. Chawes, M. Korppi, G. Wennergren, A. Heinzmann, L. Bont, H. Bisgaard, K. Bønnelykke

Teaser

This genetic study combining data from five countries shows that the CDHR3 rs6967330 polymorphism is not associated to bronchiolitis triggered by RSV but might increase risk of bronchiolitis triggered by other infectious agents.

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Blocking Bcl-2 resolves IL-13–mediated mucous cell hyperplasia in a Bik-dependent manner

Publication date: Available online 4 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hitendra S. Chand, Yohannes A. Mebratu, Philip J. Kuehl, Yohannes Tesfaigzi

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Congenital cystic adenomatoid malformation – dangers of misdiagnosis: a case report

Congenital cystic adenomatoid malformation is a rare pulmonary malformation, but is the most common lung malformation observed in children. In developing countries, such as Morocco, prenatal diagnosis is missi...

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Inside EMS Podcast: Why does skill degradation happen in EMS?

Download this podcast on iTunes, SoundCloud or via RSS feed In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss the topic of skill degradation. The debate ranges from it being secondary to a lack of confidence, poor core knowledge, or is it really because of not using the skill" They also give some tips on how to keep your skills sharp. And after listening make ...

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Effect of Radiofrequency on DNA Damage and Oxidative Status in Patients with Turbinate Hypertrophy

Abstract

The radiofrequency devices that are used generate radiofrequency in the frequency range of 1.5 and 2.5 MHz. This study aims to demonstrate whether systematic oxidative status and DNA are influenced in this frequency range. In study, 27 patients who received radiofrequency treatment on inferior turbinate as they were diagnosed with inferior turbinate hypertrophy. DNA damage was assessed by alkaline comet assay in peripheral lymphocyte cells. Plasma levels of total antioxidant status (TAS), total oxidative status (TOS) were determined by using an automated measurement method and oxidative stress index (OSI) was calculated (OSI was calculated as: OSI = (TOS/TAS) × 100). There were increased in the OSI and TOS values on days 1 and 15 as compared to the samples taken before the radiofrequency administration. Significant decreases were seen in TAS values on days 1 and 15. As for the DNA damage, no significant differences were found on day 15 compared to the preoperative values even though there was a statistically insignificant increase on day 1. Administration of radiofrequency radiation on inferior turbinates results in increased oxidative stress in the acute period and a decrease in the anti-oxidative system. Although this effect causes a slight increase in the DNA damage in the early post-operative period, the damage is restored to the pre-operative levels on day 15. Therefore, we believe that a more conservative approach should be selected for radiofrequency treatment instead of using it routinely.

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Kritische Bemerkungen zu den neuen diagnostischen Kriterien des M. Menière

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Effect of Radiofrequency on DNA Damage and Oxidative Status in Patients with Turbinate Hypertrophy

Abstract

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Diagnostik kutaner Lymphome

Zusammenfassung

Die Diagnose eines primär kutanen Lymphoms kann bei passenden klinischen Befunden, passender Histologie, Immunhistologie und molekularbiologischen Veränderungen sowohl bei einem primär kutanen B‑Zell-Lymphom als auch einem primär kutanen T‑Zell-Lymphom sichergestellt werden. Bei vielen primär kutanen Lymphompatienten sind jedoch gerade zu einem frühen Zeitpunkt nicht alle Auffälligkeiten gegeben und stellen deshalb im klinischen Alltag immer wieder eine Herausforderung dar. Dies gilt insbesondere für das Sézary-Syndrom, das initial Schwierigkeiten bereiten kann in der Abgrenzung zu einer reaktiven Erythrodermie. Der Schwerpunkt dieser Übersichtsarbeit wird deshalb die Problematik der Diagnosestellung bei einem Sézary-Syndrom beschreiben. Es wird im Detail die klinische Heterogenität des Sézary-Syndroms beleuchtet, und dann werden die typischen histologischen und immunhistologischen Kriterien zur Diagnosestellung eines Sézary-Syndroms benannt. Hier werden auch aktuelle Ergebnisse von multizentrischen, internationalen Studien der Cutaneous Lymphoma Task Force der EORTC (European Organisation for Research and Treatment of Cancer) zu dermatopathologischen Veränderungen in der Haut sowie dem Nachweis von Sézary-Zellen im Blut erläutert. Der Nachweis von Sézary-Zellen im Blut stellt auch aktuell – trotz verbesserter molekularbiologischer und zytogenetischer Charakterisierungen der Tumorzellen – eine Herausforderung dar. Hier zeigten die neuen Studien, dass unterschiedliche Marker, die aktuell noch nicht zur Standarddiagnostik eines Sézary-Syndroms gehören (CD158k, MYC, MNT, DNM, TWIST1, EPHA4 und PLS3), vielversprechend sind in der Differenzierung zu einer reaktiven Erythrodermie. Die Zukunft wird zeigen, inwieweit diese neuen Erkenntnisse im klinischen Alltag implementiert werden.

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Complementary and Alternative Medicine and Their Effect on Global Health

By Nathan Douthit

According to the World Health Organization (WHO), the use of complementary and alternative medicine (CAM) is on the rise. The US National Institute of Health defines complementary medicine as non-mainstream, non-western practice used together with conventional medicine, whereas alternative medicine is defined as the same used instead of conventional medicine. The WHO also offers a definition of traditional medicine (TM) as

"the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness"

Globally, TM and CAM are much more accessible to patients than conventional medicine. Therefore the WHO strategy for TM and CAM revolves around research into these alternative techniques as well as education and training for their practice. However, recent years have seen a surge in popularity for CAM in western countries as well, with many being willing to pay out of pocket for these treatments. Integration of these practices into national health systems can allow them to be regulated and safely practiced along with conventional medicine for the best possible outcomes.

Unfortunately, the case report "Consequences of delivery at home in a woman without prenatal care" by Kumar et al reveals the danger associated with lack of education, training and regulation. We are told,

"The patient denied having any allopathic prenatal care during the current pregnancy. She denied having gestational diabetes testing, blood work or detailed ultrasonography, but she stated that she had undergone regular Doppler and bedside ultrasound scans by her midwife."

Despite having had three prior caesarean sections, the woman chose a direct entry midwife, defined as follows.

"Direct entry midwives are defined as independent practitioners educated in midwifery through self-study, apprenticeship, a mid- wifery school or a university-based programme…. In the USA, licensure and training varies per state, with ∼50% of states not requiring licensure for direct entry midwives. Most patients are unaware of the difference between [direct entry and certified nurse midwives] and may not receive the necessary guidance to choose the appropriate provider for their needs."

This patient's past medical history puts her at increased risk, and her poor outcome is the result of lack of education, regulation and information in this alternative delivery.

BMJ Case Reports invites authors to publish cases regarding the effects both positive and negative of complementary and alternative medicine. Global health case reports can emphasize:

-Successful integration of CAM into national health systems

-Research on CAM that has proved useful in patient care

-Partnerships between practitioners of CAM and practitioners of conventional medicine that have improved patient outcomes

-Use of CAM causing delays in care, inappropriate care or worsening of patient outcomes.

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Clinical Evaluation of the OncAlert RAPID in Subjects Presenting for Evaluation and/or Initial Biopsy; Impact on Decision-Making

Conditions: Palatal Neoplasms; Lip Neoplasm; Gingival Neoplasms; Leukoplakia, Oral; Tongue Neoplasms; Oropharyngeal Neoplasms; Oral Ulcer
Intervention: Device: OncAlert
Sponsors: Vigilant Biosciences, Inc.; Pearl Pathways
Recruiting - verified May 2017

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Colonic-type Adenocarcinoma of the Tongue and Oral Cavity (CATOC)

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Occupational Argyria of the Nasal Mucosa

Abstract

A biopsy specimen from the nasal mucosa of a 37-year-old man disclosed a subepithelial accumulation of black granules mainly running parallel to the surface in the absence of any inflammatory infiltrate. Since the mucosal pigment was negative with Perls' stain and resisted to melanin bleach, an exogenous pigmentation was suspected. The biopsy specimen had been taken because of a diffuse steel-blue pigmentation of the nasal mucosa, incidentally discovered during routine clinical examination. A diagnosis of occupational argyria of the nasal mucosa was finally made since the patient was a silver cleaner. Argyria is a rare cause of nasopharyngeal mucosal pigmentation; it is not a precancerous condition, but it can be mistaken for a melanosis or a melanocytic tumor both clinically and histopathologically. Clinicopathological correlation is mandatory, since the final diagnosis is based on a history of chronic silver exposure.

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Issue Information - TOC

No abstract is available for this article.

http://ift.tt/2vzoFDO

Issue Information - Journal Info page

No abstract is available for this article.

http://ift.tt/2hubWfm

Topical therapies in the management of chronic rhinosinusitis

http://ift.tt/2ualqm4

Issue Information

http://ift.tt/2uqzdQP

Colonic-type Adenocarcinoma of the Tongue and Oral Cavity (CATOC)

http://ift.tt/2urgS64

Occupational Argyria of the Nasal Mucosa

Abstract

http://ift.tt/2uaKmKk

Correlation between E-cadherin and p120 expression in invasive ductal breast cancer with a lobular component and MRI findings

Abstract

Invasive breast cancer comprises a spectrum of histological changes with purely lobular cancer on one side and purely ductal cancer on the other, with many mixed lesions in between. In a previous study, we showed that in patients with any percentage lobular component at core needle biopsy, preoperative MRI leads to the detection of clinically relevant additional findings in a substantial percentage of patients, irrespective of the percentage of the lobular component. Detection of a small lobular component may however not be reproducible among pathologists. Loss of membrane expression of E-cadherin or p120 is useful biomarkers of ILC and may therefore support a more objective diagnosis. All patients diagnosed with breast cancer containing a lobular component of any percentage between January 2008 and October 2012 were prospectively offered preoperative MRI. Clinically relevant additional findings on MRI were verified by pathology evaluation. Expression patterns of E-cadherin and p120 were evaluated by immunohistochemistry on the core needle biopsy. MRI was performed in 109 patients. The percentage of lobular component was significantly increased in cases with aberrant E-cadherin or p120 expression (both p = <0.001). However, aberrant expression of E-cadherin and p120 was not related to the probability of detecting relevant additional MRI findings. E-cadherin and p120 did not appear to be useful objective biomarkers for predicting additional relevant findings on MRI in patients with a lobular component in the core needle of their breast cancer.

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In reference to “The transotic approach for vestibular schwannoma: indications and results”

http://ift.tt/2uarwmg

Colonic-type Adenocarcinoma of the Tongue and Oral Cavity (CATOC)

http://ift.tt/2urgS64

Occupational Argyria of the Nasal Mucosa

Abstract

http://ift.tt/2uaKmKk

Endoscopic observation of different repair patterns in human traumatic tympanic membrane perforations

Publication date: Available online 3 August 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Peng Huang, Shujun Zhang, Xinhong Gong, Xuesong Wang, Zi-Han Lou
IntroductionIn the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic.ObjectiveThis study evaluated the healing response for different repair patterns in human traumatic tympanic membrane perforations by endoscopic observation.MethodsIn total, 114 patients with traumatic tympanic membrane perforations were allocated sequentially to two groups: the spontaneous healing group (n=57) and Gelfoam patch-treated group (n=57). The closure rate, closure time, and rate of otorrhea were compared between the groups at 3 months.ResultsUltimately, 107 patients were analyzed in the two groups (52 patients in the spontaneous healing group vs. 55 patients in the Gelfoam patch-treated group). The overall closure rate at the end of the 3 month follow-up period was 90.4% in the spontaneous healing group and 94.5% in the Gelfoam patch-treated group; the difference was not statistically significant (p>0.05). However, the total average closure time was significantly different between the two groups (26.8±9.1 days in the spontaneous healing group vs. 14.7±9.1 days in the Gelfoam patch-treated group, p<0.01). In addition, the closure rate was not significantly different between the spontaneous healing group and Gelfoam patch-treated group regardless of the perforation size. The closure time in the Gelfoam patch-treated group was significantly shorter than that in the spontaneous healing group regardless of the perforation size (small perforations: 7.1±1.6 days vs. 12.6±3.9, medium-sized perforations: 13.3±2.2 days vs. 21.8±4.2 days, and large perforations: 21.2±4.7 days vs. 38.4±5.7 days; p<0.01).ConclusionIn the regeneration of traumatic tympanic membrane perforations, Gelfoam patching not only plays a scaffolding role for epithelial migration, it also promotes edema and hyperplasia of granulation tissue at the edges of the perforation and accelerates eardrum healing.

http://ift.tt/2wdSHu2

Alternative technique or mitigating strategy for sevoflurane-induced neurodegeneration: a randomized controlled dose-escalation study of dexmedetomidine in neonatal rats

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Abstract

Background. Brain injury in newborn animals from prolonged anaesthetic exposure has raised concerns for millions of children undergoing anaesthesia every yr. Alternative anaesthetic techniques or mitigating strategies are urgently needed to ameliorate potentially harmful effects. We tested dexmedetomidine, both as a single agent alternative technique and as a mitigating adjuvant for sevoflurane anaesthesia.Methods. Neonatal rats were randomized to three injections of dexmedetomidine (5, 25, 50, or 100 µg kg⁻¹ every 2 h), or 6 h of 2.5% sevoflurane as a single agent without or with dexmedetomidine (1, 5, 10, or 20 µg kg⁻¹ every 2 h). Heart rate, oxygen saturation, level of consciousness, and response to pain were assessed. Cell death was quantified in several brain regions.Results. Dexmedetomidine provided lower levels of sedation and pain control than sevoflurane. Exposure to either sevoflurane or dexmedetomidine alone did not cause mortality, but the combination of 2.5% sevoflurane and dexmedetomidine in doses exceeding 1 µg kg⁻¹ did. Sevoflurane increased apoptosis in all brain regions; supplementation with dexmedetomidine exacerbated neuronal injury, potentially as a result of ventilatory or haemodynamic compromise. Dexmedetomidine by itself increased apoptosis only in CA2/3 and the ventral posterior nucleus, but not in prefrontal cortex, retrosplenial cortex, somatosensory cortex, subiculum, lateral dorsal thalamic nucleaus, or hippocampal CA1.Conclusions. We confirm previous findings of sevoflurane-induced neuronal injury. Dexmedetomidine, even in the highest dose, did not cause similar injury, but provided lesser degrees of anaesthesia and pain control. No mitigation of sevoflurane-induced injury was observed with dexmedetomidine supplementation, suggesting that future studies should focus on anaesthetic-sparing effects of dexmedetomidine, rather than injury-preventing effects.

http://ift.tt/2htSuzF

A comparison of tracheal scaffold strategies for pediatric transplantation in a rabbit model

Objectives/Hypothesis

Despite surgical advances, childhood tracheal stenosis is associated with high morbidity and mortality. Various tracheal scaffold strategies have been developed as the basis for bioengineered substitutes, but there is no consensus on which may be superior in vivo. We hypothesized that there would be no difference in morbidity and mortality between three competing scaffold strategies in rabbits.

Study Design

Pilot preclinical study.

Methods

Tracheal scaffolds were prepared by three methods that have been applied clinically and reported: preserved cadaveric ("Herberhold") allografts, detergent-enzymatically decellularized allografts, and synthetic scaffolds (nanocomposite polymer [polyhedral oligomeric silsesquioxane poly(carbonate-urea) urethane (POSS-PCU)]). Scaffolds were implanted into cervical trachea of New Zealand White rabbits (n = 4 per group) without cell seeding. Control animals (n = 4) received autotransplanted tracheal segments using the same technique. Animals underwent bronchoscopic monitoring of the grafts for 30 days. Macroscopic evaluation of tissue integration, graft stenosis, and collapsibility and histological examinations were performed on explants at termination.

Results

All surgical controls survived to termination without airway compromise. Mild to moderate anastomotic stenosis from granulation tissue was detected, but there was evidence suggestive of vascular reconnection with minimal fibrous encapsulation. In contrast, three of the four animals in the Herberhold and POSS-PCU groups, and all animals receiving decellularized allografts, required early termination due to respiratory distress. Herberhold grafts showed intense inflammatory reactions, anastomotic stenoses, and mucus plugging. Synthetic graft integration and vascularization were poor, whereas decellularized grafts demonstrated malacia and collapse but had features suggestive of vascular connection or revascularization.

Conclusions

There are mirror-image benefits and drawbacks to nonrecellularized, decellularized, and synthetic grafts, such that none emerged as the preferred option. Results from prevascularized and/or cell-seeded grafts (as applied clinically) may elucidate clearer advantages of one scaffold type over another.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2uaOJoF

Cost-effectiveness of pediatric bilateral cochlear implantation in Spain

Objectives/Hypothesis

To determine the incremental cost-effectiveness of bilateral versus unilateral cochlear implantation for 1-year-old children suffering from bilateral sensorineural severe to profound hearing loss from the perspective of the Spanish public health system.

Study Design

Cost-utility analysis.

Methods

We conducted a general-population survey to estimate the quality-of-life increase contributed by the second implant. We built a Markov influence diagram and evaluated it for a life-long time horizon with a 3% discount rate in the base case.

Results

The incremental cost-effectiveness ratio of simultaneous bilateral implantation with respect to unilateral implantation for 1-year-old children with severe to profound deafness is €10,323 per quality-adjusted life year (QALY). For sequential bilateral implantation, it rises to €11,733/QALY. Both options are cost-effective for the Spanish health system, whose willingness to pay is estimated at around €30,000/QALY. The probabilistic sensitivity analysis shows that the probability of bilateral implantation being cost-effective reaches 100% for that cost-effectiveness threshold.

Conclusions

Bilateral implantation is clearly cost-effective for the population considered. If possible, it should be done simultaneously (i.e., in one surgical operation), because it is as safe and effective as sequential implantation, and saves costs for the system and for users and their families. Sequential implantation is also cost-effective for children who have received the first implant recently, but it is difficult to determine when it ceases to be so because of the lack of detailed data. These results are specific for Spain, but the model can easily be adapted to other countries.

Level of Evidence

2C. Laryngoscope, 2017

http://ift.tt/2uqRQnn

Contralateral R1 and R2 components of the laryngeal adductor reflex in humans under general anesthesia

Objectives

To demonstrate that under total intravenous general anesthesia (TIVA), the contralateral R1 (cRI) and contralateral R2 (cR2) components of the laryngeal adductor reflex (LAR) can be reliably elicited; to determine effects of topical anesthesia and inhalational anesthesia on the LAR; and to discuss how this technique may be utilized to continuously monitor the vagus nerve reflex arc.

Study Design

Case series.

Methods

Vocal fold mucosa was electrically stimulated via endotracheal tube surface-based electrodes to elicit a LAR. Responses were recorded using the endotracheal tube electrode contralateral to the simulating electrode for each side.

Results

Twenty-one patients (31 nerves at risk), aged between 28 to 84 years, who underwent thyroid and cervical spine surgeries (4 males, 17 females) were included. cR1 responses were reliably elicited in all patients, and cR2 responses were obtained in 14 patients (66.6%). Mean cR1 latencies ± standard deviation were 22.5 ± 2.5 milliseconds (ms) (left) and 23.4 ± 3.3 ms (right). Mean cR1 amplitudes were 237.9 ± 153.9 microvolts (uV) (left) and 265.0 ± 226.5 uV (right). Mean R2 latencies were 59.8 ± 4.9 ms (left) and 61.8 ± 7.9 ms (right). Intraoperative reversible cR1 amplitude decreases correlated temporally with surgical maneuvers stretching or compressing the RLN or internal branch of the superior laryngeal nerve (iSLN). Inhalational anesthetic agents abolished cR2 and minimized cR1 at mean alveolar concentrations > 0.5. Topical lidocaine significantly reduced LAR amplitude.

Conclusion

LAR cR1 and cR2 responses are present in humans under TIVA and may afford some airway protection against aspiration under anesthesia. They are inhibited by inhalational anesthetics and topical lidocaine. Continuous intraoperative iSLN and RLN monitoring are possible using surface-based endotracheal tube electrodes alone to stimulate and record cR1 responses.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2u9XFe1

Analysis of factors associated with electing endoscopic sinus surgery

Objective

Medically refractory chronic rhinosinusitis (CRS) can be managed with appropriate continued medical therapy (CMT) or surgery followed by CMT. Patients who initially elect CMT and do not experience adequate symptom resolution may "cross over" to endoscopic sinus surgery (ESS). Our objective was to identify patient covariates associated with this subset of patients who elect this change in treatment modality.

Study Design

Retrospective analysis of a prospective, multi-center cohort of adult patients with CRS enrolled between March 2011 and June 2015 in academic, tertiary referral clinics.

Methods

Subjects who initially elected CMT were followed up to 18 months, provided a comprehensive medical history, and completed the 22-item SinoNasal Outcome Test (SNOT-22) at baseline and during 6-month follow-up intervals. Hazard regression modeling was used to identify covariates associated with elective change in treatment modality.

Results

One hundred seventy-nine subjects were followed for an average 15.1 (standard deviation ± 4.6) months. Subjects who elected ESS (55 of 179) had significantly worse average endoscopy scores and reported worse SNOT-22 sleep dysfunction scores at baseline (P ≤ 0.026). For each single increasing (worsening) point of Lund-Kennedy endoscopy score, the hazard ratio (HR) of crossover increased by ∼6%. Similarly, for every point of worsening in baseline SNOT-22 total score, the hazard of treatment crossover increased by ∼2%. After covariate adjustment, only baseline SNOT-22 sleep dysfunction scores were associated with an increased risk of treatment crossover (HR = 1.07; 95% confidence interval: 1.02–1.11; P = 0.003).

Conclusion

Baseline total SNOT-22 and endoscopy scores are associated with treatment crossover, but reported sleep dysfunction is the only significant independent predictor of treatment crossover.

Level of Evidence

2c. Laryngoscope, 2017

http://ift.tt/2uqqKgd

Relating quality of life to outcomes and predictors in adult cochlear implant users: Are we measuring the right things?

Objective

Current clinical outcome measures for adults receiving cochlear implants (CIs) consist of word and sentence recognition, primarily under quiet conditions. However, these measures may not adequately reflect patients' CI-specific quality of life (QOL). This study first examined traditional auditory-only speech recognition measures and other potentially relevant auditory measures as correlates of QOL in CI users. Second, scores on nonauditory tasks of language and cognition were examined as potential predictors of QOL.

Study Design

Twenty-five postlingually deafened adults with CIs were assessed.

Methods

Participants completed a validated CI-specific QOL measure (the Nijmegen Cochlear Implant Questionnaire) and were tested for word and sentence recognition in quiet, as well as sentence recognition in speech-shaped noise. Participants also completed assessments of audiovisual speech recognition, environmental sound identification, and a task of complex auditory verbal processing. Several nonauditory language and cognitive tasks were examined as potential predictors of QOL.

Results

Quality-of-life scores significantly correlated with scores for audiovisual speech recognition and recognition of complex sentences in quiet but not sentences in noise or isolated words. No significant correlations were obtained between QOL and environmental sound identification or complex auditory verbal processing. Quality-of-life subdomain scores were predicted by several nonauditory language and cognitive tasks as well as some patient characteristics.

Conclusion

Postoperative measures of recognition of sentences in quiet and audiovisual sentence recognition correlate with CI-related QOL. Findings suggest that sentence recognition tasks are QOL-relevant outcomes but only explain a small fraction of the variability in QOL outcomes for this patient population.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2uazpbt

Three-dimensionally printed polyetherketoneketone scaffolds with mesenchymal stem cells for the reconstruction of critical-sized mandibular defects

Objective

Additive manufacturing offers a tailored approach to tissue engineering by providing anatomically precise scaffolds onto which stem cells and growth factors can be supplied. Polyetherketoneketone (PEKK), an ideal candidate biomaterial, is limited by a poor implant–bone interface but can be functionalized with adipose-derived stem cells (ADSC) to promote integration. This in vivo study examined the interaction of a three-dimensional printed PEKK/ADSC implant within the critical-sized mandibular defect in a rabbit model.

Study Design/Methods

Trapezoidal porous scaffolds with dimensions of 1.5 × 1.0 × 0.5 cm were printed using selective laser sintering. ADSCs were seeded on the scaffolds that were then implanted in marginal defects created in New Zealand rabbits. Rabbits were euthanized at 10- and 20-week intervals. Microcomputed tomography was used to characterize bone ingrowth and was correlated with histological analysis. Stress testing was performed on the scaffolds before and after implantation.

Results

All scaffolds were well integrated into adjacent bone. Bone-to-tissue volume increased from 30.34% ( ± 12.46) to 61.27% ( ± 8.24), and trabecular thickness increased from 0.178 mm ( ± 0.069) to 0.331 mm ( ± 0.0306) in the 10- and 20-week groups, respectively, compared to no bone regrowth on the control side (P < 0.05). Histology confirmed integration at the bone–implant interface. Biomechanical testing revealed a compressive resistance 15 times that of bone alone (P < 0.05)

Conclusion

3D-printed PEKK scaffolds combined with ADSCs present a promising solution to improve the bone–implant interface and increase the resistance to forces of mastication after mandibular reconstruction.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2uqSRvN

In-clinic application of ingenol mebutate 0.015% gel for actinic keratosis in large areas of the face is feasible and attracts a high rate of patient satisfaction: Results of a questionnaire

http://ift.tt/2uqPVzh

Adhesive arachnoiditis in mixed connective tissue disease: a rare neurological manifestation

Maria Usman Khan Dec 16, 2016; 2016:bcr2016217418-bcr2016217418 case-report

http://ift.tt/2u7jXsM

Successful weaning from mechanical ventilation in a patient with surfactant protein C deficiency presenting with severe neonatal respiratory distress

Jeroen van Hoorn Mar 19, 2014; 2014:bcr2013203053-bcr2013203053 case-report

http://ift.tt/2ht1ncG

Two cases of rare benign mucosal lesions of the stomach

Komal Agrawal Jul 31, 2013; 2013:bcr2013009506-bcr2013009506 case-report

http://ift.tt/2fed7Pu

Progressive multifocal leukoencephalopathy in a patient with Good's syndrome

Olafur Sveinsson Jul 29, 2013; 2013:bcr2013009763-bcr2013009763 case-report

http://ift.tt/2htozaz

The McKittrick-Wheelock syndrome: a rare cause of chronic diarrhoea

Jana G Hashash Apr 15, 2013; 2013:bcr2013009208-bcr2013009208 case-report

http://ift.tt/2feLxl3

Prematurity, macrosomia, hyperinsulinaemic hypoglycaemia and a dominant ABCC8 gene mutation

Dana Khoriati Apr 5, 2013; 2013:bcr2013008767-bcr2013008767 case-report

http://ift.tt/2htosvF

Nasopalatine canal cyst: often missed

Saurabh Srivastava Mar 27, 2013; 2013:bcr2012007548-bcr2012007548 case-report

http://ift.tt/2fdZvDN

Mediastinal leiomyosarcoma concurrent with intra-aortic thrombosis

Masayoshi Yoshida Feb 20, 2013; 2013:bcr2012007527-bcr2012007527 case-report

http://ift.tt/2htvqAR

Pulmonary hypertension in a patient with hereditary haemorrhagic telangiectasia

Davinder Chadha Feb 1, 2013; 2013:bcr2012008352-bcr2012008352 case-report

http://ift.tt/2fecSny

Using a bradykinin blocker in ACE inhibitor-associated angioedema in the emergency department

Andrew Volans Jan 31, 2013; 2013:bcr2012008295-bcr2012008295 case-report

http://ift.tt/2htoe7N

Prosthetic valve endocarditis caused by Propionibacterium species successfully treated with coadministered rifampin: report of two cases

Dominique Laurent Braun Jan 25, 2013; 2013:bcr2012007204-bcr2012007204 case-report

http://ift.tt/2fecMwc

Necrotising fasciitis caused by P aeruginosa in a male patient with chronic lymphocytic leukaemia

Christopher Emmett Jan 23, 2013; 2013:bcr2012008133-bcr2012008133 case-report

http://ift.tt/2ht2HMu

Three cases of severely disseminated Staphylococcus aureus infection in patients treated with tocilizumab

Mai TT Nguyen Jan 2, 2013; 2013:bcr2012007413-bcr2012007413 case-report

http://ift.tt/2feDEfw

Repeated exposure to modern volatile anaesthetics may cause chronic hepatitis as well as acute liver injury

Amanda Nicoll Nov 6, 2012; 2012:bcr2012006543-bcr2012006543 case-report

http://ift.tt/2huoV0w

Fetal warfarin syndrome

Luke D Starling Nov 1, 2012; 2012:bcr2012007344-bcr2012007344 case-report

http://ift.tt/2feDuEW

Bilateral hypogeusia caused by a small lesion in the lower midbrain tegmentum

Takao Hashimoto Sep 11, 2012; 2012:bcr2012006837-bcr2012006837 case-report

http://ift.tt/2ht1kh0

Atypical presentation of enterovirus infection in adults: outbreak of “Hand, Foot, Mouth and Scalp disease” in Northern Italy

Abstract

We read with great interest the article entitled 'Hand, foot and mouth disease: an overview of clinical features in adult patients' published by I. Neri et al. in the JEADV, in which the authors reported the atypical features of hand, foot and mouth disease (HFMD)observed over 16 months. We recently witnessed an outbreak of atypical HFDM with well defined features, almost exclusively affecting adults, and we would therefore like to report and compare our experience.

http://ift.tt/2u6G6qX

TEN treatment without immunosuppressive therapy in a Burn Centre: A series of 10 cases

Abstract

Toxic epidermal necrolysis (TEN) is a serious and infrequent skin disease, usually secondary to drugs. Since the disease includes severe exfoliative disease it has been treated in Burn Centers due to large skin losses. The mechanism leading to the development of lesions is not fully known; the main role is attributed to dysfunction of T lymphocytes (1). The mortality, ranging from 10% to 70% (2), predominantly results from severe complications of multiple organ failure and infections affecting extensive areas of inflamed skin.

http://ift.tt/2vvAN7U

Dynamic optical coherence tomography of skin blood vessels – proposed terminology and practical guidelines

Abstract

Background

Dynamic optical coherence tomography (D-OCT) has recently been introduced in dermatology. In contrast to ‚Standard' OCT imaging, which exclusively relies on the morphological analysis of the tissue, D-OCT allows the in-vivo visualisation of blood flow. Preliminary D-OCT data showed differences in the vascularisation of nevus to melanoma transition, suggesting that this technology may help to differentiate between benign and malignant lesions.

Objective

Several factors may influence the quality of D-OCT imaging. Therefore, standard operating procedures as well as a common terminology are required for better validation and comparison of the images.

Methods

Here we present practical guidelines for optimal image acquisition and a proposed terminology on vascular patterns observed by D-OCT.

Results

Dynamic OCT allows the morphologic distinction of different vascular shapes (e.g. dots, blobs, curves, lines), their distribution and organisation within skin lesions.

Conclusion

D-OCT adds functional information on skin microvasculature and the vascular networks within lesions.

http://ift.tt/2u6JbHF

Vowel intelligibility in children with cochlear implants: An acoustic and articulatory study

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Christine Turgeon, Pamela Trudeau-Fisette, Elizabeth Fitzpatrick, Lucie Ménard
In child cochlear implant (CI) users, early implantation generally results in highly intelligible speech. However, for some children developing a high level of speech intelligibility may be problematic. Studies of speech production in CI users have principally been based on perceptual judgment and acoustic measures. Articulatory measures, such as those collected using ultrasound provide the opportunity to more precisely evaluate what makes child CI users more intelligible. This study investigates speech production and intelligibility in children with CI using acoustic and articulatory measures. Ten children with unilateral or bilateral CIs and 13 children with normal hearing (NH) participated in the study. Participants repeated five English vowels (/a/, /e/, /i/, /o/, /u/) with and without auditory feedback. Ultrasound was used to capture tongue positions and acoustic signals were recorded simultaneously. The results showed that, despite quite similar acoustic results, the two speaker groups made different use of the tongue to implement vowel contrasts. Indeed, the tongue position was lower in the feedback OFF condition than the feedback ON condition for all participants, but the magnitude of this difference was larger for CI users than for their NH peers. This difference led to diminished intelligibility scores for CI users. This study shows the limitation of acoustic measurements alone and demonstrates how the use of articulatory measurements can explain intelligibility patterns. Moreover, our results show that when cochlear implantation occurs early in life and auditory feedback is available, CI users' intelligibility is comparable to that of their NH peers.

http://ift.tt/2wd3rZC

Environmental contributions to otitis media requiring tympanostomy tubes

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Reema Padia, Jeremiah A. Alt, Karen Curtin, Harlan R. Muntz, Richard R. Orlandi, Justin Berger, Jeremy D. Meier
ObjectiveOtitis media requiring tympanostomy tubes (OMwTT) is a prevalent disease process that has been previously shown to have a strong familial link. The impact from the environmental versus genetic contributions to this link is unknown. The objective was to determine the environmental involvement in the development of OMwTT.MethodsUsing an extensive genealogical database linked to medical records, we evaluated the risk of OMwTT in children of probands as compared to children of controls, individually matched 5:1 on sex and birth year, from a conditional logistic regression model. The model included adjustments for geographic and socioeconomic environmental risk factors mapped to residence location of study subjects within 63 small health statistical areas of ∼33,500 persons each.Results37,814 case probands diagnosed with OMwTT and 181,339 controls were included in our analysis. Children of probands with OMwTT had an overall 2.5× higher risk of also having OMwTT as compared to the children of controls (p < 10⁻⁹), independent of environmental factors (PM2.5 [particulate matter] air pollution, education level of parents, and density of primary care providers).ConclusionAfter accounting for geographic and socioeconomic differences that may influence risk between cases and controls, our findings suggest evidence of a genetic predisposition in families of OMwTT patients. Further characterization of high-risk pedigrees is needed for future genomic studies.

http://ift.tt/2wrcHbJ

Expression and localization of histamine H1, H2, and H3 receptors in rat olfactory epithelium

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Chao Yu, Li Li, Qingjie Xia, Yuedi Tang
ObjectiveHistamine is an important chemical mediator in the development of allergic rhinitis and plays a key role in eliciting the nasal symptoms of the disorder. Histamine may also affect smell as a neurotransmitter. However, whether histamine receptors are present in the mammalian olfactory epithelium has not yet been examined. The aim of this study was to investigate the expression and distribution of histamine H1, H2, and H3 receptors in rat olfactory epithelium.MethodsReal-time quantitative PCR and immunohistochemical staining were performed to examine the mRNA level and protein expression and localization of histamine receptors (H1, H2, and H3) in rat olfactory epithelium.ResultsWe demonstrated that mRNAs encoding histamine H1, H2, and H3 receptors were detected in rat olfactory epithelium. Immunohistochemistry also showed strong positive staining for these receptors. Co-localization of histamine H1, H2, and H3 receptors with olfactory mature protein revealed that these three histamine receptors were mainly localized in olfactory receptor neurons.ConclusionsThese findings indicate that histamine H1, H2, and H3 receptors are present in rat olfactory epithelium and may play a physiological role in olfactory transmission.

http://ift.tt/2vyXd9b

Determinants of caregivers' awareness of Universal Newborn Hearing Screening in Malaysia

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Abdul Halim Abdul Majid, Mohd Normani Zakaria, Nor Azimah Chew Abdullah, Sulaiman Hamzah, Siti Zamratol-Mai Sarah Mukari
ObjectiveThis paper aims to investigate the effects of perceived attitude and anxiety on awareness of UNHS among caregivers in Malaysia.MethodsUsing cross sectional research approach, data were collected and some 46 out of 87 questionnaires distributed to caregivers attending UNHS programs at selected public hospitals were usable for analysis (response rate of 52.8%). Partial Least Squares Method (PLS) algorithm and bootstrapping technique were employed to test the hypotheses of the study.ResultsR square value is 0.205, and it implies that exogenous latent variables explained 21% of the variance of the endogenous latent variable. This value indicates moderate and acceptable level of R-squared values. Findings from PLS structural model evaluation revealed that anxiety has no significant influence (β = −0.091, t = 0.753, p > 0.10) on caregivers' awareness; but perceived attitude has significant effect (β = −0.444, t = 3.434, p < 0.01) on caregivers' awareness.ConclusionCaregivers' awareness of UNHS is influenced by their perceived attitude while anxiety is not associated with caregivers' awareness. This implies that caregivers may not believe in early detection of hearing impairment in children, thinking that their babies are too young to be tested for hearing loss. Moreover, socio-economic situation of the caregivers may have contributed to their failure to honor UNHS screening appointments as some of them may need to work to earn a living while some may perceive it a waste of time honoring such appointments. Non-significant relationship between anxiety and caregivers' awareness may be due to religious beliefs of caregivers. Limitations and suggestions were discussed.

http://ift.tt/2wrubF7

Pediatric neck abscesses: No increase in methicillin-resistant Staphylococcus aureus

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Avital Fellner, Tal Marom, Limor Muallem-Kalmovich, Nathan Shlamkovitch, Ephraim Eviatar, Tzilia Lazarovitch, Jacob Pitaro
IntroductionRecent studies from Western countries showed an increased incidence rate of methicillin-resistant Staphylococcus aureus (MRSA) isolated from pediatric neck abscesses cultures. We sought to examine the microbiology and antibiotic susceptibility of such samples over a 10-year period, and particularly of Staphylococcus aureus (SA), in order to determine whether a similar trend exists in our institution.MethodsA retrospective chart review of children ≤18 years that underwent needle aspiration or surgical drainage of neck abscesses, including suppurative lymphadenitis, retropharyngeal abscesses, and parapharyngeal abscesses was conducted between 1/1/06–31/12/15.ResultsSixty-two children were identified with a male predominance (34, 55%). The median age was 2 years. There were 37 (60%) suppurative lymphadenitis, 15 (24%) parapharyngeal abscess, and 10 (16%) retropharyngeal abscess cases. Twenty-nine (47%) children received antibiotic treatment prior to admission, most commonly β-lactam agents. Of them, 15 (52%) had positive cultures, including 7 (47%) with SA. On admission, 45 (73%) children had already received amoxicillin-clavulanate. Of those who did not improve, 16 (26%) received ceftriaxone and clindamycin. Twenty-one (38%) cultures were negative. The most common isolated bacteria were SA in 13 (24%), Streptococcus pyogenes in 7 (13%), and Streptococcus viridians group in 9 (16%). Of the SA isolates, there was only 1 (8%) case of MRSA; however, there were 4 (31%) clindamycin-resistant SA isolates.ConclusionUnlike previously published data, there was no increase in MRSA incidence at our institution. However, the high prevalence of clindamycin-resistant SA was in line with previous reports. These findings should be considered when starting empirical therapy in pediatric neck abscesses.

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Working memory span in Persian-speaking children with speech sound disorders and normal speech development

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Mohamad reza Afshar, Ali Ghorbani, Vahid Rashedi, Nahid Jalilevand, Mohamad kamali
ObjectivesThe aim of this study was to compare working memory span in Persian-speaking preschool children with speech sound disorder (SSD) and their typically speaking peers. Additionally, the study aimed to examine Non-Word Repetition (NWR), Forward Digit Span (FDS) and Backward Digit Span (BDS) in four groups of children with varying severity levels of SSD.MethodsThe participants in this study comprised 35 children with SSD and 35 typically developing (TD) children -matched for age and sex-as a control group. The participants were between the age range of 48 and 72 months. Two components of working memory including phonological loop and central executive were compared between two groups. We used two tasks (NWR and FDS) to assess phonological loop component, and one task (BDS) to assess central executive component. Percentage of correct consonants (PCC) was used to calculate the severity of SSD.ResultsSignificant differences were observed between the two groups in all tasks that assess working memory (p < 0.001). In addition, the comparison of the phonological loop of working memory between the various severity groups indicated significant differences between different severities of both NWR and FDS tasks among the SSD children (p < 0.001). Nevertheless, comparison of the central executive between various severity groups, which was assessed with the BDS task, did not show any significant differences (p > 0.05). The result showed that PCC scores in TD children were associated with NWR (p < 0.001), FDS (p = 0.001), and BDS (p < 0.001). Furthermore, PCC scores in SSD children were associated with NWR and FDS (p < 0.001), but not with BDS (p > 0.05).ConclusionThe working memory skills were weaker in SSD children, in comparison to TD children. In addition, children with varying levels of severity of SSD differed in terms of NWR and FSD, but not BDS.

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New Developments in the Prophylactic Drug Treatment of Pediatric Migraine: What Is New in 2017 and Where Does It Leave Us?

Abstract

Purpose of Review

Headaches in children are quite common; however, the study and characterization of headache disorders in the pediatric age group has historically been limited. Because of the lack of controlled studies on prophylactic treatment of headache disorders in this age group, the diagnosis of migraine rests on criteria similar those in adults. Likewise, data from adult studies is often inferred and applied to children. Although it appears that many preventives are safe in children, currently none are FDA or EMA approved for this age group. Consequently, many children who present to their primary care physicians with migraines do not receive any preventive therapy despite experiencing significant disability.

Recent Findings

Controlled clinical trials investigating the use of preventive medications in children have suffered from high placebo response rates. The shorter duration of headaches and other characteristic features seen in children are such that designing randomized controlled trials in this age group is more problematic and limiting. Treatment practices vary widely, even among specialists, due to the absence of evidence-based guidelines from clinical trials. The Childhood and Adolescent Migraine Prevention Study (CHAMP) was developed to examine the effectiveness of two of the most widely prescribed preventive medications for pediatric migraine and help narrow this gap. To date, it has been the largest enrolling study of its kind within the pediatric migraine world; its results and implications will be discussed and considered here.

Summary

The CHAMP trial was discontinued early on account of futility and exhibited that neither of two preventive medications for pediatric migraine was more effective than placebo in reducing the number of headache days over a period of 24 weeks. Subjects in the amitriptyline and topiramate groups had higher rates of adverse events than those who had received placebo.

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Παρασκευή 4 Αυγούστου 2017

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